疯了
今天，原本只安排了一个手术，，结束后外科医生要求再加一个，若是普通个案倒也罢了，是个五十七岁的阿伯，第三次中风，因呼吸需要依赖机器，而要呼吸道上安置一个永久性的气管，前几次因急性肾衰竭，而延迟了手术，昨天证实换上心脏病，刚开始治疗。任何麻醉师都知道，这是个高风险手术。问题不在于手术过程，而是心脏血管诸塞，病情不稳定，换句话说，幸运则平安无事；若出了状况，最坏的可能是死亡。更让我懊恼的是，有必要冒险吗？为何不能等心脏问题稳定了再说？这不是一个紧急手术。于是，要求在外的同事与家属商议，并把风险直接告诉他们。我还以为，任何家属一听到有可能会死，就会打退堂鼓，原来人类可以如此残酷，家人竟然说，再拖可能又会出现其他变卦，若最坏的可能真的发生了，或许是因为他的死期已至。我在想，换成躺在病床上的是儿子，父亲会选择冒险吗？或许是我不够客观，但这样的反应，真的让我觉得家人想摆脱这个“包袱”。多讽刺的人生，有谁会知道自己会突然大病一场，成了被人嫌弃的包袱呢？其他人不明白倒也算了，外科`内科也对我们施压，心脏科居然把这手术列为低风险，还把药物终止，等手术完成后再继续，天啊！换成是他们的家人，他们会这么做吗？如果这是一个不能拖延的手术，麻醉师绝对愿意冒险，但这病人靠呼吸器持续呼吸已将近三个星期，并没有肺部感染，再等一个星期，绝对没问题。再加上医生不是家属的傀儡，这儿不是私立医院，就算他们坚持，我们也有权拒绝！因为这是一个不必要的高风险手术，医生应该以病人的安全为前提！
手术完成了，很幸运在手术室里他没病发，这整个过程，从家人的反应，到一些医生令人费解的判断和决定，只能说，让人心寒。。。
Wednesday, December 07, 2011
Sunday, November 20, 2011
笑话
先是废除了值班制度，不需on call 外还能额外休假，也罢。接着是每月送上相等于on call claim 的所谓津贴，现在更离谱，周日若迟下班，还能有额外津贴，哈！难怪大家都说，想降职当实习医生算了。如果说政府要挽留医生，因此改善制度，为免人才外流，敢问为何只有实习医生该有这些特别待遇?有多少医生每天都早到迟退？在实习医生还在大摇大摆走入病房时，他们的上司已在开始巡房？他们的态度有问题吗？那些只在办公室·冷气房里纸上谈兵精明的高层，只知道办公室里接了多少家长的投诉信，说孩子过分操劳，他们在乎的不是如何提高或维持医生的素质，而是如何回应媒体和家长，如何减少负面新闻。
实行轮班制度以来，我从未从任何专科医生口中，听见赞同或称赞的话。部门主管个个摇头感叹，医科是一个需要经验累积的科系，缩短工作时间，等于降低医生的素质。实习医生，两年的日子确实不好过，但这也是我们武装自己，以便日后应战的关键时期。虽然很累，但不至于日夜不休。或许别人会说，我们都挨过了，当然能这么说，我想说，正是因为我们经历过，才知道那段训练的重要性！
娇生惯养，斤斤计较，这将会是新制度所培育的产物的特征。我的部门里虽没有实习医生，却须常与其他部门的实习医生接触，只能说是一代不如一代。据说是有很多“大人物”的孩子正在实习，追根究底，原来一切不过是一场政治游戏，有人在利用自己的权势·财势，为亲人谋利。然而，谁将会是最终的受害者？遇上这些神医的病人！这些方案为何会通过，为何可以实行？没有任何在职的主管会支持这样的方案，然而有谁会理会我们这些底层的不满？会有那么一天，或许就在那些精明的高层必须将自己或他们的亲人的生命交到这些医生的手里的时候，他们才有可能觉悟。没想到，就连医生这样的行业，也让权贵如此操控，可悲可叹。。。
先是废除了值班制度，不需on call 外还能额外休假，也罢。接着是每月送上相等于on call claim 的所谓津贴，现在更离谱，周日若迟下班，还能有额外津贴，哈！难怪大家都说，想降职当实习医生算了。如果说政府要挽留医生，因此改善制度，为免人才外流，敢问为何只有实习医生该有这些特别待遇?有多少医生每天都早到迟退？在实习医生还在大摇大摆走入病房时，他们的上司已在开始巡房？他们的态度有问题吗？那些只在办公室·冷气房里纸上谈兵精明的高层，只知道办公室里接了多少家长的投诉信，说孩子过分操劳，他们在乎的不是如何提高或维持医生的素质，而是如何回应媒体和家长，如何减少负面新闻。
实行轮班制度以来，我从未从任何专科医生口中，听见赞同或称赞的话。部门主管个个摇头感叹，医科是一个需要经验累积的科系，缩短工作时间，等于降低医生的素质。实习医生，两年的日子确实不好过，但这也是我们武装自己，以便日后应战的关键时期。虽然很累，但不至于日夜不休。或许别人会说，我们都挨过了，当然能这么说，我想说，正是因为我们经历过，才知道那段训练的重要性！
娇生惯养，斤斤计较，这将会是新制度所培育的产物的特征。我的部门里虽没有实习医生，却须常与其他部门的实习医生接触，只能说是一代不如一代。据说是有很多“大人物”的孩子正在实习，追根究底，原来一切不过是一场政治游戏，有人在利用自己的权势·财势，为亲人谋利。然而，谁将会是最终的受害者？遇上这些神医的病人！这些方案为何会通过，为何可以实行？没有任何在职的主管会支持这样的方案，然而有谁会理会我们这些底层的不满？会有那么一天，或许就在那些精明的高层必须将自己或他们的亲人的生命交到这些医生的手里的时候，他们才有可能觉悟。没想到，就连医生这样的行业，也让权贵如此操控，可悲可叹。。。
Friday, October 14, 2011
义诊
这会是一个好的开始，我相信。我们到了一个小镇，就在街边的树下，开始工作。虽然没什么宣传，来做体检的人也有四十几位，就只我和一位护士，还好还能应付。
这是属于慈济的活动，我是在一个偶然的机缘下，知道有这项活动，才自愿参与。今天只是一个开始，计划能多找几个志工，为更多人服务。目前只能为他们测量血压和血糖，再提供医疗咨询，可能等志工人数增加了，就能开始简单的“讲座会”。我不敢自认自己够格，但是面对普罗大众，不需要糖尿病专科医生来提供专业咨询，能给他们灌输一些基本的医学常识就已足矣。
要成立一个医疗团队，并非容易，更何况这是业余，没有额外付费的，但这世上总会有这样的人，我想这样相信。病人都是顽固的，说了十句就算只能听进一句，也总比没有的好，现在只能这样才能较乐观。
记得以前在马六甲的慈济，有中医及西医服务，也有药剂师负责分派药物。目前还不能如此，但量力而为，尽力就好，一定会继续努力的。
这会是一个好的开始，我相信。我们到了一个小镇，就在街边的树下，开始工作。虽然没什么宣传，来做体检的人也有四十几位，就只我和一位护士，还好还能应付。
这是属于慈济的活动，我是在一个偶然的机缘下，知道有这项活动，才自愿参与。今天只是一个开始，计划能多找几个志工，为更多人服务。目前只能为他们测量血压和血糖，再提供医疗咨询，可能等志工人数增加了，就能开始简单的“讲座会”。我不敢自认自己够格，但是面对普罗大众，不需要糖尿病专科医生来提供专业咨询，能给他们灌输一些基本的医学常识就已足矣。
要成立一个医疗团队，并非容易，更何况这是业余，没有额外付费的，但这世上总会有这样的人，我想这样相信。病人都是顽固的，说了十句就算只能听进一句，也总比没有的好，现在只能这样才能较乐观。
记得以前在马六甲的慈济，有中医及西医服务，也有药剂师负责分派药物。目前还不能如此，但量力而为，尽力就好，一定会继续努力的。
Friday, October 07, 2011
值得深思的一段话
" the only thing that can keep me going is that i love what i did.you've gotta find what you love...work forms the major part of your life,and the only way to be truly satisfied is to do what you believe is great work.the only way to do great work is to love what you do.if you haven't found it yet,keep looking and don't settle.as would all matters of the heart,you'll know when you find it..."
得开始和工作谈恋爱咯！
" the only thing that can keep me going is that i love what i did.you've gotta find what you love...work forms the major part of your life,and the only way to be truly satisfied is to do what you believe is great work.the only way to do great work is to love what you do.if you haven't found it yet,keep looking and don't settle.as would all matters of the heart,you'll know when you find it..."
得开始和工作谈恋爱咯！
Saturday, October 01, 2011
误会
原来，我误会了那位母亲。今天结束了工作，回到了前天的病房，看见躺在床上的那位病人，情况日益严重，肺部积水的问题尚未解决。我提醒自己不能生气，询问那满脸愁容的母亲，为何不允许医生插管抽水。她说，儿子的病情已严重了，我忍不住问她，难道我们真的撒手不理，什么都不做吗？站在一旁的姐姐说，她们曾询问病房的负责医生，他说病人情况不稳定，不宜插管，还好她不记得那医生的名字，否则我一定致电问明究竟。这是哪门子的道理！当然，在家属面前，我们不宜“自相残杀”，可是让我始料不及的是，不是家属拒绝，而是有位“神医”告诉他们不能插管。那母亲可能不明白，可是还有其他家属啊！可见主治医生根本没有主动接触病人家属，只选择相信实习医生的话，所以才会有这样的结局。我不是病房的负责医生，尚能在完成职务后，试着想了解其中原因，希望能取得家属的同意，主治医生天天巡房，为何不能？如果我是那主治医师，一定会揪出罪魁祸首，把他狠狠训一顿，不懂装懂，害人不浅啊！
原来，我误会了那位母亲。今天结束了工作，回到了前天的病房，看见躺在床上的那位病人，情况日益严重，肺部积水的问题尚未解决。我提醒自己不能生气，询问那满脸愁容的母亲，为何不允许医生插管抽水。她说，儿子的病情已严重了，我忍不住问她，难道我们真的撒手不理，什么都不做吗？站在一旁的姐姐说，她们曾询问病房的负责医生，他说病人情况不稳定，不宜插管，还好她不记得那医生的名字，否则我一定致电问明究竟。这是哪门子的道理！当然，在家属面前，我们不宜“自相残杀”，可是让我始料不及的是，不是家属拒绝，而是有位“神医”告诉他们不能插管。那母亲可能不明白，可是还有其他家属啊！可见主治医生根本没有主动接触病人家属，只选择相信实习医生的话，所以才会有这样的结局。我不是病房的负责医生，尚能在完成职务后，试着想了解其中原因，希望能取得家属的同意，主治医生天天巡房，为何不能？如果我是那主治医师，一定会揪出罪魁祸首，把他狠狠训一顿，不懂装懂，害人不浅啊！
Friday, September 30, 2011
生气
很不想生气，尤其是在值班的时候，因为这不仅将影响自己的工作情绪，也很容易引起别人的不满。昨天真的好累，一整天已经停不下来，还要遇到一些不可理喻的人，我有点压抑不住情绪。一大早电话就响了，说是内科有个病人需要紧急插管，到了那病房，获得家属同意后，一群病房的负责医生就随着专科医生巡房，所有该具备的仪器都没准备好，就丢下我和几位护士，也罢，那气喘的病人是心脏病患者，因肺部细菌感染，已需提升血压的药物，而他只有仅仅一个点滴，我真的很想骂人，但还能压抑怒意。
傍晚时分，发现一个普通病房的病人从早上有个同事检查时就有神智不清的迹象，需要插喉，没人采取行动，和病房值班的主管沟通时，她居然不知情，言语间有责备我的同事没有通知她的意思，天啊，这是你的病房，你的病人神智不清你在巡房时难道没有发现？当然，一切只成了心底话，有些话说了既会伤感情，也不会改变什么，何苦？我只是同情那位病人。
到了晚上，差不多同时接受五个referral，我好希望自己会分身术，这种状况虽不属于罕见，但也不常发生，既然发生了，也只能权衡轻重，先看了不能耽误的个案。我搁下了急诊室的两位病人，赶紧到内科病房看一位二十几岁的down syndrome 病人因肺部积水，其母亲拒绝让病房医生插管把水抽出，而越来越缺氧。我自认一开始就心里有气，因为这绝对是可以被避免的！更何况类似病人的呼吸管和一般人不同，插管会比常人更具风险，但我们别无选择。我简略地解释了程序，她坚持要与家人商议，已是半夜时分，没人接电话。情急之下，我只能说狠话了，说如果她不让我们这么做，儿子会死去等话来恐吓（其实也非恐吓，因为如果我们置之不理，这会是必然的结局），以为她会“就范”，怎知她还是冥顽不灵，拿着电话不放。我气得快爆炸了，也没时间去理会她的不安，看着她越来越疲惫的儿子，纠缠了近半小时，她竟然还不能决定。我只吩咐实习医生在她有了决定后才再通知，就匆匆到急诊室。忙着忙着，再有消息时已快两个小时，还好她儿子年轻，勉强撑得住，顺利插喉。下班后太累了，睡醒后有事到医院，查看电脑，发现她还是不许病房医生给她儿子插管子抽水。我无语，因为插喉后不把积水抽出，治标不治本，白费功夫。我想再见她一次，我真的很想知道这母亲到底在想什么，她是否知道自己的决定会带来什么后果？我会心平气和，为了她儿子，一个可以医治的病例，只有二十几岁的生命，多么可惜。
很不想生气，尤其是在值班的时候，因为这不仅将影响自己的工作情绪，也很容易引起别人的不满。昨天真的好累，一整天已经停不下来，还要遇到一些不可理喻的人，我有点压抑不住情绪。一大早电话就响了，说是内科有个病人需要紧急插管，到了那病房，获得家属同意后，一群病房的负责医生就随着专科医生巡房，所有该具备的仪器都没准备好，就丢下我和几位护士，也罢，那气喘的病人是心脏病患者，因肺部细菌感染，已需提升血压的药物，而他只有仅仅一个点滴，我真的很想骂人，但还能压抑怒意。
傍晚时分，发现一个普通病房的病人从早上有个同事检查时就有神智不清的迹象，需要插喉，没人采取行动，和病房值班的主管沟通时，她居然不知情，言语间有责备我的同事没有通知她的意思，天啊，这是你的病房，你的病人神智不清你在巡房时难道没有发现？当然，一切只成了心底话，有些话说了既会伤感情，也不会改变什么，何苦？我只是同情那位病人。
到了晚上，差不多同时接受五个referral，我好希望自己会分身术，这种状况虽不属于罕见，但也不常发生，既然发生了，也只能权衡轻重，先看了不能耽误的个案。我搁下了急诊室的两位病人，赶紧到内科病房看一位二十几岁的down syndrome 病人因肺部积水，其母亲拒绝让病房医生插管把水抽出，而越来越缺氧。我自认一开始就心里有气，因为这绝对是可以被避免的！更何况类似病人的呼吸管和一般人不同，插管会比常人更具风险，但我们别无选择。我简略地解释了程序，她坚持要与家人商议，已是半夜时分，没人接电话。情急之下，我只能说狠话了，说如果她不让我们这么做，儿子会死去等话来恐吓（其实也非恐吓，因为如果我们置之不理，这会是必然的结局），以为她会“就范”，怎知她还是冥顽不灵，拿着电话不放。我气得快爆炸了，也没时间去理会她的不安，看着她越来越疲惫的儿子，纠缠了近半小时，她竟然还不能决定。我只吩咐实习医生在她有了决定后才再通知，就匆匆到急诊室。忙着忙着，再有消息时已快两个小时，还好她儿子年轻，勉强撑得住，顺利插喉。下班后太累了，睡醒后有事到医院，查看电脑，发现她还是不许病房医生给她儿子插管子抽水。我无语，因为插喉后不把积水抽出，治标不治本，白费功夫。我想再见她一次，我真的很想知道这母亲到底在想什么，她是否知道自己的决定会带来什么后果？我会心平气和，为了她儿子，一个可以医治的病例，只有二十几岁的生命，多么可惜。
Tuesday, September 27, 2011
一分温暖--我一直在寻找的“human touch"
刚工作的第一天，就要回到icu值班。一如往常，若非病入膏肓，也不会住进深切治疗病房，一整个上午至下午都忙得团团转，不是这儿有个病人血压太低，就是那个病人心脏停跳，需要抢救。遇上了这么一个个案，一个六十五岁的阿伯，细菌感染导致肾脏功能衰退，需要洗肾，血压也得靠四种药物勉强维持，用尽了最强的抗生素，病情仍急速恶化。一开始我们仍不愿放弃，已告知家属病情不乐观，但我们仍在努力。一直到傍晚，发现瞳孔放大，病情毫无起色，上司才决定放手，我把家属叫到一旁，再次告知病人状况，为我们的无能为力而深感抱歉，然后残酷地，诚实地把他们的父亲将会死去的事实说了出来。这是身为家属者多不希望从医生的口中听见的话，但他们不但能接受，还感谢我们已经尽力。我允许家属轮流进来为病人祷告，并协助他们处理一些医生证明之类的问题。这，是我第一次在病人逝世后，有家属向我致谢。其实一切只是沟通上的问题，很多医生都以忙为理由，没向家人解释病情，没让他们知道事实的真相，而往往最让人不满的不是事情最后的结局，情况有多严重，而是他们毫不知情。icu 的医生和普通病房的住院医生在告知坏消息时，所用的字眼和方式是不同的，我们常直接说出情况，为的是不让病人或其家属抱着假的希望。而为何那些家人不在我说出真相后上前揍我一顿？我觉得最重要的原因是我们在他们最茫然时告知病情，并愿意解答任何疑惑，让他们知道我们到底在做什么，让他们感觉到我们是站在同一阵线的，愿意和他们一起去面对生命的考题。所以，即使最后我们还是束手无策，他们还会对我们表示感激。这就是我一直想要找的东西，不是他们的感激，而是和他们一起面对，在冷酷的命运跟前，传递一丝暖意。跨入这行业三年了，我必须承认在医学院的时候，教授就常说‘don't be too attached to ur patient'要我们和病人保持专业的距离，我一直都是如此，所以才会觉得自己越来越无情，这是我首次觉得在工作里能找到一些温暖，希望这是个好的开始。
刚工作的第一天，就要回到icu值班。一如往常，若非病入膏肓，也不会住进深切治疗病房，一整个上午至下午都忙得团团转，不是这儿有个病人血压太低，就是那个病人心脏停跳，需要抢救。遇上了这么一个个案，一个六十五岁的阿伯，细菌感染导致肾脏功能衰退，需要洗肾，血压也得靠四种药物勉强维持，用尽了最强的抗生素，病情仍急速恶化。一开始我们仍不愿放弃，已告知家属病情不乐观，但我们仍在努力。一直到傍晚，发现瞳孔放大，病情毫无起色，上司才决定放手，我把家属叫到一旁，再次告知病人状况，为我们的无能为力而深感抱歉，然后残酷地，诚实地把他们的父亲将会死去的事实说了出来。这是身为家属者多不希望从医生的口中听见的话，但他们不但能接受，还感谢我们已经尽力。我允许家属轮流进来为病人祷告，并协助他们处理一些医生证明之类的问题。这，是我第一次在病人逝世后，有家属向我致谢。其实一切只是沟通上的问题，很多医生都以忙为理由，没向家人解释病情，没让他们知道事实的真相，而往往最让人不满的不是事情最后的结局，情况有多严重，而是他们毫不知情。icu 的医生和普通病房的住院医生在告知坏消息时，所用的字眼和方式是不同的，我们常直接说出情况，为的是不让病人或其家属抱着假的希望。而为何那些家人不在我说出真相后上前揍我一顿？我觉得最重要的原因是我们在他们最茫然时告知病情，并愿意解答任何疑惑，让他们知道我们到底在做什么，让他们感觉到我们是站在同一阵线的，愿意和他们一起去面对生命的考题。所以，即使最后我们还是束手无策，他们还会对我们表示感激。这就是我一直想要找的东西，不是他们的感激，而是和他们一起面对，在冷酷的命运跟前，传递一丝暖意。跨入这行业三年了，我必须承认在医学院的时候，教授就常说‘don't be too attached to ur patient'要我们和病人保持专业的距离，我一直都是如此，所以才会觉得自己越来越无情，这是我首次觉得在工作里能找到一些温暖，希望这是个好的开始。
一个病人的故事
July 16, 1995
The Boston Globe Magazine
UNTIL LAST FALL, I had spent a considerable part of my career as a health-care lawyer, first in state government and then in the private sector. I came to know a lot about health-care policy and management, government regulations and contracts. But I knew little about the delivery of care. All that changed on November 7, 1994, when, at age 40 I was diagnosed with advanced lung cancer. In the months that followed, I was subjected to chemotherapy, radiation, surgery, and news of all kinds, most of it bad. It has been a harrowing experience for me and for my family. And yet, the ordeal has been punctuated by moments of exquisite compassion. I have been the recipient of an extraordinary array of human and humane responses to my plight. These acts of kindness — the simple human touch from my caregivers — have made the unbearable bearable.
