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医生如何面对自己的死亡 The doctor how to face his own death

　　医生也会死。同其他大多数人相比，医生的与众不同之处并不是他们得到了更多的治疗，相反是更少。他们倾向于选择以一种安详而优雅的方式离开世间

The doctor will die.Compared with most other people,The difference is not they got more treatment,Instead is less.They tend to choose in a serene and elegant way to leave the world

　　几年前，我的导师、备受尊敬的骨科医生查理发现他的腹部有个肿块。他让一位外科医生进行了检查，结果，这个肿块被诊断为胰腺癌。给查理看病的这位医生是全美最棒的外科医生之一，他曾设计出的一套癌症治疗的新方案，能够将患者的5年存活率增加到原来的3倍(从5%增至15%)，只是这期间患者的生命质量并不高。查理对此并不感兴趣。第二天他回到家，关闭了自己的诊所，从此没再踏进医院一步。他把全部时间用来和家人在一起度过，尽情享受生活。几个月后，查理在家中辞世。他没有接受化疗﹑放射性治疗，更没有接受外科手术。医疗保险公司当然也没有为他花多少钱。

A few years ago,My tutor/The most respected members of the bone doctor Charlie found his abdomen has a mass.He let a surgeon inspected,The results,The tumor was diagnosed with pancreatic cancer.Give Charlie doctor the doctor is one of the best surgeons,He has designed a new scheme of cancer therapy,Can the person's 5 years survival rate increase to the original three times(From 5% to 15%),But this time a patient's life quality is not high.Charlie wasn't interested in it.The next day he came home,Closed his clinic,Never go into hospital step.He spends all his time to spend with family,Enjoy life.A few months later,Charles died at home.He did not receive chemotherapy, radiation therapy,More no surgery.Medical insurance company also not spend how many money.

　　这不是一个我们喜欢谈论的话题，但它却无法回避——医生也会死。同其他大多数人相比，医生的与众不同之处并不是他们得到了更多的治疗，相反是更少。

This is not a we like talking about the topic,But it is unable to avoid, the doctor will die.Compared with most other people,The difference is not they got more treatment,Instead is less.

　　医生们穷其一生去帮助人们抵抗死神，但是当轮到他们自己的时候，却往往会表现出出奇的平静。他们确切地知道接下来会发生什么，他们知道要面临的选择是什么，而且他们通常有能力得到他们希望得到的医疗措施。然而，他们却倾向于选择以一种安详而优雅的方式离开。

The doctors poor his life to help people against the god of death,But when it's their own time,But often show eerily calm.They know exactly what will happen next,They know that face choice is??????,And they usually have the ability to get what they hope to get medical treatment.however,But they tend to choose in a serene and elegant way to leave.

　　和其他人一样，医生当然也不愿意死去，但是他们对现代医学的了解太充分了，所以对医学的局限性也了如指掌。同样，他们对死亡了解得足够多，因而他们知道人们最害怕什么：在痛苦中死去、在孤独中离开。正因为如此，医生希望确保在自己的大限到来时，不会有任何过度医疗手段实施在他们身上。比如，他们不希望在自己的最后时刻有人在为他们实施心肺复苏术时折断他们的肋骨，而这正是心肺复苏术正确实施时，可能发生的情形。

And others,The doctor of course is not willing to die,But they know too full of modern medicine the,So for medical limitations also like the back of his hand.The same,They know enough to death,So they know people the most afraid of:Die in pain/Leave in solitude.Because of this,The doctor want to ensure that in his own time comes,There won't be any excessive medical treatment ways to implement on them.For example,They don't want to in their last moments in someone for them when they implement cardiopulmonary resuscitation broken ribs,And this is the correct implementation cardiopulmonary resuscitation,Possibility.

