五妹五妹
小護士的世界
正文
不由自主
Lucy 八十五歲了，看上去頂多七十歲的樣子。她是那種可以算得上是美人的老太太，即使躺在病床上也保持著一種優雅的姿態，薄薄的嘴唇塗得鮮紅。
她今天應該有一個小手術，因為腎衰，她需要植入一根Dialysis catheter for Hemodialysis .她的手術同意書還沒有簽字，對於一個八十五歲的老人，她即使看上去身體狀況還不錯，我們也還是很謹慎的。她必須明白她在做什麽，她什麽樣不同的決定會產生什麽樣的後果。
她有三個孩子，都住在外州。自從丈夫幾年前過世後，她一直住在養老院裏。為了確保她理解醫生跟她講的所有的東西，我們特意邀請精神科的醫生來評估她的competent.(勝任力）。她真的很棒，對於這樣年紀的人來說，我認為她的表現堪稱完美。
早晨我問她," Are you ready for your consent?"
"Yes, I'll have a prolonged life if I go on dialysis."She answered.
"Tell me where you are now?"I keep asking.
"Of course Hospital."She said.
"What's your birthday?"
"Next Monday I will be 86 years old."She answered happily.
No doubt, She is competent to make any medical decision now.
遞給她同意書，簽字，時間，日期，一切搞定。Keep her NPO, Waiting for the surgery afternoon. Maintain her blood sugar stability, I don't want her blood sugar drop before the procedure.
She has diabetes, Discussed with pharmacist about the insulin dosage, Start D5 W at TKO rate. Give her a bath, Prep skin, Give 阝 blocker，Call OR room, Check the schedule,中午之前一切停當。
下午，The clerk call me＂Patient's son on the line wants to talk to you ."我正忙著但也不得不接電話。
先是一番自我介紹，然後他說＂I don't want my mom have a surgery. Dialysis is not good for her."
What?! 我驚到了。＂Your mom signed the consent. She knows what's going on. The doctor explained the procedure to her in detail, she totally understand." I said.
"Hold the procedure , I will talk to my mom In the afternoon. I will be there soon."He said firmly.
I can't argue with him.給醫生打電話，主治醫生，腎髒科醫生，手術醫生 ，一圈下來半個小時就過去了。Lucy 看我忙來忙去，忍不住問我" anything wrong with me?"我不知道該怎樣回答，也許他的兒子來了，我們跟他聊聊會改變主意吧，他或許並不知道dialysis(透析）對於腎衰的病人的重要性。"Can I go on the airplane if I'm on dialysis?" Lucy asked me.
"Yes."
"So I can go to Oregon to see my grandkids."She smiled.
"Yes."
Lucy 閉上眼睛，嘴角一直淺淺地笑著，她一定在臆想著盡享天倫的瞬間吧。
下午他的兒子終於來了，我把他叫出房間，我可不願意守著Lucy來討論這個問題。我一招手，他就溜出來了，一瞬間我體會了什麽叫隻可意會，不可言談。
＂Do you want say something?"I asked him directly. 我不知道該跟他說什麽，就讓他來說吧。
他突然問很多關於透析問題，我一一回答了他。又讓我拖過來電腦逐項解釋化驗結果。我的心沉下去了，這些表演就像一件華麗的袍子，掩蓋著難以說出口的用心。終於他說＂ I want my mom on hospice care."(臨終護理）
"Your mom wants have a surgery and then on dialysis. She wants aggressive treatment."我說，盡量保持著微笑。我在心裏對自己說"don't judge him!"
"Dialysis, There is no quality of life. I'm sure my mom doesn't want it. I'll talk to my mom in private, I'll let you know her final decision."He said.
我沒有辦法，Lucy在我眼裏就像一葉扁舟，隻用一根細繩我們把她拖到岸邊，而現在繩子斷了，又被狠狠的一腳踹回到漩渦裏。
繼續給醫生打電話，我可以明顯的感覺到腎髒科醫生的不甘心。終於她忍不住說"let me talk to the patient's son."我把電話遞給他，過了一會兒，他遞回給我。醫生依然在線上，她說她要和病人講話。我又把電話又遞給Lucy，站在她身邊，我聽見醫生在對她說，"If you don't go on the dialysis , you will die soon!" Lucy不回答，大顆大顆的眼淚落下來。
All the procedure canceled, All the medication discontinued. Lucy on hospice care only .
Lucy象一尊蒼白的雕像，高貴而優雅地靠在床上。他的兒子坐在床邊，低著頭不時地啜泣。她抬起手，溫柔的撫摸著兒子的滿頭灰發，就像在安慰著一個十歲的淘氣男孩。我忽然想起Lucy說下個星期一是她86歲的生日，那一天我會再見到她嗎?
生命，由得你做主嗎?
下班了，天黑了，起風了，秋天來了。
病人家屬比病人本人更有權力決定醫療方案嗎？
Lucy死了她的兒子有什麽好處？