Author's Note:
I remember when I was in the anatomy class, the last few classes would be cut into the abdomen, and suddenly found that our teacher seemed to be a little different from the other groups, and the teacher told us that she may have died of pancreatic cancer. So I will also be curious about the story of these teachers, but I have not and cannot understand her.
The following is the story of a cancer patient in the department of hematology, who will become the general teacher of a future student. They deserve respect. If your general teacher is a tall young man, I hope you will think of him and this story.
图源Times of India
01 It's a handsome guy
When he entered the hematology ward in early November, he was undergoing his first round of chemotherapy, and he looked no different from a healthy person except because he was a little pale.
More than one meter and eight tall, big eyes, high nose bridge, shaved inch, very sunny and handsome, I heard that he is a quite talented director, and when he was first admitted to the hospital, he also combed a fashionable and exquisite curly hair.
In September, he was diagnosed with leukemia because of fever and bone pain, and bone puncture indicated that 94% of the proto-juvenile gonorrhea were found, so he was diagnosed with "acute lymphoblastic leukemia". He always sat in a chair next to the bed and worked in a notebook, and every time he checked the room, he would always make a joke or two, talk with some Beijing accent, and accompany his mother to the bed.
Words like "knowledgeable, polite, gentle" were appropriate for him and his mother.
Every time I went to draw his blood, he would find a position that would make it easy for me to operate; once I didn't get the blood gas, and he and his mother both comforted me and said don't worry; his bone wear was difficult to do, the dry pumping was obvious, and I remembered the hardest one, from the left to the right, from the back of the iliac to the front of the iliac.
Obviously seeing that the nerves in his whole body were tense, he still pretended to be relaxed and said, "It's okay, attack my ass." Like many leukemia patients, he underwent multiple bone punctures, PIC, high-intensity chemotherapy, and blood transfusions.
We all look forward to him, like other leukemia patients, completely relieved after one course of chemotherapy, and then consolidated and waited for transplantation... and smoothly and smoothly developed in a good direction.
Bone marrow puncture site
Image source: study.com
02 A sharp turn for the worse
In late November, he suddenly suffered from right peripheral facial paralysis, and there was no abnormality in the head MRI, because the platelets were extremely low and he did not make a waist piercing, which he did not expect at the time, which was the warning of his rapid deterioration.
After the first course of chemotherapy, the results of bone piercing made everyone frown:
There is no relief at all.
After a brief discharge he was called back to the hospital again, and his facial paralysis had developed bilaterally, as well as polycranial nerve palsy. Perfect lumbar puncture reveals a very high number of white blood cells in the cerebrospinal fluid, and the results of bone puncture suggest that burkitt lymphoma is most likely involved in the bone marrow and center.
Burkitt lymphoma is highly aggressive, such as invasion and central prognosis is very poor, our hospital has no precedent for survival.
03 Death kicked the throttle to the bottom
Next he began a lumbar puncture + triple sheath injection and systemic chemotherapy once every other day. But the speed of the disease caught people off guard.
In mid-December, somehow he insisted on being discharged from the hospital, and just 3 days after discharge, he was admitted to the ward again due to high fever, followed by bloodstream infections, lung infections, meningeal infections, aerobic and anaerobic bottles, high fever seizures, delirium, coma...
It seems that Death has stepped on the throttle to the bottom, leaving us no chance to fight at all.
The last days of his life were spent in constant composure, and the night of December 26 was the coldest night in Beijing since the beginning of winter, and his heart stopped beating at 20:18, not long after his 26th birthday.
Image source: vectorstock
04 Body donation
The family offered to donate the body to Peking Union Medical College free of charge.
Looking back now,
Did he insist on being discharged from the hospital because he had a premonition of death?
What did he do during that time outside the hospital, and what did he say to his family?
Was the donation of the body a joint decision between him and his family during that time?
If so, how did they feel when they decided?
I don't know which kind of teachers and sisters he will become, and we will not and should not know the identity of the general teacher before he died. But what we should know is that these lives once bloomed and remain radiant after they passed, and we should remember that they were brave people when they were alive.
I always feel that in the face of death, any tears, sorrow, helplessness, comfort... It all seems a little powerless, but we can't help but face it, maybe like the main theme of the movie Coco, all we can do is commemorate and respect.
