>A doctor faces life and death

>A doctor faces life and death The Department of Neurology where I work is one of the top key departments in the country. When I came here after graduating from university, I felt that all the experts were great...

The Department of Neurology where I work is one of the leading key departments in the country. When I came here as a college graduate, I felt that all the experts were great and I admired them so much. Slowly rotating through clinical practice and becoming a resident physician, I did receive quite rigorous and high-end training as a neurologist. Patients came from all over the country to seek final diagnosis. The diagnostic level of the experts was almost the same as that of other countries, and even exceeded that of foreign countries (China has a large number of people and many types of diseases, so there is a lot of experience here). But this is only a diagnosis. About one-third of the diseases that can be clearly diagnosed by neurology are estimated to be one-third that can be treated. Neurology can often use various advanced diagnostic technologies to diagnose the cause. However, due to the many difficult and complicated diseases, it is often only possible to obtain a general treatment direction, and it is difficult to establish individualized treatment. Therefore, there is a so-called "emphasis on diagnosis and light treatment" industry tradition, and treatment is stretched. I often think wildly, is this how modern medicine, which claims to be scientific and advanced, can treat illnesses and save lives?

Only three days after entering the NICU (Neuro Intensive Care Unit), I became extremely frustrated. Every day I was discussing how much nutrient solution to use, what antibiotics to use, and how to treat symptoms to extend the survival period of these comatose patients. I began to doubt the value of doctors: What on earth do doctors do? Is it to endlessly maintain patients’ lives that have no meaning or quality at all?

I will always remember the lung cancer patient I met during my one-year residency rotation in the internal medicine department. She was just 30 years old, suffering from advanced lung cancer, her chest was deformed, and there were two skull metastases on her head, which were wrapped in white gauze. She hadn't slept on her back for three whole months. She could only sit upright with her pillow in her arms, and occasionally squinted her eyes and dozed off. Her worthy lover watched over her day and night. The day I was on duty, her lover came to me and said she was in severe pain. I rushed to see her, and the situation was already quite tragic: her blood pressure was maintained entirely by medication (medically speaking, she was in a terminal state), she barely ate every day, and her whole body was swollen, showing a transparent white color, and her weak blood vessels could be seen through the thin skin, still pulsing tenaciously. I listened to her lungs, which were full of phlegm, but she had no strength to cough it out. She had to rely on the nurse to suction the phlegm, but every time she suctioned, it was extremely painful. The tumor made her so painful that she was delirious. Ordinary painkillers did not help, so she could only take meperidine. Only then did I believe how severe the cancer pain recorded in the book was.

I gave her one, but it didn’t work very well and she was still in pain. I don’t dare to give it anymore, I don’t know what to do. Her lover took a popsicle from the refrigerator to her, with an extremely complicated expression on his face. In this cold late night, in the warm ward, she was fed popsicles one by one, and she sucked them slowly like a child, enjoying them as sweet treats. For her, every time she eats and every time she sees the sun the next day, it is a miracle.

Every day I would know that she was still consuming and sustaining. Until the noon that I had expected but didn’t want to arrive, the atmosphere at the rescue scene was one of helpless calmness. Her lover kept calling relatives and friends: "My wife is dying, you guys can take a taxi." She burst into tears. The extremely depressed and sad voice made me almost suffocated.

> She was completely unconscious, her face was severely swollen, showing a gray-white "dead air", and she was breathing lightly. She could finally lie down on the bed that she had not seen for three months. She slept forever on this bed that she had been lying on for three months but had never laid on. The senior doctor was calmly resuscitating her at the end of her life. Everyone knew that this was a relief for her and her family, but I couldn't watch the whole process. Maybe it's because my seniority is too low and my job is still short. There is still a gap in my heart that a doctor shouldn't have. My whole heart feels very painful. This is a frustrating thing. I tried my best to talk about it with others for a long time to cover up my unprofessional psychology, but the result was even more depressed.

