that has ever happened to me in my years of working as a palliative care physician.

我想跟你們說說， 在我擔任臨終關懷治療師的時候，

This happened a couple of years ago.

曾經發生過最尷尬的一件事。

I was asked as a consultant to see a woman in her 70s --

那是在好幾年前發生的。

retired English professor who had pancreatic cancer.

我受託去見一位 70 多歲的女士， 擔任她的醫療顧問──

I was asked to see her because she had pain, nausea, vomiting ...

她是一位退休的英文教授， 罹患胰腺癌。

When I went to see her, we talked about those symptoms

我被找去是因為她覺得 疼痛、噁心、想吐......

and in the course of that consultation,

當我去見她的時候， 我們談論了這些症狀；

she asked me whether I thought that medical marijuana might help her.

而在諮詢的過程中，

I thought back to everything

她問我是否認為 藥用大麻能幫助到她。

that I had learned in medical school about medical marijuana,

我回想了所有在醫學院學過的， 關於藥用大麻的知識；

which didn't take very long because I had learned absolutely nothing.

這並不需要很多時間，

And so I told her that as far as I knew,

因為我完全沒學過 任何藥用大麻的知識。

medical marijuana had no benefits whatsoever.

所以我告訴她：

And she smiled and nodded and reached into the handbag next to the bed,

據我所知，藥用大麻 並沒有什麼用處。

and pulled out a stack of about a dozen randomized controlled trials

她微笑並點點頭， 然後從床邊的提袋裡，

showing that medical marijuana has benefits

拿出將近一打的 隨機對照試驗報告，

for symptoms like nausea and pain and anxiety.

結果都顯示藥用大麻有助於減緩 噁心、疼痛、焦慮等症狀。

She handed me those articles and said,

她把那些報告遞給我，並且說：

"Maybe you should read these before offering an opinion ...

「或許你應該先讀讀這些， 再發表意見......醫生。」

doctor."

（笑聲）

(Laughter)

於是我照做了。

So I did.

那天晚上，我把那些報告全讀過了，

That night I read all of those articles and found a bunch more.

還找到了更多的資料。

When I came to see her the next morning,

當我第二天去見她的時候，

I had to admit that it looks like there is some evidence

我不得不承認，

that marijuana can offer medical benefits

看起來的確有一些證據， 支持大麻具有醫療效果；

and I suggested that if she really was interested,

於是我建議， 如果她真的有意願的話，

she should try it.

她應該試一試。

You know what she said?

你知道她怎麼回答嗎？

This 73-year-old, retired English professor?

那位 73 歲的退休英文教授？

She said, "I did try it about six months ago.

她說：「我大約六個月前就試過了。

It was amazing.

它超級棒。

I've been using it every day since.

之後我每天都用，

It's the best drug I've discovered.

這是我所發現過最棒的藥。

I don't know why it took me 73 years to discover this stuff. It's amazing."

我不曉得為何花了 73 年 才發現這個東西，它棒極了。」

(Laughter)

（笑聲）

That was the moment at which I realized

那時我才意識到，

I needed to learn something about medical marijuana

我需要學習藥用大麻相關的知識，

because what I was prepared for in medical school

因為我在醫學院裡所學到的，

bore no relationship to reality.

已經和現實脫節了。

So I started reading more articles, I started talking to researchers,

於是我開始閱讀更多資料， 開始和研究人員交流，

I started talking to doctors,

開始和醫生們交流，

and most importantly, I started listening to patients.

更重要的是， 我開始傾聽患者的聲音。

I ended up writing a book based on those conversations,

基於那些對話，我後來寫了一本書，

and that book really revolved around three surprises --

那本書以三件 「意料之外」的事件為中心──

surprises to me, anyway.

反正對我來說是意料之外的，

One I already alluded to --

第一件事我剛剛已經提到了──

that there really are some benefits to medical marijuana.

藥用大麻的確是有一些效果的。

Those benefits may not be as huge or as stunning

或許那些藥用大麻的成效，

as some of the most avid proponents of medical marijuana

並不像某些積極擁護者 所希望我們相信的──

would have us believe,

藥用大麻具有顯著或者驚人的效果，

but they are real.

但是它真的有效。

Surprise number two:

第二個意料之外是：

medical marijuana does have some risks.

藥用大麻也具有某些危害。

Those risks may not be as huge and as scary

但那些危害並沒有嚴重或者恐怖到，

as some of the opponents of medical marijuana would have us believe,

藥用大麻的反對者 想讓我們相信的程度，

but they are real risks, nonetheless.

