Thursday, June 24, 2010

飲鴆止渴

馬政府刻與中國在簽訂ECFA,早收清單出爐,蕭誇為互利,吳
以為中國讓利很多,盛讚旗下談判手,且沾沾自喜。中國堅持
以一中原則簽訂,明顯在以經促統。馬不堅持以WTO架構與中國
周旋,卻乞靈於雙方簽ECFA來充數,不顧台灣經濟鎖住於中
國。馬素以終極統一為職志,固然心甘情願,台灣人卻何辜而
被逼飲鴆止渴。 身為兩千三百萬台灣人之一的尊駕以為這樣
公平嗎?

Saturday, March 20, 2010

百萬元徵「讓人民想生育的口號」

林萬哲

最近內政部鑒於台灣生育率頗低,恐怕人口會逐漸減少,任事者突發奇想,懸賞一百萬元要徵一個響亮的口號讓人民看了就會想生育。當然有不少人馬上口誅筆伐他們亂花納稅人的錢辦傻事。但我仍不揣冒昧,撰句如下,以響應內政部袞袞諸公憂心國事之熱忱。

你生孩子國家養
我攬辛苦你包爽

Tuesday, February 2, 2010

高球趣談

林萬哲

高爾夫球運動似乎越來越受歡迎,國內打高爾夫球的人數相應地也在逐年增加。這種運動可讓球友置身於開闊的球道綠地之間,一面欣賞美麗的風景、呼吸新鮮的空氣、聯絡球友間的情誼,一面擊球飛向目標、活動筋骨而達到運動健身的目的。因此,高球說它遊戲也好,說它運動也好,都有吸引一旦嘗試過的球友繼續打下去的魅力。筆者雖說起步較晚,球技無法達到理想的水準,但對此運動仍算情有獨鍾,所閱讀的書籍也不在少數,因而願就所見所聞的一些趣事公諸同好。
高球遊戲,1場打18洞,切磋的球友之間,以打出的總桿數減去差點算淨桿數的多寡而論輸贏。這比其他的球戲合理,因為計差點就是正式的禮讓,實力不相同的人也可以一起比賽。打高球不用裁判,球友計桿全憑榮譽制度;所以說它是紳士遊戲。
高球打1場為何定為18洞呢?習慣憑直覺思考的人大概會以為打18洞所走的腳程和所花的時間恰好適量才這樣決定;其實不然。據說在高球發祥地的蘇格蘭,原先每場打幾洞都沒有一定,以致有人打多了疲憊不堪,有人打少了意猶未盡,熱心的先驅們於是召開會議來決定。在討論進行中,眾說紛紜,莫衷一是。後來有1個高球元老現身說法:他每次下場打球總攜帶1瓶陳年威士忌,每洞發球之前就倒1杯喝,而第18洞發好球剛好整瓶威士忌倒完喝光。為了避免再補給的麻煩,他懇請與會諸公同意1場高球以18洞為限。蘇格蘭地處寒帶,加以海濱球場寒風凜冽,球友多數習慣飲些酒禦寒,故此言一出,馬上獲得舉座共鳴;於是全員贊成1場高球打18洞。這個辦法從那時候就成定案而沿用至今。
一般人一旦涉足高球運動就很少會再打退堂鼓,可見高球的迷人之處。為什麼高球會有偌大的魅力呢?在下認為打高球運動量適中,很適合中年以上的人來從事,而且可以持續打球打到相當高齡。其次,打高球雖說球在靜止狀態由球友揮桿擊出,但揮桿的軌跡很難保持始終如一,所以球並不一定會盡如人意地飛出且落於預定地點;即使落於預定地點,也可能由於落點地面的凹凸傾斜或草紋的順逆而讓球彈跳的方向無法掌握。這也就是說,打高球很具挑戰性。球友樂於迎接挑戰,有征服草地的意味,當然不會退避了。再其次,打1場球平均要花三五個鐘頭,球友一同行走在綠油油的球道,談論古往今來,敘述高球趣事,如此聯誼,豈非人生一大快事?最後,有些球友熱中於小賭一下,以提高競技的興趣,展現自己的球技或比運氣,如果規模不大,有如吃生魚片所塗的芥茉,倒也無傷大雅,亦無可厚非。
關於打高球健身的說法,可以日人松岡氏的報告為參考。他測量球友打球前後的血壓,統計出收縮壓平均降低5 mmHg,舒張壓平均降低1.1 mmHg,皆具統計學上之意義。也就是說,打高球可以收到降血壓的效果,這當然是期望健身者的福音。不過,從開打到結束予以測量,則可看出起初四五洞,血壓比平常稍高,嗣後到結束為止,血壓就降得比平常低了。每一洞發球及球道擊球都沒有問題,但到推桿的時候,血壓稍有升高的傾向,尤其是發球打OB(球出界)的球洞進到推桿時更明顯,可能是意圖挽回頹勢又擔心打多桿的關係。這就給我們一個啟示:打推桿別太在意。為健身打高球者,球上果嶺,可以嘗試推1次桿,進了算1桿,不進則算2桿而不再推,這可免去3次推桿的壓力。除了降血壓之外,在下親眼目睹的健身成果有下述情形:原來腦滿腸肥之人打過高球,腰圍變細了,走起路來虎虎生風;原來萎靡不振之人打過高球,宛如換了一個人,容光煥發,精神百倍。
