I thought I might as well share my own story.

Among all the physicians in Taiwan,

I am probably the one ER doctor who has seen the most cadavers.

I've seen many cases of life and death.

Perhaps that's why I'm suited to share such stories on this stage.

There's a joke about

the most famous physician -- Dr. Yeh

here in Taiwan.

After Taichung First Lady's car accident,

a patient went to Chi-Mei Hospital in Liu-Ying city

to seek a doctor named Yeh.

The staff in the hospital said

that there's no Dr. Yeh.

"There is, " said the patient.

"I was told that his name is 'Yeh Ker-mo' (ECMO: Extra-Corporeal Membrane Oxygenation).

This Dr. Yeh was the one who saved the first lady's life!"

Speaking of ECMO, its concept is quite easy to understand.

Blood flows from femoral vein

and passes through a pump,

also known as an artificial heart.

The blood then passes through membrane oxygenator,

which acts as a pair of artificial lungs.

Afterwards, the blood re-enters the body.

So, ECMO is a temporary substitute of a human's cardiovascular system.

From another perspective,

it is a host that represents an artificial heart

that pumps blood to the oxygenator and back to the body.

As a matter of fact, ECMO technique

was already available and widely used

at the National Taiwan University (NTU) Hospital

since 1994 prior to the first lady's car accident.

It was only since her incident that folks in Taiwan are aware of the ECMO technique.

It's similar to the saying: "One can spend decades painting in relative obscurity,"

"but the world only sees the artist's finished masterpiece."

That's just my personal opinion.

ECMO became a household term due to its overexposure from Taiwan's media press.

There's no doubt that ECMO technique has its relatively successful cases.

One prominent example is the case of singer Jay Chou's backup dancer.

One day, this patient was admitted with fulminant myocarditis,

and was undergoing cardiac arrest.

I would like to show you a photo of her at the time,

with the patient lying on her hospital bed.

The eyes of this patient were wide open,

and were staring straight,

reading the flat lines showing on the ECG screen.

As a result of fulminant myocarditis,

the patient's heart stopped beating.

She suffered a cardiac arrest.

This is a biopsy of her cardiac muscle

magnified 100 times under the microscope.

Even under this type of magnifying power,

it's still quite hard to see.

However, magnified 400 times will be much clearer.

Those blue spots are lymphocytes.

From here, we can see a serious case of fulminant myocarditis.

Lymphocytes infiltrated her entire heart,

which caused sudden cardiac arrest.

The patient stared at the screen,

as it displayed no signs of a working heart.

After the ninth day,

after a heart and a kidney transplant,

She returned to dance in less than one month's recovery.

It was a great miracle in modern medicine.

In modern medical records,

this patient holds the longest record for CPR survival:

4 hours.

CPR was performed on her from Cathay General Hospital to NTU Hospital.

When physicians tried ECMO technique at the NTU hospital,

they found that over 100 doses

of cardiotonic drugs

were already given to her.

When an incision was made

to insert an ECMO tube,

the patient's veins and arteries were too narrow.

Therefore, CPR had to be conducted again

until she was in the operating room.

Surgeons had to saw open the patient's chest

to insert ECMO tubes from the top.

The entire procedure sounds surreal right now.

Every time I recall this case, I always say it's a modern medical miracle.

The fact that a person's heart had stopped for 9 days.

And after enduring heart and kidney transplants,

a 4 hour CPR,

she could still survive.

Here is another patient case.

The headline reads ”World's First:

Miracle of Taiwan".

Man without heart for 16 days.

In this case, the patient is a 56-year-old man.

He had a tooth decay.

Bacteria from the cavity went into the blood,

and spread to the portions of the heart.

It caused a pus buildup.

The patient went to a different hospital

where the surgical team opened up his chest,

and began to eliminate

infected tissues of the heart.

The team continued to remove

more affected tissues

until not much of the muscular organ was left.

So what can the team do now?

Transfer this patient to NTU hospital.

It seems that NTU hospital is the last line of medical defense in Taiwan.

NTU hospital has to take patients in.

In the first case, the case was cardiac arrest.

This case is more extreme.

This is a man with not much of a heart left.

It was almost all surgically removed.

When the patient was transferred to NTU hospital,

because of the state he was in,

our medical team had to use two ECMOs.

Look at this slide.

There are two ECMO devices.

This one is even more unbelievable.

Since he didn't have a heart left,

so the ECG displayed a completely flat line.

