I thought I might as well share my own story.

我當時想了老半天

Among all the physicians in Taiwan,

想說不如講自己的故事好了

I am probably the one ER doctor who has seen the most cadavers.

在台灣的醫生裡面

I've seen many cases of life and death.

我大概是看過死人最多的醫生

Perhaps that's why I'm suited to share such stories on this stage.

在生死之間看過最多

There's a joke about

所以要我來講生死的故事應該是最恰當

the most famous physician -- Dr. Yeh

台灣最有名的醫生

here in Taiwan.

有人開玩笑說是葉醫師

After Taichung First Lady's car accident,

很多人都聽過這個笑話

a patient went to Chi-Mei Hospital in Liu-Ying city

邵曉玲事件後

to seek a doctor named Yeh.

有人跑到柳營奇美醫院

The staff in the hospital said

說要找一位葉醫師

that there's no Dr. Yeh.

他們急診室出來說

"There is, " said the patient.

我們沒有一個姓葉的

"I was told that his name is 'Yeh Ker-mo' (ECMO: Extra-Corporeal Membrane Oxygenation).

那個民眾說有有有

This Dr. Yeh was the one who saved the first lady's life!"

有個叫葉克膜的

Speaking of ECMO, its concept is quite easy to understand.

當年邵曉玲就是被他救起來了

Blood flows from femoral vein

其實葉克膜很簡單

and passes through a pump,

他就是靜脈血頸流出來

also known as an artificial heart.

經過一個pump

The blood then passes through membrane oxygenator,

就是人工心臟

which acts as a pair of artificial lungs.

再經過一個氧合器

Afterwards, the blood re-enters the body.

就是人工肺臟

So, ECMO is a temporary substitute of a human's cardiovascular system.

再送回身體

From another perspective,

就是暫時取代心肺功能

it is a host that represents an artificial heart

那實體上大概就是這個樣子

that pumps blood to the oxygenator and back to the body.

就是一個主機當人工心臟

As a matter of fact, ECMO technique

到氧合氣再送回去

was already available and widely used

這個葉克膜

at the National Taiwan University (NTU) Hospital

在邵曉玲之前

since 1994 prior to the first lady's car accident.

台大醫院在1994年就有葉克膜

It was only since her incident that folks in Taiwan are aware of the ECMO technique.

已經用很久了

It's similar to the saying: "One can spend decades painting in relative obscurity,"

邵曉玲事件算是

"but the world only sees the artist's finished masterpiece."

十年寒窗無人問

That's just my personal opinion.

一舉成名天下知

ECMO became a household term due to its overexposure from Taiwan's media press.

我想是這樣的

There's no doubt that ECMO technique has its relatively successful cases.

葉克膜在台灣的新聞媒體炒作之下

One prominent example is the case of singer Jay Chou's backup dancer.

的確它有非常成功的案例

One day, this patient was admitted with fulminant myocarditis,

像這個是周杰倫的舞群

and was undergoing cardiac arrest.

有一天猛爆性心肌炎

I would like to show you a photo of her at the time,

心臟就不跳了

with the patient lying on her hospital bed.

那為什麼這張幻燈片

The eyes of this patient were wide open,

他躺在床上時我特別照一張？

and were staring straight,

他的眼睛大大的

reading the flat lines showing on the ECG screen.

看著他的螢幕

As a result of fulminant myocarditis,

可是他的螢幕全部都是平的

the patient's heart stopped beating.

因為他猛爆性心肌炎

She suffered a cardiac arrest.

他的心臟不跳了

This is a biopsy of her cardiac muscle

幾乎是停止的

magnified 100 times under the microscope.

這是一百倍底下的心肌切片

Even under this type of magnifying power,

就是病理切片

it's still quite hard to see.

在一百倍底下

However, magnified 400 times will be much clearer.

還不是看得很清楚

Those blue spots are lymphocytes.

如果到四百倍底下就很明顯了

From here, we can see a serious case of fulminant myocarditis.

藍色一點一點的就是淋巴球

Lymphocytes infiltrated her entire heart,

所以很清楚這是個很厲害的猛爆性心肌炎

which caused sudden cardiac arrest.

整個心臟都被淋巴球浸潤

The patient stared at the screen,

心臟幾乎就不跳了停止了

as it displayed no signs of a working heart.

他的眼睛大大的看著他的螢幕

After the ninth day,

他的心臟幾乎已經不動了

after a heart and a kidney transplant,

可是在九天之後

She returned to dance in less than one month's recovery.

心臟加腎臟移植

It was a great miracle in modern medicine.

他不到一個月就回去跳舞了

In modern medical records,

所以這是現代醫學的奇蹟

this patient holds the longest record for CPR survival:

在醫學的文獻上

4 hours.

CPR最久還有救回來的就是這個案例

CPR was performed on her from Cathay General Hospital to NTU Hospital.

4個小時

When physicians tried ECMO technique at the NTU hospital,

因為他是從國泰醫院CPR壓到台大醫院

they found that over 100 doses

在台大醫院要裝葉克膜的時候

of cardiotonic drugs

發現強心劑已經打了一百支了

were already given to her.