高球球友打球的願望之一是進到低差點的境界。不過,運動成就實在七分靠天、三分靠努力,絲毫勉強不得。雖說揮桿有標準要領,但十人十色,在勤練之後,還要講究「運用之妙,存乎一心」才能有所突破。在下覺得既然不做靠高球吃飯的職業球手,只要達到娛樂健身的目的就可以了。對業餘的球友來說,1場球有幾桿打得漂亮—高高飛起又直又遠又準—就已值回票價了,也可以得意一陣子。這可不同於職業球手,他們1場球只要失誤一兩桿就足以自怨自艾一整天。業餘球手雖說沒有賴高球維生的壓力,但既然涉足,就應求其最佳表現。況且人天生有不服輸的精神,如果是比賽,就不得不全力以赴了。對球技平平的球友,在下認為並非全無希望,在此願提出一些要領與大家共勉。也就是說,在球技未改進之前,只要運用一些技巧,就能獲取頗佳的成績。
1. 巧用戰略 按照自己的實力配合戰略來打球,每一桿都要打到安全的地點,盡量避開像水池、砂坑或出界線的陷阱。如果發球不幸進入密林區,就要安份地把球撥回球道中央,再繼續打下去。
2. 活用規則 高球規則有34條,最重要的只有兩條:
第一 每洞用一顆球,從發球到打進洞為止,除非球在中途破損不能換球。擊球按次序打下去,全洞所打桿數的和即為該洞的桿數。
第二 嚴守「球不移位,原地揮擊」(play the ball as it lies)的規則,免得瓜田李下,啟人疑竇。
高球規則看似嚴格,其實簡單,而且除國際規則之外又有球場單行規則。不
過,能夠有救濟措施的時節,千萬不要放棄權利。譬如,宣告球無法打(unplayable)是根據自己的判斷,只要兩害相權取其輕而於己有利就不妨認罰一桿為之。其次,可以拋球(drop)而免罰桿的場合,不要自行棄權。可以擦球的時候,也要把握機會,尤其球上果嶺,即可標記把球揀起來擦乾淨。
3. 慎重從容 無論長桿或短桿都要慎重其事地打,不急躁,不馬虎,而且揮桿從容,做到盡其在我的地步。當然,擊球之外在球道內走路則須輕快,以免耽誤後組球手打球的時間。
業餘球手進場打球,若能做到這樣,包管可以有近乎滿意的演出成績。
球友打球的另一願望是有朝一日能打個一桿進洞。一桿進洞大都在標準桿3桿的短洞打出,其機率非常小,一般的業餘球手只有43000分之1,比起男性職業球手及男性頂尖業餘球手的3700分之1和女性職業球手及女性頂尖業餘球手的4660分之1還要小得多。機率雖小,總比0大,所以一桿進洞也還時有所聞。業餘的球手如果1星期打2場,1年大約是100場,打1場的短洞有4個,也就是1年有400個短洞可打,以此來除43000,可算出百年也不過才約1次一桿進洞的機會。所以,一般人就說一桿進洞全憑運氣或巧合;可是美國的1位曼利先生就不做如此想。曼利打高球差點為4而截至1988年止,就已經一桿進洞過50次以上;因此,他很驕傲地說一桿進洞還是要憑準確的技術。他的說法是先練多支球桿練到方向奇準而且一定打多少距離,落地後又滾多遠;碰到短洞,先研究果嶺地面的起伏和草紋的走向,從而決定擊球的落點,一桿進洞的可能性就大大地提昇了。職業球手有1個傑可布先生則曾做過一桿進洞的表演。那是某旅館落成的噱頭,為了招募基金,請傑可布當眾一顯身手。發球台築在20公尺高的樓頂,果嶺連球洞則設於90碼遠,傑可布時年35歲,就給他35個球打。傑可布在起初打的29個球雖然都打上了果嶺,但不是有一些兒短,就是有一些兒偏。他一面觀察,一面調整,此時已經成竹在胸,就叫大家屏息以待,接著再揮桿,球正好落於果嶺旗竿之前兩碼,彈跳兩下而滾進洞內。全場歡呼自不在話下;但也印證了曼利的理論。
一桿進洞的打者年齡上最年幼者有5歲的小孩,最年長者有90歲以上的老翁;有平生頭一次下場打第一洞就打進者,也有打了數十年仍然緣慳一次者。而一桿進洞也是樣式繁多:有球直飛進入洞口被旗竿和洞口緣夾住者,有球落果嶺倒退入洞者,有球落果嶺彈跳一兩下前進或斜進而入洞者,有打到球的頂端使球從發球台滾到果嶺入洞者,有飛球撞到出界線的植樹折射彈到果嶺入洞者…,不一而足。據統計,一桿進洞有3分之1的情形是由失誤的揮桿打進去的,但其為一桿進洞的價值則絲毫不差。
中年以上而希望靠運動健身的人,對運動項目的選擇,若從程度比較不劇烈、興趣比較能持久來考量,則高爾夫稱得上是上上之選。
﹙此文曾刊於1993年5月出版的《景福醫訊》第9卷11期﹚

