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Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.


It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.


Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).


Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

几乎所有的医务人员在工作中都目睹过“无效治疗”。所谓的无效治疗,指的是在奄奄一息的病人身上采用一切最先进的技术,来延续其生命。病人将被切开,插上导管,连接到机器上,并被持续灌药。这些情景每天都在ICU(重症监护病房)上演,治疗费可达到10,000美元/天。这种折磨,是我们连在惩罚恐怖分子时都不会采取的手段。我已经记不清有多少医生同事跟我说过:“答应我,如果有天我也变成这样,请你杀了我。” 每个人的话都如出一辙,每个人在说的时候都是认真的。甚至有些同道专门在脖子上挂着“不要抢救”的铜牌,来避免这样的结局。我甚至还见过有人把这句话纹在了身上。

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.

将明知会带来痛苦的医疗措施用在病人身上,这本身就是一种折磨。作为医生,我们被训练得“从不在医疗实践中表露私人情感”,但私下里,医生们会各自交流发泄:“他们怎么能对自己的亲人做出那种事?” 我猜,这大概是医生和别的职业相比,有更高的酗酒率及抑郁倾向的原因之一。这个原因使我提前10年结束了自己的医务生涯。

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

将明知会带来痛苦的医疗措施用在病人身上,这本身就是一种折磨。作为医生,我们被训练得“从不在医疗实践中表露私人情感”,但私下里,医生们会各自交流发泄:“他们怎么能对自己的亲人做出那种事?” 我猜,这大概是医生和别的职业相比,有更高的酗酒率及抑郁倾向的原因之一。这个原因使我提前10年结束了自己的医务生涯。

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

将明知会带来痛苦的医疗措施用在病人身上,这本身就是一种折磨。作为医生,我们被训练得“从不在医疗实践中表露私人情感”,但私下里,医生们会各自交流发泄:“他们怎么能对自己的亲人做出那种事?” 我猜,这大概是医生和别的职业相比,有更高的酗酒率及抑郁倾向的原因之一。这个原因使我提前10年结束了自己的医务生涯。
2011-12-14 14:03 编辑:kuaileyingyu