On The Headlines

The Wall Street Journal APRIL 22, 2009, 2:35 P.M. ET

Poems and Tears for 'Silent Mentors' Spark a Surge of Cadavers in Taiwan
Medical Students Bond With Families to Quell Traditional Resistance to Donating Bodies

By IAN JOHNSON

HUALIEN, Taiwan -- A young medical student stood in front of a corpse as sobbing filled the operating room.

The aspiring doctor, Hsu Jun-k'ai, worked up the nerve to glance at the relatives crying next to him. Tears trickled down his own cheeks. But the surgery wasn't a failure. It hadn't even begun.

Mr. Hsu was taking part in an elaborate farewell for eight people who had donated their bodies to Tzu Chi University's medical school for use in a surgery-simulation class. Medical schools around the world have ceremonies to honor donors, but Tzu Chi (pronounced Seh-Gee) is taking the practice to unusual levels.

By the time students here wield their scalpels, they will know the dead intimately, composing poems and slide shows to them, writing their biographies and sometimes lighting incense in their honor. When they are finished, the students will carry the donors' coffins to the crematory, mourning them as their "silent mentors" who taught them with their bodies.

The reason for such care lies in the origins of Mr. Hsu's university. Tzu Chi is the brainchild of one of Asia's most charismatic religious figures, Cheng Yen, a 72-year-old Buddhist nun who in the 1960s founded the Buddhist Compassion Relief Tzu Chi Foundation. Now the Chinese-speaking world's largest nongovernmental charity, it last year channeled more than $300 million in private donations to victims of natural disasters around the world.

Ms. Cheng has broader ambitions. In the 1970s and '80s, Tzu Chi was part of a social and religious awakening in Taiwan that helped undermine the island's dictatorship and helped usher in democracy. The cadaver program is aimed at changing how traditional Chinese society in Taiwan and China views the human body -- and in the process, end a body deficit plaguing Taiwanese medical schools.

Traditionally, Chinese view their bodies as a bequeathal from their ancestors. This means bodies mustn't be damaged before burial. At Tzu Chi, therefore, Ms. Cheng insists that -- unlike in Western medical schools -- cadavers be sutured after being cut up. The laborious process takes days, but in the end the body is whole.

Ms. Cheng also makes a more profound pitch to potential donors: Society needs you.

It is an argument that has deeply touched Taiwanese, whose economic miracle of the past decades has left some morally unmoored. More than 23,500 Taiwanese have willed their bodies to Tzu Chi, allowing the hospital to satisfy its educational needs and supply other schools on the island. Following Tzu Chi's lead, other schools have implemented similar commemorative services, eliminating the shortage of corpses that long hindered the Taiwanese medical establishment.

"The public was conservative about corpse donation, but Tzu Chi has made the public more open-minded," says Lu Ko-shian, director of the National Taiwan University's Graduate Institute of Anatomy and Cell Biology. "Tzu Chi changed that mindset with the power of religion."

At first, medical professionals also viewed the efforts skeptically. Tseng Guo-fang was one of them. Formerly head of anatomy at National Taiwan University's medical school, Mr. Tseng didn't see the point in the elaborate efforts to treat the bodies with so much respect. But after agreeing to teach courses at Tzu Chi, he came to appreciate it and eventually took a senior posting at the school.

At Tzu Chi University in Taiwan, people who donated their bodies to science are honored as medical students' most valuable teachers.

"I was trained as a hard-core scientist and this didn't make sense to me," says Mr. Tseng. " But I began to see that there's more to teaching a student than just technical ability; we need to create compassionate doctors too."

The efforts are spreading to China, where hospitals are also chronically short of corpses. Nine of the students in the February workshop in Hualien were from Shanghai. Western observers have been likewise impressed.

"It's something that we can learn from," said Sylvia Cruess, former director of medical services at McGill University in Montreal, who recently witnessed one of the Tzu Chi ceremonies.

The farewell ritual begins anew each summer before classes begin, when students like Mr. Hsu fan out from Hualien, a small city on the rocky coast of eastern Taiwan, to visit the donors' families.

After a two-hour ride, Mr. Hsu and two classmates arrived at the home of Li Syu Yue-E, a 62-year-old who died of septic shock brought on by diabetes. Ms. Li Syu had asked that her body be donated to Tzu Chi, which froze it for use in a surgery simulation class.

"You want the family to understand what we're doing so they feel part of it," Mr. Hsu said. "We also learned about Teacher Li Syu. We got to know her as a person."

In late February, Mrs. Li Syu's body was unfrozen along with the other seven bodies to be used in a surgery simulation, one of four such workshops the school holds every year.

The night before the workshop was to start, some of the school's 350 medical students gave PowerPoint presentations about the lives of each donor to school staff and family members. When Mr. Hsu's group was up, a classmate showed pictures of Mrs. Li Syu, accompanied by a poem written by the classmates:

Like a warm lantern in our heart,

Like the supple light of the moon,

To embrace you forever

In the fragrance of a flower,

We will remember you forever

Then, Jeff Sun, head of the Tzu Chi hospital's surgery department, addressed the relatives. "The students are right next to you. They know how dear the departed are to you. They will treat them with respect."

