1
00:00:16,099 --> 00:00:19,329
主持人要我講正向的破壞

2
00:00:19,329 --> 00:00:20,628
我當時想了老半天

3
00:00:20,628 --> 00:00:22,924
想說不如講自己的故事好了

4
00:00:22,924 --> 00:00:26,709
在台灣的醫生裡面

5
00:00:26,709 --> 00:00:30,255
我大概是看過死人最多的醫生

6
00:00:30,255 --> 00:00:32,937
在生死之間看過最多

7
00:00:32,937 --> 00:00:36,831
所以要我來講生死的故事應該是最恰當

8
00:00:36,831 --> 00:00:38,815
台灣最有名的醫生

9
00:00:38,815 --> 00:00:40,036
有人開玩笑說是葉醫師

10
00:00:40,036 --> 00:00:42,940
很多人都聽過這個笑話

11
00:00:42,940 --> 00:00:44,426
邵曉玲事件後

12
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有人跑到柳營奇美醫院

13
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說要找一位葉醫師

14
00:00:48,797 --> 00:00:49,868
他們急診室出來說

15
00:00:49,868 --> 00:00:51,653
我們沒有一個姓葉的

16
00:00:51,653 --> 00:00:52,882
那個民眾說有有有

17
00:00:52,882 --> 00:00:55,930
有個叫葉克膜的


18
00:00:55,930 --> 00:00:59,543
當年邵曉玲就是被他救起來了

19
00:00:59,543 --> 00:01:01,044
其實葉克膜很簡單


20
00:01:01,044 --> 00:01:03,650
他就是靜脈血頸流出來

21
00:01:03,650 --> 00:01:04,835
經過一個pump

22
00:01:04,835 --> 00:01:05,929
就是人工心臟


23
00:01:05,929 --> 00:01:07,180
再經過一個氧合器

24
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就是人工肺臟

25
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再送回身體

26
00:01:09,479 --> 00:01:12,819
就是暫時取代心肺功能

27
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那實體上大概就是這個樣子

28
00:01:14,331 --> 00:01:17,214
就是一個主機當人工心臟


29
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到氧合氣再送回去

30
00:01:20,387 --> 00:01:22,341
這個葉克膜

31
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在邵曉玲之前

32
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台大醫院在1994年就有葉克膜

33
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已經用很久了

34
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邵曉玲事件算是

35
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十年寒窗無人問

36
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一舉成名天下知

37
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我想是這樣的

38
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葉克膜在台灣的新聞媒體炒作之下


39
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的確它有非常成功的案例

40
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像這個是周杰倫的舞群

41
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有一天猛爆性心肌炎


42
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心臟就不跳了

43
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那為什麼這張幻燈片


44
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他躺在床上時我特別照一張？

45
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他的眼睛大大的


46
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看著他的螢幕

47
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可是他的螢幕全部都是平的

48
00:02:01,353 --> 00:02:03,026
因為他猛爆性心肌炎

49
00:02:03,026 --> 00:02:05,164
他的心臟不跳了

50
00:02:05,164 --> 00:02:06,930
幾乎是停止的

51
00:02:06,930 --> 00:02:10,428
這是一百倍底下的心肌切片

52
00:02:10,428 --> 00:02:11,875
就是病理切片

53
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在一百倍底下


54
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還不是看得很清楚

55
00:02:15,414 --> 00:02:18,537
如果到四百倍底下就很明顯了

56
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藍色一點一點的就是淋巴球

57
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所以很清楚這是個很厲害的猛爆性心肌炎

58
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整個心臟都被淋巴球浸潤

59
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心臟幾乎就不跳了停止了

60
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他的眼睛大大的看著他的螢幕

61
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他的心臟幾乎已經不動了

62
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可是在九天之後

63
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心臟加腎臟移植

64
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他不到一個月就回去跳舞了

65
00:02:46,669 --> 00:02:49,637
所以這是現代醫學的奇蹟


66
00:02:49,637 --> 00:02:52,043
在醫學的文獻上

67
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CPR最久還有救回來的就是這個案例

68
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4個小時

69
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因為他是從國泰醫院CPR壓到台大醫院

70
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在台大醫院要裝葉克膜的時候

71
00:03:02,744 --> 00:03:05,131
發現強心劑已經打了一百支了

72
00:03:05,131 --> 00:03:06,523
所以骨動脈骨靜脈

73
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已經縮的比鉛筆還細了


74
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所以突然切開這個傷口

75
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要放的時候

76
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管子放不進去

77
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所以再繼續壓

78
00:03:13,168 --> 00:03:14,471
壓到開刀房


79
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直接鋸胸

80
00:03:15,358 --> 00:03:17,772
從上面放葉克膜


81
00:03:17,772 --> 00:03:22,138
在這個聽起來很神奇的案例


82
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所以我每次說這是現代醫學的奇蹟

83
00:03:26,072 --> 00:03:29,866
一個人九天幾乎沒有心臟功能

84
00:03:29,866 --> 00:03:33,823
在心臟移植跟腎臟移植之後

85
00:03:33,823 --> 00:03:36,412
經歷四小時CPR


86
00:03:36,412 --> 00:03:38,425
還可以救回來

87
00:03:38,425 --> 00:03:40,592
這是另外一個案例


88
00:03:40,592 --> 00:03:41,883
還寫個什麼全球首例

89
00:03:41,883 --> 00:03:43,509
台灣奇蹟

90
00:03:43,509 --> 00:03:46,247
男無心臟活16天

91
00:03:46,247 --> 00:03:49,578
這是一個56歲的男生

92
00:03:49,578 --> 00:03:51,160
他蛀牙

93
00:03:51,160 --> 00:03:52,970
細菌後來就跑到血流裡面

94
00:03:52,970 --> 00:03:54,227
跑到心臟


95
00:03:54,227 --> 00:03:56,352
後來就化膿

96
00:03:56,352 --> 00:03:57,657
在其他醫院

97
00:03:57,657 --> 00:03:59,544
打開心臟看一看


98
00:03:59,544 --> 00:04:00,437
這好像爛爛的

99
00:04:00,437 --> 00:04:01,801
給它剪一剪

100
00:04:01,801 --> 00:04:02,627
這裡也爛爛的

101
00:04:02,627 --> 00:04:03,861
也給他剪一剪

102
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最後整個心臟都剪掉了

103
00:04:06,693 --> 00:04:07,914
那怎麼辦?

