At twenty minutes past midnight, Lin Yi-ling, 21, passed away from a neural tumor. The pretty young lady was in her junior year in the School of Social Work and Family Studies at the University of British Columbia, Canada. She developed abdominal pains in April 2000 and was later diagnosed with a neural tumor. She returned to Taiwan for medical treatment in May.

A cruel fact

Yi-ling's grandfather, a doctor, rushed about caring for his beloved granddaughter because he would not accept the fact that her disease was incurable. Yi-ling was treated in several hospitals and had many tests. So many tubes were inserted into her body that she was often in great pain. Understanding how serious her condition was, Yi-ling hoped she could be transferred to Hualien Tzu Chi Hospital so that she could meet with her beloved spiritual mentor, Master Cheng Yen. Her grandfather did not support this idea, because he worried that the journey could worsen her feeble condition. However, he finally gave in to Yi-ling's tenacious request, which turned out to be her last.

Yi-ling was a beautiful and talented young lady with an understanding heart. When people brought her food, she always asked if they had eaten yet before she started eating. The people who looked after her were reluctant to let her go, as she was so thoughtful and sweet-natured. Several days before she fell into eternal sleep, she told volunteers she was very happy that there would be no more transfers between hospitals, because now she was in the place closest to Master Cheng Yen. Accompanied every day by the staff and volunteers of the Heart Lotus Ward, she felt at ease and no longer lonely. She wished to donate her organs, become a "silent anatomy teacher," and then live on in the Great Giving Hall, which contains the urns of donors' ashes. She and volunteers from the Tzu Chi Collegiate Youth Association then sang and laughed together and played the violin and piano. Everyone had a delightful afternoon.

When she passed away a few days later, her family was heartbroken. According to her wishes, her cornea and heart valves were donated to others, and her body was donated for anatomical studies. Her family also donated NT$1 million [US$30,300] to Tzu Chi, as they would always remember with gratitude the compassion of Master Cheng Yen and the kindness of the hospital staff and volunteers.

On the same day, a forty-year-old woman and the husband of a Tzu Chi member both passed away of cancer. The hospital carried out their wishes to donate their bodies for anatomical studies. Another two people passed away at home. One was a seventy-year-old gentleman from the Ami tribe (one of the nine major aboriginal tribes in Taiwan), and another was an amiable Catholic nun, Sister Tien. They had been residents of the Heart Lotus Ward, but they seemed to know their time had come and suddenly asked to go home [it is customary for Chinese people to die at home]. Sister Tien seemed to have viewed Heaven, so Dr. Hsu Li-an of the Heart Lotus Ward gently comforted her. "Don't be anxious, just wait for God to come for you." She passed away shortly after she went back to her convent.

Dr. Hsu was busy that whole night. When he finally took off his white jacket, his heart was filled with deep emotions.

The patients are our teachers

"All the patients are like bodhisattvas. They use their lives, illness, pain and death to remind us all about the impermanence of life." Dr. Hsu was comforted that these few patients had all passed away peacefully, and that they had maintained their dignity both when they were alive and in their last days.

Three years ago, Ling-ling was diagnosed with lung cancer. Her cancer had metastasized and could not be excised by an operation. Therefore, she had to undergo radiotherapy. Even though she had been given three months to live, she lived on for three more years. In this time, her appearance did not show any illness, but the malignant tumors had already spread through her whole body, to her brain, her lungs, and even to her bones. Huge, threatening tumors invaded her organs, went deep into her system and continuously proliferated and took control of her body. She visited many specialists and was transferred between quite a few major hospitals. A chest specialist saw her x-rays and was surprised and dismayed that they belonged to this beautiful woman. A year ago, Ling-ling started to feel ill and went in and out of the Heart Lotus Ward. She seemed to have realized and accepted her condition, and her clear eyes reflected the unusual tranquillity in her mind.

"Dr. Hsu, please tell me how long I have."

Dr. Hsu, who had been her physician for nearly a year, did not have the heart to tell her the truth, yet he couldn’t conceal it from her.

