WEBVTT 00:00:15.750 --> 00:00:19.447 The host (from TEDxTaipei) invited me to speak about “Positive Destruction.” 00:00:19.447 --> 00:00:24.946 After giving it some thought, I thought I might as well share my own story. 00:00:24.946 --> 00:00:26.926 Among all the physicians in Taiwan, 00:00:26.926 --> 00:00:30.448 I am probably the one ER doctor who has seen the most cadavers. 00:00:30.448 --> 00:00:32.901 I've seen many cases of life and death. 00:00:32.901 --> 00:00:36.947 Perhaps that's why I'm suited to share such stories on this stage. 00:00:36.947 --> 00:00:39.314 There's a joke about 00:00:39.314 --> 00:00:40.871 the most famous physician -- Dr. Yeh 00:00:40.871 --> 00:00:42.744 here in Taiwan. 00:00:42.744 --> 00:00:44.530 After Shao Xiao Ling's (Taichung First Lady) car accident, 00:00:44.530 --> 00:00:46.613 a patient went to Chi-Mei Hospital in Liu-Ying city 00:00:46.613 --> 00:00:48.697 to seek a doctor named Yeh. 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. Yeh. 00:00:51.988 --> 00:00:53.206 "There is, " said the patient. 00:00:53.206 --> 00:00:56.421 "I was told that his name is 'Yeh Ker-Mo' (ECMO: Extra-Corporeal Membrane Oxygenation). 00:00:56.421 --> 00:01:00.023 This Dr. Yeh was the one who saved Shao Xiao Ling's life!" 00:01:00.038 --> 00:01:01.341 Speaking of ECMO, its concept is quite easy to understand. 00:01:01.341 --> 00:01:02.610 You divert the blood flow from the femoral vein 00:01:03.879 --> 00:01:05.149 and pass it through a pump, 00:01:05.149 --> 00:01:06.012 which serves as an artificial heart. 00:01:06.012 --> 00:01:07.293 The blood then passes through a membrane oxygenator, 00:01:07.409 --> 00:01:08.558 which acts as a pair of artificial lungs. 00:01:08.558 --> 00:01:10.480 Afterwards, the blood re-enters the body. 00:01:10.480 --> 00:01:12.939 So, ECMO is a temporary substitute of a human's cardiovascular system. 00:01:12.939 --> 00:01:14.973 This is how an ECMO machine looks like. 00:01:14.973 --> 00:01:17.486 You now have a machine acting as an artificial heart 00:01:17.486 --> 00:01:20.066 that pumps blood to the oxygenator and back to the body. 00:01:20.066 --> 00:01:22.695 As a matter of fact, ECMO technique 00:01:22.695 --> 00:01:24.292 was already available and widely used 00:01:24.292 --> 00:01:27.504 at the National Taiwan University (NTU) Hospital 00:01:27.504 --> 00:01:30.054 since 1994 prior to the first lady's car accident. 00:01:30.054 --> 00:01:31.933 It was only since her incident that folks in Taiwan are aware of the ECMO technique. 00:01:31.933 --> 00:01:33.384 It’s similar to the saying: "One can spend decades painting in relative obscurity," 00:01:33.384 --> 00:01:36.239 "but the world only sees the artist's finished masterpiece." 00:01:36.239 --> 00:01:37.595 That's just my personal opinion. 00:01:37.595 --> 00:01:41.035 ECMO became a household term due to its overexposure from Taiwan's media press. 00:01:41.035 --> 00:01:43.731 here's no doubt that ECMO technique has its relatively successful cases. 00:01:43.731 --> 00:01:45.407 One prominent example is the case of singer Jay Chou's backup dancer. 00:01:45.407 --> 00:01:47.830 00:01:47.083 --> 00:01:48.761 One day, this patient was admitted with fulminant myocarditis, 00:01:48.761 --> 00:01:50.947 and was undergoing cardiac arrest. 00:01:50.947 --> 00:01:52.999 I would like to show you a photo of him at the time, 00:01:52.999 --> 00:01:56.646 with the patient lying on his hospital bed. 00:01:56.646 --> 00:01:57.922 The eyes of this patient were wide open, 00:01:57.922 --> 00:01:59.414 and were staring straight, 00:01:59.414 --> 00:02:01.739 reading the flat lines showing on the ECG screen. 00:02:01.739 --> 00:02:03.317 As a result of fulminant myocarditis, 00:02:03.317 --> 00:02:05.474 the patient's heart stopped beating. 00:02:05.474 --> 00:02:07.819 He suffered a cardiac arrest. 00:02:07.819 --> 00:02:10.636 This is a biopsy of his cardiac muscle 00:02:10.636 --> 00:02:12.395 magnified 100 times under the microscope. 