Historical Context of a Medical Career
My surgical career unfolded against the backdrop of China's remarkable transformation from an impoverished, largely rural society to a modernized global power. This national metamorphosis forms the essential context for understanding both the challenges and opportunities that shaped my professional life across seven decades.
When I graduated from Wuhu Health School in 1956, China's healthcare system faced overwhelming challenges. The newly established People's Republic inherited a population suffering from widespread infectious diseases, malnutrition, high infant mortality, and minimal healthcare infrastructure—particularly in rural areas where the majority of citizens lived. Medical resources were severely limited: few trained physicians, minimal pharmaceutical manufacturing capacity, and hospitals concentrated primarily in major cities.
The government's response emphasized rapid training of healthcare workers through abbreviated programs like my own health school education. This approach prioritized quantity over depth of training, aiming to extend basic healthcare to previously underserved populations as quickly as possible. While this strategy successfully increased healthcare access, it created a workforce with variable training quality and limited specialization—constraints I would work to overcome throughout my career.
Early health campaigns focused heavily on preventive measures and public health interventions: mass immunization, improved sanitation, maternal-child health initiatives, and infectious disease control. My initial assignment to schistosomiasis prevention work reflected these national priorities, addressing a parasitic disease that had plagued agricultural communities along the Yangtze River basin for centuries.
By the time I transitioned to surgical practice in 1961, healthcare priorities were shifting toward development of clinical capabilities alongside continuing preventive efforts. County hospitals like Nanling, where I began my surgical career, represented the front line of this clinical expansion. These institutions faced the challenging task of providing increasingly sophisticated medical care with limited resources, minimal specialized equipment, and staff who—like myself—often lacked formal specialist training.
The political campaigns of the 1960s and 1970s significantly impacted healthcare delivery. During the Cultural Revolution (1966-1976), political considerations often superseded professional criteria in medical decision-making. Hospital revolutionary committees replaced traditional administrative structures, while many senior physicians were sent for "reeducation" through rural labor. The "barefoot doctor" movement emphasized basic training for rural healthcare workers over specialized medical education.
Within this challenging environment, I focused on maintaining professional standards while adapting to political requirements. When senior surgeons were removed from our hospital for political reasons, I assumed greater responsibilities despite limited experience. This politically-driven personnel shortage paradoxically accelerated my surgical development, as I performed increasingly complex procedures simply because no one else remained to do them.
The post-Mao era brought dramatic changes to Chinese healthcare. The restoration of professional credentials, reinstatement of academic journals and societies, and renewed emphasis on technical expertise rather than political criteria created new opportunities for recognition based on actual clinical skills. My appointment as Associate Chief Surgeon in 1978 reflected this shifting environment, acknowledging practical expertise developed despite limited formal training.
The reform and opening policies initiated under Deng Xiaoping progressively transformed Chinese society throughout the 1980s and beyond, creating both opportunities and challenges for healthcare professionals. Market-oriented reforms introduced competition between institutions, increasing emphasis on technology acquisition, and growing disparities between urban and rural healthcare facilities. These changes required adaptation to new administrative systems, performance metrics, and financial incentives that sometimes created tension with clinical priorities.
My move from county-level practice to larger urban hospitals in the mid-1980s paralleled broader urbanization trends throughout Chinese society. This transition provided access to better resources and professional development opportunities but required adaptation to different institutional cultures and practice patterns. The integration of new technologies, from improved imaging systems to minimally invasive surgical techniques, offered enhanced capabilities but demanded continuous learning throughout late career.
By the time I reached traditional retirement age, China's healthcare system had undergone revolutionary transformation. Modern hospitals featured advanced technology often equal to international standards, while medical education had developed into a sophisticated system producing highly specialized practitioners. Yet challenges remained, particularly in balancing healthcare access across economic and geographic divides. My continuing practice into advanced age reflects both personal commitment and response to ongoing need for experienced practitioners despite these systemic advances.
