A few days ago, some old people suddenly wanted to see the nearby rape flowers, they got into wheelchairs, and were pushed by Huang Li and colleagues to set off to the golden field. The sun was shining, the old man was surrounded by flowers, and Huang Li thought, "Living well in every present is respect for death." ”
The full text is 6654 words, and it takes about 13 minutes to read
Beijing News reporter Wang Chang Editor Hu Jie Proofreader Chen Diyan
Everything is the most ordinary rural streetscape.
As the three-wheeled motorcycle passed, vendors set up stalls along the road and roared in the town with a Sichuan accent. There is a mahjong table on the side of the street, people smoke and play cards on the side of the road, and if a living person walks by, the earth dog in front of the door will bark wildly.
Along the cement road, from shifang city in Sichuan province to Nanquan town, you have to pass through a large field of rape flowers. Every narrow fork in the road is a road to the countryside. Nanquan Town Health Center is located in such a place.
On the afternoon of March 19, the funeral home car came again. As soon as a black car appeared in the street, two vendors on the side of the road hid in a nearby shop. It wasn't until the sound of firecrackers sounded and the black car carrying the body walked away that they stepped out to continue supporting the stall. "It's a bit obscure." They skimmed their lips.
In 2017, Nanquan Town Health Center became the first batch of national hospice care pilot units in Deyang City, and officially established the Hospice Care Department to treat end-of-life patients within 3 to 6 months for townships. The wards are opened at the Tiemenkan Branch, where the 6 hospice wards can accommodate 12 patients.
Since then, 93 people have received palliative care services at the Nanquan Town Health Center. On this day, the 73rd elderly man living in the hospice ward passed away.
Nationwide, in first-level hospitals such as the Nanquan Town Health Center, there are still a few attempts to open hospice departments. In townships where everyone is afraid of death, it is not an easy task to let the dying elderly walk the last journey of life with dignity.
▲Nanquan Town Health Center Tiemenkan Branch, the 2nd floor is a hospice ward. Beijing News reporter Wang Chang photographed
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One day in early March, an elderly man living in a hospice ward decided to commit suicide. He wrapped the tube of the ventilator around his neck and pulled hard.
His son pushed the door in and untied the tube, "You're going to kill yourself? The old man nodded. The cancer had spread almost throughout his body, and the pain was his only experience. The use of morphine became more and more frequent, and after a short while of taking the drug, he whimpered in pain.
The pain of cancer patients is a thorn in the heart of Yang Zunqiang, president of Nanquan Town Health Center. In 2012, his father developed a tumor and the pain quickly spread throughout his body. After a long time, there was a gap between father and son, and a person blamed me, I am in such pain, you can't cure me as a hospital director? A person blames himself, and it turns out that the doctor is powerless.
During an exchange trip, Yang Zunqiang learned that the hospice department can treat terminal patients with an end-of-life period of 3 to 6 months, and morphine is used in unlimited quantities here, all to alleviate the pain of patients and make them accept death with more dignity. However, such departments are mostly established in large cities, and the cost is high.
Are there no cancer patients in the countryside? Yang Zunqiang found that the problem of nursing is a pain point in society, "those families do not have professional nursing knowledge, often one person is sick, and the whole family is dragged away." ”
Yu Guanghui, a doctor at the Nanquan Town Health Center, has personally experienced such pain, his uncle died of esophageal cancer, first what to eat and vomit, the whole person was skinny into a skin and bone, and then the pain was not good, the only daughter quit her job, took care of it all night, the old man covered his chest and screamed in pain, and the daughter did not know what to do. Can't buy morphine, can't eat, the old man is painful and hungry at the end of the period, "it is not too much to say that it is tortured alive." "My uncle's serious illness also consumed a lot of savings in the family.
Yang Zunqiang also found in the survey that some one-child families can only take care of the elderly full-time later, and the dilemma of life and work is complete. He saw the arrival of the aging problem, "When my father was sick, there were three children in turn to take care of it, like an one-child family? If they are poorer, won't they be poorer? ”
In 2017, when the first batch of national hospice care pilot units fell to Deyang, Yang Zunqiang quickly submitted an application form. In deyang, they are the only medical unit to submit an application.