儘管如此，它的確具有危害。

But it was the third surprise that was most ...

但第三個意料之外，

surprising.

是最令人驚訝的。

And that is that a lot of the patients I talked with

許多我曾經接觸過，

who've turned to medical marijuana for help,

求助於藥用大麻的患者，

weren't turning to medical marijuana because of its benefits

並不是為了療效而使用藥用大麻的，

or the balance of risks and benefits,

也不是基於危害和效用的平衡，

or because they thought it was a wonder drug,

更不是因為他們覺得 那是一種特效藥，

but because it gave them control over their illness.

而是因為能給予他們 對疾病的控制感，

It let them manage their health

讓他們能用有效果、有效率、

in a way that was productive and efficient

有效益、覺得舒服的方式，

and effective and comfortable for them.

來管控自己的健康。

To show you what I mean, let me tell you about another patient.

為了表達的更清楚， 讓我來聊聊另一位患者。

Robin was in her early 40s when I met her.

我遇到羅繽的時候她 40 多歲，

She looked though like she was in her late 60s.

但她看起來像是快要 70 歲了。

She had suffered from rheumatoid arthritis for the last 20 years,

過去的 20 年，她受到 類風濕性關節炎的折磨，

her hands were gnarled by arthritis,

她的手因為關節炎扭曲，

her spine was crooked,

脊柱也彎了，

she had to rely on a wheelchair to get around.

她必須靠輪椅來移動。

She looked weak and frail,

她在外表上、身體上

and I guess physically she probably was,

看起來很虛弱，一碰即碎；

but emotionally, cognitively, psychologically,

但是在精神上、意識上、心理上，

she was among the toughest people I've ever met.

她是我所遇到過最堅強的人。

And when I sat down next to her

當我在她身邊坐下，

in a medical marijuana dispensary in Northern California

那是在加州北部 一間藥用大麻藥局裡，

to ask her about why she turned to medical marijuana,

我問她為什麼開始使用藥用大麻，

what it did for her and how it helped her,

這對她有什麼作用？如何幫助了她？

she started out by telling me things

她告訴我一些事，

that I had heard from many patients before.

那些也是我從許多患者那裡聽過的：

It helped with her anxiety;

它有助於解決焦慮；

it helped with her pain;

有助於解決疼痛；

when her pain was better, she slept better.

當疼痛減緩時，她就能睡得比較好。

And I'd heard all that before.

這些原因都是我聽過的。

But then she said something that I'd never heard before,

然而她接下來說的， 我卻從來沒聽過：

and that is that it gave her control over her life

藥用大麻讓她能掌控

and over her health.

自己的生活和健康。

She could use it when she wanted,

她可以在想用的時候就用，

in the way that she wanted,

以她想要的方式、

at the dose and frequency that worked for her.

以適合她的用量和頻率使用。

And if it didn't work for her, then she could make changes.

如果沒有效果，她可以做出調整。

Everything was up to her.

所有的事她都能自己作主。

The most important thing she said

最重要的就是，她說：

was she didn't need anybody else's permission --

她不需要得到其他人的允許──

not a clinic appointment, not a doctor's prescription,

不需要預約診所， 不需要醫生的處方，

not a pharmacist's order.

不需要向藥劑師購買。

It was all up to her.

一切都由她作主。

She was in control.

她說了算。

And if that seems like a little thing for somebody with chronic illness,

對於罹患慢性病的人來說， 這是一件小事嗎？

it's not -- not at all.

不是的，完全不是。

When we face a chronic serious illness,

當我們面對嚴重的慢性疾病時，

whether it's rheumatoid arthritis or lupus or cancer or diabetes,

不論是類風濕性關節炎、 狼瘡、癌症、糖尿病

or cirrhosis,

還是肝硬化，

we lose control.

我們都失去了控制權。

And note what I said: "when," not "if."

注意我是說「當」你患病的時候， 而不是用「如果」。

All of us at some point in our lives will face a chronic serious illness

我們所有人，到了人生的某個階段， 都要面對嚴重的慢性病，

that causes us to lose control.

這導致我們失去控制權。

We'll see our function decline, some of us will see our cognition decline,

我們看著自己的機能衰退， 有的人還會經歷智力衰退，

we'll be no longer able to care for ourselves,

我們不再有能力照顧自己，

to do the things that we want to do.

做我們自己想做的事。

Our bodies will betray us,

我們的身體終將背叛我們，

and in that process, we'll lose control.

而在那個過程中， 我們失去了控制權。

And that's scary.

這挺嚇人的。

Not just scary -- that's frightening,

不止是嚇人，簡直令人恐懼，

it's terrifying.