104
00:04:07,914 --> 00:04:13,141
轉到台大醫院去

105
00:04:13,141 --> 00:04:17,132
反正我是這樣講臺大醫院是台灣最後一道防線

106
00:04:17,132 --> 00:04:19,731
還是要做沒辦法

107
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剛才是有心臟不會跳

108
00:04:21,671 --> 00:04:22,701
這個更厲害

109
00:04:22,701 --> 00:04:23,727
這個是連心臟都沒有

110
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剪掉了

111
00:04:25,288 --> 00:04:27,167
到台大醫院的時候

112
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因為幾乎沒有心臟功能

113
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所以用兩台葉克膜


114
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看銀幕上


115
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兩台葉克膜


116
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這個更厲害

117
00:04:33,898 --> 00:04:35,409
這個是連心臟都沒有

118
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心電圖乾脆就一條線了

119
00:04:37,767 --> 00:04:39,861
連想都不用想了


120
00:04:39,861 --> 00:04:42,219
這是給他做電腦斷層

121
00:04:42,219 --> 00:04:43,136
理論上


122
00:04:43,136 --> 00:04:45,690
胸腔中間應該有個心臟

123
00:04:45,690 --> 00:04:47,191
可是現在沒有心臟

124
00:04:47,191 --> 00:04:49,261
只看到一些管子

125
00:04:49,261 --> 00:04:50,847
這個病人在十六天以後

126
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我們給他做心臟移植

127
00:04:53,447 --> 00:04:56,325
這個是心臟外科汪教授給我看的

128
00:04:56,325 --> 00:04:58,402
他說他那時給他做心臟移植

129
00:04:58,402 --> 00:04:59,717
鋸胸以後


130
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理論上應該有個心臟在中間

131
00:05:01,491 --> 00:05:03,549
他只看到一些塑膠管子

132
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接到葉克膜上

133
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所以這個病人是完全沒有心臟


134
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十六天以後再做心臟移植


135
00:05:11,360 --> 00:05:15,090
還是很清醒地回家

136
00:05:15,090 --> 00:05:18,190
這個是新加坡海峽日報的報紙

137
00:05:18,190 --> 00:05:21,637
有一天有個廠商從新加坡寄e-mail給我

138
00:05:21,637 --> 00:05:24,531
說你們在新加坡上了報紙

139
00:05:24,531 --> 00:05:26,199
16 days without heart

140
00:05:26,199 --> 00:05:28,017
一個人沒有心臟十六天

141
00:05:28,017 --> 00:05:29,095
經過心臟移植以後

142
00:05:29,095 --> 00:05:33,280
還是很健康的回家

143
00:05:33,280 --> 00:05:35,185
這是另外一個案例

144
00:05:35,185 --> 00:05:39,008
這是一個二十六歲的原住民


145
00:05:39,008 --> 00:05:40,855
喝酒醉後還去游泳


146
00:05:40,855 --> 00:05:44,923
他還以為他是李白


147
00:05:44,923 --> 00:05:46,851
台灣的池塘太髒了


148
00:05:46,851 --> 00:05:48,140
所以他一嗆到


149
00:05:48,140 --> 00:05:48,960
不得了

150
00:05:48,960 --> 00:05:50,663
就很嚴重的肺炎了

151
00:05:50,663 --> 00:05:53,101
這個葉克膜用了117天


152
00:05:53,101 --> 00:05:54,229
你看他的肺臟

153
00:05:54,229 --> 00:05:55,671
因為嗆到以後


154
00:05:55,671 --> 00:05:57,373
幾乎引起很厲害的肺炎

155
00:05:57,373 --> 00:05:59,157
這個叫急性呼吸窘迫症

156
00:05:59,157 --> 00:06:01,048
整個肺臟都白掉了

157
00:06:01,048 --> 00:06:04,953
這個葉克膜用了117天

158
00:06:04,953 --> 00:06:09,374
從這個圖可以很清楚地看到

159
00:06:09,374 --> 00:06:11,638
他有差不多長達一個多月的時間

160