▲ On the morning of March 21, Luo Yunchuan inspected the room in the hospice ward of the Tiemenkan Branch of the Nanquan Town Health Center. Beijing News reporter Wang Chang photographed
Give it a try
In 2017, Nanquan Town Health Center became the first batch of national hospice care pilot units in Deyang, and officially established the Hospice Department.
Yang Zunqiang knew that people were afraid of death, and named the department as a palliative care department. When planning the ward in 2018, he was worried that the villagers would be difficult to accept hospitalization, "First, the elderly are unwilling to be hospitalized, hoping that the fallen leaves will return to their roots, and they will die at home." The second is to send the elderly to the hospital, and the children will be considered filial piety, saying how do you ignore the elderly. ”
He looked at a neighborhood and hoped to set up a hospice ward there, "more like home, someone is willing to come." ”
Just as Yang Zunqiang began to build a ward with great interest, he was waiting for residents who were blocking the road. It turned out that the address had just been set, and the news spread in the community, and the residents did not want to live with the "people waiting to die".
The matter had to be abandoned, and the hospice department was finally opened in the Nanquan Town Health Center, and the ward was set at the Tiemenkan Branch, where the 6 hospice wards could accommodate 12 patients.
What followed were resignation letters from two new nurses. At first, Yang Zunqiang just thought they had other arrangements. Later, I heard that they did not want to face the elderly who were dying.
"To put it bluntly, why treat some people who are going to die? Isn't it enough to wait for death at home? Yang Zunqiang remembered that the medical system in Shifang City and even Deyang City also exploded. The vast majority of people do not understand the significance of establishing a special department for the dying.
The doctors at the health center didn't understand either. Yang Zunqiang found that every time they passed the hospice ward, they would suddenly pick up their pace and walk around the other side of the road, "as if they didn't even want to look inside." ”
Yang Zunqiang had no choice but to lead the people himself. Every morning at 8:30 a.m., he checked the room and turned the old man's body to check the pressure sores, which became his daily work. He also began to pay attention to team building, and Luo Yunchuan, the current director of the hospice department, joined the team at that time. This is a petite girl, meticulous and steady, always laughing and talking to the old man, Yang Zunqiang felt that this was a good seedling, so he invited her to join.
Slowly, a team of doctors, nurses, social workers, pharmacists, nutritionists, psychological counselors, etc. was built. Yang Zunqiang thought, "Just keep trying." ”
"A Brick"
"Huang Wei!" Someone shouted downstairs. The time was close to noon, and the patients who had asked for treatment had long since dispersed, and the cry was particularly clear.
The Tiemenkan Branch of Nanquan Town Health Center is two stories high, and the buildings in four directions surround a small playground. Luo Yunchuan said that the people here are "a brick" and need to be moved wherever they are. Here, primitive shouting can get the most direct response, caregivers are too busy to look at the phone, and sending messages will delay the response.
▲ At noon on March 22, at the Tiemenkan Branch of Nanquan Town Health Center, nurse Huang Li fed the patients in the hospice ward. Beijing News reporter Wang Chang photographed
Huang Li is a nurse here, in her forties, not very tall, walking in a stormy way. From 8:30 a.m. to 5 p.m., she and three colleagues need to feed the elderly people on the upper and lower floors one by one, bathe, clean the room, and sometimes feed the elderly and assist the doctor to change the medicine, and there is basically no free time.
At noon on March 22, Huang Li went upstairs with the patient's lunch. A small half bowl of soup is soaked in the rice, and meat and vegetarian dishes are poured on top. This is Luo Yunchuan's meal for the patients, she has passed the nutritionist certificate, and the hospital arranges for her to design the meal.
In the 6 hospice wards on the second floor, there are 10 bedridden elderly people, who are basically semi-disabled and disabled elderly. The nursing work is very complicated, and the nurse almost has to arrange the patient's food and drink. In order to create a good environment for them, the health center set up an access control at the staircase. In addition to medical staff, only the family members of patients with family cards can enter.
