I Actually Hope They Make Money

I first saw Doctor Wang just as he was wheeling a patient back toward the inpatient department. He was still dressed for surgery: green scrubs, a matching surgical cap, and a mask covering most of his face. The scene looked like the end of an ordinary operation. A patient had been moved from the operating room, and the next part of the doctor's work was already waiting.

Then he noticed me. He waved. A moment later, he pulled down his mask. I asked whether he had time for a few questions. He had just finished an operation, but he stopped. There was no visible transition between surgery and conversation. He did not change clothes, sit down, or make himself comfortable. He simply stood there in his surgical gown and began answering. The interview felt almost like another part of his job.

I started by asking what made a cancer hospital different from an ordinary general hospital. “A general hospital treated many kinds of illness. It could have patients with hypertension, diabetes, respiratory disease, cardiovascular problems, and cancer all under the same roof. A cancer hospital, by contrast, concentrated its expertise on one particularly complicated category of disease,” Doctor Wang answered without second thoughts. He probably had explained it to the family a thousand times. More than ninety percent of the patients admitted to a specialized cancer hospital, he explained, had a tumor-related condition. That specialization had advantages. Doctors here thought about recurrence. They thought about five-year and ten-year survival. They thought about how a tumor might respond to treatment and what might happen after surgery. That specialization led to more advanced treatment and better experience for cancer patients.

He also admitted that there was also a limitation. A cancer patient was rarely sick in only one way. Someone might have a tumor as well as heart disease. It could also be diabetes or a respiratory condition. At a general hospital, the treating team could call a cardiologist, pulmonologist, endocrinologist, or another specialist for help within the same institution. "A comprehensive hospital is more comprehensive," he concluded, "A cancer hospital is more specialized." Neither was simply better. They served different needs.

I asked whether everyone arriving at a cancer hospital already knew they had cancer. “Not necessarily,” he said. Some patients arrived with a referral from a county or township hospital. Perhaps a scan had already shown something suspicious, but the local doctor lacked the equipment or expertise to determine exactly what it was. "Sometimes the lower-level hospital already has a report," he explained. "The doctor can't handle it there, so they tell the patient to come here." An experienced oncologist could often look at the report and immediately recognize that it was likely a tumor. But there was still another question. What kind of tumor is it? Tumors were not one single disease. Different tissue types behaved differently. Their treatment, prognosis, and recurrence patterns could vary. Other patients arrived with nothing more than a symptom, like something hurt or something was swollen. Sometimes they simply did not feel right. The doctors then had to start from the beginning—imaging, blood tests, examinations, clinical judgment. So even in a cancer hospital, not every patient arrived with a confirmed diagnosis. Most came because something had already pointed toward cancer, and some came because no one yet knew what was wrong.

He explained tumors to me almost as if he were explaining a concept to a student. "Not every tumor is a lump," he said. Leukemia was the clearest example. There might be no single mass at all. Instead, malignant cells could develop within the blood-forming system and interfere with normal blood production. The underlying idea was malignant cells—cells that had escaped the body's usual controls, growing and spreading in ways the body could no longer regulate. That distinction between benign and malignant disease, he explained, was fundamental. A benign tumor, once successfully treated, generally would not return. A malignant tumor could recur even after being removed. That possibility of recurrence was one of the defining features of cancer.

Doctor Wang had been a doctor for nine years. In those nine years, he had seen the disease from many sides. He had also seen the ordinary infrastructure that had grown around cancer care. So I asked him about the charity kitchen. “I think it is good.” At first, his explanation was surprisingly simple. Cancer patients often did not have much of an appetite. After surgery, chemotherapy, radiotherapy, or medication, food could become difficult to tolerate. Hospital cafeteria food might not be what a patient wanted. They just wanted to have something that felt homely. "So the kitchen meets that particular need." He did not romanticize it. Instead, he called it something closer to a market phenomenon. People have a need. Someone provides a service. The patients pay a small amount. Everyone benefits. 

That perspective led him to a more complicated opinion about the charity kitchen. He respected what the elderly couple had built. They had received recognition, including the "Touching China" honor, and had clearly helped many families. But he did not think the kitchen should survive purely by relying on the idea of selfless charity. "I actually hope they make money." He said it without hesitation. It surprised me, but then he explained. The kitchen required seasoning, space, electricity and labor. If the owners spent the rest of their lives running it without receiving reasonable compensation, what would happen when they became too old to continue? There would be no sustainable model. "If they can earn something, then perhaps someone else will want to take over." Competition, he believed, could actually be good. If there was only one provider, there was less pressure to improve hygiene, convenience, and service. If there were several, each would have an incentive to do better. He compared it to other markets: when customers have choices, providers have to pay attention. He was not arguing that the charity kitchen should lose its kindness, but that kindness should not have to mean financial self-sacrifice. "Making money and helping people aren't contradictory." For him, sustainability was another form of care.

He had also noticed how widespread these small cooking facilities were. There were similar kitchens around other major cancer hospitals across China. The reason, he explained, was not difficult to understand. Many cancer patients stayed in rented rooms near hospitals. Others slept beside their relatives in hospital wards. Either way, families eventually needed somewhere inexpensive to cook. A meal outside could cost far more than a meal prepared with a few yuan worth of ingredients. In a region like Jiangxi, where many families had limited financial resources, that difference mattered. "Saving a little is still saving." Cancer treatment could consume a large portion of a family's resources. For some families, an inexpensive kitchen was not a sentimental convenience. It was part of how they made the project of treatment financially possible.

Then the conversation wandered somewhere I had not expected. He began talking about his own experience in the United States. The professor who supervised him worked in physiology. He applied for research funding, bought equipment, hired postdoctoral researchers, and tried to discover something that might contribute to science. His work was deeply meaningful. Meanwhile, his brother was an anesthesiologist. They earned very different incomes. That difference, Doctor Wang said, was worth understanding before choosing a career. "If you want to do research, you have to be able to tolerate a long period of hardship and solitude." He was not discouraging me. Quite the opposite. He wanted me to know what I was choosing.

Perhaps that was why the conversation continued for so long. He did not talk to me like someone trying to give a young person a motivational speech. He talked like a professional who had spent years inside medicine and had learned that every career came with a price. Medicine was difficult, and so was research. The question was not which path was easy. It was which difficulty suited you. He told me that he had seen many people who genuinely enjoyed being doctors. He had seen fewer people who genuinely enjoyed biological research. So if I liked hands-on work and direct interaction, medicine might fit better. If I loved experiments and discovery, research might be the better choice. The point, he said, was to understand the distinction early.

By then, he was still wearing the same green surgical clothes. The interview had started immediately after an operation, and he had answered question after question without ever giving the impression that speaking to me was a burden. At one point, he told me that I could contact him again if I had questions. 

Only then did I realize how unusual the afternoon had been. I had met him because he had just finished operating on someone. For him, that patient had been the immediate responsibility of the day, but once he stepped out of the operating room, he did not seem to switch into a different identity. He had just come from the place where medicine becomes action: a patient on an operating table, a team working with concentration, a decision that has to be made correctly. And now he was standing in a hospital corridor talking to an eighteen-year-old who had come to understand what medicine might mean. The two moments did not seem separate. Perhaps, for Doctor Wang, they were never supposed to be.