There was a board meeting of the Taiwan Society of Critical Care Medicine held at The Regent Hotel on the night of March 1st, 2008. I was the Director. A couple of friends and I decided to go to the bar at the lobby of the Ambassador Hotel afterwards to catch up as it had been a while since we’d last gathered together. Unfortunately the bar was full, so the maître d’ led us to a table at the corner in another spot. We first ordered a 12-year-old Macallan whiskey, which wasn’t enough, then a bottle of red wine. I stayed there until around 11 o’clock and took a cab home. At around 12 o’clock, I accompanied my wife to a social event taking place at a neighbor’s house because they had recently installed a karaoke system. We sang and drank until late in the night and when I finally got in bed it was after 3 o’clock. Normally I wake up at 6 A.M. sharp, get ready, and have a simple breakfast before I head to work, but I was awoken by a phone call the next day. March 2nd was the once-a-year Ligang Elementary School reunion. We were going to go hiking at the Junjian Yan Mountain and decided on Chung-Cheng building at the Taipei General Veterans Hospital as our meeting place. I overslept due to hangover from the night before! My wife and I rushed over to the Chung-Cheng building immediately after I hung up the phone. I didn’t eat breakfast nor got to buy a bottle of water. The President of the reunion said there were no restrooms on the Junjian Yan Mountain, so it would be a bit of an inconvenience. We were a group of 12 (the President Dr. Wu Jinn-Ann and wife, me and my wife, Prof. Tsou The-Chung and wife, Mrs. Chen Hui Qing and husband, Mrs. Hsu Shu-Er and husband, and Mr. Lai Fu He and wife) and we headed out from the Taipei General Veterans Hospital to Yang-Ming University and then to the Junjian Yan Mountain. We stopped by a gazebo on our way for a short break. I was ahead of everyone and was even worried about my fellow mate, Prof. Tsou, who happened to be a little on the heavy side. He seemed a bit out of breath and I told him to slow down a bit. Finally we reached the top of the Junjian Yan Mountain and the view over Taipei city was spectacular. The only downside was that there were too many unapproved constructions on the slope of the mountain. After a brief admiration of the view and photo taking, we took the route on the other side to go down the mountain. We passed by a temple on our way down and saw blooming cherry blossoms. It was beautiful. My mate, Prof. Tsou, was a Forestry specialist and explained to us the different types of cherry blossoms. For example: the difference between Octet Cherry, Hill Cherry, and Yoshino Cherry and how to plant them. I bought a Yoshino cherry a while ago, which cost me about 1000 NTD, but it died shortly after I potted it. In the middle of the conversation and all the photo taking in front of the cherry blossoms, just by the curve of the residential area, I suddenly felt ill and dizzy. I told my wife to move on and I would catch up shortly as I needed to rest a little. I felt weak, so I leaned on the handrail. My wife noticed that something wasn’t right and reached out to support me as I passed out. When I regained consciousness, I was already on my way to the hospital. In a later conversation with my wife she described me as being very pale, unconscious, and she immediately grabbed me when I passed out so that I wouldn’t hit my head. They wanted to lay me down on the ground but my hands were gripping the handrail so firmly that everyone had to work together to pry my fingers open. It was only a matter of seconds that my face turned blue. My wife checked my breathing and my pulse, of which both had already ceased, and proceeded to perform emergent CPR with Dr. Wu Jinn-Ann. My wife was in charge of giving me mouth-to-mouth ventilations as Dr. Wu was giving me chest compressions. Both continued on for 20 minutes (my wife was worried that it was my end because they had performed CPR for over 20 minutes). A connection with 911 couldn’t be established because the mobile signal was bad in the mountain, so they tried hitching a ride. Eventually someone was kind enough to bring us down and take us directly to the ER at the Taipei General Veterans Hospital. I regained some consciousness on the way down. Though I was near death, I didn’t see the grim reaper or the Nai-He Bridge (bridge that one must cross after death in Chinese culture). I was drowsy by the time we reached the ER but was conscious enough to tell the physician on-call to order an X-Ray, EKG, and blood samples for cardiac enzymes and other biomarkers; at the same time I asked the Head Physician of the Cardiology Department for an echocardiogram. The results came back as normal. I had some chest pain but I guessed it was due to the chest compressions. Luckily I didn’t wind up with a broken rib. Dr. Wu humbly stated that he hadn’t performed CPR for a while so he may have applied too much pressure. I believe it was my wife and Dr. Wu who saved my life. My gratitude towards them comes from the bottom of my heart. Of course I am also grateful for the kind-hearted Mr. Chen who was willing to give us a ride down to the hospital.

　　In order to find the cause of this sudden lethal episode, I was sent into the ICU of the Cardiology Department for a 24-hour EKG and pressure monitoring. The results yielded nothing abnormal. Nevertheless, I followed the orders given by Dr. Cho Chia-Yu and Dr. Chen Shih-Ann on performing a cardiac catheterization and electrical conductance test. The results were normal again. At night we continued with drug provocation tests which did cause some arrhythmic episodes. But the test required an examination every 10 minutes with 12 electrodes distributed between my chest and 4 limbs. The electrodes kept falling off and required constant re-sticking. My skin was irritated after all the re-sticking and the frequent examinations at night didn’t allow me to rest. Eventually I declined to complete this test and the cause of the episode still remained a mystery. A possible diagnosis of Brugada Syndrome was made. I researched all related articles and learned that this disease is due to unstable membrane potentials of the cardiac myocytes leading to abnormal firing of electrical pulses causing arrhythmias. It occurs most commonly between the ages of 30 – 40 years and is linked to family history, so it may be a congenital condition. It is something unlikely to happen at my age. The Head Physician wanted me to ask Dr. Chiang Zhi-Heng for a pace-maker placement just in case but, personally, I doubted it was a congenital condition in my case. Instead, I thought it might be related to a series of multiple events combined together like exhaustion, abundant alcohol ingestion, lack of sleep, no breakfast, and dehydration. I guess God watched over me and decided to give me an extension. Fortunately, I didn’t suffer any consequences of cerebral hypoxia. I only had a big bruise on the inner side of my thigh due to catheterization which remained painful for about a month. I want to thank God for letting me come back. This taught me to cherish even more every second of my life, work harder on saving lives, and help others. I even gained more empathy towards patients after having experienced hospitalization. I can now relate to the discomfort that a patient may experience whilst being hospitalized or performing exams. I will also keep monitoring my health in the future. One mustn’t be careless. The fact that I have climbed to the top of the Yushan Mountain but passed out in the Junjian Yan Mountain is kind of paradoxical. This experience also reminds us that one must rest enough before exercising and shouldn’t work until exhaustion, or it is easy for one to become part of the high risk group for karoshi (occupational sudden death).