Two patients were equipped with ventilators, electrocardiographic instruments and other equipment, and they were each admitted to a different ward. However, the ward was quiet, the ECG monitor was silenced, and the ventilator on the side continued to emit a "grunting" bubble sound, which could only be heard if it was close. The health center knew that the patients were afraid of death, and deliberately eliminated the sound of the instrument.
On this day, Uncle Chen had just been fed by another nurse, and it was time to change the medicine. Huang Li grabbed Uncle Chen's shoulder with one hand and pushed his waist with the other to help him turn over. The quilt was lifted, and the blue straps tied around the wrists were particularly bright.
This is the constraint band. Uncle Chen is more than 60 years old this year, is a nearby villager, after suffering from cerebral infarction, his body is paralyzed and bedridden. Feeling that his time was short, he was admitted to a hospice ward, where his family occasionally visited. He always scratched his body, sometimes pulling diapers and gauze to bandage wounds. Huang Li said: "This is also no way to do it, otherwise his injury will not heal." ”
His whole body was thinned into a skeleton, and his skin was loosely stretched. Huang Li gently flipped Over Uncle Chen's body, and the doctor on duty took off the paper pad that was stuck to the old man's back, and then slowly tore off the gauze, and a mattress sore the size of a palm was still not crusted.
"It's going to hurt a little bit, it's going to be good all at once." Before each operation, the doctor on duty said this. As different drugs sprayed onto the old man's back, he whimpered weakly and slowly. Huang Li immediately took his hand and leaned over to his ear, "Change the medicine, you will be fine, then we will go out and play!" ”
Lying next to him was Uncle Gu, 88 years old this year, and this day was Uncle Gu's birthday. Before changing the medicine, Huang Li shouted into his ear, "Happy birthday!" At this moment, Uncle Gu was in a good mood, and he tilted his head slightly to the neighboring bed on the right side, "It will be good, okay, let's go eat duck together." ”
Huang Li put a pillow on the back of Uncle Chen to prevent the body from writhing and touching the wound of the pressure sore. She went downstairs, the other nurses took the changed sheets, were stuffing into the washing machine, walking downstairs in the integrated medical and nursing ward, Huang Li conveniently cleaned the feces for another patient in the hospice ward.
Soon, the nurses have not yet eaten, they continue to go to the canteen, after a quick pulling, Huang Li and colleagues went upstairs again, in the hospice ward bathroom, scrubbing the bodies of the elderly.
The transformation of healthcare workers
Huang Li is one of the few caregivers who has insisted on it for more than three years, and like her colleagues, she comes from a nearby village and has a natural taboo against death.
Fatigue did not dissuade Huang Li, but death always made her heart-wrenching. She had nightmares. A big lady was laughing with her in a dream, and Huang Li was just about to help her turn over, suddenly remembering that the big lady had passed away during the day. After waking up at three o'clock in the morning, Huang Li did not fall asleep again.
"The old people here basically can't last a month." Yu Guanghui said. Perhaps because some people have passed away one after another, or maybe it is because the work is dirty and tired, and the nurses who came to the Nanquan Town Health Center at the same time as Huang Li have basically resigned.
Huang Li understood their choice, and when she first arrived, she didn't even dare to tell others about her work, and even her family thought that her job was just to feed the elderly. She endured the fear of death alone, and even if she had nightmares, she did not mention it.
▲The hospice ward of the Tiemenkan Branch of Nanquan Town Health Center. Beijing News reporter Wang Chang photographed
Facing the scene of the patient's death for the first time, Huang Li is still unforgettable. When the doctor rescued her, she stood next to her, trying to leave her head behind and not look, but she had to look because she needed help at any time. She wrapped her hands around her chest and felt her body tremble uncontrollably, thinking, "Hurry up and get better!" ”
But in fact, both the patient and the family, when admitted to the hospice ward, know in their hearts what such a choice means: to give up the active confrontation with the disease and to spend the final life in moderation.
Some doctors in the hospital can not understand this kind of action, Yang Zunqiang understands their understanding, medical staff to see a doctor to save people, but palliative care can only alleviate the patient's superficial pain, the disease still exists.
The loss of professional caregivers is one of the problems that the Nanquan Town Health Center has been facing, and Yang Zunqiang can only continue to recruit people.