00:06:11,638 --> 00:06:13,185
呼吸的通氣量

161
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不到100c.c


162
00:06:14,718 --> 00:06:18,056
不過最後還是慢慢恢復

163
00:06:18,056 --> 00:06:19,386
所以

164
00:06:19,386 --> 00:06:21,168
從剛才的案例裡面

165
00:06:21,168 --> 00:06:22,928
沒有心臟


166
00:06:22,928 --> 00:06:24,723
甚至有心臟不會跳

167
00:06:24,723 --> 00:06:27,014
甚至幾乎完全沒有肺臟功能

168
00:06:27,014 --> 00:06:29,309
在葉克膜的使用之下

169
00:06:29,309 --> 00:06:32,497
壞的就算經過九天十六天


170
00:06:32,497 --> 00:06:34,627
甚至可以到一百多天

171
00:06:34,627 --> 00:06:35,870
然後可以經過心臟移植

172
00:06:35,870 --> 00:06:37,725
甚至肺臟移植

173
00:06:37,725 --> 00:06:39,425
或是等他自己好

174
00:06:39,425 --> 00:06:41,560
這實在太神奇了

175
00:06:41,560 --> 00:06:42,954
所以坦白講

176
00:06:42,954 --> 00:06:44,983
葉克膜會在台灣的歷史上

177
00:06:44,983 --> 00:06:46,147
會這麼有名

178
00:06:46,147 --> 00:06:47,559
在媒體的炒作之下

179
00:06:47,559 --> 00:06:48,551
這麼有名


180
00:06:48,551 --> 00:06:50,558
他還是有些很成功的案例

181
00:06:50,558 --> 00:06:51,972
當然也包括邵曉玲

182
00:06:51,972 --> 00:06:53,715
星星王子


183
00:06:53,715 --> 00:06:55,688
可是是這樣


184
00:06:55,688 --> 00:06:57,027
通常媒體

185
00:06:57,027 --> 00:06:58,220
成功地會拿出來報導

186
00:06:58,220 --> 00:06:59,679
失敗的他就不會講了

187
00:06:59,679 --> 00:07:00,864
藏起來了

188
00:07:00,864 --> 00:07:03,758
做一個重症醫學的醫生

189
00:07:03,758 --> 00:07:06,388
看到成功的案例當然很高興

190
00:07:06,388 --> 00:07:08,123
可是失敗的

191
00:07:08,123 --> 00:07:10,979
這是一個出生一個半月


192
00:07:10,979 --> 00:07:13,744
先天性心臟病

193
00:07:13,744 --> 00:07:15,979
心臟手術以後


194
00:07:15,979 --> 00:07:17,773
沒辦法脫離心肺機


195
00:07:17,773 --> 00:07:19,584
所以裝了葉克膜

196
00:07:19,584 --> 00:07:20,812
就插在心臟上

197
00:07:20,812 --> 00:07:21,958
裝葉克膜

198
00:07:21,958 --> 00:07:22,906
可是不到三天

199
00:07:22,906 --> 00:07:24,123
腳就黑掉了

200
00:07:24,123 --> 00:07:25,562
我們看看他的特寫

201
00:07:25,562 --> 00:07:27,165
腳黑掉了

202
00:07:27,165 --> 00:07:28,345
這時候作為一個醫生

203
00:07:28,345 --> 00:07:29,640
他就面臨一個選擇

204
00:07:29,640 --> 00:07:31,263
你是要把雙腳剁掉

205
00:07:31,263 --> 00:07:32,406
繼續再救

206
00:07:32,406 --> 00:07:33,354
還是算了

207
00:07:33,354 --> 00:07:34,590
不要再玩了

208
00:07:34,590 --> 00:07:37,606
這就是一個很大的壓力

209
00:07:37,606 --> 00:07:40,013
如果這一題你都這麼困難決定的話

210
00:07:40,013 --> 00:07:41,132
那這一題更困難


211
00:07:41,132 --> 00:07:43,908
這是一個七歲的男生


212
00:07:43,908 --> 00:07:45,758
肺炎雙球菌敗血症

213
00:07:45,758 --> 00:07:48,890
後來引起呼吸窘迫症


214
00:07:48,890 --> 00:07:50,586
後來裝了葉克膜


215
00:07:50,586 --> 00:07:52,839
可是葉克膜裝下去後

216
00:07:52,839 --> 00:07:54,998
出現併發症


217
00:07:54,998 --> 00:07:57,358
四肢都黑掉了


218
00:07:57,358 --> 00:07:58,481
他眼睛大大的看著你

219
00:07:58,481 --> 00:07:59,479
意識清楚


220
00:07:59,479 --> 00:08:00,496
也會討水喝

221
00:08:00,496 --> 00:08:02,506
可是做一個醫生

222
00:08:02,506 --> 00:08:03,999
你面臨一個選擇

223
00:08:03,999 --> 00:08:05,991
你如果要救他的話

224
00:08:05,991 --> 00:08:07,628
要把四肢剁掉