所以骨動脈骨靜脈

When an incision was made

已經縮的比鉛筆還細了

to insert an ECMO tube,

所以突然切開這個傷口

the patient's veins and arteries were too narrow.

要放的時候

Therefore, CPR had to be conducted again

管子放不進去

until she was in the operating room.

所以再繼續壓

Surgeons had to saw open the patient's chest

壓到開刀房

to insert ECMO tubes from the top.

直接鋸胸

The entire procedure sounds surreal right now.

從上面放葉克膜

Every time I recall this case, I always say it's a modern medical miracle.

在這個聽起來很神奇的案例

The fact that a person's heart had stopped for 9 days.

所以我每次說這是現代醫學的奇蹟

And after enduring heart and kidney transplants,

一個人九天幾乎沒有心臟功能

a 4 hour CPR,

在心臟移植跟腎臟移植之後

she could still survive.

經歷四小時CPR

Here is another patient case.

還可以救回來

The headline reads ”World's First:

這是另外一個案例

Miracle of Taiwan".

還寫個什麼全球首例

Man without heart for 16 days.

台灣奇蹟

In this case, the patient is a 56-year-old man.

男無心臟活16天

He had a tooth decay.

這是一個56歲的男生

Bacteria from the cavity went into the blood,

他蛀牙

and spread to the portions of the heart.

細菌後來就跑到血流裡面

It caused a pus buildup.

跑到心臟

The patient went to a different hospital

後來就化膿

where the surgical team opened up his chest,

在其他醫院

and began to eliminate

打開心臟看一看

infected tissues of the heart.

這好像爛爛的

The team continued to remove

給它剪一剪

more affected tissues

這裡也爛爛的

until not much of the muscular organ was left.

也給他剪一剪

So what can the team do now?

最後整個心臟都剪掉了

Transfer this patient to NTU hospital.

那怎麼辦?

It seems that NTU hospital is the last line of medical defense in Taiwan.

轉到台大醫院去

NTU hospital has to take patients in.

反正我是這樣講臺大醫院是台灣最後一道防線

In the first case, the case was cardiac arrest.

還是要做沒辦法

This case is more extreme.

剛才是有心臟不會跳

This is a man with not much of a heart left.

這個更厲害

It was almost all surgically removed.

這個是連心臟都沒有

When the patient was transferred to NTU hospital,

剪掉了

because of the state he was in,

到台大醫院的時候

our medical team had to use two ECMOs.

因為幾乎沒有心臟功能

Look at this slide.

所以用兩台葉克膜

There are two ECMO devices.

看銀幕上

This one is even more unbelievable.

兩台葉克膜

Since he didn't have a heart left,

這個更厲害

so the ECG displayed a completely flat line.

這個是連心臟都沒有

There's not much to explain here.

心電圖乾脆就一條線了

This is his CT scan result.

連想都不用想了

Theoretically,

這是給他做電腦斷層

there should have been a heart in his thorax.

理論上

However, the heart is missing here.

胸腔中間應該有個心臟

There are only tubes.

可是現在沒有心臟

After 16 days,

只看到一些管子

our surgical team performed a heart transplant surgery on this patient.

這個病人在十六天以後

Cardiologist surgeon Dr. Wan showed me this.

我們給他做心臟移植

Dr. Wan said during the surgery,

這個是心臟外科汪教授給我看的

he opened the patient's chest

他說他那時給他做心臟移植

and had expected a heart in the thorax.

鋸胸以後

However, there were only plastic tubes

理論上應該有個心臟在中間

connecting to the ECMO.

他只看到一些塑膠管子

The patient had no heart at all.

接到葉克膜上

And after 16 days, the heart transplant surgery was completed.

所以這個病人是完全沒有心臟

The patient was discharged later.

十六天以後再做心臟移植

Here is the Straits Times of Singapore.

還是很清醒地回家

A vendor I know sent me an e-mail from Singapore.

這個是新加坡海峽日報的報紙

He told me that we were featured in the Straits Times.

有一天有個廠商從新加坡寄e-mail給我

16 days without heart

說你們在新加坡上了報紙

A person had lived for 16 days without a heart.

16 days without heart

But after receiving heart transplant,

一個人沒有心臟十六天

he still went home in good shape.

經過心臟移植以後

This is a third case.

還是很健康的回家

He's a 26-year-old aboriginal Taiwanese.

這是另外一個案例

He went swimming even when he was seriously drunk.

這是一個二十六歲的原住民

Jokingly, he probably thought he was Li Bai the poet.

喝酒醉後還去游泳

The pond he swam in was really unsanitary.

他還以為他是李白

He choked on water.

台灣的池塘太髒了

As a result,

所以他一嗆到

he caught a severe case of pneumonia.

不得了

He'd relied on ECMO for 117 days.

就很嚴重的肺炎了

Look at his lungs.

這個葉克膜用了117天

After he ingested unclean water,

你看他的肺臟

his condition worsened to a severe case of pneumonia.

因為嗆到以後

This is called acute respiratory distress syndrome.