Sunday, January 24, 2010

角色變換

林萬哲

在捷運東區地下街看到一個外勞女幫傭用手推車推著一位坐在車上的老人在散步。地下街既能遮蔽太陽,又陰涼舒適,在那裡也可以看過往人等,消解無聊,所以很多人在此散步或運動,實在合適不過。一般坐手推車的人,不是體弱,就是不良於行。大家看到有人坐手推車散步,本來也不以為異,但這次演出的一幕卻令人驚訝。突然間,老人很勉強地倚車站起來,請女幫傭坐上手推車,他卻踉踉蹌蹌地推著手推車走起路來。旁觀的人,都錯愕地圍觀,也不知其所以然。後來總算探出原委,才知道老人是遵醫囑在做復健走步,讓女幫傭坐上車,旨在使其保持平衡跟穩定也。

Wednesday, October 28, 2009

猴子也耍謀略

有一個人行經寵物店,看到一隻會說話的猴子標著要出售。這人聽猴子說了幾句,就付款把牠買了下來。
當晚他就帶著猴子到經常去的酒吧,宣揚說他的猴子會說話,他要跟人賭500元,願者請加入。當即有十幾人參加。他叫猴子講話,猴子卻是一言不發,任他怎麼逼迫,也是枉然。他只好認栽,賠錢了事。回家途中,猴子卻又談笑風生。
第二晚他再帶著猴子到那酒吧。這次提高賭金到1000元,簽賭者也是十幾人。但猴子依然默不作聲,主人無耐,又再度認賠。
主人大為失望,回家途中,對猴子說:「我只好把你賣回寵物店了,你這賠錢貨。」猴子卻說:「你怎麼就不能稍微沉住一下氣!你有沒有考慮到我們明天再賭的話,不是可以大撈一筆嗎?」