225
00:08:07,628 --> 00:08:08,944
繼續再救


226
00:08:08,944 --> 00:08:10,956
那如果不救的話

227
00:08:10,956 --> 00:08:12,356
機器就要關掉

228
00:08:12,356 --> 00:08:13,946
你想想看


229
00:08:13,946 --> 00:08:15,593
在生死之間


230
00:08:15,593 --> 00:08:18,028
病人頭腦清楚

231
00:08:18,028 --> 00:08:21,845
當然醫生頭腦也是清楚


232
00:08:21,845 --> 00:08:23,827
可是我要怎麼跟他講


233
00:08:23,827 --> 00:08:25,314
小弟弟


234
00:08:25,314 --> 00:08:26,583
你如果要活下去的話


235
00:08:26,583 --> 00:08:28,570
我要把四肢剁掉

236
00:08:28,570 --> 00:08:30,260
還是你就算了

237
00:08:30,260 --> 00:08:31,501
你就不願意再活了


238
00:08:31,501 --> 00:08:34,204
你如何跟一個七歲的男生

239
00:08:34,204 --> 00:08:37,427
講這種生死的問題

240
00:08:37,427 --> 00:08:41,555
這就是我當一個重症醫學專家


241
00:08:41,555 --> 00:08:43,388
我的心路歷程

242
00:08:43,388 --> 00:08:45,205
一開始見山是山

243
00:08:45,205 --> 00:08:47,790
就是我有看到一個病人


244
00:08:47,790 --> 00:08:48,753
後來慢慢地


245
00:08:48,753 --> 00:08:49,682
我只看到一個病

246
00:08:49,682 --> 00:08:51,439
看到一個心臟

247
00:08:51,439 --> 00:08:53,159
還好我過了五十歲以後

248
00:08:53,159 --> 00:08:55,612
我又慢慢看到了病人


249
00:08:55,612 --> 00:08:57,968
其實也不瞞各位

250
00:08:57,968 --> 00:09:00,371
我也算是個很會讀書的人

251
00:09:00,371 --> 00:09:02,083
我在三十幾歲的時候


252
00:09:02,083 --> 00:09:03,241
心臟移植

253
00:09:03,241 --> 00:09:04,003
肺臟移植

254
00:09:04,003 --> 00:09:05,266
葉克膜啦

255
00:09:05,266 --> 00:09:08,001
我還是台大醫院最早當主任的

256
00:09:08,001 --> 00:09:09,466
外科加護病房主任


257
00:09:09,466 --> 00:09:12,100
全國器官移植登錄系統

258
00:09:12,100 --> 00:09:13,781
還當創傷部副主任

259
00:09:13,781 --> 00:09:16,160
在我三十幾歲的時候

260
00:09:16,160 --> 00:09:17,514
在一路過程當中

261
00:09:17,514 --> 00:09:20,259
我覺得這醫學多厲害


262
00:09:20,259 --> 00:09:21,743
什麼都可以解決

263
00:09:21,743 --> 00:09:23,271
可是到了四十歲以後


264
00:09:23,271 --> 00:09:25,531
常常有裝了葉克膜

265
00:09:25,531 --> 00:09:27,153
還是失敗的case

266
00:09:27,153 --> 00:09:28,092
家屬問我說

267
00:09:28,092 --> 00:09:29,394
為什麼邵曉玲救得回來

268
00:09:29,394 --> 00:09:32,071
我的親人救不回來

269
00:09:32,071 --> 00:09:33,434
我也不曉得怎麼跟他回答

270
00:09:33,434 --> 00:09:36,633
難道跟他說因為他不是邵曉玲嗎

271
00:09:36,633 --> 00:09:37,554
不然就問我說


272
00:09:37,554 --> 00:09:39,714
為什麼那個四肢會黑掉

273
00:09:39,714 --> 00:09:40,445
我要是知道

274
00:09:40,445 --> 00:09:41,341
我就會避免了

275
00:09:41,341 --> 00:09:42,579
我就是不知道


276
00:09:42,579 --> 00:09:44,684
所以在四十幾歲的時候

277
00:09:44,684 --> 00:09:47,076
會覺得說


278
00:09:47,076 --> 00:09:48,540
為什麼這個病人會救不回來呢

279
00:09:48,540 --> 00:09:51,793
慢慢地到五十歲以後

280
00:09:51,793 --> 00:09:54,028
終於想通一個道理

281
00:09:54,028 --> 00:09:56,327
眾里尋她千百度


282
00:09:56,327 --> 00:09:57,305
驀然回首


283
00:09:57,305 --> 00:09:59,717
那人正在燈火闌珊處

284
00:09:59,717 --> 00:10:01,066
有一天

285
00:10:01,066 --> 00:10:02,502
我終於領略一個道理


286
00:10:02,502 --> 00:10:04,599
醫生是人不是神

287
00:10:04,599 --> 00:10:05,829
我們只能盡力


288
00:10:05,829 --> 00:10:07,079
就這樣而已

289
00:10:07,079 --> 00:10:10,224
