WEBVTT 00:00:15.750 --> 00:00:19.447 They asked me to talk about “positive destruction.” 00:00:19.447 --> 00:00:24.946 So I thought why not just talk about myself? 00:00:24.946 --> 00:00:26.926 I am probably the one 00:00:26.926 --> 00:00:30.448 that has seen the most deaths 00:00:30.448 --> 00:00:32.901 among the doctors in Taiwan. 00:00:32.901 --> 00:00:36.947 So I think I can share something about life and death. 00:00:36.947 --> 00:00:39.314 There's a joke: 00:00:39.314 --> 00:00:40.871 the most famous doctors in Taiwan is Dr.(?). 00:00:40.871 --> 00:00:42.744 You might know this joke 00:00:42.744 --> 00:00:44.530 After Shao Hsiao-Ling accident happened, 00:00:44.530 --> 00:00:46.613 a person went to Chi-Mei Hospital in Liu-Ying 00:00:46.613 --> 00:00:48.697 to see a doctor named Mo 00:00:48.697 --> 00:00:49.536 The staff in the hospital said 00:00:49.536 --> 00:00:51.988 that there's no Dr. Mo. 00:00:51.988 --> 00:00:53.206 "There is , " said the person. 00:00:53.206 --> 00:00:56.421 "His name is EcMo! 00:00:56.421 --> 00:01:00.023 He saved Shao's life! 00:01:00.038 --> 00:01:01.341 It’s easy to understand ECMO actually. 00:01:01.341 --> 00:01:03.650 Venous blood 00:01:04.134 --> 00:01:05.149 passes through a pump, 00:01:05.149 --> 00:01:06.012 which is an artificial heart, 00:01:06.012 --> 00:01:07.293 and then passes through an oxygenator, 00:01:07.409 --> 00:01:08.558 which is an artificial lungs, 00:01:08.558 --> 00:01:10.480 and in the end, goes back to the body. 00:01:10.480 --> 00:01:12.939 It is a temporary replacement of Cardiovascular Function. 00:01:12.939 --> 00:01:14.973 it’s look like this. 00:01:14.973 --> 00:01:17.486 It’s a machine 00:01:17.486 --> 00:01:20.066 operating as an artificial heart 00:01:20.066 --> 00:01:22.695 As a matter of fact, 00:01:22.695 --> 00:01:24.292 ECMO has been used for a long time. 00:01:24.292 --> 00:01:27.504 National Taiwan University Hospital 00:01:27.504 --> 00:01:30.054 has used ECMO since 1994. 00:01:30.054 --> 00:01:31.933 Now everyone in Taiwan knows it because of Shao ’car accident. 00:01:31.933 --> 00:01:33.384 It’s similar to the old saying” One can study for ten years in obscurity, 00:01:33.384 --> 00:01:36.239 but as soon as one passes the examination the whole world pays attention “ 00:01:36.239 --> 00:01:37.595 It became famous 00:01:37.595 --> 00:01:41.035 due to the media. 00:01:41.035 --> 00:01:43.731 There are successful cases with ECMO of course. 00:01:43.731 --> 00:01:46.645 his man is a backup dancer for Jay Chou. 00:01:46.645 --> 00:01:48.761 He suffered an Acute myocarditis one day. 00:01:48.761 --> 00:01:50.947 so his heart stopped. 00:01:50.947 --> 00:01:52.999 Why did I put the slide, 00:01:52.999 --> 00:01:56.646 and why did I take a picture of him? 00:01:56.646 --> 00:01:57.922 His eyes opened wide, 00:01:57.922 --> 00:01:59.414 staring at the screen. 00:01:59.414 --> 00:02:01.739 The lines on the screen were all flat 00:02:01.739 --> 00:02:03.317 His heart stopped, 00:02:03.317 --> 00:02:05.474 because of Acute myocarditis. 00:02:05.474 --> 00:02:07.819 The heart stopped beating. 00:02:07.819 --> 00:02:10.636 This is his biopsy of cardiac muscle, 00:02:10.636 --> 00:02:12.395 ranging 100 under the microscope. 00:02:12.395 --> 00:02:13.727 It’s not clear enough 00:02:13.727 --> 00:02:16.312 when it ranges in 100. 00:02:16.312 --> 00:02:18.831 And it’s crystal clear ranging 400. 00:02:18.831 --> 00:02:22.140 Those blue spots are lymphocytes. 00:02:22.140 --> 00:02:26.092 Obviously, it’s a serious Acute myocarditis. 00:02:26.092 --> 00:02:29.439 The heart was soaked in lymphocytes 00:02:29.439 --> 00:02:33.818 and it stopped. 00:02:33.818 --> 00:02:37.062 He stared at the screen 00:02:37.062 --> 00:02:40.421 He stared at the screen. 00:02:40.421 --> 00:02:42.880 His heart ‘d stopped for nine days, 00:02:42.880 --> 00:02:44.558 however, with heart and kidney transplant, 00:02:44.558 --> 00:02:46.807 he could dance again in a month. 