I got a phone call that changed my life.

我接到了一通電話，改變了一生，

At the time, I was cardiologist at UCLA,

那時我是加州大學洛杉磯分校的心臟病學家，

specializing in cardiac imaging techniques.

專門從事於心臟影像技術，

The call came from a veterinarian at the Los Angeles Zoo.

這通電話由洛杉磯動物園的一位獸醫師打過來，

An elderly female chimpanzee

有一隻年老的母猩猩

had woken up with a facial droop

睡醒時面部下垂，

and the veterinarians were worried that she'd had a stroke.

獸醫師擔心牠中風。

They asked if I'd come to the zoo

他們問我可否去一趟動物園，

and image the animal's heart

給母猩猩的心臟拍一張照片，

to look for a possible cardiac cause.

看看心臟有沒有問題。

Now, to be clear, North American zoos are staffed

先說明一下，

by highly qualified, board-certified veterinarians

北美洲的動物園都會雇用高水準兼持有執照的獸醫師，

who take outstanding care of their animal patients.

為生病的動物提供良好照顧，

But occasionally, they do reach into the human medical community,

但是他們偶爾也會向照顧人類的醫師尋求協助，

particularly for some speciality consultation,

特別是一些專業的諮詢，

and I was one of the lucky physicians who was invited in to help.

而我是有幸受邀前去幫助他們的其中一位醫師，

I had a chance to rule out a stroke in this chimpanzee

因此我有機會為這隻猩猩排除中風的疑慮，

and make sure that this gorilla didn't have a torn aorta,

確保這隻大猩猩的主動脈未曾破裂，

evaluate this macaw for a heart murmur,

替這隻金剛鸚鵡測量心跳聲，

make sure that this California sea lion's pericardium wasn't inflamed,

確保這隻加州海獅沒有患上心包炎，

and in this picture, I'm listening to the heart of a lion

在這張照片裡，我正在給一隻獅子聽診，

after a lifesaving, collaborative procedure

這是在獸醫師和內科醫師合作

with veterinarians and physicians

進行了一次救生之後，

where we drained 700 cc's of fluid from the sac

我們從這隻獅子心臟的心包

in which this lion's heart was contained.

排掉700毫升的液體，

And this procedure, which I have done on many human patients,

這個步驟跟我曾在很多病人身上實施過的完全相同，

was identical, with the exception of that paw and that tail.

除了那隻爪子和尾巴。

Now most of the time, I was working at UCLA Medical Center with physicians,

現在我經常會跟加州大學洛杉磯分校醫學中心的內科醫師共事，

discussing symptoms and diagnoses and treatments

討論我們病「人」的

for my human patients,

症狀、診斷和療法，

but some of the time, I was working at the Los Angeles Zoo

但是有時候我會到洛杉磯動物園工作，

with veterinarians, discussing symptoms and diagnoses and treatments

為了他們的動物患者，和那裡的獸醫師一起

for their animal patients.

討論症狀、診斷和療法，

And occasionally, on the very same day,

偶爾在同一天，

I went on rounds at UCLA Medical Center

我會在加州大學洛杉磯分校的醫學中心

and at the Los Angeles Zoo.

和洛杉磯動物園之間來回跑，

And here's what started coming into very clear focus for me.

而在這裡開始變得非常明確清晰，

Physicians and veterinarians were essentially taking care

就是醫師和獸醫師根本在處理同樣的疾病，

of the same disorders in their animal and human patients:

不管在人類還是動物身上：

congestive heart failure, brain tumors,

充血性心臟衰竭、腦部腫瘤、

leukemia, diabetes, arthritis, ALS, breast cancer,

白血病、糖尿病、關節炎、漸凍症、乳癌，

even psychiatric syndromes like depression, anxiety,

甚至精神病症狀如憂鬱症、焦慮症、

compulsions, eating disorders and self-injury.

強迫症、飲食障礙症或自我傷害。

Now, I've got a confession to make.

