Seven years ago, the Tzu Chi College of Medicine opened with the blessings of more than twenty thousand people. This year, forty-six students graduated from the Department of Medicine. After four years of basic medical education and three years of clinical training, the students have come to be more aware of the importance of treating each patient as a human being. After putting on their white robes and stethoscopes, they expect themselves to fulfill the duties of conscientious doctors and treat patients as if they were their own relatives.

In the following article, several students who graduated from the Tzu Chi College of Medicine this year share with us what they experienced and felt during their internship.

"When I first came to the hospital, I didn't know what questions I should ask my patients, and I worried about their reactions." The first thing a new intern must learn is asking patients about their medical history. Shy and timid like other fresh graduates who are making their debut into society, it was natural for them to feel nervous about facing patients.

"I remember an old man in his eighties who avoided eye contact with me and refused to answer the questions I asked. He kept talking to my classmate beside me about his good old days. He babbled on for half an hour." Chen Ching-liang had no idea what he had done wrong. It seemed perfectly natural to ask a patient, "What's bothering you?" Why did the old man refuse to acknowledge his questions?

It was only after he had carefully reviewed his conduct that he came to realize that maybe he was a little too rash. Anxious to collect all the relevant information so that he could report the case to the attending physician, he completely forgot that he was dealing with a human being who needed care and respect.

After that experience, he began to address his patients in a different way: "Sir, how are you today? How can I help you?" Although the questions he asked were basically the same, he showed concern when asking them and so the response he got was completely different.

"Learning to pay attention to a patient's feelings--that was really an important step for me." Chen said that now he leans against a bed to talk to patients, or even holds their hands and stoops down to listen to what they have to say. He finds that it is not hard at all to express his care and concern through body language. By doing so he can greatly shorten the distance between him and his patients.

Juan Shao-chiu, another student who graduated from the Tzu Chi College of Medicine this year, said that since he had chosen to become a physician, he had the obligation to behave lovingly and patiently towards his patients.

He once had the chance to attend an elderly woman who was seriously ill. Every time he asked her questions, her tough-looking husband always answered for her. Later the woman's white blood cell count decreased. Juan recommended a blood test, but her husband refused to give him the permission. Juan called on them several times a day to talk to them as a friend. At last the husband's attitude softened. He told Juan that their children had treated them badly and caused them to lose faith in people and become indifferent and apathetic. "Love can dissolve indifference," said Juan. "That's what I learned from my clinical experiences."

What illness is this?

"Once we begin our internship, we have to learn to be responsible." Huang Kuan-po observed that when he was in school all he needed to do was study hard, but after he became an intern he had to be responsible for patients and the whole medical team he was with. "The first four years of medical courses taught us the basics of medicine, but when we were dealing with real patients, the descriptions in the textbooks were often not enough. We had to spend some time adapting to the difference."

He cited an example to illustrate his point. The textbook gives a specific description of the symptoms of angina pectoris --how long the pain lasts, the tendency of the pain to increase when one is working or running, etc. But in real-life situations, a patient suffering from angina pectoris may show different symptoms. Huang himself had the experience of diagnosing a patient who was experiencing no chest pains, but who kept hiccuping. At first he thought there was something wrong with his stomach, but after he read the man's electrocardiogram, he found that he was actually a victim of myocardial anoxia and infarction, forms of heart disease. The patient was therefore transferred to the intensive care unit, and a cardiac physician was sent for to conduct a heart catheter examination.

"Some symptoms we see in patients may not be as typical as those described in a medical textbook," Huang remarked. "We have to pay close attention to every detail to find out the real problem. This is what I learned from this case."

A chance encounter on the train taught Lo Yen-yu about hyperventilation syndrome. That morning, he had just attended the enrobing ceremony (held for students of the Tzu Chi College of Medicine who are about to start their internship). That afternoon, when he was riding the train back home to Taipei, he met a passenger who was feeling unwell. The passenger was a woman in her thirties. Her hands and feet had begun to turn numb soon after she boarded the train and she was out of breath.

"What's wrong with you? Do you feel any chest pain? Can you hear me?" Lo blurted out the questions in one breath. But after asking her about her medical history and recording the information, he still had no clue what her problem was.

When the train arrived at Lotung, a large town on the east coast, the woman was rushed to a local hospital along with the medical record that Lo had made. Soon afterwards, he received a phone call from the doctor who had treated the woman at the hospital. He told Lo that she was a victim of hyperventilation syndrome, a disease often seen in young women.