00:02:46.807 --> 00:02:49.329 It's a miracle in modern medicine 00:02:49.329 --> 00:02:52.406 In modern medicine records, 00:02:52.406 --> 00:02:55.150 he’s the one that is still alive after the longest CPR treatment. 00:02:55.150 --> 00:02:57.291 4 hours. 00:02:57.291 --> 00:03:00.766 He’d been done CPR on his way from Kuo-Tei Hospital to NTU Hospital. 00:03:00.766 --> 00:03:02.808 When they installed ECMO at NTU hospital, 00:03:02.808 --> 00:03:05.015 they found out he’d been injected 100 cardiotonics. 00:03:05.015 --> 00:03:06.683 So his iliac artery and vein 00:03:06.683 --> 00:03:08.746 were narrower than pencils 00:03:08.746 --> 00:03:10.303 So when they opened the wound 00:03:10.303 --> 00:03:10.947 trying to put ECMO in 00:03:10.947 --> 00:03:12.408 ,they were unable to put the tube in. 00:03:12.408 --> 00:03:13.636 They had to do the CPR again, 00:03:13.636 --> 00:03:14.879 until he was sent to the OR. 00:03:14.879 --> 00:03:15.807 They had to saw the chest 00:03:15.807 --> 00:03:18.192 to put ECMO. 00:03:18.192 --> 00:03:22.448 It’s just like magic. 00:03:22.448 --> 00:03:27.160 It is a miracle in modern medicine without saying. 00:03:27.160 --> 00:03:30.330 A man ‘s heart had stopped for 9 days. 00:03:30.330 --> 00:03:34.100 And he was still alive, 00:03:34.100 --> 00:03:36.728 after 4 hours CPR, 00:03:36.728 --> 00:03:39.169 heart ,and kidney transplant. 00:03:39.169 --> 00:03:40.871 This is another case. 00:03:40.871 --> 00:03:42.516 It reads that ”first in the world, 00:03:42.516 --> 00:03:43.943 miracle in Taiwan, 00:03:43.943 --> 00:03:46.421 a man lived without heat for 16 days. 00:03:46.421 --> 00:03:49.746 This is a 56-year-old man. 00:03:49.746 --> 00:03:51.346 He had decayed teeth. 00:03:51.346 --> 00:03:53.396 The bacteria went into the blood, 00:03:53.396 --> 00:03:54.297 arriving at the heart. 00:03:54.297 --> 00:03:55.885 The heart then festered. 00:03:55.885 --> 00:03:57.824 The operation team in the hospital 00:03:57.824 --> 00:03:59.761 opened his chest, 00:03:59.761 --> 00:04:00.561 and was like 00:04:00.561 --> 00:04:01.945 “Well, it looks not well here. Cut it off. 00:04:01.945 --> 00:04:02.796 And it looks not fine here, either. Cut it off too.” 00:04:02.796 --> 00:04:03.849 In the end, 00:04:03.849 --> 00:04:06.866 the whole heart was cut off. 00:04:06.866 --> 00:04:07.861 What should we do? 00:04:07.861 --> 00:04:13.267 “Well, transfer to NTU hospital” 00:04:13.308 --> 00:04:17.128 I always say that NTU hospital is the line of defense in Taiwan. 00:04:17.128 --> 00:04:18.990 Well, we still had to do it. 00:04:18.990 --> 00:04:21.831 In the previous case, the man’s heart cannot beat. 00:04:21.831 --> 00:04:22.543 And here, 00:04:22.543 --> 00:04:23.779 we got a man even without a heart. 00:04:23.779 --> 00:04:25.475 It was cut off, after all. 00:04:25.475 --> 00:04:26.706 When he was transfer to NTU hospital, 00:04:26.706 --> 00:04:28.527 they had to use two ECMOs 00:04:28.527 --> 00:04:30.254 because he had no heart. 00:04:30.254 --> 00:04:31.241 Look at the screen, 00:04:31.241 --> 00:04:32.733 two ECMOs. 00:04:32.733 --> 00:04:34.376 It’s really incredible I have to say. 00:04:34.376 --> 00:04:35.511 He had no heart, 00:04:35.511 --> 00:04:37.747 so ECG showed flat lines. 00:04:37.747 --> 00:04:40.880 There is no heart after all. 00:04:40.880 --> 00:04:42.432 This is his CT result. 00:04:42.432 --> 00:04:43.285 There should have been a heart 00:04:43.285 --> 00:04:45.915 in his thorax. 00:04:45.915 --> 00:04:47.030 However, there was no heart. 00:04:47.030 --> 00:04:49.390 There were only tubes. 00:04:49.390 --> 00:04:51.285 After 16 days, 00:04:51.285 --> 00:04:53.485 they did the heart transplant surgery. 00:04:53.485 --> 00:04:56.408 Cardiologist surgeon Dr.Wan showed me this. 00:04:56.408 --> 00:04:58.472 He said that when he was doing the surgery, 00:04:58.472 --> 00:04:59.494 he should have seen a heart in the thorax 00:04:59.494 --> 00:05:01.938 after opening his chest. 00:05:01.938 --> 00:05:03.830 But there were only tubes 00:05:03.830 --> 00:05:06.634 connecting to the ECMO. 00:05:06.634 --> 00:05:09.179 The patient had no heart at all. 00:05:09.179 --> 00:05:12.196 And after the surgery, 00:05:12.196 --> 00:05:15.317 he was discharged. 00:05:15.317 --> 00:05:18.834 This is The Straits Times in Singapore. 00:05:18.834 --> 00:05:22.161 A friend of mine sent me the e-mail from Singapore. 00:05:22.161 --> 00:05:24.590 He told me that we were in the newspapers. 00:05:24.590 --> 00:05:26.329 16 days without heart