Throughout these transformative decades, my surgical practice both influenced and was shaped by evolving national healthcare priorities. From basic surgical interventions in resource-limited settings to advanced procedures in modernized facilities, from politically constrained practice during the Cultural Revolution to internationally connected academic surgery in recent decades, my career spans the full arc of modern Chinese healthcare development.
Professional Challenges and Adaptations
The extraordinary duration of my surgical career—67 years and continuing—has required continuous adaptation to changing knowledge, technologies, institutional environments, and my own evolving capabilities. This adaptive process represents not merely passive response to external changes but active engagement with emerging opportunities and constraints throughout seven decades of practice.
My earliest professional challenge involved transitioning from health school training to effective clinical practice with minimal guidance. Without formal mentorship or structured residency programs, I developed surgical skills through careful observation, diligent study of available textbooks, and progressive assumption of responsibility under limited supervision. This self-directed learning established patterns of independent study and skill acquisition that would serve me throughout my career.
The resource limitations of county hospital practice in the 1960s and early 1970s necessitated creative adaptations that profoundly influenced my surgical approach. Working with basic instruments, limited anesthesia options, minimal blood banking capacity, and restricted antibiotic availability required careful patient selection, meticulous technique, and heightened attention to potential complications. These constraints fostered surgical discipline that remained beneficial even after gaining access to better-resourced facilities later in my career.
Political campaigns periodically disrupted normal hospital function, requiring adaptation to changing administrative structures and ideological requirements. During the Cultural Revolution, traditional hospital hierarchies were replaced by revolutionary committees, while scientific decision-making sometimes yielded to political considerations. Navigating these environments required careful balance between maintaining professional standards and demonstrating sufficient political conformity to continue practice—a challenge faced by all healthcare workers during this turbulent period.
The restoration of professional standards following the Cultural Revolution brought different adaptive challenges. Reestablished medical societies, academic journals, and formal evaluation systems created opportunities for recognition but required development of previously unnecessary skills in academic writing, formal presentation, and professional networking. Despite limited formal education, I developed these capabilities sufficiently to publish dozens of papers and participate effectively in professional organizations throughout the latter half of my career.
Institutional transitions—from county hospital to transportation ministry hospital to railway hospital—each required adaptation to different organizational cultures, administrative systems, and patient populations. These changes involved both professional and personal adjustments: learning new institutional protocols, establishing credibility with unfamiliar colleagues, and relocating family to different communities. Each transition brought improved resources and opportunities but required flexibility and patience during integration periods.
Technological evolution throughout my career necessitated continuous learning well beyond formal education. From adoption of improved anesthesia techniques in the 1960s to integration of advanced imaging in the 1980s to implementation of minimally invasive surgery in the 1990s, each technological wave required developing new skills despite already being an established surgeon. This ongoing technological adaptation continued into advanced age, including mastery of electronic medical records and digital imaging systems in my seventies and eighties.
Age-related changes in my own capabilities have required particularly thoughtful adaptation in later career stages. Diminished stamina necessitated more careful case selection and scheduling, while subtle changes in manual dexterity influenced technical approaches to certain procedures. Rather than denying these natural changes, I have adapted surgical practice accordingly—choosing procedures appropriate to current capabilities while maintaining the judgment and experience that continue benefiting patients despite physical changes.
Throughout this adaptive journey, certain core principles have provided continuity: commitment to patient welfare above all other considerations, emphasis on fundamental surgical skills regardless of technological context, rigorous self-evaluation to maintain quality, and determination to continue learning regardless of career stage. These constants, maintained across seven decades of dramatic change, have enabled productive practice spanning from China's early development into contemporary modern society.
Personal Growth Through Professional Practice
Beyond technical skill development, my surgical career has profoundly shaped personal development across multiple dimensions. The physician's privileged access to human experience at its most vulnerable moments provides unique perspective on fundamental aspects of existence—perspective that has progressively deepened throughout decades of practice.
Early in my career, I approached surgery primarily as technical challenge, focusing intensely on developing manual skills and clinical judgment necessary for good outcomes. Patient interactions, while always respectful, remained somewhat secondary to technical aspects of care. This technically-centered approach reflected both my youth and the urgent need to develop procedural competence rapidly in a setting with few experienced mentors.
