Life is not only a big book that we can never penetrate, but also a drama full of helplessness and entanglement that is always live, right?
Wen | dopamine
Figure | network
At three o'clock in the morning, time passed through my heart like a sword, taking away another day's life, leaving me with another deep and sharp pain.
The rescue room was full of lives that were dying, they groaned, they were silent, they struggled, they gave up...
No one can stop the passage of life, just as no one can stop the passing of time.
And, as healers, what we can do is very limited.
Perhaps, all we can do is repair the local organs, but only slightly delay the pace of death.
Not to mention, there are human beings and souls that we can't look at directly.
Zhao Bold, who was busy replacing the infusion pump for other patients, couldn't help but say: "What do the family members say, do they give up or treat?" ”。
"You know, as long as I see this kind of dress, I always feel a little hairy in my heart." Zhao Bold seemed to be talking to himself again.
I didn't answer Zhao's bold question because I didn't know the family's answer, and all we had to do was before the family made the decision to give up treatment: perform their duties and do everything they could to save lives.
Source: Emergency Department Physician
2 hours ago, 120 ambulances stopped in the emergency room.
Pushed down from the ambulance was an elderly man less than 70 years old with sunken eye sockets, already unconscious.
What shocked me was not the patient's serious illness, but the eerie attire.
Seeing that the patient was wearing a flowery birthday robe all over his body, it was obvious that the patient had been regarded as a dead person by his family.
"They've all put on their birthday clothes, so why were they sent to the hospital again?" I can't help but mutter something about this anomaly.
Accompanying the patient to the hospital was a large group of people, some crying, some howling, some silent, some watching coldly...
From the mouth of the patient's daughter, I finally learned about the patient's condition:
About 8 hours ago, the family found that the patient was not responding.
Because they are in the countryside, the family just invited a rural doctor to their home for treatment.
The doctor found that the patient had been unconscious, and he recommended that the family immediately send the patient to a large hospital for further rescue treatment.
However, after consultation between the patient's two sons, the patient was not taken to the hospital.
They themselves felt that the old man was about to die and there was no need to come to the hospital, so they decided to start the funeral.
After 5 hours of the patient being judged to be in a coma by the doctors, the patient's daughter finally rushed home from the field.
What just appeared in front of her was no longer her father who could communicate, but a father who was dressed in a birthday coat.
If you look at it according to common sense, the patient will die slowly, and the relatives will find some kind of psychological comfort in crying and crying.
Then the dead are gone, and the living are still there.
However, after nearly 5 hours, the patient still did not stop breathing and heartbeat.
After the old man was sent to the rescue room, there was a difficult problem that made me helpless with Zhao Bold.
Because this kind of birthday coat is worn in as many as six layers, it is difficult to take it off for a while.
Inexperienced people may not understand that for patients who are unconscious, especially those who are unconscious and in a state of near-death, the body seems to become extremely heavy, and it is difficult to take off clothes quickly.
If these heavy clothes are not removed, it is difficult for nurses to puncture, doctors to have difficult physical examinations, and even an electrocardiogram cannot be done.
"If you can't take off your clothes, you can't cut them off, right?"
Taking off or even cutting off the birthday clothes that have been worn on the body is an emotionally unacceptable application for Chinese, and it is also a relatively "obscure" thing.
However, if these clothes are not removed, it is bound to have an impact on diagnosis and treatment. Although I am an atheist, I also have to take into account the wishes of my family.
After communicating with the old man's children, the old man's eldest son and daughter finally decided to cut off these cumbersome clothes, but the younger son still had some small words.
"Doctor, is my father still saved?" The patient's daughter pleaded.
This is a question that makes it difficult for me to answer because I have no understanding of the condition of the elderly.
"From experience, the condition is very serious, but I don't know the specific reason, and no tests have been done." The family's questions made it difficult for me to answer.
But the children were not satisfied with this answer, and they asked, "Doctor, how long can my father survive?" ”。
Doctors only see doctors, they can't tell fortunes, and they don't have clairvoyant eyes.
There are many reasons that can cause a 70-year-old man to suddenly coma, such as cardiovascular and cerebrovascular diseases, such as endocrine metabolic diseases, and even the possibility of poisoning.
Judging the severity of a patient's condition is not an easy task, it requires the doctor's experience, the patient's medical history, the results of the examination, and so on.
