大家都知道每年10月的第2個禮拜六是"世界安寧緩和醫療日"嗎？
今天要來跟大家聊聊有關不施行心肺復甦術的想法...
Do you know that "World Hospice & Palliative Day" is on the sencond Saturday of every October?
這雖然是個幽默的插畫...
但是實際上在進行急救的時候...
的確是會造成病人額外的傷害...
像是進行體外心臟按摩的時候會讓病人的肋骨斷掉...
電擊時也會造成皮膚壞死等等...
Though it's comic n the doctors and nurses who do the CPR are not sharks.
But during a real CPR, there must be some damages to patients.
Their ribs got fracture while doing the Cardiac Massage.
And their skin got burned after the defibrillation.
當然還是要來點小常識給大家了解了解...
所謂心肺復甦術就是大家常聽到的急救CPR(Cardiopulmonary Resuscitation)…
(施予氣管內插管、體外心臟按壓、急救藥物注射、心臟電擊、心臟人工調頻、人工呼吸或其他救治行為…)
CPR stands for Cardiopulmonary Resuscitation which is an emergency procedure to rescue people who have no breathing.
(including on endotracheal tube, chest compressions, medication injection, defibrillation and provide breaths by either exhaling into the subject's mouth or nose etc. )
這樣的註解似乎還是很文言文…
簡單來說就是大家一般看到電影裡或電視上肥皂劇裡演的…
嘴對嘴人工呼吸啦…
壓心臟或拿面板電心臟啦…
插根管子在氣管裡啦等等的…
It might be difficult for you to know…
In brief CPR is what you usually see on TV series or movies such as the following…
(以上圖片取自”愛就宅一起”劇照…)
所以不施行心肺復甦術就字面的意思…
就是在臨終、瀕死或無生命徵象時…
不進行上述的急救動作…
Then DNR means:Do Not Resuscitate.
Don’t’ do CPR while people are without vital signs or going to die…
大家應該都知道施行心肺復甦術的時機…
但是為什麼或什麼時候不施行心肺復甦術呢???
Now you know when to do CPR for people under what kind of situations…
But how about DNR???
臨床上主要適用於…
罹患嚴重傷病…
經醫師診斷(臨床上需要2位醫師診斷)認為不可治癒…
而且病程進展到接近死亡…
依照安寧緩和條例讓病人在不急救的情形下結束生命…
Clinically, patients who suffer the severe and incurable illness which is diagnosed by two doctors. Even the disease progressed to death.
Following the Hospice Palliative Care Regulations, patients end their lives by nature without CPR.
如果你年滿20歲有自主行為的人都可以簽妥意願書…
表明自己以後在生病時生命走向盡頭時不施行急救動作…
如果是已經失去意識或是沒有自主行為能力的人…
那就必須由法律上具有效益的代理人幫你簽妥同意書…
If you are over 20, you can sign the permit by yourself, and it means you don’t want to accept CPR when you are at death’s door.
Otherwise(people who under 20 or lose consciousness), your agent in low have the right to sign the permit for you.
而說到安寧療護…
我想大家比較有印象的應該就是之前不久因肺癌去世的音樂人陶大偉了吧…
他和孫越都是安寧療護的提倡者…
另外國內有位非常知名的趙可式女士也是相當有名的安寧療護專家…
(如果有興趣可以參考一些連結看看故事…)
Talking about Hospice care…
You may know 陶大偉 who died of lung cancer few months ago, who is one of the advocators of Hospice care as well as 孫越…
And there’s a famous expert in hospice called 趙可式…
其實這觀念是英國一位叫桑德絲（Dame Cicely Saunders）的護士(同時也是個醫師)所建立提倡的…
(如果有興趣可以參考一些連結看看故事…)
範疇實在太廣了也談不完…
台灣法律上有列載一項” 安寧緩和醫療條例”…
說到法律大家可能就沒啥米興趣…
在這裡用白話文跟大家粗略說明…
為了尊重病人本身意願…
減輕、緩解末期病人(指罹患嚴重傷病，經醫師診斷認為不可治癒，且有醫學上之證據，近期內病程進行至死亡已不可避免者)的痛苦所給予的醫療照護…
在生命危急時不施行心肺復甦術(施予氣管內插管、體外心臟按壓、急救藥物注射、心臟電擊、心臟人工調頻、人工呼吸或其他救治行為)…
The conception of Hospice palliative care was dated from Dame Cicely Saunders, who was a nurse and a doctor in England)
But what is exactly Hospice???
