0:00:15.750,0:00:19.447
The host (from TEDxTaipei) invited me to speak about “Positive Destruction.”

0:00:19.447,0:00:24.946
After giving it some thought, I thought I might as well share my own story.

0:00:24.946,0:00:26.926
Among all the physicians in Taiwan,

0:00:26.926,0:00:30.448
I am probably the one ER doctor who has seen the most cadavers.

0:00:30.448,0:00:32.901
I've seen many cases of life and death.

0:00:32.901,0:00:36.947
Perhaps that's why I'm suited to share such stories on this stage.[br]

0:00:36.947,0:00:39.314
There's a joke about[br]

0:00:39.314,0:00:40.871
the most famous physician -- Dr. Yeh

0:00:40.871,0:00:42.744
here in Taiwan.

0:00:42.744,0:00:44.530
After Shao Xiao Ling's (Taichung First Lady) car accident,

0:00:44.530,0:00:46.613
a patient went to Chi-Mei Hospital in Liu-Ying city[br]

0:00:46.613,0:00:48.697
to seek a doctor named Yeh.[br]

0:00:48.697,0:00:49.536
The staff in the hospital said

0:00:49.536,0:00:51.988
that there's no Dr. Yeh.[br]

0:00:51.988,0:00:53.206
"There is, " said the patient.

0:00:53.206,0:00:56.421
"I was told that his name is 'Yeh Ker-Mo' (ECMO: Extra-Corporeal Membrane Oxygenation).

0:00:56.421,0:01:00.023
This Dr. Yeh was the one who saved Shao Xiao Ling's life!"

0:01:00.038,0:01:01.341
Speaking of ECMO, its concept is quite easy to understand.

0:01:01.341,0:01:02.610
You divert the blood flow from the femoral vein

0:01:03.879,0:01:05.149
and pass it through a pump,

0:01:05.149,0:01:06.012
which serves as an artificial heart.

0:01:06.012,0:01:07.293
The blood then passes through a membrane oxygenator,

0:01:07.409,0:01:08.558
which acts as a pair of artificial lungs.[br]

0:01:08.558,0:01:10.480
Afterwards, the blood re-enters the body.

0:01:10.480,0:01:12.939
So, ECMO is a temporary substitute of a human's cardiovascular system.

0:01:12.939,0:01:14.973
This is how an ECMO machine looks like.

0:01:14.973,0:01:17.486
You now have a machine acting as an artificial heart

0:01:17.486,0:01:20.066
that pumps blood to the oxygenator and back to the body.[br]

0:01:20.066,0:01:22.695
As a matter of fact, ECMO technique

0:01:22.695,0:01:24.292
was already available and widely used

0:01:24.292,0:01:27.504
at the National Taiwan University (NTU) Hospital[br]

0:01:27.504,0:01:30.054
since 1994 prior to the first lady's car accident.

0:01:30.054,0:01:31.933
It was only since her incident that folks in Taiwan are aware of the ECMO technique.

0:01:31.933,0:01:33.384
It’s similar to the saying: "One can spend decades painting in relative obscurity,"[br]

0:01:33.384,0:01:36.239
"but the world only sees the artist's finished masterpiece."

0:01:36.239,0:01:37.595
That's just my personal opinion.

0:01:37.595,0:01:41.035
ECMO became a household term due to its overexposure from Taiwan's media press.[br]

0:01:41.035,0:01:43.731
here's no doubt that ECMO technique has its relatively successful cases.[br]

0:01:43.731,0:01:45.407
One prominent example is the case of singer Jay Chou's backup dancer.

0:01:45.407,0:01:47.830


0:01:47.083,0:01:48.761
One day, this patient was admitted with fulminant myocarditis,

0:01:48.761,0:01:50.947
and was undergoing cardiac arrest.

0:01:50.947,0:01:52.999
I would like to show you a photo of him at the time,

0:01:52.999,0:01:56.646
with the patient lying on his hospital bed.

0:01:56.646,0:01:57.922
The eyes of this patient were wide open,

0:01:57.922,0:01:59.414
and were staring straight,[br]

0:01:59.414,0:02:01.739
reading the flat lines showing on the ECG screen.

0:02:01.739,0:02:03.317
As a result of fulminant myocarditis,[br]

0:02:03.317,0:02:05.474
the patient's heart stopped beating.

0:02:05.474,0:02:07.819
He suffered a cardiac arrest.[br]

0:02:07.819,0:02:10.636
This is a biopsy of his cardiac muscle

0:02:10.636,0:02:12.395
magnified 100 times under the microscope.[br]

0:02:12.395,0:02:13.727
Even under this type of magnifying power, [br]

0:02:13.727,0:02:16.312
it's still quite hard to see.

0:02:16.312,0:02:18.831
However, magnified 400 times will be much clearer.

0:02:18.831,0:02:22.140
Those blue spots are lymphocytes.[br]

0:02:22.140,0:02:26.092
From here, we can see a serious case of fulminant myocarditis.

