不确定的。我们用这个词当我们不确定一个病人没有机械通风能够生存。我们不能确定他们有良好的预后,但我们不能说他们有一个坏一个。牧师曾经说过,那些摇摇欲坠的生死之间可以感觉到两件事:声音和气味。他们也分享一个故事,一个病人从昏迷中醒来,状态和意识到牧师的声音。这是令人震惊的她是因为她从未见过他,而他是醒着的。她唯一一次跟他说话之前,这是当他是无意识的。这是她第一次遇到这样的东西。
这个故事一直玩反复在我脑海上周当我开始我的神经病学住院服务3 rd-year医科学生。每天在这个服务,我看到一个人已经昏迷的自从我来了。不幸的是,他经历了一次心脏骤停了大约15分钟,这意味着没有氧气达到他的大脑在此期间。从那时起,他一直没有响应,气管插管,戳,戳。团队在团队来检查他和判断预后。不确定的。9天后,仍然是我们只能说在医院里。我到四天,看着居民参加,护士,和学生继续拨弄。我们的团队任务是找出他可以应对,和这部分包括捏他的皮肤,看看他对疼痛的反应。我第一次看到这个,我退缩了。他躺在那里,无法说什么,没人告诉他发生了这事。 They just did it. Could he hear us talking about him? Could he sense the pain but not move his body to respond? What does he know? If the chaplain was right, he could hear us talking about his prognosis. Indeterminate.
8天,躺着一动不动,几乎将他的嘴在油管连接到他的气道。这一次,他的妻子与他同在。团队了,打开他房间的窗帘,我看到她在病人的床边祈祷。她在床上一串念珠在他的头上。她抬起头,看着我们。我可以看到她脸上的担心和疲劳。我们更新了她的预后。不确定的。
然后,我们让她知道我们会做一个简短的物理考试他暂时。总住院医师看着我和我的同学问我们自己想进行体检。我立刻答应了,因为我想学习和练习。但是当我戴上手套,我看着病人的妻子。“噢,不,”我想。她看我们捏他,强迫他插科打诨,抬起他的眼睑,试图让他应对疼痛。没有人对她说什么,但无论如何我们开始。
我问病人:“先生,你能去oirme ?(先生,你能听到我的呼唤吗?)”我重复道。还是什么都没有。不确定的。接下来,我抬起眼皮,想象他的学生。我用我的小手电筒,检查了他的瞳孔反应。完好无损。接下来,我们把盐水滴在他的眼睛,检查了他的角膜反应,完整的一只眼睛。接下来,呕吐反射。我把阀门所以我可以放下管他的喉咙。 It went further, further, and further down his throat until I couldn’t push it anymore. I brought it out as I suctioned, and he coughed.
然后,我怕。我不得不故意伤害他。尽管如此,没有人说什么家庭成员。我抬起头让她知道将要发生什么事,所以她会知道这个测试是为了什么,能感觉到参与了访问。然后,我挤的皮肤在他的肩上脖子上。他没有退出的痛苦。但他感觉到它吗?接下来是挤压和捏在他的上肢皮肤。没有回应,但他感觉到它吗?当我们搬到下肢,我担心如果我伤害他。 Sometimes people leave bruises on patients when they do these types of exams. I didn’t want that, so I squeezed his leg over his gown. Still no withdrawal to the pain. Our attending and resident said to pinch harder to see if we could get a response. Another resident said to twist as we pinched. Finally, we got a withdrawal response to pain on both extremities at that point. It was over. That was it.
还是不确定的。但他能感觉到它吗?他能听到我们谈论他造成的痛苦?团队开始走向家庭成员讨论这次考试意味着什么。我脱下手套,走到床头病人躺的地方。paciencia“谢谢,先生,他们反对todo y lo siento穷el悲哀。(谢谢你,先生,你的耐心,我很抱歉疼痛。)”我告诉他,我把我的手放在他的肩上。没有人对他说什么。是我疯了吗?他甚至会听到我吗? Would it even matter? I’d like to think it would. I’d like to think he did hear me. I’d like to think that others would speak to him too. He’s not my family member, but he is a human being. Regardless of the word “indeterminate,” this still holds true. If he did hear, I hope it brought him peace to know that someone is still thinking of him as a person and involving him in this process. Because at the end of the day, he was the center of it all in that moment. Because at the end of the day, our patients are at the center of all medicine.
伊丽莎白·罗德里格斯是一个医科学生。