　　几乎所有的医务工作者都目睹过那些“无效治疗”在病人身上实施的情形，此时，医生会把最先进的技术用于施救垂死的病人。病人身体的某些部位会被切开、插上管子、与各种机器连上、用上各种药物。重症监护病房里所发生的这些，每天要花费数以万计的美元。而这些病人花钱所买来的，是恐怖分子也不至于对人采取的手段。不知道有多少次，我的医生同行们悄悄告诉我，“假如某一天我也落到那个地步，你记得把我杀了。”在被送入重症监护病房后，甚至有些同行在脖子上挂着“不要抢救”的牌子，来避免这样的结局。在对病人实施“非人的”医疗手段时，医生自己也备受折磨，医生的职业训练，要求他们和病人交流时不应透露自己的个人感情，但是医疗业的同行们会在私下里议论，“谁愿意在自己家人的身上做那些治疗啊！”我猜，这是医生发生酗酒和抑郁的比例大于其他很多职业的原因之一。

Almost all the medical workers who have witnessed"Ineffective treatment"In the case of the implementation of the patients,At this time,The doctor will take the most advanced technology used to rescue the dying patients.The body parts will be open/On pipe/Even with all sorts of machines on/Use all kinds of drugs.Intensive care ward what happens in these,Every day to spend tens of thousands of dollars.And these patients spend money bought,Terrorists will not to take the means.Don't know how many times,My doctor colleagues told me quietly,"If one day I also fell to the point,Do you remember put me to death."In was admitted to intensive care ward after,Even some counterparts in hung on the neck"Don't save"brand,To avoid this end.In the implementation of the patient"nonhuman"Medical methods,The doctor himself on the gridiron,The doctor's vocational training,Asking them to interact with patients should not be revealed his personal feelings,But medical industry colleagues will talk in private,"Who would like to in their own family, do the treatment ah!"I guess,This is the doctor happened alcoholism and depression scale than many other professional reasons.

　　为什么会变成这样呢？为什么医生在病人身上倾注了如此多的心血和治疗，却不愿意将其施予自身？答案说起来复杂，但是，说简单也简单，它无非包括三个方面，那就是：病人、医生、体制。

Why would become like this?Why do doctors in patients into so much effort and treatment,But I do not want to give it their own?The answer it complicated,but,Said simple and simple,It only includes three aspects,That is:The patient/The doctor/system.

　　先来看看病人所扮演的角色。假如某人失去意识后被送进急诊室，通常情况下，在面对这类突发事件时，家属们会面对一大堆突如其来的选择，而变得无所适从。当医生询问是否同意采取“一切抢救措施”时，家属们往往说“是”。于是噩梦开始了。有时家属所理解的“一切措施”意思是指“一切合理的措施”，但问题在于，他们有时可能并不知道什么叫“合理”；或者当沉浸在巨大的迷茫和悲痛中时，他们想不到去仔细询问，甚至连医生的话也听不进去。在这种时候，医生们会尽力做“所有能做的事”，哪里还顾得上什么是“合理”。

Let's look at the role of the patient.If a person loses consciousness after was sent to the emergency room,usually,In the face of this kind of incident,Family members will face a lot of sudden choice,And become disoriented.When the doctor asked if agreed to take"All the rescue measures"when,Family members often said"is".So the nightmare begins.Sometimes family members understand the"All measures"means"All reasonable measures",But the problem is that,Sometimes they may not know what call"reasonable";Or when immersed in great confusion and sorrow when,They thought to ask carefully,Even the doctor's words also won't listen.In this time,The doctors will try to do"All can do",Where manage what is"reasonable".

　　医生不可能要求每位病人家属都能冷静下来，专心致志配合医疗。很多人可能会以为心肺复苏是种可靠的生命支持方法，但事实上，它可谓成效甚微。我曾收治过几百名先被施行心肺复苏术，而后送到急诊室的病人。他们当中只有一位健康的、没有任何心脏疾病的男性是最后走着出院的(他患的是压力性气胸)。

The doctor couldn't have asked for each patient family member can calm down,Bone with medical treatment.Many people may think cardiopulmonary resuscitation (CPR) is a kind of reliable life support method,But in fact,It has little effect.I have had several hundred were to be performed cardiopulmonary resuscitation,And then sent to the emergency department patients.Among them only a healthy/No heart disease of men is the last walk from the hospital(He is suffering from pressure of wound).

