The old lady proudly told me, "Don't look at him for not being clear-headed, he has arranged things clearly and clearly, and they have been hung on the wall." ”
"What did you hang on the wall?"
Looking at me a little confused, the white-haired old lady told me in a loud voice, "He hung himself on the wall." ”
Wen | dopamine
Figure | network
cold wave
Two months ago, a cold wave struck.
The temperature drops suddenly, and even if you look at the circulating central air conditioner in the emergency room, you can still feel the slightest coolness.
The cold between Jianghuai and Huaihuai, with a breath of moisture. It is different from the cold in the north, and it is more of a taste that southerners cannot experience.
Whenever a cold wave strikes or the temperature plummets, it is the time when the emergency department doctor is extremely busy. Because temperature is one of the main culprits of various diseases, especially cardiovascular and cerebrovascular diseases and respiratory diseases.
On those days, the emergency room will concentrate on a group of patients with hypertensive emergencies, acute myocardial infarction, cerebral hemorrhage, acute exacerbation of chronic obstructive pulmonary disease, and respiratory failure.
This is one of the consequences of seasonal changes, and it is also the law of the occurrence and development of diseases. No one can change it, even if most homes now have air conditioning or heating.
At ten o'clock in the evening, an elderly couple came to the emergency room, and they helped each other into the emergency center.
Both people are already gray-haired, both are faltering, both have poor hearing, and they must raise their voices when communicating.
Although the elderly couple are relatively old, fortunately, both of them are still conscious, at least able to answer the questions.
After entering the emergency room, the old lady settled the old man on the bench and sat down. After taking off his own scarf, he helped to undo the old man's scarf. But it is obvious that it is difficult to untie for a while, and it seems to be a dead knot.
"What's wrong with the old man?" A little breathless? "While the old lady was untying the scarf for the old man, I asked.
The old lady did not answer my question head-on, but complained to the old man: "You dead old man, let you not tie so tightly, you have to make it like this..."
"It doesn't matter, don't rush to untie this first, how is the old man uncomfortable?" Since I couldn't undo the scarf for a while, I asked the old lady to stop first.
"It's cold, and he's making the old mistake again." I get sick at this time of year, and I was hospitalized in your hospital last year. Many doctors know him. The old lady laughed as she spoke.
Although the old lady believes that this is only the patient's old problem, the old problem does not mean that it is a small problem, but may lead to serious consequences due to the paralysis of the patient and his family.
"I look a little breathless!" Obviously, the old man in front of him was a little short of breath, and even a little wheezing. "Undo your clothes and I'll listen."
For this elderly male patient who looks a little short of breath, this time may be another episode of the old disease, but behind it, will there be some fatal problem hidden?
I reached out to help undo the scarf and button on the front of the patient's neck, and the old lady echoed, "It's too cold, and it's a sad end." ”
asthma
"It's so cold, three or more midnight, how come it's just the two of you, the children?" I wondered why there were no younger family members accompanying the two elderly people to the hospital. After all, the weather is very cold, it is late at night, and the two old people are very inconvenient to move.
"Kids are at work." The patient himself finally spoke, but after saying this sentence, he obviously gasped more.
Removing the red scarf that surrounded the patient's neck and unbuttoning the old man's layers of clothing, I finally managed to extend the auscultation area into the old man's chest.
"What other class is on this point?" It must be a refusal to notify the family. "While I was doing a physical examination, I was speculating in my head about why the two elderly people came to the hospital alone late at night. After all, this happens often, either because there are really no family members nearby, or because the elderly themselves refuse to bother their children.
Auscultation is clearly able to feel the wheezing and crackles in the patient's body, and physical examination also reveals that the patient's lower extremities have developed moderately depressed edema.
"How long did you catch your breath?"
The old lady held out her finger and said, "At least four or five days." ”
The patient looked at the old lady, but was not satisfied with the answer, and he told me: "She is talking nonsense, and I feel that at least a week has passed." ”
Listening to the patient's rebuttal, the old lady skimmed her mouth, shook her head, and corrected: "He is confused, not so long, on Sunday, you still go for a walk, okay." ”
The patient stared at the old lady, very dissatisfied with her answer: "That is, I don't know!" The implication is that he is very aware of his condition.
The two sentences argued, and the patient gasped even harder.
"Okay, okay, I see, four or five days is about the same as a week." Why don't you come to see the doctor during the day and only come now? I hurried to divert the topic so that the two old men would not continue to quarrel over this issue.
"I can't sleep anymore, so I have to come and see." The old lady stood behind the old man, talking, pouting and indicating that the patient did not want to come to the hospital during the day, and had to go to the hospital at night when he could not sleep.
I opened the patient's last hospitalization record and found that the old man's disease was not just superficially "asthmatic", he had many underlying diseases: chronic obstructive pulmonary disease, emphysema, pulmonary vesicles, hypertension grade 3 (extremely high risk), type 2 diabetes, diabetic nephropathy (CKD stage), coronary heart disease, after PCI surgery, and even chest closure drainage because of pneumothorax.
"Let's check it out, you have a lot of problems, they are very serious." Although it is obvious that the elderly have heart, lungs and kidney problems, they still need to be perfected and further evaluated.
The patient agreed to the examination, but the old lady was unwilling, she said: "Every time I am hospitalized, I have to check, it is these diseases, we all know." ”
"Whatever the doctor tells you to do, you do." The patient began to argue with his wife again.
"Or check it out, I'll see the specific situation, so that it's better to prescribe the right medicine." If the test results are serious, you will be hospitalized, and if you can hang up the potion in the emergency room for a few days. "Many elderly people are not willing to be hospitalized, and they can insist on it in the outpatient emergency department, because they always feel that hospitalization means that they have a serious illness."