I also managed a patient. She was a 72-year-old woman who suffered from brain tumors, high intracranial pressure, and chronic cerebral herniation. Our department of neurology can only use drugs to lower intracranial pressure, but over time, kidney failure will soon occur. Unless the underlying problem (tumor) is solved, it is impossible to get better. Therefore, after we diagnosed the tumor, we asked the family members to transfer to the hospital as soon as possible. However, as soon as the son and daughter-in-law, who had never shown up, heard that he was going to be discharged, they immediately came to negotiate with us. It seemed that they had fulfilled their filial piety by leaving the old lady in the ward and putting her in the safe.

The old man was confused by these two young couples and wanted to stay in the neurology department. In fact, if she is transferred to neurosurgery and operated on as soon as possible, the old lady can still be saved, at least she is not in the current state of waiting to die. Finally, I spoke out and finally agreed to transfer to another department, which delayed it for another week or so. At that time, I wanted to slap those pretentious children. Is this good for the old lady?

However, now I gradually understand that ordinary people are very afraid of death. They may not truly understand the meaning of death, which is the final dignity of life. Everyone should be treated with respect and humanistic care when they die, instead of forcing doctors to blindly prolong the dying process just because the living are afraid of farewell and fear of being stigmatized as unfilial. If there is hope of rescuing, one should make one hundred percent effort, but meaningless rescuing should be given up.

I have been working for ten years and have seen various death scenes and have a lot of emotions. Many patients die in the emergency room with various tubes inserted into their bodies: IV sets, gastric tubes, urinary catheters, oxygen tubes, and even endotracheal tubes. The last moment was truly horrific, which not only increased the pain of the dying person, but also increased the world's fear of death. Relatives blindly pursue prolonging the patient's quality-free survival time, sometimes just for the sake of the so-called "filial piety" in the world.

I think of the red eyes that couldn’t help but moisten when I rescued a patient for the first time; I think of the most filial son I’ve ever seen making a “bang bang bang” sound on the ground after he signed to give up invasive efforts to rescue his father. I remembered that after the patient passed away, the family members cried out miserably and calmly divided up the funeral expenses at the door; I thought of the shameless "medical trouble" of my father who was not buried in time after his death, and began to take stock of the medical mistakes and prepare for a lawsuit. Faced with life and death, all living beings are in various forms, and human nature is fully revealed.

I have a senior brother who died young. He was an extraordinary man, tall and tall, with a voice as loud as a bell. He was the most knowledgeable neurologist I have ever seen. He had super understanding and memory, and had super professional knowledge (neuroanatomy, neuropathology, neurophysiology) and social science knowledge (history, politics, culture, art).

I simply have never seen a more amazing neurologist than him. When he was seeing a doctor, we juniors were watching, which was a real pleasure. From physical examination to diagnosis to treatment, from health guidance to psychological counseling, patients feel relieved and we feel that we are in place. He gave lectures to everyone, quoted eloquently, spoke lotus words, had clear ideas, and was particularly practical. He has never been out of the country for a day, but when he gives a speech in English, his authenticity and fluency put many turtles to shame.

At the age of 45, he was diagnosed with liver cancer and underwent a liver transplant. He even came back for a time and went out to the clinic on a loose basis. He often talked to me, a person who is idle and wild, and he said that he had entered the stage of hearing loss in advance and was ready to enter the stage of doing whatever he wanted without breaking the rules. We discussed the purpose of work, and he said that at the lowest level, work is for survival; at the higher level, work is for a sense of accomplishment and happiness; at the highest level, work is for nothing, just work.

One year after his liver transplant, the cancer spread again. He also sent me a message telling me not to worry. The maximum survival time after the spread of his type is 7 months. He wanted to try to challenge the record. To this day, I can’t bear to delete these text messages from him. His funeral was in Babaoshan. Seeing him lying quietly among the flowers made me extremely sad. He probably didn't suffer much. His wife was also a doctor and gave up all invasive treatments. Senior brother can finally leave quietly. I figured it out later and said to him silently: Brother, take the first step and we will meet again.

People do not have the right to choose birth, but they should have the right to choose death. Life is as gorgeous as summer flowers, and death is as quiet and beautiful as autumn leaves. This is my wish.

The author is an attending physician at Beijing Xuanwu Hospital, and his Sina Weibo account is @lianziqingruxu.