As technical confidence grew through accumulated experience, my perspective gradually shifted toward greater appreciation of the human dimensions of surgical care. Increasingly, I recognized that technical success alone, while necessary, provided insufficient satisfaction without meaningful human connection with those receiving care. This evolving perspective led to more attentive communication with patients and families, deeper consideration of their concerns and preferences, and growing awareness of emotional aspects of the surgical experience.
Repeated exposure to suffering, mortality, and human resilience through surgical practice has progressively shaped my philosophical outlook on fundamental questions of existence. Daily confrontation with human fragility—the thin margin separating health from illness, life from death—fosters perspective difficult to achieve through ordinary experience. This awareness of life's precariousness has paradoxically led not to pessimism but to deeper appreciation for life's value and beauty despite its inherent vulnerability.
The surgeon's responsibility for life-altering decisions, often made with incomplete information under time pressure, has developed capacity for decisive action despite uncertainty—capacity extending beyond professional contexts into personal life. Rather than paralysis through analysis, surgical practice encourages thorough but time-limited evaluation followed by committed action once decision thresholds are reached. This decisiveness, tempered by appropriate humility about human knowledge limitations, has served well in both professional and personal realms.
Inevitable surgical complications and occasional poor outcomes, despite best efforts, have taught essential lessons in resilience and perspective. Early in my career, complications affected me deeply, sometimes disrupting sleep for days and generating excessive self-criticism. With experience came more balanced perspective—thorough analysis of adverse events for learning without destructive self-recrimination, maintaining confidence despite occasional setbacks, and developing emotional resilience while still caring deeply about patient outcomes.
The progressive recognition of personal knowledge limitations has fostered intellectual humility that deepens with increasing experience rather than diminishing. Early career confidence sometimes bordered on overconfidence, with insufficient appreciation for biological complexity and clinical uncertainty. Decades of practice have revealed how much remains unknown despite scientific advancement, fostering appropriate epistemic humility alongside continued pursuit of improved understanding through study and observation.
Perhaps most significantly, sustained engagement with patients across seven decades has developed deeper empathy and appreciation for diverse human experiences beyond my own limited perspective. From peasants to officials, from children to the elderly, from the highly educated to the illiterate, patients have provided window into lives and circumstances I would otherwise never encounter. This exposure to human diversity in moments of vulnerability creates understanding that theoretical knowledge alone cannot provide.
These dimensions of personal growth—from technical focus to holistic perspective, from youth's confidence to mature wisdom, from emphasis on knowledge to appreciation of its limits—represent the inner journey accompanying external professional development. The physician's privilege of accompanying others through critical life moments offers opportunity for profound personal growth for those receptive to its lessons. This inner development, though less visible than technical accomplishments, represents equally important aspect of a lifetime surgical career.
Witnessing Healthcare Transformation
Few medical careers span sufficient time to witness fundamental transformation of an entire healthcare system. My 67 years in medicine have provided this extraordinary vantage point, allowing me to observe China's healthcare evolution from basic post-revolutionary development through contemporary modern medicine. This perspective offers unique insights into both progress achieved and challenges remaining within our healthcare system.
When I began practice in 1956, healthcare in China remained primarily divided between traditional Chinese medicine and basic Western approaches, with limited integration between these systems. Many rural areas lacked access to either tradition beyond folk remedies administered by minimally trained practitioners. Urban hospitals provided more advanced care but remained inaccessible to most citizens due to geographic and economic barriers. Preventable and treatable conditions routinely resulted in disability or death simply due to healthcare inaccessibility.
The early focus on communicable disease control and basic preventive measures—campaigns against smallpox, tuberculosis, schistosomiasis, and other infectious diseases—achieved remarkable public health improvements despite limited resources. My participation in schistosomiasis prevention represented part of this broader effort that dramatically reduced disease burden through relatively simple interventions: mass screening, basic treatment protocols, and public health education.