Medical staff who come here inevitably need to deal with patients, especially nurses. Yang Zunqiang spent more time here, using mannequins to train to turn over, hit liquid food, take a bath and clean, the Nanquan Town Health Center also made a home visit to them, "to see how she behaves, to see how she and the elderly get along." "The month before the official induction is the internship period. Huang Li underwent such training before coming to the Nanquan Town Health Center.
"Reassure the elderly, reassure the families," a pennant changed the minds of medical staff. It was the summer of 2018, and the hospice ward had just opened. When the old man "left", the four children sent a pennant, and they felt that the old man was well cared for before he died. After that, there were more and more pennants hanging in the office. The doctors who came and went slowly realized that it was a meaningful thing to let people die more peacefully.
Bucket list
However, this does not mean that the patients who are admitted have accepted the fact that they are about to die.
At four o'clock in the afternoon of March 19, a shout broke the silence, "Teacher Yu! A bed critically ill, emergency first aid! Yu Guanghui heard the sound and moved, he grabbed the flashlight and blood pressure meter on the table, rushed out of the office, and went straight to the opposite staircase.
As he knelt on the hospital bed and pressed the old man's heart, he glanced up at the movement of the neighboring bed. Hou Da Niang stretched out her hand and clutched the railing next to the bed. The body is pulled up by the force of the arm. Her body lying on her side was crumbling and didn't seem to last long.
The lines of the ECG monitor flattened in silence, and the hospice department of the Nanquan Town Health Center sent away the 73rd elderly man. The atmosphere became very low, and people slowed down their pace and lowered their voices.
And Hou Da Niang insisted on the posture of facing back, until the person who handled the aftermath came and began to change the birthday clothes for the deceased. Hou Da Niang stretched out her other hand, she first pulled on the pant leg, scratched on the leg one by one, and then tore the infusion needle on her body.
According to the custom, before an elderly person is dying, he will change the room for the elderly in the same ward in advance. But this time the incident occurred suddenly, and "death" appeared directly in front of Hou Daniang's eyes. Yu Guanghui quickly grabbed the dazed hand and gently patted her back, "It's okay Ha, don't worry." ”
Yang Zunqiang found that even in the fifth year, the dying old man in Nanquan Town still could not accept the fact that he was about to die. The backwardness of local concepts is still one of the obstacles to their implementation of hospice services.
How to make people psychologically accept that they will eventually die is something that doctors in health centers often think about. Luo Yunchuan had a purple notebook. The book contains a list of the old people's wishes, and since June 2021, the old man's last wishes have been recorded in the book with a thickness of one centimeter.
▲ On March 24, Luo Yunchuan, director of the hospice department at the Nanquan Town Health Center, displayed a notebook with a list of patients' wishes written on it. Beijing News reporter Wang Chang photographed
Compiling a list of wishes for the elderly originated from a regret. During a round, the old man said that he could not rest assured of his little daughter, she was in the field, just divorced, the old man was afraid that after his death, his daughter's life would not be settled. Yu Guanghui suggested that when he was in better health, he would record some videos and send them to his daughter by year, as if he were still with him.
The old man nodded repeatedly, but 12 days later, the old man died suddenly. Before he died, he muttered about it.
The doctors in the health center thought that if they refused to face death, they probably couldn't put it down. If you can fulfill your wish, you can be less anxious. As a result, the items on the bucket list were put on the agenda.
Feel free to open the book, and one of the pages contains the conversation of January 1, 2022. An elderly man expressed three wishes, the first was to let his grandchildren come to see him, the second was to go home to see, and the third was to eat an orange. Today, two of the three wishes have been fulfilled.
When the elderly fulfill their wishes, it is also the happiest moment for medical staff. On the same day, after peeling an orange for the old man, Luo Yunchuan wrote after the wish, "Hee-hee, the day (completed). ”
Extended to "Thousands of Households"
On March 21, in the hospice ward of the Tiemenkan Branch, an old man shrugged his head and leaned his back against the head of the raised bed. The cancer had hit his lungs, and it was now terminal, and he could only sit and sleep so that he wouldn't cough. Hong Yichen on the side had red eyes and accompanied him. The old man was her father, and lung cancer was detected after the Spring Festival last year.