00:02:12.395 --> 00:02:13.727 Even under this type of magnifying power, 00:02:13.727 --> 00:02:16.312 it's still quite hard to see. 00:02:16.312 --> 00:02:18.831 However, magnified 400 times will be much clearer. 00:02:18.831 --> 00:02:22.140 Those blue spots are lymphocytes. 00:02:22.140 --> 00:02:26.092 From here, we can see a serious case of fulminant myocarditis. 00:02:26.092 --> 00:02:29.439 Lymphocytes infiltrated his entire heart, 00:02:29.439 --> 00:02:33.818 which caused sudden cardiac arrest. NOTE Paragraph 00:02:33.818 --> 00:02:37.062 The patient stared at the screen, 00:02:37.062 --> 00:02:40.421 as it displayed no signs of a working heart. 00:02:40.421 --> 00:02:42.880 After the ninth day, 00:02:42.880 --> 00:02:44.558 after a heart and a kidney transplant, 00:02:44.558 --> 00:02:46.807 She returned to dance in less than one month's recovery. 00:02:46.807 --> 00:02:49.329 It was a great miracle in modern medicine. 00:02:49.329 --> 00:02:52.406 In modern medical records, 00:02:52.406 --> 00:02:55.150 this patient holds the longest record for CPR survival: 00:02:55.150 --> 00:02:57.291 4 hours. 00:02:57.291 --> 00:03:00.766 CPR was performed on him from Cathay General Hospital to NTU Hospital. 00:03:00.766 --> 00:03:02.808 When physicians tried ECMO technique at the NTU hospital, 00:03:02.808 --> 00:03:05.015 they found that over 100 doses 00:03:05.015 --> 00:03:06.683 of cardiotonic drugs 00:03:06.683 --> 00:03:08.746 were already given to him. 00:03:08.746 --> 00:03:10.303 When an incision was made 00:03:10.303 --> 00:03:10.947 to insert an ECMO tube, 00:03:10.947 --> 00:03:12.408 the patient's veins and arteries were too narrow. 00:03:12.408 --> 00:03:13.636 Therefore, CPR had to be conducted again 00:03:13.636 --> 00:03:14.879 until he was in the operating room. 00:03:14.879 --> 00:03:15.807 Surgeons had to saw open the patient's chest 00:03:15.807 --> 00:03:18.192 to insert ECMO tubes from the top. 00:03:18.192 --> 00:03:22.448 The entire procedure sounds surreal right now. 00:03:22.448 --> 00:03:27.160 Every time I recall this case, I always say it's a modern medical miracle. 00:03:27.160 --> 00:03:30.330 The fact that a man‘s heart had stopped for 9 days. 00:03:30.330 --> 00:03:34.100 And after enduring heart and kidney transplants, 00:03:34.100 --> 00:03:36.728 a 4 hour CPR, 00:03:36.728 --> 00:03:39.169 he could still survive. 00:03:39.169 --> 00:03:40.871 Here is anthother patient case. 00:03:40.871 --> 00:03:42.516 The headline reads ”World's First: 00:03:42.516 --> 00:03:43.943 Miracle of Taiwan". 00:03:43.943 --> 00:03:46.421 Man without heart for 16 days. 00:03:46.421 --> 00:03:49.746 In this case, the patient is a 56-year-old man. 00:03:49.746 --> 00:03:51.346 He had a tooth decay. 00:03:51.346 --> 00:03:53.396 Bacteria from the cavity went into the blood, 00:03:53.396 --> 00:03:54.297 and spread to the portions of the heart. 00:03:54.297 --> 00:03:55.885 It caused a pus buildup. 00:03:55.885 --> 00:03:57.824 The patient went to a different hospital 00:03:57.824 --> 00:03:59.761 where the surgical team opened up his chest, 00:03:59.761 --> 00:04:00.561 and began to eliminate 00:04:00.561 --> 00:04:01.945 infected tissues of the heart. 00:04:01.945 --> 00:04:02.796 The team continued to remove 00:04:02.796 --> 00:04:03.849 more affected tissues 00:04:03.849 --> 00:04:06.866 until not much of the muscular organ was left. 00:04:06.866 --> 00:04:07.861 So what can the team do now? 00:04:07.861 --> 00:04:13.267 Transfer this patient to NTU hospital. 00:04:13.308 --> 00:04:17.128 It seems that NTU hospital is the last line of medical defense in Taiwan. 00:04:17.128 --> 00:04:18.990 NTU hospital has to take patients in. 00:04:18.990 --> 00:04:21.831 In the first case, the case was cardiac arrest. 00:04:21.831 --> 00:04:22.543 This case is more extreme. 00:04:22.543 --> 00:04:23.779 This is a man with not much of a heart left. 00:04:23.779 --> 00:04:25.475 It was almost all surgically removed. 00:04:25.475 --> 00:04:26.706 When the patient was transferred to NTU hospital, 00:04:26.706 --> 00:04:28.527 because of the state he was in, 00:04:28.527 --> 00:04:30.254 our medical team had to use two ECMOs. 