The development of the rural cooperative medical system and urban work-unit healthcare during the 1960s and 1970s, despite limitations, extended basic healthcare access to previously underserved populations. County hospitals like Nanling, where I spent 25 years, represented the frontline of this expansion, providing increasingly sophisticated clinical care to rural populations previously lacking any hospital access. Though resource-constrained, these institutions dramatically improved healthcare availability throughout the countryside.
The barefoot doctor movement, despite legitimate criticisms regarding training adequacy, nevertheless extended basic healthcare to village level previously lacking any formal medical presence. These minimally trained practitioners—healthcare workers rather than physicians—provided preventive services, basic treatments, and appropriate referrals that significantly improved rural healthcare access. Their integration with county hospitals created rudimentary but functional healthcare networks reaching previously unserved communities.
The post-Mao healthcare reforms beginning in the late 1970s brought renewed emphasis on professional standards, academic development, and technical advancement. Medical journals resumed publication, professional societies reformed, and healthcare institutions restored merit-based advancement rather than political criteria. These changes significantly improved technical quality but sometimes reduced accessibility as market-oriented reforms introduced financial barriers alongside quality improvements.
The scientific and technological acceleration of the 1980s and 1990s transformed clinical capabilities across all specialties. Advanced imaging modalities—first CT, then MRI and other sophisticated techniques—revolutionized diagnostic accuracy. New pharmaceutical options, improved anesthesia, minimally invasive surgical approaches, and enhanced intensive care capabilities dramatically improved outcomes for conditions previously untreatable or highly dangerous to address. These advances, implemented with increasing rapidity in Chinese hospitals, progressively closed gaps between domestic and international standards of care.
The healthcare financing reforms beginning in the 1980s created mixed outcomes still being addressed today. Market-oriented approaches increased efficiency and innovation incentives but reduced accessibility for economically disadvantaged populations. The dissolution of rural cooperative medical systems and work-unit healthcare without immediate comprehensive replacements created coverage gaps that remained problematic for decades. Recent universal coverage initiatives have addressed these issues but challenges remain in balancing access, quality, and sustainability.
Medical education has undergone parallel transformation throughout my career. The abbreviated training programs of the 1950s and early 1960s, like my own health school education, prioritized producing large numbers of providers rapidly over comprehensive individual training. Subsequent decades saw progressive development of standardized medical education, specialty training programs, and continuing education requirements that dramatically improved practitioner preparation. Today's medical graduates receive education comparable to international standards—a remarkable achievement given starting conditions seven decades ago.
Perhaps most striking has been the transformation in healthcare facilities themselves. County hospitals that once operated with minimal equipment, unreliable electricity, and basic infrastructure have developed into modern institutions with sophisticated technology. Provincial and metropolitan hospitals now feature capabilities rivaling international centers, while village clinics have evolved from rudimentary structures to functional primary care facilities. This physical transformation parallels broader improvements in Chinese infrastructure and standard of living throughout recent decades.
Throughout these transformative decades, core challenges in healthcare delivery have remained remarkably consistent despite changing contexts: balancing quality with accessibility, distributing resources equitably across geographic and economic divides, integrating technological advancement with humanistic care, and maintaining prevention alongside increasingly sophisticated treatment capabilities. These fundamental tensions, present throughout my career despite dramatically different manifestations across eras, represent enduring challenges for healthcare systems worldwide rather than unique Chinese difficulties.
Having witnessed this extraordinary healthcare transformation firsthand—from the most basic post-revolutionary conditions to contemporary modern medicine—I appreciate both the magnificent progress achieved and continuing challenges requiring attention. This historical perspective informs my current practice and teaching, helping younger colleagues understand both how far we've come and what issues remain to be addressed in China's continuing healthcare development.
Balancing Professional and Personal Life
The integration of demanding surgical career with meaningful family life has presented continuous challenges throughout seven decades of practice. The physician's commitment to patient care often conflicts with family responsibilities, creating tensions requiring thoughtful navigation rather than perfect resolution. My experience with these challenges, while reflecting particular historical circumstances, contains elements relevant across generations of medical practitioners.