At first, the old man firmly believed in his own vitality, insisted on treating chemotherapy in the hospital, and did not say a word about the pain. However, until August last year, the 6 courses of chemotherapy were over, the condition was still not better, the pain was getting more and more intense, the panting was getting more and more difficult, and as soon as I lay down, I coughed non-stop. Every night, Hong Yichen, who was lying on the sofa next to him, would always be woken up by his father. He couldn't make it hard when he coughed, and he needed Hong Yichen to pat him on the back.
It is the consensus of the family that the cure is not good, and Hong Yichen took his father back home. As the eldest sister, she took on the caregiver job alone. The pain of the disease depletes the patient's temper, and the father always cries and scolds in pain in the middle of the night, so that the family cannot sleep. Hong Yichen ran to the Nanquan Town Health Center to buy some painkillers, but accidentally learned about the palliative department.
The father was no longer reckless, but he refused to be admitted to the ward. He tilted his head and said that he knew that his time was short, but he begged for the leaves to return to their roots and die at home. On March 21, the old man coughed up blood, and Hong Yichen took him to the Tiemenkan Branch, where he again refused to stay.
Therefore, Hong Yichen accompanied him to the hospital for nutritional solution during the day and returned home at night. On the hospital bed, he closed his eyes and was indifferent to all the noise. Only when the doctor approached and held out his hand to start changing the hanging bottle, the old man would suddenly open his eyes and stare at the hanging bottle.
At this point, the morphine that stopped his pain was still his forbidden area. In his opinion, this is the medicine used by the dying person, he can not hear people mention it, he can not see the words on the medicine bottle, once someone says to give him morphine, he will be angry and curse, preferring to be in pain rather than use such a medicine. Everyone at the Nanquan Town Health Center knows this. They carefully take care of the old man's emotions to prevent stimulating his psychology.
In Nanquan Town, such patients are not in the minority. In order to let them better spend the last stage of their lives, the Nanquan Town Health Center combines hospice care with the family doctor system and goes to the countryside to provide hospice services for the elderly at the end of life.
Today, a total of 15 people enjoy home palliative care services, and doctors turn on their planes 24 hours a day, waiting for their distress information at any time.
Doing such a service means spending more time and effort. A doctor mentioned the problem of low salary, "If I only receive 26 outpatient clinics a day, I will be nervous about this month's salary." Yang Zunqiang also knows that "the efforts of medical staff are not proportional to the returns", and he can only fight for them.
Under normal circumstances, patients must meet two conditions for admission to a hospice ward: they are diagnosed by their doctors as a dying patient with an end-of-life period of 3 to 6 months, and I and my family agree with the concept of palliative care and are willing to cooperate with the nursing plan.
But in the countryside, some people have no money and can't get a diagnosis certificate from a tertiary hospital. To this end, with the support of the Deyang Municipal Health Commission, the Nanquan Town Health Center has added a condition of occupancy: if the patient really needs it, the health center can put forward a consultation request, and the hospice expert team will issue an access opinion. Yang Zunqiang hopes that this kind of pain relief treatment can walk along the rural road and enter more families in need.
Cost is one of the concerns of the villagers. Luo Yunchuan said that before eligible dying patients live in, they need to assess the self-care of the elderly, "plus food expenses, the elderly who can take care of themselves charge about 2100 yuan, semi-disabled patients charge 2700 yuan a month, like the kind of bedridden and need to use the instrument of the elderly, the fee is 3000 yuan and above." "If the elderly belong to low-income households and targeted poverty alleviation households, they will reduce or even waive fees, or even no fees."
Since 2019, Yang Zunqiang has concurrently served as the president of the Fourth People's Hospital of Shifang. With the process of urbanization, many people in nearby villages and towns have settled their work and life in urban areas. For them, the Nanquan Town Health Center is a long way away and remote. Yang Zunqiang hopes to open a hospice department in a hospital in the city to relieve the difficulties of the dying patients in the city.
After all, man will face death. Bringing up this topic, Yang Zunqiang thought of his father again, and he hoped that those who had reached the end of their lives would not be so painful, "At least not like my father." ”
(Hong Yichen is a pseudonym)
Duty Editor Lee plus minus