True power
Under the blow of disease, people will have all kinds of confusion. I documented 19 cases, each illustrating a theme. For example, a patient with Guillain-Barré syndrome (note: acute muscle paralysis caused by the immune system damaging the peripheral nervous system, causing acute, inflammatory, demyelinating, multiple radiculoneuritis, resulting in acute muscle paralysis), after tracheal intubation, ** through the stomach tube into her stomach, in fact, she can not taste the taste of water, she still swallows a lot, she said that she can feel the sweetness of the water, believe it or not, which shows that she still wants to live desperately, through this case I want to discuss how to stimulate the patient's desire to live.
I persuaded people to go home in the last case. This is a 68-year-old woman with terminal cancer, and in the later stages she has been wanting to go home. But her children disagreed, believing that going home was waiting for death. I advised them to work hard when it was time to try, to rescue when it was time to rescue, and that it was time to respect the wishes of the elderly and let go. In the end, they went home according to the patient's wishes, and the children carried the old man to the old man in his hometown to watch the pigsty and the date palm tree, and finally walked peacefully. Through this case, I would like to talk about what makes a better goodbye.
I think about these cases from time to time. Human memories are magical, the points that once moved you the most will be hidden in the depths of memory, like drifting bottles hidden in the depths of the sea, and one day a certain scene will trigger these bottles to resurface, such as hearing a song that will make you think of someone and recall a certain past. The same goes for doctors, when he encounters a new case, he will also recall the old case, and this feeling of interweaving time and space is very strong.
I didn't dare to write this book before, after all, I was only a clinician, not a medical humanities. After more than 20 years of work, I have gained considerable experience and the ability to connect these things vertically, and this experience in the past will have an impact on today's decision-making, so it is time to (write).
Of the 19 cases, I probably interviewed.
Parties in seven or eight cases. Interviews are very precious, and unlike other interviews, interviewing former patients or family members, the process is to let them revisit that experience, which is equivalent to someone else's wound has just healed, and you can open it again, so I am especially grateful to the patients and family members I interviewed. There was a father whose child was brain dead, and at first he agreed to the interview, but then he kept saying that something was wrong. I understood him and didn't look for him again. If being interviewed is for commemoration, then not being interviewed is also about being able to start over.
In the process of writing, I felt that this subject matter may be the most suitable for clinicians to write about. When recording the shock and emotion of life, you need to be able to provoke everyone to think, how to make decisions, how to live, how to be loved, these are all very important. Real cases can make people understand what it means to be rational and emotional, and the two are never opposites.
There is an 82-year-old man in the book who has multiple organ failures, including kidney failure, and his family just won't let go. At the end his son cried and said, "Can you give my kidney to my father?" He is very filial, wearing a black down jacket, squatting in the corridor every day and waiting, how cold the corridor is, it is all "whoosh" wind, but after waiting for two months, his father did not come out (from the ICU).
He told me about the conflicts he saw between family members during that time. An old man's daughter wants to give up, but his granddaughter doesn't give up, and the two of them are scolding each other at the door. Later, the daughter left, leaving the granddaughter crying outside. After two or three days, the daughter couldn't bear it anymore and came back to pay the money to continue the treatment.
On the day his father's condition worsened, Dr. Xiao Li, the chief resident physician, came out to explain his condition, crying and saying sorry, we worked so hard, but the old man still bleed. He said that at that time, he really wanted to hug Dr. Xiao Li, and told Dr. Xiao Li that it was okay, because when he saw a doctor crying, he really understood the efforts made by the doctors, and the doctors never let go, and at that moment, he felt that all the suffering was worth it. Therefore, for patients and their families, feeling the doctor's feelings is also a kind of **.
When it comes to the doctor's sense of achievement, many film and television dramas will sing praises and praises, or ups and downs, and the patient's family will send pennants - the real situation is that after the rescue, others may only have one sentence: a woman in her thirties suddenly had an amniotic fluid embolism during the operation, and after a night of rescue, when I told her husband that the patient was getting better, he didn't say a word of thanks, and after half a minute, he suddenly said to me: "You haven't eaten yet, I'll go buy you a breakfast."