. 00:05:26.329 --> 00:05:27.989 A person had lived for 16 days without heart. 00:05:27.989 --> 00:05:29.219 But after receiving heart transplant, 00:05:29.219 --> 00:05:33.337 he still went home healthily. 00:05:33.337 --> 00:05:35.103 This is the other case. 00:05:35.103 --> 00:05:39.209 He’s a 26-year-old aboriginal. 00:05:39.209 --> 00:05:41.370 He went swimming when he was seriously drunk. 00:05:41.370 --> 00:05:45.080 He thought he was Li Bai I guess. 00:05:45.080 --> 00:05:47.175 But the pond was really dirty. 00:05:47.175 --> 00:05:48.217 He choked on water. 00:05:48.217 --> 00:05:49.618 As a result, he suffered from serious pneumonia. 00:05:49.618 --> 00:05:51.410 It was terrible. 00:05:51.410 --> 00:05:53.393 He’d relied on ECMO for 117 days. 00:05:53.393 --> 00:05:55.187 Look at his lungs. 00:05:55.187 --> 00:05:55.976 This is a serious pneumonia, 00:05:55.976 --> 00:05:57.380 due to choke on water. 00:05:57.380 --> 00:05:59.818 This is called cute respiratory distress syndrome. 00:05:59.818 --> 00:06:01.948 The lungs became white. 00:06:01.948 --> 00:06:05.090 He had used ECMO for 117 days. 00:06:05.090 --> 00:06:09.524 We can see clearly from this picture. 00:06:09.524 --> 00:06:11.860 His respiratory minute volume 00:06:11.860 --> 00:06:13.486 had not exceed 100 c.c 00:06:13.486 --> 00:06:15.155 for almost one month. 00:06:15.155 --> 00:06:18.018 But he still recovered. 00:06:18.018 --> 00:06:19.459 So 00:06:19.459 --> 00:06:21.226 in the previous cases, 00:06:21.226 --> 00:06:22.961 the man lived without heart, 00:06:22.961 --> 00:06:24.606 the man with heart that couldn’t beat, 00:06:24.606 --> 00:06:27.110 or the one’s lungs did not work, 00:06:27.110 --> 00:06:29.308 they all rode out with the use of ECMO. 00:06:29.308 --> 00:06:32.590 Even though they’d waited for 9 days 00:06:32.590 --> 00:06:34.605 or even 100 days. 00:06:34.605 --> 00:06:36.373 They are still alive 00:06:36.373 --> 00:06:37.832 after heart 00:06:37.832 --> 00:06:39.519 and lungs transplant. 00:06:39.519 --> 00:06:41.629 It is really incredible. 00:06:41.629 --> 00:06:42.823 To be honest, 00:06:42.823 --> 00:06:44.578 with the media 00:06:44.578 --> 00:06:45.728 and those successful cases, 00:06:45.728 --> 00:06:47.664 ECMO seems to be really famous 00:06:47.664 --> 00:06:48.695 around the island. 00:06:48.695 --> 00:06:50.572 Of course there are successful cases, 00:06:50.572 --> 00:06:52.259 such as the cases I’ve mentioned 00:06:52.259 --> 00:06:53.761 and Shao. 00:06:53.761 --> 00:06:55.333 However, 00:06:55.333 --> 00:06:56.403 The media usually 00:06:56.403 --> 00:06:58.211 only writes the successful ones. 00:06:58.211 --> 00:06:59.408 They don’t write failure ones. 00:06:59.408 --> 00:07:00.942 So we usually can’t see them. 00:07:00.942 --> 00:07:04.117 As a Critical care medicine doctor, 00:07:04.117 --> 00:07:06.322 I am absolutely to see the successful cases. 00:07:06.322 --> 00:07:08.187 Nevertheless, there are unsuccessful ones. 00:07:08.187 --> 00:07:12.953 This baby was one and half months old. 00:07:12.953 --> 00:07:14.767 He suffered from Congenital Heart Disease. 00:07:14.767 --> 00:07:16.324 After heart transplant, 00:07:16.324 --> 00:07:17.886 he still could not live without a heart-lung machine. 00:07:17.886 --> 00:07:19.643 So 00:07:19.643 --> 00:07:20.668 they used ECMO 00:07:20.668 --> 00:07:21.965 connected to his heart. 00:07:21.965 --> 00:07:22.989 But not in three days, 00:07:22.989 --> 00:07:24.209 his feet turned black. 00:07:24.209 --> 00:07:25.379 Let’s zoom in. 00:07:25.379 --> 00:07:27.028 Look at his feet. 00:07:27.028 --> 00:07:28.488 So now, as a doctor. 