I am often asked: what kind of therapies do we use to treat those with the most difficult cancers? Some journalists even ask more specifically: is cryotherapy the only treatment for you to treat cancer?
I have said that if we only relied on one type of technology we would not be able to treat patients such as Peng Ximei, Chen Weitian or Liangliang…In a sense, medical treatment is a craft and skill. No single therapy can be completely relied upon to treat a patient comprehensively, or be regarded as the most important factor.
So what is the most important?
Dr. Niu Lizhi had answered this question in our hospital. On the morning of January 7th 2012, a ‘Lana Reborn Celebration Party’ was held in the conference room of the South District of our hospital. Dr. Niu Lizhi said, “Lana was reborn from love, our common love”. He was downcast, his eyes filled with tears.
I have worked together with Dr. Niu Lizhi for ten years. This was the second time I saw him cry. The first time was in 2003. The Hong Kong entrepreneur Mr. Wang was admitted to our hospital for recurrent liver cancer after surgery. Influenced by western culture, the children of Mr. Wang did not believe the medical technology in China, they did not believe that Fuda Hospital could treat the disease that had been considered incurable by hospitals in Hong Kong. They kept calling me and sending me emails, requesting us to give up doing any treatments for their father, also deciding to take their father home the next day in Hong Kong. I was upset because I did not know what to do. At about 9 o’clock in the evening of that day, I asked Dr. Niu to come to my office and told him to please let Mr. Wang be discharged from our hospital and that we will not treat him any more. Dr. Niu said nothing. The next morning before work, Dr. Niu came to my office and said, “Professor Xu, I think that Mr. Wang's liver cancer is treatable.” I asked him, “How can we convince his children?” “With our love, with our technology!” he said with tears streaming down his face.
Tears are expressions of love. My heart was deeply touched by Dr. Niu’s tears. I told him to continue to treat Mr. Wang as he planned and that I would shoulder all responsibility. Eventually Mr. Wang was successfully treated. At that time SARS was spreading in Hong Kong and the Chinese mainland. In order to make a contribution to society, Mr. Wang donated a great deal of bleach produced by his company to the Hong Kong communities, so he was praised as “The King of Bleach” by the Hong Kong media.
It is precisely the love from Dr. Niu Lizhi and those medical personnel, with tears in their eyes that convey many patients into a new reality. That’s how a “Lana Reborn Celebration Party” happens.
On the celebration party day, Lana was wearing traditional Chinese-style new clothes that were embroidered with perfect Chinese characters “Lana-Yueyue”. “Yueyue” is her new name given by doctors and nurses in Fuda, which means happiness in Guangdong. Lana’s father said, “The blood flowing inside Lana is from Chinese people, she is the daughter of China and the daughter of Guangdong”.
Looking at the reborn Lana and thinking of her rescue process, we were pleased, proud and gratified. This “Battle of life”
started from an email in July of 2011.
Lana, a girl from Saudi Arabia in the Middle East, was only 11 months old when she came to China. Her one-year-old birthday was celebrated together with doctors and nurses in the hospital. Lana’s parents were ordinary people and she was their second child. The moment she was born, Lana was very cute, with a pair of shining big eyes with double-fold eyelids, who was really the apple of her parents’ eyes. But God seemed to play a trick on her, on the third week she was born, her small belly was becoming larger and larger day by day. In the subsequent month, her belly was as big as a balloon. Lana began to vomit, and her condition was becoming more and more serious. When she was two months old, she spat up what she ate, and cried endlessly all day.
Lana’s parents took her to a local hospital. Medical examinations revealed there was a huge mass and ascites inside the abdomen. Abdominal paracentesis was given to drain the bloody ascites, from which cancer cells were found. Doctors there concluded that Lana suffered from malignant teratoma, so she began receiving chemotherapy.
Unexpectedly, when the doctors conducted abdominal paracentesis, Lana’s small intestine was ruptured, leading to an intestinal fistula. The intestinal contents leaked into the abdominal cavity, causing peritonitis. This undoubtedly worsened the serious situation. Once peritonitis appeared, the patient should have prompt surgical treatment. But because Lana had a huge mass in her abdomen, the doctors in the local hospital thought that surgery could not repair her intestinal canal, so they carried out peritoneal drainage for Lana. At the same time they performed enterostomy on the abdominal wall to drain the intestinal contents out of her body.
