"If I tell people, they'll probably laugh at me," says Li Kun-hua, currently a second year resident in surgery at Taipei Municipal Chung Hsiao Hospital. The reason he became a surgeon, he says, is that he was influenced by the Black Jack comic books by Tetzuko Osuma.

The Black Jack character that Tetzujo Osuma depicts is a surgeon of amazing skill, albeit one without any credentials. On the surface Black Jack only operates for the money. But in fact he often acts to save lives without much caring whether he'll end up with the cash.

Ever since he was in primary school, Li has admired Black Jack's omnipotence at rooting out diseases. While studying at China Medical College, he decided that he wanted to be a surgeon.

Many of Li's classmates shared his interest in surgery. However, after graduation, faced with practical realities, most chose different fields. But Li stayed true to his vocation, and after graduating he became a resident at Chang Gung Memorial Hospital. Later, he passed the qualifying exam and was assigned to Taipei Municipal Chung Hsiao Hospital, where he is now a second year resident in surgery.

You can see something of the shadow of Black Jack in Li's personality. "Some people like research. But I prefer to be face-to- face with patients and treat illnesses." He avers that, as far as he is concerned, helping the sick should be a doctor's first responsibility, with research and promotions secondary. That is why, after he received his qualification, he chose to go to the municipal hospital, where he could serve patients, rather than stay at Chang Gung, where he would mainly have done research.

In the face of illness

As a second year surgery resident, Li can only perform minor operations like appendectomies and hernias. For more difficult procedures, he can only observe and assist the attending physician.

Besides tasks in the operating theater, residents must also look after patients. Thus, it is typical to have to report to work at 6:00 or 7:00 am. Li is no exception. The first routine task of a resident is to do room visits, to ask the patients about their symptoms, change dressings, administer shots, prescribe medications, and solve all sorts of problems. Only then can the resident go to the operating room without any nagging worries.

Also, it is the job of the resident to do the preparatory work before an attending physician begins operating: cleaning out the patient's intestines, inserting the stomach and urinary tubes, and so on. Then, after assisting in the operation, the resident is responsible for seeing the patient to the intensive care unit (ICU) or ordinary ward.

For minor operations like appendectomies or hernias, several can be done in one day. But for complex procedures, doctors and nurses may enter the operating room in the morning and still not be out by the end of the shift that evening. Li describes a six-hour procedure in which he participated: The patient was suffering from a malignant tumor on the common bile duct, which connects to the hepatic duct, bile duct, and pancreatic duct. Because it affected so many organs, the surgery was extremely difficult. Seven persons-the assistant chief of the hospital, a chief resident, a resident, an anesthe-siologist, and three nurses-labored for those six hours to complete the job. When they left the operating room it was already 7:30 in the evening.

No matter how exhausting a day in surgery, the resident must still find time to write up each patient's chart, detailing condition, diagnosis, and treatment. As if that were not a heavy enough workload, every month a resident must take seven or eight night shifts, working straight through 36 hours from the first day through the following day's normal shift. This leaves the resident in surgery little time for socializing, and Li's former girlfriend left him for that very reason.

It's finally my turn!

The bloody scene of an operation is routine to surgeons like Li. Unlike others who tremble the first time they have to wield the scalpel and who require much training to work steadily, Li seems to have been born for the job. He describes his feeling as "excited" at the time of his first operation, thinking "It's finally my turn to operate!"

Cutting and sewing are essential skills for the surgeon. These are not learned from books, but must be developed in the operating room under the guidance of a more experienced physician. Thus there is a more obvious sense of hierarchy and of the "master-acolyte" relationship in surgery.

Li's first operation was an appendectomy on a five- or six-year-old boy. Li was guided by a resident two years ahead of him, who taught him that-for reasons of appearance-surgeons should leave as small a scar as possible on women and children. This is especially so for tykes, since scars will expand as they grow.

Chung Hsiao miracles

Li is pursuing general surgery, which mainly involves abdominal procedures. Because the abdomen is the site of the gastro-intestinal system, vital for the nutrition of the entire body, it is more complex and treatment is relatively difficult. But, correspondingly, there is a greater sense of challenge, which is what attracts Li. He says proudly that in his ten months at the hospital he has participated in two "Chung Hsiao miracles."

The "miracles" refers to treatment of patients suffering from closed-off intestines. Because the intestine is destroyed, waste leaks into the abdomen. Seeing these cases, at first doctors just shook their heads, and gave the patients little chance for survival.

Li, who was in charge of post-operative care of the patients, explains that it is an ordeal to care for patients with this condition: If waste leaks into the abdominal cavity, it is very easy for the patient to be infected, especially by anaerobic bacteria. Anaerobic bacteria are a big headache for health professionals, since it is no easy task to wipe them out with antibiotics. However, these bacteria cannot survive in an environment with oxygen. Therefore, after surgery the patient's incision is not closed; it is merely held together with a large pin. The wound must be meticulously cleaned and have the dressings changed three or four times each day, with the procedure taking about an hour each time.

After three months under Li's dedicated care, both have already left the hospital.

As long as I am happy....

During his two years as a resident, despite facing bloody sights daily and working to exhaustion, Li has never regretted his choice. Even if surgeons don't make as much money as they used to, Li doesn't really care. What concerns and saddens him is the deterioration in patient-doctor relations.

A doctor must be psychologically prepared for the fact that suffering patients are often moody and unhappy, but Li has found the current situation even worse than expected.

Not long ago he gave emergency treatment to a patient who had had an appendectomy at another hospital. The patient had gone to the hospital only after suffering abdominal pain for three days, by which time the appendix had burst. Though the appendix had been removed, it was impossible to remove all the impurities from the patient. This seems completely understandable, but when it was explained to the patient, his first response was, "So, can I sue?"

"Once a teacher told me that, though it was a fine aspiration to become a surgeon, I should only do it after achieving a certain amount of wealth and leisure. He said this wasn't a very suitable time to make a living as a surgeon," Li relates. At the time he didn't take the teacher too seriously, but what the latter said seems more and more to be the case: long working hours, relatively low rewards, possible lawsuits. . . .

Li says that, although many of his classmates were also interested in surgery, after weighing these pitfalls, they opted for other specializations. Li has no ambitions to go into private practice or become famous. Though he is bucking the trend, he still feels (at least so far) that "all I want is to be an ordinary doctor. If I am interested in what I am doing, and am happy with life, that's enough."

When you think about it, the comic book surgeon Black Jack, though working on his own, isn't really all that bizarre a figure. It's just that his heroic commitment is a little anachronistic. But that is exactly what is lacking in the present day.