00:07:28.488 --> 00:07:29.993 You had to make the call. 00:07:29.993 --> 00:07:31.510 Are you going to save his life, 00:07:31.510 --> 00:07:32.615 by having his feet amputated. 00:07:32.615 --> 00:07:33.580 Or will you just give up 00:07:33.580 --> 00:07:34.835 let him go? 00:07:34.835 --> 00:07:37.695 No matter what you do, you will suffer from pressure. 00:07:37.695 --> 00:07:40.091 But if you can’t make the call, 00:07:40.091 --> 00:07:42.114 This one is definitely much more difficult. 00:07:42.114 --> 00:07:44.830 This is a 7-year-old boy 00:07:44.830 --> 00:07:46.151 suffering from pneumoniae septicemia 00:07:46.151 --> 00:07:48.962 It resulted in cute respiratory distress syndrome. 00:07:48.962 --> 00:07:51.538 So they used ECMO. 00:07:51.538 --> 00:07:53.829 After using ECMO, 00:07:53.829 --> 00:07:55.044 there was complication. 00:07:55.044 --> 00:07:56.889 His limbs all became black. 00:07:56.889 --> 00:07:58.493 He stared at you with his eyes open wide 00:07:58.493 --> 00:07:59.316 consciously. 00:07:59.316 --> 00:08:00.711 He could even ask for water when he was thirsty. 00:08:00.711 --> 00:08:02.645 But as a doctor, 00:08:02.645 --> 00:08:04.540 you have to make a decision. 00:08:04.540 --> 00:08:05.963 If you’re going to save him, 00:08:05.963 --> 00:08:07.541 you have to cut off his limbs 00:08:07.541 --> 00:08:08.983 all his limbs. 00:08:08.983 --> 00:08:10.868 And if you give up, 00:08:10.868 --> 00:08:12.332 you have to turn off the ECMO. 00:08:12.332 --> 00:08:14.080 Now think of this: 00:08:14.080 --> 00:08:16.298 two roads diverged in the yellow woods. 00:08:16.298 --> 00:08:17.801 The patient is conscious. 00:08:17.801 --> 00:08:21.887 Well, the doctor is conscious, too. 00:08:21.887 --> 00:08:23.788 But how do you ask the boy, 00:08:23.788 --> 00:08:24.883 " hey if you want to go on, 00:08:24.883 --> 00:08:26.589 I have to have your limbs amputated, 00:08:26.589 --> 00:08:28.493 all your limbs. 00:08:28.493 --> 00:08:30.400 Or if you do not want to go on, 00:08:30.400 --> 00:08:32.397 I will turn off the machine." 00:08:32.397 --> 00:08:34.421 How do you talk about life and death 00:08:34.421 --> 00:08:37.569 with a 7-year-old. 00:08:37.569 --> 00:08:41.508 As a critical care medicine doctor, 00:08:41.508 --> 00:08:43.800 let me tell you my experiences in the past years. 00:08:43.800 --> 00:08:45.048 In the beginning, 00:08:45.048 --> 00:08:47.812 I saw a patient. 00:08:47.812 --> 00:08:48.652 Gradually, 00:08:48.652 --> 00:08:49.843 I saw only a disease. 00:08:49.843 --> 00:08:51.260 I saw a heart only. 00:08:51.260 --> 00:08:53.123 Fortunately, when I turned fifty 00:08:53.123 --> 00:08:56.585 I gradually saw a patient again. 00:08:56.585 --> 00:08:58.079 To be frank, 00:08:58.079 --> 00:09:00.505 I am good at studying. 00:09:00.505 --> 00:09:02.089 I had done heart transplant, 00:09:02.089 --> 00:09:03.057 lungs transplant, 00:09:03.057 --> 00:09:04.067 ECMO 00:09:04.067 --> 00:09:05.138 when I was about 30. 00:09:05.138 --> 00:09:07.888 I was the youngest chief doctor in NTU hospital. 00:09:07.888 --> 00:09:09.517 Chief of surgical intensive care unit. 00:09:09.517 --> 00:09:11.919 I was in Taiwan Organ Registry and Sharing Center. 00:09:11.919 --> 00:09:13.136 And I was the vice chief of Trauma Unit. 00:09:13.136 --> 00:09:15.740 In my thirties, 00:09:15.740 --> 00:09:17.207 I thought 00:09:17.207 --> 00:09:20.140 medicine was such an awesome thing. 00:09:20.140 --> 00:09:21.678 It solved everything. 00:09:21.678 --> 00:09:23.982 But in my forties, 00:09:23.982 --> 00:09:25.414 There are so many unsuccessful cases 00:09:25.414 --> 00:09:27.116 with the use of ECMO. 00:09:27.116 --> 00:09:28.052 Sometimes the families of the patients asked me, 00:09:28.052 --> 00:09:29.239 “why was Shao saved, 00:09:29.239 --> 00:09:31.926 while my family members weren’t ?” 00:09:31.926 --> 00:09:33.220 I don’t know how to answer the questions. 