Lo checked a medical book and found that the symptoms shown by the woman were identical to those described in the book. Later during his internship, he often came across patients suffering from the same illness. It was not unusual to treat three or four such patients in one day. By then he already knew that hyperventilation syndrome is a condition in which patients voluntarily hyperventilate, causing the carbon dioxide level in their blood to drop. When this illness is diagnosed, all that a doctor needs to do is ask the patient to cover his nose and mouth with a bag and then inhale the carbon dioxide he breathes into it. The symptoms quickly disappear.

"With these real-life examples, basic medicine becomes more than just theory, and we are able to apply what we have learned to examining and treating patients." Chen Mei-ying said that she often sorted through books to check for symptoms she saw in patients. When what she saw in real people tallied with what the books said, she would remember the condition or illness more clearly.

When the beeper sounds

Once medical students start their internship, they are no longer allowed to just stand to one side and watch how other doctors treat patients. Instead, they are asked to deal with some primary medical treatment. The greatest challenge is going on rotation for night duty!

"Beep..." This is the sound that interns are most afraid of hearing when they are on night duty. During the night, any kind of situation might arise which calls for their immediate attention. It is not unusual to be paged every half an hour and stay up all night.

"When working the night shift, we often had to face patients alone. We listened to their complaints and were expected to make decisions right away. The pressure on us was really intense." Chu Sung-chao said that when a nurse tells you that a patient is having a stomachache, she expects you to tell her what to do right away. If you hesitate too long, she might get impatient and go directly to the resident doctor for help. "In the beginning we naturally felt frustrated. But frustration was the driving force which motivated us to learn more quickly."

"My first night on duty was spent in the internal medicine ward. There were loads of patients to be taken care of in that ward--they kept me as busy as a beaver the whole night." Huang Kuan-po said that during that night, one situation after another arose. Often when he was in the midst of examining one patient, his pager would sound again, calling him to attend to another patient.

He would never forget a patient afflicted with chronic lung disease. Wearing an oxygen mask, he had trouble breathing and could not fall asleep. Huang decided to prescribe sleeping pills for him. In order to make sure that he was giving the right pills and the right dosage, he even thumbed through a medical brochure which provided interns with guidelines for treatment.

After taking the pills, the patient soon fell asleep. However, he slept for such a long time that when morning broke, he still did not wake up. Huang examined him repeatedly to see if he was breathing normally. It was not until the patient woke up in the morning that Huang could relax.

"I was so nervous that night that I kept checking my pager," said Huang. "Even when I was lying in bed, my mind was on the pager because I was afraid that it would suddenly beep." Later he counted the times his pager had sounded and found that he had been called more than twenty times that night. He had to take care of all kinds of situations--some were quite ticklish, some less difficult. Every page of his medical brochure had been leafed through, and of course he did not get a single wink of sleep.

"When working night shift, the thing I feared most was administering antihypertension medicine to patients." Liu Chia-hung said that one cannot be too careful when prescribing drugs that control blood pressure. "Every time I wrote out an antihypertension prescription, I'd begin to worry about the patient's reaction." The first time he was on night duty, he had to prescribe medicine for a patient suffering from hypertension. As the medical textbook advised, he checked on the patient every four hours to make sure he was all right. When morning came and he saw that the patient was safe and sound, he felt as if an enormous weight had been lifted off his shoulders.

Talk with the patients

"When making rounds in the wards, an attending physician usually doesn't have much time to spend on each patient," said Yu Ko-jen. "At times like this, an intern can fill in for the doctors. Patients tend to be fearful when they know nothing about their own illness. If you can explain their condition to them, they will be more at ease."

Chen Mei-ying said that some time ago her grandfather underwent an operation for a hernia. For fear that he might be infected with meningitis, the doctor performed a spinal puncture on him. After the operation, his spinal fluid kept leaking out from the incision, which had not yet healed. Chen's aunt, who was a nurse, knew that this was normal, but she was still very worried. Another nurse even had to comfort her to make her less anxious.

After witnessing the response of her own family during her grandfather's illness, Chen told herself that when taking care of patients, she had to pay more attention to their feelings. When necessary, she should talk to them and console them as best as she could.

Tu Chuan-en remembered clearly what a professor once said: the most important thing medical doctors should do is to cure diseases; if they can't, they should try to alleviate the pain of the patients; if they can't, they should endeavor to ease the patients' minds.

