The wisdom of life and death

Posted on 10/10/2020 by Ling Tong

Warning: Medically Explicit images, please proceed reading with care.

Three days ago, Dr. Ke Wenzhe’s TED talk titled Wisdom of Life and Death was on Youtube.

This 18-minute speech is very exciting and thought-provoking for me. I couldn’t resist translating the entire transcript for the hope that more people would read it, and think about this topic.

Introduction of the speaker

Ke Wenzhe (1959-), surgeon, director of the “Department of Trauma Medicine” of the Hospital Affiliated to the National Taiwan University School of Medicine. Professor of the National Taiwan University School of Medicine. He specializes in trauma, first aid, and organ transplantation.

Main text:

I am probably the Taiwanese doctor who has seen the most deaths, so I think I’m qualified to talk about life and death.

Let me start with ECMO.

There is famous joke talking about a question: who is the most famous doctor in Taiwan? A person went to Qimei Hospital in Liuying and said that he was looking for find Dr. Ye. The nurse at the emergency department said, “No, we don’t have any doctors with the surname Ye here.” The people said, yes, his name was Ye Kemo (the Chinese pronunciation of ECMO). My friends Mr. Shao was rescued by him back then.

ECMO is actually very simple. when you drain the venous blood, it passed through a blood pump (artificial heart), and then passed through an oxygenator (artificial lung) and returned to the body. It is used to temporarily replace cardiopulmonary function.

The real ECMO look like this. A host acts as an artificial heart, and next to it is an oxygenator to send blood back.

Ecmo does have a very successful case. This is a dancer from Jay Chou’s team. One day, she suffered from acute myocarditis and his heart stopped beating.

At that time, her eyes were wide at the screen, and the signal on the screen was all flat.

This is a pathological biopsy of her heart muscle, magnified 100 times.

It is clear at 400x magnification. The blue dots are lymphocytes. This is a very severe acute myocarditis, and the entire heart is infiltrated by lymphocytes.

However, nine days later, she had a heart and kidney transplant. Less than a month later, she went back to dancing.

In the medical literature, CPR (cardiopulmonary resuscitation) has the longest time of four hours to successfully in rescue. This is the case. She took CPR all the way from Cathay Pacific Hospital to National Taiwan University Hospital. When she was about to install ECMO, she had already given 100 inotropes. The femoral artery and femoral vein had shrunk to a size smaller than a pencil, and the tube could not be put in, so she had to continue using CPR. We have to saw the chest directly in the operating room, and put ECMO from the chest.

This case sounds amazing. Every time when I talk about it, people agree it’s a miracle of medicine. A person who has undergone 4 hours of CPR, has no heart function for nine days, can still be saved.

This is another case, the newspaper wrote “the world’s first case, a miracle in Taiwan, a man lived without a heart for 16 days”.

This is a 56-year-old man. Because of tooth decay, bacteria ran into the blood, and then ran to the heart, and later became pus. In other hospitals, when I opened the heart and found that some parts were rotten, so the surgeon in another hospital cut him off. In the end, the whole heart was cut off. What do they do? They said this patient had to go to National Taiwan University Hospital, so the patient is on my bed.

When patient arrived at National Taiwan University Hospital, I used two ECMOs because I had almost no cardiac function. There are two hosts in the picture.

In the case just now, there was a heart that couldn’t beat. This is even more serious. Even the heart is gone. The electrocardiogram is simply a line.

This is his chest CT scan. In theory, there should be a heart in the chest, but now there is no heart, only some tubes.

Sixteen days later, we gave this patient a heart transplant.

This is what Wang Shuishen, a professor of cardiac surgery, showed me. He said that after sawing the chest, he did not see the heart, but only some plastic tubes that were connected to the ECMO outside.

This patient had a successful heart transplant, and after a few months, finally went home. This is the news “Sixteen Days Without A Heart” reported by Singapore’s Straits Times.

I’ll show one more case. A 26-year-old native taiwanese, who went swimming after drunkenness, was choked by the water and suffered from severe pneumonia. ECMO have taken over his pulmonary function 117 days.

It can be seen that he has severe pneumonia (also known as acute respiratory distress syndrome), and the entire lung is whitened.

He used ECMO for 117 days. This figure shows his lung capacity over these days. It can be seen clearly, for almost a month, his lung ventilation is less than 100cc. However, he finally recovered slowly.

In the above cases, after using ECMO, a patient can last for 9 days, 16 days, or even more than 100 days, and then perform heart transplantation, heart-lung transplantation, or get better by yourself. This is really amazing. Therefore, under the hype of the media, ECMO became so famous in Taiwan, and there are indeed some very successful cases.

However, the media usually reports only successful cases, not failures. As a doctor, it’s great to see some of your patient become successful cases, but you can’t do anything when you experience other failures.

