Concord Wang Han: My uncle's medical decisions should not be decided only by the doctor!

It's been more than a month since the uncle came out of the icu.

From the trembling when I first came out, the dilemma, the only way to rely on nasal feeding and enteral nutrition, and the constant worry about repeated lung infections, to today I can cooperate with getting out of bed, eating through the oral part, and my mental state is improving day by day. I can finally look back on this journey and say that I finally made the right choice.

Centenarians suffer from lung infections, and it is not an exaggeration to say that the danger is imminent. Fortunately, our icu doctor's clever hand rejuvenated and controlled the disease in the shortest possible time. However, the body temperature is still flickering, and after just a few days of stabilization, it has a rebound trend. The doctor came to me to explain the condition, and described the prognosis to me in a serious tone: weakness - bed rest - aspiration - the vicious circle of lung infection. Poor sputum discharge is a key link, and effective sputum removal will not be possible without opening the airway.

I understand that rational choice is gassy.

However, I'm really not sure that doing this is best for my uncle.

First of all, can he bear the pain of qi cutting? After the anesthetic, how long does it take him to stop feeling pain? And how long does it take to tolerate the discomfort of the endotracheal cannula? The answer Icu gave me was half a month, and the OTOL doctor told me that some people couldn't stand it all the time. So, for a centenarian, will he live like a year in the few years he has left? Suctioning through the mouth is painful, but suctioning through the tracheal cannula is not painful at all? For an individual, what he cares about may not be how much pain he has alleviated, but how much pain he still has at the moment.

Secondly, even if he passes the adaptation period and manages the airway, he will not be able to communicate verbally. How can he express his discomfort, his unhappiness, his demands? Writing, we've tried, in hospital beds, most people can't write clearly and legibly. Then, in addition to nodding and shaking his head, he could only face the world with endless silence. I can't imagine what this state of being cut off from the world means to him. Not to mention whether wearing a tracheal cannula will make the uncle who has been a gentleman all his life feel like he has no self-esteem...

Also, can he withstand the blows of anesthesia and surgery? Can I safely launch the operating room?

However, at that time, the uncle was tired of the endless suction of phlegm every two hours, and then tired of continuing to live. Every time I see him, I hope to end his pain, the pain of sucking phlegm, as soon as possible. So, I wavered, believing that chi-chi was a rational choice.

They recommended Dr. Lu of my Department of Otolaryngology, and they described his "fast knife" as a supernatural skill, reminding me of the hero in Liang Yusheng's novel, "just listen to a gust of wind, the opponent has fallen."

I asked Dr. Lu to come to the consultation, and he looked at the old man and advised me, "Don't do it." Now I can speak, my mind is still clear... "If I have more words, I need to figure it out and make a choice." In fact, it is always the family who makes the decision. Your doctor wants to guide you to make a decision that is as correct as possible and not regrettable. But the post does not regret that it varies from person to person. I still remember a family member of a patient with encephalopathy who saw the patient's shaved head after finally deciding on surgery, and the very strong Shandong Han cried a lot, guarding the head of the bed to prevent the doctor from approaching, almost delaying the operation.

I turned to Sister Ning, who advocates palliative care in the oncology department, and she sent me a video of "Elephant Back", telling me in a fairy tale way how a life arranges its own few days. She said his own decision was something we had to respect.

After much thought and asking for help in the doctor's friend group, I decided, do. In that moment, I could only hope to relieve his immediate pain. I talked to my uncle with a pen, and I wrote: I want to give you a small operation on your throat so that you don't have any pain in sucking sputum, and we can quickly transfer back to the general ward. The uncle nodded, and I didn't even see a hint of hesitation and doubt in his eyes, for he believed that what I had given him must be the best. In front of him, I just couldn't leave the truth of the contradiction to him to decide, because I was afraid that he would choose to give up.

However, fate is such a peak and loop. I found an anesthesia doctor, found a good surgeon, and on the day of planning the operation, I found that aspirin did not stop. Dr. Lu said that he must not take a risk and stop for five days.

There are still two days until the May Day holiday. May Day holiday for three days. The doctor at Icu advised me that it would be difficult to transfer to the general ward for nursing, and you could turn around after the holiday. They didn't worry about pressing the bed, but the uncle didn't want to stay longer for a day. For awake patients and uterus, ICU is lifesaver and painful. Visiting time is limited, the number of instruments next to the bed is frightening, the alarm sound of various instruments... The uncle gestured to speak, and there were only three words, "Change wards!" "Clear and determined.

After being a doctor for a long time, you will become a bit fatalistic. I believe that this small "mistake" that did not stop the drug is actually a chance for fate to give the originally tangled decision a chance to repent. So the uncle left the icu ward in this way, and when he left, he refused to even say "goodbye" to the doctor and nurse who had been taking care of him for many days. I think he will be willing to sign dnr (do-not-resuscitate) at this point. Well, since he is so determined, I should fulfill the dignity of an old man in his last days.

I remember a few years ago, the father of a doctor of our hospital was living in our ward, with sequelae of cerebrovascular disease, bad consciousness, and repeated lung infections. I also advised her to take the road of anger, and I think my words prompted her to make up her mind. I said, "If it's my loved one, I'll do it." "But that time, there were serious complications in the gas incision. When her father left, his whole body was swollen under the skin... To this day, I still feel guilty, just because that decision was influenced by me.

Sister Ning later heard that I finally chose to transfer out of the icu ward instead of making a gas cut, and she took my hand and said, Great. I suddenly understood that she was actually biased, but she didn't want to make decisions for me. Only the decision to finally figure it out and accept the result is the best.

See an article in English today, "How Do You Determine When to Withdraw Life Support Treatment?". I hurriedly clicked on it, unfortunately, there was no guide, and my peers all over the world were divided. Leaving aside the complex cultural, religious, social resources and other factors, there is almost a consensus: decision-making requires the participation of family members and respect for their (living) wishes. Perhaps, in the future, medicine needs to solve more, not how to prolong life, but how to die with dignity. At that time, doctors may be the executors, but they should not be the only decision-makers.