Dr. Lai Chi-wan, dean of the Tzu Chi College of Medicine and vice president of Tzu Chi University, illustrates in this article how important it is to maintain a friendly and respectful relationship between patient and doctor.

In September 2000, I returned to Kansas City for my son's wedding. While sorting through some old letters in my study, I picked up a letter written to me five years ago by a patient with epilepsy. He complained of how he had been mistreated because of his illness.

For fifteen years, he had been working as a janitor in an elementary school. During that long period of time, he had only three seizures while at work. Other seizures occurred while he was sleeping at home or when he woke up at the crack of dawn. But a new principal transferred him to a cleaning unit on the grounds of safety.

Although many physicians claim they have a fair understanding of epilepsy, this young man believed that doctors never sense the frustration that patients with epilepsy feel due to unfair treatment and discrimination against them. He wrote me a letter in which he said, "I do not ask to be treated in a special way because of my problems... I do my job to the best of my ability, so please let me advance in my work like everyone else."

I remember a long talk I had with him after I received that letter. "You know, when other people have a car accident, the policeman or the insurance agent doesn't ask any questions about their personal health," he said to me cynically. "But when it happens to an epileptic, the first question they ask is whether the accident was due to his epilepsy, and the doctor asks if he forgot to take his medicine. It's incredibly unfair!"

As I recalled this conversation of so many years ago, I suddenly had an irrepressible desire to talk to him. I wanted to find out how he had been recently. I picked up the phone and called the information operator, trying to find his telephone number at his old address on the envelope. Unfortunately, he had moved. But he had an unusual German surname, which I had never heard before or since during my twenty-some years in the United States. So I called the operator again and explained to her the reason I wanted to speak to this gentleman.

The operator, apparently moved at hearing that a physician wanted to find out how his old patient was after having left the United States for two years, very kindly told me that she would try the areas around Kansas City one by one. Surprisingly, in less than five minutes she phoned me back, happily telling me she had found one family with this unique surname. She said that since this last name was rare, even if this was not the family I was looking for, they might be related and I might still find my patient by tracing through this family. She wished me good luck in finding him, and said that she envied him for having a caring doctor like me.

Fortunately, when I dialed the number, it was exactly the patient I was looking for who answered the phone. He amazed me by asking if I was Dr. Lai before I had the chance to tell him who I was. He had moved in with his parents.

I had last seen him two and a half years ago at a summer camp, during which my patients had held a farewell party for me before I returned to Taiwan. And now two years later, he was still able to identify my voice. This touched me deeply. He immediately called out to his parents that Dr. Lai was calling from Taiwan. Soon his parents were talking to me through other extensions. I said that I guessed my Taiwanese accent hadn't changed, so they were able to tell who I was immediately! I explained to them that I was not calling from Taiwan. I had returned to Kansas City and would spend several days there. They talked to me for quite a while and asked my opinions about some new advances in epilepsy treatment.

Suddenly, my patient said, "Dr. Lai, we miss your doughnuts!" This reminded me of a special anecdote about doctor-patient relationships. Several years ago, this young man's epilepsy could not be completely controlled. He would have three or four seizures a month. I advised him to consider an operation. The first step was for him to be hospitalized for video electroencephalography (EEG) to record his brain waves during epileptic attacks so that we might spot the exact location where his abnormal brain waves were coming from. After this, we could decide if an operation would be feasible or helpful. But three days after he was hospitalized, we still had not recorded any seizures. So I reduced his drug dosage in order to induce one. Unfortunately, after we recorded three major attacks and resumed the original dose, his condition could not be put back under control. Eventually he fell into status epilepticus, a condition of continuous seizures with total unconsciousness, and he was sent to the intensive care unit.

His family could not accept the fact that this lively young man, after hospitalization, had become comatose and had to use a respirator. We used several first-line anti-epileptic injections to control his condition, but to no avail. Finally I decided to use propofol, a new kind of anesthetic which I had learned about during my sabbatical leave at the Institute of Neurology at Queen Square, London.

When I made the proposal to his parents, his mother was adamantly against it. She complained that they had sent their son to our hospital in order to record his brain waves, and they had never expected that he would end up in this tragic situation. She told me not to propose any new therapy whatsoever, because she would not accept it. But his father was more reasonable. He said he knew I was trying to help their son and he did not blame me, no matter how it turned out. He said that since I had tried my best but still could not bring his son back to consciousness, he would trust me with the treatment I proposed. He believed that I would make the decision most beneficial for his son. He then asked me to give him and his wife some time to discuss it between themselves. About ten minutes later, they came back to me with the decision to try the new method as a last resort.

Fortunately, the epilepsy was brought under control. Two days later we gradually reduced the anesthesia and the patient regained consciousness. I remember the first sentence he uttered after waking from a week's coma: "I miss doughnuts." I was excited to see that he had woken up. I told him that he would be allowed to eat the following day, and I would ask the kitchen to provide doughnuts for his breakfast. The next morning on my way to work, I drove by a bakery noted for its good doughnuts. On a whim, I pulled over and bought some. I will never forget the grateful looks that he and his parents gave me when they received them.

I had felt uneasy the whole week the patient was in that coma. I could not bear to see that his mother, a kind old lady, had suddenly grown so hostile towards me. But I knew that if this young man were my own son, I would probably have reacted in the same way. He had almost become a vegetable because one of his silly doctors wanted to suppress his illness by purposely inducing seizures. It was certainly hard to accept such a situation.

This is a common dilemma we epilepsy specialists often face: if we cannot record the seizures, our preoperative localization of the lesion cannot be accurate and the evaluation of an operation and its outcome will not be effective. Sometimes the only way to record the seizures is to reduce the dosage or discontinue the treatment. Nonetheless, discontinuing or reducing the dosage too quickly can cause too many seizures, which are dangerous for the patient. Although I did not consider myself wrong from a medical doctor's perspective, I could not help worrying about the possibility of getting myself into big trouble. After all, it was and still is common in the United States for doctors to become involved in malpractice litigation. I believed that many of my colleagues were also holding their breath for me.

I will always remember the day the patient was discharged from the hospital. His mother gave me a big hug and tearfully asked me to forgive her rudeness to me while her son was in a coma. She also said that she would never forget the delicious doughnuts I had bought for her son. After that, I continued to treat him for several years, until I left for Taiwan, despite the fact that he ultimately did not receive an operation because the brain wave recordings showed that he was not a good candidate for one. Neither could I find an effective medicine that would completely control his epilepsy.

After I moved back to Taiwan, I received a card from his mother. Out of all she wrote, there was one sentence which truly touched my heart: "Thank you for always being there when we needed you..." This gave me great encouragement, and also demonstrated to me the delicate relationship between a doctor and a patient and his family. I miss this patient and his family, and I am grateful to them for reminding me to pay attention to how the patient and his family feel. I have to admit that it was something I had often ignored in the past. They enlightened me in my medical career to be more sensitive to the psychological and emotional needs of patients and their families. They enabled me to call my students' attention to the importance of mutual respect between patients and doctors.

Today I share this story with you because I believe that if doctors and patients in our society treat each other amicably and with gratitude, medical teams will draw from the caring atmosphere and thus attract more loving, talented people to join them. Only in this way can medical development in Taiwan and abroad have a brighter future.