"I'm a bit worried that you might not be able to celebrate the Chinese New Year..."

"Dr. Hsu, I'll be there to collect a red envelope from you!" Ling-ling smiled and changed the subject. She knew that at every Chinese New Year Dr. Hsu distributed traditional red envelopes with little gifts of money inside to the nurses. She asked for one only because she hoped she could stay with her family for Chinese New Year.

However, after that day her condition worsened and her emaciated appearance showed how weak she had become. Dr. Hsu was really worried that she could not hold on any longer.

"I've already prepared your red envelope, so you can collect it anytime."

"Let's wait until Chinese New Year."

She was always so optimistic, so cheerful and thoughtful. As the last days of her life counted down, she was still brave. From the moment she learned of her incurable disease and absently walked the several hours home from the hospital, she had decided not to complain about her pain. However, as her life stretched on from three months to three years, life was still just a big question mark to her. She kept looking for an exit until she met the Tzu Chi volunteers and new friends in the Heart Lotus Ward. Ling-ling started to feel the meaningfulness of her life, and she worked hard to love others and accept love from them.

The red envelope was prepared and Dr. Hsu softly told her that she could have it anytime, but Ling-ling passed away without collecting it. Even though she was not able to be with her family for Chinese New Year, she still passed away peacefully.

Lotus hearts of compassion

Nearly five years ago, in the summer of 1996, the Tzu Chi General Hospital in Hualien established a palliative care ward, named the Heart Lotus Ward by Master Cheng Yen. It was the first specialized palliative care ward in eastern Taiwan for cancer patients in the last stages of their disease.

The Master hopes that patients' hearts will blossom like lotus flowers, and that they will face illness and death with dignity in the Heart Lotus Ward. At the entrance, there is a secluded phone booth that could be easily missed. The design of the room accounted for the possible emotional reactions of family members, such as crying and the need for private conversations. At the end of the corridor there is a prayer room for Christians, set up out of respect for the different religions of the patients. Accommodations for family members coming from far away was also a first in palliative care wards in Taiwan. The bathroom has an ultrasonic bathtub with a special lift which allows patients who are unable to move to enjoy taking a bath. Also, an aromatherapy room, electric beds and a roof garden were all installed to let the patients feel more at home.

The hospital is not sumptuous or extravagant, only roomy and bright. Here it is nice and warm with a sense of home. Both the bodies and souls of patients are cared for. Since patients are the first priority here, all decisions are made and carried out with their approval. The main focus is not only on their physical health, but also on their relationships with others, their happiness and spiritual needs.

Running a palliative care ward requires a large investment in equipment and people. Under the present Taiwanese national health insurance regulations, such a high-cost operation is considered to be a money-losing proposition for any hospital. However, maintaining the spirit of caring for the dying, Tzu Chi General Hospital insists on preserving the final dignity of life and not measuring its value with money.

Complete care

Tseng Wen-ping, former superintendent of Tzu Chi General Hospital, indicated that the most important advances of twentieth-century medical care include care for the elderly and palliative care. Both areas need the efforts of individuals, families and society. The Heart Lotus Ward was established to provide complete care for the patients in four areas: the whole body, family, process and team. The members of the Heart Lotus team--including the medical staff, social workers, Tzu Chi volunteers and spiritual care-givers--look after patients and their families, and they also provide home-care service to those who prefer to leave the ward and stay at home until the end of their life journey.

Hung, a 33-year-old patient in the final stage of perineal cancer, had no family members to look after her. She took the train to Hualien Tzu Chi General Hospital (in eastern Taiwan) from Taichung (in central Taiwan) all by herself and expressed her wish to stay in the Heart Lotus Ward. Perineal cancer is an especially aggressive form of cancer. The disease had invaded Hung's pelvis to the extent that her bones and pelvic cavity were exposed. Her anus and urethra were destroyed and emitted a foul odor. People avoided her because even covering up their faces wouldn't eliminate the smell. Treating Hung's wounds was always a great trial for the nurses of the Heart Lotus Ward.

