作者：蔡昇達
《禮記．曲禮》：「凡為人子之禮，冬溫而夏凊，昏定而晨省。」
《弟子規》
冬則溫 夏則凊 晨則省 昏則定
出必告 反必面 居有常 業無變
正值壯年的復健科醫師，在美國波士頓執業，每天早上及晚上都會打電話給台灣的媽媽請安，2023 年一月回台陪爸媽過農曆春節，幾天後飛回美國，下飛機即回醫院準備上班，卻暫時失去意識，跌倒造成頭部撕裂傷，前往醫院做傷口縫合，傷口處理完約兩個小時後卻在醫院內再次失去意識、心跳停止……
隔天媽媽覺得不對勁，飛機已經到了，貼心的兒子卻沒有打電話來請安，立刻聯絡醫院，才知道兒子已在加護病房……
照片一： Peter Bent Bigham Hospital
2025 年四月我來到波士頓開會，看到美麗的城市，及世界知名的麻省總醫院布萊根醫療系統(原本的麻州總醫院和布萊根婦女醫院合併) ，百感交集，想到這位學長的故事：
照片二： 布萊根婦女醫院門口
起死回生是急重症醫師最大的成就感，身為神經內科醫師，則是醒腦開竅，GCS 3 到 15，是病人和我們的共同目標，復健科學長在波士頓的醫院做完低溫治療、早期復健後轉回台灣，希望結合中醫，幫助他早日恢復意識。為何希望結合中醫？因為波士頓的大醫院已說明病況嚴重、癲癇難控制，醒來的機會幾近於零，但在復健科病房時，有次學長在接受針灸治療後雙眼變得有神，似乎可聽懂家人說的話，故家人經討論後決定轉回中醫大後續治療。
圖片： 急救後的腦部核磁共振(T2 series)，可見腦迴邊緣變得較白(hyperintensity)，表示缺氧的損傷嚴重
這種超級 VIP 一般會找各科的主任，故我聽說這個會診時沒有太在意，但前輩林醫師託我幫忙看看，剛好是一個值班的週末，便走到復健科的病房，陪在旁的是一位新加坡的胸腔內科、重症科學長，是復健科學長的好朋友，他很誠懇、仔細的為我說明前端的治療過程、醫師對預後的分析……等，難過時數度流淚，讓我對他們的友誼產生深刻印象，新加坡醫師為了他，請假飛到波士頓，陪伴在旁，並再陪他回到台灣治療。
之後某個週三下午的門診，學長的哥哥掛了號前來，坐下來誠懇的與我討論弟弟的病情，時間雖不長，但我明顯可感受到他對弟弟的用心、也理解到家人們想到為學長多做一些的希望，讓我決定將學長從他科轉過來，負責整個意識障礙的治療決策。
意識障礙(白話：人不清醒，嚴重者即為俗稱的「昏迷」、或是「植物人」)，就台灣(及世界多數國家)的醫療常規而言，沒有專門的部門來做仔細的評估和計劃擬定，因多數的昏迷是已知原因造成，如腦中風、心跳停止，多在可處理的原因處理完後即安排下一步的安置，如轉至地區醫院、或是養護機構。經由學長的案例，讓我認識在此領域深耕很久的藍亭教授，除了科學之外，藍亭教授持續的教育大眾意識障礙的概念(如他的中文、英文文章)、且為植物人的研究募款、改善他們的處境，我們亦邀請藍亭教授一同幫忙我們評估、討論計劃。
治療期間減低癲癇藥劑量、安排腦部檢查、與中醫師討論針灸方向……，著實讓我成長不少，也在神經部蔡部長的建議下，引用最新發表的文獻(Brain Stimul. 2023 May-Jun;16(3):819-827.)，給予三叉神經電刺激治療，並在臨床神經生理學會呂主任的指導下調整刺激的參數，亦從英國購買了一條特製的電源線，終可開始執行。
照片三：用各種神經電生理機器組合起來的三叉神經電刺激設備，用電腦跑我們設定的參數
某天，跟著我的住院醫師(一個月輪換一次)在看完病人後問我，「這樣治療到底有什麼意義？！」讓我印象深刻，也理解到許多人對植物人、昏迷病人的想法，體會到藍亭教授多年來持續碰到的困難。
