Dr. Qin’s Notes – The Light in the “Black Box”

As soon as the Spring Festival arrives, all kinds of New Year’s greetings WeChat and text messages will be overwhelming and flooded on my mobile phone. I don’t bother to open most of them. However, a brief message from a friend named Xiao Ding (pseudonym) touched me and reminded me of a past event 18 years ago.

It was the spring of 2004. I treated a young and beautiful female patient, 26-year-old Xiao Ding. She had a huge tumor in her left liver with lymph node metastasis. She was a patient with advanced liver cancer. While regretting his poor life, I performed a hepatectomy for him. The pathological section is hepatocholangiocarcinoma, which is the most malignant type of liver cancer. Generally, such patients can only survive for about half a year to a year after surgery. Xiao Ding has a very good mentality. He neither complains, nor seeks medical treatment everywhere. He treats him calmly and leads a relaxed life. After several follow-up examinations, there is no sign of tumor recurrence. At the end of a follow-up consultation, Xiao Ding asked me: “Doctor Qin, can I get married with my current physical condition?” Can I get married? This question was not originally within the scope of the doctor’s answer, but looking at her longing eyes, I hesitated for a while, and answered bravely: “Marriage is a major event in life, and not getting married is a big regret. Live this dream! You are a patient with miracles, and many patients like you have relapsed, so you must cherish your life and don’t do things that consume too much physical strength and energy, such as being overworked, overexcited, and thousands of others. You can’t get pregnant and have children!”

Xiao Ding disappeared for several years, and suddenly came to my clinic one day, and the results were good. Before leaving, Xiao Ding said to me, “Dr. Qin, I want to have a baby, can I do it?” During pregnancy and childbirth, the human body undergoes great changes. Many cells will proliferate rapidly, and some tumor cells will also hit the road. The patient is at great risk. I can only truthfully explain the risks of pregnancy and childbirth to Xiao Ding, and ask her to consider it herself. Xiao Ding decided to pay the price of his life in order to complete the great mission of a mother. As a result, people’s wishes were fulfilled, and Xiao Ding gave birth to a fat baby soon after. After that, Ding disappeared again…

In the summer of 2020, Ding suddenly appeared in my office again. 16 years later, Xiao Ding looks a lot more mature, but still calm. CT showed that there were multiple giant recurrent tumors in the liver, covering the whole liver. Xiao Ding said, “Dr. Qin, let’s see if I can still operate? Is there any other way? You can use it. My child has already entered junior high school, so I’m satisfied!” Given that her recurrence of tumors is too large, surgery is not an option. If possible, I suggest that she do TACE (interventional) therapy first. After two courses of treatment, the tumor shrinkage was not obvious, so targeted therapy (anlotinib) was added, and immunotherapy (PD1 inhibitor) was added one year later. A few days ago, the tumor was basically controlled and achieved PR (partial remission of the tumor).

It is very coincidental that on the day that Xiao Ding sent me a New Year’s greeting message, an old friend called me. His father, Uncle Wan, was eager to come to the hospital. Uncle Wan is my old patient. Six years ago, because of advanced gastric cancer, I asked President Tang to perform a palliative gastric cancer resection in our hospital. After the operation, the old man felt that life and death depended on life and wealth. Forget it, save the trouble. This time I was hospitalized, not because of the recurrence of stomach cancer, but because the bed caught fire and burned my hands and feet. Uncle Wan is a middle school teacher and has two hobbies in his life: one is teaching and educating people, and the other is smoking and drinking. That year, I secretly smoked a week after the operation, and resumed drinking two months after the operation. Now 83 years old, I still take home tutors for free, and 3-4 small drinks a day, and I live a happy life.

Throughout the tumor treatment process of Xiao Ding and Wan Lao, they have created miracles:

1. Palliative treatment of advanced tumors has achieved long-term survival, especially when Xiao Ding relapsed. Afterwards, he can live peacefully with the tumor for a long time;

Second, get married and have children, or teach and educate people, and the life and career are all correct.

So what makes these miracles happen? Is it a scalpel? So why do most patients with earlier cancers and more thorough surgical removal do not have such good results? Did chemotherapy, radiotherapy, targeted therapy, and immunotherapy work? Then Xiaoding was treated after relapse, and Wanlao used tobacco and alcohol instead of drugs. This makes me feel very confused. I have practiced medicine for decades, and have treated countless cancer patients with countless failures, but there are also many successful examples. I have always wanted to find the secret of success, except to find that these lucky people are cheerful, ” I can’t find any other mysteries other than “nerve bar”.

The tumor is like a “black box” in front of me. Every time I get the same “input”, I can’t get the same “output”. There is no rule at all. But it is precisely because of the constant occurrence of miracles that I have always believed that cancer can be cured! Perhaps, one day in the future, we will be able to find a specific drug to kill tumor cells like penicillin is invented to kill bacteria. With our unremitting efforts, to find that light in life.