It really responds to Old Master Kong's famous saying: Fifty and know the destiny of heaven.
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I recently saw two books, one is Adam Kay's "Absolute Laughter and The Journal of abandoned doctors." The work tells the story of his own journey from intern to obstetrician and gynecologist. Some of it is a complaint about the doctor's tired work, and some is thinking about it in his spare time. He begins with the introduction of "a comedy that was once left in the UK's national health system", and he worked in the hospital in 2004, resigned in 2011, and turned to an independent sitcom. The failure of the obstetrics and gynecology operation was the direct cause, and he resigned in the second half of the postoperative period, and in 2017, he made the experience of obstetrician and gynecologist for six years public, causing a great sensation. The book seems to be quite relaxed, after all, some experiences read you want to roll your eyes and even clap your eyes, but also questioned and commented on the British health care system, he believes that the national health service system is so short of manpower and insufficient funds, all practitioners have to rely on personal perseverance and conscience to support the operation of the entire system. At the end, I had no doubt that the words would appear in my diary— "I'm going to swim to an antenatal clinic in Iceland today," or "I have to swallow a helicopter alive today."
The second book is Arthur Guvind's The Best Farewell: Common Sense You Must Know About Aging and Death. The author himself and his parents are doctors, and the doctor's duty is to treat the sick and save people, and their family of three spares no effort to adhere to their mission. During his years at work, Arthur Gravind has seen many patients who are nearing the end of their lives who are still suffering from disease, who have survived with instruments, but who have no good end, and the authors propose how to deal with death when faced with a known death. What kind of way to leave the world? Before his father fell ill, he continued to recognize many sick old people who, on the eve of their death, all wanted to suspend their medication and instruments, they wanted to leave the hospital, they wanted to fulfill their wishes, they wanted to complete the last journey according to their wishes, not to meet the demands of their children who wanted them to stay for one more minute. Atul Gwende's father finally died according to his own wishes, he did not continue to stay in the hospital, but lay on the bed at home, after a period of difficult breathing, finally the "exhale " gasp ended, he also left. The book also explains that "the medical science gives us the extraordinary power to resist limitations, and the potential value of this power is at the heart of what motivates us to become a doctor." But because of the limited and always limited power of people in the field of medicine, it has caused harm to the patient again and again", these words are very common facts, and the book tells us how to look at aging and death, and is a spiritual guide to comforting emotions in the face of death.
In contrast, the first book, "The Journal of Abandoned Doctors with Absolute Laughter", made me feel the sense of mission of doctors and the pressures they faced and the exhaustion they experienced, starting with intern doctors, with little rest time, not to mention the number of meetings with close people. At the same time, the salary is low, and compared with others, the sense of difference is very large.
>> Why did you choose to be a doctor? I felt like getting an email one day in early October with a message that made you decide what you wanted to eat at a Christmas work party.
>> A great doctor has to have a fat heart and a dilated aorta so that he can constantly pump out the overflowing compassion and kindness to the world.
>> If your friends are all doing something and you fall behind, that feeling... You know. It's as if they're all crowding out someone at a party, all getting a car driver's license, or both smashing hundreds of thousands of pounds on a moldy dungeon, stupid, but no one likes the feeling of being left behind.
>> On Thursday, October 21, 2010, when I left the gynecological clinic, I picked up the case of the next patient and looked through it. I remember her name — and sure enough, I saw her in March and wrote a letter to her family doctor explaining the situation. I suddenly found that due to typographical errors, the word "hesitation" was omitted from the letter, so it became: If there are any problems, please do not contact me. It worked, and the other party didn't bother me once.
(Funny, right?) ）
After the author failed the operation, everyone reassured him that it was okay, although intellectually speaking, there were always accidents on the operating table, and these things were not controllable by man, and Arthur Gerwind also said in the book: "The death of the patient does not mean the failure of the doctor." Death is a highly normal phenomenon. Death may be our enemy, but death is also in accord with the natural laws of things. In an abstract sense, I know these truths, but I lack concrete knowledge—they are true not only for everyone, but also for the person before me, the person I am responsible for healing. But afterwards, while everyone regretted it, they also regarded it as commonplace, lacking psychological counseling for the attending physician, and it was also because of the lack of this step that Adam Kai was always trapped in his heart, leaving the hospital and giving up the doctor's job.
It takes courage to start, and it takes courage to end
>> think about the price every health worker pays for the job, both at the family level and at the professional level. Remember, they're doing almost an incredible job, and everyone is always doing their best. Your experience in the hospital may be painful, but for them, the pain will only be multiplied.