Sunday, October 4, 2009

高球運動

高球運動
林萬哲

我打高爾夫球已有23年的球齡了。跟大多數球友一樣,對高球運動的興趣一直持續不減。高球運動之所以令人著迷,自然有它的特點存在。
首先是舒活全身的筋骨;這對平日坐在辦公桌邊的人特別有助益,否則成天四體不勤,體內的循環也不會順暢。
其次眼看滿地青翠的草木,可以開闊視野,也能放鬆眼睛的肌肉。這對成天看病人、看文書的人,也特別有好處。
又其次球場綠地空曠之地充滿新鮮空氣,一場球四、五個鐘頭打下來,肺內堆積的陳氣全部出清,換成新鮮多氧的空氣,所以打完球,雖然有點腳痠,精神卻為之大振。這對居住城市內飽受空氣污染之苦的人,實在是一大享受與滋養。
又有研究報告指出「運動可以保持頭腦清醒,維持記憶力於不墜」。準此,打高球也可避免老年癡呆症的光顧,則何樂而不為?
而打球同組切磋球技,一方面可以天南地北的談天,一方面可互相觀摩各別的技藝,也是一種享受。我曾經一次有幸跟一位球技高超的先生同組打球,看他每洞的打數,多維持在標準桿的程度,有幾洞打博蒂(birdie,少標準桿1桿),一、二洞打布姬(bogey,多標準桿1桿),最後18洞打下來只71桿,比標準桿還少了1桿。這樣的球技,讓同組的人是大開眼界,我也得到了不少增進球藝的啟示。
但近年來高球場卻也出現令人遺憾的一面,那就是吸菸球友人數的不斷增加及擊球下賭的風行。
高球場有大片綠地,草木繁茂,充滿新鮮空氣。如果球友一以呼吸新鮮空氣為享受,當然捨不得以菸霧汙染它。可惜目前打高球越來越普及的結果,也就帶進了不少的癮君子,他們在衡量淨化空氣與滿足菸癮之間,卻自私地選擇了後者。他們在球場的每一角落都隨興吞雲吐霧,還侈言他們既不怕死抽菸有何不可,殊不知其菸害會禍及別人。我想如果提醒他們多發揮一點公德心,嚴格禁菸,應不為過吧!
另外,球友在邀伴下場時會順便來個小賭,原以為如同吃美食配點佐料增添興趣何妨。但人心難免貪得無厭,賭項越增越多,賭注越下越大;為此傾家蕩產者亦時有所聞。即使未達這步田地,也常見球開打時是朋友,球打完後竟變成仇敵,這是何苦來哉?所以我奉勸球友們以競技為榮,不以贏賭為樂。

Tuesday, November 11, 2008

亂寫病歷

林萬哲

病歷的記載,首重精確;其次凡相干的事件,無論其為正性或負性,均不可疏漏。在用詞構句方面,一定要遵循文法的正則,才能將事體表達得清楚明白。不管使用何種語文記載,都不能含糊。
我從網路上蒐集了一些有瑕疵的英文病歷記載,有的由醫師信口口述,大都為修飾詞不當錯置,有的由其他醫事人員誤用醫學辭彙而造成。這些例句,稍予考究,就知道它錯得頗為離譜,所以會鬧笑話。從第1題到第19題乃由署名Rubin者所提供,他自Richard Lederer所著的Fractured English裡引用了多則醫師記錄。第20題到第28題則另有來源,可能是包括其他醫事人員的「傑作」,一時也查不清楚。前28題我在2001年整理脫稿,曾刊載於台大耳鼻喉科的《反射鏡》2001年秋刊。自第29題到第41題是我新近從網路ArcaMax Jokes(November 2006)上看到而剔除與第1題至第28題重複的部分;其原文晦澀難明,頗為費解,我請教了在美國的同學楊勝賢兄幫忙解讀,相信已揣摩到很接近原意的詮釋。惟從第38題至第41題,其文句詞與詞之間的關聯性很鬆散,勉強予以添加敘述,或許會與原意大相逕庭。我的立場是不越俎代庖,故只揭示原文,留待讀者之卓裁。
在此我一面將各句的原文敘出,一面將對它的修正意見附註於後。閱者同道,若有更佳高見,請不吝指正賜教。

1. By the time he was admitted, his rapid heart had stopped and he was feeling better.
這裡rapid heart如果stopped,病人還能活嗎?所以應改為:
By the time he was admitted, his tachycardia (rapid heart rate) had subsided and he was feeling better.

2. Patient has chest pain if she lies on her left side for over a year.
靠左側躺超過一年,怎能不胸痛?
For over one year, the patient feels chest pain when she lies on her left side.

