This topic is similar to the previous topic. The core of the problem is whether we can put ourselves in other’s shoes, to think for the patients and not merely from our professional perspective. I always ask myself if it were not because Xiao-Mei and I had been friends for many years, if it were not Xiao-Mei who entrusted her father to me, would I have achieved the same result. I use the word ‘Personalized’ because of a letter I received from a Danish lady.
Early February 2008, I received an email from Lila, a Danish lady. She told me that she was 22 years old. In May 2006, she was diagnosed with osteosarcoma at the 6th and 7th thoracic vertebra. She underwent surgery. September onward she was given radiotherapy until December 2006 when it was detected she had multiple lung metastases. Her mother is an anesthesiologist. In January 2007, her mother brought her to a hospital in Michigan, theUnited States. At that time she had lower extremity paralysis. She received high-dose chemotherapy and DC vaccine biological regulation treatment. Her lower extremity was restored and free of paralysis, and lung metastases were also significantly reduced. December 2007, CT showed the tumor resulted from right lung metastases grew bigger and bigger and the emergence of new left lung metastases were detected. January 2008, Lila had serious lung infection with left pneumothorax and pleura effusion. When her lung infection got better, the right lung metastases had grown to 2.5cm. She hoped that we could help her.
Our hospital had never admitted any Danish patient before.Denmarkis far away in Northern Europe. We only learn about it from Han Christian Andersen’s fairy tales and know it is a prosperous country. I emailed her back saying that we were very sympathetic that at such a tender age, her cancer had reached an advanced stage. The options available now were limited as she had been given various methods of treatment previously. Based on her current circumstances, we could probably combine various treatments to provide an integrated and personalized treatment which might work.
Lila replied my email immediately. She wrote: Dear professor Xu, Thank you for the personal and very complete explanation in the email you sent to me. I am very interested and grateful for your response and the opportunity for treatment at your hospital. I know that my time is limited I hope deeply that you can help me because it’s my last opportunity.”
Two weeks later, Lila, accompanied by her mother, came and was admitted into our hospital. She was given various therapies including vascular intervention therapy, percutaneous cryoablation and combined immunotherapy. PET-CT examination done a month later showed that there was no evidence of cancer. Two months later, new chest wall and lung metastases were detected and they were removed by cryoablation. March 2009, she emailed me fromDenmarktelling me that she and her mother would attend the International New Technology for Cancer Treatment Seminar at Shenzhen organized by us in August. She proposed me to invite her doctor in theUnited States, Dr. Pet Anderson, to attend the seminar. I agreed to her proposal. A month later, I received an unexpected email from Dr. Pet Anderson telling me that unfortunately Lila died of chemotherapy-induced aspergillosis (a type of fungus) that caused serious infection; she did not die of cancer. Dr. Pet Anderson underlined the sentence to emphasize that Lila did not die of cancer.
I felt guilty and I deeply regretted because when she was discharged for the last time four months ago, I suggested to her and her mother not to do chemotherapy because firstly, this type of cancer was not sensitive to chemotherapy and secondly she had undergone chemotherapy previously, the tumor cells had become drug-resistant. Her white blood count had been on the low side all this while. Once she had concurrent infection after chemotherapy, it could lead to grave consequences. I wanted her to adhere to immunotherapy but it was a suggestion and I did not force it on her as I thought that it was difficult for Europeans to accept the views of oriental people. Furthermore, the cultural differences between us made it difficult to achieve a state of personalization.