Three tubes were implanted into Lana’s body, the first one was a stomach tube inserted from the nose for gastrointestinal decompression, trying to relieve the intestinal obstruction. The second tube was inserted via the subclavian vein for parenteral nutrition; the third tube was implanted in the peritoneal cavity to drain ascites. Lana cried all day, apparently due to the great pain. To relieve this pain the doctor gave her intravenous morphine.
After chemotherapy, Lana’s tumors in the abdomen did not shrink but continued to increase. So the doctor changed to another stronger drug and increased the dosage to be administered for seven cycles. Lana's condition did not improve, furthermore, the side effects of chemotherapy appeared in a short time: hair loss, high fever, and heart and lung failure. She was forced to accept endotracheal intubation, and sent to the ICU twice.
Such a small child born with such a big tumour, not only distressed her parents, but also friends, relatives and the media became very sympathetic. They heard about Fuda Cancer Hospital from the television, in which a child with malignant teratoma had been successfully treated. This seemed to give them a glimmer of hope. But they had not been to distant China and questioned if such a good hospital really existed? Seeing is believing. They managed to find some patients who had been treated in Fuda, so they believed it. Therefore, they began to send medical reports to us via emails, enclosing Lana’s photos.
One afternoon in July of 2011, Dr. Zaid, a Syrian that worked in our hospital hurried to my office and gave me a photo. The photo showed an emaciated infant with thin limbs, swollen belly, sallow skin and drainage tubes inserted in the nasal and abdominal cavity, which made my heart ache. The email read that the patient’s name was Lana, aged nine months old with the diagnosis of a malignant teratoma.
She once received chemotherapy but had no response and there was intestinal obstruction; abdominal paracentesis with intestinal perforation, intra-abdominal infections and probable sepsis.
I remembered on the 23rd of November 2001, we received a six-year-old child with a malignant teratoma on the neck, named Chen Zhiming (Ming Zai). It was the local evening newspaper in Guangzhou, ‘The Yangcheng Evening News’ who contacted me hoping we could help him. It took us three months to remove his tumor successfully and now he is studying in a high school. Even though his condition was very serious at that time, Lana’s was much worse than his. I was not sure whether I could help her. Looking at her photo, I felt that my spirit was willing, but my ability perhaps insufficient. So I replied to Lana’s father that I solemnly hope there would be a better hospital that could treat Lana.
In the following ten days, I and our hospitals doctors, Lana’s father, the reporter all exchanged opinions through phone calls. Though I was the President of Fuda Hospital, I still had no courage to accept Lana.
In mid-October of 2011, a phone call from Saudi Arabia said that Lana’s illness was declining day by day and no hospitals were willing to treat her. There was only morphine, they had no other choice, Fuda was the only hope for them. Anyway, they had decided to come to Fuda!
Dr. Zaid found the Executive President Dr. Niu Lizhi. He was deeply touched and would like to visit poor Lana in Saudi Arabia. But his visa application was rejected by the embassy.
I asked Dr. Niu who took charge of daily medical matters how we should deal with this. Dr. Niu responded by saying if we do not try and save this child she will be doomed to death. He was almost pleading and said, “President, let’s take up the challenge one more time!”
“Yes, let’s take up the challenge!” Over the past decade, we had successfully treated the aforementioned Ming Zai who had teratoma, two Malaysian patients with huge facial tumors, socalled “Elephant Face,” one Chinese patient with large facial tumors weighing as much as 17 kg, which was reported by the US National Geographic TV channel, ovarian cancer patient Ms.Peng Ximei whose 55 kg tumors and cyst fluid were removed, the Malaysian youth Liangliang with rare pancreatic tumours who was on the verge of death and a Syrian Justice with 15 kg of intraperitoneal tumor etc. All these cases were challenges, they were the ultimate challenge! I was also deeply touched. Although this was a young baby from the Kingdom of Saudi Arabia, different nationalities cannot stop our willingness, love being the world’s most valued currency. How are we able to see the threat of death and not try and save that life?
Lana arrived at our hospital on the 26th of October, 2011. For her arrival, the hospital set up a medical group who had successfully treated Peng Ximei before from the second ward of the South district. The director of the ward, Dr. Li Haibo was specifically in charge of Lana’s treatments. Dr. Li had been scheduled to attend the World Congress of International Society of Cryosurgery in Austria and invited to give a speech at the meeting. Although his visa and ticket had been prepared, in order to treat Lana, he chose to stay at the hospital. Our hospital arranged a specialist nurse to provide special care for Lana.
