She doesn't know where she will be or what she will be doing for any given day beyond the present moment. In spite of this, she continues to thrive on a busy life, her days spontaneously scheduled with events including activities and visits with patients all over Taiwan. Sister Chang Mei-li, or "Pretty" Chang, is a palliative care volunteer worker whose life is filled with the unexpected and unplanned, often depending on the needs and changing conditions of her patients. Since she has been working this way for over ten years, she no longer keeps track of time. Over the years, her work with her patients has taught her much. Mei-li has seen many things and dealt with many inescapable life issues that people continue to grapple with--one being death. Here, insights can be gleaned from her words and experiences.

With her arms crossed over her pink vest, Chang Mei-li stood outside the operating room, waiting in anticipation with the patient's family. A patient was undergoing surgery for a second time to remove the remains of a benign tumor found near her chest. When the patient finally walked out looking normal and unfazed, they all smiled and embraced her.

That morning, Mei-li accompanied patients' families and visited patients at the Shin Kong Hospital in Taipei. As she made her way about the hospital, she was paged by the constant ringing of her cell phone--tients, friends, and affiliates kept calling and bidding for her time. Before lunch, she would be leaving to visit elsewhere in Taipei. And later in the afternoon, she would be heading off again to visit patients at another hospital in Kaohsiung, on the southern end of the island. Within three hours, what had started out as a relatively unscheduled day for Mei-li at Shin Kong Hospital was immediately filled with many responsibilities to address.

Spontaneity marks her life. Mei-li lives in the moment, concentrating on the present to take care of tasks that came up one after another. Even though she goes around to several places in one day, she is focused in the present and thoroughly immersed in her duties. "If you follow me as I run around, you will get tired," Mei-li chuckled. But she has grown accustomed to it, having been a palliative care volunteer worker since the 1980s. Palliative care entails visiting and soothing patients, most of whom are terminally ill, to alleviate some of their suffering during the passing remainder of their lives.

Upon entering a room on the eighth floor, Mei-li was cordially welcomed by a patient and other hospital workers, who were delighted to see her. The patient looked up from her bed, smiling brightly as Mei-li seated herself. Mei-li has apparently developed the ability to bring warmth and familiarity to her patients when they see her, as if seeing an old friend again. Indeed, she regards and talks to her patients as if they are good friends or dear family members. She is informal and personable in conversation, laughing easily and regarding matters in a relaxed way. As the patient chatted with her, Mei-li remained lively and approachable. She showed enthusiasm when speaking, sprinkling the conversation with touches of humor here and there.

"I just came back from Vancouver, and I was there for eight days..." Mei-li is able to share her life as well, not being limited to just listening to patients talk about their own lives. In this way, patients show interest in knowing her--how she is doing and what is going on in her life. Perhaps this ability gives her a down-to-earth quality that attracts people's attention when she talks.

"Have you been eating well lately? Vitamin C? Make sure to get enough vitamin C and water." Mei-li showed her concern for the patient, even through such "little" gestures. Caring for patients is not a matter of showing sympathy, of expressing excessive sentimentality or feeling. Mei-li understands this and is thus capable of showing genuine concern without the need to please her patients. For the most part, she is able to understand what her patients are going through as well, as we saw when the patient remarked that her neck felt hot. A hospital staff worker thought that perhaps the air conditioning was not cool enough for the patient. As the worker proceeded to adjust the temperature, Mei-li explained, "No, it's because she's been constantly lying in the same position on that pillow. Her neck feels hot, but the rest of her body is cool. If you lower the temperature, I'll have to get a coat for her." The patient confirmed everything she said.

"Who comes to look after you at night?" asked Mei-li.

"My daughter, a pity for her," the patient replied.

"No, let me tell you. You don't need to say that it's a pity. She should actually be thanking you. Right now, your situation is like that of a bodhisattva's. She can become a bodhisattva because you're giving her the chance to help you."