現在我必須承認，

Even though I studied comparative physiology and evolutionary biology

雖然我在大學主修對比生理學和演化生物學—

as an undergrad --

甚至畢業論文寫的是關於達爾文理論—

I had even written my senior thesis on Darwinian theory --

當理解到動物和人類疾病之間

learning about the significant overlap

存在著明顯的重疊部份時，

between the disorders of animals and humans,

我突然靈光乍現，

it came as a much needed wake-up call for me.

於是我開始想，既然有這麼多的重疊，

So I started wondering, with all of these overlaps,

為甚麼從來沒想過請求獸醫師的意見，

how was it that I had never thought to ask a veterinarian,

或者查找獸醫方面的文獻，

or consult the veterinary literature,

以更好地瞭解我的病人呢？

for insights into one of my human patients?

為甚麼我或是我詢問過的醫師朋友和同事

Why had I never, nor had any of my physician friends and colleagues

都沒參加獸醫學的會議呢？

whom I asked, ever attended a veterinary conference?

既然人類和動物的疾病是重疊的，那麼又有甚麼奇怪的呢？

For that matter, why was any of this a surprise?

我的意思是每位醫師都知道

I mean, look, every single physician accepts some biological connection

動物和人類之間有著生物學上的聯繫。

between animals and humans.

我們所處方的每份藥物，或者我們自己的用藥，

Every medication that we prescribe or that we've taken ourselves

或者給我們家人的用藥，

or we've given to our families

都曾經先在動物身上進行試驗。

has first been tested on an animal.

但是情況也有很大的不同，

But there's something very different

給動物用一種藥或是患上人類疾病時，

about giving an animal a medication or a human disease

及動物得了充血性心臟衰竭、

and the animal developing congestive heart failure

或糖尿病、乳癌。

or diabetes or breast cancer on their own.

但現在讓我們感到驚訝的是，

Now, maybe some of the surprise

也許在我們這個世界裡

comes from the increasing separation in our world

城市與鄉郊之間日漸擴大的隔閡，

between the urban and the nonurban.

我們聽說過那些城市裡的孩子，

You know, we hear about these city kids

他們認為羊毛是在樹上生長的，

who think that wool grows on trees

或者乳酪從植物長出來的。

or that cheese comes from a plant.

今天人類的醫院

Well, today's human hospitals,

正逐漸變成一些閃耀的科技教堂，

increasingly, are turning into these gleaming cathedrals of technology.

使在醫院治療的病人

And this creates a psychological distance between the human patients

跟生活在海洋、農田和森林間

who are being treated there

的動物患者

and animal patients who are living in oceans

產生一種心理上的距離感。

and farms and jungles.

但我認為還有一個更深層次的原因，

But I think there's an even deeper reason.

我們作為醫師和科學家，理智上明白到

Physicians and scientists, we accept intellectually that our species,

人類作為一個物種，也只不過是一個物種，

Homo sapiens, is merely one species,

並不比其他物種更為獨特。

no more unique or special than any other.

但其實在我們內心，我們並不完全認同。

But in our hearts, we don't completely believe that.

當我聽莫扎特的音樂時，

I feel it myself when I'm listening to Mozart

或在蘋果電腦上看火星探測器的照片，我自己是這麼感覺的。

or looking at pictures of the Mars Rover on my MacBook.

我感受到人類特殊論的勝利，

I feel that tug of human exceptionalism,

即使我意識到人類以科學方式孤立自身所付出的代價，

even as I recognize the scientifically isolating cost

把自己隔開看做一種上等的物種。

of seeing ourselves as a superior species, apart.

現時我正在嘗試，

Well, I'm trying these days.

當我替病人看病時，我總會問，

When I see a human patient now, I always ask,

獸醫對這個問題會否知道那些我不知道的事嗎？

what do the animal doctors know about this problem that I don't know?

還有如果我把病人看做人類動物患者，

And, might I be taking better care of my human patient

能否給他們更好的治療？

if I saw them as a human animal patient?

下面是幾個讓人興奮的聯繫的例子，

Here are a few examples of the kind of exciting connections

就是這種想法讓我聯想到那些點子。

that this kind of thinking has led me to.

恐懼誘發心臟衰竭—

Fear-induced heart failure.

2000年左右，

Around the year 2000,

人類心臟學家「發現」情緒會誘發心臟衰竭，

human cardiologists "discovered" emotionally induced heart failure.