還記得有天早上查房，學長的媽媽在看好萊塢電影，好奇的跟媽媽聊聊她看的電影，她說「這部電影是在波士頓拍的，就在他工作醫院的旁邊。」原來媽媽並不是在看電影，而是在思念兒子。
治療期間，家屬向我介紹了一本書，是加拿大神經科學家，Adrian Owen 的研究，利用功能性核磁共振掃描，請病人想像「打網球」及「在家中走路」分別來回答「是」或「否」的問題，因歐文(Owen)團隊發現，有的病人無法透過身體表達想法，卻可以用這兩個方法來與外界溝通(引用文獻、影片等)，我們也用相同的方法為病人測了兩次，可惜未能得到肯定的答覆，可能是學長當時想睡覺、無法完成想像、或者是意識程度沒有好到那個程度。
經過一陣子的治療，學長的昏迷評估量表有所進步(CRS-R score= 4-> 7)，但對醫療團隊而言，未能呈現出有意義的溝通(GCS= E4VtM4)，階段治療完成後家人帶他回老家照顧，回到小時候成長的地方，有爸爸、媽媽、哥哥的陪伴。
快出院時，我由學長爸爸的口中得知，當初哥哥為了將他從波士頓送回台中，訂了 12 個長榮的機位，以放置病床，但起飛前幾天，因台美段機位需求大，這些機位一一被售出，學長無法返台，後來勞煩父親出動老關係聯絡長榮高層，終順利返台。面對近兩個月的艱辛和高壓，一肩扛起弟弟的一切，在機位確認後哥哥第一次落下了男兒淚。(未選擇醫療包機，是因為包機較小，中途需降落加油，家人擔心增加移動的風險，故選擇大型的民航客機。)
也了解到哥哥為了弟弟的病情，辭去了科技業高薪的工作，每天陪伴在弟弟身邊，找遍各種資源來幫忙他，爸爸媽媽則是將家中改建，專門建一個適宜照顧的房間，並聘請專人照顧學長，學長的人生旅程仍在寧靜的繼續著，所幸之前相關的文章提到，「無法表達想法」的狀態，並不會讓他的內心變得比較不快樂。
許多人會覺得他們家是因為經濟條件佳，才能讓病人得到很好的照顧，但我感受到的是家人們投入的全心全意、還有對醫療團隊的理解和尊重，如果沒有哥哥特地掛號來門診，坐下來談、沒有胸腔科醫師為麻吉流下的眼淚、沒有爸爸含蓄但深刻的請託，我可能心中沒能有力量面對許多的質疑。
走過布萊根婦女醫院的建築，我再到麻州總醫院，參觀古老的 Ether Dome，是世界上第一例用乙醚麻醉做手術的地方，回顧醫學史，醫師常在遇到問題、解決問題時促進了醫學的突破，相信不久的將來，我們在意識障礙的診斷與治療也可有所突破。
照片四： 麻州總醫院的 Ether Dome，1946年10月，醫學史上第一例的乙醚麻醉手術(頸部腫瘤切除)即在此進行，持相機的是中國附醫神經外科林鈺翔學長，他花一年時間在麻州總醫院精進腦部及脊椎手術。
「凡為人子之禮，冬溫而夏凊，昏定而晨省。」雖人在海外，每天仍向父母請安，我覺得這是學長雖面對重大變故，仍履次化險為夷的關鍵，佛法中說，父母為具力業門，「由福田門故力大者。謂於三寶，尊重，似尊，父母等所，於此雖無猛利意樂，略作損益，能得大福及大罪故。(廣論第 131 頁)」，儒家也說「孝」為根本，我也該打電話向媽媽請安了。
English version:
The Book of Rites – “Qu Li” (Summary of Rituals):
"A son’s proper conduct includes keeping his parents warm in winter and cool in summer, settling them in the evening and checking on them in the morning."