幾乎引起很厲害的肺炎

The lungs became abnormally white.

這個叫急性呼吸窘迫症

He lived on ECMO for 117 days.

整個肺臟都白掉了

We can see clearly from this slide.

這個葉克膜用了117天

For one entire month,

從這個圖可以很清楚地看到

the patient's ventilation volume

他有差不多長達一個多月的時間

did not exceed 100 c.c.

呼吸的通氣量

But the patient still recovered.

不到100c.c

In short,

不過最後還是慢慢恢復

in the these three medical cases,

所以

the patient without a heart,

從剛才的案例裡面

the patient undergoing cardiac arrest,

沒有心臟

or the patient with lung failure,

甚至有心臟不會跳

with the help of ECMO,

甚至幾乎完全沒有肺臟功能

no matter whether 9 days later

在葉克膜的使用之下

or even 100 days afterwards,

壞的就算經過九天十六天

after a heart transplant

甚至可以到一百多天

or lung transplant,

然後可以經過心臟移植

their lives were saved.

甚至肺臟移植

It is really incredible.

或是等他自己好

To be honest...

這實在太神奇了

In recent history, ECMO has retained

所以坦白講

a high level of awareness

葉克膜會在台灣的歷史上

thanks to the media presses in Taiwan.

會這麼有名

The reason why folks know about ECMO,

在媒體的炒作之下

is because of past success cases,

這麼有名

and also because of the first lady in Taichung,

他還是有些很成功的案例

and famed astrologer Nick Yen.

當然也包括邵曉玲

However,

星星王子

the media usually

可是是這樣

only reports on the successful stories.

通常媒體

Reporters don't write failed cases.

成功地會拿出來報導

Hidden from the public eye.

失敗的他就不會講了

As a critical care physician,

藏起來了

I am certainly glad to encounter successful patient cases.

做一個重症醫學的醫生

However, there are cases that are not as successful.

看到成功的案例當然很高興

This baby was one and half months old.

可是失敗的

He suffered from a congenital heart disease.

這是一個出生一個半月

After undergoing a heart surgery,

先天性心臟病

the baby still could not live without a heart-lung machine.

心臟手術以後

So, we hooked the baby up to an ECMO.

沒辦法脫離心肺機

The ECMO was inserted in the baby's heart.

所以裝了葉克膜

After the procedure,

就插在心臟上

in three days,

裝葉克膜

the baby's feet turned black.

可是不到三天

Let's zoom in.

腳就黑掉了

Look at his tiny, blackened feet.

我們看看他的特寫

So now, as a physician,

腳黑掉了

you have to make a decision.

這時候作為一個醫生

Should you amputate his tiny feet

他就面臨一個選擇

to try to save his life?

你是要把雙腳剁掉

Or should you just give up

繼續再救

and let him go?

還是算了

These types of decisions are incredibly stressful to make.

不要再玩了

But if you can't make the call,

這就是一個很大的壓力

then the next case is more difficult to gauge.

如果這一題你都這麼困難決定的話

Here is a 7-year-old boy

那這一題更困難

suffering from streptococcus pneumonia.

這是一個七歲的男生

His condition worsened to acute respiratory distress syndrome.

肺炎雙球菌敗血症

So the medical team decided to employ ECMO technique.

後來引起呼吸窘迫症

After using ECMO, however,

後來裝了葉克膜

there were complications.

可是葉克膜裝下去後

His limbs all turned black.

出現併發症

His adorable eyes would look at you,

四肢都黑掉了

his conscious in a clear state.

他眼睛大大的看著你

He could even ask for water when he was thirsty.

意識清楚

But as a doctor,

也會討水喝

you have to make incredibly hard decisions.

可是做一個醫生

If you want to save him,

你面臨一個選擇

you have to cut off his limbs first,

你如果要救他的話

and continue with further medical treatment.

要把四肢剁掉

And if you give up,

繼續再救

you have to turn off the ECMO.

那如果不救的話

Now think of this:

機器就要關掉

Between life and death,

你想想看

when the patient is in a conscious state,

在生死之間

of course, the doctor's mind is clear, too.

病人頭腦清楚

How would you ask the boy?

當然醫生頭腦也是清楚

"Hi dear"

可是我要怎麼跟他講

"If you want to live"

小弟弟

"I will need to amputate your limbs."

你如果要活下去的話

"Or you'd rather give up,"

我要把四肢剁掉

"and rest in peace?"

還是你就算了

How do you communicate this type of life and death decision

你就不願意再活了

with a 7-year-old?

你如何跟一個七歲的男生

This is the line of work I have to deal with

講這種生死的問題

as a critical care physician.

這就是我當一個重症醫學專家

In the beginning, I made decisions rather logically.

我的心路歷程

I identified everything by patients.

一開始見山是山

Gradually,

就是我有看到一個病人

I targeted diseases, not patients.

後來慢慢地

A diseased heart, for example.

我只看到一個病

Fortunately, when I turned fifty,

看到一個心臟

I gradually realized that I should treat patient as a whole again.

還好我過了五十歲以後

To be quite honest,

我又慢慢看到了病人