A ray of insight shone through as Mei-li's comment captured the innate wisdom she had honed from her experiences. Like a flip of a coin, she had transformed a negative perception commonly held by patients (and workers) into a positive one, enlightening their spirits with an uplifting outlook. From years of experience, Mei-li understands very well that not all interactions with patients present themselves as opportunities for volunteers to become bodhisattvas (those who unselfishly and selflessly give to others while aiding them and alleviating suffering.) "Sometimes even if you want to help, you may be unable to because the patient doesn't know you well enough or doesn't want to talk to you." Those situations present challenges to anyone, even to someone like Mei-li, who thinks of ways to overcome them by accommodating herself and becoming familiar to the patient. On the other hand, Mei-li also explained, "Even if you have the heart to help in volunteer work, what matters the most is that you are sensitive enough to know how to help patients appropriately. If not, your assistance may become a harmful endeavor because you may end up hurting the patients instead."

"I've learned the most in life through my volunteer work, which always gives me opportunities to be thankful. What is there to be thankful for? There are so many different hospitals, different patients, and different methods utilized in helping patients, all teaching us so we can learn from them. All of these give us opportunities to be thankful."

When asked whether her views on life or death had changed within the past few years (from the last time she was interviewed by the Tzu Chi Quarterly in the winter of 1996), she responded with a generalized answer but gave an interesting analogy. "Of course it has changed, just as life continues to change, like an elementary school student who starts by learning the alphabet and then continues to learn whole words. Everybody is learning, carrying a backpack that is essentially empty--ybe filled with books they cannot comprehend--t eventually and completely filled with love." Patients serve as teachers, and Mei-li has worked with a multitude of them. Many of her patients have cancer or other terminal illnesses, and many have passed away over the years. From having seen the suffering and pain endured by her patients, she has learned much about the meaning of life, all the more learning to appreciate and be thankful for her own life. As Mei-li succinctly put it in a poignant Chinese phrase: "From other people's suffering, one's own fortunes can be seen."

This teaching was made clearly apparent when Mei-li ascended to the tenth floor to visit her third patient, a man inflicted with oral cancer. The patient's gaunt face was wrapped with bandaging around his lower lip and chin and a little of the neck. A small, strange-looking appendage of rotted skin protruded just at the edge of the bandage. The patient and his wife happily greeted Mei-li when they saw her enter. The patient couldn't smile very well, but he conveyed his delight towards her through his beaming eyes. His words came out in a murmur as he deliberately tried to speak. His wife later talked about the difficulties he was having in consuming food. It had gotten to the point where he could only swallow processed liquids, sometimes through a tube inserted in his mouth.

Reflections from the past

Mei-li has come a long way. Her life's journey has taken her through various life conditions and experiences, through many spiritual realms ranging from heaven to hell on earth. Her early life starkly contrasts with her present existence. In her early adulthood, Mei-li opened a bar and worked as a bargirl in order to pay off debts. It was very easy to earn money. But with money easily earned, she also easily, casually spent it. As she recalls, "I spent it every day on three things: food, drinks, and clothes." She was also a heavy smoker and drinker. She said, "I would get drunk twice a week, three times a day. It was just excessively ridiculous."

Her life changed when she met a Tzu Chi member at a beauty parlor who told her about the organization. Through an unexpected turn of events that led her to visit the Abode of Still Thoughts and to chance upon Master Chen Yen's visage--riving by car, the Master happened to gaze out the window at her--i-li was intensely shaken but deeply moved. Something was triggered inside of her, and she found herself being gradually drawn and slowly immersed in Tzu Chi. On one occasion, she decided to tag along with Tzu Chi members to visit a needy family. What she saw there shocked her and drastically altered her attitude from careless indifference to shame and repentance. It was the first time she had ever felt such deep remorse. From then on, she sincerely began to transform herself. It took nearly a year of struggle and torment for her to change her old life habits, especially to abstain from alcohol. Mei-li underwent severe withdrawal symptoms: her hands would shake and tremble so much that she had to hold a cup of tea with both hands; a spoonful of rice would look like a spoonful of worms; and floral-designed wallpaper would look like monstrous creatures.

