安寧的尊嚴
惟雯說故事
黃勝堅醫師，醫學院的學生都暱稱他叫：「堅叔！」
十多年來，年年國內外上百場演講，散播「臨終照護」與「悲傷輔導」的醫病大愛。
除腦神經外科、急重症照護專長外，黃勝堅醫師於2003年取得「安寧緩和醫療」專科醫師證照，對於重症末期病患照護有豐富的經驗。
最令黃勝堅醫師感動的事：病人往生了，家屬辦完後事，會特地寫信或打電話告訴他：「 謝謝黃醫師，讓我家人安祥和有尊嚴的離世！」
＜第一次陪病人死亡＞
這個病人，44歲，體格很好，腦外傷住院。這個病人，我們從鬼門關前搶回來了，可是根據經驗法則判斷，以他的腦傷狀態病人不會再醒過來，他將會變成植物人。
病人進來的前兩天，碰到的都是他 太太，第三天我告訴她：「必須要做氣管切開術！因為妳先生雖然活下來了，卻將變成植物人，接下來，你們要有長期照護的心理準備。」
第五天，來了一位蒼老的阿公找我，在家屬懇談的小會議室，他冷不防地跪了下來，我趕忙扶他起來。
「我今年都88歲了。」老阿公抹著流不停的眼淚：「我老來得子，我老伴也86歲了，如果我的獨子成為植物人，要叫他們怎麼辦？」老阿公打開會議室的門，門外，老阿嬤帶著三個孩子，兩個是唐氏症，一個是紅斑性狼瘡，三個不到10歲的小小孩，怯生生的縮在一起。
「沒出事前，我兒子媳婦在台北做工賺錢，一個月賺兩萬八、一個月賺兩萬四，三個孩子我們兩個老的帶，現在要是賺兩萬八的成了植物人，那我們要怎麼辦？怎麼活得下去？我和老伴都是快要走的人了，剩下一個月賺兩萬四的媳婦，一個人要帶三個這樣的小孩子，我們真的沒辦法、沒有多餘的能力，來照顧一個植物人了。」
阿公哭得老淚縱橫：「你是醫生，你一定知道，一個沒辦法被好好照顧的植物人，全身這裡爛一塊、那裡爛一塊，身上長著蛆，痛苦不堪地拖著，與其讓我兒子活著受這樣的折磨，求求你高抬貴手，放我兒子走吧，也等於救救這三個可憐的孩子，求求醫生，你同情我這一家，真的無能為力了……，老的老、小的小啊！」
這下子換我心裡糾結百感交集了，以我們現在的能力，讓他成為植物人繼續活著，是絕對沒問題的，問題是面對這樣一家人，面對兩個哭得肝腸寸斷的白髮老人家，三個驚嚇到擠成一團的小孩，我救是不救？要堅持救下去，會害苦活著的人，往後的日子怎麼過下去？要是放棄不救，我將如何對自己的良心交代？
看我沉思不語，老阿嬤步履蹣跚走到我面前，她枯槁的雙手一拳拳搥向胸前：「在這個房間裡，沒有任何人比我更有資格做決定，因為囝仔是我的心頭肉，我們如果還有辦法可想，我怎麼割捨得下？怎麼放得落？」阿嬤的聲音，嘶啞悲切；阿嬤的淚，在滿臉皺紋間潰堤，成串濕在衣襟上，卻也滴滴燒進我心頭。
從醫以來最痛苦的天人交戰，讓我呼吸困難。幾番深思後，我選擇只要俯仰無愧於天地、於良知，選擇尊重老人家的意見，讓他們簽了DNR。
病人要臨終了，我陪著這家人老老小小一起圍繞在病人床邊，老阿嬤全身顫抖，卻用雙手緊緊摀住嘴，不敢讓自己放聲哭出來。我心裡的難過，不亞於他們的生離死別，這是我第一次放手讓病人走，看著心電圖，慢慢地、慢慢地變成一直線，在心臟完全停止跳動時，老阿公拉著阿嬤，帶著媳婦和三個孫子，向醫護人員磕頭：「謝謝，謝謝你們，肯救我全家！」
扶起老人家的同時，一旁的護士也忍不住偷偷擦眼淚。有說不出的矛盾掙扎，纏繞在我腦海，不知道要怎樣來形容這樣複雜的思緒？我放手了，第一次；我努力的說服自己，我放了該放病人的手，可是心底，為什麼還是有說不出的苦澀無盡的哀傷呢？
＜是在積陰德？ 還是在作孽？＞
在腦神經外科，我們成功地救回很多生命，其中也包含了植物人。
可是當面臨醫學與人力有所不能的極限，把腦傷病人救成了植物人，真的很讓醫師不知道該如何去面對家屬？有時候連自己都不免困惑：是在積陰德？還是在作孽？
以前年輕的時候，對預後的判斷較無經驗，面對困難嚴重的案例，總是先保命再說；等到變成植物人了，整個家庭陷入困境，家屬往往抱怨：「早知道不會醒，會這樣拖磨著，就不該硬要救下來受苦了！」
多年後的我，累積許多經驗，對於不好的預後，至少能夠給家屬較正確的訊息，讓家屬在醫療資訊對等的情況之下，做出最適當的決策。