0:02:26.092,0:02:29.439
Lymphocytes infiltrated his entire heart,

0:02:29.439,0:02:33.818
which caused sudden cardiac arrest.[br]

0:02:33.818,0:02:37.062
The patient stared at the screen,[br]

0:02:37.062,0:02:40.421
as it displayed no signs of a working heart.[br]

0:02:40.421,0:02:42.880
After the ninth day,

0:02:42.880,0:02:44.558
after a heart and a kidney transplant,

0:02:44.558,0:02:46.807
She returned to dance in less than one month's recovery.

0:02:46.807,0:02:49.329
It was a great miracle in modern medicine.[br]

0:02:49.329,0:02:52.406
In modern medical records,

0:02:52.406,0:02:55.150
this patient holds the longest record for CPR survival:

0:02:55.150,0:02:57.291
4 hours.

0:02:57.291,0:03:00.766
CPR was performed on him from Cathay General Hospital to NTU Hospital.

0:03:00.766,0:03:02.808
When physicians tried ECMO technique at the NTU hospital,[br]

0:03:02.808,0:03:05.015
they found that over 100 doses

0:03:05.015,0:03:06.683
of cardiotonic drugs[br]

0:03:06.683,0:03:08.746
were already given to him.[br]

0:03:08.746,0:03:10.303
When an incision was made

0:03:10.303,0:03:10.947
to insert an ECMO tube,

0:03:10.947,0:03:12.408
the patient's veins and arteries were too narrow.

0:03:12.408,0:03:13.636
Therefore, CPR had to be conducted again[br]

0:03:13.636,0:03:14.879
until he was in the operating room.

0:03:14.879,0:03:15.807
Surgeons had to saw open the patient's chest

0:03:15.807,0:03:18.192
to insert ECMO tubes from the top.

0:03:18.192,0:03:22.448
The entire procedure sounds surreal right now.[br]

0:03:22.448,0:03:27.160
Every time I recall this case, I always say it's a modern medical miracle.

0:03:27.160,0:03:30.330
The fact that a man‘s heart had stopped for 9 days.

0:03:30.330,0:03:34.100
And after enduring heart and kidney transplants,[br]

0:03:34.100,0:03:36.728
a 4 hour CPR,[br]

0:03:36.728,0:03:39.169
he could still survive.[br]

0:03:39.169,0:03:40.871
Here is anthother patient case.

0:03:40.871,0:03:42.516
The headline reads ”World's First:

0:03:42.516,0:03:43.943
Miracle of Taiwan".[br]

0:03:43.943,0:03:46.421
Man without heart for 16 days.[br]

0:03:46.421,0:03:49.746
In this case, the patient is a 56-year-old man.

0:03:49.746,0:03:51.346
He had a tooth decay.

0:03:51.346,0:03:53.396
Bacteria from the cavity went into the blood,

0:03:53.396,0:03:54.297
and spread to the portions of the heart.

0:03:54.297,0:03:55.885
It caused a pus buildup.

0:03:55.885,0:03:57.824
The patient went to a different hospital[br]

0:03:57.824,0:03:59.761
where the surgical team opened up his chest,

0:03:59.761,0:04:00.561
and began to eliminate[br]

0:04:00.561,0:04:01.945
infected tissues of the heart.[br]

0:04:01.945,0:04:02.796
The team continued to remove [br]

0:04:02.796,0:04:03.849
more affected tissues

0:04:03.849,0:04:06.866
until not much of the muscular organ was left.

0:04:06.866,0:04:07.861
So what can the team do now?[br]

0:04:07.861,0:04:13.267
Transfer this patient to NTU hospital.[br]

0:04:13.308,0:04:17.128
It seems that NTU hospital is the last line of medical defense in Taiwan.

0:04:17.128,0:04:18.990
NTU hospital has to take patients in.

0:04:18.990,0:04:21.831
[br]In the first case, the case was cardiac arrest.[br]

0:04:21.831,0:04:22.543
This case is more extreme.

0:04:22.543,0:04:23.779
This is a man with not much of a heart left.

0:04:23.779,0:04:25.475
It was almost all surgically removed.

0:04:25.475,0:04:26.706
When the patient was transferred to NTU hospital,

0:04:26.706,0:04:28.527
[br]because of the state he was in,[br]

0:04:28.527,0:04:30.254
our medical team had to use two ECMOs.

0:04:30.254,0:04:31.241
Look at this slide.[br][br]

0:04:31.241,0:04:32.733
There are two ECMO devices.[br]

0:04:32.733,0:04:34.376
This one is even more unbelievable.[br]

0:04:34.376,0:04:35.511
Since he didn't have a heart left,

0:04:35.511,0:04:37.747
so the ECG displayed a completely flat line.[br]

0:04:37.747,0:04:40.880
There's not much to explain here.[br]

0:04:40.880,0:04:42.432
This is his CT scan result.[br]

0:04:42.432,0:04:43.285
Theoretically,

0:04:43.285,0:04:45.915
there should have been a heart in his thorax.