Despite her hardships, Mei-li persevered in her determination to become a better person. She constantly reminded herself of the wholesome beauty and goodness she saw in Tzu Chi. It was an entirely different world for her, one that was untainted and pure. Mei-li knew that becoming a part of it would mean her conduct would be noticed-- a representative, she didn't want her personal downfalls to stain or injure the integrity of Tzu Chi.

When she started volunteering at hospitals, she encountered difficulties as well. For one, Mei-li was afraid of the filth and disease she saw in the patients. She felt uncertainty and discomfort on the first day she worked in the hospital. But after reflecting on the day's events, she told herself, "I've already come this far and what have I learned? Fear. Learning fear would just be a waste. So why not get over it?" With that, she affirmed herself and stepped over that barrier.

Focusing on the present

Nothing comes that easily, as seen through Mei-li's difficult encounters when she first began working with patients. Nowadays, overcoming challenges takes a little less effort since she has accumulated years of experience. Breaking through problems is a little bit easier for her. "In the past, I probably would have been stubborn and blamed myself for being so stupid, incompetent, and so on. Or I would have wondered about others and put the blame on them, complaining that they were being uncooperative." It's different for her now. Instead, she might attribute her difficulties to communication problems or a lack of familiarity with the patients. It takes time. She explains that one needs to develop patience and tolerance.

The most challenging part in working with patients involves self-initiative. Mei-li described how taking the first step in communicating with patients was usually the most difficult, but it also depended on the individual. "Let's say that you decide to visit a patient and you don't know her very well. But you go see her anyway and you stand there--e patient doesn't know what to say and you don't know what to say. How embarrassing it is! But of course when you first come in contact with patients, you have to start from the unfamiliar. So you have to think of a way to get beyond that. This first step is the most important."

The ability to become acquainted with patients easily is a skill Mei-li developed through practice and persistence. Although she doesn't describe how she tries to get to know patients, her abilities have evidently improved over the years. Mei-li recalled, "There was one time when a friend went with me to visit a patient. After we came out, she asked me, 'So how long have you known that patient?' I said, 'No, I didn't know him. We just met today.' And she said, 'Oh! I thought you had already known him for a long time.' So you see, this has to do with a person's past experiences in life."

Everyone has their own shortcomings, some to a greater extent than others. Mei-li pointed out a specific fear that many people have, a common obstacle present in social interactions and experienced even more by those doing palliative care. Marked by wisdom and profound understanding, she offered several insights on dealing with this fear in handling patients. "What people fear the most is rejection, because if you fear rejection, you'll fear moving forward." According to Mei-li, being rejected is normal because patients have their moments when they want to be alone. Some may even have cynical attitudes about being helped and thus appear rude or unfriendly. "But no matter what, we must be extremely sensitive in paying attention to a patient's actions, words, or gestures--is offers us an opportunity to 'enter.'" When rejected by a patient, volunteers have to remind themselves that they, like the patients, have tempers as well. Volunteers have to be even more tolerant. As Mei-li says, the more negative a patient is, the more it means the patient needs help. "Through this process, one can learn from the patient, for a 'teacher' has finally appeared."

Because patients' moods vary, just as their physical conditions change, patients' reactions to volunteer workers will fluctuate, sometimes even within brief periods of time. Mei-li gave an example, saying that one minute a patient could be talking just fine, but in the next minute he could suddenly change and respond differently to another person. "When this happens, you have to accommodate yourself to the patient, not the patient to you. He's the patient and he's sick. You shouldn't ask the patient, 'How can you be like this?' or wonder, 'He was fine just then, but what's wrong with him now?'" As she points out, volunteers should be doing the adjusting, not the patient. Since volunteers also go through fluctuations, how can they reject patients when they do too?