寢食難安。

When I talk to my patients, my palliative care patients,

我和我的病患， 也就是臨終關懷患者交流時，

many of whom are facing illnesses that will end their lives,

他們之中有許多人 正面臨將奪走他們生命的疾病，

they have a lot of be frightened of --

他們對很多事情感到恐懼──

pain, nausea, vomiting, constipation, fatigue,

痛楚、噁心、嘔吐、便秘、疲倦、

their impending mortality.

即將到來的死亡。

But what scares them more than anything else

但和其他所有事相比，

is this possibility that at some point,

他們更恐懼的事情， 是可能在某個時候，

tomorrow or a month from now,

也許是明天，或是下個月，

they're going to lose control of their health,

他們將會失去對自己健康的控制權，

of their lives,

對生活的控制權，

of their healthcare,

對醫療的控制權，

and they're going to become dependent on others,

他們變得必須依賴他人，

and that's terrifying.

這是很可怕的。

So it's no wonder really that patients like Robin,

所以像羅繽這樣的患者，

who I just told you about,

就是我剛剛告訴過你們的，

who I met in that clinic,

在診所裡遇到的那一位，

turn to medical marijuana

不意外的，她會選擇使用藥用大麻，

to try to claw back some semblance of control.

是為了試圖抓住 一些表面上的控制權。

How do they do it though?

但他們怎麼做到的呢？

How do these medical marijuana dispensaries --

這些販售藥用大麻的藥局，

like the one where I met Robin --

例如我遇到羅繽的那一間，

how do they give patients like Robin back the sort of control that they need?

他們是如何讓羅繽這樣的患者

And how do they do it

獲得所需要的控制權呢？

in a way that mainstream medical hospitals and clinics,

他們是如何做到那些，

at least for Robin, weren't able to?

主流的醫院和診所

What's their secret?

無法對羅繽做的？

So I decided to find out.

他們的秘密是什麼？

I went to a seedy clinic in Venice Beach in California

我決定要搞清楚。

and got a recommendation

我去了位於加州威尼斯海灘 一間破破的診所，

that would allow me to be a medical marijuana patient.

拿到一份同意書，

I got a letter of recommendation that would let me buy medical marijuana.

允許我成為一名使用 藥用大麻的病患。

I got that recommendation illegally,

我拿到了一份同意書， 能讓我購買藥用大麻。

because I'm not a resident of California --

我用不合法的方式拿到同意書，

I should note that.

因為我並不是加州居民──

I should also note, for the record,

我應該先聲明這點。

that I never used that letter of recommendation to make a purchase,

我還要聲明，以供紀錄，

and to all of you DEA agents out there --

就是我從未使用 那份同意書購買大麻，

(Laughter)

以上的聲明是要給 美國緝毒局的調查員的──

love the work that you're doing,

（笑聲）

keep it up.

要熱愛你們的工作，

(Laughter)

繼續堅持下去！

Even though it didn't let me make a purchase though,

（笑聲）

that letter was priceless because it let me be a patient.

儘管我並沒有 用這份同意書進行購買，

It let me experience what patients like Robin experience

但是它仍然無比珍貴， 因為它讓我成為一名患者，

when they go to a medical marijuana dispensary.

讓我體驗到， 像羅繽這樣的患者所經歷的，

And what I experienced --

體驗到她們在藥用大麻藥局 所得到的經驗。

what they experience every day,

而我所體驗到的──

hundreds of thousands of people like Robin --

就如同成百上千位

was really amazing.

像羅繽一樣的人， 每天都在經歷的──

I walked into the clinic,

簡直是棒極了。

and from the moment that I entered many of these clinics and dispensaries,

我走進了藥局，

I felt like that dispensary, that clinic,

從我走進這些 診所和藥局的那一刻起，

was there for me.

我感覺到，這間藥局、這間診所，

There were questions at the outset about who I am,

是為我設立的。

what kind of work I do,

一開始的時候， 他們會詢問一些問題，

what my goals are in looking for a medical marijuana prescription,

例如我是誰？我從事什麼工作？

or product,

我希望藉由藥用大麻處方或產品

what my goals are, what my preferences are,

達到什麼效果？

what my hopes are,

我的目標是什麼？喜好是什麼？

how do I think, how do I hope this might help me,

我的期望是什麼？

what am I afraid of.

我是怎麼想的？ 我期望帶來什麼幫助？

These are the sorts of questions

我擔心什麼？

that patients like Robin get asked all the time.