Later, when Adam Kay was giving a lecture, he wrote this passage:
>> I've found that a lot of people start with questions like this: "My son/daughter/partner/neighbor/mother/best friend/uncle... Also works for the National Health Service. "I started asking the audience to raise their hands to see how many people were in direct contact with health care workers — usually at most one or two people in the whole room didn't raise their hands, and most of the time everyone would raise their hands. Of course, that makes sense – the NHS employs about 1.5 million people. I realized that there was a simpler, more effective answer to the question, "What can I do?" Everyone can do it, almost effortlessly. That is: ask the people around you if they have a good day. They'll say, "That's it. Then immediately change the subject, or shift the focus of the conversation to something interesting or something. But you have to make them understand that there are always people waiting to listen to them: you understand that you can't "just do that" every day, and the nature of illness means that there must be more bad things than good things at work. So keep asking so they have a chance to unload their burdens after each shift, whether it's a small tantrum, a rant, or a complete breakdown, pain. Don't be swayed by the deep-seated idea of saying that doctors and nurses don't need it, or shouldn't talk about it— it happens to be a massive departure of medical staff, causing people who hold their duties to get sick and take time off because of excessive stress, and even cause those who feel overwhelmed to end their lives in the extreme of suicide. We all need someone to talk to, don't let them suffer. Let them know you're there, and give back with care to those who care. Although they had a stethoscope around their necks and always liked to hang jokes about life and death, they were still the same little children, and when they graduated from high school, they arbitrarily ticked the word "medicine" on the college application form. They are fragile human beings like you.
I think that after the epidemic, we will know and feel more about doctors, and there is no need to say more about their stories.
Doctors are also human beings, and people face aging and death. Professor Wang Fang of the Institute of Medical Humanities of Peking University wrote in the general preface: Love and evil death are the norm of people, but everyone is equal before death, whether you are a king, a coachman, a tycoon, or a beggar, status and money cannot change the fact that individual life must die. The last test question in life is how to face the call of the god of death, fear, depression, and sadness are the common feelings of people, and no matter how strong and open-minded people are, they cannot be proud and calm in front of the god of death.
Arthur Gravinde uses the case of medicine to describe what we experience in the process of moving forward to a hundred years old, how do we get old, and how should we accept it? Are we ready for old age? When there is no hope of treatment, do you choose to continue or give up?
As far as the first problem is concerned, in the process of aging, we will face graying of hair, loose skin, blurred vision, loose teeth, weak body, unstable pace, decreased learning ability, difficulty in memory retrieval, and the ability to live independently. Accepting aging is not a moment, but a process, a process that even doctors who treat and save people cannot avoid. Montaigne wrote of life in the late 16th century: "Dying in old age is a rare, abnormal, and bizarre way of dying, far less natural than other ways of dying. "Today, the average life expectancy in most parts of the world is more than 80 years. In addition to the improvement of medical care and the improvement of quality of life, this increase in average life expectancy also benefits from our own structure - we have "spare tires" in our bodies, and their presence can increase the coefficient of our safe survival. We have an extra kidney, an extra lung, a pair of extra gonads, and extra teeth. Dna in cells is often damaged under normal conditions, however, our cells have several DNA repair systems. If a key gene is permanently damaged, there are usually additional identical genes in its vicinity. And, if the whole cell dies, then other cells will fill in. But our bodies are accumulating lipinoxin, oxygen free radical damage, random genetic mutations, and various other problems year by year. The process is gradual and non-stop, and aging will catch up with us sooner or later.
In the case of our parents, when they are doing familiar things but gradually slowing down and beginning to make mistakes that would not have occurred before, we should know that aging has caught up with them, and the answer is that only by facing all this calmly can people live naturally. In addition to recuperating at home, there is also a situation that is also a situation facing today's society, and the elderly have lost the ability to live independently and can only serve them at any time in nursing homes. However, nursing homes can provide basic services for people with inconvenient mobility, but they can rarely meet the spiritual needs of the elderly. There is no sense of home here, they cannot live according to their own habits and rhythms, the doors cannot be locked, they cannot keep pets indoors, they have lost their self-esteem and freedom, and they have become "prisoners" who are "locked" in the almshouse.
>> The elderly told me that what they fear most was not death, but the conditions that preceded them—the loss of hearing, memory, the loss of best friends and the inherent way of life. As Felix said to me, "Old age is a series of continuous losses. In the novel Everyman, writer Philip Roth put it even more bitterly: "Old age is not a battle, but a massacre." ”
>> her complaints are the same as the ones I often hear from nursing home patients: "That's not home." To Alice, Longwald was just a facsimile of the home. For a person, there is a place that feels like his own home, and its importance is as important as water to fish.
Finally, for diseases that are no longer incurable, letting go of this act is a topic of moral and emotional controversy, when to try to heal, when to give up treatment, and what should be done before dying?