　　如果一位病人曾患有严重的疾病、或是年事已高、或有不治之症的话，那么，他即使接受心肺复苏治疗，身体复原的几率也很小，但所要忍受的痛苦却是巨大的。病人的知识不足、期待被误导，是导致他们做出糟糕决定的主要原因。

If a patient was suffering from serious illness/Or his old age/Or if an incurable disease,so,He even accept cardiopulmonary resuscitation (CPR) treatment,The body recovery probability is very small,But to endure the pain is huge.The patient's lack of knowledge/Looking forward to be misled,They make bad is the result of the main reasons for the decision.

　　实际上，医生扮演着更主动的角色。即使医生并不想进行“无效治疗”，他们也必须找到一种能满足病人和家属愿望的方法。再想象一下急诊室里的情景：那里满是悲痛的，甚或是发疯的病人家属。医患之间互不认识，在这种时候，想要建立信任是很难的。如果医生建议不采取积极的治疗，家属很有可能会认为他是出于省事、省时间、省钱等方面的动机。

In fact,The doctor play a more active role.Even if the doctor didn't want to"Ineffective treatment",They also have to find a can satisfy the patients and their relatives on the method of desire.Imagine the scene of the emergency room:There is full of sorrow,Or even crazy of the patient's family.Doctor-patient not know each other,In this time,Want to build trust is very difficult.If the doctor advised not to take active treatment,Family is likely to think he is out of save trouble/Save time/The motivation to save money, etc.

　　有些医生善于交流，有些医生非常坚定，但他们面对的压力都是差不多的。当需要处理生死攸关的病情时，我会尽早把自己认为合理的方案一一列出。一旦病人或家属提出不合理要求，我会用通俗易懂的语言将该要求可能会带来的不良后果解释清楚。

Some doctors are good at communication,Some doctors are very firm,But they face pressure is about the same.When need to deal with vital their condition,I'll think of himself as soon as possible the reasonable plan list.Once the patient or family members put forward unreasonable demands,I'll use straightaway language will this requirement may cause adverse consequences explain.

　　是不是有时候我应该更强势一些呢？我曾收治过一位律师病人，她患有严重的糖尿病，循环功能很差，更糟的是，她的脚逐渐变得疼痛难忍。我权衡利弊后劝她不要去做足部手术。但是她最后还是找了位外院的专家，后者并不很了解她的状况，决定在她有血栓的双腿上做旁路手术。这次手术没能恢复她的循环功能，同时由于糖尿病，她的创口无法愈合。很快，她的双腿开始坏疽，最终截肢了。两周后，在那个为她做了手术的著名医院里，她去世了。

Is sometimes I should be more strong you some?I have a lawyer treated patients,She has a serious disease of the diabetes,Circular function is very poor,worse,Her feet became unbearable pain.I weigh the pros and cons after advised her not to do foot surgery.But she finally find a outer court of experts,The latter don't know her very well condition,She decided to have blood clots in the legs do bypass surgery.This operation can't restore her circular function,At the same time due to diabetes,Her wound unhealed.soon,Her legs began to gangrene,Finally the amputation.After two weeks,In that for her to do the surgery of famous hospital,She died.

　　从这类故事里想挑出医生或病人的失误并不难。但在很多时候，医患双方都是这个推广过度医疗的庞大体系的受害者。有一些医生在按服务付费的医疗体系中，只顾尽量赚钱。而在更多情况下，医生们只是出于害怕被诉讼，而尽量满足病人的要求，不去把自己的专业意见反馈给病人，以避免日后官司缠身。

From this kind of story want to pick out the doctor or the patient's mistake is not difficult.But most of the time,Doctor-patient both sides is the promotion of excessive medical huge system of the victims.Some doctors in the service pay medical treatment system,Only try to make money.But in more cases,The doctors just out of fear of being litigation,And try to meet the requirements of the patients,Not to put their own professional feedback to the patient,In order to avoid future with the case.