· · · · ·
DURING SEPTEMBER and October of 1994, I made several visits to the outpatient clinic of a Boston teaching hospital for treatment of a persistent cough, low-grade fever, malaise, and weakness. The nurse practitioner diagnosed me as having atypical pneumonia and prescribed an antibiotic. Despite continued abnormal blood counts, she assured me that I had a post-viral infection and didn't need an appointment with my physician until mid-November, if then. By mid-October, I felt so bad that I decided I could not wait until November 11 to be seen. Disappointed with the inaccessibility of my physician, I decided to seek care elsewhere, with the hope that a new doctor might be more responsive.
‘‘The rule books, I’m sure, frown on such intimate engagement between caregiver and patient. But maybe it’s time to rewrite them.’’
Kenneth B. Schwartz
My brother, a physician who had trained at Massachusetts General Hospital, arranged for an immediate appointment with Dr. Jose Vega, an experienced internist affiliated with MGH. Dr. Vega spent an hour with me and ordered tests, including a chest X-ray. He called within hours to say he was concerned by the results, which showed a ‘‘mass’’ in my right lung, and he ordered a computerized tomography scan for more detail. I remember leaving my office for home, saying quickly to my secretary, Sharyn Wallace, ‘‘I think I may have a serious medical problem.’’ Indeed, the CT scan confirmed abnormal developments in my right lung and chest nodes.
The next day, Dr. Vega, assuring me that he would continue to be available to me whenever I needed him, referred me to Dr. Thomas Lynch, a 34-year-old MGH oncologist specializing in lung cancer. Dr. Lynch, who seems driven by the ferocity of the disease he sees every day, told me that I had lung cancer, lymphoma, or some rare lung infection, although it was most likely lung cancer.
Mimi Bartholomay, RN, MSN, an outpatient oncology
nurse with the author at Massachusetts General Hospital
Photography by Bill Greene / The Boston Globe
My family and I were terrified. For the next several months, my blood pressure, which used to be a normal 124 over 78, went to 150 over 100, and my heart rate, which used to be a low 48, ran around 100.
Within 72 hours of seeing Dr. Lynch, I was scheduled for a bronchoscopy and a mediastinoscopy, exploratory surgical procedures to confirm whether I indeed had lung cancer. Until this point, I had thought that I was at low risk for cancer: I was relatively young, I did not smoke (although I had smoked about a cigarette a day in college and in law school and for several years after that), I worked out every day, and I avoided fatty foods.
The day before surgery, I was scheduled to have a series of tests. The presurgery area of the hospital was mobbed, and the nurses seemed harried. Eventually, a nurse who was to conduct a presurgical interview called my name. Already apprehensive, I was breathing hard.
The nurse was cool and brusque, as if I were just another faceless patient. But once the interview began, and I told her that I had just learned that I probably had advanced lung cancer, she softened, took my hand, and asked how I was doing. We talked about my 2-year-old son, Ben, and she mentioned that her nephew was named Ben. By the end of our conversation, she was wiping tears from her eyes and saying that while she normally was not on the surgical floor, she would come see me before the surgery. Sure enough, the following day, while I was waiting to be wheeled into surgery, she came by, held my hand, and, with moist eyes, wished me luck.
The author with wife Ellen Cohen
and their son Ben
This small gesture was powerful; my apprehension gave way to a much-needed moment of calm. Looking back, I realize that in a high-volume setting, the high-pressure atmosphere tends to stifle a caregiver's inherent compassion and humanity. But the briefest pause in the fre netic pace can bring out the best in a caregiver and do much for a terrified patient.
The nurse left, and my apprehension mounted. An hour later, I was wheeled to surgery for a biopsy of the chest nodes and the mass in my lung. I was greeted by a resident in anesthesiology, Dr. Debra Reich, who took my pulse and blood pressure and said gently, ‘‘You're pretty nervous, huh?’’ She medicated me with tranquilizers, but that did not stop me from asking about where she lived, where she had trained, and whether she was married. I jokingly asked her how come she was the only Jewish doctor I had met during my time at MGH. When it turned out that she lived down the street from me and liked the sandwiches at the same corner shop, Virginia's, I felt comforted. She squeezed my shoulder, wished me luck, and wheeled me into surgery.
When I awoke, I was told that I had adenocarcinoma in my right lung and in several chest nodes — in other words, advanced lung cancer. I don't remember a lot about those hours, but I remember Dr. Vega's face with tears in his eyes. I also remember feeling very sad and scared.
A few days later, I received a letter from Dr. Reich: ‘‘Remember me, your friendly anesthesiologist? I came by to see you this afternoon as my professional duty but also to express my sadness in hearing about your diagnosis. Your door was closed and there seemed to be a lot of activity, so I decided not to disturb you.
‘‘As I'm sure you know, we as physicians are taught not to become emotionally involved in our patients because then we would be continually devastated. But I guess because we had such a nice interaction before your surgery and because your life was one which I could relate to so well — being Jewish, professional, renovating a house, sandwiches at Virginia's, etc. — your situation really struck a chord in me. (Hey, maybe you can't even remember any of this because of the medicine I gave you, but hopefully you do...)
‘‘I was very impressed that during the fear and anxiety you were experiencing, you still maintained your composure, your sense of humor, and even thought to ask me when I was getting married.
‘‘So, anyway, as you told me, keeping your wife and son in mind will make you fight strong, and I know this to be true! I know that you have a very loving and supportive family who will help you through this as well.
‘‘Best wishes, and maybe I'll run into you sometime at Virginia's.’’
I had not forgotten Dr. Reich, nor will I ever forget her willingness to cross the professional barrier, hold my hand, and write those words.
· · · · ·
IT WAS CLEAR THAT I WOULD soon begin a new chapter in my illness and undergo the classic treatment for such advanced cancer: intensive chemotherapy and radiation, followed by surgery to remove the tumors, nodes, and entire lung, if necessary. Dr. Lynch told me that this option presented the real possibility of a cure.
Over the next week, I had a series of additional radiologic scans to determine if the cancer had spread beyond my chest. These scans are incredibly scary: You are placed in a tube resembling a sarcophagus, with only 6 inches between you and the walls, and you may spend several hours inside, deafened by the clanging machine. And the scans always raise fears about whether more bad news is around the corner.
Dr. Vega or Dr. Lynch always made it a point, though, to relay results within 24 hours, so my family and I didn't have to endure the anxiety of uncertainty any longer than necessary.
The scans of my body, head, liver, bones and back were clear. I was relieved.
The doctors soon began an intensive regimen of chemotherapy and radiation, with the goal of destroying the cancer and preparing for surgery to remove my lung.
Before being admitted for my first five-day course of chemotherapy, I had a radiation-simulation session. During such sessions, therapists meticulously map their targets by marking your skin where the radiation should be directed. I was asked to lie on a table in a large, cold chamber. The radiation therapist, Julie Sullivan, offered me a blanket and, mentioning that the staff had a tape deck, asked if I had any requests: I recalled my college days and asked for James Taylor. Listening to ‘‘Sweet Baby James’’ and ‘‘Fire and Rain,’’ I thought back to a time when the most serious problem I faced was being jilted by a girlfriend, and tears ran down my cheeks. As therapists came and went, Julie Sullivan held my hand and asked me if I was OK. I thanked her for her gentleness.
After having a Port-o-Cath implanted in my chest — a device that allows chemotherapy to be administered without constant needle sticks in the arm — I was admitted to MGH in mid-November. During that and other hospitalizations, either my mother or sister would stay overnight, often sleeping in cramped chairs. When I awoke at night in an anxious sweat or nauseated, I would see one of them and feel reassured.
While doctors managed my medical care, my day-to-day quality of life and comfort were in the hands of two or three nurses. These nurses showed competence and pride in their work, but they also took a personal interest in me. It gave me an enormous boost, and while I do not believe that hope and comfort alone can overcome cancer, it certainly made a huge difference to me during my time in the hospital.
During the period between my two chemotherapies, when I also received high-dose radiation twice a day, I came to know a most exceptional caregiver, the outpatient oncology nurse Mimi Bartholomay. An eight-year veteran who had experienced cancer in her own family, she was smart, upbeat, and compassionate. I had to receive fluids intravenously every day at the clinic, and while there we talked regularly about life, cancer, marriage, and children. She too was willing to cross that professional Rubicon — to reach out and talk about my fear of dying or, even worse, my fear of not living out my life, of not biking through the hills of Concord and Weston on summer weekends with my brother, of not seeing my child grow up, of not holding my wife in my arms. And she took the risk of talking about her own father's recent bout with cancer. I cannot emphasize enough how meaningful it was to me when caregivers revealed something about themselves that made a personal connection to my plight. It made me feel much less lonely. The rule books, I'm sure, frown on such intimate engagement between caregiver and patient. But maybe it's time to rewrite them. THE BEST MEDICINE
In my new role as patient, I have learned that medicine is not merely about performing tests or surgeries, or administering drugs. These functions, as important as they are, are just the beginning.
· · · · ·
AFTER MY SECOND ROUND of chemotherapy, I was ready for the final stage of what we hoped would be a cure: surgery. Before this could happen, Dr. Lynch repeated my radiologic scans, to be sure that the cancer had not spread. He assured me that the chance of any such metastasis was remote — less than 5 percent — although it would be a disaster if it occurred.
The scans were endless, scary, and lonely. While members of my family stayed with me in the waiting rooms, they could not accompany me to the scanning rooms; the experience again was harrowing. But I felt my greatest fear while awaiting the results. After a week of tests, I had one last scan of my bones. I was concerned when the technologist asked to do a special scan of my back that had not been done before.
The next day, I called Dr. Lynch's office and asked his assistant, Mary Ellen Rousell, when I could come in to find out the results. She said, ‘‘How about this afternoon?" and then added, ‘‘You might want to bring someone.’’ My heart skipped. When my wife and I entered Dr. Lynch's office and saw his face, our hearts sank. He was ashen. He said that while all the other scans were clear, there appeared to be a metastic tumor in my spine. He explained that this meant that lung surgery at this point would be futile, since other metastases were likely to surface.
Dr. Lynch said that he could n ot be 100 percent certain that this was a tumor and that, because so much was at stake, we should do a biopsy. My wife and I wept openly — in part, because, looking at Dr. Lynch's face, we felt that he had lost hope.
I could not help but ask what treatment options were available, and he mentioned a drug called Taxol. Still being the lawyer, I quizzed him:
Me: What is the percentage of people who benefit from Taxol?
Dr. Lynch: Forty percent.
Me: How much do they benefit?
Dr. Lynch: They can get several years of life, although it is not a cure. And the median survival for patients on Taxol with your advanced stage of disease is nine months.
Nine months! My wife and I cringed. I ended the session by asking Dr. Lynch, ‘‘How do you do this work?’’ And he answered, in genuine pain, ‘‘By praying that I don't have days like today.’’
· · · · ·
I BEGAN TO HAVE TROUBLE sleeping, and when I awoke, I was filled with dread and despair. I thought frequently of the observation of Richard Block, the founder of H&R Block, who had survived lung cancer after being told initially that he had only months to live: ‘‘I lived for five days without hope and...my life during those five days...was far worse than at any time during the 'horrible' ordeal of tests or treatments.’’
And when I contemplated not living to see my son grow up or not cherishing my wife for a lifetime, I thought of King Lear, who, at a low point, wailed:
I am bound
Upon a wheel of fire, that mine own tears
Do scald like molten lead.
I desperately needed to regain hope, and I needed Dr. Lynch to regain his sense of hope.