There’s a law about Hospice care in Taiwan…
It might be boring for you to read this kind of articles, so let me say it in brief…
To respect terminal patients’ will for relieving the pain and discomfort they suffered, the doctor won’t do CPR when the patients are going to die.
只要是年滿20歲有自主行為的人都可以簽妥意願書…
表明自己以後在生病時生命走向盡頭時不施行急救動作…
If you are over 20, you can sign the permit by yourself, and it means you don’t want to accept CPR when you are at death’s door.
安寧著重在”緩和”臨終病人症狀面的痛苦…而不在”治療”…
臨床上醫師還有醫療團隊會仔細評估病人…
是否能再繼續接受治療或是時機已到了走向安寧…
而安寧療護在台灣多半用於癌末患者…
Hospice care emphasizes on alleviating the pain but not curing the disease.
**********(點點說說) **********
在臨床上不誇張…有些堅持急救的人就是像肥皂劇那樣演的…
有的是擔心自己陷於不孝…
有的孩子們為了遺產尚未分配好…
有的是因尚未找到算命師口中那塊埋了可以庇佑子孫的墳地…
We often see people insist on rescuing their family because they are afraid others will say they don’t do their duty for their parents, or they haven’t inherited the money, or they haven’t found a good place to bury bodies.
但是如果今天你生命快走向盡頭…
而且也已經為你自己做好臨終安寧不急救的決定…
不會再有你的親人可以為了上面那些事情…
在你快斷氣的時候…心跳快停止的時候…
叫醫護人員使命的在你心臟上按壓到胸骨碎裂…
插管子在你的氣管內只為了留一口氣…
If you already signed the DNR permit, no one can do the above things to you just for fulfilling their selfish needs.
(主觀意見)
我甚至不明白如果你都已經知道快沒多久可以活了…
而且也真的在臨死邊緣的那一刻…
即使經過急救過後…
機器上那些心跳呼吸數值看起來似乎很完美…
因為你還沒被火化或土葬…身體還躺在那所以理論上你還活在這世上…
但插了很多管子然後可能已經沒有思想…也無法開口說話…
讓你這樣的躺在那裏就是孝順了嗎…
意義到底在哪裡…
(My opinion…)
I don’t and I can’t understand if you already know you are going to die, would you choose to let others broke your bones and insert a tube in your trachea just to keep your vital signs in stable???
What a pity!!! You still are a ” body” lie on the bed, just the body haven’t buried in or burned up yet.
當然…在這裡並不是要鼓吹大家一定都要簽什麼拒絕治療同意書或是安寧緩和…
而是要為自己的善終做決定…
不論你是決定在生命危急的時候堅持要救自己到底…
或是你選擇不要急救坦然地離開…
都是你自己現在就必須要做好決定的…
(或許你現在決定好的會因為時間而改變觀念想法…
但無論如何從現在起你都要開始想想這些問題而不要再逃避它了…)
你人生中已經損失太多可以為自己決定的自主…
屬於你生命的最後一天該是你自己決定該如何離開的時候…
I’m not here to encourage you guys to sign your DNR permit.
No matter you insist on saving your life at the last minute or you want to die peacefully without CPR, anyway it’s your own decision.
Just it’s time for you to think about this “DEATH” question.