0:04:45.915,0:04:47.030
However, the heart is missing here.[br]

0:04:47.030,0:04:49.390
There are only tubes.[br]

0:04:49.390,0:04:51.285
After 16 days,

0:04:51.285,0:04:53.485
our surgical team performed a heart transplant surgery on this patient.[br]

0:04:53.485,0:04:56.408
Cardiologist surgeon Dr. Wan showed me this.

0:04:56.408,0:04:58.472
Dr. Wan said during the surgery,[br]

0:04:58.472,0:04:59.494
he opened the patient's chest

0:04:59.494,0:05:01.938
and had expected a heart in the thorax.

0:05:01.938,0:05:03.830
However, there were only plastic tubes

0:05:03.830,0:05:06.634
connecting to the ECMO.[br]

0:05:06.634,0:05:09.179
The patient had no heart at all.[br]

0:05:09.179,0:05:12.196
And after 16 days, the heart transplant surgery was completed.[br]

0:05:12.196,0:05:15.317
The patient was discharged later.[br]

0:05:15.317,0:05:18.834
Here is the Straits Times of Singapore.[br]

0:05:18.834,0:05:22.161
A vendor I know sent me an e-mail from Singapore.

0:05:22.161,0:05:24.590
He told me that we were featured in the Straits Times.

0:05:24.590,0:05:26.329
16 days without heart

0:05:26.329,0:05:27.989
A person had lived for 16 days without a heart.

0:05:27.989,0:05:29.219
But after receiving heart transplant,[br]

0:05:29.219,0:05:33.337
he still went home in good shape.

0:05:33.337,0:05:35.103
This is a third case.[br]

0:05:35.103,0:05:39.209
He’s a 26-year-old aboriginal Taiwanese.

0:05:39.209,0:05:41.370
He went swimming even when he was seriously drunk.

0:05:41.370,0:05:45.080
Jokingly, he probably thought he was Li Bai the poet.[br]

0:05:45.080,0:05:47.175
The pond he swam in was really unsanitary.

0:05:47.175,0:05:48.217
He choked on water.[br]

0:05:48.217,0:05:49.618
As a result,

0:05:49.618,0:05:51.410
he caught a severe case of pneumonia.

0:05:51.410,0:05:53.393
He’d relied on ECMO for 117 days.[br]

0:05:53.393,0:05:55.187
Look at his lungs.[br]

0:05:55.187,0:05:55.976
After he ingested unclean water,

0:05:55.976,0:05:57.380
his condition worsened to a severe case of pneumonia.[br]

0:05:57.380,0:05:59.818
This is called acute respiratory distress syndrome.[br]

0:05:59.818,0:06:01.948
The lungs became abnormally white.

0:06:01.948,0:06:05.090
He lived on ECMO for 117 days.

0:06:05.090,0:06:09.524
We can see clearly from this slide.[br]

0:06:09.524,0:06:11.860
For one entire month,

0:06:11.860,0:06:13.486
the patient's ventilation volume

0:06:13.486,0:06:15.155
did not exceed 100 c.c.[br]

0:06:15.155,0:06:18.018
But the patient still recovered.

0:06:18.018,0:06:19.459
In short,

0:06:19.459,0:06:21.226
in the these three medical cases,

0:06:21.226,0:06:22.961
in the these three medical cases,

0:06:22.961,0:06:24.606
the patient undergoing cardiac arrest,

0:06:24.606,0:06:27.110
or the patient with lung failure,

0:06:27.110,0:06:29.308
with the help of ECMO,

0:06:29.308,0:06:32.590
no matter whether 9 days later

0:06:32.590,0:06:34.605
or even 100 days afterwards,[br]

0:06:34.605,0:06:36.373
after a heart transplant

0:06:36.373,0:06:37.832
or lung transplant,[br]

0:06:37.832,0:06:39.519
their lives were saved.[br]

0:06:39.519,0:06:41.629
It is really incredible.

0:06:41.629,0:06:42.823
To be honest...[br]

0:06:42.823,0:06:44.578
In recent history, ECMO has retained

0:06:44.578,0:06:45.728
a high level of awareness [br]

0:06:45.728,0:06:47.664
thanks to the media presses in Taiwan.

0:06:47.664,0:06:48.695
The reason why folks know about ECMO,[br]

0:06:48.695,0:06:50.572
is because of past success cases,

0:06:50.572,0:06:52.259
and also because of the first lady in Taichung,[br]

0:06:52.259,0:06:53.761
and famed astrologer Nick Yen.[br]

0:06:53.761,0:06:55.333
However,[br]

0:06:55.333,0:06:56.403
the media usually[br]

0:06:56.403,0:06:58.211
only reports on the successful stories.

0:06:58.211,0:06:59.408
Reporters don’t write failed cases.

0:06:59.408,0:07:00.942
Hidden from the public eye.[br]

0:07:00.942,0:07:04.117
As a critical care physician,

0:07:04.117,0:07:06.322
I am certainly glad to encounter successful patient cases.

0:07:06.322,0:07:08.187
However, there are cases that are not as successful.[br]

0:07:08.187,0:07:12.953
This baby was one and half months old.[br]

0:07:12.953,0:07:14.767
He suffered from a congenital heart disease.