If they should encounter patients or their families who refuse to be comforted or listen to their explanations, they should still try to be understanding and tolerant.

"I once had the chance to examine a patient who had a fever," remembered Liu Chia-hung. "After I had his blood, urine and sputum tested, his family complained that I had only placed an ice bag under his head and asked why I didn't do something else to bring down the fever." Liu believed he had done all that a doctor could do. "The reasons for a patient's illness can be complicated. We can't give any medicine until the cause of the illness has been ascertained. It takes time to run tests and get the results. But how can the family understand?"

"If I were the patient's family, I would be as worried as them," Liu said thoughtfully. He knew that it was normal for patients' families to react that way, so he told himself to be more patient. No matter how difficult a situation might be, he must maintain a sincere attitude.

In the hospital wards, apart from nurses, interns are the ones who interact most closely with patients. If they can provide loving care, patients often respond warmly. To be able to win the trust of a patient is the greatest sense of achievement for a doctor.

Chang Yu-Hsun remembered that when he first began his internship at the Hualien Tzu Chi Hospital, he was responsible for taking care of an old man who was in the terminal stage of lung cancer. Even though the cancer cells had metastasized to his bones and caused them to fracture, the old man still looked very cheerful.





"LEARNING TO PAY ATTENTION TO A PATIENT'S FEELINGS
--THAT WAS REALLY AN IMPORTANT STEP FOR ME."

"I visited him every day and talked with him. We talked not only about his illness, but also about his family and job. We had a very happy time together." Later as the old man was leaving the hospital, he even invited Chang to visit him at his home.

One day Chang happened to pass through Kuanfu Village in Hualien, so he dropped in on the old man. "I didn't expect that he'd tell his family to prepare such a big meal for me. And he kept telling them how lovingly I had cared for him." Chang said that the greatest joy of being a doctor was revealed at that very moment. He felt that he was only doing what a doctor should do, but just see how amply he was rewarded!

Going through the Tiger Gate

Some people feel that doctors tend to be more rational and are very good at hiding their feelings. What did these young interns think about this? "With so many patients to take care of, if we don't learn to be more rational, how can we bear all that we have to go through?" they said.

Lo Yen-yu recollected that in the early days of his internship, he had the chance to take care of a mouth cancer patient who had two daughters taking turns to care for him. One of them had especially returned from the United States to look after him.

Because Lo once studied abroad when he was younger, he and the daughter who had returned from the United States had a lot to talk about. Through her, he came to know a lot about the patient.

"I wondered if I was intervening too much in the family's business. I paid them so much attention. Was it fair to the other patients? It's very likely that I'll find myself in the same situation again sometime. Should I follow my feelings or should I restrain them?" Lo admitted that he still had not found the answer to his question.

Wang Po-han also shared his experiences of treating cancer patients. He said that when he first started his internship at the Tzu Chi Hospital, he met two cancer patients in a row. They often cried when talking to him. Unconsciously he shared a lot of negative emotions when taking care of them.

One of the patients was in the final stage of liver cancer. On one occasion, he wiped away his tears and said to Wang, "The Harvest Festival is coming. Would you like to come to my hometown and have some fun?" Although Wang knew that the patient would probably not be able to make it, he still answered, "Yes, I'd love to." He felt phony deep down in his heart.

"I used to be very enthusiastic about helping my patients," said Wang. "I once knew a patient who couldn't afford his medical expenses. In addition to seeking help from social workers, I also found other resources for him. But after some time, I found that I didn't have as much time and energy to give help."

Yu Hsing-tse once met a blood cancer patient who had a strong will to live on, but in the end was still unable to escape death's clutches. One day after the patient had received chemotherapy, his white blood cell count dropped drastically and he became highly feverish. His attending physician tried all kinds of methods to save him, but all were in vain.

"I used to keep him company every day. On the day he died I no longer had to walk into his ward. I felt kind of lost." Yu told himself that he had to stop himself from being so sentimental--as a doctor he could not afford the luxury of wallowing in an emotional mire.

Huang Kuan-po once tried to save the life of a middle-aged woman by performing CPR on her, but to no avail. Because it was his first encounter with death, the event cast a dark shadow over his mind. He suddenly had a new feeling toward the impermanence of life!