之前看過一個很有趣(?)的廣告…
廣告裡的意思大概就是在講很多人在一生當中鮮少可以為自己做決定…
似乎都是別人幫你做好選擇…你在依照他們決定地走下去…
雖然可笑荒謬…但好像多數人你我的人生到目前為止都是如此…
這個廣告的主打標的和今天要說的內容完全不同…
但卻是要告訴大家是為自己做些決定的時候了…
I had seen an interesting ads before…
it says you seldom can make decisions by yourself in lifetime…
Little connection between the topic today but all I want to say is…
It’s about time to make the decision by yourself…
談到生命本無常…尤其在臨床上看到更多來來去去的生命…
有些家屬就會問說:
你們應該已經看習慣這個沒感覺了吧…
死去的不是你們家人所以你們根本不會傷心…
並不能說司空見慣…看到麻木沒感覺不害怕不難過…
其實我們是人當然會有感覺…
只是在處理病人遺體的時候我們護理人員更要控制好自己的情緒…
讓他們離開的祥和又尊嚴…
Life is always unpredictable.Many people think we may don’t have any feeling about death since we nurses see many lives gone in hospital.
Of course we do have feelings!!! Just we can’t bring our true feelings (especially sad feeling)to those patients so that they would have good deaths.
在台灣接受拒絕治療和走向安寧緩和治療會那麼不暢行的原因…
我想主要還是和傳統觀念帶給我們的影響有關…
老一輩的人害怕探討”死”的議題…
常會覺得提到”死”這個話題是不吉利的…
當然也就不願意正視它…
或許你可以避免談論”死”…
但並不代表”死”不會發生…
I think that few people here in Taiwan face the issue of DEATH because old people always tell us DEATH is unlucky.
You can choose to avoid talking about DEATH, but that doesn’t mean you won’t die and won’t see people die around you.
有的時候就是因為你了解的越少你越害怕它...
其實你可以練習從現在開始…
和你的親人…你信任或親密的人…
談談對於死亡的想法概念…
把所有對於死亡的感覺想法都聊過甚至可以寫下來…
不用相當嚴肅…可以是很輕鬆的…
不用急著做決定…但…請試著去開始決定…
In fact you can practice how to face DEATH from now on.
Discuss it with your family or people you trust in, and talking with them or writing down everything you think about death.
Don’t take it too seriously, and don’t make the final decision in a hurry.
The more you know about it, the less you fear of it.
像我都會和我把拔馬麻討論這個話題…
我馬麻就跟我說…
她不准我在她去世那天流眼淚…
然後我跟我哥都不准急救她的…
她要走得很灑脫祥和之類的…
不過我跟她說我還是會捨不得還是會偷偷哭…
我把拔也跟我說他以後老了要去世了不想要痛苦的離開…
每個人對於死亡都有自己的想法…
不管好的壞的正向的負向的都可以勇敢的說出來…
I’ve discussed about death with my parents, and my mom always tells my brother and I that we can’t cry and decide for her to cancel her DNR permit while she is going to die.
(she has already signed her DNR permit) But I told her I still will cry because I love her so much.My dad also tells me that he want to die in a peaceful way.
Everyone has his/her thought about death, no matter it’s positive or negative, he/she has to learn how to express it.
當然我自己看過很多急救的場面…
所以我…已經簽好不施行急救意願書囉…
(但也不要因為這樣就假裝釀造一場車禍殺我拜託…)
Of course I already signed my DNR permit after seeing so many CPRs.
(But please don’t try to kill me by making a fake car accident :P)
在此獻上一首歌…
“蘇見信-如果還有明天”
如果還有明天…
你想怎樣裝扮你的臉…
如果沒有明天…
要怎麼說再見…
“Slaughter - Live Like There's No Tomorrow”
Now you know in your mind
You're burnin' candles at both ends all of the time and you feel fine
And you're livin' everyday of your life
Like there's no tomorrow
我們無法擁有每個明天…
就盡情活在當下的今天…
Be happy for this moment, this moment is your life.
C'est la vie, profite le moment.
Reference參考資料：
1.安寧照顧基金會
http://www.hospice.org.tw/2009/chinese/index.php
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