00:04:30.254 --> 00:04:31.241 Look at this slide. 00:04:31.241 --> 00:04:32.733 There are two ECMO devices. 00:04:32.733 --> 00:04:34.376 This one is even more unbelievable. 00:04:34.376 --> 00:04:35.511 Since he didn't have a heart left, 00:04:35.511 --> 00:04:37.747 so the ECG displayed a completely flat line. 00:04:37.747 --> 00:04:40.880 There's not much to explain here. 00:04:40.880 --> 00:04:42.432 This is his CT scan result. 00:04:42.432 --> 00:04:43.285 Theoretically, 00:04:43.285 --> 00:04:45.915 there should have been a heart in his thorax. 00:04:45.915 --> 00:04:47.030 However, the heart is missing here. 00:04:47.030 --> 00:04:49.390 There are only tubes. 00:04:49.390 --> 00:04:51.285 After 16 days, 00:04:51.285 --> 00:04:53.485 our surgical team performed a heart transplant surgery on this patient. 00:04:53.485 --> 00:04:56.408 Cardiologist surgeon Dr. Wan showed me this. 00:04:56.408 --> 00:04:58.472 Dr. Wan said during the surgery, 00:04:58.472 --> 00:04:59.494 he opened the patient's chest 00:04:59.494 --> 00:05:01.938 and had expected a heart in the thorax. 00:05:01.938 --> 00:05:03.830 However, there were only plastic 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 16 days, the heart transplant surgery was completed. 00:05:12.196 --> 00:05:15.317 The patient was discharged later. 00:05:15.317 --> 00:05:18.834 Here is the Straits Times of Singapore. 00:05:18.834 --> 00:05:22.161 A vendor I know sent me an e-mail from Singapore. 00:05:22.161 --> 00:05:24.590 He told me that we were featured in the Straits Times. 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 a 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 in good shape. 00:05:33.337 --> 00:05:35.103 This is a third case. 00:05:35.103 --> 00:05:39.209 He’s a 26-year-old aboriginal Taiwanese. 00:05:39.209 --> 00:05:41.370 He went swimming even when he was seriously drunk. 00:05:41.370 --> 00:05:45.080 Jokingly, he probably thought he was Li Bai the poet. 00:05:45.080 --> 00:05:47.175 The pond he swam in was really unsanitary. 00:05:47.175 --> 00:05:48.217 He choked on water. 00:05:48.217 --> 00:05:49.618 As a result, 00:05:49.618 --> 00:05:51.410 he caught a severe case of pneumonia. 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 After he ingested unclean water, 00:05:55.976 --> 00:05:57.380 his condition worsened to a severe case of pneumonia. 00:05:57.380 --> 00:05:59.818 This is called acute respiratory distress syndrome. 00:05:59.818 --> 00:06:01.948 The lungs became abnormally white. 00:06:01.948 --> 00:06:05.090 He lived on ECMO for 117 days. 00:06:05.090 --> 00:06:09.524 We can see clearly from this slide. 00:06:09.524 --> 00:06:11.860 For one entire month, 00:06:11.860 --> 00:06:13.486 the patient's ventilation volume 00:06:13.486 --> 00:06:15.155 did not exceed 100 c.c. 00:06:15.155 --> 00:06:18.018 But the patient still recovered. 00:06:18.018 --> 00:06:19.459 In short, 00:06:19.459 --> 00:06:21.226 in the these three medical cases, 00:06:21.226 --> 00:06:22.961 in the these three medical cases, 00:06:22.961 --> 00:06:24.606 the patient undergoing cardiac arrest, 00:06:24.606 --> 00:06:27.110 or the patient with lung failure, 00:06:27.110 --> 00:06:29.308 with the help of ECMO, 00:06:29.308 --> 00:06:32.590 no matter whether 9 days later 00:06:32.590 --> 00:06:34.605 or even 100 days afterwards, 00:06:34.605 --> 00:06:36.373 after a heart transplant 00:06:36.373 --> 00:06:37.832 or lung transplant, 00:06:37.832 --> 00:06:39.519 their lives were saved. 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 In recent history, ECMO has retained 00:06:44.578 --> 00:06:45.728 a high level of awareness 00:06:45.728 --> 00:06:47.664 thanks to the media presses in Taiwan. 00:06:47.664 --> 00:06:48.695 The reason why folks know about ECMO, 00:06:48.695 --> 00:06:50.572 is because of past success cases, 00:06:50.572 --> 00:06:52.259 and also because of the first lady in Taichung, 00:06:52.259 --> 00:06:53.761 and famed astrologer Nick Yen. 