我慢慢就想通一個道理


290
00:10:10,224 --> 00:10:11,511
我們看四季

291
00:10:11,511 --> 00:10:13,500
有春夏秋冬


292
00:10:13,500 --> 00:10:15,593
其實醫學還是有極限


293
00:10:15,593 --> 00:10:16,628
不管人類的科學怎麼發達


294
00:10:16,628 --> 00:10:19,025
以現在的科技

295
00:10:19,025 --> 00:10:20,515
沒有心臟

296
00:10:20,515 --> 00:10:20,944
沒有肺臟

297
00:10:20,944 --> 00:10:21,494
沒有肝臟

298
00:10:21,494 --> 00:10:22,384
沒有腎臟

299
00:10:22,384 --> 00:10:23,700
都還可以存活

300
00:10:23,700 --> 00:10:26,074
但是難道我們可以裝著機器


301
00:10:26,074 --> 00:10:27,753
一輩子下去嗎？

302
00:10:27,753 --> 00:10:30,303
所以醫學還是有它的極限

303
00:10:30,303 --> 00:10:32,348
後來我就想通一個道理


304
00:10:32,348 --> 00:10:35,057
園丁能不能改變春夏秋冬

305
00:10:35,057 --> 00:10:37,441
當然沒有辦法

306
00:10:37,441 --> 00:10:39,654
園丁只是讓花

307
00:10:39,654 --> 00:10:41,931
在春夏秋冬時開得好看一點

308
00:10:41,931 --> 00:10:43,214
當一個醫生

309
00:10:43,214 --> 00:10:45,912
有辦法去改變生老病死嗎

310
00:10:45,912 --> 00:10:47,757
坦白講


311
00:10:47,757 --> 00:10:48,919
很困難

312
00:10:48,919 --> 00:10:50,244
當一個醫生

313
00:10:50,244 --> 00:10:52,370
只是讓人在生老病死之間

314
00:10:52,370 --> 00:10:53,583
活得好看一點

315
00:10:53,583 --> 00:10:54,755
就這樣而已

316
00:10:54,755 --> 00:10:55,880
所以慢慢的

317
00:10:55,880 --> 00:10:57,393
我想通一個道理


318
00:10:57,393 --> 00:10:59,793
醫生只是生命花園的園丁


319
00:11:01,586 --> 00:11:05,556
但是醫師是個生命花園的園丁

320
00:11:05,556 --> 00:11:07,574
面對草木的枯榮

321
00:11:07,574 --> 00:11:09,979
他到底要怎麼去面對

322
00:11:09,979 --> 00:11:11,898
所以作為一個重症醫學的專家


323
00:11:11,898 --> 00:11:15,266
我如何去面對死亡


324
00:11:15,266 --> 00:11:16,877
就死亡的科學觀來講


325
00:11:16,877 --> 00:11:18,993
如果從物理化學來講

326
00:11:18,993 --> 00:11:20,572
一切的物理反應

327
00:11:20,572 --> 00:11:21,849
物理化學反應

328
00:11:21,849 --> 00:11:23,433
應該是最低能量

329
00:11:23,433 --> 00:11:24,676
最大亂度

330
00:11:24,676 --> 00:11:27,078
所謂的Delta S要大於等於零


331
00:11:27,078 --> 00:11:29,489
當然有人說Delta S大於零到底怎麼來的

332
00:11:29,489 --> 00:11:31,702
有人認為是大爆炸理論

333
00:11:31,702 --> 00:11:34,001
因為大爆炸整個宇宙在擴充


334
00:11:34,001 --> 00:11:36,463
所以Delta S會大於零

335
00:11:36,463 --> 00:11:37,849
或是這樣


336
00:11:37,849 --> 00:11:39,296
宇宙定理有沒有恆一性

337
00:11:39,296 --> 00:11:40,520
坦白講


338
00:11:40,520 --> 00:11:41,747
我也不知道

339
00:11:41,747 --> 00:11:43,309
所以有一句話

340
00:11:43,309 --> 00:11:46,156
夏蟲不可語冬雪

341
00:11:46,156 --> 00:11:47,836
就是說夏天的蟲


342
00:11:47,836 --> 00:11:49,034
沒有辦法講冬天的事情

343
00:11:49,034 --> 00:11:50,625
因為他活不了那麼久

344
00:11:50,625 --> 00:11:52,689
到底宇宙的物理

345
00:11:52,689 --> 00:11:53,910
有沒有恆一性


346
00:11:53,910 --> 00:11:55,520
在無限的空間和時間當中


347
00:11:55,520 --> 00:11:56,710
有沒有恆一性

348
00:11:56,710 --> 00:11:58,355
坦白講


349
00:11:58,355 --> 00:11:59,603
我不知道

350
00:11:59,603 --> 00:12:01,236
但是至少

351
00:12:01,236 --> 00:12:02,359
在我們可以感受的範圍內

352
00:12:02,359 --> 00:12:03,758
Delta S還是大於零

353
00:12:03,758 --> 00:12:05,695
什麼叫Delta S大於零呢

354
