血栓剛形成的時候像火鍋店的嫩鴨血、塞久了就變成豬血糕，拖越久越難清除。

「噴射機械除栓」正式英文名稱為Angiojet system，是微創機械除栓設備的一種，大千醫院心臟血管外科正式引進這項技術，將苗栗地區的血栓治療向前邁入微創除栓的領域。

（ps. 造成鴨血跟豬血糕印象受影響感到抱歉⋯）

#大千醫院心臟血管外科
#下肢血栓 #腳中風
#機械除栓

https://www.chinatimes.com/realtimenews/20210929004081-260418

《我的幸福5/2 週末》

*週日下午兩點誠品信義書店「廿世紀典範人物」新書分享會，我下午二時開始演講，離上次在台灣大學公開演説。快半年了！分享會報名一小時預告已額滿，但TVBS電視台慷慨的支持。派出SNG車，屆時TVBS文茜的世界周報YouTube 及世界周報Facebook 都將同步直播。

*新書分享會後我將直奔高雄衛武營，參加劉孟捷（李斯特巡禮之年）鋼琴獨奏會。這是劉孟捷回台，最重要的一場音樂會，我目睹他用盡了一切心力。過去即使21歲時在費城代打缺席大師的音樂會，劉孟捷都未曾如此緊張。他此次回台，手術前為了沒有遺憾，共舉行三場音樂會：其中4/17與5/30皆是與國家交響樂團NSO合作：530那一場指揮是呂紹嘉。但他告訴我，某些曲目對他而言，是Piece of Cake ：惟獨衞武營這一場，曲目由他自己決定，現場錄影，並且找了金曲獎錄音師同步錄音。

5/2衛武營-劉孟捷鋼琴獨奏會《李斯特巡禮之年》購票連結
https://www.opentix.life/event/1384752689074294784

劉夢捷明白他即將面對一個大手術，手術風險之外，他的免疫系統疾病，將使他的康復之路更長。

沒有人可以預知未來，為了圓他的夢，醫院每天都要求他早上、晚上量血壓，報告直接傳給院長。振興醫院院長魏崢雖然是亞洲第一把心臟外科醫師，但也不敢大意。

畢竟這個人的生命那麼脆弱，他的心臟主動脈剝離，那是實質的「心碎」了：但他仍有詩，仍有音樂夢。在生命的交接處，在白日與黑夜的交义口，劉孟捷想為他的音樂生涯，留下最美好的紀錄。

他選擇了李斯特。

在這場音樂會前，他甚至以英文寫下了自己與音樂、疾病的半生回顧：如李斯特的巡禮，有仰望，有沉思，有失落，有幽微的疼痛。他以詩篇般的演奏模式，傾訴，詠嘆。他曾得到天賦，也走過死蔭的幽谷。命運是一層又一層的黑影逼近，老天爺隨時想帶走他。

而他已不再流淚，不再沉浸於悲愴告別：因為對他而言活著並不容易，他要讓自己更深刻的抓住每一分時光之美。

如果時間和空間，正如哲人們所形容的
都是不實際存在的東西：那從不感到衰敗的太陽，也不會比我們了不起多少！

他如艾略特的詩句中所形容的：我們為什麼要如此貪心總在祈禱，想活上整整一個世紀？

蝴蝶雖僅活了一天，已經歷了永恆。

當他的身軀如露水還在藤蔓顫抖時，他送給我們一場「完全浪漫又超技的李斯特」。

等音樂會結束了，至少有一張CD，一段YouTube 影像：不論孟捷代表生命的那朵鮮花是否枯萎，他彈奏如天使的音聲不會飛離，它會停留在那夜，繼續釋放芬芳。

這是盡生命之力、之情獨奏的音樂會。劉孟捷説：這樣當他走進手術室時，會少一點悲傷。

或許快樂的日子本來就不多，但讓這場「完全李斯特．完全劉孟捷」的獨奏會放出神聖的光彩吧！

我必將赴會，不會錯過！我知道此刻的獨奏會，很難複製，因為它綜合了太多的情感、愛念，釋放與生命的抒情。

*劉孟捷為此次獨奏會寫下的文字：This past year has seen some unprecedented changes in the world. Many lives have been lost and many have changed. The world has changed while many of us confront the uncertainty of the future.