Standards for Being a Good Student and Child:
Keep parents warm in winter and cool in summer,
Check on them in the morning and settle them at night.
Inform them before leaving, report back upon returning.
Maintain regular habits and consistent work.
A rehabilitation physician practicing in Boston, U.S., called his mother in Taiwan every morning to express his love and care. In January 2023, he returned to Taiwan to celebrate the Lunar New Year with his parents. Just a few days later, he flew back to the U.S. and went straight to the hospital upon landing to prepare for work. However, he suddenly lost consciousness, collapsed, and suffered a head laceration. He was rushed to the hospital for stitches. Around two hours after the wound was treated, he lost consciousness again—this time, his heart stopped.
The next day, his mother felt something was wrong. Her son’s flight had already landed, but the thoughtful daily warm call never came. She immediately contacted the hospital and was shocked to learn her son was in the ICU...
In April 2025, I came to Boston for a conference. Seeing the beautiful city and the world-renowned Massachusetts General Brigham hospital system (formed from the merger of the former Massachusetts General Hospital and Brigham and Women’s Hospital) stirred deep emotions. I thought of this senior's story.
Bringing patients back from the brink of death is the greatest achievement for critical care physicians. As a neurologist, our goal is to help patients "wake up"—from a Glasgow Coma Scale (GCS) score of 3 to 15. After undergoing hypothermia therapy and early rehabilitation at a Boston hospital, the rehabilitation physician was transferred back to Taiwan. His family hoped to incorporate traditional Chinese medicine to aid in regaining consciousness. Why? Because the hospital in Boston had clearly stated that the condition was severe, seizures were difficult to control, and the chance of waking up was near zero. However, during rehabilitation, after one acupuncture session, his eyes suddenly became alert, and he seemed to understand what his family said. This led the family to decide, after much discussion, to transfer him to China Medical University Hospital for further treatment.
This kind of super VIP case usually involves consultations with department chiefs. So when I first heard about this consult, I didn’t think much of it. But when Dr. Lin asked me to take a look, it happened to be a weekend on call. I walked over to the rehab ward and met a senior from Singapore, a pulmonologist and critical care specialist, who was a close friend of the patient. He sincerely and thoroughly explained the previous treatments and prognoses to me. He even cried several times as he spoke, leaving me deeply moved by their friendship. This Singaporean doctor took leave to fly to Boston, stayed by his friend’s side, and accompanied him back to Taiwan.
One Wednesday afternoon during clinic, the patient’s older brother registered for a consultation. He sat down and sincerely discussed his younger brother’s condition with me. Although the conversation was brief, I could clearly sense his dedication. I understood the family’s wish to do everything possible for the patient, and this moved me to transfer the case under my care and take charge of all treatment decisions related to consciousness disorders.
Consciousness disorders—commonly referred to as coma or a vegetative state—do not have a dedicated department in Taiwan (or most countries) for thorough evaluation and planning. Most comas are caused by known events, like strokes or cardiac arrest. Once the acute issues are handled, patients are typically sent to regional hospitals or care institutions. Through this case, I became acquainted with Professor Timothy Joseph Lane, who has long worked in this field (see the two links below), and invited him to join our team for assessments and planning.
Liberty Times Health: https://health.ltn.com.tw/article/breakingnews/5002551
Taipei Times: https://www.taipeitimes.com/News/editorials/archives/2024/12/04/2003827917
During treatment, we reduced the dosage of anti-epileptic drugs, conducted brain imaging, and consulted with traditional Chinese medicine practitioners about acupuncture plans. Under the guidance of Neurology Department Head Dr. Tsai, we also tried a new technique from recent literature (Brain Stimul. 2023 May-Jun;16(3):819-827.): trigeminal nerve stimulation. With advice from Clinical Neurophysiology Chair Dr. Lu, we adjusted the stimulation parameters. We even imported a specially made power cable from the UK to begin treatment.
