Cancer treatment however, is rather complicated. As a cancer patient, I can’t control my destiny. Whenever I feel discomfort or pain, I nervously wonder whether my cancer has relapsed. Whenever I receive a routine blood test, tumor markers or ultrasound, CT or PET-CT scan, I’m quite anxious and often awake by a nightmare of a tumor relapse whilst waiting for the results.
As a doctor, when I face cancer patients afflicted by suffering and am unable to relieve their pain, I am often unable to sleep or eat in peace. Even if I could use my own pain in exchange for patients’ happiness I would. Some people say that doctors have two kinds of heart that is, hard-hearted and soft-hearted. Now I only seem to be soft.
Being a cancer doctor especially, I feel sometimes particularly anxious and confused. In mid-January of 2012, I received an email in English of a complaint from a patient’s family in a Southeast Asian country. To the effect that:
“My father died on the…we were very disappointed with your hospital. We should not have sent my father to your hospital to have surgery, which caused acid regurgitation and cancer recurrence…XX doctor’s nonsense caused my father's death. The doctor said that my father can live for at least three years after surgery, but that was bullshit.”
Although the tone of the email was not polite, as a father, I can fully relate to this patient’s son’s thoughts and complaints. He was a dutiful son, his father would be pleased in his grave. When I received this e-mail, I immediately examined the patient’s medical records and inquired about the disease and treatments from the department’s director and doctors. The patient suffered from oesophageal and cardiac carcinoma, he underwent an oesophageal and cardiac cancer operation. The postoperative pathological examination showed it was poordifferentiated adenocarcinoma-mucinous carcinoma. Invasion was to the oesophagus and stomach wall and with lymphatic and blood vessels involved, this was the third stage of gastric cancer. After surgery the patient received chemotherapy. Six months later the patient was readmitted to the hospital, he was emaciated with no appetite. The examinations revealed he had multiple lung and liver metastases with left pleural effusion, while the endoscopy showed gastro-oesophageal anastomotic oedema and stenosis. He was given symptomatic treatment, but the effect was not obvious. The entire treatment procedures including surgical indications, surgical method and postoperative treatment had no significant errors.
The prognosis of stage III oesophageal and cardiac cancer is poor, especially the poor-differentiated adenocarcinoma type. The median survival period is generally about six months. Chemotherapy can be applied, but it will not necessarily prolong the survival time. The patient’s son was not a doctor so he did not understand his father’s illness and foresee the treatment consequences, which were caused by our doctors’ failure in their obligations.
When our doctors received an email from the patient’s son, they gave him a brief response, to the effect that:
“We followed the conventional treatments and can not guarantee that all cancers will be cured and all patients have responses after treatment…”
The doctor’s reply can’t be considered wrong, but the approach was not appropriate. After I read the reply, I immediately wrote an e-mail as long as 2500 words in English to the patient’s son, which roughly expressed my deep condolences to families of the patient. Further describing the patient's condition and the current treatments of advanced gastric cancer; reviewing the shortcomings and deficiencies in our work. I tried to illustrate the treatment plight of gastric cancer asking for understanding and talked about my experience as a cancer patient…
Some people might say that my reply to this e-mail was to deal with accusation from the patient’s son and avoid responsibility. I always think that we should take on responsibilities if patients and their families have any complaints or discontent with our hospital. Patients give their lives over to us and we should fulfil our duties, sparing no efforts to help the patient without counting gains and losses.
Almost simultaneously, I received an email from Mr. Huang who came from the same country:
Dear President Xu,
Greetings! On February 22nd of 2011, I accompanied Dato Mr. XXX to Fuda for treatment. So far three hundred and thirty days have passed, your accompaniment and care made us feel warmly welcomed. During Dato’s treatment we could say that two miracles happened. Early in July of 2011, he was diagnosed with late stage lung cancer. Every doctor said that he would not live for more than six months, but he survived that. Following this another view was that he could not live on to 2011, but he brought us a second miracle, and now we are waiting for the third, fourth and countless good news ... To a large extent, this depended on the help of President Xu and the efforts of all the medical staffs. Without you, it would have been very hard,
thank you for all you have done for us.