A few days later, I had the biopsy. Dr. Lynch met with my family to report that, indeed, after considerable searching, the pathologist had found small deposits of adenocarcinoma in my vertebra. It was now confirmed that I had metastatic lung cancer. Although my brother and my father, who is also a physician, raised the possibility of radical surgery on my back and lung to remove all the tumors, Dr. Lynch and the surgeons rejected this option because further metastases were likely to appear, and the surgery would be debilitating and reduce my quality of life at a time when my life could well be substantially shortened.
The clear treatment was more chemotherapy. Dr. Lynch again recommended the use of Taxol, with the hope of slowing the cancer's spread.
My wife and I were largely silent during the medical discussion. I asked my father and brother to leave so my wife and I could talk not facts and figures but matters of the heart. When they had left, I said to Dr. Lynch, ‘‘You told me two things all along: One, that you were aiming for a total cure and if that were not feasible, you would tell me at that time. And two, you would never, ever give up on me, never stop trying to fight, to extend my life as long as possible. Am I no longer on the cure route?’’
He looked somberly at us and explained that there were no known treatments to cure this stage of cancer.
‘‘And will you stick by me and fight to the end?’’ I asked.
He nodded vigorously and then outlined a number of state-of-the-art, experimental protocols from which I might benefit after Taxol.
And, leaving statistics behind, he talked of several patients who had defied the odds and lived for years beyond expectations. He advised that my goal should be to be here the same time next year, and then the year after, and the year after — one day at a time, one month at a time, one year at a time. He mentioned several breast-cancer patients who had told him that they had relished their final years with their children in a way that they had never known before. It felt good to leave the medical talk and speak heart to heart, and it felt to me that he had regained a sense of hope — not for some magical cure but for the possibility of extending my life.
It was crucial to my wife and to me that he not give up hope. I understood his surprise and disappointment at the metastasis; in fact, as one friend suggested, his distress at that event was a sign of his caring about me and his involvement with my case. But we desperately needed him to give us a realistic basis for hope — and he had.
‘‘If I have learned anything, it is that we never know when, how, or whom a serious illness will strike. If and when it does, each one of us wants not simply the best possible care for our body but for our whole being.’’
Kenneth B. Schwartz
· · · · ·
THE NEXT DAY, I BEGAN A NEW chapter in my fight. And once again, Mimi Bartholomay was by my side, monitoring my reaction and assuring me that most people tolerated Taxol very well. I had no allergic reactions, and I felt good that the battle was under way. I had hoped that maybe this could buy me time.
Time was now my best friend, since it could allow medical research to advance and doctors to find new strategies and maybe even a cure for advanced lung cancer.
During this period, with help from my father, who has had a long and distinguished career in academic medicine, I began to explore potential cutting-edge protocols that could supplement or follow Taxol.
My father arranged a meeting for my wife and me with Dr. Kurt J. Isselbacher, a distinguished researcher and director of the MGH Cancer Center. He is a small man with a large presence and piercing blue eyes, and he was surrounded by medical books, papers, and many pictures of his family. He was upbeat, telling us of protocols under way that showed promise in fighting metastatic tumors. Like several others, he told me a personal story that cut to the bone: A close family member, he said, had been diagnosed with advanced cancer, which the attending oncologist had said was ‘‘very, very bad.’’ The family member had said to him: ‘‘Kurt, you have helped so many people in your life, can you now help me?’’ He personally treated the family member in that person's home with chemotherapy, and, 21 years later, that person is thriving.
Dr. Isselbacher offered to serve as an advocate for me, to work with my father and Dr. Lynch to find the most promising protocols. I told him at the meeting that while I had no illusions, I was deeply moved by his refusal to give up and by his abiding hope; I was especially affected because such hopefulness was not coming from a faith healer but a distinguished researcher. He had strengthened our resolve to fight.
‘‘I was especially affected because such hopefulness was not coming from a faith healer but a distinguished researcher’’
Kenneth B. Schwartz
As I grappled to maintain my hope in the face of the advancing disease, I was referred to Dr. Ned Cassem, a senior MGH psychiatrist who not only had had vast experience with the seriously ill but was himself a Jesuit priest. I had met with him once during my second hospitalization, and my memory through the haze was that he was the first person with whom I had discussed death. I remembered that when I asked him if, when, and how I should say goodbye to people, he said, ‘‘You know, you don't have to wait to say goodbye; you can express your love and appreciation for people right now, every day.’’
After the devastating news of the metastasis, I felt the urge to seek out Dr. Cassem again, in part to ask if there was anything more I should be doing to help my son, Ben, cope with my illness or the eventuality of my death. I mentioned that several people had suggested I make a videotape for Ben but that I thought I couldn't do that. Dr. Cassem replied that every time we played or laughed together, we were creating building blocks, precious memories that will be a part of him forever.
I also asked him if he thought I should be doing more to prepare for the possibility of an early death. He looked perplexed and asked, ‘‘Have you prepared your will?’’ I said yes. ‘‘Are your affairs otherwise in order?’’ I again said yes. ‘‘So it sounds like you are prepared. ... Remember, death is a minor matter. Living ... that's the challenge.’’
I then told him of the paradox that moments of great pleasure — playing with my son, snuggling with my wife, talking intensely with friends — also caused me great pain and tears. Was I depressed? Was this something to worry about? He looked at me thoughtfully and said: ‘‘When you cry about your son, it's because he has touched you deeply. It's an affirmation of your love for him. When you weep about the joy you experienced with your wife or close friends, that's an acknowledgment of your love for them. That's not a bad thing. ...Maybe a day without tears has been a dull day.’’ I nodded and then could not help but ask: ‘‘Do you believe in the power of prayer?’’ Dr. Cassem nodded. ‘‘Absolutely,’’ he said, ‘‘and your name is on my prayer list.’’ I felt warmed in his presence, by his wisdom, his common sense, and his spirituality.
· · · · ·
IN RECENT MONTHS, I have had several setbacks: a bone scan that showed four to five additional tumors, and a CT scan that showed significant progression of the cancer in both lungs. The only good news was that it had not spread to my head or liver. I am pained, but not surprised, at the relentlessness of the disease, and I am straining to retain hope that one of the experimental treatments may succeed where chemotherapy has failed.
For the first time, I recently mentioned to Dr. Lynch the idea of a hospice service and wondered how I might reduce future pain as the cancer progresses. Dr. Lynch answered that we were still a long way from that discussion, that we still had many avenues to explore, and that he remained as committed as ever to doing whatever he could to extend my life in a quality way.
Around the time of the CT scan, when I was feeling particularly dejected, I had an appointment with Mimi Bartholomay for an injection. She was running late, and as she approached me in the clinic waiting room, she looked harried. But as she got closer, she could see how unhappy I was, and she put her arm around me and directed me to a private room. I began to cry, and she intuitively responded: ‘‘You know, scan days are the worst. But whatever the results, we are not going to give up on you. We're going to fight with you and for you all the way.’’ I hugged her and thanked her for hanging in there with me.
If I have learned anything, it is that we never know when, how, or whom a serious illness will strike. If and when it does, each one of us wants not simply the best possible care for our body but for our whole being.
I still am bound upon Lear's wheel of fire, but the love and devotion of my family and friends, and the deep caring and engagement of my caregivers, have been a tonic for my soul and have helped to take some of the sting from my scalding tears.
Kenneth B. Schwartz died of lung cancer in September 1995. Shortly before his death he founded the Kenneth B. Schwartz Center at Massachusetts General Hospital, which is dedicated to strengthening the relationships between patients and caregivers.
July 16, 1995
The Boston Globe Magazine
UNTIL LAST FALL, I had spent a considerable part of my career as a health-care lawyer, first in state government and then in the private sector. I came to know a lot about health-care policy and management, government regulations and contracts. But I knew little about the delivery of care. All that changed on November 7, 1994, when, at age 40 I was diagnosed with advanced lung cancer. In the months that followed, I was subjected to chemotherapy, radiation, surgery, and news of all kinds, most of it bad. It has been a harrowing experience for me and for my family. And yet, the ordeal has been punctuated by moments of exquisite compassion. I have been the recipient of an extraordinary array of human and humane responses to my plight. These acts of kindness — the simple human touch from my caregivers — have made the unbearable bearable.
· · · · ·
DURING SEPTEMBER and October of 1994, I made several visits to the outpatient clinic of a Boston teaching hospital for treatment of a persistent cough, low-grade fever, malaise, and weakness. The nurse practitioner diagnosed me as having atypical pneumonia and prescribed an antibiotic. Despite continued abnormal blood counts, she assured me that I had a post-viral infection and didn't need an appointment with my physician until mid-November, if then. By mid-October, I felt so bad that I decided I could not wait until November 11 to be seen. Disappointed with the inaccessibility of my physician, I decided to seek care elsewhere, with the hope that a new doctor might be more responsive.
‘‘The rule books, I’m sure, frown on such intimate engagement between caregiver and patient. But maybe it’s time to rewrite them.’’
Kenneth B. Schwartz
My brother, a physician who had trained at Massachusetts General Hospital, arranged for an immediate appointment with Dr. Jose Vega, an experienced internist affiliated with MGH. Dr. Vega spent an hour with me and ordered tests, including a chest X-ray. He called within hours to say he was concerned by the results, which showed a ‘‘mass’’ in my right lung, and he ordered a computerized tomography scan for more detail. I remember leaving my office for home, saying quickly to my secretary, Sharyn Wallace, ‘‘I think I may have a serious medical problem.’’ Indeed, the CT scan confirmed abnormal developments in my right lung and chest nodes.
The next day, Dr. Vega, assuring me that he would continue to be available to me whenever I needed him, referred me to Dr. Thomas Lynch, a 34-year-old MGH oncologist specializing in lung cancer. Dr. Lynch, who seems driven by the ferocity of the disease he sees every day, told me that I had lung cancer, lymphoma, or some rare lung infection, although it was most likely lung cancer.
Mimi Bartholomay, RN, MSN, an outpatient oncology
nurse with the author at Massachusetts General Hospital
Photography by Bill Greene / The Boston Globe
My family and I were terrified. For the next several months, my blood pressure, which used to be a normal 124 over 78, went to 150 over 100, and my heart rate, which used to be a low 48, ran around 100.
Within 72 hours of seeing Dr. Lynch, I was scheduled for a bronchoscopy and a mediastinoscopy, exploratory surgical procedures to confirm whether I indeed had lung cancer. Until this point, I had thought that I was at low risk for cancer: I was relatively young, I did not smoke (although I had smoked about a cigarette a day in college and in law school and for several years after that), I worked out every day, and I avoided fatty foods.
The day before surgery, I was scheduled to have a series of tests. The presurgery area of the hospital was mobbed, and the nurses seemed harried. Eventually, a nurse who was to conduct a presurgical interview called my name. Already apprehensive, I was breathing hard.
The nurse was cool and brusque, as if I were just another faceless patient. But once the interview began, and I told her that I had just learned that I probably had advanced lung cancer, she softened, took my hand, and asked how I was doing. We talked about my 2-year-old son, Ben, and she mentioned that her nephew was named Ben. By the end of our conversation, she was wiping tears from her eyes and saying that while she normally was not on the surgical floor, she would come see me before the surgery. Sure enough, the following day, while I was waiting to be wheeled into surgery, she came by, held my hand, and, with moist eyes, wished me luck.
The author with wife Ellen Cohen
and their son Ben
This small gesture was powerful; my apprehension gave way to a much-needed moment of calm. Looking back, I realize that in a high-volume setting, the high-pressure atmosphere tends to stifle a caregiver's inherent compassion and humanity. But the briefest pause in the fre netic pace can bring out the best in a caregiver and do much for a terrified patient.
The nurse left, and my apprehension mounted. An hour later, I was wheeled to surgery for a biopsy of the chest nodes and the mass in my lung. I was greeted by a resident in anesthesiology, Dr. Debra Reich, who took my pulse and blood pressure and said gently, ‘‘You're pretty nervous, huh?’’ She medicated me with tranquilizers, but that did not stop me from asking about where she lived, where she had trained, and whether she was married. I jokingly asked her how come she was the only Jewish doctor I had met during my time at MGH. When it turned out that she lived down the street from me and liked the sandwiches at the same corner shop, Virginia's, I felt comforted. She squeezed my shoulder, wished me luck, and wheeled me into surgery.
When I awoke, I was told that I had adenocarcinoma in my right lung and in several chest nodes — in other words, advanced lung cancer. I don't remember a lot about those hours, but I remember Dr. Vega's face with tears in his eyes. I also remember feeling very sad and scared.
A few days later, I received a letter from Dr. Reich: ‘‘Remember me, your friendly anesthesiologist? I came by to see you this afternoon as my professional duty but also to express my sadness in hearing about your diagnosis. Your door was closed and there seemed to be a lot of activity, so I decided not to disturb you.
‘‘As I'm sure you know, we as physicians are taught not to become emotionally involved in our patients because then we would be continually devastated. But I guess because we had such a nice interaction before your surgery and because your life was one which I could relate to so well — being Jewish, professional, renovating a house, sandwiches at Virginia's, etc. — your situation really struck a chord in me. (Hey, maybe you can't even remember any of this because of the medicine I gave you, but hopefully you do...)
‘‘I was very impressed that during the fear and anxiety you were experiencing, you still maintained your composure, your sense of humor, and even thought to ask me when I was getting married.
‘‘So, anyway, as you told me, keeping your wife and son in mind will make you fight strong, and I know this to be true! I know that you have a very loving and supportive family who will help you through this as well.
‘‘Best wishes, and maybe I'll run into you sometime at Virginia's.’’
I had not forgotten Dr. Reich, nor will I ever forget her willingness to cross the professional barrier, hold my hand, and write those words.
· · · · ·
IT WAS CLEAR THAT I WOULD soon begin a new chapter in my illness and undergo the classic treatment for such advanced cancer: intensive chemotherapy and radiation, followed by surgery to remove the tumors, nodes, and entire lung, if necessary. Dr. Lynch told me that this option presented the real possibility of a cure.
Over the next week, I had a series of additional radiologic scans to determine if the cancer had spread beyond my chest. These scans are incredibly scary: You are placed in a tube resembling a sarcophagus, with only 6 inches between you and the walls, and you may spend several hours inside, deafened by the clanging machine. And the scans always raise fears about whether more bad news is around the corner.
Dr. Vega or Dr. Lynch always made it a point, though, to relay results within 24 hours, so my family and I didn't have to endure the anxiety of uncertainty any longer than necessary.
The scans of my body, head, liver, bones and back were clear. I was relieved.
The doctors soon began an intensive regimen of chemotherapy and radiation, with the goal of destroying the cancer and preparing for surgery to remove my lung.
Before being admitted for my first five-day course of chemotherapy, I had a radiation-simulation session. During such sessions, therapists meticulously map their targets by marking your skin where the radiation should be directed. I was asked to lie on a table in a large, cold chamber. The radiation therapist, Julie Sullivan, offered me a blanket and, mentioning that the staff had a tape deck, asked if I had any requests: I recalled my college days and asked for James Taylor. Listening to ‘‘Sweet Baby James’’ and ‘‘Fire and Rain,’’ I thought back to a time when the most serious problem I faced was being jilted by a girlfriend, and tears ran down my cheeks. As therapists came and went, Julie Sullivan held my hand and asked me if I was OK. I thanked her for her gentleness.
After having a Port-o-Cath implanted in my chest — a device that allows chemotherapy to be administered without constant needle sticks in the arm — I was admitted to MGH in mid-November. During that and other hospitalizations, either my mother or sister would stay overnight, often sleeping in cramped chairs. When I awoke at night in an anxious sweat or nauseated, I would see one of them and feel reassured.
While doctors managed my medical care, my day-to-day quality of life and comfort were in the hands of two or three nurses. These nurses showed competence and pride in their work, but they also took a personal interest in me. It gave me an enormous boost, and while I do not believe that hope and comfort alone can overcome cancer, it certainly made a huge difference to me during my time in the hospital.
During the period between my two chemotherapies, when I also received high-dose radiation twice a day, I came to know a most exceptional caregiver, the outpatient oncology nurse Mimi Bartholomay. An eight-year veteran who had experienced cancer in her own family, she was smart, upbeat, and compassionate. I had to receive fluids intravenously every day at the clinic, and while there we talked regularly about life, cancer, marriage, and children. She too was willing to cross that professional Rubicon — to reach out and talk about my fear of dying or, even worse, my fear of not living out my life, of not biking through the hills of Concord and Weston on summer weekends with my brother, of not seeing my child grow up, of not holding my wife in my arms. And she took the risk of talking about her own father's recent bout with cancer. I cannot emphasize enough how meaningful it was to me when caregivers revealed something about themselves that made a personal connection to my plight. It made me feel much less lonely. The rule books, I'm sure, frown on such intimate engagement between caregiver and patient. But maybe it's time to rewrite them. THE BEST MEDICINE
In my new role as patient, I have learned that medicine is not merely about performing tests or surgeries, or administering drugs. These functions, as important as they are, are just the beginning.
