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I asked him to contact his family immediately, because the disease could not be cured in the short term, and the hole in the lungs was so large that there could be a serious hemoptysis at any time, which was fatal. He couldn't get out of bed now, and he didn't inform his family who would take care of him to eat and drink Lazar.
—This is the 629th story of the National Stories Project—
One
Every year in August is the hottest season in Chongqing, the continuous hot weather makes all kinds of traffic accidents, drunken troubles and even criminal cases are greatly increased, every year at night shift at this time, we will treat more trauma patients caused by various reasons.
At three o'clock in the morning that day, 120 pulled back a male injured person, and the medical staff before admission explained that the patient jumped off the bridge by himself, and there were many beer bottles and snacks on the spot.
It was an emergency call from a couple selling barbecue on the bridge. The couple told them that the injured had been there drinking all night, calling people and saying that if the other person did not show up, he would jump. They also called the police, who came to persuade him and tried to help him contact his family, but he was not very drunk at the time, and he told the police that he would go home immediately. But not long after the police left, he returned to the same place, lost his heart and continued to call, always saying that he believed that he would really jump this time.
On the phone, he kept scolding "dead mother-in-law and stinky bitch", and the couple also persuaded him, and he drank back every time. After knowing that the other party turned off the phone, he was even more angry, and any ugly dirty words flew out. Seeing that there was no response on the other end of the phone, thinking that he would gradually stop the flag, the couple did not pay any more attention and continued to do their own business until they were ready to close the stall, the man suddenly stopped them, saying that his death was all caused by his wife, and he would not let her go, and then jumped.
The man should be less than thirty, far away can smell the strong smell of alcohol when he breathes, although the vital signs on the ECG monitor are stable, but because of the confusion and the blood on his face, he still has to be treated as a serious injury.
I knew that the small bridge on the moat, about four meters high, was dry at the moment, and there were many stones on the embankment. Such a height is a high fall injury, although the initial physical examination found that only a piece of the head has a tear injury, but such a large impact can easily cause serious damage to the brain, chest and abdominal organs, spine, although he drank a lot of alcohol, but can not rule out such a disorder of consciousness is caused by trauma.
I applied to open a green channel for emergency departments, and did CT examinations of the head, chest, abdomen, and spine of patients, and I was hesitant to know the patient's condition, and from time to time there would be many patients who evaded expenses in the emergency department, especially such people who were injured after drinking.
The CT results came out quickly, his scalp was severely torn, his skull was exposed, and there was a lot of dirt and grass clippings on the wound, but there was no problem in the skull, chest and abdominal organs, and spine. During this time, I contacted the police and asked them to go to the hospital to help identify the injured and contact the family.
The injured person, who has been in a coma after admission, gradually became irritable after the examination and could not cooperate with the debridement and suturing of the head. During the anesthesia, he tried several times to rip off the sterile hole towel covering his head and kicked twice at the nurse who was holding him.
Fortunately, at this time, the police had arrived, and several thick arms pressed his limbs, finally allowing him to cooperate with the debridement, but in the whole process, he began to pull his throat and howl, crying that his wife was going to abandon him, and he was completely loveless.
The debridement room is already narrow and does not allow non-medical personnel to enter on weekdays, but because of his lack of cooperation, it is crowded with people. His wounds are heavily contaminated, the scalp is torn off, and it is somewhat tricky to deal with, unlike other patients with scalp lacerations, a few stitches can be done. Caught between his wailing and the smell of blood and alcohol in the air, I resisted debridement and stitching until I was finally pressurized and bandaged.
He broke off the indwelling needle in his wrist during the struggle, and a sweet-sounding nurse gently persuaded him to cooperate with the needle again. He did cooperate, not as fierce as before, saying that he wanted to find his wife and the whole family to settle the account, taking advantage of the drunken Meng Lang, the words to the nurse also began to flirt.
After the debridement was completed, we cleaned up the blood scabs and dirt on his face, so that we could see the full picture of the injured person, if it were not for such a rogue honor of drunkenness, this face would still be a little handsome.
The police quickly confirmed his information after taking a picture of his face, that he was an out-of-town, unemployed, and divorced. As soon as I heard the news, my heart also clucked.
Another fringe man with a headache, he is no longer a big deal, but it is estimated that he can't find anyone to pay him.
