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Interpreters of Maladies
2007/07/18

Nestled among other buildings in the east of Nanjing, one can spot the twin towers of what used to be the Central Hospital during the Kuomintang government. Built in 1929, it now serves as the Nanjing General Military Hospital. One of the towers houses the Research Institute of Nephrology while the other is home to the Research Institute of General Surgery.

Three brothers who are famously known as the Li Brothers of the medical profession in Nanjing explored new medical techniques and took part in pioneering research. All of them became members of the Chinese Academy of Engineering.

To acknowledge the enormous contribution to medical science made by the Li Brothers in Nanjing over the last sixty years, the towers of the Nanjing General Military Hospital could very well be named the Li Towers.

The eldest of the Li brothers, Li Ao, passed away in 1999. He had specialized in treating burn injury, pioneering techniques to prevent secondary infections. When the boys lost their father unexpectedly in 1937, Li Ao took charge and brought up his younger siblings Li Jieshou and Li Leishi. He later introduced them to medical science, thus creating the famous legend of three pioneering medical academics in the same family.

Talking about Li Ao one of the two younger Lis says, "He was like a father to us," and the other one nods to confirm this fact.

Even though the youngest of the three Li brothers, Li Leishi, jocularly derides his elder brother of not being innovative enough, Li Jieshou, the second of the Li brothers, and a leading member of the Research Institute of General Surgery, is a pioneer in his own right. He was one of the first surgeons to specialize in the transplant of the small intestine and intestinal fistula treatment in China.

Li Jieshou is of the opinion that his younger brother's strong personality makes him very independent, clearheaded and one willing to take risks, while he himself is mild mannered and of a more cautious character. "We have different characters but we share the same passion for medicine," says Li Jieshou.

The baby of the family, 81-year-old Li Leishi, still works seven days a week and rarely takes a holiday. The garrulous Li has many stories to tell. He starts narrating one about a young woman who came to the hospital in 2002. The doctor in charge of her case diagnosed her with lupus erythematosus, which put her life in total disarray – she couldn't find employment anymore because of her medical records.

The desperate woman finally decided to come to Li for a second opinion. After reviewing her records, and reexamining all the pathological slides, Li ruled out the possibility of lupus erythematosus. "I believe in my own judgment, and I have a responsibility to help my patients," he says firmly, when asked about how he could have been so sure of negating the earlier diagnosis.

In September 2004, a woman bearing surname Xie, who was suffering from seasonal systemic edema, was transported to Nanjing after being refused treatment at several other hospitals. She was practically on her deathbed when she arrived at the hospital without a trace of heartbeat and extremely low blood pressure. Li says, "She told other doctors that I had treated her 20 years earlier, so they sent her back to me."

Li thought she might be suffering from a rare type of adrenalin cancer and wanted to perform an operation. But a physical examination couldn't detect any tumor so her parents would not agree. Li argued with them, and even "threatened them" saying that he would stop treating the patient if they didn't allow him to carry out the operation. He decided to pay for all the medical expenses himself if he was proved wrong.

"I love each one of my patients like my own child and am willing to take risks in order to save their lives," he says.

He was right. Xie recovered and left the hospital three months after Li had removed the tumor. This was an extremely rare case. Only six such cases have been recorded in world medical history. Li claims that good doctors must empathize with their patients. "I'm a good doctor," he finally rules.

Li remembers Xie's name because of her extraordinary case history, which was at once very serious and extremely complex. But he generally doesn't recall the names of his patients. "I often tell my students to forget about the patients we've saved but remember those who still need our help," he articulates.

At the beginning of his career, Li Leishi specialized in schistosomiasis, but when he turned 52 in 1978, he decided to move into the field of nephrology. During the Cultural Revolution from 1966-1976, he had to work in rural areas and discovered that many villagers were dying from kidney failure, which could not be treated in China at the time. So he decided to shift his research to kidney related diseases.

"My colleagues and friends told me that I was too old for such a change, but I had already made up my mind," Li recalls. The white-haired man exudes self-confidence. "I'm adventurous, unlike my brother Li Jieshou who prefers to refine his techniques," he says with an impish grin.

But in the Research Institute of General Surgery, just across the courtyard from Li Leishi's Nephrology Institute, Li Jieshou's colleagues regard him as one of the most creative surgeons ever.

Li Jieshou began his intestinal experiments on pigs. The experiments took eight years during which he had to spend most of his time with pigs. "I went to see them first thing every morning and said goodbye to them every afternoon," he recalls. "That's how I got the nickname 'Grandpa Pig'," he laughs.

"I never thought of myself as being particularly intelligent. My achievements are the result of perseverance and relentless research," Li says quite humbly. His humility is truly admirable as he eventually mastered the techniques of intestinal fistula treatment and is credited with the first successful small intestine transplant in Asia.

Compared to his loquacious brother, Li Jieshou might be quiet, but not without a sense of humor. He smiles and says, "Patients suffering from some kind of intestinal disorder have a pungent odor about them and this odor often rubs off onto the doctor treating them." With the same quiet smile on his lips, Li recalls going home on a bus one day and one of his fellow passengers suddenly shouting out, "Hey, who shat on the bus?"

Reflecting on a highly successful career, Li Jieshou has a few moments from the past that he regrets. In 1987 he failed to save a 13-year-old girl who had her small intestine removed in an operation and died of blood loss. Her father wanted to donate his intestine to save his daughter, but in those days transplant of the small intestine was still an alien science for Chinese doctors. It was a terrible experience to watch the little girl die recalls Li.

The tragedy propelled him toward the research of small intestine transplants, which finally led to amazing achievements. But those achievements could not bring back the little girl. "If only I could have done the research earlier," bemoans Li.

On a rainy Monday morning in July, in this ancient city in east China's Jiangsu province, as the Nanjing General Military Hospital clock strikes 6:00 and a hundred odd patients holding umbrellas begin queuing up in front of the outpatient ward, one can clearly picture inside the towers, the two indomitable octogenarian siblings getting ready for another day of interpreting maladies.

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