Have a Cigarette?

A movie director was hospitalized. A friend managed to send his wife away so that he could meet his girlfriend in the ward. Just as they were fondling each other, a nurse came in. She swore at him and contemptuously yelled at the girl to get out.

That was an episode in the Japanese movie "Great Patient." The subject of the movie was palliative care. Is a terminally ill patient forbidden to enjoy sex? Of course not. However, the nurse in that movie morally condemned the patient.

The patients are the center of palliative care. Even if they raise an unreasonable request, it should still be considered. Under the premise that any wish of a terminally ill patient should be satisfied as best as possible, the medical team in the Heart Lotus Ward inevitably encounters similar situations, which challenge the team's original commitment.

One day a patient, Mr. Liu, said he wanted to get some fresh air outside the ward. Nurse Su-yueh said it was a good idea. However, when she began to push his bed outside the ward, he smiled complacently. Su-yueh read his mind and said, "Hey, you just want to get outside to have a cigarette." He lowered his head. She told him that he could tell her frankly what he really wanted. There were several tanks of oxygen in his ward, and if he tried to sneak in a smoke there, it would be quite dangerous. A tacit agreement of honesty and trust was thus established between the patient and the nurse.

"Dr. Chen Shih-chi was nearby. I told him the patient wanted to smoke. He immediately came over to help me push the bed. Wow! A doctor and a nurse were pushing a patient outside to smoke. At that moment, I thought it was very funny. But I think that it really was humanized nursing because we respected him as an individual."

Su-yueh found this event so ironic because it went against all her past experience. Smoking was prohibited in the whole hospital compound. Besides, smoking would affect the health of patients. Doctors and nurses should never allow any patient to smoke, to say nothing about actively helping a patient to smoke by pushing his bed out of the ward. The decision that Su-yueh made was definitely against the rule, but the incident could not be judged in accordance with the rule. To Su-yueh, it seemed rather absurd.

Su-yueh said that once when she was working in another ward, there was an aboriginal patient whose relatives brought in a bottle of wine which they wanted to share with him. "I figured that the man was terminally ill. Besides, in their culture, drinking is a gesture of sharing. I couldn't bear to deprive the patient and his family of that pleasure. So I gave them special permission. They also made a concession by drinking moderately."

Su-yueh noted that this way of doing things is characteristic of the medical staff. There are no fixed standards of behavior. "We respect the patients in the Heart Lotus Ward. We accept them sincerely and openly. We care about their needs. Therefore, they trust us. When they realize that their behavior is acceptable, they are honest with us."

Now we look back at the behavior of the director in the movie "Great Patient." Was he lustful? Or was it a normal human desire? Doctors and nurses have no responsibility to judge between right and wrong. What they truly care about are the needs and feelings of the patients and how to take good care of them.

Supernatural Power

One patient declared that he had supernatural power. He said he had studied for more than ten years and could see where people would go after they died. In short, he was some kind of spiritual medium who could act like a bridge between the living and the dead.

Unfortunately, when he himself became terminally ill, his "power" caused a great deal of disturbance in the ward. He frequently saw figures that others could not see, and he often performed exorcisms to drive away those threatening spirits.

"Miss, there are two people standing behind you." Su-yueh frequently heard this when she was on the graveyard shift. She pretended not to care, but inside her heart she was really scared.

Recalling that period, she realized that her fear affected her care for that patient. When he clutched her hand and insisted that someone was standing beside them, she felt helpless. As a Buddhist herself, she could not help him because she knew nothing about his beliefs. "If I could do it again, I would spend more time listening to him talk about what those figures looked like and what he was worried about."

That patient described to Dr. Hsu Li-an a vision that frightened him. There were about fifty to seventy people. He didn't know any of them. He said they were ghosts who had come to take him away. He further predicted, "My number is 128, and I am also No. 2 in this ward." Although his prediction was based on his "special power," the nurses still moved him to another room to reduce his anxiety.

Dr. Hsu's commented that although medical team members were not sure that what the patient said was true, they would at least believe that he did see those things. They wouldn't think that he was just talking nonsense. They would listen to what he was worried about and how he himself described his visions.

"When the patient was scared, we would turn on all the lights in the ward to make him feel better. Or when he saw all those ghosts, we moved his bed to the nursing station so that nurses could be with him. However, the illusions could have been produced by a physical problem, such as an imbalance of electrolytes inside his body. We would observe him carefully. If it was a physical problem, we would treat him for that."

That patient was taken home by his family members and he passed away not long after. What made us sympathetic was that until he took his last breath, he had struggled hard to resist his fear of death and his belief that he might go to hell after his death.

Take Our Time-The Nurse

"We need time to respect life," said Su-yueh. There are endless routines that keep the nurses busy. Frequently when they are pushing a cart somewhere, they hear a bell calling from a ward. They have to drop everything to see what is going on. All day long, they run here and there. They must do everything according to the doctors' orders. However, in the case history of any patient, they never see the order, "Respect life."

Because of this, Su-yueh thinks that nurses always have to remind themselves of the principle, "Respect life." In order to do that, they must have time. If a nurse is only doing her work according to the schedule and has to finish her assignments within the working time, then a patient may have to be woken up for tests even when he is so tired that he can't keep his eyes open. He will either wait or be pushed around just to cooperate with the nurse so that she can accomplish her work in time. This way she might do whatever has been assigned to her, but the needs of patients are neglected.

Su-yueh's interpretation of "respect life" is that a patient's needs and comfort should always be considered first. Su-yueh agrees that "Only when you have time can you smell the fragrance of the roses." Only when she takes her time can she see clearly what is happening around her. She treasures every encounter with each patient.