"If there is no salvation, it is not necessary." The patient's younger son continued.
I looked at my young son who was talking and didn't answer him, because I didn't know if the old man lying in front of me still had any rescue value or hope of survival.
At this time, Zhao Bold has linked an ECG monitor for the patient: blood pressure 60/30mmHg, 12 breaths per minute, pulse 45 times per minute, and finger pulse oxygen 80%.
The problem of the patient's younger son is the most headache for me, and it is also the problem that makes me complain the most.
Because he indirectly threw all the pots to the doctor, the implication was that if he cut off his clothes, it meant that he must be rescued. If you don't cut off your clothes, it means that the doctor has declared that there is no need for rescue.
Zhao boldly measured peripheral blood glucose for patients while trying a venipuncture.
The only two words I can answer to the family are: "What is the purpose of your sending the elderly to the hospital?" "If you actively rescue, there may be a glimmer of hope, if you do not rescue, there is no hope at all." ”
After a few seconds of silence, the daughter said: "Doctor, this is not a matter of money, we also want to treat, if you rescue, you are worried about the old man's crime, and if you do not rescue, you will not go in conscience." ”
I was examining the pupils of this old man wearing a breathing mask with a peripheral blood glucose of 3.9 mmo/l, only to see large isocircles on both sides of the pupil, 5.0 mmo/l in diameter, and a sluggish reflex to light.
The mood of the family is understandable, but if you want to treat, some tests are essential, such as arterial blood gas analysis, electrocardiogram, head CT, etc.; some measures are also essential, such as tracheal intubation, deep vein catheterization, catheter and so on.
In addition to the discussion among the family members, I learned more information from my mouth.
The old man has been paralyzed for three years, living in the basement of his younger son's house on weekdays, and even urinating and defecating cannot take care of himself.
On weekdays, the two sons take turns to take care of the family, and the daughter rarely takes care of the elderly because she is hundreds of miles away.
A week ago, the elderly began to cough and cough up sputum, which affected sleep when severe.
However, the family members only bought some oral medicines, because they thought that the elderly only had a cold once.
Until the day of the incident, when the younger son delivered food for him, he found that the patient was reclining on the bed in a semi-reclining position, which was no longer deserved.
After discussion, the two sons decided not to go to the hospital again, not only because the patient was already unconscious, but more importantly, for the father, who had been paralyzed for three years and could not take care of himself: death may be a relief.
So, they began to organize the funeral, and put on a six-layer birthday robe for the old man!
However, after the daughter rushed to the house, she found that the old man was still breathing, so she strongly demanded that the old man be taken to the hospital despite the discouragement.
Some people say: Emergency doctors have seen so many deaths, are they still afraid?
I wasn't scared, I was upset.
What disturbs me is that lying in front of me is a life, albeit a life that will never be recovered.
However, the responsibility of the doctor, the respect for life, and the helplessness of reality had to make me feel painful and entangled in my heart.
What makes me feel uneasy is not those thick flowers and green birthday clothes, not the end of life, but the helplessness and human feelings reflected on the cold life clothes.
The comatose old man in the hospital bed reminded me of my grandmother, who suddenly fell unconscious due to cerebral hemorrhage.
At that time, the doctor at the county hospital told his father and uncle: "Even if you operate, it is estimated that you will not be able to get off the operating table." Later, the uncle and father decided to abandon the treatment and brought grandma home.
In fact, at that time, Grandma also had a heartbeat and breathing, but the elders had already put on a birthday dress for Grandma, because there was a custom that if you put on a shou robe when your heartbeat had not stopped, the Huangquan Road would be safe.
The whole family wore ma dai filial piety in front of grandma's hospital bed, and some respected people said that it was because the mirror in the middle of the house blocked the way of grandma's soul, so the old man refused to leave.
Perhaps by coincidence, Grandma soon lost any signs of life after taking the mirror away.
It wasn't until the day my grandmother came out of the funeral that I realized I had completely lost her.
It wasn't until many years later, when I stepped into a clinical position, that I realized that my grandmother, who was lying on the spiritual hall at that time, was still a person with a breathing heartbeat.
It wasn't until more years later, when I was accustomed to parting in life and death, that I truly realized that although this is cruel, sometimes it is not the same as filial piety.
