Since the establishment of the Community Care Team for Terminally Ill Patients, Ah-mei was the first patient to pass away at home. With the support of her family and her religious beliefs, plus the continuous care of the team members, she bade farewell to the stage of life with ease and dignity.

Medical Care in a Warm Home

When Ah-mei went to Tzu Chi Hospital, she was in the last stage of stomach cancer for which her whole stomach had already been completely removed. She had edema, felt nauseous and couldn't eat anything. The doctor immediately gave her an IV infusion to maintain her nutrition.

"Actually, for terminally ill patients who don't need active treatment, home is the most comfortable place," said Dr. Hsu Li-an. "They can play their usual roles at home. Their family members can take good care of them and they can enjoy the family atmosphere." After two months, Ah-mei left the hospital. Her case was referred to the Public Health Office of Tzu Chi Hospital, and the Community Care Team for Terminally Ill Patients joined together to take care of her at her own home.

The procedure was as follows. When the care team first received Ah-mei's case, the entire team paid her a visit. After that, the team members were divided into two groups. One group consisted of Dr. Hsu Li-an and Miss Chang Jui-chin, a nurse from the Public Health Office. They made regular visits to the patient every Tuesday to give her necessary treatments. The other group consisted of social workers plus some volunteers. Each group had no more than five people in order to avoid disturbing Ah-mei's family. The team met every Friday morning to discuss the case. All members were required to attend.

The main symptom of a cancer patient is pain. More than eighty percent of cancer patients have to face this problem. Pain does not happen in only one place. Dr. Hsu pointed out that Ah-mei felt pain all over her body. She had to keep in one position because she couldn't endure the torture of even the slightest movement. "To use plain words," said Dr. Hsu, "she would rather die than endure such agony. If the doctor doesn't take action immediately, the patient will have no quality of life at all." Moreover, other minor symptoms are disguised by the pain and cannot be dealt with. At this time, the doctor can only rely on heavy anesthesia.

Dr. Lin Pi-sheng, the anesthetist in the care team, first assessed the pain, and then suggested proper methods and treatments to stop it. He installed pain control equipment and continually gave medicine to alleviate Ah-mei's suffering. Dr. Lin did follow-up observations to see if there were any side effects. After installation of the pain controller, a smile finally appeared on Ah-mei's face. Her condition had obviously improved. After that, Dr. Hsu treated her for other symptoms, such as loss of appetite, constipation, etc., so that she wouldn't become thinner and weaker.

"The ideal is to prevent any symptoms," Dr. Hsu said. "For instance, if we could prevent pain, we would reduce the patient's subsequent fear of pain."

Miss Chang Jui-chin, the head nurse of the public health office, phoned Ah-mei's family every day. At least twice a week, she went to their home to give Ah-mei an IV infusion, change dressings and change the nasogastric tube. She also taught the family how to look after her. Ah- mei's sister-in-law was the one who looked after her at home. She actively learned how to take care of Ah-mei and how to operate the equipment.

Other important work for the team members included making psychological evaluations of Ah-mei, finding social resources for her, helping her fulfill her final wishes, assisting her to face death, and also helping the family through their grief. The volunteers gave her emotional support, such as listening to her and accepting her. They also helped other team members take care of her. Miss Liu Hsiung-nan, one of the team members, found out that the support from the patient's family was very good, and that with her firm religious belief the patient was not afraid of death. The team also paid attention to the family's financial situation and the realization of Ah-mei's last wishes.

Ah-mei's wish was to have a look at her new-born grandson. She also wanted to go once more to her favorite mountain. The team members contacted her oldest son and told him his mother's wish. They suggested that her family could take her to the mountain on a wheelchair when her situation was stabilized.

"The round-the-clock vigilance of the doctors and nurses was a great support to the patient's family," said Dr. Hsu. "It gave them confidence in looking after the patient." From the regular visits of the care team, Ah-mei's family knew that they could find help immediately if anything should happen.