逝者已矣，活著的家屬，還有好長的路要走，尤其是頓失經濟支柱的弱勢家庭，問題不是唱唱高調之後，就能解決掉的，生活，真的很現實；不論是社會福利制度、或來自民間的救助，伸手能幫的忙，到底還是有限度的！
＜女兒跪＞
一個肝硬化末期的爸爸，全身臘黃、肚子漲得大大的、插著鼻胃管，由三個女兒連扶帶撐著，一路喘進醫院。
醫生一看病人情況不對，馬上進行急救，準備插氣管內管，沒想到病人看來像個國中生年紀的二女兒立刻出言阻止：「醫師叔叔，不要幫我爸爸插管，他是末期病人。」
醫生聽了很不高興：「這樣還不要插管？那你們來醫院做什麼？」
像高中生的大女兒哽咽的說：「如果醫生你判斷我爸就要死了，那我們就帶他回家，我們還能幫忙他撐著，好好的陪在他身邊。如果說我爸爸還有一段時間，三四天或一兩個禮拜，我爸爸喘成這樣，我們姐妹沒有醫學專業知識，我們不知道該怎麼辦才好？醫生你可不可以先打個嗎啡，讓我爸舒服一點就好？」
「妳爸爸現在這樣，不急救，不插管，直接要打嗎啡，萬一一針下去人出了人命，那是要算誰的錯？」
喘得說不出話的爸爸眼神絕望，吃力的揣著大女兒手不停搖晃，大女兒再怎麼裝鎮定，也掩飾不了害怕：「我爸說他受夠了折磨，再也不要這樣喘下去，該簽什麼放棄急救的文件，我們都同意都簽。」
簽完DNR後，醫生說：「那我幫妳們爸爸找間病房好了。」
電話打到內科問，內科說：「他都已經這樣了，沒有什麼可治療了呀！」
打到加護病房，加護病房說：「滿床吶，一時之間也調不出床位來！」
醫生從病歷上看到外科曾幫這個爸爸開過刀，打電話把狀況說一說，然後問我可不可以收這樣的病人？
「好吧，我收！」心裡也不忍那垂危的父親，和三個年紀不大的女兒們，只能窩在急診的走廊上，眼睜睜看著爸爸受苦，卻又束手無策的抹淚乾著急。
病人送上來了，住院醫生一個頭兩個大：「主任你收這樣的病人啊？我們真的已經都幫不上什麼忙了，要怎麼照顧啊？現在要寫住院病歷，待會兒就得寫出院病歷了！」
資深的護理長更是直言：「這種病人，不用四小時就走人了。」
「這種事，請大家勉為其難吧，別讓三個姐妹太難過、太無助了。」我硬著頭皮說。
住進一間三人房的床位，其他兩床病人和家屬流露出的神色，讓三個女兒難堪又不安。護士看了也覺很不妥，又回頭找我想辦法，總算喬出間隔離病房來，讓他們可以單獨相處。
「爸爸剩下的時間不多了，妳們就在這裡好好的陪陪爸爸吧！」我實話實說，雖然為了她們爸爸，我被同事唸到臭頭，但也不能就丟下撒手不管。
我們的資深護理長還真神準，三個半鐘頭後，那位爸爸過世了。
住院醫師忍不住搖頭：「看吧，收這種病人，住院病病歷才剛寫完，現在又要開始寫出院病歷了……」。
往生室推車來了，簡單的遺體整理後就往外推走，三個女兒跟在車後嚶嚶哭泣，經過護理站的時候，姐姐拉著兩個妹妹跪下去，向護理站裡的醫護人員磕頭：「謝謝醫生叔叔，謝謝護士阿姨，沒把我爸爸丟在急診走廊上等死，沒人管，沒人理，謝謝你們，謝謝。」
護理站裡的醫護人員，被突來的震撼，震到寂靜無聲，剛還在碎碎唸的醫生悄悄低下了頭、護士眼眶泛紅；護理長忍不住跑出來，抱著三個女孩，輕聲的安慰，眼淚，卻也跟著掉個不停。
＜讓人能夠壽終正寢的尊嚴＞
想想看，如果沒有病房收治這個病人，不願收這個病人，讓這個爸爸真的死在急診的走廊上，你覺得這三個年齡不大的女兒，在往後的人生，因為這個事件，對人情世故，對這個社會的觀感，會產生什麼樣的偏差？甚至怨懟？
這個案例，給了我們大家紮紮實實上了一課：我們雖然救不了爸爸的生命，卻救了他的三個女兒，給了她們人性可貴的溫暖－ 雪中送炭。她們就算孤貧一身，也不曾被遺棄、被不聞不問過！
我相深信，老天爺讓我們穿上這白衣，賦予我們的責任絕對不是只有治病與救命！
換個角度來看，如果我們的基層社區照護，能夠照顧死亡，女兒們也不必千辛萬苦把父親送到醫院。看來台灣民眾要能夠壽終正寢，社區生命末期照護還有得努力！
—— 摘自黃勝堅醫師的話
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