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 reports on the successful stories. 00:06:58.211 --> 00:06:59.408 Reporters don’t write failed cases. 00:06:59.408 --> 00:07:00.942 Hidden from the public eye. 00:07:00.942 --> 00:07:04.117 As a critical care physician, 00:07:04.117 --> 00:07:06.322 I am certainly glad to encounter successful patient cases. 00:07:06.322 --> 00:07:08.187 However, there are cases that are not as successful. 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 a congenital heart disease. 00:07:14.767 --> 00:07:16.324 After undergoing a heart surgery, 00:07:16.324 --> 00:07:17.886 the baby still could not live without a heart-lung machine. 00:07:17.886 --> 00:07:19.643 So, we hooked the baby up to an ECMO. 00:07:19.643 --> 00:07:20.668 The ECMO was inserted in the baby's heart. 00:07:20.668 --> 00:07:21.965 After the procedure, 00:07:21.965 --> 00:07:22.989 in three days, 00:07:22.989 --> 00:07:24.209 the baby's 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 tiny, blackened feet. 00:07:27.028 --> 00:07:28.488 So now, as a physician, NOTE Paragraph 00:07:28.488 --> 00:07:29.993 you have to make a decision. 00:07:29.993 --> 00:07:31.510 Should you amputate his tiny feet 00:07:31.510 --> 00:07:32.615 to try to save his life? 00:07:32.615 --> 00:07:33.580 Or should you just give up 00:07:33.580 --> 00:07:34.835 and let him go? 00:07:34.835 --> 00:07:37.695 These types of decisions are incredibly stressful to make. 00:07:37.695 --> 00:07:40.091 But if you can’t make the call, 00:07:40.091 --> 00:07:42.114 then the next case is more difficult to gauge. 00:07:42.114 --> 00:07:44.830 Here is a 7-year-old boy 00:07:44.830 --> 00:07:46.151 suffering from streptococcus pneumonia. 00:07:46.151 --> 00:07:48.962 His condition worsened to acute respiratory distress syndrome. 00:07:48.962 --> 00:07:51.538 So the medical team decided to employ ECMO technique. 00:07:51.538 --> 00:07:53.829 After using ECMO, however, 00:07:53.829 --> 00:07:55.044 there were complications. 00:07:55.044 --> 00:07:56.889 His limbs all turned black. 00:07:56.889 --> 00:07:58.493 His adorable eyes would look at you, 00:07:58.493 --> 00:07:59.316 his conscious in a clear state. 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 incredibly hard decisions. 00:08:04.540 --> 00:08:05.963 If you want to save him, 00:08:05.963 --> 00:08:07.541 you have to cut off his limbs first, 00:08:07.541 --> 00:08:08.983 and continue with further medical treatment. 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 Between life and death, 00:08:16.298 --> 00:08:17.801 when the patient is in a conscious state, 00:08:17.801 --> 00:08:21.887 of course, the doctor's mind is clear, too. 00:08:21.887 --> 00:08:23.788 How would you ask the boy? 00:08:23.788 --> 00:08:24.883 "Hi dear" 00:08:24.883 --> 00:08:26.589 "If you want to live" 00:08:26.589 --> 00:08:28.493 "I will need to amputate your limbs." 00:08:28.493 --> 00:08:30.400 "Or you'd rather give up," 00:08:30.400 --> 00:08:32.397 "and rest in peace?" 00:08:32.397 --> 00:08:34.421 How do you communicate this type of life and death decision 00:08:34.421 --> 00:08:37.569 with a 7-year-old? 00:08:37.569 --> 00:08:39.646 This is the line of work I have to deal with 00:08:39.646 --> 00:08:41.723 as a critical care physician. 00:08:41.723 --> 00:08:43.800 In the beginning, I made decisions rather logically. 00:08:43.800 --> 00:08:47.368 I identified everything by patients. 00:08:47.368 --> 00:08:48.652 Gradually, 00:08:48.652 --> 00:08:49.843 I targeted diseases, not patients. 00:08:49.843 --> 00:08:51.260 A diseased heart, for example. 00:08:51.260 --> 00:08:53.123 Fortunately, when I turned fifty, 00:08:53.123 --> 00:08:56.585 I gradually realized that I should treat patient as a whole again. 00:08:56.585 --> 00:08:58.079 To be quite honest, 00:08:58.079 --> 00:09:00.505 I consider myself academically inclined. 