00:12:05,695 --> 00:12:06,837
理論上


355
00:12:06,837 --> 00:12:07,598
一切要最低能量最大亂度

356
00:12:07,598 --> 00:12:09,718
越來越混亂


357
00:12:09,718 --> 00:12:10,960
所以我的存在

358
00:12:10,960 --> 00:12:12,587
Delta小於零


359
00:12:12,587 --> 00:12:15,340
他是違反整個物理化學的反應

360
00:12:15,340 --> 00:12:17,081
那如何看待生死

361
00:12:17,081 --> 00:12:19,058
其實是這樣的

362
00:12:19,058 --> 00:12:21,085
我們常常只看到我

363
00:12:21,085 --> 00:12:23,100
沒有看到我們是個宇宙


364
00:12:23,100 --> 00:12:24,305
我加上環境才是個宇宙

365
00:12:24,305 --> 00:12:26,766
所以Delta S total

366
00:12:26,766 --> 00:12:29,637
Delta S system 加 Delta S surrounding


367
00:12:29,637 --> 00:12:31,688
所以


368
00:12:31,688 --> 00:12:33,269
這個很重要的概念

369
00:12:33,269 --> 00:12:35,755
任何有組織的團體

370
00:12:35,755 --> 00:12:37,335
他都是不穩定的

371
00:12:37,335 --> 00:12:39,845
他必須破壞環境

372
00:12:39,845 --> 00:12:41,406
所以雖然Delta S小於零


373
00:12:41,406 --> 00:12:43,507
但是我要破壞整個環境

374
00:12:43,507 --> 00:12:44,958
讓Delta S大於零


375
00:12:44,958 --> 00:12:46,865
加起來還是要大於零

376
00:12:46,865 --> 00:12:48,269
所以我的存在

377
00:12:48,269 --> 00:12:49,755
就是要破壞這個環境

378
00:12:49,755 --> 00:12:51,239
當有一天


379
00:12:51,239 --> 00:12:52,773
我再也不能破壞這個環境的時候

380
00:12:52,773 --> 00:12:54,442
我只好破壞我自己

381
00:12:54,442 --> 00:12:56,850
因為我還是要維持Delta S大於零


382
00:12:56,850 --> 00:12:58,027
所以存在之目的是為了破壞

383
00:12:58,027 --> 00:12:59,687
當不能再破壞時


384
00:12:59,687 --> 00:13:01,344
只好破壞自己

385
00:13:01,344 --> 00:13:02,555
這個叫死亡


386
00:13:02,555 --> 00:13:04,540
這是從物理化學的觀點來看待死亡

387
00:13:04,540 --> 00:13:06,155
可是


388
00:13:06,155 --> 00:13:08,625
做一個醫生

389
00:13:08,625 --> 00:13:10,583
物理化學我懂


390
00:13:10,583 --> 00:13:12,721
可是如果去看待人生呢


391
00:13:12,721 --> 00:13:14,673
有一天我在加護病房

392
00:13:14,673 --> 00:13:16,483
在巡房時

393
00:13:16,483 --> 00:13:18,117
突然大徹大悟


394
00:13:18,117 --> 00:13:19,539
人生的結局只有兩種

395
00:13:19,539 --> 00:13:21,176
一個有插管


396
00:13:21,176 --> 00:13:22,437
一個沒插管

397
00:13:22,437 --> 00:13:24,414
但是都是死掉


398
00:13:24,414 --> 99:59:59,999
所以死亡是個普遍存在的現象

399
99:59:59,999 --> 99:59:59,999
那到底

400
99:59:59,999 --> 99:59:59,999
我們如何看待死亡呢

401
99:59:59,999 --> 99:59:59,999
其實這個問題我有個翻轉的想法

402
99:59:59,999 --> 99:59:59,999
你問我什麼叫死亡

403
99:59:59,999 --> 99:59:59,999
我如此的回答

404
99:59:59,999 --> 99:59:59,999
怎樣才算是活著

405
99:59:59,999 --> 99:59:59,999
所以今天各位

406
99:59:59,999 --> 99:59:59,999
來這裡聽演講

407
99:59:59,999 --> 99:59:59,999
我希望你們回家以後


408
99:59:59,999 --> 99:59:59,999
今天晚上睡覺的時候

409
99:59:59,999 --> 99:59:59,999
躺在床上

410
99:59:59,999 --> 99:59:59,999
問自己一個問題

411
99:59:59,999 --> 99:59:59,999
怎樣才算是活著


412
99:59:59,999 --> 99:59:59,999
因為

413
99:59:59,999 --> 99:59:59,999
怎樣才算是活著

414
99:59:59,999 --> 99:59:59,999
我們要思考一個問題

415
99:59:59,999 --> 99:59:59,999
什麼是人生


416
99:59:59,999 --> 99:59:59,999
我對這個問題的答案是這樣

417
99:59:59,999 --> 99:59:59,999