◆ What to do when the limit comes
>> In 2008, studies published by the Coping With Cancer showed that patients with terminal cancer who used mechanical ventilators, electrical defibrillation, chest compressions, or were admitted to a intensive care unit before death were of much worse quality in the last week of their lives than those who did not receive these interventions. And, 6 weeks after death, their caregivers were three times more likely to develop severe depression. For most people, spending the last days of their lives in a care unit because of an incurable disease is a complete mistake. You are lying there, with a ventilator on, every organ has stopped functioning, your mind is swinging between delusions, never realizing that you may not be able to leave this temporarily borrowed, brightly lit place. When the big limit comes, you don't have the opportunity to say "goodbye," "don't be sad," "I'm sorry," or "I love you."
And these problems are difficult, the end of life finally brings people into the arms, ignorant of the space after death, this is my fear, I believe it is also the fear of many people. When you are alive, you will continue to expand the tentacles of cognition, and death is like throwing people into boundless darkness, without a sense of direction and without feeling. Close your eyes, all the outward receptors close in unison, you can't even hear whether the outside world is mourning about your departure, you can't feel any emotion. It takes courage to say goodbye to the world.
When the disease strikes, 100 treatments may not necessarily be useful, when a patient with advanced cancer sees a doctor, the goal he most hopes to achieve is not to live a good year or two, this is the doctor's expectation, their expectation is to live for 10 years, 20 years, in exchange for any patient will think so.
For situations where there is no hope of treatment, Arthur Gravinde's advice from his own experience is to talk frankly and seek consensus for the good end of life; to choose a doctor to trust, and doctors should not make unfulfilled promises to patients in order to escape reality. Letting the patient decide for himself whether to treat or not and how to leave is a process of reconciliation between himself and life, and it is also a process in which family members learn to let go, no longer have illusions, and face reality. The Bible says ' sometimes in life , sometimes in death' – When I live to the end, I want to be able to face the end of my life calmly, and in the way I choose. For the most part, however, I prefer the more militant view that death is the ultimate enemy — and I don't think there's anything to blame for those who are furious about the extinguishing of the light. ”
>> accepting the mortality of the individual and clearly understanding the limitations and possibilities of medicine is a process, not an epiphany.
>> rescue is not a unilateral decision, but a negotiated act, the patient calls for help, and the clinician passively agrees to rescue, no matter how impossible it is to come back to life, no matter what kind of pain, injury or cost will be generated in the process of treatment, the doctor can only go forward with a hard scalp. While trying a new model of palliative care (through the means of care and comfort), we are newbies. To seek a consensus on the mortality of human beings, and to pursue the dignity of life and the maintenance of a meaningful life as a survival pursuit, both doctors and patients are faced with the task of learning, including me, whether as a doctor or as an ordinary individual.
Atul Gwunder realized this even more after his father died of illness, and as I read the book, I thought about what my own loved ones would think when they were sick. What was she trying to say when she looked at you with her eyes open? There was a smile in her sparkling eyes, but at the same time, would she also slowly lose her memory, I was not around when she left, did she think of me at that time, would she think that she had not seen me yet, so sorry? Was the sudden dizziness at noon that day telepathic? He also kept thinking that it was time for him to come, was he also afraid at that time? Are you afraid of more, or are you not willing to give up more? What was he looking at as he sat there and looked ahead? The process of dying is a process of sadness and gradual rationality, but rationality is overwhelmed by fearful and boundless sadness.
I have seen the process of aging now, others are witnesses to my growth, I am also a witness to the aging of others, the first half of Atul Gervind's book I am experiencing, the second half of my family should also be slowly experiencing. I doubted life for a while, I didn't know the meaning of human life, while advising myself not to think too much, in case I didn't understand and then made myself depressed. These two days of reading books to find the meaning of death, the end of life is my disconnect with this world, I often think of my deceased family, those scenes are really fragmented, not at all like the TV series in the plot of several minutes, generally an expression, an action, a sentence.
The afterlife, Arthur Govind did not say, of course he would not know, who would not know, unless the soul world can produce a writer, if there is a soul world.
Arthur Guvinde's understanding of good endings is not to die well, but to live well to the end of life (to live according to one's own wishes). I can understand, just thinking about the future, I can't predict.
>> Sometimes he "surfaces" and smiles when he hears our voices when he is most conscious. Then he "fully ashore" and realized that things were not over. He realized that the pain and anxiety that he had hoped had all gone were still there: the physical problems were still there, but what was more difficult for him were the mental problems—confusion, worries about unfinished business, worries about his mother, worries about what memories he would leave behind. He is calm only when he is asleep, and he cannot be calm when he is awake. Since life was approaching its limits, he hoped that the last few lines of his story would be tranquility.