　　不过，医生们不会对自己过度治疗，因为这种治疗的结局他们见得太多。他们中几乎所有人都能宁静地离去，疼痛也可以被缓解。和无效治疗相比，临终关怀更注重为病人提供舒适和尊严感，让他们安然度过最后的日子。值得一提的是，研究发现，生活在临终护理院的终末期病人，比患有同样疾病但积极寻求治疗的病人活得更久。

but,The doctors not to excessive treatment,Because of this the end of the treatment they see too much.Almost all of them can quiet away,Pain can also be ease.Compared with invalid treatment,Hospice care for patients pay more attention to provide comfort and dignity,Let them come through last days.Be worth what carry is,The study found that,Life in the terminal nursing home end-stage patients,With the same than disease but actively seeking treatment for patients live longer.

　　几年前，我的表哥阿炬(他在手电筒的照亮下在家里降生，因而得名)突然浑身抽搐发作，事后查出是肺癌扩散至脑所致。我带着他去见了各种专家，最后知道，像他这种情况，如果采用积极的治疗，需要每周3～5次去医院化疗，而即使这样，他最多也只能活4个月。

A few years ago,My cousin, torch(He is in the light of the flashlight in home was born,Hence its name)Suddenly all the seizures,Find out later is spread to the brain caused by lung cancer.I took him to see the various experts,The last to know,Like his this kind of situation,If the active treatment,Need 3 ~ 5 times a week went to the hospital to chemotherapy,And even so,At most, he can only live 4 months.

　　最终，阿炬决定拒绝任何治疗，仅服用防止脑水肿的药物，回家休养。他搬到我家，我们在接下来的8个月里共度了一段快乐时光，做了许多小时候爱做的事。我们去了迪士尼乐园，这是他平生第一次。我们有时也宅在家里。阿炬热爱体育，他最喜欢的事就是边看体育比赛转播，边吃我做的饭。在那段时光里，他甚至长胖了几斤，每天想吃什么就吃什么，完全不用忍受医院里糟糕的饮食。他没有经受剧烈的疼痛，一直保持情绪饱满，直到有一天没再醒来。此后，他昏睡了三天，最后安静地走了。这8个月来他在医疗上所有的花销，仅有20美元的药费。

finally,O torch decided to reject any treatment,Only taking drugs to prevent cerebral edema,home.He moved to my house,We in the next eight months had a very good time,Do a lot of childhood love to do.We went to Disney World,This is for the first time in his life.We sometimes curtilage at home.O torch love sports,His favorite thing is watching sports broadcast,Eat what I cook.During that time,He even long fat a little weight,A: do you eat every day,Completely don't bear the hospital bad diet.He did not undergo severe pain,Keep in high spirits,Until one day didn't wake up.Since then,The last three days,Finally quietly away.The eight months in all of his medical costs,Only the medicine of the twenty dollars.

　　阿炬不是医生，但他知道他要的是生活质量，而非数量。我们中的绝大部分人，不也正是这样想的吗？

O torch is not a doctor,But he knows that he is the quality of life,Not quantity.We most of the people,Don't think exactly the same?

　　假如有一种挽救生命的“最新技术”的话，那就是：有尊严地死去。说到我自己，我的医生知道我的意愿，和很多医生为自己所做的选择一样，他们不难为我做一个好的选择。当死亡最终来临的时候，我不需要奋力抢救，而愿意安详地睡去，就像我的导师查理、我的表哥阿炬一样；也像我的那些医疗同行们一样。(文/肯·默里(美)作者系美国南加州大学医学副教授。本文原发于Zócalo Public Square网站www.zocalopublicsquare.org，中文版经该网站授权本刊独家发表。)

If there is a life saving"The latest technology"words,That is:To die with dignity.Said to myself,My doctor know I will,And many of the doctors for what we do choose one,It is not difficult to them for me to do a good choice.When death finally comes,I don't need to save,And are willing to go to sleep peacefully,Just like my mentor Charlie/My cousin, as the torch;I also like the medical treatment as well as colleagues.(Text/Ken Murray(beauty)The author is an associate professor of medicine at the university of southern California.This paper primary in Zocalo Public Square website HTTP: / / www.zocalopublicsquare.org,Chinese version of the site by the authorized sole published.)