88岁孤身老人严重烧伤,似乎没有抢救必要了……

2017-07-18 殳儆、王筝扬 医学界

这是一个关于医生的专业精神传授的故事。


我是一个ICU医生。

老曹收进ICU的时候,不习惯接触烧伤病人的护士小燕帮病人过床,吓得倒退一步,发出惊呼。那是一个严重烧伤的病人。双手完全烧毁,头部,颈部,前胸部都是深度的烧伤,皮肉烧得处处焦痂,水泡,肿胀,看上去十分恐怖。

不仅如此,老曹在火灾的时候,吸入了大量烟雾,发生窒息昏迷,脑部缺氧。当他在手术室做完初步的清创手术,进入ICU的时候,送他进医院的村干部就说:老曹怕是没救了。

一个88岁的老人,即便是完全不懂医学的人,也能判断要重新恢复是不太可能了。人的自身修复能力是随着年龄改变的,细胞会老化。

用医生最客观的技术路线来判断,他的治疗是一个“死局”。严重的创面感染,植皮手术,无法医治的脑部缺氧,加上多种慢性基础疾病……像不可能走出的地雷阵,不管怎么做,都会以死亡为结局。

老曹是一个“孤老”,没有妻子,没有子女,没有在世的亲人。世上,已经没有人在等他,期待他的康复。

他在这个世间仅剩的资源是:他有医疗保险,国家政策也会为他补上不能报销的部分医疗费用。不过他自己已经不知道了,从火灾现场被救下来的那一刻起,他再也没有醒过。

生命支持,补液,肠道营养,预防感染,创面换药……ICU医生把医嘱开出来,和治疗大多数病人一样。心却疑惑了。

“williamhill asia 要把他治疗成什么状态?williamhill asia 的治疗目标是什么?”住院医生问我。临床培训了一年多,他们已经知道,这样的脑部缺氧状态,没有太多治疗手段。

死亡有时候是个非常折磨人的过程,即使知道他必然在不远处,这个过程还是漫长而痛苦。老曹的生命体征还算稳定,但是创面开始感染,腥臭。连续一个多星期,他都在那个状态下僵持。

每天的换药是个大工程,即使是昏迷状态,病人也会痛得抽动。五官烧的一团模糊的脸,明明知道他没有意识,不能发声,无端感觉在惨呼。

“你觉得呢?williamhill asia 的治疗目标是什么?”我反问。

我心里有现成的答案在,由很久前的一位带教老师教授给我。但住院医生未必知道,目标在哪里?williamhill asia 的教课书从来没有教过这样一章。医生的历程中,却迟早要经历类似的状态。

--医生,你到底要做什么?你在为什么而治疗?你的治疗会去向何方?

“我觉得,他不可能手术植皮,植了也活不了,他的手,除了截肢,已经没有办法了。他醒过来的可能微乎其微……退一万步,即使他好起来,他怎么生活?所以,眼下做的所有治疗,看上去都没有什么必要……”住院医生很没有信心地回答我,我看到他每天换药的时候,面对那些可怖的伤口,表现得尽心尽力,绝无厌烦。

“没有一项必要的治疗吗?”我问他。

“镇痛是必要的,还有,换药……”住院医生看了看医嘱。

“说的没错,williamhill asia 要做的,就是接受死亡。但是在这之前,需要镇痛,换药。医生经常扭转不了病人的命运,但是死亡之前减少痛苦,不分贫富贵贱地表达对人的尊重,也是医疗的目标之一。”我把我的答案给他。

这是多年前,我的带教老师教给我的。

记忆犹新:那个流浪汉,消化道大出血,一个人蜷卧在病床上,快要死了。我的老师说:夜班,williamhill asia 的职责就是多去看看他,让他知道,他不是被世界遗弃的人。

记得那一天,我和我的带教老师站在床边,陪他最后一程。我开始明白,在开具医嘱以外,医生所担负的职责。

编者王筝扬的话:

这是一个关于医生的专业精神传授的故事。

临床医师很多时候无法区分医学教育和学校教育的区别,教一点年轻医生在学校里没有学过的医学知识和技术(Knowledge&Skills),“炒一炒知识冷饭”,以后可以养家糊口,应对日常职责就是所谓的临床带教了。

当问起怎么教“专业精神”时?不少医生会摇摇头,“意思是那个意思,但看不到,摸不着,又不能当饭吃,怎么教?”

其实,这就是医学教育的最后一块内容:态度(Attitude)。

当你在临床上带着年轻的住院医师们夜以继日、黑白颠倒的工作,最后还能站在病床边,送一个无亲无故的流浪汉患者最后一程——还有什么方法能比这个时刻对“专业精神”更好地诠释和教学呢?

美国医生苏珊娜.勃兰登堡在她的“教学时刻”回忆录中和williamhill asia 分享这样的话:“专业精神可以讲授吗?作为教师我会尽力,但是我不肯定它能讲授。

然而,作为一名医生,同时永远是一名学生,我很确定医生的专业精神是可以被学习的。

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    2017-08-02 endlesskevin

    有时去治愈,常常去帮助,总是去安慰

    0

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    2017-07-20 lfyang
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    2017-07-20 龙胆草

    学习谢谢分享

    0

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    2017-07-19 虈亣靌

    学习了,谢谢分享

    0

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    2017-07-19 戒馋,懒,贪

    每当这样送走一位患者,总会有深深的挫败感

    0

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    2017-07-19 lyh994

    让他知道,他不是被世界遗弃的人。

    0

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    2017-07-19 执着追梦

    学习,谢谢分享

    0

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    2017-07-19 159****0390

    说的真是好

    0

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    2017-07-19 飛歌

    说的很有道理

    0