It wasn't until I was a little tired of the industry and the position that I deeply realized: Don't easily blame others for making decisions, because we simply can't appreciate the hardships and bitterness of others.
There are many cases such as my grandmother and this comatose old man in reality, and not everyone who is dying in danger of dying has begun to attend the funeral after the doctor's rescue is ineffective and declared clinically dead.
Although this is a very complex social cause and cultural phenomenon, we cannot simply and rudely accuse the family of ruthlessness and filial piety.
Every family has its own story, everyone has their own helplessness, and every patient has his own story.
"Let's put it here first, and then we'll decide after we've discussed it?" After my younger son told me, I was still not at ease.
At this time, I had already painstakingly removed two layers of clothing for the old man, and was preparing to pick up scissors and cut off the rest of the clothes.
Although it has taken a lot of time in terms of text, it actually did not take more than ten minutes from the time the old man was taken to the hospital to the time I removed two layers of clothing for the old man.
I can fully understand the feelings and wishes of the family members, but this is not in line with the rescue process, especially the rescue time that will delay the race against the clock.
Because the family can say this: "After the old man was sent to the hospital, the doctor did not do any rescue except for checking the blood sugar!" ”。
It is not that I am a villain, but I must take into account this possibility.
Not only because this is not in line with the doctor's principles and the process of treatment, but also because of the ancient people's heart and the tense doctor-patient relationship, I always pay attention to protecting myself.
Therefore, I deliberately stood in a position with video surveillance and secretly turned on the function of mobile phone recording.
Sometimes what we see is not necessarily the truth, at least not the whole truth. We cannot use morality to kidnap the helplessness of others, because morality cannot fill the belly.
The children outside the rescue room are engaged in a "war" of bargaining between you and me, which is perhaps the most difficult time in the children's lives!
The old man's youngest son repeatedly confided in me: the old man has been ill for many years, has spent a lot of money, and we have tried our best.
The other son, however, never spoke.
Only the daughter of the old man repeatedly asked the question that I could not answer precisely: "How long can it last?" ”。
"You can die at any time, you can die the next minute, or you can drag on for a while." This is the truest situation for patients, and it is also an inevitable fact.
In this way, after nearly an hour of stalemate, the old man's cousin, another old man, pulled on my clothes and said, "Even if it is cured, it will be a sin to live." If it doesn't work, we'll pull it home. ”
At five o'clock in the morning, at the turn of night and dawn: the old man who had come to the hospital in his birthday robe was brought home again.
I never even understood the purpose or significance of their coming to the hospital: neither examination nor treatment, or even getting the doctor to completely remove the old man's life clothes.
Come and go in a hurry.
Even acting in an incomprehensible drama, but it is just a life drama at the cost of life.
In fact, many elderly people are sent to the hospital not for real rescue treatment, but only to complete the patient's last wish or just to express their attitude to relatives and friends.
If they meet a family member who understands the matter, they themselves will say to the doctor: "Give up the rescue, leave the hospital automatically, and bear the consequences."
If you meet a family member who does not understand the matter, it is a very troublesome thing for the doctor. Because the family members themselves are not willing to actively rescue treatment, but also unwilling to give up.
Judging from experience, the cause of the sudden coma after the elderly cough for a week is entirely likely to be lung infection and respiratory failure.
Unfortunately, my family did not give me the opportunity to prove it.
If you treat it at all costs, you may not have no hope of life.
But will this kind of life really be what the old man himself hopes?
No one knows in that dark and unventilated basement, in the night when it is difficult to sleep with coughing, at the moment when life cannot take care of itself, whether the old man's heart is longing for life or going to heaven?
The words of a few children can only make me feel the real world, but the words of the old man's cousin really touched my heart.
We cannot blame others because we cannot feel the lives and lives of others.
If you have not experienced the joys and sorrows of the world, if you have not fought with life, you will not be able to appreciate the true meaning of life.
Perhaps, they sent the elderly to the hospital for only one purpose: to come to the hospital in order to come to the hospital.
"Doctor, how long can my father survive?"
The words of the family members have been repeated countless times in my ears, they are not longing for a miracle to appear, but looking forward to the arrival of death.
Although it sounds cruel, I can understand it very well.
Xingbiao pays attention to the "Last Dopamine" WeChat public account
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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