00:09:00.505 --> 00:09:02.089 When I reached my 30s, 00:09:02.089 --> 00:09:03.057 heart transplants, 00:09:03.057 --> 00:09:04.067 lung transplants, 00:09:04.067 --> 00:09:05.138 ECMO technique, 00:09:05.138 --> 00:09:07.888 youngest chief physician in NTU hospital, 00:09:07.888 --> 00:09:09.517 chief physician of the Surgical Intensive Care Unit, 00:09:09.517 --> 00:09:11.919 Initiated the Organ Registry and Sharing Center project, 00:09:11.919 --> 00:09:13.136 Chief physician of the Trauma Unit. 00:09:13.136 --> 00:09:15.740 All these were accomplished by my 30s. 00:09:15.740 --> 00:09:17.207 During this journey, 00:09:17.207 --> 00:09:20.140 I believed that medical knowledge was incredibly powerful. 00:09:20.140 --> 00:09:21.678 Medical knowledge can cure everything. 00:09:21.678 --> 00:09:23.982 But in my 40s, 00:09:23.982 --> 00:09:25.414 there were 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 “How come the First Lady of Taichung survived, 00:09:29.239 --> 00:09:31.926 but my family member didn't make it?” 00:09:31.926 --> 00:09:33.220 I don’t know how to answer such questions. 00:09:33.220 --> 00:09:36.495 I couldn’t say because he or she was not the First Lady, could I? 00:09:36.495 --> 00:09:37.390 Others ask me, 00:09:37.390 --> 00:09:39.234 “why do his limbs turned black?” 00:09:39.234 --> 00:09:40.131 If I'd known the answer, 00:09:40.131 --> 00:09:41.048 I would have definitely prevented it from happening. 00:09:41.048 --> 00:09:42.354 I have to admit that I don't know. 00:09:42.354 --> 00:09:44.440 So when I was in my 40s, 00:09:44.440 --> 00:09:46.487 I thought that 00:09:46.487 --> 00:09:49.553 why couldn't this patient be saved? 00:09:49.553 --> 00:09:51.557 Finally, when I was reached my 50s, 00:09:51.557 --> 00:09:54.057 the concept dawned on me. 00:09:54.057 --> 00:09:56.661 There's a Chinese poetry that says: "I've searched high and low for her." 00:09:56.661 --> 00:09:57.533 "It's only when I turned around," 00:09:57.533 --> 00:09:59.652 "The woman I seek is just standing behind me near a lantern." 00:09:59.652 --> 00:10:00.439 That 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 Doctors can only try our best. 00:10:05.262 --> 00:10:08.058 That’s it. 00:10:08.058 --> 00:10:10.284 I began to reason this philosophy out. 00:10:10.284 --> 00:10:11.144 Let's look at seasons. 00:10:11.144 --> 00:10:13.199 There's spring, summer, 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 advanced science is, 00:10:18.010 --> 00:10:19.243 with today’s technology, 00:10:19.243 --> 00:10:19.921 a person without a heart, 00:10:19.921 --> 00:10:20.497 or lungs, 00:10:20.497 --> 00:10:21.530 or liver, 00:10:21.530 --> 00:10:21.894 or kidney, 00:10:21.894 --> 00:10:23.168 can still live. 00:10:23.168 --> 00:10:26.162 But can we replace our organs with devices or gadgets 00:10:26.162 --> 00:10:27.981 forever? 00:10:27.981 --> 00:10:30.493 Medicine still has its limits. 00:10:30.493 --> 00:10:32.696 So I came to a conclusion. 00:10:32.696 --> 00:10:35.604 Can gardeners change the seasons? 00:10:35.604 --> 00:10:37.168 Of course not. 00:10:37.168 --> 00:10:39.070 Gardeners can only make flowers 00:10:39.070 --> 00:10:42.221 grow prettier in the four seasons. 00:10:42.221 --> 00:10:43.490 As a doctor, 00:10:43.490 --> 00:10:45.806 am I capable of changing nature's rules to birth, aging, sickness or death? 00:10:45.806 --> 00:10:46.731 Well, 00:10:46.731 --> 00:10:47.990 it's very difficult. 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 enable people 00:10:52.358 --> 00:10:53.692 to go through life a little easier when they’re alive. 00:10:53.692 --> 00:10:54.557 That’s all. 00:10:54.557 --> 00:10:55.356 So gradually, 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's garden. 00:11:01.231 --> 00:11:05.380 As a gardener, 00:11:05.380 --> 00:11:07.308 when faced with the withered plants, 00:11:07.308 --> 00:11:09.070 how to treat them is a great question. 00:11:09.070 --> 00:11:11.563 As an expert in critical care, 00:11:11.563 --> 00:11:14.931 how do I face death? 00:11:14.931 --> 00:11:16.884 From a scientific aspect, 00:11:16.884 --> 00:11:19.289 or more precisely, from molecular science, 00:11:19.289 --> 00:11:20.615 a system undergoing physical reaction 00:11:20.615 --> 00:11:21.548 on a molecular level 00:11:21.548 --> 00:11:22.398 will tend to minimize energy 00:11:22.398 --> 00:11:23.418 and maximize entropy. 