· · · · ·
AFTER MY SECOND ROUND of chemotherapy, I was ready for the final stage of what we hoped would be a cure: surgery. Before this could happen, Dr. Lynch repeated my radiologic scans, to be sure that the cancer had not spread. He assured me that the chance of any such metastasis was remote — less than 5 percent — although it would be a disaster if it occurred.
The scans were endless, scary, and lonely. While members of my family stayed with me in the waiting rooms, they could not accompany me to the scanning rooms; the experience again was harrowing. But I felt my greatest fear while awaiting the results. After a week of tests, I had one last scan of my bones. I was concerned when the technologist asked to do a special scan of my back that had not been done before.
The next day, I called Dr. Lynch's office and asked his assistant, Mary Ellen Rousell, when I could come in to find out the results. She said, ‘‘How about this afternoon?" and then added, ‘‘You might want to bring someone.’’ My heart skipped. When my wife and I entered Dr. Lynch's office and saw his face, our hearts sank. He was ashen. He said that while all the other scans were clear, there appeared to be a metastic tumor in my spine. He explained that this meant that lung surgery at this point would be futile, since other metastases were likely to surface.
Dr. Lynch said that he could n ot be 100 percent certain that this was a tumor and that, because so much was at stake, we should do a biopsy. My wife and I wept openly — in part, because, looking at Dr. Lynch's face, we felt that he had lost hope.
I could not help but ask what treatment options were available, and he mentioned a drug called Taxol. Still being the lawyer, I quizzed him:
Me: What is the percentage of people who benefit from Taxol?
Dr. Lynch: Forty percent.
Me: How much do they benefit?
Dr. Lynch: They can get several years of life, although it is not a cure. And the median survival for patients on Taxol with your advanced stage of disease is nine months.
Nine months! My wife and I cringed. I ended the session by asking Dr. Lynch, ‘‘How do you do this work?’’ And he answered, in genuine pain, ‘‘By praying that I don't have days like today.’’
· · · · ·
I BEGAN TO HAVE TROUBLE sleeping, and when I awoke, I was filled with dread and despair. I thought frequently of the observation of Richard Block, the founder of H&R Block, who had survived lung cancer after being told initially that he had only months to live: ‘‘I lived for five days without hope and...my life during those five days...was far worse than at any time during the 'horrible' ordeal of tests or treatments.’’
And when I contemplated not living to see my son grow up or not cherishing my wife for a lifetime, I thought of King Lear, who, at a low point, wailed:
I am bound
Upon a wheel of fire, that mine own tears
Do scald like molten lead.
I desperately needed to regain hope, and I needed Dr. Lynch to regain his sense of hope.
A few days later, I had the biopsy. Dr. Lynch met with my family to report that, indeed, after considerable searching, the pathologist had found small deposits of adenocarcinoma in my vertebra. It was now confirmed that I had metastatic lung cancer. Although my brother and my father, who is also a physician, raised the possibility of radical surgery on my back and lung to remove all the tumors, Dr. Lynch and the surgeons rejected this option because further metastases were likely to appear, and the surgery would be debilitating and reduce my quality of life at a time when my life could well be substantially shortened.
The clear treatment was more chemotherapy. Dr. Lynch again recommended the use of Taxol, with the hope of slowing the cancer's spread.
My wife and I were largely silent during the medical discussion. I asked my father and brother to leave so my wife and I could talk not facts and figures but matters of the heart. When they had left, I said to Dr. Lynch, ‘‘You told me two things all along: One, that you were aiming for a total cure and if that were not feasible, you would tell me at that time. And two, you would never, ever give up on me, never stop trying to fight, to extend my life as long as possible. Am I no longer on the cure route?’’
He looked somberly at us and explained that there were no known treatments to cure this stage of cancer.
‘‘And will you stick by me and fight to the end?’’ I asked.
He nodded vigorously and then outlined a number of state-of-the-art, experimental protocols from which I might benefit after Taxol.
And, leaving statistics behind, he talked of several patients who had defied the odds and lived for years beyond expectations. He advised that my goal should be to be here the same time next year, and then the year after, and the year after — one day at a time, one month at a time, one year at a time. He mentioned several breast-cancer patients who had told him that they had relished their final years with their children in a way that they had never known before. It felt good to leave the medical talk and speak heart to heart, and it felt to me that he had regained a sense of hope — not for some magical cure but for the possibility of extending my life.
It was crucial to my wife and to me that he not give up hope. I understood his surprise and disappointment at the metastasis; in fact, as one friend suggested, his distress at that event was a sign of his caring about me and his involvement with my case. But we desperately needed him to give us a realistic basis for hope — and he had.
‘‘If I have learned anything, it is that we never know when, how, or whom a serious illness will strike. If and when it does, each one of us wants not simply the best possible care for our body but for our whole being.’’
Kenneth B. Schwartz
· · · · ·
THE NEXT DAY, I BEGAN A NEW chapter in my fight. And once again, Mimi Bartholomay was by my side, monitoring my reaction and assuring me that most people tolerated Taxol very well. I had no allergic reactions, and I felt good that the battle was under way. I had hoped that maybe this could buy me time.
Time was now my best friend, since it could allow medical research to advance and doctors to find new strategies and maybe even a cure for advanced lung cancer.
During this period, with help from my father, who has had a long and distinguished career in academic medicine, I began to explore potential cutting-edge protocols that could supplement or follow Taxol.
My father arranged a meeting for my wife and me with Dr. Kurt J. Isselbacher, a distinguished researcher and director of the MGH Cancer Center. He is a small man with a large presence and piercing blue eyes, and he was surrounded by medical books, papers, and many pictures of his family. He was upbeat, telling us of protocols under way that showed promise in fighting metastatic tumors. Like several others, he told me a personal story that cut to the bone: A close family member, he said, had been diagnosed with advanced cancer, which the attending oncologist had said was ‘‘very, very bad.’’ The family member had said to him: ‘‘Kurt, you have helped so many people in your life, can you now help me?’’ He personally treated the family member in that person's home with chemotherapy, and, 21 years later, that person is thriving.
Dr. Isselbacher offered to serve as an advocate for me, to work with my father and Dr. Lynch to find the most promising protocols. I told him at the meeting that while I had no illusions, I was deeply moved by his refusal to give up and by his abiding hope; I was especially affected because such hopefulness was not coming from a faith healer but a distinguished researcher. He had strengthened our resolve to fight.
‘‘I was especially affected because such hopefulness was not coming from a faith healer but a distinguished researcher’’
Kenneth B. Schwartz
As I grappled to maintain my hope in the face of the advancing disease, I was referred to Dr. Ned Cassem, a senior MGH psychiatrist who not only had had vast experience with the seriously ill but was himself a Jesuit priest. I had met with him once during my second hospitalization, and my memory through the haze was that he was the first person with whom I had discussed death. I remembered that when I asked him if, when, and how I should say goodbye to people, he said, ‘‘You know, you don't have to wait to say goodbye; you can express your love and appreciation for people right now, every day.’’