文獻曾經記述過一個嗜賭成性的父親，

It was described in a gambling father who had lost his life's savings

他一次擲骰子就輸光畢生積蓄，

with a roll of the dice,

一個在聖壇前面被離棄的新娘，

in a bride who'd been left at the alter.

但最後我們發現這種「全新」的人類疾病，

But it turns out, this "new" human diagnosis

既不新奇又不為人類所獨有，

was neither new, nor was it uniquely human.

獸醫早就已經在診斷、治療甚至防止

Veterinarians had been diagnosing, treating and even preventing

動物身上的情緒誘發症狀，

emotionally induced symptoms in animals

從猴子到火烈鳥、從鹿到兔子，

ranging from monkeys to flamingos, from to deer to rabbits,

乃自 19 世紀 70 年代起開始。

since the 1970s.

如果急診室和心臟專科醫師能運用

How many human lives might have been saved

這一點獸醫學的知識，

if this veterinary knowledge had been put into the hands

那麼有多少人類生命可被拯救？

of E.R. docs and cardiologists?

自殘—

Self-injury.

有些病人會傷害自己，

Some human patients harm themselves.

有些會拔出整把頭髮，

Some pluck out patches of hair,

有些會實際地切割自己。

others actually cut themselves.

有些動物患者也傷害自己，

Some animal patients also harm themselves.

有些鳥類會拔掉自己的羽毛，

There are birds that pluck out feathers.

有些成年公馬反覆地咬自己的側腹直到流血。

There are stallions that repetitively bite their flanks until they bleed.

但是獸醫師使用一些特定且有效的方式

But veterinarians have very specific and very effective ways

去治療甚至防止自我傷害的動物

of treating and even preventing self-injury

在身上自殘。

in their self-injuring animals.

難道這些有關獸醫學的知識

Shouldn't this veterinary knowledge be put into the hands

不該被努力對抗自殘的精神治療師、

of psychotherapists and parents and patients

父母和病人所運用嗎？

struggling with self-injury?

產後抑鬱症和產後精神錯亂—

Postpartum depression and postpartum psychosis.

有時就在生產之後不久，

Sometimes, soon after giving birth,

有些婦女會變得憂鬱，

some women become depressed,

有時她們患上嚴重憂鬱症甚至精神錯亂，

and sometimes they become seriously depressed and even psychotic.

她們或者會忽視剛出生的寶寶，

They may neglect their newborn,

在些極端的案例中，

and in some extreme cases,

甚至會傷害她們的孩子。

even harm the child.

馬專科獸醫師也知道

Equine veterinarians also know that occasionally,

偶爾一頭母馬剛剛生產後，

a mare, soon after giving birth,

也會忽視小馬，拒絕餵奶，

will neglect the foal, refusing to nurse,

有些時候會踢牠，甚至把牠們踢死。

and in some instances, kick the foal, even to death.

但是獸醫師設計出

But veterinarians have devised

一種介入方法以處理這類馬駒抗拒症狀，

an intervention to deal with this foal rejection syndrome

就是增加母馬體內的催產素。

that involves increasing oxytocin in the mare.

催產素是一種跟聯繫有關的荷爾蒙，

Oxytocin is the bonding hormone,

它會給母馬重新

and this leads to renewed interest,

感到對小馬的興趣。

on the part of the mare, in her foal.

難道這種知識不應該

Shouldn't this information

被正在與產後憂鬱症和精神錯亂抗爭的

be put into the hands of ob/gyn's

婦產管理者、醫師

and family doctors and patients

和病人所運用嗎？

who are struggling with postpartum depression and psychosis?

好吧，即使這些都已實現，

Well, despite all of this promise,

不幸地在我們領域間的鴻溝還很大，

unfortunately the gulf between our fields remains large.

為了解釋這一點，我恐怕要揭露一些陰暗面，

To explain it, I'm afraid I'm going to have to air some dirty laundry.

有些醫師是完完全全的勢利眼，

Some physicians can be real snobs

他們看不起不是醫學博士的醫師，

about doctors who are not M.D.'s.