00:11:23.418 --> 00:11:26.607 So delta S (entropy) should be greater or equal to zero. 00:11:26.607 --> 00:11:29.524 Some may ask how delta s is greater than zero. 00:11:29.524 --> 00:11:31.317 Some believe it's from the Big Bang theory, 00:11:31.317 --> 00:11:33.748 as it describes the state of ever-expanding universe. 00:11:33.748 --> 00:11:35.827 So that's how delta S is greater than zero. 00:11:35.827 --> 00:11:36.697 Or you may ask, 00:11:36.697 --> 00:11:38.784 is anything constant in the laws of this universe? 00:11:38.784 --> 00:11:39.353 Honestly, 00:11:39.353 --> 00:11:40.244 I don’t have an answer to this. 00:11:40.244 --> 00:11:41.720 There’s an old saying 00:11:41.720 --> 00:11:46.173 "A blind man is no judge of colors." 00:11:46.173 --> 00:11:47.329 Visually impared folks 00:11:47.329 --> 00:11:48.644 can’t distinguish colors 00:11:48.644 --> 00:11:50.435 so it's pointless to ask them to judge. 00:11:50.435 --> 00:11:52.263 Does constant apply 00:11:52.263 --> 00:11:53.449 to the laws in this universe? 00:11:53.449 --> 00:11:55.297 Does eternity exist 00:11:55.297 --> 00:11:55.993 in space and time? 00:11:55.993 --> 00:11:56.483 Frankly, 00:11:56.483 --> 00:11:57.535 I don’t know these answers. 00:11:57.535 --> 00:11:58.562 But at least, 00:11:58.562 --> 00:12:00.605 within the realm of our discussion 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 objects tends to be in minimum energy and maximum entropy, 00:12:07.157 --> 00:12:08.176 creating greater disorder. 00:12:08.176 --> 00:12:10.140 My existence 00:12:10.140 --> 00:12:11.361 would mean a delta S less than zero, 00:12:11.361 --> 00:12:14.958 which defies molecular science. 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 us 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 is always in an unstable state. 00:12:37.240 --> 00:12:39.428 The group disrupts its surrounding. 00:12:39.428 --> 00:12:41.178 So even if delta S for the group is negative, 00:12:41.178 --> 00:12:43.284 because the group disrupts its surrounding, 00:12:43.284 --> 00:12:44.561 delta S total is greater than zero 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 disrupt my surroundings 00:12:49.326 --> 00:12:50.298 until one day 00:12:50.298 --> 00:12:52.062 when I can no longer do so, 00:12:52.062 --> 00:12:53.659 that's when I disrupt myself 00:12:53.659 --> 00:12:56.399 so Delta S total can remain positive. 00:12:56.399 --> 00:12:58.207 In essence, our existence is to disrupt. 00:12:58.207 --> 00:12:59.268 When you’re unable to disrupt the surrounding, 00:12:59.268 --> 00:13:00.311 you end up disrupting yourself. 00:13:00.311 --> 00:13:01.635 That is the meaning of death. 00:13:01.635 --> 00:13:04.917 It's death from a molecular science aspect. 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 molecular science. 00:13:10.885 --> 00:13:13.159 But what about the meaning of life? 00:13:13.159 --> 00:13:14.758 One day, when I was in ICU 00:13:14.758 --> 00:13:15.620 making my rounds 00:13:15.620 --> 00:13:16.907 I came to realize 00:13:16.907 --> 00:13:18.623 that humans only have two types of ending. 00:13:18.623 --> 00:13:19.286 One is with inserted tubes. 00:13:19.286 --> 00:13:21.529 The other is without. 00:13:21.529 --> 00:13:24.340 Both represent death. 00:13:24.340 --> 00:13:26.855 Death is every person's final journey. 00:13:26.855 --> 00:13:27.804 So 00:13:27.804 --> 00:13:30.780 what does death mean to us? 00:13:30.780 --> 00:13:33.692 I'd like to share a contrasting viewpoint on this. 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 does it mean to be alive? 00:13:40.495 --> 00:13:41.452 Everyone here in this audience 00:13:41.452 --> 00:13:43.149 came to hear 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 Before falling asleep tonight, 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 this question: 00:13:49.017 --> 00:13:58.424 "What does it mean to be alive?" 