0:07:14.767,0:07:16.324
After undergoing a heart surgery,

0:07:16.324,0:07:17.886
the baby still could not live without a heart-lung machine.

0:07:17.886,0:07:19.643
So, we hooked the baby up to an ECMO.[br]

0:07:19.643,0:07:20.668
The ECMO was inserted in the baby's heart.[br]

0:07:20.668,0:07:21.965
After the procedure, [br]

0:07:21.965,0:07:22.989
in three days,[br]

0:07:22.989,0:07:24.209
the baby's feet turned black.[br]

0:07:24.209,0:07:25.379
Let’s zoom in.

0:07:25.379,0:07:27.028
Look at his tiny, blackened feet.[br]

0:07:27.028,0:07:28.488
So now, as a physician,[br]

0:07:28.488,0:07:29.993
you have to make a decision.[br]

0:07:29.993,0:07:31.510
Should you amputate his tiny feet

0:07:31.510,0:07:32.615
to try to save his life?

0:07:32.615,0:07:33.580
Or should you just give up

0:07:33.580,0:07:34.835
and let him go?[br]

0:07:34.835,0:07:37.695
These types of decisions are incredibly stressful to make.

0:07:37.695,0:07:40.091
But if you can’t make the call,

0:07:40.091,0:07:42.114
then the next case is more difficult to gauge.[br]

0:07:42.114,0:07:44.830
Here is a 7-year-old boy

0:07:44.830,0:07:46.151
suffering from streptococcus pneumonia.[br]

0:07:46.151,0:07:48.962
His condition worsened to acute respiratory distress syndrome.

0:07:48.962,0:07:51.538
So the medical team decided to employ ECMO technique.

0:07:51.538,0:07:53.829
After using ECMO, however,[br]

0:07:53.829,0:07:55.044
there were complications.[br]

0:07:55.044,0:07:56.889
His limbs all turned black.

0:07:56.889,0:07:58.493
His adorable eyes would look at you,

0:07:58.493,0:07:59.316
his conscious in a clear state.

0:07:59.316,0:08:00.711
He could even ask for water when he was thirsty.

0:08:00.711,0:08:02.645
But as a doctor,[br]

0:08:02.645,0:08:04.540
you have to make incredibly hard decisions.[br]

0:08:04.540,0:08:05.963
If you want to save him,

0:08:05.963,0:08:07.541
you have to cut off his limbs first,

0:08:07.541,0:08:08.983
and continue with further medical treatment.[br]

0:08:08.983,0:08:10.868
And if you give up,[br]

0:08:10.868,0:08:12.332
you have to turn off the ECMO.[br]

0:08:12.332,0:08:14.080
Now think of this:[br]

0:08:14.080,0:08:16.298
Between life and death,

0:08:16.298,0:08:17.801
when the patient is in a conscious state,[br]

0:08:17.801,0:08:21.887
of course, the doctor's mind is clear, too.

0:08:21.887,0:08:23.788
How would you ask the boy?

0:08:23.788,0:08:24.883
"Hi dear"

0:08:24.883,0:08:26.589
"If you want to live"[br]

0:08:26.589,0:08:28.493
"I will need to amputate your limbs."

0:08:28.493,0:08:30.400
"Or you'd rather give up,"

0:08:30.400,0:08:32.397
"and rest in peace?"

0:08:32.397,0:08:34.421
[br]How do you communicate this type of life and death decision[br]

0:08:34.421,0:08:37.569
with a 7-year-old?[br]

0:08:37.569,0:08:39.646
This is the line of work I have to deal with

0:08:39.646,0:08:41.723
as a critical care physician.

0:08:41.723,0:08:43.800
In the beginning, I made decisions rather logically.

0:08:43.800,0:08:47.368
I identified everything by patients.

0:08:47.368,0:08:48.652
Gradually,

0:08:48.652,0:08:49.843
I targeted diseases, not patients.

0:08:49.843,0:08:51.260
A diseased heart, for example.[br]

0:08:51.260,0:08:53.123
Fortunately, when I turned fifty,[br]

0:08:53.123,0:08:56.585
I gradually realized that I should treat patient as a whole again.

0:08:56.585,0:08:58.079
To be quite honest,

0:08:58.079,0:09:00.505
I consider myself academically inclined.

0:09:00.505,0:09:02.089
When I reached my 30s,

0:09:02.089,0:09:03.057
heart transplants,

0:09:03.057,0:09:04.067
lung transplants,[br]

0:09:04.067,0:09:05.138
ECMO technique,[br]

0:09:05.138,0:09:07.888
youngest chief physician in NTU hospital,

0:09:07.888,0:09:09.517
chief physician of the Surgical Intensive Care Unit,

0:09:09.517,0:09:11.919
Initiated the Organ Registry and Sharing Center project,[br]

0:09:11.919,0:09:13.136
Chief physician of the Trauma Unit.[br]

0:09:13.136,0:09:15.740
All these were accomplished by my 30s.

0:09:15.740,0:09:17.207
During this journey, [br]

0:09:17.207,0:09:20.140
I believed that medical knowledge was incredibly powerful.

