| Good Medicine | ||||
| By Gao Yu-mei Condensed and translated by Wu Hsiao-ting | ||||
The combined efforts of many people healed his physical wounds and despairing heart. Scleroderma, a long-term autoimmune disease that results in hardening of the skin, made A-yuan’s hands stiff and deformed. Furthermore, he could not walk. He moved around in a chair with wheels, using what little strength was left in his feet to propel himself forward or sideways. His condition caused him to fall to the floor often. One day, he was slowly scooting around in his room when he fell again. It was a hard fall—his body was injured in several places, and he was in so much pain he couldn’t even crawl. He yelled for help with all his might, but no one responded. It was winter, so most of his neighbors had their doors and windows closed to shut out the chill. They probably couldn’t even hear his cries for help. A-yuan eventually mustered all the strength he had left and was able to crawl to the phone and call the police. The chief of the local police station hurried over and helped him get up from the chilly floor. A-yuan had another visitor that day—Tzu Chi volunteer Lin Yu-jin (*L٪ة❊A). She said to him, “A-yuan, you’d better go to the hospital for treatment and a thorough checkup.” A-yuan knew that Lin was concerned about him and for that he was very thankful. But he didn’t want to see a doctor. He had always been passive and reluctant about seeking medical help. He felt he would be better off dead, and he had in fact attempted suicide several times.
A sad past A-yuan lived in Liujiao, a quiet, remote town in Chiayi County, southern Taiwan. One summer evening in 2011, Tzu Chi volunteers held a prayer service at a temple in Liujiao. It was there that Lin first met A-yuan. Noticing his deformed hands, she approached him and struck up a conversation. “Doctors have said I have scleroderma and that it is incurable,” said A-yuan, as he explained his condition to Lin. She pulled up a chair, sat down, and began listening to him relate his story. A-yuan used to work at an ironworks factory in Taipei when he was younger. One day at work, a heavy object fell on him and badly injured his legs. Even though he eventually recovered from those injuries, he noticed he wasn’t as agile as he had been before. In fact, he found his body growing stiffer day after day. He had no choice but to move back in with his parents so they could care for him. Sadly, his parents passed away one after the other a few years later. With no one around to care for him and with his mobility becoming more and more restricted, he found it really hard to get by. Deprived of both physical and emotional support, he felt completely alone and helpless. He became depressed and saw no reason to go on living. When police officers at the local station learned of his situation, they worried about him and began keeping an eye on him. Scleroderma led to the hardening and atrophy of A-yuan’s skin and muscles. His joints became stiff too. As a result, he often fell and sustained injuries. Such injuries were especially hard on A-yuan. With his limited range of motion, it was a real challenge for him to tend to his own wounds. While telling Lin his story, A-yuan lifted up his long pants. Lin was shocked to see his legs covered with pitted scars and sores; some sores were so deep the bones were visible. “Have you ever seen the doctor?” she asked. A-yuan just sighed and complained more about his miserable life. A few days later, Lin and other Tzu Chi volunteers had a meeting in which they reviewed some cases of care recipients. Lin brought up A-yuan’s situation, and the volunteers decided that even if scleroderma was incurable, they would see to it that his wounds were taken care of.
Difficult wounds One Sunday morning, Dr. Honda Hsu (許宏達), a plastic surgeon at Dalin Tzu Chi Hospital, Chiayi County, showed up in the lobby of the hospital. Though it was a day off for him, he had come to the hospital to meet with other members of the Tzu Chi International Medical Association. Together they were going to visit some needy patients in remote regions. Dr. Hsu emigrated from Taiwan to South Africa with his family when he was little. When he had grown up, he followed in his grandfather’s footsteps and became a doctor. As a child, he had seen his grandfather treating impoverished patients free of charge, sometimes even giving them money to pay for their transportation home. His grandpa’s kindness made an impact on him. After he became a physician, Hsu volunteered at Tzu Chi free clinic events in Johannesburg. In 2000, Hsu returned to Taiwan and worked at Hualien Tzu Chi Hospital, in eastern Taiwan. He later transferred to Dalin Tzu Chi Hospital. It was the most natural thing for him to volunteer his time to help care for needy patients in remote areas. It was what he was about to do on this particular Sunday. On the way to the patients’ homes, Hsu learned from volunteer Lin Yu-jin that there would be a particularly difficult case that day. A terrible stench assailed Hsu and the other volunteers when they stepped into A-yuan’s home. Hsu did not cringe or hold back though. He walked right toward A-yuan, bent down, and checked the big and small wounds and sores on his legs. He gently pressed a cotton swab on a festered sore and some pus immediately spurted out. “Sir, your wounds are too far advanced,” Hsu said to A-yuan. “Just cleaning and dressing them won’t make them heal. You need to check into a hospital for more thorough treatment.” While he was speaking, Hsu continued to press on the sore to release more pus, which he then dabbed away with tissues. Lin added, “Right, right, you must listen to the doctor. He has your best interests at heart.” But A-yuan seemed unmoved, and he didn’t say a word. On another day, Dr. Chien Jui-teng (簡瑞騰), vice superintendent of Dalin Tzu Chi Hospital, called on A-yuan personally. He had learned about his reluctance to go to a hospital. Squatting before him, he saw spots on his pants that had been soaked wet with pus and blood. He cleaned his wounds and sores and explained to him how far they had deteriorated. He said that even those that didn’t look so bad had festered with pus. When he was done tending to the lesions, Chien stood up and said to A-yuan, “You must receive further treatment. I’ll arrange hospitalization for you.” A-yuan didn’t say a word. A volunteer piped up: “A-yuan, we’re really worried about you. Don’t let us down and let our efforts go down the drain.” Dr. Chien continued, “You don’t need to worry about money. We’ll take care of that for you. Just go to our hospital. Only after your wounds have been treated and healed can we rest at peace.” Money had been a big concern to A-yuan, and that was the main reason why he had refused to seek medical help. After hearing Chien say that they would take care of the money issue for him, he hung his head in thought for a moment and then nodded. “I’m sorry to put you through so much trouble. I guess I’ll thank you in advance for your help then,” he said. The volunteers left A-yuan’s place, and some of them set to work arranging for his hospitalization.
