不安


这是一种我无法认同的做法，因为在我心里，它不应该是这样的。器官捐赠，在我国可能还是很多人并不了解的课题，一个生命的结束，或许就改善甚至可能延续了六七个人的生命，这原本应该是件值得被推崇的事，只是当有些人积极得不知是为了证明什么，就歪曲了它应有的意义。
在人们不太能接受这种做法的地方，就连是想要在家属肝肠寸断之际，提出这么一个建议，都特别困难。当中牵涉的种种过程，医护人员不为人知的心理挣扎，本着想帮更多病人的信念，厚着脸皮接触家属，我不得不佩服投身参与工作的医生和护士。这精神是可敬的，我必须承认。但很多人都不明白凡事适可而止的道理，如果选择较乐观层面的思考，我应该称之为--过分积极。那种近乎丧失理智，“宁杀错，勿放过”的作风，真叫人不以为然。结果往往是失败的，一点都不意外。
在接洽家属前，病人得进入深切治疗病房，把身体状况重新调理，才能确定器官是否可取，毕竟谁会大费周章，把坏掉的器官移植到另一个病人的体内？给家属假的希望，又或者在另一个医生刚从他们身上夺走所有希望之际，使他们重燃最终只会破灭的希望，这件事究竟有多残忍，我无法置评，或许应该说，得看你究竟站在哪个角度去思考。
偶尔我也在想，在资源如此短缺的中心，把病床留给已经或可能脑干死亡的病者，妥协其他病情严重的病者获得深切护理的机会，公平吗？其实我很支持器官捐赠，因为与其任由残留的躯体腐化，不如把器官物尽其用，造福其他病人。只是对有些人执行的方式和态度不能苟同，或许大家的出发点是好的，但也得考虑不为牵涉在内的工作人员和家属制造压力，事情才可能更圆满。

如果你可以选择

深切治疗病房住进了一个癌症末期的病人，癌细胞已扩散至肺部，导致呼吸困难。于是外科医生就建议动手术，并装上永久性的呼吸管，手术并不顺利，因大量失血而必须分两个阶段进行，手术后病情更不稳定，现在已处于＂等时间＂的阶段。对于这样的结果，说真的，并不意外，如果你问我，眼睁睁看着一个病人缺氧失救，会不会太残忍？我倒想问，换成你是那病人，你会想呼吸困难，然后短时间内昏迷，还是躺在深切治疗病房里，插满了点滴，管子，撑个几个星期才断气？医生常常自以为是地替病人决定，告诉他们种种治疗方案，给家属希望，但很多人在手术前，并没有告知病人或家属最坏的可能。这是仁慈吗？表面上好像很伟大，事实上我们总以慈悲为理由，没有给病人选择的权利。但最终需要面对希望破灭，失去至亲的痛苦，是医生吗？我很想知道，如果他知道这很可能是最后的结果,他是否还会选择手术？
没错，很多时候，把决定权交到没有医学知识的病人或家属手上，听起来好像很不负责任，尤其是在我们的社会里，一般上茫然失措的家属都只会说，＂请你为他做最好的＂，也曾有人问我＂换成是你，，你会怎么选择？＂，今天，请允许我问，如果你是医生，你会如何选择？如果你是那病人，你会希望医生替你选择吗？

赌气

好久都没有生自己的气，有时我也不清楚这到底算不算是好事。我曾经常自我期许，在达不到自己的要求时，就会发自己脾气。上一次有这种感觉，好像是好久以前的事了。今天，这种感觉回来了，如果要正面地思考，那应该是好的，因为在我选择颓废的那段时间里，它就不曾出现过。说起来也不是什么严重的事，但当下我很任性地放纵自己，差点泛滥成灾，还好没殃及池鱼。不顺心的事太多了，但和那些身陷苦难中的人们相比，这又算什么？