3. The patient states there is a burning pain in his penis which goes to his feet.
病人penis到達feet(腳),也未免太長了吧!揣其意,應是其痛放散(radiate)到腳才對。
The patient states there is a burning pain in his penis and the pain radiates to his feet.

4. On the second day the knee was better and on the third day it had completely disappeared.
翌日膝蓋改善,第三天則完全消失,這是甚麼話?他把症狀漏寫了吧。茲以pain為例:
On the second day knee pain got better and on the third day the pain had completely disappeared.

5. She has had no rigors or shaking chills, but her husband states she was very hot in bed last night.
丈夫說她昨夜very hot in bed,令人想入非非。這無非要表示她昨夜體溫高,發燒而已。
She has had no rigors or shaking chills, but her husband states she was rather febrile in bed last night.

6. The patient has been depressed ever since she began seeing me in 1983.
此句給人的印象是病人自從1983年開始看這位醫生就引發憂鬱而一直未癒。我們不禁要問:該醫生是不是長得三頭六臂,不然外觀一定有甚麼特別嚇人之處?實際上應是病人憂鬱之後才開始並一直看這位醫生才對。
The patient has been depressed since 1983. For that depression, she began to consult me.

7. I will be happy to go into her GI system. She seems ready and anxious.
進入她的消化道,醫師會happy(快樂),這是甚麼道理?
I am going to perform endoscopic examination for her GI system. She seems to be ready, though anxious.

8. Patient was released to outpatient department without dressing.
別讓人誤以為without dressing是不穿衣服。這dressing不難看出是wound dressing吧,而wound dressing內的任何一字可不是能省的。
The patient was released to the outpatient department without wound dressing.

9. I have suggested that he loosen his pants before standing, and then, when he stands with the help of his wife, they should fall to the floor.
我想這句只是單純肯定、否定弄錯而已。
I have suggested that he tighten his pants before standing, and so, when he stands with the help of his wife, they should not fall to the floor.

10. Discharge status: Alive but without permission.
活著,還要許可?應是出院未經許可吧。
Discharge status: Alive, but leaves hospital without doctor’s permission.

11. The patient will need disposition; therefore Dr. Blank will dispose of him.
真希望病人需要的處置只是治療,而非把他處理(幹)掉。
The patient will need treatment; therefore Dr. Blank will treat for him.

12. Healthy-appearing, decrepit 69-year-old male, mentally alert but forgetful.
此處healthy-appearing與decrepit(衰弱),互相矛盾,取其一即可。
Healthy-looking, 69-year-old man, mentally alert, but forgetful.

13. The patient refused an autopsy.
許諾autopsy可是百年後的事,因此別把biopsy錯成autopsy才好。
The patient refused a biopsy.

14. The patient has no past history of suicides.
病人過去若自殺成功,這次也不會來就醫了;所以suicides應是suicidal attempts。
The patient has no past history of suicidal attempts.

15. The patient expired on the floor uneventfully.
斷氣在地板上(或病房),誰說uneventfully?將該字刪除即可。
The patient expired on the floor.

16. Patient has left his white blood cells at another hospital.
白血球留在其他醫院,也太吊詭了吧!不用說講的一定是檢查報告。
The patient has left his white blood cell count report at another hospital.

17. Patient was becoming more demented with urinary frequency.
更加癡呆,與頻尿何干?應該分別敘述。
The patient was becoming more demented. He also had urinary frequency.

18. The patient's past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
病人既往歷無啥特別(當然無需remarkably),這次發病乃自三天(?)之前。只要分開敘述,應無問題;但3天增加40磅也太多了吧!這裡我想留待閱者之卓裁。或許非3天,而是3個月(或3星期)甚至3年也說不定。
The patient’s past medical history has been insignificant until the onset of present illness. This time there is a 40-pound weight gain in the past three months (or years).

19. The patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary edema at home while having sex which gradually deteriorated in the emergency room.
修飾詞使用不當,惡化的應為肺水腫,而非性行為。
While having sex at home, the patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary edema, which gradually deteriorated in the emergency room.

20. Rectal exam revealed a normal size thyroid
檢查thyroid不需靠rectal examination甚明。
Physical examination revealed a normal-sized thyroid.