0:09:20.140,0:09:21.678
Medical knowledge can cure everything.[br]

0:09:21.678,0:09:23.982
But in my 40s,[br]

0:09:23.982,0:09:25.414
there were many unsuccessful cases

0:09:25.414,0:09:27.116
with the use of ECMO.[br]

0:09:27.116,0:09:28.052
Sometimes the families of the patients asked me,[br]

0:09:28.052,0:09:29.239
“How come the First Lady of Taichung survived,

0:09:29.239,0:09:31.926
but my family member didn't make it?”

0:09:31.926,0:09:33.220
I don’t know how to answer such questions.

0:09:33.220,0:09:36.495
I couldn’t say because he or she was not the First Lady, could I?

0:09:36.495,0:09:37.390
Others ask me,[br]

0:09:37.390,0:09:39.234
“why do his limbs turned black?”[br]

0:09:39.234,0:09:40.131
If I'd known the answer,

0:09:40.131,0:09:41.048
I would have definitely prevented it from happening.

0:09:41.048,0:09:42.354
I have to admit that I don't know.

0:09:42.354,0:09:44.440
So when I was in my 40s,

0:09:44.440,0:09:46.487
I thought that

0:09:46.487,0:09:49.553
why couldn't this patient be saved?[br]

0:09:49.553,0:09:51.557
Finally, when I was reached my 50s,

0:09:51.557,0:09:54.057
the concept dawned on me.[br]

0:09:54.057,0:09:56.661
There's a Chinese poetry that says: "I've searched high and low for her."

0:09:56.661,0:09:57.533
"It's only when I turned around,"[br]

0:09:57.533,0:09:59.652
"The woman I seek is just standing behind me near a lantern."

0:09:59.652,0:10:00.439
That day,

0:10:00.439,0:10:01.880
it dawned on me that

0:10:01.880,0:10:04.143
doctors are people, not God.[br]

0:10:04.143,0:10:05.262
Doctors can only try our best.

0:10:05.262,0:10:08.058
That’s it.

0:10:08.058,0:10:10.284
I began to reason this philosophy out.

0:10:10.284,0:10:11.144
Let's look at seasons. [br]

0:10:11.144,0:10:13.199
There's spring, summer, autumn, and winter.

0:10:13.199,0:10:15.449
Medicine has its limit.[br]

0:10:15.449,0:10:18.010
No matter how advanced science is,

0:10:18.010,0:10:19.243
with today’s technology,

0:10:19.243,0:10:19.921
a person without a heart,

0:10:19.921,0:10:20.497
or lungs,

0:10:20.497,0:10:21.530
or liver,

0:10:21.530,0:10:21.894
or kidney,

0:10:21.894,0:10:23.168
can still live.

0:10:23.168,0:10:26.162
But can we replace our organs with devices or gadgets[br]

0:10:26.162,0:10:27.981
forever?

0:10:27.981,0:10:30.493
Medicine still has its limits.

0:10:30.493,0:10:32.696
So I came to a conclusion.

0:10:32.696,0:10:35.604
Can gardeners change the seasons?

0:10:35.604,0:10:37.168
Of course not.[br]

0:10:37.168,0:10:39.070
Gardeners can only make flowers

0:10:39.070,0:10:42.221
grow prettier in the four seasons.

0:10:42.221,0:10:43.490
As a doctor,

0:10:43.490,0:10:45.806
am I capable of changing nature's rules to birth, aging, sickness or death?

0:10:45.806,0:10:46.731
Well,[br]

0:10:46.731,0:10:47.990
it's very difficult.

0:10:47.990,0:10:49.455
As a doctor,[br]

0:10:49.455,0:10:52.358
all we can do is to enable people

0:10:52.358,0:10:53.692
to go through life a little easier when they’re alive.

0:10:53.692,0:10:54.557
That’s all.

0:10:54.557,0:10:55.356
So gradually,[br]

0:10:55.356,0:10:57.114
I came to realize that

0:10:57.114,0:11:01.231
doctors are just the gardeners in the life's garden.

0:11:01.231,0:11:05.380
As a gardener,

0:11:05.380,0:11:07.308
when faced with the withered plants,[br]

0:11:07.308,0:11:09.070
how to treat them is a great question.[br]

0:11:09.070,0:11:11.563
As an expert in critical care,

0:11:11.563,0:11:14.931
how do I face death?

0:11:14.931,0:11:16.884
From a scientific aspect,

0:11:16.884,0:11:19.289
or more precisely, from molecular science,

0:11:19.289,0:11:20.615
a system undergoing physical reaction

0:11:20.615,0:11:21.548
on a molecular level[br]

0:11:21.548,0:11:22.398
will tend to minimize energy

0:11:22.398,0:11:23.418
and maximize entropy.

0:11:23.418,0:11:26.607
So delta S (entropy) should be greater or equal to zero.[br]

0:11:26.607,0:11:29.524
Some may ask how delta s is greater than zero.

0:11:29.524,0:11:31.317
Some believe it's from the Big Bang theory,

0:11:31.317,0:11:33.748
as it describes the state of ever-expanding universe.