追求這個問題的答案

418
99:59:59,999 --> 99:59:59,999
就是這個問題的答案


419
99:59:59,999 --> 99:59:59,999
因為人一定會死

420
99:59:59,999 --> 99:59:59,999
沒有人會把死亡


421
99:59:59,999 --> 99:59:59,999
當作人生的目的

422
99:59:59,999 --> 99:59:59,999
所以人生只是個過程


423
99:59:59,999 --> 99:59:59,999
因此這個過程當中

424
99:59:59,999 --> 99:59:59,999
我們在這個過程當中


425
99:59:59,999 --> 99:59:59,999
不斷去追尋一個問題

426
99:59:59,999 --> 99:59:59,999
到底什麼才叫做活著

427
99:59:59,999 --> 99:59:59,999
所以追求這個問題的答案


428
99:59:59,999 --> 99:59:59,999
就是這個問題的答案

429
99:59:59,999 --> 99:59:59,999
所以死亡不用當作是人生的目的

430
99:59:59,999 --> 99:59:59,999
人生只是個過程

431
99:59:59,999 --> 99:59:59,999
最近我常常去講一坨大便的啟示

432
99:59:59,999 --> 99:59:59,999
有一次我的老師退休

433
99:59:59,999 --> 99:59:59,999
就跟我說

434
99:59:59,999 --> 99:59:59,999
老師要退休了


435
99:59:59,999 --> 99:59:59,999
請好一點的


436
99:59:59,999 --> 99:59:59,999
我說好啦好啦

437
99:59:59,999 --> 99:59:59,999
我就跟我的學長和老師

438
99:59:59,999 --> 99:59:59,999
到喜來登飯店二樓

439
99:59:59,999 --> 99:59:59,999
法國餐廳


440
99:59:59,999 --> 99:59:59,999
三個人吃了兩萬六千塊

441
99:59:59,999 --> 99:59:59,999
我臉都快綠掉了

442
99:59:59,999 --> 99:59:59,999
我怎麼吃這麼貴的東西


443
99:59:59,999 --> 99:59:59,999
因為我也沒去過那種地方

444
99:59:59,999 --> 99:59:59,999
亂點

445
99:59:59,999 --> 99:59:59,999
也不曉得點了什麼菜

446
99:59:59,999 --> 99:59:59,999
所以看到賬單的時候


447
99:59:59,999 --> 99:59:59,999
兩萬六千塊

448
99:59:59,999 --> 99:59:59,999
我第二天早上上廁所


449
99:59:59,999 --> 99:59:59,999
一直看我的大便


450
99:59:59,999 --> 99:59:59,999
我在想

451
99:59:59,999 --> 99:59:59,999
這個花九千元才製造的東西

452
99:59:59,999 --> 99:59:59,999
我看來看去


453
99:59:59,999 --> 99:59:59,999
跟我平常在台大醫院地下室一樓

454
99:59:59,999 --> 99:59:59,999
那個自助餐70塊的

455
99:59:59,999 --> 99:59:59,999
我看不出差別

456
99:59:59,999 --> 99:59:59,999
我在廁所裡突然大徹大悟


457
99:59:59,999 --> 99:59:59,999
人生的榮華富貴


458
99:59:59,999 --> 99:59:59,999
不過就是一陀大便

459
99:59:59,999 --> 99:59:59,999
儒家還是中國最重要的思想


460
99:59:59,999 --> 99:59:59,999
可是儒家他的優點


461
99:59:59,999 --> 99:59:59,999
他把人提升到一個境界

462
99:59:59,999 --> 99:59:59,999
可是你看看論語怎麼講

463
99:59:59,999 --> 99:59:59,999
論語裡面說

464
99:59:59,999 --> 99:59:59,999
未知生，焉知死


465
99:59:59,999 --> 99:59:59,999
未能事人

466
99:59:59,999 --> 99:59:59,999
焉能事鬼


467
99:59:59,999 --> 99:59:59,999
生

468
99:59:59,999 --> 99:59:59,999
事之以禮

469
99:59:59,999 --> 99:59:59,999
死


470
99:59:59,999 --> 99:59:59,999
葬之以禮

471
99:59:59,999 --> 99:59:59,999
祭之以禮


472
99:59:59,999 --> 99:59:59,999
他就是不想談論生死

473
99:59:59,999 --> 99:59:59,999
你一直追問

474
99:59:59,999 --> 99:59:59,999
他就說什麼是捨生取義


475
99:59:59,999 --> 99:59:59,999
朝聞道夕死可矣

476
99:59:59,999 --> 99:59:59,999
什麼有殺身以成仁

477
99:59:59,999 --> 99:59:59,999
這個儒家對生死的態度


478
99:59:59,999 --> 99:59:59,999
他採取逃避的態度

479
99:59:59,999 --> 99:59:59,999
他不想討論


480
99:59:59,999 --> 99:59:59,999
所以

481
99:59:59,999 --> 99:59:59,999
他積極面

482
99:59:59,999 --> 99:59:59,999
