五妹五妹
小护士的世界
正文
不由自主
Lucy 八十五岁了，看上去顶多七十岁的样子。她是那种可以算得上是美人的老太太，即使躺在病床上也保持着一种优雅的姿态，薄薄的嘴唇涂得鲜红。
她今天应该有一个小手术，因为肾衰，她需要植入一根Dialysis catheter for Hemodialysis .她的手术同意书还没有签字，对于一个八十五岁的老人，她即使看上去身体状况还不错，我们也还是很谨慎的。她必须明白她在做什么，她什么样不同的决定会产生什么样的后果。
她有三个孩子，都住在外州。自从丈夫几年前过世后，她一直住在养老院里。为了确保她理解医生跟她讲的所有的东西，我们特意邀请精神科的医生来评估她的competent.(胜任力）。她真的很棒，对于这样年纪的人来说，我认为她的表现堪称完美。
早晨我问她," 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.
递给她同意书，签字，时间，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,中午之前一切停当。
下午，The clerk call me＂Patient's son on the line wants to talk to you ."我正忙着但也不得不接电话。
先是一番自我介绍，然后他说＂I don't want my mom have a surgery. Dialysis is not good for her."
What?! 我惊到了。＂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.给医生打电话，主治医生，肾脏科医生，手术医生 ，一圈下来半个小时就过去了。Lucy 看我忙来忙去，忍不住问我" anything wrong with me?"我不知道该怎样回答，也许他的儿子来了，我们跟他聊聊会改变主意吧，他或许并不知道dialysis(透析）对于肾衰的病人的重要性。"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 闭上眼睛，嘴角一直浅浅地笑着，她一定在臆想着尽享天伦的瞬间吧。
下午他的儿子终于来了，我把他叫出房间，我可不愿意守着Lucy来讨论这个问题。我一招手，他就溜出来了，一瞬间我体会了什么叫只可意会，不可言谈。
＂Do you want say something?"I asked him directly. 我不知道该跟他说什么，就让他来说吧。
他突然问很多关于透析问题，我一一回答了他。又让我拖过来电脑逐项解释化验结果。我的心沉下去了，这些表演就像一件华丽的袍子，掩盖着难以说出口的用心。终于他说＂ I want my mom on hospice care."(临终护理）
"Your mom wants have a surgery and then on dialysis. She wants aggressive treatment."我说，尽量保持着微笑。我在心里对自己说"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.
我没有办法，Lucy在我眼里就像一叶扁舟，只用一根细绳我们把她拖到岸边，而现在绳子断了，又被狠狠的一脚踹回到漩涡里。
继续给医生打电话，我可以明显的感觉到肾脏科医生的不甘心。终于她忍不住说"let me talk to the patient's son."我把电话递给他，过了一会儿，他递回给我。医生依然在线上，她说她要和病人讲话。我又把电话又递给Lucy，站在她身边，我听见医生在对她说，"If you don't go on the dialysis , you will die soon!" Lucy不回答，大颗大颗的眼泪落下来。
All the procedure canceled, All the medication discontinued. Lucy on hospice care only .
Lucy象一尊苍白的雕像，高贵而优雅地靠在床上。他的儿子坐在床边，低着头不时地啜泣。她抬起手，温柔的抚摸着儿子的满头灰发，就像在安慰着一个十岁的淘气男孩。我忽然想起Lucy说下个星期一是她86岁的生日，那一天我会再见到她吗?
生命，由得你做主吗?
下班了，天黑了，起风了，秋天来了。
病人家属比病人本人更有权力决定医疗方案吗？
Lucy死了她的儿子有什么好处？