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A recent interview of Dr. Wen-Je Ko
on becoming President Chen's private doctor

Translated by Jay Tu

Dr. Ko called President Chen's medical case a combination of physical and mental trauma. The re-election by Ma Yin-Jeou was a tipping point for President Chen's psyche, leading to his recent rapid health deterioration. In Taiwanese, the phrase for this medical condition is called "Gien-Si", which means one person is died of being too upset. Dr. Ko stated that he did not like Ma Yin-Jeou and he would slight him or make fun of him. However, some people hate President Chen so much and want him die. For these people, this hatred is stronger than the one toward the Communists, the former enemy of the Nationalists.

Dr. Ko described how he, accidentally, became the private doctor of President Chen. One day, the son of President Chen, Bryan Chen, came to see him with a form similar to power attorney, expressing the desire to hire him as his father's private doctor. Bryan Chen told him that his father was suffering badly. Dr. Ko hesitated and told Bryan that he himself was in hot water these days (Note: this reminds me when President Chen was approached in 1980 to defend the wrongly accused in the Formosa Magazine Persecution). However, Bryan Chen was persistent and Dr. Ko signed the form. This form was then submitted and was promptly rejected by Department of Justice because the name of Wen-Je Ko caused some concerns. Former Vice-President Anette Lu and the minority leader of DPP in congress, Chien-Ming Ko, objected to Department of Justice, arguing that it was Department of Justice which asked President Chen to find his own doctors at the first place. Under pressure, Department of Justice did a semi-180 but would only allow Dr. Ko to visit President Chen as a form of special visit, not as a formal medical checkup. On the day of visit, Dr. Ko, along with Dr. CD Kuo, took a taxi to Taipei Prison without being accompanied by Mr. Ko, the DPP minority leader, because he was busy on the day. Both doctors became the first private medical team to practice in the jail in the ROC history. However, the director of Taipei Prison impressed upon them that they were not conducting a medical checkup but a special visit as a favor to minority leader Ko, and they should not write any medical records regarding this visit. To become President Chen's private doctors, a new form would be sent to them for their signatures by Department of Justice, stated Prison Director.

From the reactions of the prison authority, Dr. Ko thought this was the redux of white terror. Very few doctors in the Hospital of Taiwan University would dare to sign such a form, he thought. The justification for Dr. Ko to be hired as President Chen's private doctor is based on a law, Article 57 of Prison Law of ROC, which allows an inmate to hire his/her own doctor under some special circumstances. And this is probably the first time this law is enacted. After his visit, Dr. Ko issued some statements regarding medical care President Chen received in the jail (Note: he called the care non-existent, see this link: http://www.taiwanenews.com/doc/20120521102.php )

The prison director was not happy with Dr. Ko and banned him from visiting a second time. When President Chen was sent to Cheng Gung Memorial Hospital for checkup on May 23rd, President Chen asked Dr. Ko if he could stay in the hospital for a night because he would like to sleep on a bed for a change. This statement revealed by Dr. Ko brought tears to many supporters of President Chen. The prison director announced that all inmates sleep on the ground, no bed and no exception, not even for an ex-President. However, if President Chen has been treated equally as other inmates, he would be allowed to step out of his small cell for eight hours a day to work in a factory, to fix some streets, or even to tend a garden. But, no, President Chen is denied this very right because of safety concerns. The prison director declared "No, we cannot promise his safety if he is allowed to work in a factory."

As for the Acid Reflux (GERD) symptom of President Chen, it is because he has been forced to write on the floor in the last four years. His cell is too small to have a desk and a chair, or a bed. Dr. Ko asked the prison director if he could allow a desk and a chair to relieve the GERD symptom. The director offered to put a hinged board on the wall, which could be folded up without taking up space when not used. However, it is impossible for President Chen to use it because he would have to sit on the ground and slouch over, causing more discomfort. (Note that it has been reported two days ago, President Chen was offered a small folding desk but its use was limited to one hour a day.) Dr. Ko did not want to argue more about this desk issue as he felt that President Chen has enjoyed a privilege to own a board on the wall for writing.

