作为一名临床医科学生,第一次走进医院是一种奇怪的两极化。在成为一名医生之前,你还有很多东西要学,但你很快就会陷入生死攸关的境地。我早期的一个轮岗是在急诊室。作为一名学生,你没有实际的权力,必须一直被密切监视。很多时候你需要后退一步,观察并远离活动人员的道路。
在我早期在市中心一家大医院的急诊室轮班时,我发现了在医学领域工作的真实情况。我快下班的时候,一辆救护车把一个男人送进了创伤室。他被推到轮床上急救人员跪在他身边做胸外按压。急诊室的工作人员立即采取行动。他被从轮床上转移到桌子上,十几个医护人员在床边忙乱地工作。一名护士在做胸外按压,另一名护士在试图放置外周静脉输液线,还有几名护士在收集药物和用品。急诊室的住院医生和医生在床头,在病人剧烈的有节奏的身体抽搐和胸外按压之间给病人插管。另一位住院医生在病人的腹股沟处,试图把股静脉注射线插到位。患者是一名50多岁的健康男性,在家中割草坪时突然晕倒。就像有时发生的那样,他的肠子已经排空了,所以一开始房间里有粪便的味道,很快就有股血的味道混合在房间里,那是一次不成功的股静脉注射。 Occasionally the flurry of activity would pause as the team checked to see if any signs of life were present, looking for a pulse or signs of cardiac activity. The patient’s heart was in ventricular fibrillation, so the attending doctor yelled “all clear” and a jolt of electricity shocked through the patient. His body jerked, and then the staff resumed their compressions.
试图救活一个人是一项脏乱的体力活,工作人员需要更多的帮助。我被叫到床边做胸外按压。我站在一个小金属凳子上,专注于我的力量和节奏的压缩。随着药物的找到和使用,呼吸管的安全就位,血液样本被送到实验室,周围的活动在可控的混乱中继续进行。在保护病人气道的同时,医生对气道组织造成了一些创伤,所以血液充满了管子,并随着每次压迫而冒出来。呼吸治疗师吸气,试图清除血分泌物,让空气流动。血溅到了杖上和房间里。在蓝色警报期间,时间似乎变慢了。我们都知道每一分钟是多么珍贵,因为每过一分钟,大脑就会失去关键的氧气。在救护车到达他的家之前,这位病人已经倒下了大约10分钟。 By the time our ER team was working on him, he had been without oxygenation and cardiac activity for 25 minutes. As time in a code goes on, it slows down even more. The rhythm of the team is established, and everyone is perfectly in place doing their role. At a certain point, the attending will call again for time. It had been over 45 minutes since the patient was found down in his yard. “Hold compressions and check for pulse,” said the attending. Silence. No electrical activity of the heart, no pulse, no breathing. In those last seconds, silence overtakes the room. “Time of death 1746.”
医生们迅速离开了房间;他们还有其他急需照顾的病人。在安静中,护士们着手从病人身上取出侵入性医疗设备,清理体液和碎片。他们的工作效率很高,但也会做一些同情的小动作,比如闭上病人的眼睛,把手放在他的额头上一会儿。我呆在房间里,帮忙收拾。当我在处理一些用过的医疗设备时,主治医生在隔壁的接待室里和病人家属说话。我能听到从墙上传来的哀号声。声音越来越大。当护士们把尸体整理好后,病人的家人就被带了进来。他的妻子和几个孩子围着他的尸体,悲痛万分。 A nurse stood close by, keeping her arm on his wife to steady her and offer support. Simultaneously as the family came into the room, the other unneeded staff members and I exited. The family, who had last seen the patient lying dead on the front lawn, were reunited to spend their last moments together in the ER bay.
在这个时候,我的轮班已经结束了。我很快和主治医生联系好,走到停车场。我坐在我的车里。一个波浪向我袭来。我在车库里开始抽泣。我刚刚目睹了我的第一个病人的死亡。我无法忘记妻子的哀嚎。心肺复苏术中剧烈的身体刺激,有力的胸外按压,侵入性设备被插入病人体内,体液在房间里混合在一起,这些都是创伤性的见证。这位病人曾是一位年轻、健康的父亲和丈夫。当我在车库里抽泣时,他的生命在一瞬间就消失了,他的家人再也见不到他活着了,这对我来说就像一辆卡车。 And then I did what everyone in medicine does, I went home, and I came back the next day and did it all again.
珍妮哈索克他是一名医院医生,在“一定规模的医生”上写博客。
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