Image source: Movie COCO
05 Postscript: From Residency
C has become a star in the sky today.
The immediate cause was corynebacterium striated with spreading infection, and if it hadn't been for the wave of strong demands for discharge in mid-December, it probably wouldn't have gone so quickly. However, it should be a very important wish for him to be discharged from the hospital at all costs.
He was so handsome, so good, but the disease was so evil, and after only two months of discovery, he came to the end.
Finally, I also made a body donation, and his image in my heart was even higher. I recalled the scene when I was in the anatomy class 5 years ago, and I couldn't help but feel very emotional when I thought that he would become a general teacher in the ninth courtyard in the future.
I remembered how he was doing, because he had run into him and his mom in the elevator on monday afternoon the week he had left, and it felt as if he were a little weak. I said hello, and he didn't respond to me, but his mother nodded to me. Soon my floor arrived, and before I stepped out of the elevator, I said" and said, "Everything went well after the treatment," thinking that he would also make the hospitalization process as familiar with the hospitalization process like those old patients who repeatedly came to chemotherapy - over-the-occlusion - chemotherapy.
On Wednesday, he saw the results of his blood qi in the duty group, and when he saw that even the blood qi was checked, he suddenly felt bad, and asked the sister who was still in the hematology department to know that he had been in a very poor condition recently. I had been out of the hematology department for 4 weeks, and when I changed departments, he had just returned home from his first chemotherapy and rested for a few days, but he did not expect to come back to the hospital with bad news. I opened his medical records and looked at them again, and I felt heart-wrenching. Initially thought to be rapid lymph, it was later discovered that burkitt affected the bone marrow, and the IPI score had all the risk factors beyond age. After 1 course of chemotherapy, it was not relieved, and it was found that the central involvement was found - the professional group round was impressively written, "Burkitt was affected by the central center, and there is no precedent for survival in our hospital.". Come to think of it, the facial paralysis that appeared in the later stage of the first course of chemotherapy is a sign of central involvement, and it turned out that from that day on, it had already entered the countdown. After that is the waist piercing of qod, it is difficult to control the primary disease, and now there is a systemic disseminated infection infection, sudden convulsions at noon today are unconscious, and the course record says that follow-up treatment considers BiTE or CAR-T, which means that first-line chemotherapy fails; and the chances of winning later are even less than a few points.
I comforted myself, and I comforted my sister, who was also concerned about him. "Maybe there's a miracle." A patient whose condition had deteriorated to the point of being automatically discharged from the hospital had come back for a second chemotherapy, and he should have been able to do the same.
But it backfired. For the next few days, I would check every day to see if his name was still on the list and see what the medical records had been updated. Thursday's course of illness reads, "The patient's family has offered to donate the remains." This is followed by a persistent coma, cessation of antibiotics, nutritional therapy and invasive rescue. The constant pumping of liyuexi and dexmedetomidine in the list of doctors' orders suggests that the patient still existed until Sunday night, when the "respiratory heartbeat stopped" appeared.
That night, the sister of the group next door asked me if I remembered him? I said of course I remember. I remember when he didn't shave his hair, he looked exactly like the male protagonist of a Korean drama. I remember when I met him on duty and pushed him hard to the emergency room to do a CT. I remember when he and his mother were walking in the ward. I still remember the boredom in the room during the lack of time, coming to the office to bargain with us, and being driven back to the house by his brother.
The sound and smile are still there, but the sky and people are separated. Sometimes I can't remember the knowledge in the book, but it is difficult to forget the real patient. Now that I think back to the MYC gene I learned in my senior molecular biology class, I can't help but feel awe. I went back to his outpatient medical records and saw that the LDH of 1147 had soared to 1147 when he started the disease, and his heart sank.
It is also at this moment that I begin to re-understand each of the tests required in the leukemia diagnosis and treatment routine, and I begin to feel that the work of each node is very meaningful.
Let's remember him. He also continues to spur himself on, as if approaching the abyss, as if walking on thin ice. As a doctor for a day, you learn a little more. If everyone can be a little more powerful, maybe they will give patients a little more time and more opportunities.
May you be like a star, and may it be bright in the sky.
author:
Peking Union Medical College Hospital
Resident: Rabbit Xiaoman
Intern: Watermelon Green Coat, Wooden Grapefruit Adventures
EDIT: The Great Theory is Hong
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