However, is it a real privilege? Why President Chen is not allowed to work in a factory and is trapped in his cell, essentially as a solitary confinement, a treatment which is a lot worse than those of other inmates? Dr. Ko wondered. It is not right for Taiwan, a so called democratic country, founded under the principle of human rights, to let all its inmates sleep on the ground. Dr. Ko told his students that from the case of President Chen, he discovered a higher meaning of being a doctor.

When President Chen saw Dr. Ko the first time, he held Dr. Ko's hands, nearly broke down in tears. However, when he spotted the prison director, President Chen instantly changed to become tough and argued for his rights to hire Dr. Ko. For the first time, Dr. Ko witnessed a drastic change in a person in such a short time. Why? Once, the minority leader Ko asked Dr. Ko if President Chen was really sick. "He still acts like a dragon or a tiger (literally). Is he really sick or pretending to be sick?" asked minority leader Ko. Dr. Ko thinks he knew the answer as soon as he witnessed the drastic switch of personality of President Chen. Yes, he has been acting but acts to appear dignified as one would expect from a two-term Taiwanese President. In fact, he is already broke inside. When visited by others, he needs to act as a president because most of them were his subordinates in the past. However, in front of Dr. Ko, he is a patient, a normal person, with his true condition revealed. Dr. Ko again realized the enormous privilege and responsibility he is carrying as a medical doctor. He is entrusted with an entry into the soul of a human being, and an important one, if not a great one.

To him, it becomes clear why President Chen is sick. It is a no brainer. In the past, President Chen enjoyed a large entourage but now he is trapped in a small cell with no bed, no chair, and no desk. He is forced to write on the floor, which is damp because water seeps through when it rains (his cell is on the first floor, the worst floor of the whole maximum security building). It is like sleeping in a water prison. With the re-election of Ma Yin-Jeou, there is no ending in sight of his situation. Understandably, his psyche broke and his health rapidly deteriorated.

To Dr. Ko, President Chen's medical condition is a combination of physical and mental illness. In Taiwanese, it is called "Gien-Si" or "upset to death, literally", and one can die this way without obvious symptoms. In medical terms, it is called "Hyperventilation" or "Overbreathing" (Note: at the end of this article, see a quote from http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm on the symptoms and causes of hyperventilation). Due to overbreathing, the CO2 level in the blood can drop too low, causing the PH value of the body to change, which in turn can cause symptoms of short of breath, chest pain, or even seizure. This was why President Chen once almost fainted when using his Japanese style toilet.

Dr. Ko also came to realize why President Chen could not be treated properly in jail, other than the illness causing environment. One reason is that there is an unbalance in the doctor and patient relationship. The prison doctors are not willing to challenge President Chen to tell him the truth. They considered President Chen suffering from depression; therefore, they presribed him Ativan, an anti-depression drug, but they were afraid to tell him so. For over 14 months, President Chen took Ativan unknowingly but eventually, he noticed that his mental sharpness had dropped significantly. Once he realized that he was prescribed Ativan without his consent, he was angry with these prison doctors from Tao-Yuan General Hospital. He no longer trusted them and refused to be seen by them. After being subject to four years of solitary confinement, one could develop victim syndrome. He does not know whom to trust. “In front of me, he trusted me enough to reveal his true self because I dared to yell at him.” Dr. Ko said. "I told him that he had mental problems. Reluctantly, he agreed to be seen by a psychiatrist." "Imagine how would a prison doctor tell a president that he was a cuckoo." Put yourself in his shoes, if you have been tortured and are not allowed to confide anybody with your suffering, what would become of you. To Dr. Ko, President Chen survived this long due to his strong will but how much longer can he keep it up if his imprisonment condition is not improved? Psychologically, how can you convince President Chen to accept his imprisonment as a justified punishment? How can he accept the sentence he was given in view of double standards and the irregularities in his trial procedures, such as switching out legally appointed judges, coercing witnesses to testify against him, jailing him without indictments, perjuries by witnesses without penalites, and biased judicial discretion (Note: see the article by Judge Huang, http://www.taiwanenews.com/doc/20120416101.php ). President Chen’s case has become a political issue, not merely a legal case. At the end, Dr. Ko revealed a conversation he had with President Chen. When he asked if President Chen could undress so that he could examine his private area, “Go ahead. I have been peeped at for four years.” President Chen declared. President Chen has no privacy because his cell is monitored through a surveillance camera 24 hours a day. There is no window, only an opening with bars. “Why am I helping him?” “Because I don’t want Taiwan to be viewed as a country with no heart and no justice”, explained Dr. Ko. “There is a difference between sin and crime.” And “The case of President Chen must be resolved because legally it is too marred to be fair.”