For most musicians, life has changed. For months, we have been conducting our lessons online, and concerts have mostly stopped or become an online experience as well. More time has been spent learning how to improve the online teaching experience than one could have imagined. While I have felt the duty to continue teaching, the format the pandemic requires for teaching leaves me unwilling to spend more time than I have to.

And truly, I have had other things to deal with. When the pandemic started to worry the American public in March, I was in the middle of a tour with the String Quartet-in-Residence at Curtis, the Vera Quartet. However, our concerts were canceled, and everything came to a sudden halt.

I felt the universe had sent me an unexpected gift, as I had also just received some terrible news concerning my worsening aortic arches and a diagnosis of kidney cancer. The sudden halt in my professional schedule seemed perfect in its timing. I was able to settle into a monastic existence, to simply practice and attempt to heal.

I see many musicians itching to be concertizing again, and many stepped into new territory, performing on the internet. Many took time to develop new podcasts, and to write new materials for their art. Sadly, many have struggled as they have fallen into desperation without any concert incomes. Altogether the music industry seems to be in peril, and many worry about how music and musicians will survive.

However, I had my own survival to think about. Having been through many difficult experiences in my life, I knew this might be the most difficult I would encounter. My Doctors describe me as a walking time bomb. My condition could be lethal at any moment if my blood pressure gets out of control. So while others wrestle with the fate of the music industry, I’ve needed to face my own fate and mortality.

Playing concerts can mean many things to people. At different times throughout my life, I’ve felt the need to express different aspects of myself. When I was young, I wanted to embody the spirit of romanticism, playing lots of Chopin and Schumann. Then there was a period of time when I wanted to challenge myself by showing off pyrotechnics. I had a brooding period where I turned to the pathos of Rachmaninoff, and then felt the need to return to the purity of Schubert and nobility of Brahms. Throughout this pandemic, I wanted to play Bach. Through Bach’s music I found a kind of spiritual sanctuary.

In considering the program for this concert, I felt again the urge to play music that reflects my current feelings and state of mind. The title of today’s recital, “Years of Pilgrimage” seems to fit exactly what I am experiencing.

Liszt wrote several volumes of “Années de pèlerinage” throughout his life to reflect on thoughts he had during his travels. He links his philosophical thoughts to the scenery which inspired them. “Au Bord d’un Source” describes feelings of rejuvenation while standing next to a clear stream of water, a symbol and source of life and energy. It seems to say, when the stream is so pure, life can be so full of joy.

In the Les jeux d'eaux à la Villa d'Este (The Fountains of the Villa d'Este), the water has a magical and supernatural quality, as Liszt himself wrote in the inscription: "But the water that I shall give him shall become in him a well of water springing up into eternal life,"( from the Gospel of John.)

For me, I have never felt more connected to Liszt than when he looked upon the valley of Obermann and questioned the meaning of existence. At this moment in my life, I often find myself reflecting my experiences of what I see and read into philosophical musings. Perhaps many people come to a time when this is so.

In all this I have felt gratitude for the love stories and sonnets that one can romantically indulge in, and for storms so violent that they threaten to destroy one’s spirit, even the hell-bound journey which brings up questions about the purpose of life…

On this journey, I felt full and alive as a human being. Looking back on this journey, I am grateful for everything, whether happy or sad, to have made an impact, found and imparted meaning to this life.