After the devastating news of the metastasis, I felt the urge to seek out Dr. Cassem again, in part to ask if there was anything more I should be doing to help my son, Ben, cope with my illness or the eventuality of my death. I mentioned that several people had suggested I make a videotape for Ben but that I thought I couldn't do that. Dr. Cassem replied that every time we played or laughed together, we were creating building blocks, precious memories that will be a part of him forever.
I also asked him if he thought I should be doing more to prepare for the possibility of an early death. He looked perplexed and asked, ‘‘Have you prepared your will?’’ I said yes. ‘‘Are your affairs otherwise in order?’’ I again said yes. ‘‘So it sounds like you are prepared. ... Remember, death is a minor matter. Living ... that's the challenge.’’
I then told him of the paradox that moments of great pleasure — playing with my son, snuggling with my wife, talking intensely with friends — also caused me great pain and tears. Was I depressed? Was this something to worry about? He looked at me thoughtfully and said: ‘‘When you cry about your son, it's because he has touched you deeply. It's an affirmation of your love for him. When you weep about the joy you experienced with your wife or close friends, that's an acknowledgment of your love for them. That's not a bad thing. ...Maybe a day without tears has been a dull day.’’ I nodded and then could not help but ask: ‘‘Do you believe in the power of prayer?’’ Dr. Cassem nodded. ‘‘Absolutely,’’ he said, ‘‘and your name is on my prayer list.’’ I felt warmed in his presence, by his wisdom, his common sense, and his spirituality.
· · · · ·
IN RECENT MONTHS, I have had several setbacks: a bone scan that showed four to five additional tumors, and a CT scan that showed significant progression of the cancer in both lungs. The only good news was that it had not spread to my head or liver. I am pained, but not surprised, at the relentlessness of the disease, and I am straining to retain hope that one of the experimental treatments may succeed where chemotherapy has failed.
For the first time, I recently mentioned to Dr. Lynch the idea of a hospice service and wondered how I might reduce future pain as the cancer progresses. Dr. Lynch answered that we were still a long way from that discussion, that we still had many avenues to explore, and that he remained as committed as ever to doing whatever he could to extend my life in a quality way.
Around the time of the CT scan, when I was feeling particularly dejected, I had an appointment with Mimi Bartholomay for an injection. She was running late, and as she approached me in the clinic waiting room, she looked harried. But as she got closer, she could see how unhappy I was, and she put her arm around me and directed me to a private room. I began to cry, and she intuitively responded: ‘‘You know, scan days are the worst. But whatever the results, we are not going to give up on you. We're going to fight with you and for you all the way.’’ I hugged her and thanked her for hanging in there with me.
If I have learned anything, it is that we never know when, how, or whom a serious illness will strike. If and when it does, each one of us wants not simply the best possible care for our body but for our whole being.
I still am bound upon Lear's wheel of fire, but the love and devotion of my family and friends, and the deep caring and engagement of my caregivers, have been a tonic for my soul and have helped to take some of the sting from my scalding tears.
Kenneth B. Schwartz died of lung cancer in September 1995. Shortly before his death he founded the Kenneth B. Schwartz Center at Massachusetts General Hospital, which is dedicated to strengthening the relationships between patients and caregivers.
Sunday, September 25, 2011
工作心情
在飞机上，翻阅了一本杂志，一篇有关著名发型设计师的专访，谈及她的工作，她说每天早上起床，她都会抱着兴奋地心情去上班。我自省了一阵子，怎么我没有这样的热诚？假日结束，该回到工作岗位了，心情反而是沉重的。即使没有放假，日复一日，机械化地操作，我的工作不曾让我感到兴奋和期待啊？！是麻醉科接触清醒的病人时间太少？是这科系不合适？是工作环境，对上司的不满，对“政治”的厌烦？工作应该是一种享受，不是吗？她说，面对挑战让她更充满力量；不知是否因行业区别的关系，不仅是我，就连工作经验比我丰富的上司在遇上难题时都会眉头深锁。因为很多决定，很多当机立断，赌上的可能是一个人的健康，甚至是生命，我们怎可能感觉雀跃呢？难道这职业真的没有让人愉悦的空间吗？
和友人的父母闲聊。他们问说，这份工作，辛苦吗？我说，只要值得，就不辛苦。但为何我不快乐呢？为何我不对工作有期待的心情呢？是我觉得不值吗？焦点错了，如果工作会想获得上司的重视，公平的待遇，怎么可能快乐呢？但这是正常的，不是吗？我找不到自己想要的满足感，所以我没有爱上自己的工作，我这样总结着。该怎样才能满足呢？或许我该问--自己的欲望究竟是什么，才能想办法填补这心灵上的空缺。人的欲望不外乎钱`权`情。钱嘛，能自给自足就成了；权，我最讨厌管理层乏味的工作，还有那副政治家的嘴脸。我觉得，我想要的，反而是最难得到的--情。我不喜欢自己的无情。曾有那么一次，接收紧急传召为一个三十几岁的癌症病人插管。已是第四期的癌症了，肿瘤压着呼吸管，导致只有一个肺部还能操作。我翻了病历，发现已有其它同事看了这位病人，与上司商议，决定不插管，选择不急救策略，换句话说，如果她能靠自己的能力活着，是个奇迹，如果不能，是命运。外行人一定不明白，为何这个医学还算昌明的世纪，居然会有由病人自生自灭的景象。这方策其实只有在一种情况下才能实行--当你认为延续其生命等于延长其痛苦，医学或医院没有把病人治愈的能力，所以选择放手。但命运总爱弄人，有些癌症偏选上了较年轻的病患，让我们更难取舍。放弃吗？三十几岁的生命，多么可惜，看着喘不过气的病人苦苦哀求，该怎么说不？该怎么告诉那站在一旁，泪痕满面的丈夫，反正插不插管，死亡对于他年轻的太太是必然的结局？我心疼，但电话响了，又有其它的紧急传呼，我没有多余的时间去安抚。对于自己的无情，我无法释怀。医生不是应该给病患带来希望的吗？但我的科系，却让我一而再地面对这一切。记得有一次因资源的问题，我只好告诉一个内科的同事，筛选你的病人。我讨厌让人心力交瘁的无力感，让我快乐不起来的压迫感。我们不是上帝，别人的命运凭什么由我们来决定？
写着写着，我似乎找到自己不快乐的原因，我想在自己的工作里找到带给病人及家属欢笑的成就感，在面对不治之症时和他们一起面对生命的无奈，我希望他们能了解我们已经尽力，也希望他们能继续相信，在能力和资源允许的情况下，医生不会选择放弃他的病人。现实是残酷的，但总得去面对，有谁会喜欢？但总得有人去背负这样的使命，但我希望去面对的心情不再是无奈的，而是充满着使命感与成就感。
在飞机上，翻阅了一本杂志，一篇有关著名发型设计师的专访，谈及她的工作，她说每天早上起床，她都会抱着兴奋地心情去上班。我自省了一阵子，怎么我没有这样的热诚？假日结束，该回到工作岗位了，心情反而是沉重的。即使没有放假，日复一日，机械化地操作，我的工作不曾让我感到兴奋和期待啊？！是麻醉科接触清醒的病人时间太少？是这科系不合适？是工作环境，对上司的不满，对“政治”的厌烦？工作应该是一种享受，不是吗？她说，面对挑战让她更充满力量；不知是否因行业区别的关系，不仅是我，就连工作经验比我丰富的上司在遇上难题时都会眉头深锁。因为很多决定，很多当机立断，赌上的可能是一个人的健康，甚至是生命，我们怎可能感觉雀跃呢？难道这职业真的没有让人愉悦的空间吗？
和友人的父母闲聊。他们问说，这份工作，辛苦吗？我说，只要值得，就不辛苦。但为何我不快乐呢？为何我不对工作有期待的心情呢？是我觉得不值吗？焦点错了，如果工作会想获得上司的重视，公平的待遇，怎么可能快乐呢？但这是正常的，不是吗？我找不到自己想要的满足感，所以我没有爱上自己的工作，我这样总结着。该怎样才能满足呢？或许我该问--自己的欲望究竟是什么，才能想办法填补这心灵上的空缺。人的欲望不外乎钱`权`情。钱嘛，能自给自足就成了；权，我最讨厌管理层乏味的工作，还有那副政治家的嘴脸。我觉得，我想要的，反而是最难得到的--情。我不喜欢自己的无情。曾有那么一次，接收紧急传召为一个三十几岁的癌症病人插管。已是第四期的癌症了，肿瘤压着呼吸管，导致只有一个肺部还能操作。我翻了病历，发现已有其它同事看了这位病人，与上司商议，决定不插管，选择不急救策略，换句话说，如果她能靠自己的能力活着，是个奇迹，如果不能，是命运。外行人一定不明白，为何这个医学还算昌明的世纪，居然会有由病人自生自灭的景象。这方策其实只有在一种情况下才能实行--当你认为延续其生命等于延长其痛苦，医学或医院没有把病人治愈的能力，所以选择放手。但命运总爱弄人，有些癌症偏选上了较年轻的病患，让我们更难取舍。放弃吗？三十几岁的生命，多么可惜，看着喘不过气的病人苦苦哀求，该怎么说不？该怎么告诉那站在一旁，泪痕满面的丈夫，反正插不插管，死亡对于他年轻的太太是必然的结局？我心疼，但电话响了，又有其它的紧急传呼，我没有多余的时间去安抚。对于自己的无情，我无法释怀。医生不是应该给病患带来希望的吗？但我的科系，却让我一而再地面对这一切。记得有一次因资源的问题，我只好告诉一个内科的同事，筛选你的病人。我讨厌让人心力交瘁的无力感，让我快乐不起来的压迫感。我们不是上帝，别人的命运凭什么由我们来决定？
写着写着，我似乎找到自己不快乐的原因，我想在自己的工作里找到带给病人及家属欢笑的成就感，在面对不治之症时和他们一起面对生命的无奈，我希望他们能了解我们已经尽力，也希望他们能继续相信，在能力和资源允许的情况下，医生不会选择放弃他的病人。现实是残酷的，但总得去面对，有谁会喜欢？但总得有人去背负这样的使命，但我希望去面对的心情不再是无奈的，而是充满着使命感与成就感。
台北之旅
一个比预期更难忘的旅行。由抵达台北市的第一个夜晚，就对这个城市留下好印象。公共巴士（称为客运）由司机一人负责开车，为旅客处理认领行李等工作，坐在车上的我们，用不着担心行李会让人趁机领走-这可是一般的客运哦，在我国可没有这种服务。记忆中几乎每一家店铺的员工或是夜市小贩的服务态度，总结--赞！非常有礼貌，回到了吉隆坡，实在看到了非常直接的对比，去过台湾的人肯定知道我并没有夸大其词。谈到公民意识，捷运不曾见过互相推挤的现象，大家都会守秩序；今天搭KTM时，又目睹天渊之别的现象，让我不禁怀疑究竟是别人的国家太进步，还是我国太落后了？或许是我不曾到过先进国的关系，这是我第一次觉得自己的国家和社会与别人相比，实在是望尘莫及。问题究竟是什么？要如何才能塑造一个这样的社会？再过五十年后的今天，我国人民是否也能那么有文化涵养？购物`乘搭计程车，也没有让人敲诈，我在想，如果我是由台湾到吉隆坡观光的旅客，肯定不会对这里留下好印象。我国商家对游客的“额外关照”，还有那服务员让人印象深刻的服务态度，唉，我们有太多需要改进之处。台湾是一个会让游客想再回去的地方，不仅是因为其名胜地，我认为更重要的原因是其人民对旅客的诚实和友善，让他们可以安心地享受整个旅程。
一个比预期更难忘的旅行。由抵达台北市的第一个夜晚，就对这个城市留下好印象。公共巴士（称为客运）由司机一人负责开车，为旅客处理认领行李等工作，坐在车上的我们，用不着担心行李会让人趁机领走-这可是一般的客运哦，在我国可没有这种服务。记忆中几乎每一家店铺的员工或是夜市小贩的服务态度，总结--赞！非常有礼貌，回到了吉隆坡，实在看到了非常直接的对比，去过台湾的人肯定知道我并没有夸大其词。谈到公民意识，捷运不曾见过互相推挤的现象，大家都会守秩序；今天搭KTM时，又目睹天渊之别的现象，让我不禁怀疑究竟是别人的国家太进步，还是我国太落后了？或许是我不曾到过先进国的关系，这是我第一次觉得自己的国家和社会与别人相比，实在是望尘莫及。问题究竟是什么？要如何才能塑造一个这样的社会？再过五十年后的今天，我国人民是否也能那么有文化涵养？购物`乘搭计程车，也没有让人敲诈，我在想，如果我是由台湾到吉隆坡观光的旅客，肯定不会对这里留下好印象。我国商家对游客的“额外关照”，还有那服务员让人印象深刻的服务态度，唉，我们有太多需要改进之处。台湾是一个会让游客想再回去的地方，不仅是因为其名胜地，我认为更重要的原因是其人民对旅客的诚实和友善，让他们可以安心地享受整个旅程。
Sunday, September 04, 2011
Saturday, August 27, 2011
Saturday, August 06, 2011
不为五斗米折腰
那天和上司、同事的闲聊，谈及身为公务员，应配合政府，随机应变，顺应时势。对于这样的作风，我无法认同。这种做事不够圆滑，坚持自己立场的处事方式，我已不是第一次得罪别人了。。。
深切治疗病房住进了一个遭抢劫，头部重伤的病人，院方通知说州务大臣会到访。我们一如往常地执行自己的任务，突然一群警察走进深切治疗病房，后面紧跟着一群记者。护士长每次遇见这种情况，就会急着传呼有关负责医生。朋友拉着我一同前往。。。但那群人根本不理会我们，那警官靠着床边，记者拼命照相，接着一群人一窝蜂地冲出深切治疗病房。我望着自己的上司，怒火中烧，如果我有权利，一定上前喝止。他们根本不在乎那位病人，他们以为病人是陈列品，病房是陈列室，可以随心所欲？他们真正的目的是什么？这病人当下的状况如何对他们而言，重要吗？据说，是院长批准这些记者进来。或许，大家都没错，只是各自奉命行事。。。还以为只要不从商，就不需要参与这些政治游戏，看来我错了。
最讨厌那些vip或他们的亲戚入院。私立医院以利益为先的作风，众所周知；但如果你认为公立医院，是公平地对待每一位病人，这未必是事实。但不管那些人在玩什么把戏，也庆幸自己不是什么重要人物，所以不需恭维这些人，我可以问心无愧地面对自己的病人。对病人的关注，是应该以其病情决定，而不是因其官位或经济背景。或许你可以说，我没身在江湖，又怎会明白他们的立场？很多事都是身不由己，很多事都不是看起来那么简单。先别说我这种不事权贵，经常得罪别人的人根本不可能位居显要，就算有朝一日会有这样的机会，我情愿做个平凡，踏实却能无愧于心的人。
那天和上司、同事的闲聊，谈及身为公务员，应配合政府，随机应变，顺应时势。对于这样的作风，我无法认同。这种做事不够圆滑，坚持自己立场的处事方式，我已不是第一次得罪别人了。。。
深切治疗病房住进了一个遭抢劫，头部重伤的病人，院方通知说州务大臣会到访。我们一如往常地执行自己的任务，突然一群警察走进深切治疗病房，后面紧跟着一群记者。护士长每次遇见这种情况，就会急着传呼有关负责医生。朋友拉着我一同前往。。。但那群人根本不理会我们，那警官靠着床边，记者拼命照相，接着一群人一窝蜂地冲出深切治疗病房。我望着自己的上司，怒火中烧，如果我有权利，一定上前喝止。他们根本不在乎那位病人，他们以为病人是陈列品，病房是陈列室，可以随心所欲？他们真正的目的是什么？这病人当下的状况如何对他们而言，重要吗？据说，是院长批准这些记者进来。或许，大家都没错，只是各自奉命行事。。。还以为只要不从商，就不需要参与这些政治游戏，看来我错了。
