給生命最後的安詳
惟雯說故事
人們關於臨終的認識普遍有很多誤區,應該好好宣導,不要給親人帶來不必要的痛苦!。
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一個遭遇車禍的 22 歲男性被送進了急診室,此時的他生命垂危,幾乎不能說話。
然後,在長達 3 個小時的時間裡,醫院不允許家人進入病房看望這個隨時會告別人生的親人,在隨後的時間裡,也只允許一個親人每隔 2 小時進去看望 5 分鐘。
在漫長的等待中,沮喪的女友只好回家了,父母也抵不住身心疲憊睡著了,直到護士通知他們病人已身亡時才驚醒過來。
由於痛惜沒能在最後時刻與親人見上一面,說上幾句告別的話,家屬的悲痛驟然升溫 …
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那麼,生命在最後的幾週、幾天、幾小時裡,到底人處於什麼樣的狀態?一個人在臨近死亡時,體內出現了什麼變化?在想什麼?需要什麼?我們該做什麼?不該做什麼?怎樣做才能給生命以舒適、寧靜甚至美麗的終結?
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臨終期一般為 10-14 天(有時候可以短到 24 小時)。
在這一階段,醫生的工作應該從“ 幫助病人恢復健康 ”轉向“ 減輕痛苦 ”。
臨終病人常處於脫水狀態,吞嚥出現困難,周圍循環的血液量銳減,所以病人的皮膚又濕又冷,摸上去涼涼的。你不要以為病人是因為冷,需要加蓋被褥以保溫。相反,即使只給他們的手腳加蓋一點點重量的被褥,絕大多數臨終病人都會覺得太重,覺得無法忍受的重壓,更何況一條毯子!
呼吸衰竭使臨終病人喘氣困難,給予氧氣似乎是順理成章的事。但他們已失去了利用氧氣的能力,此時給他們供氧無法減輕這種“ 呼吸飢餓 ”。
正確的做法是:打開窗戶和風扇,給病床周圍留出足夠的空間。
另外,使用嗎啡或其他有類似鴉片製劑的合成麻醉劑是減輕病人喘氣困難和焦慮的最好辦法。
當吞嚥困難使病人無法進食和飲水時,有些家屬會想到用胃管餵食物和水,但瀕死的人常常不會感到飢餓。相反,脫水的缺乏營養的狀態造成血液內的酮體積聚,從而產生一種止痛藥的效應,使病人有一種異常歡欣感。這時即使給病人灌輸一點點葡萄糖,都會抵消這種異常的欣快感。而且,此時給病人餵食還會造成嘔吐、食物進入氣管造成窒息、病人不配合而痛苦掙扎等後果,使病人無法安靜地走向死亡。靜脈輸液雖然能解決陷入譫妄狀態病人的脫水問題,但同時帶給病人的是水腫、噁心和疼痛。
在生命的最後階段,甚至在死前三個月之久,不少病人與別人的交流減少了,心靈深處的活動增多了。不要以為這是拒絕親人的關愛,這是瀕死的人的一種需要:離開外在世界,與心靈對話。
一項對 100 個晚期癌症病人的調查顯示:死前一周,有 56% 的病人是清醒的, 44% 嗜睡,但沒有一個處於無法交流的昏迷狀態。但當進入死前最後6小時,清醒者僅佔 8%,42% 處於嗜睡狀態,一般人昏迷。所以,家屬應抓緊與病人交流的合適時刻,不要等到最後而措手不及。
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有時,我想 —– 為什麼,為什麼直到現在,我才和這篇文章相遇,所以在無知中鑄成大錯。
所有的誤解都基於一個前提,我們和臨終者已經無法溝通,我們至親的親人已經無法講出他們的心願和需求,我們只好一意孤行。而本來只需要一點點起碼的醫學常識,事情並不復雜。
我現在才知道,對於臨終者,最大的仁慈和人道是避免不適當的、創傷性的治療。不分青紅皂白地 “ 不惜一切代價 ” 搶救,是多麼的愚蠢和殘忍!
生和死都是自然現象,這我明白。只是現在才知道,自然竟然把生命的最後時光安排得這樣有人情味,這樣合理,這樣好,這樣的自然而然,是人自作聰明的橫加干涉,死亡的過程才變得痛苦而又漫長。
一天上午。我突然發現我對面的同事淚流滿面,一個 50多歲的男人的失態讓我詫異。忙問他怎麼了,他告訴我看了上面的文章想起了他母親臨終前情形,他說就像上文描述的那樣,覺得母親冷了給她穿保暖的衣服,蓋厚厚的被子,覺得母親幾天沒有進食,不停給她輸液,他母親想回家,可他堅持讓她住在醫院。他自認為盡了孝心,可是沒想到給她帶來莫大的痛苦。
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美國老年病學會制定的臨終關懷八要素:
1 、減輕病人肉體和精神症狀,以減少痛苦;
2 、採取能讓病人表現自己願望的治療手段,以維護病人的尊嚴;
3 、避免不適當的、有創傷的治療;
4 、在病人還能與人交流時,給病人和家屬提供充分的時間相聚;
5 、給予病人盡可能好的生命質量;
6 、將家屬的醫療經濟分擔減少到最小程度;
7 、所花醫療費用要告知病人;
8 、給死者家庭提供治喪方面的幫助。
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這還算不上殘忍。在最後的日子裡,病人常常得被動地接受這樣的 “ 待遇 ” :
一是過度治療。有些病人甚至直到生命的最後一息仍在接受創傷性的治療。
另一個極端是治療不足,也就是說,病人受到的痛苦和不適直到死亡也沒有得到充分的解脫。
隨著死亡的臨近,病人的口腔肌肉變得鬆弛,呼吸時,積聚在喉部或肺部的分泌物會發出咯咯的響聲,醫學上稱為 “ 死亡咆哮聲 ” ,使人聽了很不舒服。但此時用吸引器吸痰常常會失敗,並給病人帶來更大的痛苦。此時應將病人的身體翻向一側,頭枕的高一些,或用藥物減少呼吸道分泌。
瀕死的人在呼吸時還常常發出嗚咽聲或喉鳴聲,不過病人並不一定有痛苦,此時可用一些止痛劑,使他能繼續與家屬交談或安安靜靜地走向死亡。記住,沒有證據表明緩解疼痛的藥物會促使死亡。
我竟然現在才知道,聽覺是人最後消失的感覺—-親人沒有聽到我們的哭泣,不知道他是高興還是難過?
所以,不想讓病人聽到的話即便在最後也不該隨便說出口。那時候,只要讓他從病痛中解脫出來,天很藍風很輕,樹很綠花很艷,鳥在鳴水在流,就像藝術、宗教中描述的那樣 ……讓他安心踏上美麗的歸途。
我們應該做的,只是靜靜地守著他,千萬千萬不要走開。臨終者昏迷再深,也會有片刻的清醒,大概就是民間傳說的迴光返照吧,這時候,他必要找他最牽腸掛肚的人,不能讓他失望而去。
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人總是要死,死即生,它帶來輕鬆、美麗踏進另一個世界,一定耍好好的走。
現在,我讀到了這篇文章,我要保留著它直到最後的時光,如果有可能,我要求我的孩子照此辦理,任我的靈魂作最後的欣快飛翔。
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