The unusual time of this pandemic has marked a milestone for me. I have journeyed back home, and as it happened, this is the first time I have spent so much time in my hometown Kaohsiung in over 35 years. It’s particularly nostalgic to play these pieces as some of them were significant in my early musical career. Vallée d’Obermann was the piece I played in my first competition at the junior high school level, in which I won first prize on the national level, which allowed me to be qualified to apply for a special permission to study abroad. This meant my dream to be educated as a musician could be continued in an environment where I could develop fully. In the following year when I was 13, I won the first Asia-Pacific Youth PIano Competition with the Dante Sonata. The competition catapulted me into national attention as I was headlined in several newspapers, and especially since it was held in Kaohsiung, I became a local hero as well. During the same event, I had a fateful meeting with one of the important influences in my life, Mr. Gary Graffman, who then mentored me throughout not only the years when I was studying at Curtis, but throughout my illness and recovery as a pianist. Right before I departed to study in Philadelphia, I played my first solo recital throughout Taiwan, and along with the Dante Sonata, I also performed the three sonnets.

It’s perfect that now, back in Kaohsiung, all these memories have flooded back into my head. I feel so lucky to have been born here, and to have met my first teacher, Chin-Li Lee, who inspired me on the path to become a musician. Prof. Alexander Sung filled me with dreams of becoming an artist. I am grateful for his belief in my talent, when he chose to give a 12 year old such philosophical pieces to play.

Having once again spent some months in Kaohsiung, I can freshly appreciate the source of inspiration it once was for me. I have returned to the source to heal. Having already glimpsed hell’s gate several times, battered and weathered by the storms of life, I know there is a reason life is this way, and it all will be alright.

Meng-Chieh Liu
April, 2021

*劉孟捷衛武營《李斯特巡禮之年》演奏會中，包括李斯特以佩脫拉克三首情詩譜寫的鋼琴琴詩：這三首情詩是從大詩人佩脫拉克一百多首情詩挑出來的，詩本身就很優美，依此激發李斯特的浪漫主義創作靈感，成為琴藝上最困難演奏，但也特別細膩溫柔的琴詩。

這三首分別是：
〈佩脫拉克第47號十四行詩〉〈佩脫拉克第104號十四行詩〉及〈佩脫拉克第123號十四行詩〉。
Franz Liszt（1811-1886）: Sonetto 47 del Petrarca, Sonetto 104 del Petrarca, Sonetto 123 del Petrarca, from Années de pèlerinage, Deuxième année: Italie