The past few days, we have been discussing the following treatment schedules, in February we hope we can return and see you. Four months have passed since the PET scan on September 9th, 2011. We are prepared to recheck the PET scan in advance…
If I said when I received the first email I felt regret, trouble and sorrow, then could I say receiving the second email made me feel pleased and grateful? Yes, I was grateful but not happy as I knew Dato’s condition was very serious and although his condition improved and was stabilized, it would not necessarily stay this way. I felt a lot of pressure as with the passage of time his treatments would become increasingly difficult.
Our patients and their relatives really hope our treatments can effectively treat and even cure diseases. These, of course are their most sincere and best wishes; doctors have the same hopes as patients and their relatives. Doctors also have parental hearts. There are no doctors that don’t wish to cure all diseases. But hopes and wishes cannot replace reality. We are not able to cure all cancer patients and this is not entirely due to doctor’s incompetence but rather the limitations with the development of medicine. The responsibilities of doctors lie in breaking through theses limits as much as possible, treating patients with allround care including the physical and psychological aspects.
Often I would tell doctors that since they had chosen to work in the medical field, they should abide by doctor’s ethics, which were primarily to be approachable, earnest, tolerant, uncomplaining and encouraging. Working in this manner is not an easy task.
My son decided not to become a medical student, due to a foolish mistake of mine: it was because of my discouragement and complaint. Upon graduating from high school he was ready to apply for a medical school and I also supported him to follow the profession of his father. But an unexpected accident changed his life. It was in 1985 and I was serving as the chief physician in the Department Of Gastroenterology at the Affiliated Hospital of Nantong University. One morning in July, I did a liver biopsy for an inpatient with chronic hepatitis. The patient was one of our hospital’s drivers, an acquaintance. He requested I specifically treat him and carry out a biopsy. The biopsy itself went smoothly, afterwards the patient rested in bed without any discomfort. That evening after nine someone hurriedly knocked on my door, when I opened it I saw the driver’s wife out of breath, whereupon she took my hands and said, “My husband suddenly has abdominal pain, could it be due to the biopsy?” I ran to the ward where the patient was yelling with intense abdominal pain. An abdominal examination revealed no muscle tension and no clinical manifestation of organ perforation or peritonitis. I required a bedside X-ray machine to carry out an abdominal plain scan, which found no free intraperitoneal air. I gave him pain killer injection, relieving his pain a little, which relapsed in a short time. I stayed by the patient, considering all the possibilities of what could be causing the pain. Surely if it was liver rupture caused by the liver biopsy, it would be necessary to open the abdomen…at dawn, I suddenly considered whether the patient had biliary tract disease? At that time ultrasound examination had not been widely used in China so there was not a lot of experience. But I still invited an ultrasound doctor and moved the ultrasound machine to do an examination for him. The probe was put on the patient’s upper abdomen and soon a few shiny oval stones were displayed on the monitor screen: gallstones. I asked the patient whether he had medical history of biliary tract disease. The patient said he hadn’t.
I had a sleepless night and suddenly felt quite week. After the other doctors began their shift, I returned home. My son was waiting for me because that day he had to apply to attend the college entrance examination and I would help him decide and finalize which subject he would major in at university. I lazily said to him, “Choose yourself, you can decide to major in other subjects.” My son was stunned, “Don’t I have to study medicine as my major?” In a bad mood I said, “Do you know how I spent last night!?”
These days China’s medical equipment has greatly advanced, it would be hard to make such a simple mistake. But in the medical work of a hospital, medical accidents are common. Some people say that medicine is not only a science but a craft.
People who have not studied medicine cannot become doctors, but a doctor who does not have close contact with patients can never be a good doctor. Different patients have dissimilar conditions and alternative requirements. Treatment of a disease is the combination of technology and art, especially with regarding cancer treatment. There is a Chinese saying, “If people often walk along the river bank, where will you not find wet feet?” It means that Doctors can never always be considerate and even make mistakes. There are certainly unsatisfactory and inconsiderate treatments of patients, including making mistakes by doctors. Doctors though cannot make excuses, they should wholeheartedly serve patients.
“We originate from the same root, so why do we slaughter each other so frightfully?” The relationship between doctors and patients is one of comrades and brothers. Let the miracle of life be revealed in mutual understanding, support and encouragement( Figure 24).