According to Mei-li, people need to have the capacity and endurance to see all different points of view when others give opinions concerning them or their work. Stubbornness will lead to problems. "If you constantly think, 'But my way is right' and so on, then you'll have several blind spots." Mei-li explains that these blind spots--rsonal faults and errors--ed to be broken by others. When they're broken though, it really hurts. "It's just like wearing a fake mask. When people point out blind spots, this mask is ripped off, resulting in pain. The amount of pain experienced depends on how tightly the mask has been worn." Mei-li has discovered that wearing a mask is of no use when working with patients. There is no need to wear a mask because one just has to be genuine. "The real self is the best self," she observed. External appearances are superficial and unnecessary. People often try to maintain facades or masks to cover up personal flaws and protect themselves from getting hurt. Ironically, their attempts end up getting them hurt even further

"There's nothing glorious about doing volunteer work." From Mei-li's perspective, volunteer work is simply about others giving people the chance to learn, to learn things that one has never seen in books. The things people read and learn from books often transpire much differently from real life experiences. Academic learning (the kind learned from books) usually just grazes the surface level of existence and affects people only temporarily. So experiences and feelings attained from books are only short-lasting and easily forgotten. "But when you devote yourself to doing something in real life, that experience will leave a mark upon your heart, carving a deep and lasting impression that will probably never be forgotten." Mei-li continued to elucidate the fleeting nature of experience from books and mentioned that speeches had the same quality as well. She felt that the transience of these experiences was comparable to the short-lasting nature of mundane activities such as eating, drinking, and socializing.

Speculating about the future

"I'm afraid of death. Who's not afraid? There isn't anyone who's not afraid. Death comes to everyone, so who wouldn't fear it?"

Death is unavoidable, and no one is exempt from it. Even Mei-li, who has witnessed the deaths of many of her patients, is afraid. But she points out that fear is natural. The fear of dying is innate in everyone. What matters is how people approach death in the way they live. She explained, "You often hear about learning from life's experiences. Life is here now. Death hasn't come yet. Your life at this very moment is the most important--w to live your present life well, how to make the best use of it... You can learn things from a teacher and recite lessons word for word, which is useless. You might as well be a tape recorder. What is important is having direct experience. Not until you directly experience something by taking action and going through with it can you own it and call it your own experience."

"I'm not afraid to go to hell in my next life. If I go there, I'll continue to help all the suffering creatures there." Mei-li further explained, "What I mean is that people don't necessarily have to go to heaven. There's already a heaven and hell on earth. It depends on what you do. If you don't go to heaven and end up in hell instead, that's alright, as long as you help living beings cross over to the other shore of enlightenment." According to Mei-li, going to hell is not necessarily suffering. Going there is to help suffering creatures. So everyone's mission is different. Going to heaven or hell isn't a choice given to people. She emphasizes that no matter where one goes in this life's mission, one needs to have a lot of endurance.

Mei-li has emerged as a brave woman, instilled with strength and clarity about her life's mission. One wonders if it would have been possible for her to arrive at her present state if she hadn't undergone the previous experiences in her early life. But she has no way of knowing. It is hard to say. Speculating on this, Mei-li said that maybe she would have been a placid child, a very simple girl. Maybe she would have gotten married, had children, and stayed home to take care of them. It's also possible that she might not have gotten involved with volunteer work. She believes that people's lives are based on cause and effect, a process that is constantly in motion. [The Buddhist law of cause and effect explains that all of life's occurrences are the effects of causes planted in previous lives. What one sows in the present will produce an effect in the future.]

After many years, Mei-li's role as a palliative care worker has shaped her into what she is today. No matter where she goes, she devotes her life to helping others. "Live in the moment" will continue to be her motto. Mei-li best summed up her life's volunteering experiences when she said, "Volunteer work becomes a duty. It's not that you help patients. Rather, they give you the chance to learn."