God Gave Her Strength, the Family Gave Her Love

The widowed Ah-mei and her children had lived in her brother's home for four years. When told she was in the terminal stage of stomach cancer, Ah-mei was somewhat depressed. She regretted that her long-time drinking habit had damaged her health and also made her abandon God. She had not been to church in a long time. Now it was too late to change.

Ah-mei was on good terms with her brother and sister-in-law. After she became ill, Lai-yin, her sister-in-law, looked after her. "I didn't know how to look after her," said Lai-yin. "I only did what she wanted me to do." Ah-mei's father had also suffered from stomach cancer before. He had been in and out of Tzu Chi Hospital for a long period of time. Therefore, Lai-yin had some experience in looking after cancer patients. Actually, looking after a patient according to his or her needs was the best way to take care of him.

Ah-mei asked Lai-yin to take care of her two young children. That was perhaps the biggest request Ah-mei made before her death. She trusted that her sister-in-law would definitely do it, so she never mentioned it again. Her oldest children had already grown up. Ah-mei thought they could look after themselves, so she did not ask her sister-in-law to take care of them.

Whether it was the one who needed care or the ones who gave it, they all had their weak sides. Ah-mei and her brother's family were all pious Christians. They needed their God to give them strength. After Ah-mei repented and returned to God's embrace, Lai-yin comforted her by saying that as long as she could really repent, God would accept her. Therefore, Ah-mei later asked her Christian friends to pray for her. Lai-yin, who had been raised in a Christian family, put into her prayers all her burdens, such as the psychological pressures of taking care of Ah-mei, the expenses of the medical treatments, etc. By praying, she hoped that the Lord's strength would support her weakness.

Accompanying Them Through the Difficult Time

Lai-yin recalled the time when her sister-in-law passed away. "I got up in the middle of the night to change Ah-mei's diaper. I found her very weak. I told her to cheer up. I ran and woke up my husband to help. At that time, her breathing was different. It seemed like her breathing was going to stop. She passed away at about 3:00 a.m."

Lai-yin woke up Ah-mei's children and told them their mother had already gone. They all sat around her. Dr. Hsu, Jui-chin and Su-hua, a volunteer, had planned to see the patient that day, but in the morning they received a phone call from her family, telling them that she had already passed away in the early morning.

The three team members went to Ah-mei's home. "Ah-mei, now you are free from pain," Su-hua said. "Your children will grow up under the care of their uncle, aunt and older brothers. They will receive a good education and grow up to be good people. You can be at peace now and let God lead you to the place where you always longed to go, a place where there is only peace and no pain." Jui-chin covered Ah-mei's still open eyes with a warm towel, and Dr. Hsu gently fixed it with some tape. After that, Jui-chin and Su-hua cleaned her body and dressed her while Dr. Hsu made out a death certificate.

"We are really grateful to you for being with us during this period of time. Otherwise, we wouldn't know what to do." Lai-yin, who was not very good at talking, repeatedly expressed her gratitude. After the funeral, she and her husband went to Tzu Chi Hospital with a basket of fruit and a red envelope with some cash inside to show their appreciation to the care team. The Tzu Chi volunteers refused to accept the red envelope, but donated the money to Tzu Chi charity funds. Furthermore, the family brought the unused IV equipment, needles, injectors, etc. They could have gotten a refund for all these, but they insisted on donating them for other patients in the hospital who might need those things .

The care team continued to give grief counseling to the bereaved family, and they were concerned for the problems of raising Ah-mei's children. Social worker Liu Hsiung-nan made an evaluation of the financial situation of Ah-mei's brother. He had three children of his own, all in school. Along with his sister's two young children, he and his wife had to support five children. Being aborigines (who have great difficulty in getting employment in Taiwan), neither of them had regular jobs. Apparently, they wouldn't be able to go on very long. Therefore, the care team continued to be concerned for their financial situation and, when needed, the team took the family to the Tzu Chi Foundation or other social resources to look for help.

Epilogue