How death changed her life

SINGAPORE - Professor Chao Co-Shi faced death early on in life.

At 15, she was diagnosed with a brain tumour. Doctors told her parents she needed an operation, but there was a 50 per cent chance she might not survive.

For several months after the operation, she haemorrhaged a lot. She was so weak that she could not attend school for a year.

During that critical time, her mother fell ill and died. It gutted the Taiwanese teenager.

"I faced my own death, and then saw my mother's. I had a lot of questions. Why is there death? Where do we go after we die? I had a lot of questions; I asked my siblings, but no one could answer me," says the youngest of seven children of a military man and a homemaker.

"My grief was deep, but no one could help me cope with it," Prof Chao, 65, adds in lilting Mandarin.

The lack of answers and the reluctance of her loved ones to talk about death and illness unsettled her.

"In Chinese culture, it is taboo to talk about illness and death, and how we want to be cared for before we die."

The experience helped chart her destiny, which led her to becoming an expert in palliative care, the care of the terminally ill.

At first, she set her mind on becoming a doctor.

"I wanted to go to medical school because I didn't think the doctors knew what illness my mother was suffering from," says Prof Chao, who was a speaker at a palliative care forum organised in Singapore earlier this year by Fei Yue Community Services.

But her medical ambitions were crushed. She was running a fever while sitting the university entrance exam and missed getting into medical school by just one point.

She enrolled as a nursing student at the National Taiwan University instead.

"The plan was to resit my medical school entrance exams again after one year, but I discovered I really liked nursing," she says.

The nursing school's dean, a paediatrician, also said something which left a deep impression on her.

"He said computers may take over what doctors do one day, but nurses are irreplaceable because nursing is all about the personal touch," she says.

As a nursing student, she developed a reputation for preferring to look after dying patients.

"It probably has something to do with what I went through. I also thought dying people needed more care, not that I knew how to take care of them then," she says.

For 17 years after she graduated in 1972, she worked in several of Taiwan's top hospitals and was also director of a home-care programme for terminally ill cancer patients.

During this period, eight of her patients committed suicide. All were suffering from terminal illnesses and from great pain.

One who she remembers vividly was a 42-year-old lung cancer patient.

"Every day, he would say: 'I can't breathe. I feel as though I am being hanged.' Then one night, he disappeared."

The staff combed the grounds of the hospital, but could not find the patient.

"At 6am, the wife arrived with their nine-year-old son. They were with me when I opened the door to a room and found him hanging from a rope inside," she says quietly.

She tried but could not stop the patient's wife and child from entering the room.

"I think the son must have been traumatised for life. Imagine seeing his father in that state," she says sadly.

The incidents upset her. She felt that Taiwan's medical education was giving palliative medicine and patient services short shrift.

"These patients are terminally ill. While we can't cure them, what about their pain and suffering - both physical and emotional - and that of their loved ones? I felt we were not doing enough," she says.

Prof Chao started reading up on the subject. That was when she chanced upon the works of Dr Cicely Saunders, a nurse, social worker and physician who pioneered the discipline and culture of palliative care.

"It was exactly what I was looking for," says Prof Chao.

She saved up some money and left for Case Western Reserve University in Cleveland, Ohio, in 1987 to get her master's degree majoring in oncology nursing, and later her PhD in hospice and palliative care in 1993.

She worked as she studied and, each summer, would fly to London, where she trained at the renowned St Christopher's Hospice under Dr Saunders herself. Dr Saunders died in 2005.

When Prof Chao returned to Taiwan in 1993, she had already mapped out a blueprint to promote palliative care there. Hers, she says, was a four-pronged approach: direct care, education, policy and local research.

The Taiwanese media feted her as the island's first palliative care expert. As a result, many patients started knocking on her door.

She spent her first year training nurses, helping hospitals to set up palliative care units and looking after patients.

She did not charge for her services.

"My condition was that whatever I wanted, I must get. If I wanted automated beds or special mattresses and bath tubs for my patients, they had to give them to me. I could make those demands because I was a volunteer. I wouldn't have been able to do that if I were an employee," she says.

The frantic pace at which she worked, however, took its toll on her. One day, she collapsed while on the way to see a patient.

Doctors found a tumour in her stomach, and she was operated on again. It turned out to be benign.

"But my illness did a lot of good," she says with a laugh. "Newspaper headlines screamed that I was going to die barely one year after my return, so many officials from the Ministry of Health came to see me and asked me what needed to be done."

Upon recovering, she started teaching at the medical college of National Cheng Kung University, where she is now a professor.

About 10 years ago, Taiwanese President Ma Ying-jeou presented her with a special award for her contributions to the medical profession.

Prof Chao has helped to set up more than 20 hospices in Taiwan, and trained more than 2,000 of the island's doctors, nurses and social workers in the intricacies of palliative care.

She has also been instrumental in making Taiwan the only place in Asia to introduce a Natural Death Act, in 2000. It allows patients to choose a "natural" death, unencumbered by medical technology.

Then, in 2006, a routine medical check-up revealed that several of her lymph nodes were cancerous.

Several rounds of chemotherapy were recommended, but Prof Chao said no after just one.

"The medicine was so potent. I couldn't go near anything hot. If I did, it felt as though I was being poked by a thousand needles. They even had to soak my limbs in ice water. I probably would have died if I had continued," says Prof Chao, whose cancer is now under control.

Dying, however, does not faze her.

"I am very prepared. My will is prepared. I have even left instructions on which priest I want to conduct my funeral services and what songs I want played.

"I am spiritually very happy and feel very blessed, so it does not matter if I don't wake up tomorrow," she says.

Asked to recall her most memorable patient among the thousands she has cared for, Prof Chao smiles.

"Her name was Xiao Ling and she was a beautiful 19-year-old girl," she says. "She stayed in our hospice for three months and called me Auntie Chao."

The daughter of a businessman and a homemaker, Xiao Ling suffered from a rare form of cancer and died five years ago.

"One day, she told me that she was not content. When I asked her why, she said, 'For 20 years, my parents have loved me, my teachers have taught me and my country has given me a lot. But I have only taken but not given anything in return.'"

After several heartfelt discussions with the professor, the teenager decided she would donate not only her eyes - her other organs could not be used - but also her body for medical research.

A few months after her death, Prof Chao received a package of photos from Xiao Ling's mother.

"Her mother told me Xiao Ling had instructed her to send them to me. She wanted me to take her along and tell her story each time I have a speaking engagement," she says.

"Her message to me was, 'Use my life. Tell your audience they have to live life well. Tell them my only regret in life is that I have never given because giving is such a gift and such a blessing.'"

The kindly professor has told Xiao Ling's story more than 300 times.

"Each time I speak, I tell her story. It is a promise I made her, and one I intend to keep," she says.

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