When he was still feeling downhearted, he looked up and saw that the attending physician, after explaining to the woman's family about her death, had already gone on to examine the next patient. "How can he be so cool-headed? Will I be able to do that too?" Originally Huang questioned his own ability to remain cool and composed, but after he had seen more deaths he found himself better able to control his emotions: "There's always the next patient waiting for you to take care of. You simply have no time to indulge yourself in emotions."

"Doctors are often mistaken for being cold-blooded. Actually, they don't want to appear that way either." Huang said that doctors are people who have feelings and emotions. They can just control their own feelings better.

As Juan Shao-chiu said, being a doctor is perhaps no different from being an actor. Putting on the white robe is like passing through the Tiger Gate between the front and back stages in Cantonese opera. Once in a white robe, doctors have to set aside all their emotions and start to play the role of a good physician.

The best commitment

Having received their medical education at the Tzu Chi College of Medicine, this year's graduates all admitted that the culture and spirit of Tzu Chi had exerted a positive influence on them.

"Aphorisms selected from Master Cheng Yen's Still Thoughts could be seen everywhere from the first floor up to the fifth floor of the school buildings," Chu Sung-chao remarked. "It was hard not to be influenced by them."

Chen Ching-liang remembered that he used to dislike the rules and regulations laid down by the school, which in his opinion were far too numerous. He also disliked wearing uniforms at school. Whenever he heard Tzu Chi people express their gratitude, he would think, "What's to be grateful for?"

It was not until he had become an intern at the Tzu Chi Hospital that he began to reflect: "Why should Tzu Chi volunteers be so nice to me? If patients feel better when I bend down or stoop to listen to them, why shouldn't I do so?"

One thought led to another: "This is what it means to humble oneself!" The more he thought about it, the more he felt that he had not done enough.

He thought of Chen Ching-hsiang, a staff member of the Tzu Chi Hospital who died of biliary tract cancer a short while ago. "He always said little but did a lot. When he died, he even donated his body for medical research. In my opinion, he fully embodied the spirit of Great Love."

"Be a good doctor!" "I will," he promised Chen before he died. He knew that it would not be easy to live up to the promise, but he would do the best he could. At least he would try his best to care for his patients compassionately and lovingly.

Juan Shao-chiu said that during his seven years at the Tzu Chi College of Medicine, the thing which impressed him most was the anatomy course. It taught him what "respect for life" should really mean. "At Tzu Chi, we were taught to respect our 'silent teachers,' the bodies donated for the anatomy classes. After dissecting a body, we had to stitch everything back with care. Tzu Chi not only provides special lazurite urns to hold the ashes of the body donors, but also organizes funeral services to honor them. All these actions have had a great impact on medical education in Taiwan."

Yu Ko-jen and Chen Ying-mei, who belonged to the same Yi Te "family," said that their Tzu Cheng "father" and Yi Te "mothers" (Tzu Chi members selected by Master Cheng Yen to take care of students studying in the Tzu Chi schools) had opened a door for them and enabled them to see a different world. "If our Tzu Cheng father and Yi Te mothers hadn't taken us to visit the Losheng Sanatorium [a refuge for lepers] and schools for the mentally challenged, we'd never have known that there were such people in our society."

Yu Ko-jen said that among the Yi Te fathers and mothers who took care of them--every group of ten to twelve students has one Tzu Cheng father and two Yi Te mothers--at least one must have a medical background. This is a very thoughtful arrangement, and they greatly benefited from it.

"I remember that when my internship just began, I was really nervous. Knowing how I felt, my Tzu Cheng father, Lin Jung-tzung, who is also a doctor, told me that I could call him whenever I had a problem." Yu said that the enthusiasm and devotion of their "fathers" and "mothers," who cared for them as though they were their own children, would melt even hearts of steel.

"To be honest, as the first batch of students who entered the Tzu Chi College of Medicine, we were treated too nicely. All the people around us--be it teachers at the college or medical workers at the Tzu Chi Hospital--took good care of us and taught us as much as they could." Chen Chien-han, who got the best grades every semester and graduated at the top of his class, said that he had been hired for the pediatrics department at National Taiwan University Hospital. Although he felt sad at the prospect of leaving Hualien and Tzu Chi, he knew that no matter where he went he would always be a child of Tzu Chi. Tzu Chi is his home, the cradle that nurtured him. He will fulfill his role as a doctor with the abiding Tzu Chi spirit of kindness, compassion, joy and unselfish giving.