Early in my career, newly married and beginning surgical practice, I established patterns that would persist for decades: long and unpredictable hours, frequent emergency recalls to the hospital, and mental preoccupation with difficult cases even when physically present at home. These demands reflected not only personal commitment but systemic realities of understaffed facilities with minimal coverage redundancy. When emergencies arrived, no alternative surgeon was available—creating responsibility that couldn't be delegated regardless of family circumstances.
My wife, herself a healthcare professional working as a nurse, demonstrated extraordinary understanding of these demands. Her insider's perspective on medical necessity provided foundation for partnership that accommodated professional requirements without resentment, though not without occasional frustration during particularly demanding periods. Her support proved essential to maintaining both career and family functioning throughout decades of practice.
The arrival of our children in the early 1960s increased both the importance and difficulty of achieving appropriate balance. Unpredictable surgical emergencies meant missed family meals, abbreviated holiday celebrations, and absence during significant childhood events. I attempted to compensate through quality of engagement during available time—maintaining genuine interest in children's activities, participating meaningfully in their education, and creating family traditions sustainable within the constraints of medical practice.
Cultural expectations regarding gender roles somewhat eased professional-personal tensions during this period. In 1960s China, mothers were expected to provide primary childcare regardless of their own professional responsibilities. While my wife maintained her nursing career, societal norms placed disproportionate family responsibility on her rather than expecting equal domestic participation from fathers. This arrangement, while enabling my surgical immersion, created inequitable burden I recognize more clearly in retrospective assessment than I did contemporaneously.
The political campaigns of the Cultural Revolution paradoxically improved work-life balance in certain respects while creating different family tensions. Reduced emphasis on professional advancement and increased focus on political activities actually decreased hospital hours during certain periods. However, political study sessions and mandatory participation in mass campaigns consumed time that might otherwise have been available for family. The politicization of education created concerns about children's development requiring careful navigation between official expectations and family values.
My transition to larger hospitals in the 1980s and 1990s brought both increased professional opportunities and improved work-life balance. Better staffing and more sophisticated call systems reduced emergency disruptions, while improved transportation shortened commuting time. Our children had reached adulthood by this period, transforming family responsibilities from daily parenting to supporting their educational and career development—support requiring financial resources more than time commitment.
Throughout all career stages, I maintained certain protective practices for family relationships: preserving regular meals together whenever possible, maintaining genuine interest in family members' activities and concerns, and creating clear boundaries around vacation periods except for genuine emergencies. These practices, while imperfectly implemented amid professional demands, preserved family connection despite workload that might otherwise have proven devastating to meaningful relationships.
In retrospective assessment, I recognize both successes and shortcomings in this lifelong balancing effort. My children developed into successful, well-adjusted adults despite my frequent absences during their formative years—testament primarily to their mother's excellent parenting rather than my limited contribution during their early development. Our marriage has endured for over 60 years with genuine partnership and mutual support, despite sacrifices my wife made to accommodate my professional commitments.
The primary shortcoming I acknowledge is insufficient recognition and appreciation for my wife's disproportionate contribution to family functioning throughout the demanding decades of my surgical career. Her management of household, primary childcare responsibility, and maintenance of her own nursing career created foundation that enabled my professional development. Contemporary perspective reveals inequity in this arrangement that seemed normal within historical context but deserves acknowledgment from current vantage point.
For younger physicians seeking insight from my experience, I would emphasize several principles: first, explicit recognition and appreciation for family members' sacrifices supporting medical career; second, intentional creation of protected family time despite professional demands; third, genuine engagement during available time rather than mere physical presence; and finally, recognition that while medical practice offers profound satisfaction, family relationships provide irreplaceable meaning that professional accomplishments alone cannot supply.
The ideal balance between professional commitment and personal life remains elusive across generations of physicians. My experience suggests not perfect resolution but thoughtful navigation of inevitable tensions—maintaining patient commitment without sacrificing family relationships that ultimately give meaning to professional service itself. This balance, pursued imperfectly but persistently across seven decades, represents perhaps the most challenging and important aspect of a long medical career.