为何失眠

昨天的值班真的让我血压飙升了好几次，情绪难以平复。骨科有个腿骨折断的病人要动手术，两天前意外，除了骨折，还要脑部创伤，不完全清醒，却也不昏迷，住在神经外科病房，留院观察了两天。病人送到手术室，有呕吐及头疼的现象，我取消了手术，并知会了神经外科的医生，病人有征兆，恐怕需要再照脑扫描，腿部手术暂且搁置无妨，他说了会到病房去看病人。我事后汇报上司，他的反应让我意外之余，还真是心里有气。责问我为何把病人送回病房，而不继续腿部手术，我据理力争，他当然不高兴，没错病人是曾扫描，但那已是两天前的事，更何况他当时并没有那些征兆，难道真要为了一条腿而罔顾脑吗？这算什么道理？更何况腿部也没有细菌感染，就算暂缓手术也不会带来太大影响。他还是只愿意相信我是因为懒惰，才找个借口推搪，不肯为病人麻醉，他可知道，我等了将近两小时，三催四请才安排就绪，让病人可以动手术！我若是刻意想延缓，又何必大费周章？还真冤枉！
手术室忙着接下来的几个剖腹产，再查看这位病人的记录，最可悲的是，那位说好会去病房看病人的医生只派了个实习生代劳，说大概是因为药物，造成病人有这些症状，打算只是继续观察，直到今早，发现症状没有减退，才急着安排扫描。但愿结果不是像我刚开始时担心的那样。对于这一切，我只觉得有心无力，每个人都有自己的工作岗位，我不可能要越界去干涉其他部门的事，更何况手上还有一大堆病人等着麻醉。但我问心无愧，只是对一些人的处事手法，无法认同。对别人质疑我的工作，心灰意冷。但我不是为他而工作的。我累了，让这一整天的不满，再加上睡眠不足的半清醒状态折腾，只能靠着文字来整理情绪，然后随着思绪暂缓，躲进我能逃离现实的梦里。

不能被原谅的过错

才刚说要学会放下和原谅，就遇上了这样的考验。或许这样说吧，有些错是不该被遗忘的，它应该留下深深的印记，让自己永远不会重蹈覆辙。处罚，往往特别容易造成这样的效果。但最后它是否有意义，就得看受罚的人是否愿意悔改。多少人在受罚、挨骂时，会好好反省？大家第一个反应，通常都是抗拒、不甘、愤怒，不是吗？

今早临时来个剖腹产，病人因无法取出胎盘而大量失血，一早就已叫产房派人到血库取血，等了快一小时，再查问才知道，那被委托取血的实习医生去了一个部门会议，也没把事情交代给其他同事。我快气疯了，这些人到底懂不懂自己在干嘛？手术室要血，就是紧急要务，不能耽误！就算无法分身，也要马上请别人代劳,怎么可以不了了之？！所幸失血速度不算太快，勉强还撑得住。

我很少压抑不住情绪，但若关乎病人安危，我就不会保持沉默。正在手术台上挣扎的妇科专科知道此事，那实习生自然难逃处分。这种事也不是史无前例，我真的不想历史再重演。受罚者若要恨别人，就证明他是个不负责任，无可救药的家伙，因为他的疏忽，我们差点赌上了病人的生命，罪大恶极！不贵于无过，而贵于能改过，处罚要可以起警惕作用，它才会有价值。人孰无过？只求这些新生们，学会如何权衡轻重，以别人的安全为前提，毕竟从事这份工作，我们就已失去了懒散和敷衍的权利。

这天--苏打绿

够深刻了吗来躺下吧
让我轻抚你安慰伤害我后的疲累
够尖锐了吗看我的疤
用温柔包覆勇敢给喘息的你笑脸
生命从来不觉得自己对谁该负责任
太多虚伪情节的表面模糊陌生的眼
请让我在你身边一起穿越这条街
请让我在你身边一起纪念
够痛快了吗我知道啊
躲在你利刃之内骄傲的自卑作祟
够鲜艳了吗血染的花
被你刺满的双手此刻擦乾你眼泪
生命从来不觉得自己对谁该负责任
我们看了编造的谎言就如此轻易
将彼此划成碎片
太多虚伪情节的表面模糊陌生的眼
请让我在你身边一起穿越这条街
请让我在你身边一起纪念这一天
总有一天我们都死去
丢掉名字的回忆再没有意义
总有一天我们都忘记
曾为了一个越演越烂的故事伤心
总有一天我们都叹息
笑着缅怀有过的愚蠢的美丽
就让现在过去
让我握你的手让你握我的手
彻底了解颤抖你会知道我
让我握你的手让你握我的手
彻底了解颤抖你会知道我
让我握你的手你会知道我
让我在你身边一起穿越这条街
请让我在你身边一起纪念这一天
透过我的眼泪看你的脸
自由是我们需要的特权
你笑了我笑了笑了这一天


特别喜欢这首歌
如果每个人都能如此，这世界会否更美好一些？
原谅所有曾伤害过你的人，在浩瀚的宇宙中探索的你我，无知地以为自己能紧握些什么， 在追寻的过程，伤害过别人，当然也曾受伤。我们都忘了这路的尽头，一切都将回归根本，既然什么都带不走，又何必播下怨恨`愤怒的种子给这个已是遍体鳞伤的世界，多添一道伤痕？