00:13:58.424 --> 00:13:59.208 Because 00:13:59.208 --> 00:14:00.621 this question 00:14:00.621 --> 00:14:02.552 leads us to contemplate 00:14:02.552 --> 00:14:03.831 on the meaning of 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 one will set death 00:14:14.200 --> 00:14:15.404 as his or her goal in life. 00:14:15.404 --> 00:14:17.299 Therefore, life is just a process. 00:14:17.299 --> 00:14:20.082 In this process 00:14:20.082 --> 00:14:21.371 during one's entire lifespan 00:14:21.371 --> 00:14:23.530 we keep searching for the answer 00:14:23.530 --> 00:14:25.133 to the meaning of existence. 00:14:25.133 --> 00:14:27.403 So when you’re searching for the answer to existence 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 just a process. 00:14:33.491 --> 00:14:37.558 Recently, I've been sharing the story of feces. 00:14:37.558 --> 00:14:39.110 At one time, my advisor was going to retire. 00:14:39.110 --> 00:14:39.673 So he said, 00:14:39.673 --> 00:14:40.556 "I am going to retire, 00:14:40.556 --> 00:14:41.375 treat me to somewhere fancy." 00:14:41.375 --> 00:14:42.480 I said, "Of course." 00:14:42.480 --> 00:14:44.389 So my advisor, another schoolmate, and I 00:14:44.389 --> 00:14:46.503 went to the 2nd floor of the Sheraton Hotel 00:14:46.503 --> 00:14:48.959 to celebrate in a French restaurant. 00:14:48.959 --> 00:14:51.654 The three of us spent TWD$ 26,000. 00:14:51.654 --> 00:14:54.397 I was astonished when I got the bill. 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 before, 00:14:57.909 --> 00:14:58.596 so we ordered 00:14:58.596 --> 00:14:59.993 some random and unknown dishes. 00:14:59.993 --> 00:15:01.369 When I saw the bill, 00:15:01.369 --> 00:15:03.168 TWD$ 26,000, I was too shocked to speak. 00:15:03.168 --> 00:15:04.927 The next morning, in the toilet, 00:15:04.927 --> 00:15:09.081 I examined my feces carefully. 00:15:09.081 --> 00:15:10.606 I thought in my mind, 00:15:10.606 --> 00:15:15.390 "I’d spent TWD$ 9,000 dollars producing this." 00:15:15.390 --> 00:15:15.909 After careful examination, I concluded that 00:15:15.909 --> 00:15:18.394 this "poo" looks no different from the feces I produced after dining in the NTU hospital cafeteria. 00:15:18.394 --> 00:15:19.800 The buffet there costs TWD$ 70 only. 00:15:19.800 --> 00:15:23.550 I couldn't tell the difference. 00:15:23.550 --> 00:15:26.659 On the toilet, I came to realize that 00:15:26.659 --> 00:15:28.606 all the wealth one desires 00:15:28.606 --> 00:15:35.666 turns out to be crap. 00:15:40.074 --> 00:15:43.061 Confucianism is the most important philosophical system in the Chinese culture. 00:15:43.077 --> 00:15:45.613 The advantages of Confucianism are that 00:15:45.613 --> 00:15:48.047 its philosophy is about human virtues. 00:15:48.047 --> 00:15:50.254 Let's look at a few passages 00:15:50.254 --> 00:15:51.104 in the Analects of Confucius. 00:15:51.104 --> 00:15:52.455 "“If you don't understand what life is, how will you understand death?" 00:15:52.455 --> 00:15:53.059 "If you can't yet serve men," 00:15:53.059 --> 00:15:54.474 "how can you serve the spirits?” 00:15:54.474 --> 00:15:55.223 “When your parents are alive," 00:15:55.223 --> 00:15:55.624 "serve them with propriety;" 00:15:55.624 --> 00:15:56.015 "when they die," 00:15:56.015 --> 00:15:56.921 "bury them with propriety," 00:15:56.921 --> 00:15:58.320 "and then worship them with propriety." 00:15:58.320 --> 00:15:59.975 Confucianism refused to talk about life and death. 00:15:59.975 --> 00:16:00.955 Instead, Confucius gave answers to 00:16:00.955 --> 00:16:02.620 sacrificing life for justice 00:16:02.620 --> 00:16:04.293 and how man holds no regret 00:16:04.293 --> 00:16:06.653 once he understands "the way". 00:16:06.653 --> 00:16:09.508 To a follower of Confucianism, the question of life and death 00:16:09.508 --> 00:16:11.074 is a topic to be avoided. 00:16:11.074 --> 00:16:12.281 He offered no direct answers. 00:16:12.281 --> 00:16:14.439 So... 00:16:14.439 --> 00:16:15.292 on the positive side, 00:16:15.292 --> 00:16:15.986 he focuses on the time when he is alive. 