0:11:33.748,0:11:35.827
So that's how delta S is greater than zero.

0:11:35.827,0:11:36.697
Or you may ask,

0:11:36.697,0:11:38.784
is anything constant in the laws of this universe?

0:11:38.784,0:11:39.353
Honestly,

0:11:39.353,0:11:40.244
I don’t have an answer to this.

0:11:40.244,0:11:41.720
There’s an old saying[br]

0:11:41.720,0:11:46.173
"A blind man is no judge of colors."

0:11:46.173,0:11:47.329
Visually impared folks

0:11:47.329,0:11:48.644
can’t distinguish colors

0:11:48.644,0:11:50.435
so it's pointless to ask them to judge.

0:11:50.435,0:11:52.263
Does constant apply

0:11:52.263,0:11:53.449
to the laws in this universe?

0:11:53.449,0:11:55.297
Does eternity exist[br]

0:11:55.297,0:11:55.993
in space and time?

0:11:55.993,0:11:56.483
Frankly,

0:11:56.483,0:11:57.535
I don’t know these answers.

0:11:57.535,0:11:58.562
But at least,

0:11:58.562,0:12:00.605
within the realm of our discussion[br]

0:12:00.605,0:12:02.618
delta S is still positive.[br]

0:12:02.618,0:12:04.490
[br]What does it mean when we say delta S is positive?[br]

0:12:04.490,0:12:05.295
In theory,

0:12:05.295,0:12:07.157
objects tends to be in minimum energy and maximum entropy,

0:12:07.157,0:12:08.176
creating greater disorder.[br]

0:12:08.176,0:12:10.140
My existence

0:12:10.140,0:12:11.361
would mean a delta S less than zero,

0:12:11.361,0:12:14.958
which defies molecular science.[br]

0:12:14.958,0:12:17.202
Then how should we view life and death?[br]

0:12:17.202,0:12:18.611
Actually,[br]

0:12:18.611,0:12:20.682
[br]we often see ourselves only.[br]

0:12:20.682,0:12:22.601
[br]We don’t realize that we are in the universe.

0:12:22.601,0:12:24.923
The universe is the combination of us and the environment.

0:12:24.923,0:12:26.347
So total delta S[br]

0:12:26.347,0:12:29.446
equals to delta S system and delta S surrounding.[br]

0:12:29.446,0:12:30.437
So

0:12:30.437,0:12:32.631
this is an important concept.

0:12:32.631,0:12:35.202
Any organized group[br]

0:12:35.202,0:12:37.240
is always in an unstable state.[br]

0:12:37.240,0:12:39.428
The group disrupts its surrounding.[br]

0:12:39.428,0:12:41.178
So even if delta S for the group is negative,

0:12:41.178,0:12:43.284
because the group disrupts its surrounding,[br]

0:12:43.284,0:12:44.561
delta S total is greater than zero

0:12:44.561,0:12:46.361
to make the equation positive.

0:12:46.361,0:12:47.188
So my existence

0:12:47.188,0:12:49.326
is to disrupt my surroundings

0:12:49.326,0:12:50.298
until one day[br]

0:12:50.298,0:12:52.062
when I can no longer do so,

0:12:52.062,0:12:53.659
that's when I disrupt myself[br]

0:12:53.659,0:12:56.399
so Delta S total can remain positive.

0:12:56.399,0:12:58.207
In essence, our existence is to disrupt.

0:12:58.207,0:12:59.268
When you’re unable to disrupt the surrounding,[br]

0:12:59.268,0:13:00.311
you end up disrupting yourself.

0:13:00.311,0:13:01.635
That is the meaning of death.[br]

0:13:01.635,0:13:04.917
It's death from a molecular science aspect.[br]

0:13:04.917,0:13:07.544
However,[br]

0:13:07.544,0:13:08.797
as a doctor,

0:13:08.797,0:13:10.885
I understand molecular science.

0:13:10.885,0:13:13.159
But what about the meaning of life?

0:13:13.159,0:13:14.758
One day, when I was in ICU

0:13:14.758,0:13:15.620
making my rounds[br]

0:13:15.620,0:13:16.907
I came to realize

0:13:16.907,0:13:18.623
that humans only have two types of ending.[br]

0:13:18.623,0:13:19.286
One is with inserted tubes.[br]

0:13:19.286,0:13:21.529
The other is without.

0:13:21.529,0:13:24.340
Both represent death.[br]

0:13:24.340,0:13:26.855
Death is every person's final journey.

0:13:26.855,0:13:27.804
So[br]

0:13:27.804,0:13:30.780
what does death mean to us?[br]

0:13:30.780,0:13:33.692
I'd like to share a contrasting viewpoint on this.

0:13:33.692,0:13:35.840
If you ask me what death is,

0:13:35.840,0:13:37.486
I will ask you:

0:13:37.486,0:13:40.495
what does it mean to be alive?

0:13:40.495,0:13:41.452
Everyone here in this audience

0:13:41.452,0:13:43.149
came to hear a lecture.[br]

0:13:43.149,0:13:45.157
I hope you can do one thing when you leave.