Just as the photo shows Lana was baldheaded on admission, which was caused by the chemotherapy. She had sallow lustreless skin, scrawny limbs and drum-like big belly that was a typical cachexia. Her temperature was as high as 39 degrees Celsius. Her parents told us that she almost had fever every day in the past months. She was an 11-month-old child, weighing 11 kg, but one-third of which was estimated to be tumors. A gastric tube was inserted from the nose, she cried constantly, but the voice was low and weak as if she would stop breathing at any time. Her parents always required the doctor to inject morphine for Lana. They told us that even though she was flying on a plane, she needed to be injected with morphine every hour.
The preliminary inspection results were concerning: anaemia, high leukocytes, dehydration, electrolyte and acid-based balance disorders. What’s more, Lana had not eaten anything for more than six months, but relied entirely on intravenous nutrition. Besides the tumor's effects and serious infections, the above symptoms and signs had to be expected.
The morning of the 26th of October, doctors decided to give Lana supportive treatment which included adding, correcting and maintaining nutrition and water balance after an accurate calculation of the water, calories, protein and electrolytes she demanded. Antibiotics were given as soon as possible to control infection.
Eyes are the mirror of the soul. Lana’s eyes were still bright and her lips were constantly moving, showing her tenacious vitality, which gave us hope and motivation. Based on years of experience rescuing critically ill patients, we believed that if given good support, Lana’s condition could take a favourable turn. As a doctor, this was a critical moment. Any wavering and hesitation may lead to the loss of life that can never be retrieved. I required the rescue group not to weigh gains and losses but spare no pains to treat Lana.
Dr. Li Haibo had been engaged in thoracic surgery for years and had treated a lot of patients with congenital heart disease, many of them infants. He had rich experience in nutrition conditioning and caring for children. As expected, a week later, Lana's skin became smooth and elastic. Blood tests showed that biochemical indexes were maintained within the normal range and Lana's temperature had also started to drop.
After Lana’s general condition improved, she was sent to have an ultrasound, CT, MRI, CT angiography and other tests immediately, which found intra-abdominal tumors had occupied 80% of the abdominal cavity and her intestinal canal had been pushed to below the diaphragm. 80% of the tumors were substantial, while the remaining 20% were cystic fluid.
On November 7th after group consultation, doctors decided to carry out paracentesis to drain the cystic fluid. Under the guidance of ultrasound, the largest cystic mass on the right abdominal cavity was first punctured. Surprisingly the liquid drained was clear without blood components. We saw a glimmer of hope that the tumors may not be as malignant as we previously thought!
300 ml of cystic liquid was drained from the cystic mass on the right abdominal cavity. The next day, the cystic mass on the left abdominal cavity was punctured and 200 ml of cystic liquid was drained, then finally the third cystic mass was punctured and more liquid was drained…
There were many cystic masses in the abdominal cavity that didn’t connect with each other. Worse still after the cystic fluid was drained, it quickly returned. It seemed that the cystic fluid drainage alone could not solve the problem. But cystic fluid drainage not only made us clearly understand the tumor size and location it also urged us to consider how can such a huge and complicated tumor be removed? If it could not be removed, could we do in situ cryo-ablation? The most important aspect was could removal or ablation save the little infant?
Further medical consultation concluded that her condition needed to remain under observation.
After a month’s observation, we found that Lana’s general condition had improved and stabilized. She could smile and wave her lovely hands. On her birthday party held by the ward, Lana could clearly call out “Dad” and “Mum” to her parents and to the nurses who took care of her.
We became more and more confident that we could treat Lana. We increasingly considered Lana’s tumor may be benign based on experience and intuition! If the tumor was benign, removal could save her life; but even it were benign, failure to remove it would make it impossible for her to survive!
However, the question was whether or not the tumor could be removed by surgery? She was only 12 months old and had been threatened by the tumor for most of that time. Could she withstand such major surgery? We were different from the Arabs in background and culture. Lana was from Saudi Arabia, did her parents, relatives and their community understand our ideas, thoughts and the treatments we did? If the surgery was a failure what could we do?
My colleagues and I considered all the possibilities, including surgery, minimally invasive treatment or persuading them to give up treatment and return home.
As president of the hospital, this was precisely the time when leading with a decision was most difficult. I had to make the choice and bear the heavy burden!
