The Weight Between Words

The consultation room was quieter than the corridors outside. Patients drifted past the half-open door with scan reports tucked under their arms. Nurses hurried between wards with clipboards and medication trays. Somewhere downstairs, the familiar piano floated faintly through the building, almost disappearing beneath the steady rhythm of footsteps.

Director He apologized before we had even begun. "I'm not sure I can answer everything you're looking for," she laughed. "I might forget something." It was an unnecessary apology. Over the next hour she answered far more than I had expected—not with rehearsed speeches, but with stories.

When people imagine oncology, they often imagine chemotherapy drugs, operating theatres, or CT scans. Director He spoke first about conversations. "The hardest patients," she said, "are usually those who have just been diagnosed." Many arrived frightened before treatment had even begun. Some refused examinations. Others questioned every recommendation. Some simply stopped talking. "You can't force treatment," she explained. "Before medicine comes trust." Building that trust rarely happened in one visit. Sometimes it required several days of repeated conversations—not only with patients, but with spouses, sons and daughters. “Younger doctors now learn how to communicate with patients,” she said, “But when they encounter difficult patients, they turn to senior doctors.” Oftentimes the distinction between a regular physician and a director lies not just in medical skills, but also in interpersonal skills.

She remembered one man with rectal cancer. His tumour could still be cured, but surgery was not the first step. According to current guidelines, he needed chemotherapy and radiotherapy before the operation. He refused all of these. Instead, he believed immediate surgery was the only sensible choice. Chemotherapy (化疗, pronounced as huà liáo in Chinese) sounded like a delay, and delay sounded like danger. So the doctors used talking therapy (话疗, also pronounced as huà liáo). They explained the evidence. They described previous patients with similar conditions. They answered the same questions again and again. They spoke separately with his wife. Then his daughter. Only after several days did he finally agree. Months later, imaging showed that the tumour had almost completely disappeared before surgery. "He recovered very well," Director He said with a quiet smile. "He's living in Shenzhen now." There was no triumph in the way she told the story. Only relief.

The conversation shifted from treatment to emotion. I asked whether psychologists helped cancer patients in the department. "We have a psychiatry department," she said, "but most of the psychological support actually comes from us." I thought back to the patients I had met downstairs, the retired volunteer pianist who believed music reached people more directly than words, and the caregiver who stayed awake through the night because someone had to. Director He seemed to connect all of them without ever mentioning their names. Patients rarely arrived carrying only cancer. They arrived carrying fear. I was curious if the physicians teach patients ways to stay positive. Director He did not directly deny but went on explaining that most of the patients were from rural areas. They are probably less educated, so they rarely think beyond the fact of surviving cancer. Easing physical discomfort—relieving constipation, reducing abdominal pain, controlling nausea—was often the first step toward easing emotional distress. "When people feel a little better physically," she explained, "they're usually much more willing to talk." Medicine, I realised, often begins with making conversation possible.

Not every story ended so well. Some patients had already spent years fighting recurrent disease, treatment after treatment, hospital after hospital. Eventually many asked the same question—should I stop? "There are people who worry they'll lose both their money and their life," Director He said. When treatments still existed, doctors encouraged them to continue. When medicine had reached its limits, honesty became another form of care. I had assumed doctors always discussed every detail directly with patients. Instead, Director He explained that conversations in China often followed another path. Technically, patients have the right to know everything. In practice, families are usually told first. Serious prognoses, survival estimates, difficult decisions—these are often shared with spouses or children before patients themselves. Families decide how much to reveal. The intention is kindness. Hope, however fragile, is sometimes considered another medicine worth protecting. Listening to her, I realised that oncology treats more than individual bodies. It treats families, since every diagnosis spreads through an entire household.

Our discussion gradually expanded beyond individual patients. She described the third-party caregivers who worked throughout the wards. Most had little formal education but shouldered immense responsibilities. She spoke about palliative care, where nurses celebrated birthdays, washed patients' hair, and tried to preserve dignity when cure was no longer possible. She described why relatively few patients could access those wards—not because the need was small, but because the beds were.

Then the conversation turned unexpectedly toward doctors themselves. Medicine, she admitted, had changed enormously. When she graduated decades ago, employment was guaranteed. Promotion depended largely on experience and examinations. Today's young physicians face another reality: research publications, national grants, teaching responsibilities, night shifts, growing patient complaints, shrinking hospital budgets. Even something as ordinary as an IV catheter could cost the hospital more than reimbursement covered. "I still think medicine is meaningful," she said. She didn't say it dramatically. She said it as someone who had already weighed the costs.

She kindly gave me advice for the interview. If I wanted to interview patients, she warned, I should prepare for dialects. If I wanted to understand caregivers, I should speak with the attendants rather than only the doctors. "They probably have many stories," she said, "Many grievances too." She smiled again, not because the work was easy. Perhaps because difficult stories deserved to be heard as well.

When we stepped back into the corridor, the hospital sounded exactly as it had before. Phones rang. Wheelchairs rolled past. Someone called for a nurse. Downstairs, faint but unmistakable, the piano was still playing. Earlier that week I had wondered whether medicine was mostly about knowledge. Director He had shown something different. Knowledge explains what disease does to the body, but conversation determines whether people can bear what comes next.