There's not much to explain here.

This is his CT scan result.

Theoretically,

there should have been a heart in his thorax.

However, the heart is missing here.

There are only tubes.

After 16 days,

our surgical team performed a heart transplant surgery on this patient.

Cardiologist surgeon Dr. Wan showed me this.

Dr. Wan said during the surgery,

he opened the patient's chest

and had expected a heart in the thorax.

However, there were only plastic tubes

connecting to the ECMO.

The patient had no heart at all.

And after 16 days, the heart transplant surgery was completed.

The patient was discharged later.

Here is the Straits Times of Singapore.

A vendor I know sent me an e-mail from Singapore.

He told me that we were featured in the Straits Times.

16 days without heart

A person had lived for 16 days without a heart.

But after receiving heart transplant,

he still went home in good shape.

This is a third case.

He's a 26-year-old aboriginal Taiwanese.

He went swimming even when he was seriously drunk.

Jokingly, he probably thought he was Li Bai the poet.

The pond he swam in was really unsanitary.

He choked on water.

As a result,

he caught a severe case of pneumonia.

He'd relied on ECMO for 117 days.

Look at his lungs.

After he ingested unclean water,

his condition worsened to a severe case of pneumonia.

This is called acute respiratory distress syndrome.

The lungs became abnormally white.

He lived on ECMO for 117 days.

We can see clearly from this slide.

For one entire month,

the patient's ventilation volume

did not exceed 100 c.c.

But the patient still recovered.

In short,

in the these three medical cases,

the patient without a heart,

the patient undergoing cardiac arrest,

or the patient with lung failure,

with the help of ECMO,

no matter whether 9 days later

or even 100 days afterwards,

after a heart transplant

or lung transplant,

their lives were saved.

It is really incredible.

To be honest...

In recent history, ECMO has retained

a high level of awareness

thanks to the media presses in Taiwan.

The reason why folks know about ECMO,

is because of past success cases,

and also because of the first lady in Taichung,

and famed astrologer Nick Yen.

However,

the media usually

only reports on the successful stories.

Reporters don't write failed cases.

Hidden from the public eye.

As a critical care physician,

I am certainly glad to encounter successful patient cases.

However, there are cases that are not as successful.

This baby was one and half months old.

He suffered from a congenital heart disease.

After undergoing a heart surgery,

the baby still could not live without a heart-lung machine.

So, we hooked the baby up to an ECMO.

The ECMO was inserted in the baby's heart.

After the procedure,

in three days,

the baby's feet turned black.

Let's zoom in.

Look at his tiny, blackened feet.

So now, as a physician,

you have to make a decision.

Should you amputate his tiny feet

to try to save his life?

Or should you just give up

and let him go?

These types of decisions are incredibly stressful to make.

But if you can't make the call,

then the next case is more difficult to gauge.

Here is a 7-year-old boy

suffering from streptococcus pneumonia.

His condition worsened to acute respiratory distress syndrome.

So the medical team decided to employ ECMO technique.

After using ECMO, however,

there were complications.

His limbs all turned black.

His adorable eyes would look at you,

his conscious in a clear state.

He could even ask for water when he was thirsty.

But as a doctor,

you have to make incredibly hard decisions.

If you want to save him,

you have to cut off his limbs first,

and continue with further medical treatment.

And if you give up,

you have to turn off the ECMO.

Now think of this:

Between life and death,

when the patient is in a conscious state,

of course, the doctor's mind is clear, too.

How would you ask the boy?

"Hi dear"

"If you want to live"

"I will need to amputate your limbs."

"Or you'd rather give up,"

"and rest in peace?"

How do you communicate this type of life and death decision

with a 7-year-old?

This is the line of work I have to deal with

as a critical care physician.

In the beginning, I made decisions rather logically.

I identified everything by patients.

Gradually,

I targeted diseases, not patients.

A diseased heart, for example.

Fortunately, when I turned fifty,

I gradually realized that I should treat patient as a whole again.

To be quite honest,

I consider myself academically inclined.

When I reached my 30s,

heart transplants,

lung transplants,

ECMO technique,

youngest chief physician in NTU hospital,

chief physician of the Surgical Intensive Care Unit,

Initiated the Organ Registry and Sharing Center project,

Associate chief physician of the Trauma Unit.

All these were accomplished by my 30s.

During this journey,

I believed that medical knowledge was incredibly powerful.

Medical knowledge can cure everything.

But in my forties,