最讨厌那些vip或他们的亲戚入院。私立医院以利益为先的作风，众所周知；但如果你认为公立医院，是公平地对待每一位病人，这未必是事实。但不管那些人在玩什么把戏，也庆幸自己不是什么重要人物，所以不需恭维这些人，我可以问心无愧地面对自己的病人。对病人的关注，是应该以其病情决定，而不是因其官位或经济背景。或许你可以说，我没身在江湖，又怎会明白他们的立场？很多事都是身不由己，很多事都不是看起来那么简单。先别说我这种不事权贵，经常得罪别人的人根本不可能位居显要，就算有朝一日会有这样的机会，我情愿做个平凡，踏实却能无愧于心的人。
Monday, July 18, 2011
Sunday, July 17, 2011
如果我说 我累了
这世界是否会有空隙 让我喘气
如果我说 我想停了
时针它可会停止转动 让我躲避
如果我说 我受不了了
命运你会否大发慈悲 让我解脱
这是个何其苛刻的环境，没有人会在乎你是否不眠不休，没有人会理会你是否已尽心尽力，做得好是份内事，做错了每个细节都会被放大研讨。不顺心，我接受了，还来不及沉淀，就要步入下一个战区。工作表密得没有缝隙透气，那一天，走在医院的走廊上，心已累得很不愿意，但脑里那严厉的意识却警告我，如果让情绪和过去影响工作能力，对今天的病人是不公平的，于是再度封锁了那烦人的情绪，把自己带上战场，机械化地操作。这是我自愿选择的环境，凭什么埋怨？我不怨，但我能不能也喊累？这时间表能不能有个空间，让我释放情绪？
这世界是否会有空隙 让我喘气
如果我说 我想停了
时针它可会停止转动 让我躲避
如果我说 我受不了了
命运你会否大发慈悲 让我解脱
这是个何其苛刻的环境，没有人会在乎你是否不眠不休，没有人会理会你是否已尽心尽力，做得好是份内事，做错了每个细节都会被放大研讨。不顺心，我接受了，还来不及沉淀，就要步入下一个战区。工作表密得没有缝隙透气，那一天，走在医院的走廊上，心已累得很不愿意，但脑里那严厉的意识却警告我，如果让情绪和过去影响工作能力，对今天的病人是不公平的，于是再度封锁了那烦人的情绪，把自己带上战场，机械化地操作。这是我自愿选择的环境，凭什么埋怨？我不怨，但我能不能也喊累？这时间表能不能有个空间，让我释放情绪？
Thursday, July 14, 2011
你是器官捐献者？
为期两天的“器官捐献营”结束了，很累，但值得。一个生命结束了，在家属肝肠寸断的当下，要如何和他们讨论器官捐献的课题，实在太需要技巧了，但器官的功能也会随着时间的流失而衰退，我们是分秒必争，却又不能操之过急。我国人民对这个课题，能接受的程度还是有限的，因此这项工作变得更艰巨。在这个部门工作，和器官捐献扯不开关系，所以我们都知道这过程有多繁琐。由血液检验，接触家属，证明病人死亡，再安排手术，安抚家属。。。之前，一有合适的捐献者，大家都唉声叹气；但如果能明白这累人的工作，对那些有需要的病人存在着多大的意义，再累也值得。一个器官，可以让一个人重生；一个躯体，可以救几条人命？听起来好像挺伟大的，但如果你是那病人的家属，在你刚获知噩耗，悲痛欲绝的时候，有人问你，想从你至亲的身上割去那些有用的器官，你能保持冷静，认真思考吗?有些国家，采取的政策，是人民必须说明不愿捐献的意愿，才能免除捐献，但我国政府的政策并非如此,所以我真心佩服那些参与这些工作的人。在毫无获利的情况下，去面对家属的抗拒·不解，甚至斥骂，为的只是那些和自己没有关系，但天天期盼奇迹的病人。或许，不是所有医生都为了病人而工作，但至少有些人是，能看见一些生命之火死灰复燃，就是自己最大的收获。
为期两天的“器官捐献营”结束了，很累，但值得。一个生命结束了，在家属肝肠寸断的当下，要如何和他们讨论器官捐献的课题，实在太需要技巧了，但器官的功能也会随着时间的流失而衰退，我们是分秒必争，却又不能操之过急。我国人民对这个课题，能接受的程度还是有限的，因此这项工作变得更艰巨。在这个部门工作，和器官捐献扯不开关系，所以我们都知道这过程有多繁琐。由血液检验，接触家属，证明病人死亡，再安排手术，安抚家属。。。之前，一有合适的捐献者，大家都唉声叹气；但如果能明白这累人的工作，对那些有需要的病人存在着多大的意义，再累也值得。一个器官，可以让一个人重生；一个躯体，可以救几条人命？听起来好像挺伟大的，但如果你是那病人的家属，在你刚获知噩耗，悲痛欲绝的时候，有人问你，想从你至亲的身上割去那些有用的器官，你能保持冷静，认真思考吗?有些国家，采取的政策，是人民必须说明不愿捐献的意愿，才能免除捐献，但我国政府的政策并非如此,所以我真心佩服那些参与这些工作的人。在毫无获利的情况下，去面对家属的抗拒·不解，甚至斥骂，为的只是那些和自己没有关系，但天天期盼奇迹的病人。或许，不是所有医生都为了病人而工作，但至少有些人是，能看见一些生命之火死灰复燃，就是自己最大的收获。
Sunday, July 10, 2011
Saturday, July 09, 2011
基本要求
等你发现时间是贼了，它早已偷光你的选择。。。
不知不觉，已快一年了，一年前，曾经有过明确的目标，却遇上了一些障碍，计划被搁置了。一开始的决心，早已消失无踪，几度迷失。这是命运的安排？还是我自己的意志根本不堪一击？
怨天尤人，不如怨自己。然而，这一切都是毫无意义的。塞翁失马，或许是冥冥中另有安排。
我总在荒废岁月，一直在探索，不敢对未来寄望些什么，因为前景，它还在迷雾中，时隐时现。
模糊，这是形容我的当下最贴切的词汇。想要什么？这怎么会变成一个让我不知所措的问题？是我不知道想要什么？还是我根本没有勇气去面对它为我设下的挑战？很惭愧，但不能否认，答案是后者。要入虎穴吗？我一再却步。还真希望这时候会有个人把我给推进去。犹豫，是因为缺乏自信，自信必须源自实力，而实力，是我最需要的武器。
如果这是上天在人生的这一个阶段，给我出的考题，我应该坦然面对，不再逃避。深入虎穴，未必定能夺得虎子，但不入虎穴，肯定不能。人生有着无限可能，我无法确定，这一刻的这个选择是对的，但如果连尝试的勇气都找不到，我真不知道自己该以什么态度去走接下来的路。
等你发现时间是贼了，它早已偷光你的选择。。。
不知不觉，已快一年了，一年前，曾经有过明确的目标，却遇上了一些障碍，计划被搁置了。一开始的决心，早已消失无踪，几度迷失。这是命运的安排？还是我自己的意志根本不堪一击？
怨天尤人，不如怨自己。然而，这一切都是毫无意义的。塞翁失马，或许是冥冥中另有安排。
我总在荒废岁月，一直在探索，不敢对未来寄望些什么，因为前景，它还在迷雾中，时隐时现。
模糊，这是形容我的当下最贴切的词汇。想要什么？这怎么会变成一个让我不知所措的问题？是我不知道想要什么？还是我根本没有勇气去面对它为我设下的挑战？很惭愧，但不能否认，答案是后者。要入虎穴吗？我一再却步。还真希望这时候会有个人把我给推进去。犹豫，是因为缺乏自信，自信必须源自实力，而实力，是我最需要的武器。
如果这是上天在人生的这一个阶段，给我出的考题，我应该坦然面对，不再逃避。深入虎穴，未必定能夺得虎子，但不入虎穴，肯定不能。人生有着无限可能，我无法确定，这一刻的这个选择是对的，但如果连尝试的勇气都找不到，我真不知道自己该以什么态度去走接下来的路。
Saturday, June 25, 2011
无所适从
那天，须要负责一个高风险的手术，在手术进行时发现病人心律数次出现反常的状况，虽不持久，却让我开始担心。那医生看起来有点挣扎，我大胆提出建议，毕竟尽早结束手术，确保病人安全才最重要，他有点不高兴，所以我向他道歉，再怎么说我都已跨越自己的界限。他好像很大方地接受了，笑着说没事。我以为事情已圆满结束了，隔天他传来一封简讯，把我训了一顿，说我没资格教他该怎么做，如果我真有本事，就该由我来操刀，还说是因为他很有忍耐力，才会容忍我的无礼，还叫我不要试着要挑战他的底线。我看完后觉得心好冷，回想他昨天的若无其事，再想到他简讯中的怒意。为何人竟能如此做作？我真的饱受这部门的闷气，这些人就是这么自大，完全不能接受别人的意见。而他真有他自以为的大量吗？据说我已是第二次对他无礼，而我完全不记得第一次是什么时候。经过这件事，我对这人彻底改观。
简讯回了，我一向讨厌虚伪假装，却只向他道歉，也保证绝不会重犯，并说明我没资格干涉他的专业范围之内的事。或许是我措辞不当，但动机也是为了病人安全。为何我们不能同心协力为病人服务？人生就只几十年，背负这么多愤怒和仇恨，不累吗？倒是我觉得累了，但还好，问心无愧。
那天，须要负责一个高风险的手术，在手术进行时发现病人心律数次出现反常的状况，虽不持久，却让我开始担心。那医生看起来有点挣扎，我大胆提出建议，毕竟尽早结束手术，确保病人安全才最重要，他有点不高兴，所以我向他道歉，再怎么说我都已跨越自己的界限。他好像很大方地接受了，笑着说没事。我以为事情已圆满结束了，隔天他传来一封简讯，把我训了一顿，说我没资格教他该怎么做，如果我真有本事，就该由我来操刀，还说是因为他很有忍耐力，才会容忍我的无礼，还叫我不要试着要挑战他的底线。我看完后觉得心好冷，回想他昨天的若无其事，再想到他简讯中的怒意。为何人竟能如此做作？我真的饱受这部门的闷气，这些人就是这么自大，完全不能接受别人的意见。而他真有他自以为的大量吗？据说我已是第二次对他无礼，而我完全不记得第一次是什么时候。经过这件事，我对这人彻底改观。
简讯回了，我一向讨厌虚伪假装，却只向他道歉，也保证绝不会重犯，并说明我没资格干涉他的专业范围之内的事。或许是我措辞不当，但动机也是为了病人安全。为何我们不能同心协力为病人服务？人生就只几十年，背负这么多愤怒和仇恨，不累吗？倒是我觉得累了，但还好，问心无愧。
Monday, June 20, 2011
Wednesday, June 15, 2011
公正-存在吗？
今天，发生了一件我的“工作史”上，最可笑的事。诊所病人人数少了，上司觉得我闲着，竟想扣工钱。当然，她没权这么做，只是这种半开玩笑的话，非常惹人反感。早到迟退，彻夜未眠时，可曾嘉许？加薪？简直是妄想。准时上班，未曾离开工作岗位，病人少了，凭什么怪罪于我？这种话，亏她说得出口。我不是为钱而工作，所以不会在乎扣钱，只是当一个员工自认尽责，却让别人这么诬蔑，就会怀疑自己的付出是否值得。但这念头很快就消失--当然值得，我不是为她而工作的！就是这种要不得的使命感，让我继续俯首称臣。三个月才请一次假，还得让别人觉得我懒，真傻，及时行乐吧，干嘛总爱这样折腾自己？
谈到钱与权，今天听见另一件趣事，曾经有位vip的儿子拔牙，居然得让专科医生耐心等候那孩子甘心让医生打点滴，，全程由父亲大人陪伴左右，不能强迫他儿子。除非那孩子疯了，否则怎可能静坐忍受皮肉之痛？还真佩服当时负责手术的那几位上司。在我们立过的誓言里，曾说过不分贵贱，给病人平等的待遇，不是吗？这世界怎么老是得有灰色地带？我越来越不懂。。。
今天，发生了一件我的“工作史”上，最可笑的事。诊所病人人数少了，上司觉得我闲着，竟想扣工钱。当然，她没权这么做，只是这种半开玩笑的话，非常惹人反感。早到迟退，彻夜未眠时，可曾嘉许？加薪？简直是妄想。准时上班，未曾离开工作岗位，病人少了，凭什么怪罪于我？这种话，亏她说得出口。我不是为钱而工作，所以不会在乎扣钱，只是当一个员工自认尽责，却让别人这么诬蔑，就会怀疑自己的付出是否值得。但这念头很快就消失--当然值得，我不是为她而工作的！就是这种要不得的使命感，让我继续俯首称臣。三个月才请一次假，还得让别人觉得我懒，真傻，及时行乐吧，干嘛总爱这样折腾自己？
谈到钱与权，今天听见另一件趣事，曾经有位vip的儿子拔牙，居然得让专科医生耐心等候那孩子甘心让医生打点滴，，全程由父亲大人陪伴左右，不能强迫他儿子。除非那孩子疯了，否则怎可能静坐忍受皮肉之痛？还真佩服当时负责手术的那几位上司。在我们立过的誓言里，曾说过不分贵贱，给病人平等的待遇，不是吗？这世界怎么老是得有灰色地带？我越来越不懂。。。
Friday, June 03, 2011
养儿防老
深切治疗病房，住了一个阿伯，应该五十几岁，糖尿病，高血压，肾功能衰竭，需要长期洗肾，脚部溃烂，已经锯断，因伤口没有清洗，引起并发症，需要再动手术。据说，他并没定期洗肾，因为家人没空接送的问题。我是心里有气，养儿防老？这是在上个世纪才有可能会发生的奇迹吧？那天正好值班，就让护士把家属请来，商议手术的事，我决定保持客观的态度，或许背后有我们不知情的事，不能武断。于是我先询问他的儿子，让他先发言，他毫无愧疚，侃侃而谈，说家里没人能放下自己的工作，去照顾他的父亲，还指着他的父亲说，怎可能要他二十多岁的妹妹去扛七十公斤重的父亲到洗肾中心，接着说同意手术，他们已经尽力了，不能保证手术后，会定期洗肾，也不能保证能细心照顾伤口，不受细菌感染，如果这真是他父亲的宿命，他们也认了。我听完后没有想象中的愤怒，只是心平气和地以专业的口吻告诉他，手术会做，因为我们想为病人做最好的治疗，但若没有人愿意扛起照顾他父亲的责任，他肯定会不断因同样的问题入院，甚至死于并发症。他走后，我看着他躺在床上的父亲感叹，也不知道他前世今生造了什么罪孽，要遭此劫难。这不是绝症！而是人为的，可以避免的并发症。脚锯了再锯又如何？始终解决不了问题。这也难怪肾科医生有时在面对这样的家属，会做出暂停洗肾的决定。因为洗肾中心的床位有限，何不把机会让给其他更想接受治疗的病人？
如果他们真的愿意，有可能办不到吗？但这毕竟是别人的家事，站在自己的工作岗位，我不便干涉。我察觉到他在言谈间的自我保护意识很强，好像很害怕我会责备他。与其白耗力气和他争辩，不如想办法找些社工，能在手术后接送他父亲洗肾，并为他清洗伤口。至于这位年轻人呵，有一天，你一定会后悔自己没有好好照顾你的父亲，因为我隐约觉得你还是有点良知的。但愿你会好好教育自己的孩子，别让他们日后也以同样的方式对待你。
深切治疗病房，住了一个阿伯，应该五十几岁，糖尿病，高血压，肾功能衰竭，需要长期洗肾，脚部溃烂，已经锯断，因伤口没有清洗，引起并发症，需要再动手术。据说，他并没定期洗肾，因为家人没空接送的问题。我是心里有气，养儿防老？这是在上个世纪才有可能会发生的奇迹吧？那天正好值班，就让护士把家属请来，商议手术的事，我决定保持客观的态度，或许背后有我们不知情的事，不能武断。于是我先询问他的儿子，让他先发言，他毫无愧疚，侃侃而谈，说家里没人能放下自己的工作，去照顾他的父亲，还指着他的父亲说，怎可能要他二十多岁的妹妹去扛七十公斤重的父亲到洗肾中心，接着说同意手术，他们已经尽力了，不能保证手术后，会定期洗肾，也不能保证能细心照顾伤口，不受细菌感染，如果这真是他父亲的宿命，他们也认了。我听完后没有想象中的愤怒，只是心平气和地以专业的口吻告诉他，手术会做，因为我们想为病人做最好的治疗，但若没有人愿意扛起照顾他父亲的责任，他肯定会不断因同样的问题入院，甚至死于并发症。他走后，我看着他躺在床上的父亲感叹，也不知道他前世今生造了什么罪孽，要遭此劫难。这不是绝症！而是人为的，可以避免的并发症。脚锯了再锯又如何？始终解决不了问题。这也难怪肾科医生有时在面对这样的家属，会做出暂停洗肾的决定。因为洗肾中心的床位有限，何不把机会让给其他更想接受治疗的病人？
如果他们真的愿意，有可能办不到吗？但这毕竟是别人的家事，站在自己的工作岗位，我不便干涉。我察觉到他在言谈间的自我保护意识很强，好像很害怕我会责备他。与其白耗力气和他争辩，不如想办法找些社工，能在手术后接送他父亲洗肾，并为他清洗伤口。至于这位年轻人呵，有一天，你一定会后悔自己没有好好照顾你的父亲，因为我隐约觉得你还是有点良知的。但愿你会好好教育自己的孩子，别让他们日后也以同样的方式对待你。
Monday, May 30, 2011
突然。茫然
我不知道，这算不算正常，我仿佛已到达了一个点，一个不知所措的点。以前都是我在问别人对未来的打算；最近这反而成了我最想逃避的问题。于是，我决定要放假，虽然就只短短几天，能离开一下也好，心里清楚，是该喊停了。有机会逛书局，让一本书的书名吸引了-生命没有如果，拿起来后才发现，这是朋友之前介绍我看的一个部落格，同一位作者所写的。记得以前的我，总是很踏实的过日子，人生哪有那么多如果？我总这样对那些喜欢幻想的朋友说，完全不让自己有空隙去追悔任何决定，这反而有助于改变悲观与消极的态度，我发现。当下的我不爱假设吗？或许应该说，我不敢假设，可是生活也因此变得不知所措，因为少了梦想，少了希望。我就是这样犯贱的，总不能安于当下，开始觉得，是该去寻找一些新的刺激点，这是好事吗？我不知道。但如果我选择维持现状，五年后的我一样会在原地踏步，届时就更没有冒险的勇气了。这次的假期，有机会约了一些朋友相聚，闲聊间说了有关闪电结婚的事，朋友说我绝对有这样的潜能，我笑说若是遇到了对的人，不排除这样的可能性。很多事情，常因一时冲动才会促成，人不能永远都那么理智，当然，结果是好是坏，也只能自己去承担。有时也会规划再过几年，想有些新的尝试，但我不能保证几年后的我还会这么想。或许，我接下来会有一些让别人以为我疯了的决定，我是说或许，因为当理智选择放任情绪时，就连自己也无法确定自己的心思，我不是想当情绪的奴隶，但如果理智的意识过于强势，我觉得我又会裹足不前。管他呢，做了再算！
我不知道，这算不算正常，我仿佛已到达了一个点，一个不知所措的点。以前都是我在问别人对未来的打算；最近这反而成了我最想逃避的问题。于是，我决定要放假，虽然就只短短几天，能离开一下也好，心里清楚，是该喊停了。有机会逛书局，让一本书的书名吸引了-生命没有如果，拿起来后才发现，这是朋友之前介绍我看的一个部落格，同一位作者所写的。记得以前的我，总是很踏实的过日子，人生哪有那么多如果？我总这样对那些喜欢幻想的朋友说，完全不让自己有空隙去追悔任何决定，这反而有助于改变悲观与消极的态度，我发现。当下的我不爱假设吗？或许应该说，我不敢假设，可是生活也因此变得不知所措，因为少了梦想，少了希望。我就是这样犯贱的，总不能安于当下，开始觉得，是该去寻找一些新的刺激点，这是好事吗？我不知道。但如果我选择维持现状，五年后的我一样会在原地踏步，届时就更没有冒险的勇气了。这次的假期，有机会约了一些朋友相聚，闲聊间说了有关闪电结婚的事，朋友说我绝对有这样的潜能，我笑说若是遇到了对的人，不排除这样的可能性。很多事情，常因一时冲动才会促成，人不能永远都那么理智，当然，结果是好是坏，也只能自己去承担。有时也会规划再过几年，想有些新的尝试，但我不能保证几年后的我还会这么想。或许，我接下来会有一些让别人以为我疯了的决定，我是说或许，因为当理智选择放任情绪时，就连自己也无法确定自己的心思，我不是想当情绪的奴隶，但如果理智的意识过于强势，我觉得我又会裹足不前。管他呢，做了再算！
Saturday, May 14, 2011
医者仁心
刚开始，只是因为无聊，想找部电视剧看看，厌倦了尔虞我诈，总在反映现实的港剧，就选看内地剧场。这是一部有关医生的故事，我是抱着好奇的心态在观看，想试着了解中国的医药背景和医生的生活和我国的差异。它不像《house》，在炫耀多离奇病案与诊断，只能说它是老老实实地在叙述一些医学的理想，医生的生活，我们面对的种种挣扎，医院里常被隐藏的实况，这是它，令人感动的地方。但，里面很多治疗方案，都是错误的，电视剧追究只是戏剧，并不专业。
也不晓得它是否因为只是戏剧，而被理想化了，还是这世上真的会有那么多热情的，坚持自我原则的医生？可悲吧？这竟然会是个疑惑，而非信仰。我们都立过誓的，hippocrate's oath，在毕业的那一天。抱着满腔热情，踏入现实，它一天一点地冷却，所以你们才会感受到医患之间的那一种冷淡的关系。患者对医生的敬重少了，质疑多了；医者对病人的关怀少了，谨慎多了。为何要谨慎呢？那每天都在见报的医疗官司，媒体锋利的字眼，社会的不信任，叫人心寒，怎能不防？当然，不是所有医生都坚持自己的高尚情操，这是无可否认的事实，就看个人作何选择。