Quote on hyperventilation:
Your doctor will determine the cause of your hyperventilation. Rapid breathing may be a medical emergency -- unless you have experienced this before and have been reassured by your doctor that your hyperventilation can be self treated.

Often, panic and hyperventilation become a vicious cycle. Panic leads to rapid breathing, and breathing rapidly can make you feel panicked.

If you frequently overbreathe, you may have hyperventilation syndrome that is triggered by emotions of stress, anxiety, depression, or anger. Occasional hyperventilation from panic is generally related to a specific fear or phobia, such as a fear of heights, dying, or closed-in spaces (claustrophobia).

If you have hyperventilation syndrome, you might not be aware you are breathing fast. However, you will be aware of having many of the other symptoms, including:
•Belching
•Bloating
•Chest pain
•Confusion
•Dizziness
•Dry mouth
•Lightheadedness
•Muscle spasms in hands and feet
•Numbness and tingling in the arms or around the mouth
Palpitations
•Shortness of breath
•Sleep disturbances
•Weakness

Causes

  • Anxiety and nervousness
  • Bleeding
  • Cardiac disease, such as congestive heart failure or heart attack
  • Drugs (such as an aspirin overdose)
  • Infection such as pneumonia or sepsis
  • Ketoacidosis and similar medical conditions
  • Lung disease such as asthma, chronic obstructive pulmonary disease (COPD), or pulmonary embolism
  • Panic attack
  • Pregnancy
  • Severe pain
  • Situations where there is a psychological advantage in having a sudden, dramatic illness (for example, somatization disorder)
  • Stimulant use
  • Stress
  • 「凝死驗無傷」 柯文哲獄中醫扁自敘

    新頭殼 newtalk 2012.06.15 / ◎ 莊豐嘉/專訪

     

    「正確來講,阿扁是犯了身心症,焦慮加憂慮,台語叫作『凝死』,『凝死又驗無傷』」。「為什麼最近情況會突然變差?說實話,就是因為馬英九又當選。」「我不喜歡馬英九,頂多嘲笑他,揶揄他,但我不會要把他整死;對阿扁,有人就討厭他到要讓他死,對共匪也沒那麼痛恨。」

    台大醫師柯文哲意外成了陳水扁在獄中的私人醫師,這樣的經歷讓他對醫事倫理、人情冷暖和獄政改革有了許多感觸。以下是他接受專訪,從醫師專業和人文關懷的角度,敘述他直擊並體會阿扁處境的談話全文;娓娓道來,平淡見情:

    有一天陳致中戴著鴨舌帽,鬼鬼祟祟、偷偷摸摸跑到台大醫院來找我。陳致中說,阿爸說「足艱苦」,要他找比較好的醫師。「可是我都自身難保啊!」但陳致中還是拜託,把醫事證書拿給我簽字,然後拿去台北監獄申請,聘我為阿扁私人醫師。結果法務部一看是柯文哲,就說不可以。

    後來呂秀蓮和柯建銘打電話去K法務部,說你們要阿扁自己找醫生,找了又說不可以。柯建銘就說用特見的方式;結果要去的那一天,他說要主持中常會,就要我一個人自己去。我就和郭正典醫師兩人坐計程車去北監,我們成了中華民國有史以來第一個在監獄執行醫療業務的醫生。