The next day at dawn, Mr. Hsu stood, clad in a white uniform and surrounded by classmates, in a small, bright shrine on the university campus. Across the aisle were about 30 family members of eight donors. After a short service of Buddhist prayers, the two sides filed into the operating room. On a screen at the head of each of the eight operating tables was a photo of the deceased.

Slowly, family members broke down. Some prostrated themselves over the bodies, wailing. Others stood silently sobbing. Like many of the other medical students, Mr. Hsu's face began to turn red. He bit his lip as it started to quiver. His eyes welled up with tears. Across the table from him, Ms. Li Syu's daughter, Syu Yue-chen, looked at him appreciatively before everyone trooped out and the service concluded with more prayers. As family members headed home, Mr. Hsu and his classmates went back in to begin their work.

Four days later, the surgery workshop ended, and all reunited for the final funeral. The bodies were taken to a crematorium and the remains put in cut-glass urns donated to Tzu Chi by one of the island's most popular craftsmen, Heinrich Wang.

"This was her will, to let the students learn from her body," said Ms. Syu as she prepared to make her way back home to Hong Kong. "And maybe now I can accept it."
—Ting-I Tsai in Taipei contributed to this article.

Write to Ian Johnson at ian.johnson@wsj.com

Life Right Now

Is not exactly a bed of roses, but we all manage - some barely crawling by, some slithering away stealthily, some soaring across. Once over the hedge, we all have different gains as well, depending on how you spend your time and life.

The pile of books recently taken. No, I did not remove all my books and stack them up for a picture, they were basically laying there when I decided to take a picture.

Microbiology lab.

Is very interesting, especially with an absent-minded partner ("what? That was Salmonella? I thought it was a Shigella? Or was it Staphylococcus? I think I might have mixed all of them together!" = =b) [not pictured to avoid controversy] and a fun-loving teacher.

Went to another Miharasi camp this afternoon. It was all fun and rewarding, especially with children swarming around you; until you come back and see the amount of work piling up.

Heading to Sabah for 2 weeks this summer, guess why?

Why We Love Abbr.

Remember not so long ago in Form 5 English lesson when the teacher repeatedly emphasized no abbreviations in your essay. Yes, not a single one she says, not even in describing daily scenarios like "Dad and I bought some DVDs and watched TV at home for the remainder of the night."
Now, basically everything we approach daily are abbreviations. I guess it's common of human nature to be lazy, especially so when you're discussing genetics or molecular biology - you don't expect your lab professor talking "Now, we know that cyclosporin will activate mammalian activator of T cell. Hence mammalian activator of T cell is an important factor in regulating immune response. Inhibition of mammalian activator of T cell using Fermentek catalogue number 506 will decrease autoimmune diseases effectively." Hail Mary.
While abbr. comes in handy when we're discussing knowledge or writing for a Nobel prize, massive appearance of them on textbooks are specially annoying. When you already have words occupying the entire page, and what you want to do is just to finish the chapter and go to sleep, here they come:

[blah blah blah]...once the FRC has been determined, the RV can be determined by subtracting the ERV from the FRC. Also, the TLC can be determined by adding IC to FRC...[blah blah blah]

[yadda yadda] asthmatic and diabetic patients should use ACEIs because activation of the RAAS will not severely affect... [yadda yadda]

What's more, medical abbr. alters your perception of your previous learned abbreviations. We have MD, which years of dictionary flipping tells me it is 'doctor of medicine', but my doctors told me it is macula densa (something to do with cells). We have CA, which our American friends would proudly say that's the state of California, but we read as 'cancer' (so seeing CA on your disease description doesn't mean you won a free trip there). We see MH, which I proudly reads aloud 'Malaysia Airlines', but my teacher whacks me and say 'watch your mental health, or else you'll not be graduating'.
Of course, we have the more complicated abbr. as well. Think p53, BCL2, CsA, TxA2, MAPKKK which activates MAPKK which activates MAPK which activates MAP. See kRAS, c-myc, 15q11, HbSAg. Now you know why we are so prone to unstable MH, and we have an average LE of 10 years shorter than the MLE (mean life expectancy).
And if you think a medical student's job is to match an alphabet to another and form the longest abbr. you can think of, think again. The names, be it diseases, cells, or medical equipment - accumulated across the century with every doctor hoping to patch something up in the medicine hall of fame. Reed-Sternberg cell, Hodgkin lymphoma, Churg-Strauss disease, Osler-Weber-Rendu disease, Takayasu disease, Aschoff bodies - is it so much fun attaching your name on a disease you find? Which causes death across worldwide hospitals every year? - "Oh, my in-law died from Kawasaki disease." I personally think the WHO should just impose a law 'no more human names on human diseases', which would reduce our disease names to merely 'liver cancer type 2c-7ja' or something like that.
So next time you see a medical student, don't start pouring out how you admire a job which is recession-proof or earns a stable and happy income. Tell them you understand medical school is next to hell and you will be with them even if MS or the MB decides to abbr. everything ASAP. And tell them you'd be a compliant patient who requests for DNR (do not resucsitate) if the time comes and will not do anything AMA (against medical advice).