曾有位病人，七十岁高龄了，卧床十多年，所有关节都僵硬了，因肺炎入院，情况不乐观，喘得厉害，需要插管，那天我刚好值班，三点凌晨，内科部的同事让我去看她。确实，紧急插管是必要的，但这过程对她的风险较大，x光片所显示，也不确定是肺癌，还是细菌感染，于是我们和家属商议了三小时，一开始还闹得很不愉快，说真的我还没遇过这么情绪失控的家属。我们解释了，再解释，其实都是同样的道理，只是他不够冷静，不肯静心听我们的解释。医学不是万能的，我们都认为对一个这样的老人家进行插管，不仅过程有风险，就算真成功了，她能撑得了多久？能否活着出院？这些都是我们会考虑的因素，外行人不懂，还觉得我们是见死不救。相信医生的人，总会认为医生会为他们做最好的决定，而当我们觉得最好的决定是选择放弃时，如何与家属沟通，让他们理解情况，是很需要技巧的。毕竟，这是他们的亲人，说放手，谈何容易？我可以给她插管，事情不就解决了吗？何须费三小时，和在闹情绪的家属，对牛弹琴？在这过程中，我确实有在想，自己真笨，自讨苦吃，搞不好还得让人投诉，给她插管不就了事了吗？但后来我说服自己了，因为我相信这是对她最好的决定，也是一种尊重。最后，那家属终于冷静了，也明白我们的说法，决定不插管。这时，我又想起已去世的姑姑，心脏衰竭，中风，意识却是清醒的，她总示意，不想活了，于是，当她再度心脏病发，我们选择了不抢救。这不是个容易的决定，对家属和医生，都一样，或许是司空见惯了，我们总能表现的客观与冷静，专业化了，让家属觉得我们无情。那家属问我的一个问题，让我至今印象深刻，他想知道的，不是我们职业性地解释我们的决定，而是换成我是这病人的孙子，我会怎么选择。站在医者的立场，或许我应该说，站在这个年代，身为一个医生的立场，对这种情况，我们常常只是说明一些程序的风险，好处与坏处，决定权交予病人及家属，换句话说，我们的立场是中立的。这是职业的需要，当然换成是个三四十岁的，有康复希望的年轻人，就不是这么处理了。所以，有很多灰色地带，很多不为人知的难处，是很难解释的，需要经验的累积，慢慢巩固自己的信念，去面对别人的不解。沟通是重要的，反正说了也不懂，很多医生就是因为懒得解释，才会引起家属和病人的不满。我们常常因为一些专业的坚持，表现得冷酷，忽略了别人的感受，造成别人的误解，然而仔细想一想，这能算得上是专业吗?一个敬业的医者，是应该在合理的情况下，满足病人的需求，知道他们想要什么，哪怕是已经绝望的情况下，或许他们想要的只是一点关怀与安慰。A DOCTOR RARELY CURES，SOMETIMES TREATS，BUT ALWAYS PROVIDE COMFORT。这是在医学生时期，就常听说的名言，我越来越明白它的意思，科学的有限，在人情与职业化之间的平衡点，一个医生应该扮演的角色。
很多时候，我们常会因对现实的失望，而认为对理想的坚持，是过于单纯的，但如果不去坚持，生活还能有什么希望？又该以什么心态去面对每一天？继续混日子吗？意义何在？往往就是因为不再坚持，我反而不知道自己想要什么。但我可以肯定的是，医生所面对的种种压力，不是靠混，就能得过且过的。站在今天的工作岗位上，清楚自己的责任，我不是什么了不起的专科医生，但我有我必须承担的责任，不能被妥协的原则，我们是立过誓的，我记得。
刚开始，只是因为无聊，想找部电视剧看看，厌倦了尔虞我诈，总在反映现实的港剧，就选看内地剧场。这是一部有关医生的故事，我是抱着好奇的心态在观看，想试着了解中国的医药背景和医生的生活和我国的差异。它不像《house》，在炫耀多离奇病案与诊断，只能说它是老老实实地在叙述一些医学的理想，医生的生活，我们面对的种种挣扎，医院里常被隐藏的实况，这是它，令人感动的地方。但，里面很多治疗方案，都是错误的，电视剧追究只是戏剧，并不专业。
也不晓得它是否因为只是戏剧，而被理想化了，还是这世上真的会有那么多热情的，坚持自我原则的医生？可悲吧？这竟然会是个疑惑，而非信仰。我们都立过誓的，hippocrate's oath，在毕业的那一天。抱着满腔热情，踏入现实，它一天一点地冷却，所以你们才会感受到医患之间的那一种冷淡的关系。患者对医生的敬重少了，质疑多了；医者对病人的关怀少了，谨慎多了。为何要谨慎呢？那每天都在见报的医疗官司，媒体锋利的字眼，社会的不信任，叫人心寒，怎能不防？当然，不是所有医生都坚持自己的高尚情操，这是无可否认的事实，就看个人作何选择。
曾有位病人，七十岁高龄了，卧床十多年，所有关节都僵硬了，因肺炎入院，情况不乐观，喘得厉害，需要插管，那天我刚好值班，三点凌晨，内科部的同事让我去看她。确实，紧急插管是必要的，但这过程对她的风险较大，x光片所显示，也不确定是肺癌，还是细菌感染，于是我们和家属商议了三小时，一开始还闹得很不愉快，说真的我还没遇过这么情绪失控的家属。我们解释了，再解释，其实都是同样的道理，只是他不够冷静，不肯静心听我们的解释。医学不是万能的，我们都认为对一个这样的老人家进行插管，不仅过程有风险，就算真成功了，她能撑得了多久？能否活着出院？这些都是我们会考虑的因素，外行人不懂，还觉得我们是见死不救。相信医生的人，总会认为医生会为他们做最好的决定，而当我们觉得最好的决定是选择放弃时，如何与家属沟通，让他们理解情况，是很需要技巧的。毕竟，这是他们的亲人，说放手，谈何容易？我可以给她插管，事情不就解决了吗？何须费三小时，和在闹情绪的家属，对牛弹琴？在这过程中，我确实有在想，自己真笨，自讨苦吃，搞不好还得让人投诉，给她插管不就了事了吗？但后来我说服自己了，因为我相信这是对她最好的决定，也是一种尊重。最后，那家属终于冷静了，也明白我们的说法，决定不插管。这时，我又想起已去世的姑姑，心脏衰竭，中风，意识却是清醒的，她总示意，不想活了，于是，当她再度心脏病发，我们选择了不抢救。这不是个容易的决定，对家属和医生，都一样，或许是司空见惯了，我们总能表现的客观与冷静，专业化了，让家属觉得我们无情。那家属问我的一个问题，让我至今印象深刻，他想知道的，不是我们职业性地解释我们的决定，而是换成我是这病人的孙子，我会怎么选择。站在医者的立场，或许我应该说，站在这个年代，身为一个医生的立场，对这种情况，我们常常只是说明一些程序的风险，好处与坏处，决定权交予病人及家属，换句话说，我们的立场是中立的。这是职业的需要，当然换成是个三四十岁的，有康复希望的年轻人，就不是这么处理了。所以，有很多灰色地带，很多不为人知的难处，是很难解释的，需要经验的累积，慢慢巩固自己的信念，去面对别人的不解。沟通是重要的，反正说了也不懂，很多医生就是因为懒得解释，才会引起家属和病人的不满。我们常常因为一些专业的坚持，表现得冷酷，忽略了别人的感受，造成别人的误解，然而仔细想一想，这能算得上是专业吗?一个敬业的医者，是应该在合理的情况下，满足病人的需求，知道他们想要什么，哪怕是已经绝望的情况下，或许他们想要的只是一点关怀与安慰。A DOCTOR RARELY CURES，SOMETIMES TREATS，BUT ALWAYS PROVIDE COMFORT。这是在医学生时期，就常听说的名言，我越来越明白它的意思，科学的有限，在人情与职业化之间的平衡点，一个医生应该扮演的角色。
很多时候，我们常会因对现实的失望，而认为对理想的坚持，是过于单纯的，但如果不去坚持，生活还能有什么希望？又该以什么心态去面对每一天？继续混日子吗？意义何在？往往就是因为不再坚持，我反而不知道自己想要什么。但我可以肯定的是，医生所面对的种种压力，不是靠混，就能得过且过的。站在今天的工作岗位上，清楚自己的责任，我不是什么了不起的专科医生，但我有我必须承担的责任，不能被妥协的原则，我们是立过誓的，我记得。
Tuesday, May 10, 2011
责任
又是一个无聊的mortality review，为何我会觉得无聊?它应该是很有意义的检讨会才对，从别人的错误中学习，是用一个生命换来的经验，无论死因是否属于“能避免”，重点是要找出预防的方法。但一般上，它都会被变成别人互相推卸责任，互相指责场面。这次我不能躲开，因为我得代表我的部门，成为其中一个presenter，尽管我并没接触过这位阿伯。
外科医生与麻醉医生一向都是宿敌，在很多医院都是，曾有位外科医生朋友说，她只想和自己认识的一位麻醉医生打招呼，就马上让自己的同事制止。麻醉医生一向都不会讨人喜欢，而且拥有很大的“权势”，他们说得取消手术，外科医生不能说不。但在我们的医院，情况是相反的，我们常常倒过来让外科医生欺负，因为我们的老板较喜欢做个“好人”，受罪的当然是我们这些无名小卒，无权发言，只能埋头苦干。
这位阿伯是手术后，死于心脏病，一箩筐的病史，八十的高龄，我们把这手术列为高风险，但在手术期间及复苏观察，病人情况稳定，结果只送回普通病房。可笑的是，外科医生居然怪罪麻醉医生为何不把病人送入icu,为何没有麻醉医生到普通病房去看这位病人。我倒想问一问，外科医生，就不是医生？外科医生就只需要会动手术？他们就不应该知道如何诊断并急救心脏病病人？这有多荒唐！出事了，不懂自我反省，只想着要怎么怪别人。最可笑的是，他们居然问高风险手术同意书，应该由麻醉师或外科医生给病人解释，而当我们认为是双方时，他们竟然不高兴，认为麻醉才是造成高风险的主因。天啊，哪有麻醉师会在病人不需要手术时给病人麻醉？手术是谁要做的？倒把责任给推得一干二净的。一个真正的好医生，会以病人的利益与安危为前提，而不是在乎究竟谁应该背负较大的责任。
研讨会结束了，我对这种态度，无话可说。。。
又是一个无聊的mortality review，为何我会觉得无聊?它应该是很有意义的检讨会才对，从别人的错误中学习，是用一个生命换来的经验，无论死因是否属于“能避免”，重点是要找出预防的方法。但一般上，它都会被变成别人互相推卸责任，互相指责场面。这次我不能躲开，因为我得代表我的部门，成为其中一个presenter，尽管我并没接触过这位阿伯。
外科医生与麻醉医生一向都是宿敌，在很多医院都是，曾有位外科医生朋友说，她只想和自己认识的一位麻醉医生打招呼，就马上让自己的同事制止。麻醉医生一向都不会讨人喜欢，而且拥有很大的“权势”，他们说得取消手术，外科医生不能说不。但在我们的医院，情况是相反的，我们常常倒过来让外科医生欺负，因为我们的老板较喜欢做个“好人”，受罪的当然是我们这些无名小卒，无权发言，只能埋头苦干。
这位阿伯是手术后，死于心脏病，一箩筐的病史，八十的高龄，我们把这手术列为高风险，但在手术期间及复苏观察，病人情况稳定，结果只送回普通病房。可笑的是，外科医生居然怪罪麻醉医生为何不把病人送入icu,为何没有麻醉医生到普通病房去看这位病人。我倒想问一问，外科医生，就不是医生？外科医生就只需要会动手术？他们就不应该知道如何诊断并急救心脏病病人？这有多荒唐！出事了，不懂自我反省，只想着要怎么怪别人。最可笑的是，他们居然问高风险手术同意书，应该由麻醉师或外科医生给病人解释，而当我们认为是双方时，他们竟然不高兴，认为麻醉才是造成高风险的主因。天啊，哪有麻醉师会在病人不需要手术时给病人麻醉？手术是谁要做的？倒把责任给推得一干二净的。一个真正的好医生，会以病人的利益与安危为前提，而不是在乎究竟谁应该背负较大的责任。
研讨会结束了，我对这种态度，无话可说。。。
Wednesday, April 27, 2011
Monday, April 18, 2011
世界末日
最近看个综艺节目，聊到关于世界末日的课题，它真的会发生吗？天晓得！有一阵子，我也曾这样地多虑，甚至失去了斗志，反正明年也快到了，我又何苦天天沉溺于工作？反正到最后结果也都一样，何不及时行乐？于是我开始懒散了，不再那么执着了。。。
现在我却想，如果它真的存在，会在什么时候呢？那时的我还会存在吗？可笑吧，连自己的末日都不知何时，居然还为世界末日操心？明天你还在吗？下星期，下个月呢？无常啊，这就是人生！如果让你选择，你可想知道？懂了又能改变什么呢？生命是一本奇怪的小说，它的结局早已拟定，不容更改，我们只能去编写开端以后，结尾之前的空页。
我再也不愿顾虑这个问题，因为它已经不重要了。积极把握当下，每一天，其实就已经是一份恩赐。
最近看个综艺节目，聊到关于世界末日的课题，它真的会发生吗？天晓得！有一阵子，我也曾这样地多虑，甚至失去了斗志，反正明年也快到了，我又何苦天天沉溺于工作？反正到最后结果也都一样，何不及时行乐？于是我开始懒散了，不再那么执着了。。。
现在我却想，如果它真的存在，会在什么时候呢？那时的我还会存在吗？可笑吧，连自己的末日都不知何时，居然还为世界末日操心？明天你还在吗？下星期，下个月呢？无常啊，这就是人生！如果让你选择，你可想知道？懂了又能改变什么呢？生命是一本奇怪的小说，它的结局早已拟定，不容更改，我们只能去编写开端以后，结尾之前的空页。
我再也不愿顾虑这个问题，因为它已经不重要了。积极把握当下，每一天，其实就已经是一份恩赐。
Sunday, April 03, 2011
心灰意冷
此事虽与我无关，却令人愤愤不平。如此政策，怎能怪人不愿为政府效劳？他已行医至少五年了吧，三番四次申请继续深造，却没被录取，嘴上不说，心里难免会联想到可与肤色有关？做事尽责又如何？很少放假又如何？我们就是活该比别人付出十倍的努力却不能得到相等的报酬。。。所以，我打从一开始，就不想抱着期望。我的上司曾问我，为何要考外国的考试，我只说国际承认的文凭，将来参与国际慈善机构受录取的可能性较大，更重要的原因是，想等政府给我机会深造，是遥遥无期啊！非土著生来就注定要靠自己，清醒些吧！
听说他突然辞职了，在大学录取名单正式公布了以后，这决定把大家吓了一跳，可惜啊，白白流失了一个人才。但也难怪，他盼了那么久，别人却捷足先登，怎可能不绝望？希望他会有更好的际遇。而我也好像被当头棒喝，别傻了，还是老老实实地筹考试费，计划自己的下一步吧。
此事虽与我无关，却令人愤愤不平。如此政策，怎能怪人不愿为政府效劳？他已行医至少五年了吧，三番四次申请继续深造，却没被录取，嘴上不说，心里难免会联想到可与肤色有关？做事尽责又如何？很少放假又如何？我们就是活该比别人付出十倍的努力却不能得到相等的报酬。。。所以，我打从一开始，就不想抱着期望。我的上司曾问我，为何要考外国的考试，我只说国际承认的文凭，将来参与国际慈善机构受录取的可能性较大，更重要的原因是，想等政府给我机会深造，是遥遥无期啊！非土著生来就注定要靠自己，清醒些吧！
听说他突然辞职了，在大学录取名单正式公布了以后，这决定把大家吓了一跳，可惜啊，白白流失了一个人才。但也难怪，他盼了那么久，别人却捷足先登，怎可能不绝望？希望他会有更好的际遇。而我也好像被当头棒喝，别傻了，还是老老实实地筹考试费，计划自己的下一步吧。
Tuesday, March 29, 2011
ORDER
今天，我的上司命令我做一件事，自从加入这部门，已有一段时间没人刻意强调“命令”这词汇，我反复思索，我看起来像是一个会抗命的人吗？记忆中，好像没尝试过。他是一个常会小心措辞的人，我有点惊讶，也没多说什么。后来回想，也问心无愧，只是有点困扰，因为出乎意料。我太诚实了，我的坦白赢得了一些人的信任，却也让一些人不知所措，或许得罪别人而不自知。
想让别人做一些事，有很多方式，智者，总有办法让人为他鞠躬尽瘁。记得曾有一位上司，在我值了夜班后，向我道谢，这也让我惊讶，因为我只是在尽本分，即使不眠不休，也没什么好谢，但他的一句道谢，却让下属甘之如饴，难以忘怀。
活了二十几年，我还学不会如何说不，一般上都是有求必应，究竟是我哪些行为会让这位上司必须命令我做事，真叫我百思不解。算了吧，我非十全十美，很难满足每个人的要求，偶尔也会想，为何总该讨人欢心，而委屈了自己？有位法师说，吃亏是福，顺便套句我小学校长的口头禅“做人不妨傻一点”，就当作是在积些福报吧，来弥补我前世今生所造的罪业。
今天，我的上司命令我做一件事，自从加入这部门，已有一段时间没人刻意强调“命令”这词汇，我反复思索，我看起来像是一个会抗命的人吗？记忆中，好像没尝试过。他是一个常会小心措辞的人，我有点惊讶，也没多说什么。后来回想，也问心无愧，只是有点困扰，因为出乎意料。我太诚实了，我的坦白赢得了一些人的信任，却也让一些人不知所措，或许得罪别人而不自知。
想让别人做一些事，有很多方式，智者，总有办法让人为他鞠躬尽瘁。记得曾有一位上司，在我值了夜班后，向我道谢，这也让我惊讶，因为我只是在尽本分，即使不眠不休，也没什么好谢，但他的一句道谢，却让下属甘之如饴，难以忘怀。
活了二十几年，我还学不会如何说不，一般上都是有求必应，究竟是我哪些行为会让这位上司必须命令我做事，真叫我百思不解。算了吧，我非十全十美，很难满足每个人的要求，偶尔也会想，为何总该讨人欢心，而委屈了自己？有位法师说，吃亏是福，顺便套句我小学校长的口头禅“做人不妨傻一点”，就当作是在积些福报吧，来弥补我前世今生所造的罪业。
Sunday, March 06, 2011
坏人
他已在深切治疗病房一星期了，病情毫无起色，每况愈下，依赖着药物和机器在延续生命，我们又遇上了同样的窘况，拖下去，前路茫茫，好起来的机率近乎零；留下来，每天持续同样的治疗，情况恶化-不抢救政策，不会增加其他药物，说得直接一些，就是在等死。问题在于，你要让他继续拖，不知何时死？还是抽离所有令他还能一息尚存的药物，让他马上死？如果他生于五十年前，我想他早就去世了。。。这是何其困难的决定啊，明知停止药物，他必不能支撑多久，这和杀手何异？但继续药物，拖拖拉拉，届时对他的家人只会造成不胜负荷的身心与经济负担，而他也只会继续处于昏迷状态，更重要的是，病床有限啊，还有好几个更有希望的病人等着床位。。。另一难处是，家人虽表面上已能接受情况不乐观的事实，但要他们决定是否要把病人接回家中等死，会不会太残酷呢？总得有人扮演坏人，总得有人扛起这责任。。
药物停了，电话拨了，叮嘱家属不用太赶，小心驾驶，不到一小时，一切就告一段落了。。。看着我进退两难，最后还是狠下心肠，我的老板微笑着说：“welcome to my world",这就是在深切治疗病房工作，免不了的责任。。。希望这样能结束你的痛苦，我是这样说服自己的。。安息吧，阿伯，愿你能往生极乐。
他已在深切治疗病房一星期了，病情毫无起色，每况愈下，依赖着药物和机器在延续生命，我们又遇上了同样的窘况，拖下去，前路茫茫，好起来的机率近乎零；留下来，每天持续同样的治疗，情况恶化-不抢救政策，不会增加其他药物，说得直接一些，就是在等死。问题在于，你要让他继续拖，不知何时死？还是抽离所有令他还能一息尚存的药物，让他马上死？如果他生于五十年前，我想他早就去世了。。。这是何其困难的决定啊，明知停止药物，他必不能支撑多久，这和杀手何异？但继续药物，拖拖拉拉，届时对他的家人只会造成不胜负荷的身心与经济负担，而他也只会继续处于昏迷状态，更重要的是，病床有限啊，还有好几个更有希望的病人等着床位。。。另一难处是，家人虽表面上已能接受情况不乐观的事实，但要他们决定是否要把病人接回家中等死，会不会太残酷呢？总得有人扮演坏人，总得有人扛起这责任。。
药物停了，电话拨了，叮嘱家属不用太赶，小心驾驶，不到一小时，一切就告一段落了。。。看着我进退两难，最后还是狠下心肠，我的老板微笑着说：“welcome to my world",这就是在深切治疗病房工作，免不了的责任。。。希望这样能结束你的痛苦，我是这样说服自己的。。安息吧，阿伯，愿你能往生极乐。
Saturday, March 05, 2011
底线
没到这些诊所赚外快，也不知道原来这些病人是这样的。在医院，一令吉，包括了诊疗`医药；在这些诊所，病人居然还能讨价还价，随意在药单上删减，然后又会投诉治疗无效。最气的是，那些自以为是的“药剂师”居然不告知医生，自己更换药物。我发现后，已暗自决定，绝不再踏入这诊所。虽然这不是我的诊所，他们爱怎么做，我管不着，但我有自己的专业操守，不能容忍别人任意更改我的专业判断。更讨厌的是，那人竟静悄悄的吩咐病人，若不见好转，记得来见这诊所的“主治医师”。既然对我不信任，又何必找我？哈！可笑啊，这些普通科医生治不好的病人，到最后还是得来医院求医，甚至有很多都来迟了，但他们为何会得到病人更多信任？原因只有一个，他们总有很多时间去建立并维系病人与医生之间的良好关系。于是，当我们这些临时被找来当替工的，一旦用药有异，就开始被质疑了。站在专业的立场，我不愿对别人的医疗判断置评，也无须为了那些无知的“信徒”动怒，但别人随便更改我的药单一事，绝不能容忍。
没到这些诊所赚外快，也不知道原来这些病人是这样的。在医院，一令吉，包括了诊疗`医药；在这些诊所，病人居然还能讨价还价，随意在药单上删减，然后又会投诉治疗无效。最气的是，那些自以为是的“药剂师”居然不告知医生，自己更换药物。我发现后，已暗自决定，绝不再踏入这诊所。虽然这不是我的诊所，他们爱怎么做，我管不着，但我有自己的专业操守，不能容忍别人任意更改我的专业判断。更讨厌的是，那人竟静悄悄的吩咐病人，若不见好转，记得来见这诊所的“主治医师”。既然对我不信任，又何必找我？哈！可笑啊，这些普通科医生治不好的病人，到最后还是得来医院求医，甚至有很多都来迟了，但他们为何会得到病人更多信任？原因只有一个，他们总有很多时间去建立并维系病人与医生之间的良好关系。于是，当我们这些临时被找来当替工的，一旦用药有异，就开始被质疑了。站在专业的立场，我不愿对别人的医疗判断置评，也无须为了那些无知的“信徒”动怒，但别人随便更改我的药单一事，绝不能容忍。
Thursday, March 03, 2011
what's your comment?