    監獄長還特別告訴我:「今天不能寫病歷,你們是來特見,不是來執行醫療業務,是柯建銘的關係才讓你們特見。」「如果你要當阿扁的醫生,我們法務部會發公文給你,你要簽名,證明你願意接受委託,當阿扁的醫療委任代理人。」

    我想,這簡直是白色恐怖,因為有幾個台大醫生敢簽名? 難怪陳致中要來找我。

    我簽就簽,後來才發現《監獄行刑法》第57條「自費延醫」,聽說歷史上從來還沒被用過,法務部因此特別設計一個公文格式來給我用。我出來後講了一些話,典獄長警告我,第二次就不讓我進去了。

    上次去長庚醫院看阿扁,他說了一句會讓綠營支持者人掉淚的話。他問我:「可以在長庚住一天嗎? 」

    為什麼?因為他過去4年在監獄裡面是睡在地上。典獄長說:「我們是一視同仁。」
    我才知道,我們所有犯人都是睡在地上。

    我們以前看美國電影,犯人都有床可以睡,但中華民國自稱以人權立國,結果建國那麼久,所有犯人都睡地上。真是太慘了。這不只是阿扁一個人的問題,而是一個國家的人權。我呼籲應該把人當人看待。

    阿扁為什麼有胃食道逆流? 因為他睡在1.3坪的地方,沒有桌子和椅子,趴在地上寫字,我就問典獄長給他個桌子椅子。

    典獄長說:「我在牆上給他釘個板子,他折下來可以當桌子,折起來不影響空間。」可是阿扁說,板子雖然可以當桌面,但腳沒地方放,所以還是在地上趴著寫。聽完我就沒話講了。因為從監獄的立場,我把他當一般犯人看待,給他釘板子,已經是給他特權了。

    但是如果把阿扁當一般犯人看待,我跟典獄長說,那你就給他上工,一般犯人每天上工8小時,不管是種菜、挖地還是修路,每天出去嘛,但典獄長說:「不行,萬一有什麼差錯,我們無法負責他的安全。」

    你給他一般犯人看待,可是他也不能上工,關在1.3坪的地方,比一般犯人更爛的遭遇。

    從這件事上,我在上課時告訴學生,為什麼醫生在社會上,在特殊倫理教育上受到更高的要求,因為,我在阿扁身上看到作為醫生的價值。

    我去北監看阿扁時,阿扁看到我,握著我的手,都快哭出來,非常的憔悴。可是他看到典獄長跟從後面跟著進來時,我第一次看到一個人可以在一秒內變成另外一個人。他馬上跟典獄長說:「依據《監獄行刑法》第57條,我要求自費延醫,我要聘柯醫師。」開始跟他argue,變得很強悍。

    我要去看阿扁時,柯建銘問我:「我看阿扁生龍活虎,怎會有病呢 ? 到底是真病還是假病 ? 」 我在看到阿扁的一霎那才知道為什麼。因為別人去看他,都是他的部下,他一定要裝出台灣總統的樣子,所以是戴上面具,可是私底下他已經在崩潰了。因此我才知道,作為醫生的價值,在我面前他是病人,在別人面前他是長官。

    其實用膝蓋想也知道,他已經被關到崩潰了。你想想看,以前是總統,前呼後擁、現在關在1.3坪,沒有桌子沒有椅子,趴著寫字。牢房沒有床,鋪著棉被睡,下雨時候水氣會上升,就像睡在水牢裡一樣。

    為什麼最近情況會突然變差? 說實話,就是因為馬英九當選。

    阿扁本來想,如果小英當選,看是否會特赦,或是牢房情況可以改善,或換到別的監獄或醫院。但馬英九當選,他想完了完了,他才關4年。這是為什麼那段時間他差點整個崩潰掉。在別人面前他要裝出總統的氣派,但是內心很惶恐。