One day, after making rounds with my resident (residents rotate monthly), he asked me, “What’s the point of this treatment? He is not going to regain consciousness.” That question stuck with me—it reflected how many people view coma and vegetative states, and helped me understand the persistent challenges Professor Lane has faced in this field.
I remember one morning during rounds, the patient’s mother was watching a Hollywood movie. Curious, I asked her what she was watching. She said, “This movie was filmed in Boston, right next to the hospital where he worked.” I realized that she wasn’t just watching a film—she was missing her son.
During treatment, the family introduced me to a book by Canadian neuroscientist Adrian Owen. His research (Science. 2006 Sep 8;313(5792):1402. doi: 10.1126/science.1130197.) used functional MRI scans to ask patients to imagine playing tennis or walking through their home—responses that corresponded to “yes” or “no.” His team found that some patients who couldn’t express themselves physically could still communicate through these tasks (as documented in his publications and videos). We tried the same method twice with our patient, but unfortunately, didn’t receive conclusive responses. Perhaps he was too tired, unable to focus, or his consciousness wasn’t clear enough yet.
After some time, the patient’s Coma Recovery Scale-Revised (CRS-R) score improved from 4 to 7. However, he still could not communicate meaningfully (GCS = E4VtM4). When this phase of treatment concluded, the family took him back to their hometown to care for him—back to where he grew up, surrounded by his parents and brother.
Just before discharge, I learned from the patient’s father that to bring him back from Boston to Taichung, the brother had booked 12 seats on an EVA Airlines flight to accommodate the stretcher. But due to high demand for U.S.–Taiwan flights, those seats were gradually sold off. The transfer seemed impossible until the father reached out through old connections to the airline’s top management. Finally, the transfer was arranged. After nearly two months of stress and hardship, carrying everything on his shoulders, the brother broke down in tears for the first time after the flight seats were confirmed. (They did not choose a medical charter flight because smaller planes would require refueling stops, increasing risk. Instead, they chose a large commercial aircraft.)
I also learned that the brother quit a high-paying tech job to care for his sibling full-time, seeking out every possible resource. Their parents renovated their home to create a special care room and hired professionals to look after the patient. His journey continues quietly. Fortunately, previous literature has shown that being unable to express thoughts does not necessarily mean someone is unhappy inside (Orphanet J Rare Dis. 2015 Jul 19:10:88. doi: 10.1186/s13023-015-0304-z.).
Many people might think the family could provide such care because they are financially well-off. But what I felt was their wholehearted dedication, and their respect and understanding for the medical team. Without the brother visiting my clinic, without the pulmonologist’s tears for his dear friend, without the father’s quiet but heartfelt request—I might not have had the strength to face so much doubt and pressure.
As I passed Brigham and Women’s Hospital again, I visited the historic Ether Dome at Mass General, where the world’s first surgery under ether anesthesia was performed. Reflecting on medical history, breakthroughs often came from confronting and solving problems. I believe we’ll also see advances in diagnosing and treating consciousness disorders in the near future.
"A son’s proper conduct includes keeping his parents warm in winter and cool in summer, settling them in the evening, and checking on them in the morning." Though he was living abroad, he still greeted his parents every day. I believe this devotion played a crucial role in his repeated survival through such adversity.
Buddhist teachings regard parents as a powerful source of karmic merit. In The Great Treatise on the Stages of the Path (Volume 1, p. 231), under the section The Varieties of Karma, it states:
“There is strength in actions directed toward the three jewels, gurus, those who are like gurus, parents, and the like, for, though you direct no intense thoughts toward them and do them only small harm or help, the ensuing misdeed and merit is great.”
Confucianism also holds filial piety as a foundational virtue. Perhaps it’s time I called my mother too.
