Can We Do A Little Extra for Others?

                             To give is doubly blessed.

Moralizing too much will drive every audience away. This essay I want to relate to you only what I have done when dealing with two of my patients while I worked in Macau.

First I’d like to give a brief introduction about the health care system in Macau. The hospital where I worked is the largest public hospital, providing free medical care to a majority of Macau residents. Free service is very appealing to many of us, but it has a price. Few governments can actually afford to cater to each citizen’s needs for medical care, even though one is granted the right to enjoy it. The medical system in Macau is two tiered, consisting of the central hospital and health centers. Except for emergencies, seeing a doctor needs booking, the time taken varies at each center. One can go to the health center to book for himself, but to see a specialist one needs a referral letter from a general practitioner, an ER doctor or another specialist. Generally speaking, it takes at least a month to book for my appointments after other doctors have agreed to recommend to. If one wants to enjoy his free medical care, he must first have access to a doctor. This system is quite different from ours. I shall skirt over the issue of our system which is a breeding ground for controversy. What I want to relate to my friends is that doctors in Macau is privileged and decently paid and they have only one single goal: expert performance.

Mr. Lei was only 24 years old when he was diagnosed “Ulcerative colitis”, a chronic relapsing disease characterized by diarrhea, abdominal pain and passage of bloody stools. He worked as a clerk in the Bureau of Finances and had a good salary. The first time he was admitted into KW Hospital, the largest private hospital in Macau, where his disease was brought under control. Later on, he was transferred to my hospital due to economical reasons, as the medication he used was very expensive. Naturally when he visited my office, he let slip his distrust in my expertise, a faux pas many patients make when seeing a doctor. Doctors are expert in discerning the slightest change of tone or facial expression of his patients both as a professional requirement and as a conditioned protection reflex against recriminations. Thinking in his shoes, I didn’t blame him and offered some advice, much of which I knew that he might not listen to. Such things often happen when trust has not been adequately built between physician and patient, a phenomenon called lack of compliance. For the next two years he visited regularly to my office every two or three months, and eventually he knew that he had found the right doctor for his illness. His disease was more serious than he expected, and his anxiety was written on his face. To assist him in his battle against his disorder, I broke the rules by generously allowing him to see me any day if his disease flared up. He was really grateful. When I told him that I was leaving, he was surprised and distressed, which took me some time to calm him down. The last time he went to my office, I was surprised to see he was a changed man, his face clean-shaven, his hair trimly cut and he in a new suit. The consultation over, he said whether I could do him a favor by taking a picture with him. Then I saw his real intentions in trimming up his appearance. Surely with the help of the nurse we were photographed together like old friends. From distrust to trust, his attitude to me was an about-turn within two years, a reward of patience and magnanimity. Readers must give up the notion of any profit-based motive in this case. He received not only free expert opinion but also free medications from the government, an amount surpassing nearly a quarter of a million Macau dollars within two years.

Ms. G was in her fifties when she visited my office due to abdominal distention and jaundice. Her diagnosis was liver cirrhosis at an early stage. She was born also in Shandong province and only immigrated to Macau for no more than ten years. Seeing that I was friendly, she told me more about herself. She found her blood platelet was very low at a routine examination and immediately sought expert advice in Beijing. The hospital she visited was very famous and the professor receiving him was considered Number one in the field of connective tissue disease, who promptly made the diagnosis of Systemic Lupus Erythematosus(SLE) and prescribed some steroids for her. She took the medication as advised continuously for half a year with no improvement till another doctor in Guangzhou, after reevaluation, made the right diagnosis as liver cirrhosis. She complained and mumbled the name of the professor like a possessed person. I told her that I knew the doctor well and he was kind, responsible, and had a good repute. He was not fully responsible for the misdiagnosis as there were too many patients lining up to see him and she should see him again if the medication was not working well. She accepted my explanations and never mentioned about this incident afterwards. It’s futile lamenting over what has gone amiss. I sincerely felt pity for her as she looked very nice.

At the next appointment three months later, I found her a bit emaciated. She told me she had just had an operation because a malignant tumor was found on her uterus. Anyway she was not at all deterred from being optimistic, and said that she had confidence in winning the battle against cancer. I encouraged her belief by telling her that the tumor was localized and she would fare well. Now her gastrointestinal problem was not a major issue and I could discharge her from my follow-up list, but she insisted on seeing me regularly, to which I complied. Within a year, this woman had been diagnosed serially with gastric cancer, lung cancer, and had her spleen removed. Strand by strand, her hair disappeared completely as an adverse reaction of chemotherapy, so she wore a cap to cover her baldness. Anytime she went to my office, she always fought back her tears, and my assuring words were what she needed most. I philosophized with her about her illness, about life and death, which, I hoped, might provide a little relief of her agony. At the last appointment, I didn’t tell her that I was leaving for Beijing, lest she might be sentimental, and I knew her days were numbered and she might not be able to make the next appointment.

 A few days later the secretary informed me that a patient insisted on seeing me that day whether I was busy or not, so I went out to investigate whom the visitor was. It was her! She looked ghastly and her eyes were swollen from sobbing. The afflictions had aged her ten years older and she had difficulty in walking and speaking. It took determination and effort for her to come to the hospital by herself. She murmured faintly, “I don’t want you to go…” and she burst into tears. When I told her that I would leave at the next month, she took heart and promised to bring a gift for me. Whatever she may bring with her, I will appreciate it: it stands for genuine gratitude. She never made it. The last time I saw her was in the emergency room, where she lay in the bed in a critical condition. Her eyes shone at the sight of me and struggled to sit up, but I stopped her, knowing that the slightest effort was agony to her. I have examined her cranial CT, and this time it was brain, the tumor having invaded there and utterly crippled her. This time she seemed to have come to terms with fate， and in a low despairing voice, she murmured, “The time has come for me, I know.”  I promised to find a good neurosurgeon for her before I stepped out of the room. A few days later they told me that she had passed away. She was finally relieved from this long ordeal. What I have done for her is more as a pastor than as a physician, providing a little spiritual comfort, which she cherished to her last breath. Isn’t it a reward when one’s effort is appreciated? Thousands of people have volunteered to help others in this way or that; I hope one day I will become one member of them, assisting those in need within my means.