當然要有人


483
99:59:59,999 --> 99:59:59,999
就不要管他

484
99:59:59,999 --> 99:59:59,999
管你現在的東西就好

485
99:59:59,999 --> 99:59:59,999
可是有個問題

486
99:59:59,999 --> 99:59:59,999
他躲避了死亡的問題

487
99:59:59,999 --> 99:59:59,999
我的想法是這樣


488
99:59:59,999 --> 99:59:59,999
在這個中華文化圈裡


489
99:59:59,999 --> 99:59:59,999
儒家還是中國最重要的思想

490
99:59:59,999 --> 99:59:59,999
可是過去我們都不想面對生死

491
99:59:59,999 --> 99:59:59,999
採取躲避的態度


492
99:59:59,999 --> 99:59:59,999
這是我個人的看法

493
99:59:59,999 --> 99:59:59,999
置於死地而後生


494
99:59:59,999 --> 99:59:59,999
我們唯有能夠面對死亡


495
99:59:59,999 --> 99:59:59,999
甚至開始凝視死亡的時候


496
99:59:59,999 --> 99:59:59,999
才能轉過來看人生到底是什麼


497
99:59:59,999 --> 99:59:59,999
所以人生終究會死亡


498
99:59:59,999 --> 99:59:59,999
人生只是個過程

499
99:59:59,999 --> 99:59:59,999
只是追求人生意義的過程

500
99:59:59,999 --> 99:59:59,999
這是我個人的感想

501
99:59:59,999 --> 99:59:59,999
其實我算是很聰明的人

502
99:59:59,999 --> 99:59:59,999
體力也不錯

503
99:59:59,999 --> 99:59:59,999
腳踏車第一次去騎就環島一圈回來

504
99:59:59,999 --> 99:59:59,999
我是個比較聰明的人


505
99:59:59,999 --> 99:59:59,999
身體也比較好

506
99:59:59,999 --> 99:59:59,999
難道我用我的優勢

507
99:59:59,999 --> 99:59:59,999
去欺負別人

508
99:59:59,999 --> 99:59:59,999
去占人家便宜嗎


509
99:59:59,999 --> 99:59:59,999
不是嘛

510
99:59:59,999 --> 99:59:59,999
所以有時候


511
99:59:59,999 --> 99:59:59,999
我們人比較有優勢


512
99:59:59,999 --> 99:59:59,999
要感恩

513
99:59:59,999 --> 99:59:59,999
萬一有這個能力

514
99:59:59,999 --> 99:59:59,999
是不是應該去幫助別人


515
99:59:59,999 --> 99:59:59,999
讓我們的人生更有意義

516
99:59:59,999 --> 99:59:59,999
這叫感恩報恩


517
99:59:59,999 --> 99:59:59,999
去法鼓山的時後

518
99:59:59,999 --> 99:59:59,999
法師跟我講了老半天

519
99:59:59,999 --> 99:59:59,999
就在講這個

520
99:59:59,999 --> 99:59:59,999
感恩報恩


521
99:59:59,999 --> 99:59:59,999
抱願不報怨

522
99:59:59,999 --> 99:59:59,999
他說我也知道你受很多委屈

523
99:59:59,999 --> 99:59:59,999
可是你不能抱願

524
99:59:59,999 --> 99:59:59,999
應該是要有更遠大的宏願去幫助別人

525
99:59:59,999 --> 99:59:59,999
所以我最後提出個概念


526
99:59:59,999 --> 99:59:59,999
叫a的n次方

527
99:59:59,999 --> 99:59:59,999
a如果大於1

528
99:59:59,999 --> 99:59:59,999
a的n次方就無限大

529
99:59:59,999 --> 99:59:59,999
a如果小於1

530
99:59:59,999 --> 99:59:59,999
a的n次方很快就趨近於0


531
99:59:59,999 --> 99:59:59,999
這句話什麼意思

532
99:59:59,999 --> 99:59:59,999
我對社會的付出

533
99:59:59,999 --> 99:59:59,999
多於我對社會得奪取

534
99:59:59,999 --> 99:59:59,999
a就大於1

535
99:59:59,999 --> 99:59:59,999
這個社會就越來越好

536
99:59:59,999 --> 99:59:59,999
我對社會的奪取

537
99:59:59,999 --> 99:59:59,999
多餘我對社會的付出

538
99:59:59,999 --> 99:59:59,999
a就小於1

539
99:59:59,999 --> 99:59:59,999
就越來越劣勢

540
99:59:59,999 --> 99:59:59,999
所以我用最後這句話

541
99:59:59,999 --> 99:59:59,999
作為今天演講的結束

542
99:59:59,999 --> 99:59:59,999
面對挫折打擊不是最困難

543
99:59:59,999 --> 99:59:59,999
最困難的是

544
99:59:59,999 --> 99:59:59,999
面對各種挫折打擊


545
99:59:59,999 --> 99:59:59,999
而沒有失去對人世的熱情

546
99:59:59,999 --> 99:59:59,999
謝謝各位