0:13:45.157,0:13:46.567
Before falling asleep tonight,

0:13:46.567,0:13:47.433
when you’re lying on your bed,

0:13:47.433,0:13:49.017
ask yourself this question:

0:13:49.017,0:13:58.424
"What does it mean to be alive?"[br]

0:13:58.424,0:13:59.208
Because[br]

0:13:59.208,0:14:00.621
this question[br]

0:14:00.621,0:14:02.552
leads us to contemplate [br]

0:14:02.552,0:14:03.831
on the meaning of life.[br]

0:14:03.831,0:14:05.909
My answer to the question is this:

0:14:05.909,0:14:07.168
"When you’re searching for the answer to the question,

0:14:07.168,0:14:10.508
it is the answer to the question."

0:14:10.508,0:14:12.331
Everyone dies eventually.[br]

0:14:12.331,0:14:14.200
No one will set death[br]

0:14:14.200,0:14:15.404
as his or her goal in life.

0:14:15.404,0:14:17.299
Therefore, life is just a process.

0:14:17.299,0:14:20.082
In this process [br]

0:14:20.082,0:14:21.371
during one's entire lifespan[br]

0:14:21.371,0:14:23.530
we keep searching for the answer

0:14:23.530,0:14:25.133
to the meaning of existence.

0:14:25.133,0:14:27.403
So when you’re searching for the answer to existence

0:14:27.403,0:14:29.042
that is the very answer to the question.[br]

0:14:29.042,0:14:31.249
Death is not the goal of life.[br]

0:14:31.249,0:14:33.491
Life is just a process.

0:14:33.491,0:14:37.558
Recently, I've been sharing the story of feces.

0:14:37.558,0:14:39.110
At one time, my advisor was going to retire.

0:14:39.110,0:14:39.673
So he said,

0:14:39.673,0:14:40.556
"I am going to retire,

0:14:40.556,0:14:41.375
treat me to somewhere fancy."

0:14:41.375,0:14:42.480
I said, "Of course."

0:14:42.480,0:14:44.389
So my advisor, another schoolmate, and I

0:14:44.389,0:14:46.503
went to the 2nd floor of the Sheraton Hotel

0:14:46.503,0:14:48.959
to celebrate in a French restaurant.

0:14:48.959,0:14:51.654
The three of us spent TWD$ 26,000.

0:14:51.654,0:14:54.397
I was astonished when I got the bill.[br]

0:14:54.397,0:14:56.010
How could I eat something so expensive?[br]

0:14:56.010,0:14:57.909
I’d never been to that kind of restaurant before,

0:14:57.909,0:14:58.596
so we ordered

0:14:58.596,0:14:59.993
some random and unknown dishes.

0:14:59.993,0:15:01.369
When I saw the bill,

0:15:01.369,0:15:03.168
TWD$ 26,000, I was too shocked to speak.

0:15:03.168,0:15:04.927
The next morning, in the toilet,[br]

0:15:04.927,0:15:09.081
I examined my feces carefully.

0:15:09.081,0:15:10.606
I thought in my mind,[br]

0:15:10.606,0:15:15.390
"I’d spent TWD$ 9,000 dollars producing this."

0:15:15.390,0:15:15.909
After careful examination, I concluded that[br]

0:15:15.909,0:15:18.394
this "poo" looks no different from the feces I produced after dining in the NTU hospital cafeteria.

0:15:18.394,0:15:19.800
The buffet there costs TWD$ 70 only.

0:15:19.800,0:15:23.550
I couldn't tell the difference.

0:15:23.550,0:15:26.659
On the toilet, I came to realize that

0:15:26.659,0:15:28.606
all the wealth one desires

0:15:28.606,0:15:35.666
turns out to be crap.

0:15:40.074,0:15:43.061
Confucianism is the most important philosophical system in the Chinese culture.

0:15:43.077,0:15:45.613
The advantages of Confucianism are that

0:15:45.613,0:15:48.047
its philosophy is about human virtues.[br]

0:15:48.047,0:15:50.254
Let's look at a few passages

0:15:50.254,0:15:51.104
in the Analects of Confucius.

0:15:51.104,0:15:52.455
"“If you don't understand what life is, how will you understand death?"

0:15:52.455,0:15:53.059
"If you can't yet serve men,"

0:15:53.059,0:15:54.474
"how can you serve the spirits?”

0:15:54.474,0:15:55.223
“When your parents are alive,"

0:15:55.223,0:15:55.624
"serve them with propriety;"

0:15:55.624,0:15:56.015
"when they die,"

0:15:56.015,0:15:56.921
"bury them with propriety,"

0:15:56.921,0:15:58.320
"and then worship them with propriety."

0:15:58.320,0:15:59.975
[br]Confucianism refused to talk about life and death.[br]

0:15:59.975,0:16:00.955
Instead, Confucius gave answers to

0:16:00.955,0:16:02.620
sacrificing life for justice

0:16:02.620,0:16:04.293
and how man holds no regret

0:16:04.293,0:16:06.653
once he understands "the way".