21. She stated that she had been constipated for most of her life until 1989 when she got a divorce.
這裡constipation與divorce應該沒有關聯,所以只好分別敘述。
She stated that she had been constipated for most of her life until 1989. In that year she got a divorce.

22. The baby was delivered, the cord clamped and cut and handed to the pediatrician, who breathed and cried immediately.
此句pediatrician後面的修飾子句,很明顯是描述嬰兒。
The baby was delivered, the cord being clamped and cut. It breathed and cried immediately. Then the baby was handed to the pediatrician.

23. The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.
此句who以下的子句,顯然在修飾father。
The patient lives at home with his mother, father, and a pet turtle. His father is currently enrolled in day care three times a week.

24. Both breasts are equal and reactive to light and accommodation.
把pupils寫成breasts也太菜了。
Both pupils are equal and reactive to light and accommodation.

25. She is numb from her toes down.
此處所說的from toes down,不知是甚麼部位?也許是from hip down吧。
She is numb from her hip down.

26. While in the emergency room, she was examined, X-rated and sent home.
自己造字,看似高明;奈有違「約定俗成」何?
When in the emergency room, she received physical and radiographic examinations. Then she was sent home.

27. Patient suffers from occasional, constant, infrequent headaches.
這裡又是constant,又是infrequent,顯然矛盾。
The patient suffers from occasional headaches.

28. Patient was alert and unresponsive.
又alert,又unresponsive,也太矛盾了吧。
The patient was alert and responsive.

29. The patient is tearful and crying constantly. She also appears to be depressed.
憂鬱而好哭,很有可能;但眼淚盈眶的描述,似無必要。所以這tearful顯然多餘,就免了罷。重新排列,成為:
The patient appears depressed and cries constantly.

30. Patient had waffles for breakfast and anorexia for lunch.
病人吃waffles(雞蛋餅)當早餐,以anorexia(食慾不振)為午餐。這是什麼話?若改為病人吃雞蛋餅當早餐,但午餐時間就變得食慾不振了。
The patient had waffles for breakfast but became anorexic at lunch time.

31. Between you and me, we ought to be able to get this lady pregnant.
你我守個默契不要透露給任何人,我們應能使這位女士懷孕。這不會讓人以為你們兩人要幹什麼歪事才怪。要保證不令人起疑,且讓人覺得你們醫術高明。 只得寫…我們有辦法治療這位女士的不孕症,而成:
Between you and me, we ought to be able to treat this lady's infertility.

32. The skin was moist and dry.
皮膚又濕又乾,合起來說一定不合理。一個辦法是刪掉其中一項,留下另外一項,變成:
The skin was moist. 或
The skin was dry.
另一個辦法是假定病人全身皮膚,有些地方濕,有些地方乾,而寫為:
The skin was moist in some areas but dry in other areas.

33. I saw your patient today, who is still under our car for physical therapy.
很顯然car是care之誤。所以改為:
Today I saw your patient, who is still under our care for physical therapy.

34. The lab test indicated abnormal lover function.
此公把liver誤植為lover,可以說有一點心不在焉。準此以改,就是:
The lab test indicated abnormal liver function.

35. Skin: somewhat pale but present.
皮膚蒼白已足表達,present刪除即可。變成:
Skin: somewhat pale.

36. Patient was seen in consultation by Dr. ____, who felt we should sit on the abdomen
and I agree.
這裡的sit on非常吊詭,不得已,代之以focus on。
The patient was seen in consultation by Dr.____, who felt we should focus on the abdomen and I agreed.

37. The pelvic exam will be done later on the floor.
雖說floor也可以當成病房(ward)使用,但如此描述,難免令人誤會為在地板上做內診檢查。為了清晰表達,假設檢查室在二樓,就可改為:
The pelvic exam will be done later in the examination room on the second floor.

38. The patient was to have a bowel resection. However, he took a job as a stockbroker instead.
39. Large brown stool ambulating in the hall.
40. Patient has two teenage children, but no other abnormalities.
41. Patient was found in bed with her power mower.
這四題僅提出原文,請讀者自行琢磨。

以上舉例闡述,旨在希望能引起醫師同道們寫病歷時隨時注意,且巨細靡遺、面面俱到,而能收恰到好處的記述之效。