The man who was sent to the ward for infusion after the operation was still uneasy, and like many patients who were restless after drinking, they kept shouting in the ward, causing complaints from the families of patients in the same ward as him. The nurse came forward many times to persuade him to no avail, and he even pulled off the compressive dressing that was wrapped over his head several times, saying that the pressure on his head was uncomfortable.
The night shift in the emergency department has never been idle, three more has passed, and the continuous high-intensity work has also almost exhausted the energy of medical staff, not only to deal with patients who continue to visit in the middle of the night, but also to deal with these fringe patients who are constantly suffering from headaches.
Between treatments for new patients, I had to go to the ward several times to check on the injured person who had fallen off the bridge. I repeatedly told him that tearing off the dressing could cause the wound to become infected, and that he had torn off such a large piece of his scalp that without dressing and pressurized, he might bleed again or have a large hematoma. And the doctors and nurses are busy in the middle of the night, and we won't care anymore if he tosses and turns like this!
Although I let go of the harsh words, I knew that if he ripped him off again, I would only be able to re-bandage him. Although he did not pay the fee, but he had a complication, he would definitely come to the hospital.
He squinted at me, and there was a hint of pleasure in his eyes. He stuck his tongue wide and said that he was just uncomfortable anyway, and if he was uncomfortable, of course, he would have to tear off the dressing. And he listened to his wife, and whenever he called her to come here, he would listen to the arrangement.
In the years of working in the emergency department, all kinds of drunken patients are naturally not uncommon, but I feel that his nonsense at this moment is not drunken nonsense, but like a huge baby, everything in the universe must be centered on him, and everyone must immediately carry out his will.
I suddenly sympathized with the woman. However, when I thought that I was already an ex-wife, I was relieved for her.
Near the morning shift, a slender young woman came to the pre-examination triage desk to inquire about the patient's condition. As soon as the nurse heard about the person she was looking for, she immediately asked her to come to me. As soon as she heard me talk about her ex-husband, she was relieved at first, but as soon as she talked about her ex-husband, her eyes and nose were red.
The ex-husband is very lazy, no job can do enough for three months, after marriage directly and completely rotten and no longer go out to work, she raises the family alone, and she has to keep wiping the ass of this giant baby husband who is always troublesome. It took a lot of work to get a divorce, and she ran away to work here, but her ex-husband still found it.
Her ex-husband called her last night and said he would have to see her anyway or he would jump off the bridge. From the time she mentioned the divorce to the divorce after the nearly two years, he often used this means to threaten her submission, so that the three days of the two-headed "wolf coming" she naturally will not pay attention to, last night she was overwhelmed, the child had a fever again, she simply shut down. When I woke up in the morning, I found that this pile of missed calls and WeChat were all persecution and threats.
Speaking of which, this beautiful-looking woman was already crying to the point of not being able to help herself.
Finally, I stayed up to work, and after a busy night, I didn't have time to repeatedly persuade. When I passed the toll room after work, I saw her holding the payment slip at the window to pay, after hearing the specific fee, she was first stunned, looked quite embarrassed, hesitated for a moment or checked out. Ct of multiple parts of the body, plus surgery fees, monitors, etc., are thousands, and they are all at their own expense.
Seeing this scene, my heart is somewhat mixed feeling, and I have such a marginal person, even if I become an ex-husband, I still can't get rid of the entanglement.
Two
A few months after this incident, I was on duty again that night, and at about one o'clock in the morning, 120 picked up a special male patient.
The patient was in his early fifties, his hair sticky and his eyes were unfocused, and Pai was glowing black under the lamp, which should be dark brown under close inspection. His groin had been festering for some time, and more than an hour ago, he found that the ulcer was bleeding non-stop, which dialed 120.
After being pulled to the examination room, his lower body was covered with dark red blood, and the bleeding place was the location of the femoral vein, and I knew the reason when I saw the part of his bleeding.
He was an addict, and to the point of intravenous injection, the femoral vein was one of the most convenient sites for these addicts to inject themselves. The hygiene in the groin is not ideal, and they are not particular about injections, so the injection site is prone to infection and the formation of fistulas, and the blood vessels are naturally affected.
