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Ms. Liu's grandmother, 91 years old, is suffering from cancer and is in an advanced stage. The elderly are homesick and unwilling to stay in the hospital, and the family has considered it again and again and decided to respect the wishes of the elderly. The old man went home, but the various painful symptoms of the body continued, the inability to eat, the swelling of the body, the continuous pain... The family was at a loss, and Ms. Liu traveled between various departments in the hospital for her grandmother's condition.
I want the old man not to suffer, and I want not to leave regrets. Ms. Liu began to face up to this problem: if you know that life will come to an end, how to accompany the elderly to better complete the last journey of life and say goodbye?
By chance, Ms. Liu came to the Hospice And Palliative Medical Clinic of Peking Union Medical College Hospital. With the idea of trying it out, she described her grandmother's condition to the doctor. She was relieved that the treatment provided by the doctor did alleviate her grandmother's pain. "When no treatment can reverse the outcome, this is where we can help professionally."
△ Peking Union Medical College Hospital Hospice And Palliative Medical Clinic
The dilemma between patients and their families, who will break it?
Ning Xiaohong is the deputy chief physician of the Department of Geriatric Medicine of Peking Union Medical College Hospital and the leader of the Hospice and Palliative Care Team of Peking Union Medical College Hospital.
Many people are unfamiliar with palliative and palliative care, and Ning Xiaohong explains it in layman's terms: to help patients with serious illnesses and limited life spans and their families, so that patients can have less pain in the final journey of life. It not only relieves the patient's physical pain, but also emphasizes the care for the patient's mental and psychological pain, and also needs to comfort the patient's family. As long as the patient feels pain, it is an area of palliative and medical care. Ning Xiaohong particularly pointed out that palliative care and palliative care are parallel to the existing medical methods, do not conflict, and do not mean that other treatments should be abandoned.
△ Ning Xiaohong is checking the room
The son of a malignant tumor patient once asked Ning Xiaohong for help. His father, who is 70 years old, has repeatedly gone through the painful process of treatment, rest, recurrence, and re-treatment.
Now the disease begins to affect the expression ability of the elderly, who is afraid of missing out on the last communication with his father. Do you want to tell the old man the truth? Do you want to continue to treat the disease? Cure, watching the old man exhaust his life in the pain of treatment; if not cured, is it waiting for death? Such a stalemate has caused everyone in the family to suffer.
At the suggestion of Ning Xiaohong, the children brought the patient and their wife to the clinic together. Ning Xiaohong should talk about the things that should be discussed with the old man one by one, and only when the old man expresses his wishes clearly, can his family get out of the endless pain and entanglement.
Ning Xiaohong found that the old man's thinking was very clear, but due to the limitation of illness, he could only say simple short sentences. She thought of a way, she came up with to describe, and the old man only had to answer yes or no.
From the current treatment plan to the death faced in the future, and then to the handling of the aftermath, Ning Xiaohong asked the elderly little by little. "Are you taking medication now?" "Do you still want to take chemotherapy pills?" "Would you like to intubate if your condition gets worse?" "Would you rather be in the hospital or at home when you leave?" "Do you have any thoughts about funerals and burial places?" ...... These problems are destined to be heavy, and the sobs of family members in the clinic are never stopped.
The old man listened carefully, expressing his thoughts briefly but clearly one by one, he was now taking drugs very badly, did not want to continue to take chemotherapy drugs, did not want to do intubation in the future... Finally, the old man put his arms around his wife, touched her face, and comforted: "Don't cry, don't cry, it's okay, people are like this." ”
This process of communication is undoubtedly very painful, and the topic of death that was previously avoided is not all sentimental in the conversation. The last journey of life is not only pain and nightmares. When they leave the clinic, both the patient and the family are relieved.
Ning Xiaohong said that in palliative care, doctors often act as decision-making coordinators, respect the expression of patients' wishes, guide patients to communicate with their families, and doctors provide professional advice, ultimately promoting patients and families to make decisions in harmony. At the same time, because the patient has clearly expressed his wishes, the pain and entanglement of the family will be alleviated.
What else can the healer do on the patient's final journey?
The contact with anthroposiac palliative medical treatment stems from Ning Xiaohong's own confusion and helplessness. She was a former oncologist and often faced powerlessness in the treatment of patients with advanced tumors. In addition to the pain, she couldn't help but think: At this time, what else can I do for the patient?
This is not only the confusion of Ning Xiaohong alone, but also the heavy stone that weighs on the hearts of many medical staff. In 2012, Ning Xiaohong was exposed to palliative and palliative care during a study and felt that she had found a feasible path. Since 2014, she has been actively promoting hospice and palliative care through courses, clinical practice, consultations, etc. Slowly, many medical staff in the hospital understood and accepted this concept and applied it to their daily work.
In 2017, the National Health Commission issued relevant documents on hospice care and began to promote hospice care in the form of a pilot.
In 2018, medical staff from various departments of Peking Union Medical College Hospital who are interested in palliative care gathered together and established a palliative care team to use their spare time to volunteer to help patients with relevant needs. The consultation system of hospice and palliative care has also gradually spread out in Peking Union Medical College Hospital.
In January this year, the Hospice and Palliative Medical Clinic of Peking Union Medical College Hospital opened.
△Infographic (Image source/Visual China)
In Ning Xiaohong's view, if medical staff have the concept of peaceful and palliative medical treatment, they can pay attention to more dimensions of treatment, spend more thought, ask about the physical discomfort of seriously ill patients, and do not avoid the psychological pain of patients and families to alleviate them in a targeted manner. Ning Xiaohong said that these practices have gone beyond the scope of medical use, but they are precious things in medicine.
In the Department of Oncology, Head Nurse Zheng Ying used palliative care to bring comfort to patients. "Care, patients, and families are all aware that death is an unavoidable consequence and what else is important in the process." She respects the autonomy of the patient more, and she informs the patient of what situations they may face in the last moment, so that they can be prepared and alleviate the fear of the unknown.
In addition to doctors and nurses, medical social workers and volunteers are also important players in palliative care. They give patients and their families more humanistic care, understand their needs, guide patients and their families to thank each other, apologize, love and say goodbye, minimize each other's regrets, and make life and death safe.
△ Peking Union Medical College Hospital Hospice And Palliative Medical Volunteer
What is a better farewell, Ning Xiaohong said, she can not define, every family, every patient has their own answer. In her view, the patient has no physical pain, psychologically prepared for the end of life, according to their own wishes to complete the last journey, all the worries have been confessed, the wishes have been concluded, it can be said that it is a calm farewell.
It is not easy to achieve such a farewell, but it is the direction of everyone's efforts. Perhaps only by facing death can we truly gain the courage to live. Ning Xiaohong has a vision, hoping that more medical staff will have the concept of peaceful and palliative medical care, give care to patients in the final journey of life, and protect their life return.