00:16:15.986 --> 00:16:17.812 Just avoid these big questions 00:16:17.812 --> 00:16:19.564 and focus on the things you have at hand. 00:16:19.564 --> 00:16:20.551 But there is one problem. 00:16:20.551 --> 00:16:23.685 He totally sidesteps the question of life and death. 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 philosophy. 00:16:29.722 --> 00:16:31.506 Back then, our forefathers didn't want to discuss life and death. 00:16:31.506 --> 00:16:33.372 They tried to avoid the question. 00:16:33.372 --> 00:16:36.354 There’s a saying from Sun Tzu's Art of War: 00:16:36.354 --> 00:16:38.198 "Force soldiers to see the face of death; they will fight to stay alive." 00:16:38.198 --> 00:16:40.219 Only when we can face death 00:16:40.219 --> 00:16:42.735 or even face death straight up 00:16:42.735 --> 00:16:45.724 can we begin to reflect on 00:16:45.724 --> 00:16:47.234 what life is. 00:16:47.234 --> 00:16:49.549 We will all die one day. 00:16:49.549 --> 00:16:51.760 Life is just a process, 00:16:51.760 --> 00:16:55.428 a process of searching for the meaning of existence. 00:16:55.428 --> 00:16:57.351 That's just my humble opinion. 00:16:57.351 --> 00:16:58.845 I think I can be considered an astute person. 00:16:58.845 --> 00:17:00.571 My stamina is good, too. 00:17:00.571 --> 00:17:03.362 I've biked around the entire Taiwan island on my first biking tour. 00:17:03.362 --> 00:17:05.459 Just because I'm asute 00:17:05.459 --> 00:17:07.231 and also in good physical shape, 00:17:07.231 --> 00:17:09.225 can I use these blessings 00:17:09.225 --> 00:17:10.153 to bully 00:17:10.153 --> 00:17:11.317 or to take advantage of others? 00:17:11.317 --> 00:17:12.127 Definitely not. 00:17:12.127 --> 00:17:12.815 So 00:17:12.815 --> 00:17:14.870 those who are blessed 00:17:14.870 --> 00:17:16.527 should be grateful. 00:17:16.527 --> 00:17:18.480 If we are very capable, 00:17:18.480 --> 00:17:20.088 shouldn't we actively help others 00:17:20.088 --> 00:17:22.717 and make our lives more meaningful? 00:17:22.717 --> 00:17:23.861 Life is about "knowing gratitude" and "repaying gratitude." 00:17:23.861 --> 00:17:25.832 When I visited Dharma Drum Mountain Monastery, 00:17:25.832 --> 00:17:27.717 the abbot there, Veneralble Guo-Dong, shared with me 00:17:27.717 --> 00:17:28.709 the idea of "knowing and repaying gratitude," 00:17:28.709 --> 00:17:29.568 as well as "being grateful, not resentful." 00:17:29.568 --> 00:17:31.245 He said, 00:17:31.245 --> 00:17:32.530 “I know you've been wronged,” 00:17:32.530 --> 00:17:34.504 “but you can’t complain." 00:17:34.504 --> 00:17:38.666 "Instead, you should make greater vows to help others in need.” 00:17:38.666 --> 00:17:40.659 Lastly, let me share a concept 00:17:40.659 --> 00:17:42.430 called “a to the power of n.” 00:17:42.430 --> 00:17:44.080 If "a" is greater than 1, 00:17:44.080 --> 00:17:45.442 "a" to the power of "n" is infinity. 00:17:45.442 --> 00:17:46.679 If "a" is less than 1, 00:17:46.679 --> 00:17:48.282 "a" to the power of "n" will approach zero rapidly. 00:17:48.282 --> 00:17:49.763 What does that mean? 00:17:49.763 --> 00:17:52.543 If what I give to the society 00:17:52.543 --> 00:17:54.062 is greater than what I take from the society, 00:17:54.062 --> 00:17:55.283 my "a" is greater than one. 00:17:55.283 --> 00:17:57.256 This society will become better and better accordingly. 00:17:57.256 --> 00:17:58.801 If what I take from the society 00:17:58.801 --> 00:18:00.488 is greater than what I give to the society, 00:18:00.488 --> 00:18:01.642 my "a" will be less than 1. 00:18:01.642 --> 00:18:03.431 Consequently, this society will increasingly collapse. 00:18:03.431 --> 00:18:05.419 I will end my speech 00:18:05.419 --> 00:18:07.295 with these words. 00:18:07.295 --> 00:18:09.415 "Facing hardships is not the most difficult thing." 00:18:09.415 --> 00:18:11.167 "The most difficult thing is..." 00:18:11.167 --> 00:18:12.784 "to facing the hardships" 00:18:12.784 --> 00:18:14.241 "without loosing your passion for mankind." 00:18:14.241 --> 00:18:16.177 Thank you, everyone!