00:09:33.220 --> 00:09:36.495 I couldn’t say because he or she was not Shao, could I? 00:09:36.495 --> 00:09:37.390 Or they asked me, 00:09:37.390 --> 00:09:39.234 “why does his limbs turned black?” 00:09:39.234 --> 00:09:40.131 If I had known, 00:09:40.131 --> 00:09:41.048 I would definitely avoid it. 00:09:41.048 --> 00:09:42.354 I did not know. 00:09:42.354 --> 00:09:44.440 When I was in my forties, 00:09:44.440 --> 00:09:46.487 I thought that 00:09:46.487 --> 00:09:49.553 why could not some patients be saved? 00:09:49.553 --> 00:09:51.557 Finally, when I was about 50 00:09:51.557 --> 00:09:54.057 the principle dawned on me. 00:09:54.057 --> 00:09:56.661 It’s like a poetry said, "for, everywhere, no trace of her can be seen. 00:09:56.661 --> 00:09:57.533 When, all of a sudden, I turned about. 00:09:57.533 --> 00:09:59.652 It’s her. Where lanterns are few and far between." 00:09:59.652 --> 00:10:00.439 One day, 00:10:00.439 --> 00:10:01.880 it dawned on me that 00:10:01.880 --> 00:10:04.143 doctors are people, not God. 00:10:04.143 --> 00:10:05.262 All we can do is try our best. 00:10:05.262 --> 00:10:08.058 That’s it. 00:10:08.058 --> 00:10:10.284 It’s just like seasons. 00:10:10.284 --> 00:10:11.144 There are spring, summer 00:10:11.144 --> 00:10:13.199 autumn, and winter. 00:10:13.199 --> 00:10:15.449 Medicine has its limit, 00:10:15.449 --> 00:10:18.010 no matter how well developed is the science. 00:10:18.010 --> 00:10:19.243 With today’s technology, 00:10:19.243 --> 00:10:19.921 we can still be live 00:10:19.921 --> 00:10:20.497 without heart 00:10:20.497 --> 00:10:21.530 without lungs 00:10:21.530 --> 00:10:21.894 without kidney 00:10:21.894 --> 00:10:23.168 or without liver. 00:10:23.168 --> 00:10:26.162 But we can’t rely on machines 00:10:26.162 --> 00:10:27.981 for our whole lives. 00:10:27.981 --> 00:10:30.493 Medicines has its limit. 00:10:30.493 --> 00:10:32.696 It’s just like 00:10:32.696 --> 00:10:35.604 the gardeners 00:10:35.604 --> 00:10:37.168 can’t change seasons at all. 00:10:37.168 --> 00:10:39.070 All the gardeners can do 00:10:39.070 --> 00:10:42.221 is to make the flowers prettier in seasons. 00:10:42.221 --> 00:10:43.490 As a doctors, 00:10:43.490 --> 00:10:45.806 can we change birth, aging, sickness or death? 00:10:45.806 --> 00:10:46.731 Well, 00:10:46.731 --> 00:10:47.990 of course not. 00:10:47.990 --> 00:10:49.455 As a doctor, 00:10:49.455 --> 00:10:52.358 All we can do, is to make people 00:10:52.358 --> 00:10:53.692 live a little better when they’re alive. 00:10:53.692 --> 00:10:54.557 That’s all. 00:10:54.557 --> 00:10:55.356 So 00:10:55.356 --> 00:10:57.114 I came to realize that 00:10:57.114 --> 00:11:01.231 doctors are just the gardeners in the life of garden. 00:11:01.231 --> 00:11:05.380 As a gardener, 00:11:05.380 --> 00:11:07.308 how to face the withered plants 00:11:07.308 --> 00:11:09.070 is a question. 00:11:09.070 --> 00:11:11.563 As an expert of critical care medicine, 00:11:11.563 --> 00:11:14.931 how do I face death? 00:11:14.931 --> 00:11:16.884 From scientific aspect of death, 00:11:16.884 --> 00:11:19.289 or precisely, from physical and chemical aspects of death. 00:11:19.289 --> 00:11:20.615 Every physical reaction , 00:11:20.615 --> 00:11:21.548 or chemical reaction, 00:11:21.548 --> 00:11:22.398 tends to achieve minimum energy 00:11:22.398 --> 00:11:23.418 and maximum entropy. 00:11:23.418 --> 00:11:26.607 Delta S is always positive. 00:11:26.607 --> 00:11:29.524 Some will ask where does the relation come from? 00:11:29.524 --> 00:11:31.317 Some people believe it came from the Big Bang Theory. 00:11:31.317 --> 00:11:33.748 The universe is expanding due to the Big Bang Theory, 00:11:33.748 --> 00:11:35.827 delta S is always positive. 00:11:35.827 --> 00:11:36.697 Or 00:11:36.697 --> 00:11:38.784 is there universality in the laws of universe ? 00:11:38.784 --> 00:11:39.353 Honestly, 00:11:39.353 --> 00:11:40.244 I don’t know either. 