Last Night of the World

From a very old musical, Miss Saigon, featured during a very old TV show, with Lea wearing an old fashioned pantsuit. The music is just as timeless though.

Trivial Nothings April

• I recall the month of April, whether in traditional literature, music or poetry, is always associated with tender, fine weather and blossoms of natural beauty marking the return of spring.
• The romanticism doesn't apply to Hualien, or maybe Taiwan in general. It started out with a terrible chill spell, and being spring humidity was to be expected. We had a few days of soggy socks and umbrella carrying. Then the tender sun appears. Just as I was preparing for an outdoor picnic under a blossoming yellow shower, rain comes pouring down in a span of less than 20 minutes. I hardly catch my breath rushing home stowing the laundry.
• And much as I like to start packing away my winter clothing, evenings and nights are so bone-bitingly cold I overturned my entire wardrobe for the touch of warm acrylic and polyester (who wears wool nowadays, that's so 50's).
• That's when we truly miss the feel of light cotton or linen under a hot sun back home.
• And speaking of home:

• Of course this year's award sparks another controversy. Partly because an airline from a kiasu nation isn't on Airline of the Year, and the airline of the year is just mediocre in my personal opinion (we're not giving out names, Cathay Pacific) - with no pillows and blankets, no on-demand entertainment system, simply...mediocre.
• I had a great laugh yesterday, literally more exercise to my abdominal muscles in the entire year combined while reading this (in Malay):
  

Nama orang-orang Jepun :-

1. Yang pemarah - Keiji Cacimaki

2. Yang suka berjimat - Sayori Sukamura

3. Yang bisu - Kieta Tadasora

4. Yang suka makan nasi - Nanachi Kasibanya

5. Yang suka layan "blues" - Apo Nadikato

6. Yang suka belajar - Ashiko Ulangkaji

7. Yang kerap mengacau - Wakasi Huruhara

8. Yang sangat kedekut - Matimati Tamokasi

9. Yang suka tidur - Ichiban Tidomati

10. Yang suka mengintai - Hintai Akosuka

11. Yang tua - Taragigi Padanmuka

12. Yang kena bini lari - Susahati Binilari

13. Yang suka merempit - Sajaro Carimati

14. Yang lembap/bodoh - Ayumi Siputbabi

15. Yang suka bersumpah - Saiifoo Baukari

And I'm still bursting out laughing while my roommate blasts away on his bidding on eBay ("why are you laughing? My bid was just overturned at the final second! THE FINAL SECOND!")

Well, that should be enough for one month don't you think?
Come back for more laughs whenever you want.

I Walk Through The Valley of the Shadow of Death

It's hard to imagine how a microbe beyond the visual capability of the naked eye can wreak such havoc when inoculated into a weak, unsuspecting body.

Orienta tsutsugamushi under the electron microscope. Don't ask me where the germ is.

Sometime during our leisurely evening walk along a forested track on Yang Ming National Park the previous weekend in Taipei, a mite took to the liking of biting on my left forearm. Unsuspecting at most, the aforementioned bacteria had entered a human host.
Over the following several days, the host develops increasingly severe fever, with postural hypotension, malaise and severe chills in the peripheries (sounding too professional for you?).
Yours sincerely is brought up to realize the importance of every single penny, and hence like all other traditional Chinese, resorts to seeking medical treatment as the last resort in most circumstances. Even though he is trained to become a physician in future and realizes the importance of early diagnosis and treatment, many a time we'll all assume it's a virus, or it's common cold, it'll go away in 2 days.
And it did not. By the 4th day the chill was very bad. Nails turn purplish, and even with paracetamol the fever recurs with greater intensity and force with every Panadol. With chance, the diseased met with Prof. Hsu, the Head of Pathology of TCU. He advised yours sincerely to seek medical attention immediately as he suspects it being a typical case of scrub typhus.
"Will it get better by itself?" yours sincerely asked naively. That was when Prof. Hsu mentioned his experience as a pathologist - post-morteming several typhus patients, deceased. And that scrub typhus has a mortality rate of 40% if untreated.
Realizing 20 is too young an age to die, and there are many more dreams not yet realized - such as visiting Istanbul and flying round-the-world in First Class, yours sincerely skipped the remaining lesson and headed to the hospital.
It took several tabs of antibiotics to eradicate the unpleasantness, but the amount of tests done before that was chilling to say the least. Hospitals are required to report cases of scrub typhus to the Center of Disease Control (CDC). Bottles of blood samples were collected, and even the technician gawked at the amount of blood sample tubes laying on the desk waiting to be filled with my infectious fluid. X-rays were taken. And I received a phone call dictating me to "make sure you take the drug on time, rest well, and return for another series of tests next week."
I feel well enough to fly round-the-world in First Class today, but I lacked the money. On another hand, our very own Malaysia Airlines regains its position of World's Best Cabin Staff 2009, making this a sixth. This is a recognition of warmth and hospitality of all Malaysians! Malaysia Boleh!