我指的是牙醫、配鏡師和心理醫師，

I'm talking about dentists and optometrists and psychologists,

也尤其指獸醫師。

but maybe especially animal doctors.

當然大多數醫師意識不到

Of course, most physicians don't realize that it is harder

現在進入獸醫學院較進入醫學院更難，

to get into vet school these days than medical school,

而且當我們上醫學院時，

and that when we go to medical school,

我們在那裡所學的全部東西

we learn everything there is to know

都只為瞭解一個物種—人類，

about one species, Homo sapiens,

但是獸醫師需要學習哺乳動物、

but veterinarians need to learn about health and disease

兩棲動物、爬行動物、魚類和鳥類的健康和疾病，

in mammals, amphibians, reptiles, fish and birds.

因此我不會責怪獸醫師，

So I don't blame the vets for feeling annoyed

因著我的專業所帶來的優越感與無知而感到厭煩，

by my profession's condescension and ignorance.

但是獸醫有個說法:

But here's one from the vets:

你會把一個只能照顧

What do you call a veterinarian

某一物種的獸醫師叫做甚麼？

who can only take care of one species?

一位醫師（笑聲）

A physician. (Laughter)

將兩者的差距縮小變成我的熱情，

Closing the gap has become a passion for me,

而我正在通過一些專案來做這件事，

and I'm doing this through programs

比如加州大學洛杉磯分校的「達爾文巡邏員」專案，

like Darwin on Rounds at UCLA,

我們把動物專家和演化生物學家找來，

where we're bringing animal experts and evolutionary biologists

安插在我們的醫療隊伍中，

and embedding them on our medical teams

跟我們的實習生和住院醫師一起工作。

with our interns and our residents.

而且通過「人獸同源學」會議，

And through Zoobiquity conferences,

我們讓醫學院和獸醫學院聚在一起，

where we bring medical schools together with veterinary schools

討論動物患者

for collabortive discussions

和人類病者之間

of the shared diseases and disorders

的共同疾病和失調，

of animal and human patients.

在「人獸同源學」會議上，

At Zoobiquity conferences,

參與者學習到替老虎治療乳腺癌

participants learn how treating breast cancer in a tiger

將會如何幫助我們更好地治療

can help us better treat breast cancer

一位幼兒園老師的乳腺癌；

in a kindergarten teacher;

好好瞭解荷斯坦牛的多囊卵巢

how understanding polycystic overies in a Holstein cow

將會如何幫助我們

can help us better take care

更好地照顧一位受經痛困擾的舞蹈老師；

of a dance instructor with painful periods;

深入瞭解一隻患上分離焦慮症

and how better understanding the treatment of separation anxiety

且高度緊張的喜樂蒂牧羊犬的治療，

in a high-strung Sheltie

將會如何幫助一個首天上學就感費力的焦慮幼孩。

can help an anxious young child struggling with his first days of school.

在美國，而且現時在全球， 於「人獸同源學」會議上，

In the United States and now internationally, at Zoobiquity conferences

醫師和獸醫師會將態度以及成見留在會議室外，

physicians and veterinarians check their attitudes and their preconceptions

然後以同行的身份、

at the door and come together as colleagues,

同輩的身份、以及醫師的身份聚在一起。

as peers, as doctors.

畢竟我們人類也是動物，

After all, we humans are animals, too,

是時候讓我們醫師去接受

and it's time for us physicians to embrace

我們同時是病人和動物的本質，

our patients' and our own animal natures

和獸醫師合作

and join veterinarians

以跨越物種的方式處理健康問題。

in a species-spanning approach to health.

因為最後證明是

Because it turns out,

一些最好且最合乎人道主義的藥物治療，

some of the best and most humanistic medicine

正被患者並不是人類的醫師所使用，

is being practiced by doctors whose patients aren't human.

而我們照顧人類患者的最好方法之一

And one of the best ways we can take care

就是密切注意

of the human patient is by paying close attention

在這星球上其他病患者

to how all the other patients on the planet

是如何生活、成長、患病以及康復。

live, grow, get sick and heal.

謝謝！

Thank you.

（掌聲）

(Applause).