Combined efforts Back at Dalin Tzu Chi Hospital, Dr. Chien assembled doctors from various departments and together they consulted on how to treat A-yuan. Dr. Hsu would be A-yuan’s attending physician. After looking at his test reports, Hsu said that although his condition looked like cellulitis, it was in fact necrotizing fasciitis (NF), commonly known as flesh-eating disease, which is caused by bacteria. It had to be treated as soon as possible, before it led to a fatal case of sepsis. Dr. Huang Kuang-yung (黃光永), from the department of immunology and rheumatology, then reported that A-yuan had been diagnosed with scleroderma, a condition that causes the hardening and tightening of the skin and connective tissues. The disease can also harm blood vessels and internal organs. With the hardening of the skin and muscles, mobility and motor control are affected. That’s why A-yuan fell a lot, leading to his various wounds. With his hands deformed and stiff, he could not properly care for his wounds, and so he eventually developed NF. The first major surgery A-yuan underwent lasted two hours. “Debridement [the surgical removal of dead or contaminated tissue] is not a difficult procedure,” Hsu explained. “But the areas on A-yuan that were afflicted with NF were large and deep, all of which added to the difficulty of the surgery.” The scleroderma made it hard for A-yuan’s tissue to become attached to artificial skin, so the medical team could not use it on him to speed up the recovery of his wounds. Instead they could only help the tissue grow back by continually cleaning and dressing his wounds. After A-yuan was discharged, Tzu Chi volunteers worked with the village office and applied to the social welfare department of the Chiayi County government for home care services. May, who had been an in-home care provider for many years, began visiting A-yuan twice a day to clean up his place, feed him, and change his dressings. May was good at caring for bedridden patients, but it was not easy to care for A-yuan. “The infections have gone deep into his sores. Often when I feel that I’ve made some progress, the bacteria invade tissue surrounding an old sore and a new sore emerges. It’s a real challenge tending to him.” Every time a sore was not healing well, May would take a picture of it and send it to Hsu via a messaging app on her cell phone so that the doctor could decide whether A-yuan needed further attention.
In the company of love One Saturday evening, Dr. Hsu returned home after work and saw his two little daughters doing their homework at their desks. He was visiting A-yuan the next day, and he invited the two of them along. Back when they were still in kindergarten, Hsu had started taking them with him when he visited needy patients at home. He hoped that such experiences would help his daughters learn to give to others, care for the underserved, and appreciate their own blessings. The following day, a party of people including Hsu and his daughters arrived at A-yuan’s home. The two little girls did not show even a hint of fear at seeing A-yuan’s unhealed wounds, from which pus and blood were still occasionally oozing. Instead, they said to their father, “Daddy, be gentle so that you don’t hurt Uncle A-yuan.” Their sweet words were like a stream of warmth flowing through A-yuan’s heart. The love and care from Tzu Chi volunteers, the medical help from doctors, the assistance of the in-home care provider, and the sweet compassion from the two little girls…. With so many people caring for him, A-yuan no longer felt all alone in this world. He was receiving so much from others. In addition to Tzu Chi, staffers from the social welfare department checked on him on a regular basis, and the Eden Social Welfare Foundation subsidized his living expenses and home care service expenses. With time, more hospitalizations, and care at home, A-yuan’s wounds gradually got better. Even more noteworthy was that his mind and attitude improved too. That was manifested in how much more often he smiled. He said to Dr. Hsu, “Thank you for taking such good care of me, both physically and emotionally.” Hsu was really heartened by the progress he saw in A-yuan. “We have a lot to be thankful for—Tzu Chi volunteers, the in-home care provider, and the government’s social policy. As a medical care provider, I feel I have so much support behind me.” One day, Tzu Chi volunteers visited A-yuan again and pushed him out of his home for a little stroll. Looking at the setting sun, A-yuan exclaimed, “I never knew a setting sun could be so beautiful!” When your mind shifts into a positive mode, you begin to see a different world. You become more alive to the beautiful things life has to offer. “I need to be grateful that I’m still alive today,” said A-yuan. “I’ll cherish what I have and treasure my life.” Love has led him out of the dark tunnel of his past. Gazing at the setting sun, A-yuan looked forward to the new dawn of tomorrow.
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