00:11:40.244 --> 00:11:41.720 There’s an old saying 00:11:41.720 --> 00:11:46.173 Blind men can judge no colours 00:11:46.173 --> 00:11:47.329 Blind people 00:11:47.329 --> 00:11:48.644 can’t talk about colours 00:11:48.644 --> 00:11:50.435 because they can see nothing. 00:11:50.435 --> 00:11:52.263 is there universality 00:11:52.263 --> 00:11:53.449 in the laws of universe ? 00:11:53.449 --> 00:11:55.297 Is there university 00:11:55.297 --> 00:11:55.993 in the unlimited space and time . 00:11:55.993 --> 00:11:56.483 Frankly, 00:11:56.483 --> 00:11:57.535 I don’t know. 00:11:57.535 --> 00:11:58.562 But at least, 00:11:58.562 --> 00:12:00.605 among the scope we’re in 00:12:00.605 --> 00:12:02.618 delta S is still positive. 00:12:02.618 --> 00:12:04.490 What does it mean when we say delta S is positive? 00:12:04.490 --> 00:12:05.295 In theory, 00:12:05.295 --> 00:12:07.157 it should be minimum energy and maximum entropy. 00:12:07.157 --> 00:12:08.176 So it all becomes more chaotic. 00:12:08.176 --> 00:12:10.140 My existence 00:12:10.140 --> 00:12:11.361 would mean a negative delta S 00:12:11.361 --> 00:12:14.958 and this disobey the theory. 00:12:14.958 --> 00:12:17.202 Then how should we view life and death? 00:12:17.202 --> 00:12:18.611 Actually, 00:12:18.611 --> 00:12:20.682 we often see ourselves only. 00:12:20.682 --> 00:12:22.601 We don’t realize that we are in the universe. 00:12:22.601 --> 00:12:24.923 The universe is the combination of we and the environment. 00:12:24.923 --> 00:12:26.347 So total delta S 00:12:26.347 --> 00:12:29.446 equals to delta S system and delta S surrounding. 00:12:29.446 --> 00:12:30.437 So 00:12:30.437 --> 00:12:32.631 this is an important concept. 00:12:32.631 --> 00:12:35.202 Any organized group 00:12:35.202 --> 00:12:37.240 are unstable. 00:12:37.240 --> 00:12:39.428 It has to destroy the environment. 00:12:39.428 --> 00:12:41.178 Delta S is negative, 00:12:41.178 --> 00:12:43.284 however, it should be positive. 00:12:43.284 --> 00:12:44.561 As a result, it will destroy the environment 00:12:44.561 --> 00:12:46.361 to make the equation positive. 00:12:46.361 --> 00:12:47.188 So my existence 00:12:47.188 --> 00:12:49.326 is to destroy the environment. 00:12:49.326 --> 00:12:50.298 Until one day, 00:12:50.298 --> 00:12:52.062 when I can no longer destroy the environment, 00:12:52.062 --> 00:12:53.659 can I destroy myself only. 00:12:53.659 --> 00:12:56.399 Delta S should maintain positive, 00:12:56.399 --> 00:12:58.207 so to exist is to destroy. 00:12:58.207 --> 00:12:59.268 When you’re unable to destroy, 00:12:59.268 --> 00:13:00.311 you can only destroy yourself. 00:13:00.311 --> 00:13:01.635 This is death. 00:13:01.635 --> 00:13:04.917 This is death from physical and chemical aspects. 00:13:04.917 --> 00:13:07.544 However, 00:13:07.544 --> 00:13:08.797 as a doctor, 00:13:08.797 --> 00:13:10.885 I understand physics and chemistry. 00:13:10.885 --> 00:13:13.159 How do I think of life? 00:13:13.159 --> 00:13:14.758 One day, 00:13:14.758 --> 00:13:15.620 when I took round in the intensive care units. 00:13:15.620 --> 00:13:16.907 I came to realize 00:13:16.907 --> 00:13:18.623 that there are only two kind of outcomes in lives. 00:13:18.623 --> 00:13:19.286 One is with tubes insertion, 00:13:19.286 --> 00:13:21.529 while the other is not. 00:13:21.529 --> 00:13:24.340 But they’re all called death. 00:13:24.340 --> 00:13:26.855 Death is an immutable law. 00:13:26.855 --> 00:13:27.804 So 00:13:27.804 --> 00:13:30.780 how do we think of death? 00:13:30.780 --> 00:13:33.692 I have a flip point of view. 00:13:33.692 --> 00:13:35.840 If you ask me what death is. 00:13:35.840 --> 00:13:37.486 I will ask you: 00:13:37.486 --> 00:13:40.495 what is life? 00:13:40.495 --> 00:13:41.452 You guys came here 00:13:41.452 --> 00:13:43.149 to attend a lecture. 00:13:43.149 --> 00:13:45.157 I hope you can do one thing when you leave. 00:13:45.157 --> 00:13:46.567 Tonight, when you are going to sleep, 00:13:46.567 --> 00:13:47.433 when you’re lying on your bed, 00:13:47.433 --> 00:13:49.017 ask yourself a question: 00:13:49.017 --> 00:13:58.424 what is being alive? 