李斯特於1846年先出版藝術歌曲《三首佩脫拉克十四行詩》（Tre sonetti del Petrarca），再改成鋼琴獨奏版。

三首佩脫拉克十四行詩
中譯：焦元溥（元溥也是友情贊助，特別準備音樂資料，周日南下，聆賞劉孟捷的樂曲，並且陪同他盯著錄音共三天）

〈第47〉
祝福每天、每月、每年，
所有片刻與鐘點、時間與季節，
在那美麗的原野，

我為一雙眼眸魂縈夢牽。

祝福初遇時的甜，
與愛同在、受苦不停歇，
如弓箭刺穿令我淌血，
傷口永留感動在我心間。

祝福一切我發出的聲音，
當呼喚著我深愛的女郎，
渴望、嘆息、淚濕滿襟。
祝福我寫下的文字遠揚，
歌頌她的芳名，萬古長新。
我心永屬於她，無人能闖。

〈第104〉
我找不到和平，也無意打仗，
我恐懼、我期望，燃燒又冰透。
我向天飛升，卻躺在地上，
我一無所有，卻又擁抱整個宇宙。

我身陷囹圄，監牢又開敞；
我不受囚禁，卻銬著鎖頭。
愛情不讓我死，也不讓我飛翔；
不要我活，也不准我逃離悲愁。

欲看卻無眼，啞口還在發言，
我甘心殞滅，卻仍高聲呼救，
我痛恨自己，但仍愛著他人。

憂傷滋潤我，淚水伴隨笑臉，
生命不足惜，死亡也不煩憂；
我淪落至此，都是妳啊，我的愛人！
〈第123〉

我在塵世見到仙子的美，

她天堂般優雅無與倫比。
想起她讓我悲傷又歡喜，
所見如幻夢迷霧與幽黑。

妳的可愛眼睛使我落淚，
多少次讓太陽也要妒忌。
我還聽到四周發出嘆息，
移動了山嶽停止了河水。

愛情智慧憐憫憂傷財富，
在淚水中形成甜美聲響，
奇妙和諧世上未曾目睹。
天堂追隨著音樂的流淌，
雖然枝上樹葉並未飛舞，
空氣與風息卻充滿芬芳。

5/2衛武營-劉孟捷鋼琴獨奏會《李斯特巡禮之年》購票連結
https://www.opentix.life/event/1384752689074294784

記得以前當住院醫師，值病房班時，最怕遇到譫妄的病人。

「譫妄」是內外科疾病最終的表現，不是原發性精神疾病。

譫妄可以理解成「急性大腦衰竭」，也可以此向患者家屬衛教說明。就如同「急性心臟衰竭」一樣，是很多原因最終的表現。

「混亂評估量表」(Confusion Assessment Methods，簡稱CAM) 是最好的評估工具，並且有3分鐘診斷會談(3D-CAM)的版本，值得非精神科的專業人士採用。

CAM 包含四項特徵，須符合以下(1)、(2) 以及 (3)或(4)的其中一項：

(1) 急性意識狀態改變與病程起伏，通常晚上患者的狀況更為嚴重，稱為「日落症候群」。

(2) 注意力障礙：主要以「逆序記憶廣度測驗」測試：例如「3項逆序記憶廣度測驗」評估者說「3-5-8」，病人須回答「8-5-3」；患者若無法能完成「4項逆序記憶廣度測驗」，則算是注意力障礙。

(3) 思考混亂 或 (4) 意識狀態改變：
思考混亂主要評估患者對「時、地、人」的定向感。失去定向感（disorientation）的順序通常為「時 → 地 → 人」。

造成譫妄的原因，可以用譫妄的英文字母DELIRIUM記憶：

D:
藥物(Drug):最常見可以解決的譫妄原因

E:
電解質不平衡（Electrolyte disturbance): 特別注意脫水、鈉離子不平衡、甲狀腺異常

L:
減藥（Lack of drugs）：評估停掉長期使用的鎮靜安眠藥、酒精的戒斷症狀（譫妄可能是戒斷症狀）；評估是否有控制不好的疼痛（Lack of analgesia）：定時給藥、局部用藥，避免使用鴉片類止痛藥（特別是meperidine，常見商品Demerol）

I:
感染（Infection）

R:
視力聽力不佳（Reduced sensory input）：使用眼鏡、助聽器

I:
顱內病變（Intracranial disorders）

U:
排泄困難（Urinary and fecal disorders）：尿液、糞便滯留

M:
心肺疾病（Myocardial and pulmonary disorders）

#譫妄
#delirium
#CAM
#ConfusionassessmentMethods
.
.

【深夜談心】一年馬偕兒科經驗分享！最後選整形外科的原因？醫學生涯如何規劃？醫學系選科心路歷程｜依心唯美 謝東穎醫師

談心系列第一集👉🏻https://youtu.be/2xPvoutrGcA

談心系列第二集✨
在一萬訂閱快問快答中
分享了幾個工作上遇到的小故事

一時興起就想跟大家講古
分享一下在成為 #整外醫師 前
曾經擔任過一年的 #兒科醫師 的經歷👶🏻

想讓對未來工作選擇迷惘的
無論是醫學系學生、實習醫生或住院醫生
都能敲敲敲找到自己的出路🔨

有更多想跟我分享的
都歡迎在下方留言問問題喔！

💡影片重點
00:00 搶先看
01:23 成為兒科醫師的原因
01:48 馬偕兒科住院醫師經歷分享
03:54 轉科的原因
05:12 給猶豫志業的學弟妹的一段話
07:00 選擇當整外醫師的原因
08:30 適合當整外醫師的原因
09:16 東東的逃獄理論
10:00 名言佳句時間

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