Seeing me say this, the old lady had no opinion.
Source: "White Tower"
outcome
I asked the nurse to bring in a wheelchair and let the patient sit on it. Although the patient's breathing, heart rate, and finger pulse oxygen at this moment are OK, it can be estimated that if the patient is active, it will inevitably aggravate the condition.
The old lady pushed the patient for examination, but threw the patient's red scarf in the emergency room. Because it wouldn't take long for the two elderly people to return to the emergency room again, I didn't call them back to get their scarves.
I picked up the scarf and prepared to throw it in the corner of my job. But when I picked up the scarf, I was attracted by a small cloth on the scarf.
It was a small square piece of white cloth, like a commodity label, but hand-sewn over a scarf. The white cloth is densely covered with words. When you look at it, it actually has the words in the Diamond Sutra written on it.
This made me very curious, because I had never seen anyone write on such a small piece of cloth, and the handwriting was small and neat, obviously with care.
After a while, the results of the examination came out.
There are many problems, and they are so serious that it seems impossible to treat them with emergency infusions alone.
Chest CT suggests a large area of lung infection, with the lower and middle third of the right lung already infected and mutated. Blood gas analysis boosts type II exhalation, biochemistry is almost all high and low arrows, and BNP results have exceeded 35,000.
It's no wonder that patients have chest tightness and wheezing, and it's not surprising that even if they are unconscious.
In fact, in the emergency department, patients with such a condition can often be encountered. Sometimes, more than half of the patients lying in the emergency room are elderly people with such heart failure and wheezing.
"This situation requires hospitalization, not a matter of hanging a potion for a few days. You better inform your niece. "I communicated with the two old men in plain language.
Because the ward is temporarily bedless, and because the waiting time for nucleic acid examination is long, the elderly can only be arranged to monitor the infusion treatment in the emergency room at night. to wait for the next day's bed.
The two elderly people did not disagree with the treatment opinion, but only asked that if it did not work, the endotracheal intubation should not be stopped. Because the elderly have been hospitalized many times and are critically ill many times, it is very clear what the consequences of respiratory failure that are difficult to correct may be.
"I, 83, understand everything!" In order to prove that he was conscious, the patient deliberately raised his arm and danced to me.
"I know, as long as you know the situation yourself and sign it yourself." For the conscious patient, all decisions are naturally up to them, but only if the patient understands the consequences of the decisions he or she makes.
In this way, the patient was arranged to infuse fluids and use a noninvasive ventilator.
On the wall
The patient was being treated while lying in a hospital bed, and the symptoms of chest tightness and wheezing had been alleviated.
After busying the other patients, I remembered the red scarf that the old man had thrown in the emergency room. I returned the scarf to the old lady and asked her, "Is the word on it the Diamond Sutra?" ”
The old lady was surprised that I would know the above.
"Yes." This is safe.
"Do you believe in Buddhism?"
The old lady put the scarf in her bag and told me, "I didn't believe it. This scarf was woven by my daughter, and the words were written by me. Picture a gilli. You doctors must not believe it. ”
People always have some faith, and only with faith can there be hope. Although some people's beliefs are science, some people's beliefs are religions, and even some people's beliefs are superstitions.
But in a sense, it is all a sustenance, a wish.
"Do you want to talk to your daughter about this situation, if it really gets serious, it is better to be prepared, otherwise she will complain that you don't tell her." Although the patient himself has signed, he still has to notify the family, after all, the two elderly people are old, if there is an unexpected situation, it may not be calm to deal with.
The old lady poured out the truth: "She is abroad, she can't help, I really want to tell her, it is also tomorrow's matter." ”
"Oh." I finally understood why the two elderly people came to the hospital alone in the middle of the night.
Seeing that I was thinking about it, the old lady proudly told me: "Don't look at him as if his mind is not clear, he has arranged things clearly, and he has hung them on the wall." ”
"Huh?"
"He hung his picture on the wall!" Under the explanation of the old lady, I finally understood that the old man had prepared the statue and had already hung it on the wall.
Hearing the old lady's words, I didn't know how to answer for a while.
When people are still alive, they have already prepared a portrait, which is a very taboo thing, not to mention that the statue is hung at home early.
There may be many reasons why the elderly do this. But one thing that can also be seen and admired is that this patient of mine is not afraid of death.
As a doctor, I naturally can't ask why the old man did this, what kind of story the old man's family has, and I can only perfunctorily conform to the old lady: "It's okay, he has a clear mind now." ”
old age
After a night of work on a non-invasive ventilator, with the help of drugs such as furosemide and methylprednisolone, the old man survived another winter night, and even his breathing felt much smoother.
The wards have been contacted and the nucleic acid results have been released. Now you only need to wait for the last patient to complete the discharge procedures, you can apply for the admission procedures for the elderly.
The patient recovered very well, and even comforted the patient in the next bed: "Man, that's it, who can not die?" Eyes closed, legs extended, nothing felt. ”
The patient in the next bed did not have the heart to take care of him, and even became impatient. Because this is a 60-year-old patient with acute myocardial infarction waiting to be sent to the operating room for surgery.
I quickly stopped the old man's stubble, deeply afraid that his remarks would affect the psychology of other patients.
"Rest well and don't talk much. I know, you've hung yourself on the wall. I held out my thumb and gave him a thumbs up gesture.
He didn't speak again, like a child who had made a mistake, always peeking at the people coming and going in the emergency room.
Such elderly people often appear in the emergency room, they are not afraid of death, afraid of loneliness.
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Great stories never to be missed
I measured the lives of one person after another with a stethoscope, and the lives that passed in my hands explained to me the meaning of life with drops and tears piled up in the corners of my eyes.
I was the last dopamine to record sounds from the real world.
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