Placeholder Image

字幕列表 影片播放

  • TEDxTaipei invited me to speak in thisBreaking Throughsession.

    主持人要我講正向的破壞

  • 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 readsWorld'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