00:13:58.424 --> 00:13:59.208 Because 00:13:59.208 --> 00:14:00.621 when you think of the question 00:14:00.621 --> 00:14:02.552 we have to think of a question: 00:14:02.552 --> 00:14:03.831 what is life ? 00:14:03.831 --> 00:14:05.909 My answer to the question is this: 00:14:05.909 --> 00:14:07.168 when you’re searching for the answer to the question, 00:14:07.168 --> 00:14:10.508 it is the answer to the question. 00:14:10.508 --> 00:14:12.331 Everyone dies eventually. 00:14:12.331 --> 00:14:14.200 No when will set death 00:14:14.200 --> 00:14:15.404 as the goal of life. 00:14:15.404 --> 00:14:17.299 Life is a process. 00:14:17.299 --> 00:14:20.082 We keep searching 00:14:20.082 --> 00:14:21.371 for the answer 00:14:21.371 --> 00:14:23.530 to what being alive is 00:14:23.530 --> 00:14:25.133 in our life. 00:14:25.133 --> 00:14:27.403 So when you’re searching, 00:14:27.403 --> 00:14:29.042 that is the very answer to the question. 00:14:29.042 --> 00:14:31.249 Death is not the goal of life. 00:14:31.249 --> 00:14:33.491 Life is a process. 00:14:33.491 --> 00:14:37.558 Recently, I always share the story of feces. 00:14:37.558 --> 00:14:39.110 My teacher was going to retire, 00:14:39.110 --> 00:14:39.673 he said, 00:14:39.673 --> 00:14:40.556 "
 I am going to retire, 00:14:40.556 --> 00:14:41.375 let’s go to somewhere fancy." 00:14:41.375 --> 00:14:42.480 So 00:14:42.480 --> 00:14:44.389 My teacher, my schoolmate and I 00:14:44.389 --> 00:14:46.503 went to a French restaurant at Sheraton. 00:14:46.503 --> 00:14:48.959 And it’s on me. 00:14:48.959 --> 00:14:51.654 We spent 26,000 NT dollars. 00:14:51.654 --> 00:14:54.397 I was too astonished to speak. 00:14:54.397 --> 00:14:56.010 How could I eat something so expensive? 00:14:56.010 --> 00:14:57.909 I’d never been to that kind of restaurant. 00:14:57.909 --> 00:14:58.596 I had no idea 00:14:58.596 --> 00:14:59.993 about what I’d ordered. 00:14:59.993 --> 00:15:01.369 When I saw the bill, 00:15:01.369 --> 00:15:03.168 I almost collapsed. 00:15:03.168 --> 00:15:04.927 The next morning, in the restroom, 00:15:04.927 --> 00:15:09.081 I examined my feces carefully. 00:15:09.081 --> 00:15:10.606 I’d spent 9,000 NT dollars 00:15:10.606 --> 00:15:15.390 producing it. 00:15:15.390 --> 00:15:15.909 But I could not tell the difference 00:15:15.909 --> 00:15:18.394 with the meals in the cafeteria, which cost 70 NT dollars, 00:15:18.394 --> 00:15:19.800 at the NTU hospital. 00:15:19.800 --> 00:15:23.550 I just could not tell the difference. 00:15:23.550 --> 00:15:26.659 Then, in the restroom, I came to realize 00:15:26.659 --> 00:15:28.606 that all the wealth you can get 00:15:28.606 --> 00:15:35.666 is just feces. 00:15:40.074 --> 00:15:43.061 Confucianism is the most crucial ism in Chinese culture. 00:15:43.077 --> 00:15:45.613 Confucianism has its virtues. 00:15:45.613 --> 00:15:48.047 It talks about human. 00:15:48.047 --> 00:15:50.254 You can see the sayings in Confucian Analects as followed. 00:15:50.254 --> 00:15:51.104 While you do not know life, 00:15:51.104 --> 00:15:52.455 how can you know about death? 00:15:52.455 --> 00:15:53.059 While you are not able to serve men, 00:15:53.059 --> 00:15:54.474 how can you serve their spirits? 00:15:54.474 --> 00:15:55.223 When alive, 00:15:55.223 --> 00:15:55.624 be served according to propriety; 00:15:55.624 --> 00:15:56.015 that, when dead, 00:15:56.015 --> 00:15:56.921 they should be buried according to propriety; 00:15:56.921 --> 00:15:58.320 and that they should be sacrificed to according to propriety. 00:15:58.320 --> 00:15:59.975 Confucianism refuses to talk about death. 00:15:59.975 --> 00:16:00.955 If you keep asking, 00:16:00.955 --> 00:16:02.620 he would answer something about laying downing one's life for justice, 00:16:02.620 --> 00:16:04.293 or if a man in the morning hear the right way, he may die in the evening without regret, 00:16:04.293 --> 00:16:06.653 or sacrificing their lives to preserve their virtue complete. 00:16:06.653 --> 00:16:09.508 Confucianism avoids 00:16:09.508 --> 00:16:11.074 talking about death. 