At that time, my hospital had not yet established a special vascular surgery department, and such diseases were also classified as general surgery.
But when the patient was admitted, there was a difficulty, the doctor who came to the consultation looked embarrassed, frankly said that such a patient is a hot potato, they have received this kind of addict before, there is an addiction to the side of the oxygen and light a cigarette regardless of the disregard, it was on fire at the time, fortunately, it did not cause other serious consequences, but the patient himself had two degrees of burns on the face and chest, and the family was entangled for a long time.
Another was hospitalized because of cholecystitis, and during the hospital, he had a severe withdrawal reaction, which scared an old man in the same ward and almost had a heart attack. Moreover, this patient does not even have a family member, and which department to receive is a major hidden danger.
After taking hemostatics and locally vasopressing, the bleeding in his femoral veins stopped temporarily. But the doctor who came to the consultation clarified that this is just a soup to stop boiling, the fundamental problem has not been effectively solved, from the current examination situation, his arteries and veins are very bad, there are conditions it is best to go to the higher hospital to change blood vessels, so that the bottom of the salary can be drawn.
In this way, he was stranded in the observation ward of the emergency department. When he first arrived at the hospital, the pre-hospital emergency personnel helped him hang up, and when I saw his message, I was stunned, he was actually the object of preferential care, this kind of person most of them have made meritorious achievements when they were young, and now the government is also giving them preferential treatment in many places. In the case of medical treatment, they not only enjoy the right to give priority to medical treatment, but also the reimbursement ratio is much higher than that of ordinary people. It is also really sad that the heroes of the past have ended up in this kind of field.
I asked him to call his family, and he said he was divorced, he lived alone, and he still had contact with his daughter, but it was the middle of the night, it was cold, and he would talk about it during the day. The bleeding has stopped, and there is really no hurry to deal with it at the moment, and he is still a bit of a child.
Before the morning shift, I asked him to call the family again, and his wife and daughter soon arrived, and her daughter was still carrying a bowl of steaming wontons. As soon as she saw her father, she wet her eyes. After explaining the situation, the mother and daughter discussed for a while and agreed to transfer to the hospital. Just before leaving, his daughter timidly asked if the operation would cost a lot.
I confess that I don't know the specific cost, but this kind of surgery involving vascular replacement, expensive on consumables, these artificial vascular basically can not be reimbursed for any money.
After more than ten days, in the evening, the man was sent to the hospital again, not because of bleeding, but because of the mental disorder accompanied by the convulsions of the limbs, because he had recently recuperated at his ex-wife's home, and he was sent here at the first time. When he arrived at the hospital, his hands were still slightly trembling, salivating, and he was still yawning and shedding tears.
Considering that it was a withdrawal reaction, I did not do anything else. I asked her if her daughter had been operated on, and the other person bowed his head and did not say anything, but only sobbed quietly, saying that the cost of the operation was too high and exceeded their expectations.
She looked at her father, who was no longer human in the hospital bed, and cried that his father was very capable in the past and made a lot of money in business. But then the business can not live the slippery slope people gradually depressed, and made some friends, as soon as they got infected with this thing, they completely fell into the bottomless pit, these years the family has nothing, the mother and her rent a house in the living ...
The more she cried, the more she cried, saying that she also hated such a father who was not a weapon, and once she was infected with this, people were no longer human. But before that, her father treated her and her mother very well, and emotionally she could not give up on her father.
One morning when I was on shift, I heard the doctor on duty mention him, and last night he was sent to the hospital again, this time the bleeding was very bad, the conservative treatment effect was not good, and I received general surgery to stop the bleeding.
Three
In the winter, the emergency department is busier, and the number of patients with various respiratory and cardiovascular and cerebrovascular diseases has surged, and there are all kinds of patients who need to be rescued every day. Near the end of the year, a middle-aged man with a thin body was sent to the emergency department.
I have never seen such an emaciated patient, and the bones around him are tight under a thin skin. His eyes were horribly sunken in, his cheekbones bulging high, and his cheeks extremely concave, making his face look like a praying mantis in early spring.
Such severe malnutrition is mostly seen in malignant tumors or some wasting diseases, and after a preliminary physical examination, I saw that his mouth was covered with okara-like secretions, and I estimated that this person was mostly an HIV-infected person.