On the 10th of December, a sunny day, Lana’s surgery finally began. The surgery was conducted by a surgeon who was the best paediatric surgical oncologist in Guangzhou and the most experienced anaesthetist using the most advanced Siemens paediatric anaesthesia machine. Adequate blood and rescue drugs were prepared. The surgery was carried out step by step as planned. First the incision of the abdomen, then the separation of the intestinal canal and the exposed lumps drained of the intratumoral cystic fluid.
I stood on the side of the operating table, staring at the display screen, my heart beating along with the ECG curve on the screen. Bags of blood hanging on the infusion support flew through the infusion tube inserted in the central vein, and then rapidly into the blood vessels of Lana, which perfectly supplemented the blood lost during the surgery.
The tumors were taken out piece by piece and added to the dish where they piled up. After 4 hours, almost all the tumors were removed, weighing as much as 2.5 kg.
The most difficult part was the intestinal repair, the question was where the original intestinal canal rupture was located. If this could not be repaired, the surgery would be unsuccessful. But this intestinal canal rupture had been there for over half a year. There was local infection and inflammation mixed together with adhesions, trying to repair the rupture that couldn't even be located was extremely difficult. The surgeon Dr. Zou who had decades of experience in paediatric surgery separated the small intestine from the colon little by little, observing with naked eyes or probing with a magnifying glass. Finally after 4 hours, the rupture was found on the junction of duodenum and jejunum. It was like looking for a needle in a haystack. Soon after locating it, the intestinal rupture was repaired by fibre surgical method.
With doctors’ instinct we considered Lana’s tumor curable, with doctors’ will and skill, we cleared away the dreaded illness. Lana was reborn. Outside the operating room, Lana’s father could not wait to share the good news with their family, friends and the media who were anxiously waiting in Saudi Arabia by telephone, MSN and e-mail.
Postoperatively, Lana was recovering every day. She was born beautiful and cute. When people saw her they fell in love with her…The representative of the Saudi Embassy in China made a special trip from Beijing to visit her. (Figure 22)
No difficulty is insurmountable if you set your mind to it. Eventually Lana recovered. Perhaps God tended to favour the kind person. Lana’s tumor turned out to be benign. Lana will grow up to be a beautiful lady whom Saudi Arabia, China and
the world should be proud of.
Lana-Yueyue became a friendship symbol between China and the Arab world. On the 28th of December 2011, I went to Qatar, a Gulf country as the Kingdom of Saudi Arabia. This was a small country with a population of only 300,000, but the capital of Qatar, Doha was famous for its round table negotiations, football and also the Arabic equivalent of the CNN, Doha based broadcaster Al-Jazeera Media Network. All of these made this country full of interest and mystery. The second day I arrived in Doha, the largest English newspaper in Qatar and the Arabic newspaper interviewed me, thus Lana’s story was spread. One prince of Qatar praised that he admired and appreciated China. A young lady from Jordan who suffered from cancer, despite her forbidding religion, cried and hugged me saying, “I have hope!”
I stayed in a suite on the top floor of Doha Hilton Hotel, facing the bay. On the left hand side the view overlooked a white conference building. Dr. Tilib, my friend from Qatar told me that it was this conference building where China applied to join the WTO. The world is always changing! China is becoming increasingly strong! As Chinese people, we should shoulder more responsibilities! We have treated Lana, but there are more Lana's waiting for being treated.
Sighing with emotion, I rethought all the technical skills used to rescue Lana. I was pleased that I had made the right decision at a critical time, it was, after all, my duty as an older relatively qualified doctor and hospital president. But without medical discussion and disputes time and time again before the surgery, without clinical observations of doctors and without everyone’s opinions, it would have been impossible for me to make up my mind.
I don’t appreciate how so many countries continue to use the “My Patient” system. Once a patient is accepted by a doctor, he will become that doctor’s patient and subsequently be responsible for all medical treatments and the patient must follow the doctor’s advice. Thus this kind of system triggered the following phenomenon: if the patient finds a doctor whosebackground is chemotherapy the patient will always be given chemotherapy. If the doctor is engaged in radiotherapy, his patients may always accept radiotherapy. There was an Indonesian lady who suffered from breast cancer. Her doctor gave her chemotherapy as many as thirty-five times but her condition did not get better and deteriorated beyond control.
I do not believe one doctor’s knowledge alone can meet every cancer patient’s individual needs. Why do so many western patients come to China for medical treatment? One reason is they consider they will be treated by a team of doctors in China. Lana’s treatment success was due to our medical team’s joint efforts.