00:16:11.074 --> 00:16:12.281 It doesn’t want to discuss about it 00:16:12.281 --> 00:16:14.439 So 00:16:14.439 --> 00:16:15.292 it is enthusiastic 00:16:15.292 --> 00:16:15.986 about human, 00:16:15.986 --> 00:16:17.812 and it leaves others behind. 00:16:17.812 --> 00:16:19.564 It cares about the things you can see now. 00:16:19.564 --> 00:16:20.551 However, 00:16:20.551 --> 00:16:23.685 it doesn’t talk about death at all. 00:16:23.685 --> 00:16:26.098 The following is what I think. 00:16:26.098 --> 00:16:27.749 In Chinese culture, 00:16:27.749 --> 00:16:29.722 Confucianism is the most crucial thought. 00:16:29.722 --> 00:16:31.506 But we didn’t want to think of death in the past. 00:16:31.506 --> 00:16:33.372 We avoided talking about it. 00:16:33.372 --> 00:16:36.354 There’s a common saying based onSunzi's Art of War: 00:16:36.354 --> 00:16:38.198 Placing somebidy on field of death and he will fight to live. 00:16:38.198 --> 00:16:40.219 Only when we face the death, 00:16:40.219 --> 00:16:43.720 seriously, 00:16:43.720 --> 00:16:47.743 can we ask what life is. 00:16:47.743 --> 00:16:49.930 We will all die in the end. 00:16:49.930 --> 00:16:51.371 Life is just a process, 00:16:51.371 --> 00:16:54.333 of searching for the meaning of being alive. 00:16:54.333 --> 00:16:56.782 This is my point of view. 00:16:56.782 --> 00:16:58.619 Actually, I am a smart person, 00:16:58.619 --> 00:16:59.931 and strong enough. 00:16:59.931 --> 00:17:03.440 I can travel around the island by bike. 00:17:03.440 --> 00:17:05.553 But can I 00:17:05.553 --> 00:17:07.810 bully others 00:17:07.810 --> 00:17:09.780 just because I am a little smarter, 00:17:09.780 --> 00:17:10.063 or a little stronger? 00:17:10.063 --> 00:17:11.273 Well, 00:17:11.273 --> 00:17:12.315 definitely not. 00:17:12.315 --> 00:17:13.420 So 00:17:13.420 --> 00:17:15.092 those who benefit from the society 00:17:15.092 --> 00:17:16.692 should be grateful. 00:17:16.692 --> 00:17:18.300 You should help others 00:17:18.300 --> 00:17:20.044 if you’re able to. 00:17:20.044 --> 00:17:21.922 That makes your life much more meaningful. 00:17:21.922 --> 00:17:23.567 It’s about gratitude. 00:17:23.567 --> 00:17:25.228 When I went to Dharma Drum Mountain, 00:17:25.228 --> 00:17:27.322 the master talked with me 00:17:27.322 --> 00:17:28.234 about gratitude. 00:17:28.234 --> 00:17:29.263 Being grateful. 00:17:29.263 --> 00:17:30.516 Being kind instead of being revengeful. 00:17:30.516 --> 00:17:33.153 “I know you are misunderstood,” he said, 00:17:33.153 --> 00:17:37.158 “but you can’t complain. 00:17:37.158 --> 00:17:40.166 You should help others instead.” 00:17:40.166 --> 00:17:41.633 At the end of my speech, let me share a concept with you. 00:17:41.633 --> 00:17:43.170 It is “a to the power of n.” 00:17:43.170 --> 00:17:44.351 If a is greater than 1, 00:17:44.351 --> 00:17:45.927 a to the power of n is infinity. 00:17:45.927 --> 00:17:47.080 If a is less than 1, 00:17:47.080 --> 00:17:50.039 a to the power will approach zero rapidly. 00:17:50.039 --> 00:17:51.827 What does that mean? 00:17:51.827 --> 00:17:53.185 If what I give to the society 00:17:53.185 --> 00:17:54.537 is greater than what I get from the society, 00:17:54.537 --> 00:17:55.810 a is greater than one. 00:17:55.810 --> 00:17:57.265 Our society will become better and better. 00:17:57.265 --> 00:17:58.610 If what I get from the society 00:17:58.610 --> 00:18:00.045 is greater than what I give to the society, 00:18:00.045 --> 00:18:00.993 a is less than 1 00:18:00.993 --> 00:18:02.578 Our society will become worse. 00:18:02.578 --> 00:18:04.490 And I end the my speech, 00:18:04.490 --> 00:18:07.205 with these words. 00:18:07.205 --> 00:18:09.389 Facing difficulties is not the hardest thing. 00:18:09.389 --> 00:18:10.376 The hardest thing is 00:18:10.376 --> 00:18:12.117 facing the difficulties 00:18:12.117 --> 00:18:12.117 without losing passion for your life and world. 00:18:12.117 --> 00:18:16.302 Thank you very much.