Letting go and never giving up are both ways to say I love you

By Dr. Xu Kecheng,Chief President of Fuda Cancer Hospital 

Recently, I read an online article titled “letting go is also one way to say I love you”, written by a professor of surgery at a cancer hospital in Beijing. The article is focused on the topic of whether doctors should persuade patient out of treatment when there is no treatment available. The article tells about the story of how the professor of surgery encountered a patient’s father. The patient is a 16-year-old girl who was suffering from advanced colon cancer with liver metastases. The parents have sold off all their valuables to raise money for their daughter’s treatment. The professor found himself to be in a dilemma as the patient only has a couple of month to live even if she underwent operation and hence the couple might lose both their daughter and the money. The professor had a candid communication with the father and in the end he persuaded the father to “bringing his daughter back home...”

The professor believed that letting go is also one way to say love to advanced cancer patients who have undergone untold suffering from sickness.

I don’t know the real situation of the girl so that I’m not poised to make any comment. Cancer is a type of heterogeneous disease as the same type of cancer might have different characteristics and therapeutic effects on different patients. It’s not at all unusual for an advanced cancer patient to survive several years or even longer after undergoing comprehensive treatments. I understand what the professor was thinking about. It must be very difficult and painful for the doctor to give up treatment on such a patient.

Medicine is a combination of science, technology and craftsmanship. As patients are very different from each other in thoughts and backgrounds, doctors should take into consideration not only the feasibility and limitations of treatment but also the patient’s (including his/her relatives’) expectations, mental status and financial status.

About one month ago, I was confronted with a test of whether I should persuade the parents to bringing their daughter back home. The patient, 8 years old, is called Airin from Ipoh, Malaysia.

On March 28, Dr. Mu Feng, Vice President of FUDA, took me to visit Airin at room 319. Airin was hairless (caused by chemotherapy) with a pale face. Her intercostal space was deeply pitting and her abdomen was like a small boat. The right leg was as thin as a deadwood with the circumference standing at 5.5cm while the left leg wrapped by gauze was as thick as a bucket with the circumference of the oval tumor standing at 61.5cm. The superficial skin was in dark purple with part of the skin ulcerated. The CT scan showed a giant tumor in left shank. Pathological result from Malaysian Hospital showed malignant spindle cell tumor. My suggestion was that Airin should have a CT and MRI reexamination to check the structure of blood vessels and have her general nutrition status improved.

Before surgery, the tumor in left shank of Airin was shocking 

Two days after her admission, we held the first round of consultation for Airin. On the consultation, different people put forward different views. Some doctors suggested amputation with their reasons listing as follows: (1) As the patient was at a state of systemic failure, called dyscrasia in medicine, the patient could not be able to tolerate tumor resection; (2) The tumor, being malignant in nature, has grown for two years and has been growing very fast in the recent few months. It is invading and compressing inward the blood vessels and is breaking the skin. It is almost impossible to remove the tumor; (3) The blood vessels and nerves of the left shank might have been invaded. It is of no significance to remove the tumor if the left lower limb is dysfunctional after the surgery; (4) The patient had been hospitalized at several hospitals in Malaysia and Guangzhou, the doctors from which all believed that the only way out is amputation.

Others suggested that the tumor should be removed so as to preserve the left lower limb. Their reasons are as follows: (1) The CT/ MRI showed the tumor is relatively well defined; (2) Children’s tissue grows strongly. As long as part of blood vessels and nerves are preserved, patient will have a fast postoperative recovery; (3) The tumor grows on the left shank. As long as tourniquet is applied at the lower segment of thigh during the surgery, no massive haemorrhage will be caused; (4) We have completed several cases of resecting tumor while preserving the limb.

Several hours later, the patient’s condition worsened with high fever, increased heart rate, low blood potassium which stands at 2.5 mEq/L. White blood cell stood at 19000. Neutrophilic cell stood at 86%. CT scan showed pericardial effusion and diffused inflammation in lungs. The patient was transferred to the ICU.

A second round of consultation was held to analyze the reasons behind her worsened condition. Firstly, it might be caused by worsened infection, pulmonary infection in particular; secondly, tumor necrosis leads to large amount of toxicity being absorbed and further causes systemic sera. The two conditions are both fatal. At that moment, the problem was not whether the operation could be performed or not but how to save the child’s life. In general conditions, to rescue the child was almost challenging the impossible.

Such a difficult choice it was. There was no ground for blame even if doctors ask the parents to bring their daughter back home. Even if there was any accident happened on passage, it will be understood as natural degradation. We shoulder no responsibility whatever happens to the girl. However, the hospital’s reputation might be jeopardized if there is any accident happened during the surgery, even if a simple amputation.

The parents understood the misgivings of doctors. Airin’s father said, Airin was able to think like an adult. She never smiled ever since the doctor told them the only way out was amputation. She also said, she would like to go back home if she had to undergo amputation. He asked the doctors to rest assured, saying that they have prepared for the worst. That was to bring their daughter back home. Her parents burst out of tears when they said this to me.

I was so anxious about what decisions we should make: letting go or never giving up. As the president of FUDA, I required the medical team to change another way of thinking and change the impossible become the possible.

At 12:30, April 1, after nearly 20 hours preoperative operation, the operation started. After 5 hours’ operation, the tumor was completely removed. The tumor was 32 in length, 29 cm in width, 17 cm in thickness and 3.9 kg in weight.

Half a month later, Airin was discharged with her hand holding flowers presented by doctors and nurses. On April 27, Dr. Mu Feng, who was the first doctor to have received Airin, and I made a special trip to Penang, Malaysia. We were amazed to find that Airin, with the companion of her parents, had been waiting for us at the VIP access in the airport. We were even more pleased to see that Airin was able to stand for a while. In the morning of April 30, hundreds of people gathered at Airin’s house in Ipoh to celebrate her rebirth. With the scarf on her head, Airin nestled into my arms and said with a smile, “Grandpa, thank you! I love you!”

I'm gratified and tears welled up in my eyes. It is from never giving up that love is originated.

President Xu and the party paid visits to patients in Malaysia. Airin’s family went all the way to the airport to greet the party. Around 20 days after the surgery, Airin was able to stand for a while.

 Airin nestled into President Xu's arms and said with a smile, “Grandpa, thank you! I love you!”