像羅繽這樣的患者，

These are the sorts of questions that make me confident

會不斷地被問到這些類型的問題。

that the person I'm talking with really has my best interests at heart

像這樣的問題，會讓我有信心，

and wants to get to know me.

覺得這個和我談話的人， 是從內心關注我的利益，

The second thing I learned in those clinics

並且想要更瞭解我。

is the availability of education.

我從這些診所學到的第二件事，

Education from the folks behind the counter,

是可以獲得許多指導。

but also education from folks in the waiting room.

除了從櫃台裡的人得到指導，

People I met were more than happy, as I was sitting next to them --

也從等候室裡的其他人得到指導。

people like Robin --

當我坐在他們旁邊時， 這些人都很高興──

to tell me about who they are, why they use medical marijuana,

他們都是像羅繽那樣的人──

what helps them, how it helps them,

他們告訴我：他們是誰， 為什麼使用藥用大麻？

and to give me advice and suggestions.

什麼幫助了他們？如何幫助了他們？

Those waiting rooms really are a hive of interaction, advice and support.

並給我意見和建議。

And third, the folks behind the counter.

那些等候室就像是提供交流、 建議和支持的場所。

I was amazed at how willing those people were

第三，坐在櫃檯裡面的人，

to spend sometimes an hour or more talking me through the nuances

讓我驚訝的是， 他們非常心甘情願的，

of this strain versus that strain,

願意花一個小時甚至更多時間， 跟我討論許多細節，

smoking versus vaporizing,

像是這個品種和那個品種的比較，

edibles versus tinctures --

透過吸菸還是霧化方式，

all, remember, without me making any purchase whatsoever.

食用的還是酊劑──

Think about the last time you went to any hospital or clinic

還記得嗎，這是在我還沒有 購買任何東西的情況下。

and the last time anybody spent an hour explaining those sorts of things to you.

回憶一下你上次去醫院或診所，

The fact that patients like Robin are going to these clinics,

以及上一次有人花了一個小時 向你詳細解釋，是什麼樣的情況？

are going to these dispensaries

實際上像羅繽這樣的患者， 會去這些診所，

and getting that sort of personalized attention

會去這些藥局，

and education and service,

得到這種程度的關注、

really should be a wake-up call to the healthcare system.

指導和服務，

People like Robin are turning away from mainstream medicine,

真是現今醫療系統的警鐘。

turning to medical marijuana dispensaries

像羅繽這樣的人，會放棄主流醫療，

because those dispensaries are giving them what they need.

轉向藥用大麻藥局尋求協助，

If that's a wake-up call to the medical establishment,

是因為那些藥局 能給予他們真正需要的。

it's a wake-up call that many of my colleagues are either not hearing

如果那是對於現今醫療機構的警鐘，

or not wanting to hear.

那也是針對我那些不去聆聽，

When I talk to my colleagues, physicians in particular,

或是不願聆聽的同僚。

about medical marijuana,

當我告訴我的同僚，特別是內科醫生

they say, "Oh, we need more evidence.

關於藥用大麻的事，

We need more research into benefits, we need more evidence about risks."

他們總是說： 「哦！我們需要更多證據。

And you know what? They're right.

我們需要更多關於成效的研究， 以及更多關於危害的證據。」

They're absolutely right.

你知道嗎，他們是對的。

We do need much more evidence about the benefits of medical marijuana.

他們絕對正確。

We also need to ask the federal government to reschedule marijuana to Schedule II,

我們的確需要更多證據， 來證明藥用大麻的成效。

or to deschedule it entirely to make that research possible.

我們也需要要求聯邦政府， 把大麻重訂為二類藥物，

We also need more research into medical marijuana's risks.

甚至是完全取消限制， 才能讓研究進行。

Medical marijuana's risks --

我們也需要針對藥用大麻的危害 進行更多研究。

we know a lot about the risks of recreational use,

關於藥用大麻的危害──

we know next to nothing about the risks of medical marijuana.

對於一般娛樂用大麻的危害， 我們了解很多，

So we absolutely do need research,

但是對於藥用大麻的危害， 我們幾乎一無所知。

but to say that we need research

所以我們當然需要進行研究，

and not that we need to make any changes now

但話說回來，我們需要研究

is to miss the point entirely.

並不等於現在就不必做出改變，

People like Robin aren't seeking out medical marijuana

這是完全忽略了重點。

because they think it's a wonder drug,

像羅繽那樣的人使用藥用大麻，

or because they think it's entirely risk-free.

不是因為他們認為那是萬能藥，

They seek it out because the context in which it's delivered and administered

也不是因為他們覺得沒有風險。