I once ** a man in his 40s who was in critical condition and finally got better. When I reported the good news to his lover that day, I thought she would cry with joy. As a result, she turned to a child in the hallway and shouted, did you hear me? Your dad is all right, hurry up and go to school. The kid was crying and running to school. He was a high school student who hadn't been to school for several days, just waiting for his dad to wake up at the door of the ICU.
Therefore, the real thing touches people the most, and this is the sense of accomplishment of doctors. A good doctor should have three criteria: the first is good technique, the second is good attitude, and the third is to retain a little bit of emotion in the depths of his heart when he is becoming more and more calm and rational.
Everyone needs time
When you are young, almost all doctors strive for the ultimate in technical refinement, and this is certainly true. When I was a young doctor, I also encountered a lot of things that I didn't understand, such as encountering an unavoidable disease, I wouldn't understand, why the family couldn't look at it rationally, how to treat it, why would I rather spend so much money to buy a result that I knew had no results, why was it so desperate? In my opinion, when there is no hope for the patient, we should decisively stop using the radical ** and turn to relieving the patient's suffering.
Later, I met an old gentleman whose wife suffered cardiac arrest due to malignant arrhythmia caused by coronary heart disease and myocardial infarction, and her pupils were dilated when she was brought to the hospital. For half a year, the old gentleman would come almost every day to ask what changes had been made in the indicators, and then write them down in a small notebook, and then ask the doctor all kinds of questions. If the explanations are inconsistent, he will repeatedly ask questions and even complain.
Finally, on his wife's birthday, the old gentleman deliberately dressed up and sang her an old song out of tune. As a result, she cried, shed two tears, and left.
I didn't understand why he asked every day if there was any hope. Why do you always take unreliable home remedies to direct doctors? Later, I slowly understood that when people are unavoidable, family members, doctors, and patients do not let go, and not letting go is the ultimate comfort in life. Because (the patient) feels like he is not being given up.
If you look at it with absolute rationality, some people may say, there is no hope, you still don't let go, which makes the patient suffer and the family suffers financial losses. But you have to know that people live for a lifetime, and what they are most afraid of when they are sick may not be death, but that they have not lived well, and everyone needs time. With time, the patient can slowly see through the matter, can walk more calmly, and with time, the family's guilt can also be comforted.
Medicine is not just science, it is also human, in addition to care, when you can't, not letting go is the greatest comfort. In this world, there are no black and white answers to many things, especially when it comes to life and death. What if the patient still wants to be treated, but the family has no money? Sell the house and sacrifice this generation or even the next generation to maintain it for a while longer? More often than not, it is a family's perception and actual situation (determined).
There is a child who is only a few years old, and when he sleeps at night, he suddenly has a cerebral hemorrhage, and when he is sent to the hospital, his pupils are dilated, and his brain stem function is gone, which is brain death, and brain death means death in medicine, and there is no possibility of reversal. We artificially used machines and drugs to maintain breathing and heartbeat, but we only delayed the time, and sooner or later he would still have to leave.
But the child's parents had to insist on selling the house to maintain it. The doctor advised them not to let the child suffer like this again. The child's parents said that he was very smart and had good grades, which parent was willing to give up? As long as he has a heartbeat, we will always hold on. After persevering for more than a year, the child finally looked taller when he left than when he first arrived.
So, it doesn't make any sense for us to evaluate what others should or shouldn't do. Everyone's **patient is also **himself. This is true for families, and it is also true for doctors. As a doctor, when the patient is really hopeless, you have to make it clear to the family, but the family should respect them no matter how they choose, there is no absolute right or wrong.
I once resuscitated a patient in septic shock who had a ruptured intestine, a perforated intestine, and a severe infection of the entire abdominal cavity, and came to our hospital in an ambulance from the mountains. That night, I tried very hard to treat him. When he first met me, his family asked when he would be able to transfer out of the ICU. I say that the risk of death is not completely detached. He asked, why is there a risk of death after surgery?