    我跟學生說,為什麼作為醫生很重要。因為醫生可以進入另外一個人的靈魂和身體,這是作為醫生的特權。因為有這種特權,所以要有更高的社會倫理要求。所以我在阿扁身上看到醫生的價值。他在別人面前戴上面具,但在醫生面前可以拆下,因為他是我的病人,可以不必戴面具。

    正確來講,阿扁是犯了身心症,焦慮加憂慮,台語叫作「凝死」,「凝死又驗無傷」。醫學名詞叫作「過度換氣症」。就是呼吸速度很快,不知不覺速度變快,二氧化碳濃度下降,降到一個程度,酸鹼值會改變,四肢酸麻,胸悶,嚴重的話會筋攣。所以阿扁上廁所會昏倒,後來我看病例,就覺得這是很典型的。

    為什麼阿扁在獄中會醫不好? 我後來知道一個大道理,就是大人物沒辦法給小醫生去看。

    阿扁明明是很厲害的焦慮症,署桃的醫院就開鎮定劑的藥給他吃,RP1,吃了14個月。可是小醫生不敢跟他說他有焦慮症,像我跟阿扁說:「你的精神有問題。」他雖然不太服氣,但也只好說:「好啦,好啦,不然要看精神科也可以。」

    可是小醫生不敢跟他講,給他吃RP1吃了14個月。有一天,阿扁覺得他怎麼好像愈來愈笨,突然發現怎麼有這顆藥,他就抓狂,吃了14個月為什麼都沒告訴他。這也是為什麼他跟署桃翻臉的原因。我才學到這一課,大人物沒法給小醫生去看。大人物剋過他,小醫生不敢講實話。

    一個人關在警閉室4年,會變被害妄想。我後來知道為什麼要找我去看,因為我會罵他,他反而相信我。連民進黨人去看他,他都搞不清楚是朋友還是敵人。只有我他比較確定不是敵人。其實是同理心,一個人關在那裡睡1.3坪四年,只能睡地上,趴在地上寫字,只剩下一個精神力量,而且還不能訴苦。

    典獄長把他當一般犯人看待沒錯,但是他比一般犯人待遇更差,一般犯人還可以去上工,挖路,修理地球,至少有人可以講話。以安全為由,就是怕出事,乾脆關在那裡,最安全。

    可是他就被關到 breakdown,崩潰。更慘的是,他在別人面前又必須戴上面具。因為我從來沒看過那樣的陳水扁。

    全世界會把總統關在監獄裡的,只有非洲國家或東帝汶這樣的國家。韓國也只是軟禁。獄政也要改革。我從來不知道中華民國的犯人全部是睡在地上,人權實在應該改善。坦白講,他當總統時沒找過我,現在他被關,每個人都拱我,其他人都閃到走無路。

    我為什麼要幫他 ? 因為我不希望台灣被人家認為是一個無情無義的國家,人情冷暖啊。

    扁案已經變成台灣無解的題目。因為他覺得受到不公平待遇,不公平審判。例如為什麼要換法官,為什麼要先押後審 ? 檢察官還去教唆證人作偽證,還是證人出來講,而且後來都沒事。阿扁怎麼會服氣! 如果有罪,該怎麼判就怎麼判嘛,不要做那些動作,變成政治事件,永遠都沒辦法化解。

    我進去北監做醫療業務,要他躺著,問他脫褲子好嗎,怕被看光。阿扁說:「沒關係,我已經被看4年了。」

    他的房間24小時裝監視器。他上廁所和洗澡也是都在1.3坪裡頭,除了柵欄,沒有窗戶。一般會搞成像阿扁那樣子,早就被放出去了,像翁大銘很快就放出來。

    這個案子,你要把他一視同仁,已經是不可能,你沒辦法把他當一般犯人看待。台灣是兩極化社會,我不喜歡馬英九,頂多嘲笑他,揶揄他,但我不會要把他整死;對阿扁,有人就討厭他到要讓他死,對共匪也沒那麼痛恨。

    扁案部分,sin 和 crime 不一樣,道德有罪和法律有罪是不一樣。所以我主張結束扁案,因為扁案已經成為一個無法結案的案。

    台灣e新聞