The terminally ill male patient was also a marginal man, and according to the hospital's medical staff, it was passers-by who found him curled up at a staircase, which hit 120.
He was in a very poor spirit, but he was also sober, but he never answered questions such as the address of his family, and even his own name and age were lied several times.
The results of the test came out quickly, he was indeed infected with HIV, and he was in the AIDS phase, with multiple infections. At that time, the inpatient ward of the infection department was reconstructed, and it was impossible to admit patients, and this three-no-one patient could only be treated in the emergency department.
With the help of the police, I finally knew the basic information of this man, a 42-year-old from Guizhou, unmarried and childless, unemployed. Both parents have died, and there is only one sister who is still in Guizhou.
I called his sister and told her the patient was very ill and asked her to come here as soon as possible. But the other party did not seem to be surprised at all, and said bluntly whether it was the onset of the disease, and she knew that he had this disease a few years ago.
The other party choked me like this for a moment without words. The public is still somewhat taboo and even demonized about this kind of disease, but she does not care about her brother's disease.
She complained to me over the phone: since she was more than ten years old, the money earned by this brother from odd jobs was basically lost in the hair washing room and massage parlor, and later she openly brought a woman home, and the woman's first look was doing that line, and the family was so angry that the lungs were going to explode, but there was no way to take him.
Later, he was hospitalized with trauma while working at the construction site, and he discovered the disease during the period, but people did not take it too seriously. When he returned home, he quarreled with his parents, saying that he had this disease and had no hope for the future, so he lay at home all day and nibbled on the whole family for more than two years.
The parents were not in good health, and then they were killed by their sons. She was heartbroken for this brother, and naturally after her parents left, she would no longer care about him, blocking all his contact information.
At the end, she also confessed that she would not care about this brother, everyone had their own lives, and he was also to blame for doing so. She hung up the phone. I can't get through anymore.
In recent years, public hospitals have given full play to their public welfare side, and naturally will not refuse to accept such a critically ill sanwu personnel, and the hospital will bear the cost of treatment, but it will only ensure basic treatment.
No one delivered food, no money to order takeout, and his three meals were provided by the hospital canteen. But every time I went to check the room, I saw that the food in the box had basically not moved, and often appeared in the garbage can intact.
He also never communicated with people, there was no light in those eyes, and the kind of decadence and gray defeat did not look like the eyes of a living person. He also knew that his time was approaching, and calmly waited for the day to come.
Or a few years ago, when he first learned of this disease, he was already waiting for this day. As long as he would be willing to eat the antiviral drugs distributed by the hospital for free, he would never end up like this.
His condition is still deteriorating, repeated fever and shivering, the waking time of the day is getting shorter and shorter, the whole person is even more emaciated than when he first arrived at the hospital, and it is estimated that he will not be able to survive the Spring Festival.
He was completely unable to take care of himself, and he had incontinence, and the nurse had to change his sheets and bedding after a while, and the nurses on duty were bitter every shift.
I changed the number to call his sister, this time she did answer, but after hearing the intention, she also said concisely, really when it came to that time, she would notify the funeral home. She wouldn't claim the body either, and the person who killed her parents would let him be a lone ghost. She hung up the phone again resolutely, giving no room for maneuver.
All the holidays for the emergency department are like a robbery, in addition to the inevitable surge of internal diseases in winter, the closer to the Spring Festival, because of debt conflicts or family disputes and other reasons injured or even slashed patients have also surged, all kinds of traffic accidents are more frequent, every time, all the staff on duty in the department are overloaded.
Just when everyone was busy in the dark, the nurse in the ward suddenly shouted, the patient is not OK, hurry to rescue. I knew he was in the last two days, but I didn't expect to lose my temper in my class.
Although we know that death is inevitable, the rescue process that should be in place in the hospital still has to be there. During regular CPR, without a few presses, I heard the sound of my ribs breaking. He was even more eerily thin, a skeleton, the skin on his chest stretched like a thin piece of rice paper on every rib.
After half an hour of CPR, he still didn't have spontaneous breathing and heart rate, and the nurse gave him an electrocardiogram, an incredibly flat straight line that could be pronounced dead. The funeral home also came quickly, I had told them on the phone that the patient had an infectious disease, and the staff who came was dressed very formally, N95 masks, isolation gowns, and latex gloves were all matched. Because it was contagious, we worked with the funeral home staff to move people into white bags.