The next morning, the family insisted on taking the sick away, saying that the local custom was not to die outside. Do you say it's a pity? I must regret that one night's hard work, a fresh life, as long as the patient can stay, I will most likely be able to save it. But you can't solve all the problems. Doctors can only provide the best technology, and a kindness is enough. You don't take the money, and you never know the story behind everyone.
All I can do is try to persuade you, I will say, I look hopeful, you listen to me, I will try to save you money. But the uncertainty of medicine is too great, what if you leave someone else behind and you still die? So a big risk for doctors is the human heart. But in fact, most people are still reasonable.
There is no absolutely right answer to many questions, but there is an important principle: giving up is not abandonment, and giving up radical ** cannot give up care. When the patient has no choice, the focus should be on alleviating the patient's pain at this time, so that he can walk more at ease and with dignity. Only language and other aspects of care are not enough, medicine can make the process more dignified, such as giving pain relief, turning over and patting the back, relieving muscle pain, so that the patient does not develop bedsores, and wiping his body every day to make him feel better, these will have dignity.
Can't see through death
A person just knows that he has a disease that he can't **, and you give him dignity, let him accept it, and let it go, which is a very difficult thing to accept. In the face of death, most people still value "I have to live first", and then the so-called dignity.
We once had a case of ALS, this old woman relied on a ventilator, lying in bed for 8 years, only her eyes can move, her thoughts are clear, how painful is this? There is no quality of life at all. Many people may say that if it is my words, I will not live. You say this because you're not yet at this time, how do you know that you don't want to live at this time?
Later, I asked her wife, the quality of life is so poor, didn't you consider not wearing a ventilator anymore? He said, Dr. Bo, I can't bear the first point, I'm retired, and I come to visit for half an hour every afternoon, which makes me feel that there is one more thing, and there is such a person, if she is gone, I don't know what else I can do? Second, I also asked her, you are in such pain, why don't you stop your ventilator? She rolled her eyes from side to side, meaning that she still wanted to be alive.
So what is dignity? There is no absolute answer, and it is dignity to try to meet the patient's own wishes.
I once said in a short ** that "when people die, they die, and there is nothing", and many fans left me messages, saying that they have followed you for so long, but you actually spoke so desperately. This incident also made me reflect on the fact that we can understand the function of every cell, every tissue, and every organ more and more clearly through reason, through calculation, deduction, and induction. But life is too complex for it to be fully explained by pure science, reason.
There was a parting the other day that was worth learning from. An elderly man in his 80s suffered a massive cerebral infarction. Although the surgery was successful, he had various complications after the operation, and he also had chronic heart failure with an ejection fraction of only 30% (note: ejection fraction is an important indicator of heart function). His condition was getting worse.
The old man said a word before he fell unconscious, all come. It means calling all the children. On that day, all his family came, and his three children, as well as their partners and children, all came. They were in pain, and they encouraged each other not to cry. When the old man was about to leave, they shouted to him, grandpa, don't be afraid, remember to go to the place where there is light, you wait in front, we will meet sooner or later. Shouting like this, the old man walked peacefully, for his brain could still hear it in the seconds before leaving.
In fact, I have gained a lot from this incident, and I don't necessarily have to cry in the face of the loss of my loved ones. Treat him well when he is healthy, ** when he is sick, and remember him forever after leaving, this is the best care and love for relatives. Each of us must take this step in the end, don't regret, don't suffer, don't get entangled.
I've seen so many lives and deaths, and to be honest, I still can't see through death. The incomprehensible meaning is that I don't understand what's on the other side of death. Because I can't see through it, many patients have reached the end of their lives, and I still can't bear it. I used to think that terminally ill patients must be very scared before death, but a 24-year-old girl said she was not afraid of death. She is terminally ill of cancer, so young, I advise her, you insist on treatment. She calmly told me that she would either die now or die after the pain, but she didn't want her family to be poor for the rest of her life.
I've always had the anxiety of death myself, and sometimes I wake up when I dream of death. Every day in my life is important, and I am especially reluctant to rest, and rarely simply go for entertainment. Sometimes, when I see other people running in the scorching sun, in the subway, I feel that it is too good to be alive, everyone is desperately trying to live, so I can't let go.