怎样才算公平？

已是凌晨三点，手术室里从早上八点开始运作，一直没有可以暂停的迹象。才刚抢救一位病人，来不及喘气，上司就在问是否已叫了下一位病人。当时我真的好想问她，再等个十五至三十分钟，是会怎样？其实，我刻意暂缓了传呼下一位病人，想先把这个才刚稳定的病人先送回icu才继续下一个手术，好让我们能趁再等下个手术的十几分钟内来得及小憩。我们累了，我真想告诉她，如果不是我那位伙伴累了，我相信他不至如此大意，没留心外科医生已不知觉地造成病人大量失血，让我必须离开自己的手术，去参与抢救工作。我不是故意离开自己的工作岗位，在病人相对稳定的情况下，我只能这么做。才刚抢救成功，你好歹也让我们可以先整理思绪。
敢问如果你是那下一个病人，你会愿意有个神智不清的麻醉师吗？这么做对病人公平吗？可能就是那短短的十几分钟，对一个已因其他更严重的手术而被迫延后的病人而言，根本不会恶化病情，但对一个已无法正常思考的麻醉师而言，或许就因来得及充电，而改写了下一个手术的结局，下一个病人的命运！岂止麻醉医生如此，你可以想象由一个疲累不堪的外科医生操刀的手术，会有多大后遗症的机率？你可以认为我懒，在找借口不愿意赶快完成接下来的手术，导致更多病人必须重新禁食，造成那一直无法清算的“烂帐”，你不是一直都这么相信吗？你可曾想过，如果躺在手术台上的是你或你的亲人呢？这就是为何先进国的劳工制度，会限定员工能工作的时间长度的主因，因为我们终究只是人类，因为这才能确保工作的素质。我当然知道，我们没有足够的人力资源，但长时间的过分耗资，对员工公平吗？对病人公平吗？我因习惯了得彻夜不眠，所以还能维持安全的清醒状态，但不是每个人都能如此，更何况这是一个需要团队精神的工作，就算自己撑得住，也得顾虑其他团员，任何一方出了问题，都会有严重的后果。
这行业，我们是依赖彼此才能生存，常自以为是的外科医生没了麻醉师，没了护士，没了手术助理，能对病人下刀吗？但病人永远只记得他们的外科医生，一般麻醉医生的心酸：在外科医生执刀时，是谁给病人止痛？当他导致病人失血时，是谁在进行抢救？手术结束了，他们离开了手术室，留下麻醉医生还在守候着病人，确定病人真正“安全”。但病人每次遇着麻醉医生还有意识的时候，就是那短暂的麻醉前较清醒的时刻。不是想邀功，因为不管哪一个专业，为病人服务，终究是每一位医生选择的使命，但每次看见那外科医生不懂尊敬别人，不可一世的样子，就很想喊冤。难怪在众多医学专业里，麻醉师属于较容易患上精神病的一群。而还不是专科医生的我们，除了得面对不通情达理的上司，还有外界的欺凌，真是哑巴吃黄连。

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。。。

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。。。

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。

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！

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！

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。

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。

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.

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。

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。

暂缓


终于告一段落，这几天来隔天值班的时间表，那倦意睡了一整天还是无法消除。他们的假日结束了，一切应该可以恢复正常了。我想我已经学会了放下，或许这也不是一件好事，但是总不由自主地觉得，反正自己为了完成工作而尽心尽力，也是枉然，那些人也不会感激，只会一而再，再而三地欺负你`利用你。我明知不该为这些人而工作，却不知该怎么处理这种负面情绪。不愿意承认我追求完美，也不认为自己做事敷衍，我想我只是需要一个平衡点，别让自己那么累。至于那些人就随便他们爱怎样，只要我知道我还是应该为什么而工作就好。

十一年前，毕业典礼，发现这歌特别有意思。此时此刻，重听旧曲，百感交集--梦做了又碎，我停了又追，唯一不变的是那最初的目标。人生还有几个十年？我不晓得。荆棘密布的路上，我跌过`疼过`哭过`想放弃过，也不知道这是否正常，人活到了某一天，生命会空虚得仅仅剩下梦想。而梦想，是虚拟的，不踏实的，握不住的，对未来的承诺。如果对明天的寄望，是生命奢侈的消耗，我愿意这样挥霍。人们说，现在造就未来，活在当下才最实际，我非常认同，但想稍做更改--今天会变得精彩，是因为我们愿意相信明天会更好。然而未来它真的存在吗？直到它变成现在的那一天，它始终是虚幻的，只是对它存在的信仰，让现在变得更有意义。

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。