As soon as the man was pulled away, the cleaning aunt began to clean up the bed and bedside table. Having worked in the hospital for a long time, my aunt was no surprised by these things. But everything he used was received by his aunt in a yellow garbage bag and disposed of according to medical waste. Soon, the messy scene was cleaned up, and a young nurse who was interning began to disinfect the bed, everything was proceeding in an orderly manner, and all traces of his existence were removed.
Four
During the New Year, the workload of the emergency department is too large, and the outpatient emergency department alone is already tired of coping, so it is generally not distracted to treat inpatients here, but on the third day of the Chinese New Year, we made an exception again.
This morning, a twenty-eight-year-old young man was sent to the department by 120, and the same patient who died on the eve of the Spring Festival, this young man was horribly thin, the limb muscles were also atrophied, it seemed that he had been bedridden for a long time, and he had seen many elderly patients who were forced to stay in bed because of incapacity over the years, and their limbs were all so thin and thin, and they felt that if they did not pay attention, they could break their limbs. Such a young person is like this, and it is easy for me to think in the direction of infectious diseases at the first time.
When he first arrived at the emergency room, his whole body was cyanosis, the lack of oxygen was very serious, the breathing was severe, like he had just run a marathon, there was no way to communicate with people normally, and he checked the blood gas analysis and had severe respiratory failure.
After the high flow of oxygen in the mask, his symptoms improved slightly, and he was barely able to communicate with people. He said that he coughed and coughed phlegm for a long time, intermittently bought some medicines in the pharmacy, but the effect was not good, these days he felt more and more tired, getting out of bed activities are difficult, until today he feels that he can no longer drag on, which is 120.
Although the patient is also thin and out of phase, but from the temperament of the conversation, it is also like a good education, and it is young, not to make themselves like this. He had been in the emergency room for some time, but no one had registered, let alone his family. I asked him to contact his family quickly, but he kept pushing back that he was seriously ill with a cold.
Because severe respiratory symptoms are accompanied by such severe malnutrition, it is inconvenient to keep him in the rescue room even if he is tuberculosis. I applied for a chest CT scan of the emergency green channel, and sure enough, it was tuberculosis, and both lungs were full of lesions and full of holes, no wonder he had such a heavy respiratory failure.
The renovation of the infection ward has not yet been completed, which means that such an infectious disease patient can only be treated in the emergency department, and he has been placed in the isolation ward where the deceased patient stayed the other day.
When I went in again, I changed into an N95 mask and asked him to contact his family immediately, this disease cannot be cured in a short period of time, and the lung is so large that there may be severe hemoptysis at any time, which is fatal. He couldn't get out of bed now, and he didn't inform his family who would take care of him to eat and drink Lazar.
Thinking of the scene of the department staff taking care of the marginalized person who was completely abandoned by the family the other day, I will never let a similar situation happen again this time.
That afternoon, his father rushed to the hospital. His father must have been in his sixties, dressed and behaved decently, and when he saw his son like that, he burst into tears.
After understanding his son's condition, he immediately expressed his request for active treatment and paid the deposit at the window. Only then did his father know that he had not gone to work more than a year ago, that health insurance and social security had long since been cut off, and that he could only pay for his own hospitalization.
The patient's sputum smear to find the results of acid-fast bacilli also came out quickly, several plus signs, such patients are very contagious, we also told his father to take care of more carefully, sputum must be destroyed in time, after all, tuberculosis bacteria are inside. And told him to strengthen the nutrition of his son, tuberculosis itself is a very expendable infectious disease.
On the day the patient arrived at the department, the asthma symptoms worsened, and the blood oxygen saturation was still low under the high-flow oxygen inhalation of the mask, so he switched to a non-invasive ventilator. However, the patient's cooperation is extremely poor, and it is always said that wearing a ventilator mask is uncomfortable, and the mask is ripped off five times at night. After each removal, the oxygen saturation dropped sharply, and his father carefully soothed it like he was coaxing a toddler to inject, but he intensified it, saying that death would die, and he did not want to wear it anyway.