This is a one-and-a-half-month-old baby with congenital heart disease. After heart surgery, there is no way to get rid of the heart-lung machine, so ECMO was installed.

But within three days, his feet were blackened. At this point, doctors face a choice. Are you going to amputate his feet and continue to save him, or stop trying? This is a lot of pressure.

If the above case, you may feel very difficult to make a decision. Then the next case is even more difficult. It was a seven-year-old boy who had pneumococcal septicaemia, causing respiratory distress, and was later fitted with ECMO.

After the installation, complications occurred, and all limbs were blackened. He stared at you with his eyes open, he was conscious and would beg for water. But as a doctor, you face choices. If you want to save him, you have to chop off the limbs, or, you need to persuade their parents to turn off the machine.

Think about it, between life and death, when a patient is clear-headed, how can I tell him, “Hey little one, if you’re going to live, we have to chop off your limbs. If you don’t, you can choose not to live anymore. “How do you talk about this kind of topic to a 7-year-old boy?

This is my journey as a critical care medicine specialist.

When I was in my thirties, I became the director of the department. I felt that medicine was very powerful and could solve everything. But after the age of 40, there are often cases where ECMO still fails. The families ask me, “Why can’t others be saved but my son can’t survive?” I don’t know how to answer. Why do the limbs of the patient turn black? If I knew, I could have avoided it, but I just don’t know.

After slowly reaching the age of 50, I finally figured out a reason. Doctors are people, not gods, we can only do our best, that’s all.

No matter how advanced medicine is, it still has its limits. With current technology, one can survive without heart, lungs, and kidneys, but is it possible to live a lifetime with a machine like this?

Nature has spring, summer, autumn and winter. Can a gardener change this law? Of course, there is no way, the gardener can only make the flowers bloom better in spring, summer. But he can’t save flowers in late autumn and winter. Can a doctor have a way to rescue people’s life, getting younger, help recover from sickness, and fight with death? Impossible. Doctors just make people live a better life when a person is still in the world, that’s all.

A physician is only the gardener of the garden of life. How does he face the withering and prosperity of plants like a gardener and peacefully face death?

Scientifically speaking, all physical and chemical reactions should tend to the lowest energy and the highest chaos, that is, more and more chaos. Human existence is against this tendency. This is a very important concept. Any organized group is unstable, and the environment must be destroyed so that the general trend is the lowest energy and the highest chaos. One day, when I can no longer destroy the environment, I have to destroy myself, which is called death.

One day, when I was doing my rounds as usual in the hospital, I suddenly understand it. There are only two endings in life: intubation and not intubation, but both are death.

If you ask me, what is death? My answer is, what does it mean to be alive? if you then ask me, what is life? My answer is that pursuing the answer to this question is the answer to this question.

Because people are bound to die, death is not the purpose of life. Life is a process. In this process, we constantly pursue a problem. This is life.

Recently, I have often talked about my experience of “a piece of shit”.

Once, when my respected teacher retired, I invited the teacher and another senior to dinner. The three of us went to the French restaurant on the second floor of the Sheraton Hotel, and we spend 26,000 yuan ($800), an average of 9,000 yuan ($260) per person! When I saw the bill, my face turned green, why is it so expensive! I’ve never been to such a place, and I don’t know what dishes I ordered cost 26,000 yuan. The next morning, I went to the toilet and kept looking at my toilet. This thing cost me 9,000 yuan. It seems that I went to the food court and just eat a buffet of 70 yuan. When I was in the toilet, I suddenly realized that the glory and wealth of life is nothing but a piece of shit.

The most important ‘life wisdom’ of Chinese people is Confucianism, but “The Analects of Confucius” says that “you don’t know life, how can you know death”, “you can’t deal with people, how can you deal with ghosts”, “life, deal with courtesy; death, bury it. With rites and sacrifices with rites”, in short, I don’t want to talk about death. If you keep asking, it will say “to sacrifice one’s life for righteousness”, “to hear the Dao in the evening can die”. Confucianism adopts an evasive attitude towards the question of life and death, that is, it does not want to discuss it.

The positive side of this approach, of course, is that it makes people pay attention to the time of life, but after all, there is no answer to death.

My personal opinion is “death and then life”. Only when we face death, can we see what life really is. Everyone will eventually die, and life is just a process of pursuing the meaning of life.

Life should be like a raised to the nth power. If a is greater than 1, the nth power of a is infinite; if a is less than 1, the nth power of a quickly approaches zero. Do you know what this means? If I give more to the society than I take, it means that a is greater than 1. Everyone is like this, and the society will get better and better. If everyone takes more than they give to the society, it means that a is less than 1, and the society will soon collapse

I use the following sentence as the conclusion of today:

“The most difficult thing is not to face all kinds of setbacks and blows, but to face all kinds of setbacks and blows without losing enthusiasm for the world.”