终于为家属和手术医生安排了见面，他匆匆赶来，好像很不耐烦地和家属解释，因为他觉得之前已解说多次了，不了解为何他们还是有所不满。会谈结束后，我和自己的上司对望，他问我：我what's your comment？。我只说那手术医生太急躁，言语间透露着你们不是医生，我怎么详细解释你们也不会懂的意思，若我是家属也不会满意他说话的方式，我的上司微笑点头，说他终于明白为何那医生虽声称自己已解释好几次，家属还是搞不清状况。
他们绝对有询问的权利，身为医者，当已无法治愈病人时，如何与家属沟通，澄清病情，告诉他们最坏的可能，是很重要的，因为那往往是我们唯一还能做的事。或许你扪心自问，已竭尽全力，但我们的责任并不止于此，病人虽已昏迷不醒，但他们还有日日守护在外，刻刻忧心如焚的家属，又该怎么安抚？又想起那句话-a doctor rarely cures,sometimes treat,but always provide comfort. 老板，我想我懂了，一个尽责的医生，除了关心病情，手术多成功，治疗多有效外，不能忽略了最重要的一环--病人和家属的心。
终于为家属和手术医生安排了见面，他匆匆赶来，好像很不耐烦地和家属解释，因为他觉得之前已解说多次了，不了解为何他们还是有所不满。会谈结束后，我和自己的上司对望，他问我：我what's your comment？。我只说那手术医生太急躁，言语间透露着你们不是医生，我怎么详细解释你们也不会懂的意思，若我是家属也不会满意他说话的方式，我的上司微笑点头，说他终于明白为何那医生虽声称自己已解释好几次，家属还是搞不清状况。
他们绝对有询问的权利，身为医者，当已无法治愈病人时，如何与家属沟通，澄清病情，告诉他们最坏的可能，是很重要的，因为那往往是我们唯一还能做的事。或许你扪心自问，已竭尽全力，但我们的责任并不止于此，病人虽已昏迷不醒，但他们还有日日守护在外，刻刻忧心如焚的家属，又该怎么安抚？又想起那句话-a doctor rarely cures,sometimes treat,but always provide comfort. 老板，我想我懂了，一个尽责的医生，除了关心病情，手术多成功，治疗多有效外，不能忽略了最重要的一环--病人和家属的心。
Wednesday, March 02, 2011
Tuesday, February 22, 2011
硬起心肠
原以为在深切治疗室数月以来，已能接受不抢救政策的概念，当它发生在一个意志清醒的病人身上，才知道自己还不够无情。她已是年纪不轻的阿婆，百病缠身，以药物和科技虽能延续她的生命，但想活着走出医院，重见天日，应该也需要奇迹，所以我们才选择放弃。很多时候这种情况只发生在神智不清，奄奄一息的病人身上，这只是少数罕见的病例。看着她血压偏低，明知还能做点什么，却只静观其变，延长其生命，等于延长其痛苦，只能如此说服自己。曾走入深切治疗病房者都知道，那是个充满忧郁气息的地方，有住了好几个星期，已丧失求生意志的病人，也有很多神智不清，依赖药物与机器苟延残喘者，当然也有正在康复中，恨不得能早一秒离开这病房的人。
曾经有一次，我告诉一个家属，病人将被送入深切治疗病房，他应该觉得欣慰，他诧异，还好没揍我，哈！须知道那是一个病人最有可能获取最好治疗的地方，在病床有限的情况下，我们常须筛选，较有可能痊愈者，较年轻者会获得优先考虑。试想若深切治疗尚无法将病人治愈，普通病房又能为这些人做些什么？所以，它既是弥漫着低迷`绝望之处，却也是充满着最多希望和生机的地方。
尽管再不愿，也不得不自认能力与资源有限，茅盾啊，我不确定病人本身的求生意愿，他们很可能也觉得生不如死，偶尔我总会暗自期盼奇迹，希望他们能撑过去。
原以为在深切治疗室数月以来，已能接受不抢救政策的概念，当它发生在一个意志清醒的病人身上，才知道自己还不够无情。她已是年纪不轻的阿婆，百病缠身，以药物和科技虽能延续她的生命，但想活着走出医院，重见天日，应该也需要奇迹，所以我们才选择放弃。很多时候这种情况只发生在神智不清，奄奄一息的病人身上，这只是少数罕见的病例。看着她血压偏低，明知还能做点什么，却只静观其变，延长其生命，等于延长其痛苦，只能如此说服自己。曾走入深切治疗病房者都知道，那是个充满忧郁气息的地方，有住了好几个星期，已丧失求生意志的病人，也有很多神智不清，依赖药物与机器苟延残喘者，当然也有正在康复中，恨不得能早一秒离开这病房的人。
曾经有一次，我告诉一个家属，病人将被送入深切治疗病房，他应该觉得欣慰，他诧异，还好没揍我，哈！须知道那是一个病人最有可能获取最好治疗的地方，在病床有限的情况下，我们常须筛选，较有可能痊愈者，较年轻者会获得优先考虑。试想若深切治疗尚无法将病人治愈，普通病房又能为这些人做些什么？所以，它既是弥漫着低迷`绝望之处，却也是充满着最多希望和生机的地方。
尽管再不愿，也不得不自认能力与资源有限，茅盾啊，我不确定病人本身的求生意愿，他们很可能也觉得生不如死，偶尔我总会暗自期盼奇迹，希望他们能撑过去。
Saturday, February 19, 2011
真的假不了
这是个何其复杂的社会，当你在面对一个人时，不管是熟悉的，陌生的，你是在面对着重重心墙。人与人之间的沟通，在于你是否有能力跨越这些墙。我曾经也筑起了这些墙，言行举止都十分拘谨，不知为何，现在的我，反而自己拆下了这些围墙，坦荡荡的面对造访者，反正我也没什么好隐瞒，偶尔觉得有趣的是，我的诚实与直率，反而吓着了有些人，好像孔明摆下的空城计，曹操反而步步为营，不敢侵犯。
或许没错，这样是很危险的，但我的人生却因此轻快了许多，不像以前一样瞻前顾后，多愁多虑。人生短短几十年，何必让它变得如此沉重，装着那么多秘密，那么多武器，防备？如果每个人都必须有武器，那我会选择坦然，作为我的兵器。一来，我无愧于心，更不须提心吊胆，害怕别人有一天会拆穿自己的谎言，最重要的是，“坦诚”就是让“虚伪”最不知所措的武器。前卫生部长坦白承认自己的私生活的事就可以证明，当全世界以为他会设法否定时，他就偏认了。很多人都会不以为然，在一开始的时候，但转念一想，总会有人认为他敢作敢当，是个可以信赖的领袖。
我懒得去想，反正我就是坦诚相对，至于该如何应对，该怎么说，怎么做才能让他们能维护自己的利益，又不失体面，就让他们自己去烦。站在旁观者的角度，静观其变，常会冷笑，人性，不过如此，我不气，没有什么对错，只是没几个人，会愿意牺牲自己，成全别人，如此而已。
这是个何其复杂的社会，当你在面对一个人时，不管是熟悉的，陌生的，你是在面对着重重心墙。人与人之间的沟通，在于你是否有能力跨越这些墙。我曾经也筑起了这些墙，言行举止都十分拘谨，不知为何，现在的我，反而自己拆下了这些围墙，坦荡荡的面对造访者，反正我也没什么好隐瞒，偶尔觉得有趣的是，我的诚实与直率，反而吓着了有些人，好像孔明摆下的空城计，曹操反而步步为营，不敢侵犯。
或许没错，这样是很危险的，但我的人生却因此轻快了许多，不像以前一样瞻前顾后，多愁多虑。人生短短几十年，何必让它变得如此沉重，装着那么多秘密，那么多武器，防备？如果每个人都必须有武器，那我会选择坦然，作为我的兵器。一来，我无愧于心，更不须提心吊胆，害怕别人有一天会拆穿自己的谎言，最重要的是，“坦诚”就是让“虚伪”最不知所措的武器。前卫生部长坦白承认自己的私生活的事就可以证明，当全世界以为他会设法否定时，他就偏认了。很多人都会不以为然，在一开始的时候，但转念一想，总会有人认为他敢作敢当，是个可以信赖的领袖。
我懒得去想，反正我就是坦诚相对，至于该如何应对，该怎么说，怎么做才能让他们能维护自己的利益，又不失体面，就让他们自己去烦。站在旁观者的角度，静观其变，常会冷笑，人性，不过如此，我不气，没有什么对错，只是没几个人，会愿意牺牲自己，成全别人，如此而已。
Wednesday, February 16, 2011
可悲
又是一个可以避免的悲剧，宣告病人不治后，和外科医生聊天，大家都一致认为，这只是另一个因延误治疗，而造成的收场，假如那病房里的医生和护士能多几分警觉性，假如能尽早抢救，结局很可能就不一样了。在内科病房里病重的病人太多了，在习以为常的情况下，对于一般人可能会造成惶恐的血压，对这些人而言，却能处之泰然。这是正常的吗？或许我该问，这是应该的吗？我们归咎于环境，但追根究底，事在人为，环境因素自然不可忽视，愿否出淤泥而不染，决定权在于自己。我也常感觉有心无力，以前在普通病房，有很多有待改善之处，让
我常觉得自己杯水车薪；现在虽也常觉无奈，却是因已束手无策。
可悲的是，这种现象到底还要持续多久？或许该问那些人，你在乎你的病人吗？你可曾想过，这个人也是别人的父母，是别人的爷爷奶奶？可能很多人一开始时也会很气，久而久之，也就习惯了，反正到最后，结果还是一样。
人孰无过？我也曾犯错，至今仍历历在目，不敢忘却。有人虽时隔多年，还常提起，我还真想告诉那人，看看这些后起之秀，他们才真的有能力杀人，你若再不加以调教，到了你年迈多病时，为你送行的，很可能就是他们。把自己的懒散合理化，做事敷衍塞责，悲剧怎可能不重演？
又是一个可以避免的悲剧，宣告病人不治后，和外科医生聊天，大家都一致认为，这只是另一个因延误治疗，而造成的收场，假如那病房里的医生和护士能多几分警觉性，假如能尽早抢救，结局很可能就不一样了。在内科病房里病重的病人太多了，在习以为常的情况下，对于一般人可能会造成惶恐的血压，对这些人而言，却能处之泰然。这是正常的吗？或许我该问，这是应该的吗？我们归咎于环境，但追根究底，事在人为，环境因素自然不可忽视，愿否出淤泥而不染，决定权在于自己。我也常感觉有心无力，以前在普通病房，有很多有待改善之处，让
我常觉得自己杯水车薪；现在虽也常觉无奈，却是因已束手无策。
可悲的是，这种现象到底还要持续多久？或许该问那些人，你在乎你的病人吗？你可曾想过，这个人也是别人的父母，是别人的爷爷奶奶？可能很多人一开始时也会很气，久而久之，也就习惯了，反正到最后，结果还是一样。
人孰无过？我也曾犯错，至今仍历历在目，不敢忘却。有人虽时隔多年，还常提起，我还真想告诉那人，看看这些后起之秀，他们才真的有能力杀人，你若再不加以调教，到了你年迈多病时，为你送行的，很可能就是他们。把自己的懒散合理化，做事敷衍塞责，悲剧怎可能不重演？
Saturday, January 29, 2011
Saturday, January 08, 2011
对自己的承诺
我能不能说对一个人心生厌恶，说我涵养不足也罢，我想让自己放肆一次。我也不怕你会知道，反正那是事实。终日怀疑自己的下属，你难道没察觉很多人已经不满？还是你从不觉得问题出在自己身上？大家早已麻木了，只有我这样的新丁才会在意。最讨厌别人怀疑我偷懒，因为这是连我自己都无法接受的行为！你可以笑我笨，现阶段而言，如果我比你更有实力，也不会成为你的下属，但当我比别人早到迟退时，就无法接受这样的质疑。我再也不会低声下气，对你这种无理取闹的人。和同事聊及为日后与你共事烦恼，他们劝我祈祷，希望你会有好心情，我说，管你是什么心情，我不是为你而工作，只要我对得起我的病人就已足够，你爱怎么想，随你，心情好坏，与我无关！总有一天，我一定会让你知道，我不是你想的那么笨，你也没什么了不起！
我能不能说对一个人心生厌恶，说我涵养不足也罢，我想让自己放肆一次。我也不怕你会知道，反正那是事实。终日怀疑自己的下属，你难道没察觉很多人已经不满？还是你从不觉得问题出在自己身上？大家早已麻木了，只有我这样的新丁才会在意。最讨厌别人怀疑我偷懒，因为这是连我自己都无法接受的行为！你可以笑我笨，现阶段而言，如果我比你更有实力，也不会成为你的下属，但当我比别人早到迟退时，就无法接受这样的质疑。我再也不会低声下气，对你这种无理取闹的人。和同事聊及为日后与你共事烦恼，他们劝我祈祷，希望你会有好心情，我说，管你是什么心情，我不是为你而工作，只要我对得起我的病人就已足够，你爱怎么想，随你，心情好坏，与我无关！总有一天，我一定会让你知道，我不是你想的那么笨，你也没什么了不起！
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