After the nurse, who was too busy to get on the ground at night, reprimanded him a few times, he did improve slightly, but each time he would stubbornly take off his mask after his symptoms were slightly better. Until he suddenly began to cough up blood, the amount was not much, and it was estimated that it was only a few milliliters or so, but this time he was not lightly frightened, and obediently cooperated with the doctors and nurses. He reminded me of the drunk man who jumped off the bridge a few months ago, no matter how old they were, they were still giant babies.
In his father's mouth, I learned some basic information about him. He also has an older sister, but the relationship between the sisters and brothers has been very poor since childhood, and after the death of their mother a few years ago, the sisters and brothers have no contact with each other. After his father retired, he helped his sister take care of the housework with the children in another city, and they did not live together.
He came here to work after graduating from college six years ago, he studied art and design, but what kind of work he was doing all these years, his father did not know at all, just three days and two ends of the father asked for money, these years his retirement salary is basically all attached to his son.
In this way, the sister was also angry with her father, blaming him for spoiling his brother, and when he was old, he was still nibbling on the old, afraid that his father could not help but help this incomplete brother, she simply took his father's salary card.
But Rao was so, the father was still careful to help his son in the field, but he could not come up with so much money, and the son did not want to call him again after arguing with him several times. The next time I got a call from my son was to know that he was sick and hospitalized.
He has not been to work for more than a year, has been staying in the Internet café, and relies on takeaways on weekdays.
No wonder you get such a disease. The Internet café is a place with a closed space, the air does not circulate, he eats takeaway for a long time and stays up all night, and his immunity is also poor, so he naturally becomes a tuberculosis susceptible group.
He needed a human blood albumin transfusion because albumin was too low, so his father bought ten bottles at a time. In order to improve his nutritional status, his father prescribed thousands of yuan of nutritional powder in the nutrition department. But he always complained that the nutritional powder was difficult to drink, and his father urged him to drink it every time, but he was always lazy to take care of it, until it became cold and lumpy, so that his father would pour it out and re-brew it.
His breathing gradually stabilized, and people became more and more energetic, but every time in the middle of the night he always said that his stomach was uncomfortable, at first I thought it was the cause of tuberculosis drugs, but I knew that every day I carried us to order hot pot powder, fried chicken and other takeaways when supper, I scolded in my heart.
At that time, he had already got rid of the ventilator, but he still did not want to get out of bed and go to the toilet, which was a complete degeneration to the state of a toddler, eating, drinking, washing his face, wiping his body and defecation, all of which were taken care of by his sixty-year-old father.
At that time, he was playing games in the hospital bed, and his father was helping him massage his lower limbs, and he had not gotten out of bed for too long, and he had to help his son passively exercise to make the muscle atrophy better. During this period, his son suddenly began to cough, and he immediately used toilet paper to help his son pick up phlegm.
When the patient's symptoms improved, I suggested that he be discharged from the hospital, and his father asked if he could be treated for a longer period of time. I told the other party that the treatment time of this disease is very long, at least half a year, there is no need to stay in the hospital, you can first go to the tuberculosis clinic to prescribe medicine and go home to recuperate, and regularly review it.
Another thing I didn't tell this father, the medical staff in the department didn't want to see his giant baby again.
Five
After the fifteenth day of the New Year, the department gradually stopped, although it was still as fast-paced as ever, but the intensity and pressure of the good work were much smaller than those in the New Year.
This night was still on duty, this night most of the treatment is all kinds of abdominal pain, eat too well during the Spring Festival, cholecystitis, pancreatitis, gastroenteritis are also door to door. When I met the girl in the pink down jacket, I felt that her eyes were somewhat familiar, and she recognized me, and said hello at the first time, she was the daughter of the addict I had treated earlier.
She broke her wrist when she went downstairs, and her wrist was so swollen that she came to the hospital to take a film. I gave her a checklist, and it didn't take long for her to come back with the film.
Nothing to do, just go back and chill it. There were not many people this night, and I had been in contact with her several times, and I was half an acquaintance, and I asked about her father's recent situation.
He left on the second day of junior high school. Her voice was soft, and although I sat close to her, I could barely hear it. Her face was half hanging, and I couldn't see her expression clearly. But for some reason, when I heard this news, I suddenly felt a little relieved.
(Excerpt from the WeChat public account National Story Project, the seventh night / text)