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看完这些,你可能对ICU有全新的认识

2015-12-18 虞竹溪 南京鼓楼医院

提起ICU,也就是医院里的“重症监护室”,你的第一反应是怎样的画面呢?在死亡线上苦苦挣扎的病人、惊心动魄的大抢救还是各种冷冰冰的医疗器械和维持生命体征的大小管道? 然而,在一位每天奔忙于ICU,每日与死神战斗的临床女医生的眼中,真实的ICU是怎样的呢?是的,这里有眼泪有离别,有伤痛有无奈,但也有奇迹与感动,充满着温情的暖色调。看完下面几则小故事,也许你从此会对ICU有了不一样的理解和

提起ICU,也就是医院里的“重症监护室”,你的第一反应是怎样的画面呢?在死亡线上苦苦挣扎的病人、惊心动魄的大抢救还是各种冷冰冰的医疗器械和维持生命体征的大小管道?

然而,在一位每天奔忙于ICU,每日与死神战斗的临床女医生的眼中,真实的ICU是怎样的呢?是的,这里有眼泪有离别,有伤痛有无奈,但也有奇迹与感动,充满着温情的暖色调。看完下面几则小故事,也许你从此会对ICU有了不一样的理解和体验。

孩子,我们天堂见

回忆起我第一次没有二线在医院值班,领着几个比我胆子还小的轮转医生,忙了一夜。三点才刚爬上床休息,四点接到妇产科急会诊电话。一个人走在医院空空荡荡的走廊里,凌晨的医院是从没见过的寂寞与冷清,走廊里间或睡着几个裹着棉被的患者家属。走到产房,这里却是让我震惊的热闹与喧哗。

我来会诊的是一个年轻的产妇,孕38周,离卸货不远了,然而让人难过的是因为重症胰腺炎,她的孩子没了。剖宫产术后,她被转到了ICU。因为同为女人,我总是对我们科的产妇有种莫名的同情。我能体会一个AKI(急性肾损伤)的产妇因为产后不能亲自哺乳她的龙凤胎宝宝而在深夜拉着我的手哭泣;也能理解一个肝癌晚期的妈妈在弥留之际一定要见到自己半岁的儿子……
胰腺炎产妇的预后终究不好,在经历了耐药菌导致的严重腹腔感染及巨额的治疗费用之后,她最终还是随着她的孩子去了。在ICU治疗期间,由于病情太重,她一直没有再和我说过话,而我也没有机会问问她,是否记得我去看她的那个噪杂而冷清的夜晚。

一碗饺子

我在甲乳外科轮转的那三个月,走路是带风的:病床周转率高、操作多、手术也多。那也是我怀孕初期的三个月,认识了一帮女患者。她们是乳腺癌患者,需要定期来化疗,一来二去都成了熟客,深知哪位医生深静脉穿刺技术娴熟。

她是一个肿瘤性质未定,来做包块穿刺的老太太。我第一给她做穿刺时,她似乎看出了我的忐忑,温柔地对我说:“你别紧张,随便穿。”很不幸,她的病理结果不好,又进行了一系列化疗。出院的那天,她叫住我说:“我生这个病要花很多钱,也没什么东西送你,我女儿包的饺子很好吃,你不嫌弃就吃一碗吧。”数月之后,我在门诊又看见她了,她似乎带了假发,但脸色很好,精神也不错。

许多日子之后,我依然清晰地记得,那碗白菜肉饺子的味道。

花开就一次成熟我却错过

如果让我当外科医生,我绝对不会选的一定是脑外科。原因是:太辛苦!
那个病人入院的时候,已经是脑肿瘤合并脑积水了,只能急诊手术。可怜他只有17岁,更让人扼腕的是术后他不出所料地持续昏迷了。后来又陆续经历了三四次手术,他始终在我们科沉睡着,没有一丝反应。他的父母自然是伤心欲绝,几次深夜病危时,父母在ICU门口都几乎崩溃。
有一天夜班,我在他的房间门口竟然听见了很小声的杰伦歌声。身为杰伦粉丝的我进去把歌曲放到最大之后又立刻关小。后来才知道,他是杰伦的铁杆粉丝。有一次探视,他爸爸在他耳边说:“儿子,赶紧醒过来。这都是你最爱的歌,爸爸以前都没仔细听过,现在为了你一首首去搜的。”

想来,没有生病的时候,他应该也是个每天与父母和老师斗智斗勇,把耳机藏在袖子里上课偷偷听歌,用杰伦的歌词当作情书给女生传小纸条的大男孩吧。直到转出ICU他依旧没有醒过来,后来我去脑外科看过他的病历,直到他出院的那天,他依旧没有醒过来……

120天的住院生活,真的可以改变一个人吗?

他是我所见过的肝移植患者里性格最好的一个。中医说:忧虑伤肝。不知道有没有科学依据,但至少我见过的肝移植患者大多是沉默寡言、不苟言笑的,而他是个例外。

他术后恢复得很好,也很乐观,术后第一天刚拔管就和我大谈他家的资产分配和各种趣事。很快他便转回病房了,我再见到他已是四个月后,他因为肺部感染再次转入ICU。

一个夜班,他竟认出了我,即使我因为天天喝奶茶又胖了,而我却没有认出他,因为他已经瘦得脱了相。我们又开始大聊特聊,甚至彼此分享了孩子的照片。眉飞色舞的畅聊之后是片刻的冷场和沉默,突然他问我:“我这次是不是出不去了?”我惊讶于他的悲观。要知道,以前的他,是可以在术后第二天就和我笑谈人生的呀!

后来我才知道,当时他已经在医院足足住了四个月。我不知道疾病的牢笼究竟是怎样改变了他的想法又是如何打击了他的希望。后来的他,话越来越少,情绪也越来越消沉,即使在家人面前他还是努力地佯装坚强。希望他能好起来,变回我初见时的那个话痨。

一开始,我以为他会死的

那是记忆里最忙碌的一个春天,我们科收治了6例人感染H7N9禽流感患者。每天的治疗调整、大量的操作、外出检查、全副武装的医护人员、每天的数据统计和标本采集以及频繁的专家会诊与领导视察……我整日辗转于自己那一窝病人之间,每天都忙得晕头转向。

他才20多岁,来的时候病情很重很重,以我可怜的临床经验,觉得他一定没救了。不可救药的氧合、可怕的白肺、持续的昏迷……可他终究奇迹般地挺过来了。

拔管的那一刻,他竟然孩子一样地哭了。拔管之后,他也很少和我们说话,我却每天乐呵呵地给他带杂志看,主动和他说说笑笑。在后来慢慢康复的过程中,我才知道他原来也是个爱玩爱笑的小伙子,也许之前的沉默寡言是对自己的忧心忡忡吧。后来他病愈出院了,随访时再见到他,他胖了许多,而我们至今还保持着联系。

他也许永远不会知道,一开始,我以为他会死的。

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    2018-06-26 1e145228m78(暂无匿称)

    学习了.谢谢作者分享!

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    2016-09-27 童小孩

    ICU,神秘高大上的地方

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2015-12-25 忠诚向上

    真感人

    0

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这项发表在Critical Care Medicine的文章,主要内容是评估面对亲人住院这一事件时家庭决策者不同的应对策略、60天后决策者是否及如何患上创伤后应激障碍(PTSD)。凯斯西储大学弗朗西斯佩恩博尔顿护理学院的博士后Amy Petrinec,解释道,当患者住在重症监护病房(ICU)时,不仅患者会受到一定程度的影响,负责制定决策并签署医疗知情同意书的患者家属也会受到影响。为了使自己制定的决

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