Although changing her dressings was such a big job, it still had to be done every time she urinated. The pungent odor always made others feel queasy, and other patients could not stand to be near her. The ward staff tried all kinds of methods, and they finally found a nurse who specialized in the treatment of such wounds. They transferred Hung to a single room and with the use of an exhaust fan, air cleaner, aromatherapy and other deodorizing methods, the smell eventually improved.

Hung had been a prostitute, and she had no family or friends with her. She once wished to locate her mother. Volunteers accompanied her back to Taichung, but they were unable to find her mother. She said that she also had a sister with whom she had lost contact long ago. When Hung first moved into the Heart Lotus Ward, her emotions were very unstable. She often played malicious tricks on the staff and several times reduced the nurses to tears. For a period of time, she was always the case that they discussed the most.

When the nursing staff received her medical records from other hospitals, they found that when she stayed in a major hospital in Taichung, she had been placed in the farthest room. Her dressings were never changed and no one came to help her because of the unbearable smell. Maybe this was why she did not trust the nursing staff.

With the continuous care of the Heart Lotus Ward medical team and Tzu Chi volunteers, Hung started to undo the tight knot in her heart. She remembered the names of everyone in the ward, and she always wanted to talk with the nurses.

Although she sometimes had unreasonable, childish requests, the nurses always happily turned her body for her to avoid bedsores and the volunteers gladly accompanied her. She passed away on June 4, 2000.

Home-care services

For patients without family and friends, like Hung, the Heart Lotus staff members always automatically become their family. Ward personnel also provide home-care services for those who wish to stay at home. This allows patients to return to the hospital if their health worsens and stay at home when their condition stabilizes with continuing care from the hospital staff. All the staff members in the Heart Lotus Ward care for the patients, and they also show consideration for the patients' families. They look after the patients until they pass away, and they also help their families overcome their grief.

When the disease has entered the final stage, we should not give up on the patients, but should instead care for them even more actively and attentively. Patients should have no great physical pain and no feelings of anxiety, fear or spiritual loneliness at the end of their lives. The members of the Heart Lotus family want to minimize the trauma of the patients and their families so that they can cherish their last moments together. They encourage the patients to live and help them carry out their wishes so that they will have no regrets in this lifetime. These are the reasons that Dr. Tseng Wen-ping insisted on setting up the Heart Lotus Ward.

Dr. Hsu, who has always devotedly promoted the concept of palliative care, said with a sense of humor, "In this entire hospital, I must be the doctor who has issued the most death certificates and who holds the record for treating patients to death." Due to the limitations of medical technology some patients still cannot be cured, and this invariably is the sorrow of many good doctors. Many medical workers feel helpless when facing and looking after these dying patients. Smiles disappear like pages torn off a daily calendar. It is totally hopeless. Thus, psychological support is very important for the medical staff. Dr. Hsu says that he has gradually learned the importance of powerlessness. "The secret is not to be afraid of it or run away from it. Dying patients know that we are not God and that we only want to be with them in the toughest time of their life journey."

Medical personnel come into contact with patients every day. They have the same hope as the patients' families--that the patients will get better. When the wishes don't come true, people are unable to handle their feelings. It is always hard to face death. People normally cannot accept the death of friends, let alone their own death, yet preparing for death is a daily routine in this ward.

A life with no regrets

"We are not patients, and therefore we cannot feel the deep sorrow that sickness brings. We are just students, and the patients are our teachers." Behind Dr. Hsu is the living room of the Heart Lotus Ward, and a painting drawn by Hsieh Kun-shan hangs on the wall. [Hsieh, a famous Taiwanese artist who paints with his mouth and foot, is an optimistic and industrious person. His arms and one of his legs were amputated after an accident.] If we look closely at the painting, we can see that among the lotuses there is a Buddha sitting cross-legged and teaching the dharma. He seems to hold a lotus flower with his right hand, which implies that there are no regrets in this impermanent life because of the love we share with each other.