0:16:06.653,0:16:09.508
To a follower of Confucianism, the question of life and death

0:16:09.508,0:16:11.074
is a topic to be avoided.

0:16:11.074,0:16:12.281
He offered no direct answers.

0:16:12.281,0:16:14.439
So...

0:16:14.439,0:16:15.292
on the positive side,

0:16:15.292,0:16:15.986
he focuses on the time when he is alive.

0:16:15.986,0:16:17.812
Just avoid these big questions

0:16:17.812,0:16:19.564
and focus on the things you have at hand.

0:16:19.564,0:16:20.551
But there is one problem.

0:16:20.551,0:16:23.685
He totally sidesteps the question of life and death.

0:16:23.685,0:16:26.098
The following is what I think.

0:16:26.098,0:16:27.749
In Chinese culture,[br]

0:16:27.749,0:16:29.722
Confucianism is the most crucial philosophy.

0:16:29.722,0:16:31.506
Back then, our forefathers didn't want to discuss life and death.

0:16:31.506,0:16:33.372
They tried to avoid the question.

0:16:33.372,0:16:36.354
There’s a saying from Sun Tzu's Art of War:

0:16:36.354,0:16:38.198
"Force soldiers to see the face of death; they will fight to stay alive."

0:16:38.198,0:16:40.219
Only when we can face death

0:16:40.219,0:16:42.735
or even face death straight up

0:16:42.735,0:16:45.724
can we begin to reflect on

0:16:45.724,0:16:47.234
what life is.

0:16:47.234,0:16:49.549
We will all die one day.

0:16:49.549,0:16:51.760
Life is just a process,

0:16:51.760,0:16:55.428
a process of searching for the meaning of existence.

0:16:55.428,0:16:57.351
That's just my humble opinion.

0:16:57.351,0:16:58.845
I think I can be considered an astute person.

0:16:58.845,0:17:00.571
My stamina is good, too.

0:17:00.571,0:17:03.362
I've biked around the entire Taiwan island on my first biking tour.

0:17:03.362,0:17:05.459
Just because I'm asute

0:17:05.459,0:17:07.231
and also in good physical shape,

0:17:07.231,0:17:09.225
can I use these blessings

0:17:09.225,0:17:10.153
to bully [br]

0:17:10.153,0:17:11.317
or to take advantage of others?

0:17:11.317,0:17:12.127
Definitely not.

0:17:12.127,0:17:12.815
So

0:17:12.815,0:17:14.870
those who are blessed

0:17:14.870,0:17:16.527
should be grateful.[br]

0:17:16.527,0:17:18.480
If we are very capable,

0:17:18.480,0:17:20.088
shouldn't we actively help others

0:17:20.088,0:17:22.717
and make our lives more meaningful?

0:17:22.717,0:17:23.861
Life is about "knowing gratitude" and "repaying gratitude."

0:17:23.861,0:17:25.832
When I visited Dharma Drum Mountain Monastery,

0:17:25.832,0:17:27.717
the abbot there, Veneralble Guo-Dong, shared with me

0:17:27.717,0:17:28.709
the idea of "knowing and repaying gratitude,"

0:17:28.709,0:17:29.568
as well as "being grateful, not resentful."

0:17:29.568,0:17:31.245
He said,

0:17:31.245,0:17:32.530
“I know you've been wronged,”

0:17:32.530,0:17:34.504
“but you can’t complain."

0:17:34.504,0:17:38.666
"Instead, you should make greater vows to help others in need.”

0:17:38.666,0:17:40.659
Lastly, let me share a concept

0:17:40.659,0:17:42.430
called “a to the power of n.”[br]

0:17:42.430,0:17:44.080
If "a" is greater than 1,

0:17:44.080,0:17:45.442
"a" to the power of "n" is infinity.

0:17:45.442,0:17:46.679
If "a" is less than 1,

0:17:46.679,0:17:48.282
"a" to the power of "n" will approach zero rapidly.

0:17:48.282,0:17:49.763
What does that mean?

0:17:49.763,0:17:52.543
If what I give to the society

0:17:52.543,0:17:54.062
is greater than what I take from the society,

0:17:54.062,0:17:55.283
my "a" is greater than one.

0:17:55.283,0:17:57.256
This society will become better and better accordingly.

0:17:57.256,0:17:58.801
If what I take from the society

0:17:58.801,0:18:00.488
is greater than what I give to the society,[br]

0:18:00.488,0:18:01.642
my "a" will be less than 1.

0:18:01.642,0:18:03.431
Consequently, this society will increasingly collapse.

0:18:03.431,0:18:05.419
I will end my speech

0:18:05.419,0:18:07.295
with these words.

0:18:07.295,0:18:09.415
"Facing hardships is not the most difficult thing."

0:18:09.415,0:18:11.167
"The most difficult thing is..."

0:18:11.167,0:18:12.784
"to facing the hardships"

0:18:12.784,0:18:14.241
"without loosing your passion for mankind."

0:18:14.241,0:18:16.177
Thank you, everyone!