In her eight-year career, she has been a special nurse and a teacher, but now she has chosen to work in the Heart Lotus Ward. In the eyes of her colleagues, she is going back to the basics. However, Su-yueh said, "We have to learn from the best models. In the Heart Lotus Ward, the patients are my teachers. There are also colleagues with different specialties who encourage each other."

The Understanding Flower-The Assistant Nurse

"Yin-hua, Yin-hua!" We frequently heard that name called in the Heart Lotus Ward.

Yin-hua ["silver flower"] assists nurses and patients' families. Whether it is for changing diapers, turning a patient over in bed, changing dressings, bathing, massaging, or doing a pedicure, the nurses and patients' families always ask Yin-hua for help. If family members are not in the hospital, then Yin-hua listens to the patients.

When she was first assigned to the Heart Lotus Ward, the nurses said to her, "You are so tall and strong-the nursing department made the right choice." It was true. This aboriginal girl of the Ami tribe already had eight years' experience in pediatric and maternity clinics. After one year in the Heart Lotus Ward, she could do anything without difficulty, including the tough job of bathing a patient.

Yin-hua arranges her work schedule carefully. However, if a patient is in a critical situation, she bathes him and changes his clothes first, because that is a very important process for terminally ill patients. If a patient passes away without a clean change of clothes, his family members blame themselves for not having taken good care of him.

When a patient appears in her dreams, the first thing she does the next morning is check the board with the names of all the patients. Her hunch is always accurate. The name of the patient that appeared in her dream was erased overnight. She has seen too many lives reach their ends. However, she always keeps an optimistic attitude. "The patient has already suffered so much. If death can relieve him from his suffering, it might be just as well. After all, everyone goes on that journey sooner or later. The only thing that worries me is that the patient may not be psychologically prepared to die."

When Yin-hua first applied for a job at Tzu Chi Hospital, she did not expect that she would be assigned to the Heart Lotus Ward. Once she was assigned there and met so many cancer patients and their families, she found out that the most terrible thing about cancer is that most people are so ignorant about it. People are even afraid that the disease could be contagious. Because many cancer patients do not get treatment in time, their cancer spreads. Each time she treats a patient's wounds, she is very careful not to hurt him. On the other hand, she can see how important prevention and treatment are.

Yin-hua is a Christian. She provides Protestant patients with cassette tapes of religious music or she prays with them. Although Tzu Chi Hospital is a Buddhist institution, it fully respects each patient's beliefs. One day, a Buddhist patient was dying. His family played a tape chanting the holy name of Amitabha Buddha. That disturbed the family of a Protestant patient. Yin-hua negotiated between both sides. She advised the Buddhist family to turn down the volume. At the same time, she told the Christian family that, just as they needed Jesus Christ to lead them on the road of eternity, the Buddhists also needed guidance from their god. Thus, she solved the problem smoothly as both sides yielded a little.

"Avoid offending others" is what Yin-hua has learned during her service in the Heart Lotus Ward. She said that she used to yell at others if she saw them do something wrong. Having worked in the Heart Lotus Ward, she realized that we do not live in the world just to get the upper hand. She deals thoughtfully with other members of the medical team. She understands that each one has his own viewpoint and his own way of handling things. With accommodation and toleration, everyone can cooperate more smoothly.

Yin-hua's own father-in-law passed away in the Heart Lotus Ward last November. The old man faced death bravely. He said to Yin-hua frankly, "You tell me how much time I have." He told her his wishes and what should be done after his death. She thinks her father-in-law showed her a good way to die.

"The palliative care ward is only one year old. It is still in an infant period with many things to learn." Yin-hua has high hopes for her own work and the quality of the whole service in the ward.

Giving Courage-Volunteers

Very often when we pass by the scene of a death, we make a detour and put that person's death behind us. Then we eat, talk, walk and sleep as if nothing had happened. Who wants to remember such an unpleasant thing? But if death is very close to you-if one of your family members or good friends passes away or a doctor tells you that you are close to death-then you will wonder how such a cruel thing could happen.

Very few people are not afraid to die. Even fewer people make preparations for that final journey that all of us must make. People are more afraid of death than sickness. To help others not to be afraid is the job of the volunteers in the Heart Lotus Ward. They accompany terminally ill patients on their last journey of life and help reduce their fear to a minimum.

"When I see people pass away, I ask myself if I will be like them when I die. At that moment, I feel I am dead too." Liu Mei-li, one of the volunteers in the Heart Lotus Ward, said that she used to think death was still far away from her. It was perhaps because she never thought seriously about her own death. However, having worked with dying people in the emergency room and the Heart Lotus Ward for the past seven years, she has seen that at any moment a life could end. She is aware that some day one of those dying faces could be hers.

"It is very difficult describe such feelings. By seeing someone's death as if it were my own, I become more open-minded. I'm not afraid to approach patients that smell bad because of their illness, because someday I may be just like them. They show me the road I am going to walk on in the future."

Treating dying patients as if they were herself, Mei-li makes use of their last moments to help them fulfill their wishes, including things to be done after they are gone. She says she has made a commitment to serve people like this until her own time comes.

A female patient was the same age as Mei-li's own daughter. "The first time I saw her, I thought she was like my daughter. When I told her so, she immediately called me 'Mom.'" When she was young, the girl made a serious mistake for which her mother never forgave her. Mei-li's thoughtfulness made her feel that she had been accepted, so right away she opened her heart to receive the precious love of this "mother."

"One time she told me weakly that she would like to change her diaper. I felt very sad, but I couldn't cry in front of her. If she were my own daughter, I wouldn't know how to face her. After that, her health became worse and worse. I asked her what else she would like to do. She said she just wanted to look at me." There were tears flickering in her eyes. Mei-li took the patient's hand and put it to her own face. She also leaned her own face against the patient's forehead. They looked just like mother and daughter. Mei-li hoped that the patient could feel her love.