醫學生日記2016年5月31日 --- 責任

醫學生日記2016年5月31日 --- 責任

阿山 （龐靜譯）

 

第二個星期我轉回婦產科的白班了。第一個星期我有幸協助了三次自然生產，三次都是我取出了胎盤，還有一次半夜剖腹產。和其他婦科見習的同學比起來，有幾個同學第一個星期根本沒見過一例自然生產或剖腹產。到此為止，沒人比我見的多。一方麵這是運氣，我們這個大學城人口不多，孕婦相對也少。但是，另一方麵是我自己學習的積極態度。對我們學生的要求是每班跟一兩個病患，而我卻想見盡可能多的病患。結果，我更容易適應見習的安排，也更有自信。這隨之演變成病患在他們生命的關鍵時刻願意我在旁邊。而且，住院醫也信任我，讓我在旁邊多幫忙。到此，我學到了受教育的一個關鍵的基本信條：你必須負責任地為自己創造機會。

 

今天我第四次參加自然生產。生產過程不太順。又讓我取出胎盤。其實已經有信號了，當時連著胎盤的臍帶突然鬆了，一股血流淺到我的胳膊肘上（穿著大袍子呢）。我們清理幹淨之後就離開了，讓媽媽和她的新生嬰兒，還有其他家庭成員在一起，照了很多照片。

 

大約一小時之後，病房呼叫我們回去。母親陰道出了很多血。我們進去時都可以聽到，就像汨汨流著的泉水。我們看到暗紅色的血從她的陰道滾淌而出。住院醫壓住了她的肚臍，由此向子宮施加壓力，血止住了。我們把她清幹淨，正準備離開，出血又開始了。住院醫檢查了她的陰道和子宮。大塊的黑色血塊流出來了。母親開始感覺頭暈，把她懷抱的嬰兒遞給了祖母。我們搬來了超聲波儀器。整個過程，我都在試著用西班牙語解釋，因為母親不會講英文，我告訴她正在發生什麽，我們要怎麽處理。

 

又一大股血流噴出來了。我不停地換著母親身下的大毛巾，我可以感到那些被血漫透的大毛巾有多重。因為母親失血太多，一個護士加上了第二袋IV。住院醫在做超聲波時宣布可能有一部分胎盤還留在子宮內，因此引起出血。住院醫說我們可能得去急診中心手術室止血。

 

這時我的肚子直往下沉。至此，我們做的每一件事都是嚴格按照要求做的，做為醫學生，我們的訓練不允許我們隨意做任何事，因為那樣就可能造成病患的極大的不幸。但現在，這位新母親正在迅速失血，麵臨著死亡。這很可能是我取胎盤時出了什麽差錯引起的。這個念頭在我腦子裏飛轉。當我取出胎盤時我們檢查過，它是完整的。我真的很想去翻專用垃圾筒，找到包著那個胎盤的袋子。我很害怕，但也很有意識地不讓這種情緒出現在臉上。我很努力地用西班牙語讓病人和家屬明白怎麽回事。這其實是很難的平衡，既要照顧到病人，還要藏住我自己內心的失望和痛苦。

 

主治醫生來到病房，馬上開了一堆藥。這些藥用上十分鍾之後血就止住了。她向我們解釋，高齡產婦，以前有過數次懷孕經曆，就像我們的病人，生產之後，她的子宮收縮比較慢。這就造成了出血。她開的藥就是幫助子宮收縮，增加肌肉能力，最終控製住血管。

 

出血過程中沒有胎盤殘片隨著流出。再一次超聲波檢查也看不到胎盤痕跡。我終於鬆了口氣，並不是我造成了產婦的生命危險。但是這件事卻使我明白了，以後也會終生受用。病人如此地信任我，把他們的健康交給我，我在治療他們時會更在意我做什麽，怎麽做，稍有不慎都會對他們造成巨大的傷害。

 

這就是真正的責任。

 

原文

 

Tuesday, May 31, 2016 – Responsibility

 

 I am back onto the day shift for my second week of Labor & Delivery. In my first week, I had the opportunity to assist in 3 vaginal deliveries, personally delivering 3 of the placentas, and one middle-of-the night C-section. When comparing numbers to the other students on the rotation, there were several that had gone the entire first week without seeing a single vaginal delivery or C-section. No student so far had gotten to see more than me. Part of this is luck, our college town does not have the biggest population, and a population of childbearing women was proportionately smaller. However, I believe part of it is my own aggressive pursuit and control of my education. Medical students on the service are expected to only follow one or two patients per shift, but I come in wanting to see as many patients as I can. Consequently, I feel more comfortable and confident in the setting. That translates into the patients feeling more comfortable with having me in this important moment of their lives. That also translates into the residents trusting me enough to let me stick around and do more. This, I’m learning, is an important basic tenet of education: you must take responsibility for creating your own opportunities.

 

 Today, I was participating in vaginal delivery number 4. The proceedings were quite uneventful. I was allowed to deliver the placenta again. There were the good signs, the cord suddenly losing a bit of tension and a small gush of blood squirting up to my gowned elbow. We cleaned up and left mom to bond with her new baby and the rest of the family to adore and take many pictures.

 

 About an hour later, we get called back to the room. There is a lot of blood coming from mom’s vagina. As we walk in, we can hear it, almost like a gurgling spring, and we can see it, the dark red blood gushing in spurts out of her vagina. The resident presses on the mom’s belly a bit to apply pressure to her uterus, and the bleeding stops. We clean her up and as we’re turning to go, the gushing starts again. The resident manually examine her vagina and uterus. Big dark clots come tumbling out in a sludge of thick dark blood. Mom is becoming light-headed at the moment and has passed her baby off to grandma. We grab the ultrasound machine. All while this is happening, I’m trying to roughly explain in Spanish, because mom did not speak English, what is happening and what we’re trying to do.

 

 Another big gush of blood spurts out. I’m constantly replacing the towels under mom and I can feel how heavy they have become with soaked blood. A nurse is starting a second IV to pump fluid because mom is losing a lot of blood. The resident is doing the ultrasound and announces that there might still be placenta remaining in the uterus that is causing the bleeding and we might need to go emergently to the operating room to stop the bleeding.

 

 My stomach drops at this moment. All throughout our training so far, every thing we did was well supervised and controlled, there was little that we as medical students were allowed to do that could cause serious harm to patients. But here, this new mom was in danger of bleeding to death very rapidly, and it may have been because I improperly delivered the placenta. The thoughts were racing through my head. We had examined the placenta when I delivered it and it was intact. I almost considered digging through the red bio-waste garbage bin to look for the plastic carton that contained the placenta. I was very scared, but also conscious enough to try not to let it show on my face.  I was also trying my hardest to give the patient and her family a rough Spanish understanding. It was a weird balance of trying to balance the patient care and my own internal desperation and panic.

 

 The attending physician came to the room and immediately ordered a slew of drugs. As soon as all of them were administered, the bleeding stopped within 10 minutes. She explained to all of us in the room, with women that are slightly older and have had multiple pregnancies, like our patient, sometimes their uterus was slower to firm up after delivery. This allows the blood vessels to continue to leak and bleed. All the drugs she administered were to help the uterus firm up and gain muscle tone and essentially allow it clamp off its bleeding vessels.

 

 During this process, there were no placental fragments that came out with the bleeding. Repeated examinations and ultrasound showed no evidence of retained placenta. I was able to breathe a sigh of relief, it was not my action that had endangered this woman’s life. But it also has me thinking and realizing, for the rest of my life, I will be thinking about how my actions, in their intention to care, can cause serious harm to patients who have entrusted me with their health.

 

 That, is truly responsibility.