Birth, aging, illness and death are natural processes of life, and people often attach great importance to [life], but deliberately ignore old age, illness, especially death.
Once anyone is on the list of obstetric clinics, countless pamphlets will be sent to you and even special prenatal training classes will be held to tell prospective parents what it is like to have children and to make some what preparations.
But when have we seen any hospital or institution send you pamphlets to educate the general public, especially the elderly and their families, what kind of process will it be if the elderly are ill, especially in the final stage of life, and what kind of what preparations should be made to make the process smooth and peaceful? In fact, this is a more common problem that everyone and every family will face than having children.
The Last Peace
When I was a doctor in the United States, I once went out with a nurse who was engaged in hospice care. It was an old lady with heart failure and had to be sent to the hospital in three days and two ends. It was not expected to take more than six months.
In the end, the old lady and her children both decided not to send blood and transfusion to the hospital for examination, but to carry out hospice care and treatment at home.
The old lady lived in her familiar home, which was equipped with a hospice medicine cabinet. The nurse visited her once a week and adjusted the dosage of the medicine according to the symptoms.
When I saw her, She slept in a warm room, covered with a big blanket made by her own hand more than ten years ago, dressed in a chic set of small flower pajamas, and even holding a lovely fluffy bear in her hand. The nurse had just given her a small dose of morphine, and she fell asleep. She could not see what’s pain and was very peaceful. The children were all around her.
The peaceful and serene picture is quite different from the scene I once saw in domestic hospitals, where I was covered with various pipes and died in pain.
Is what a soothing medicine?
Since the 1960s, it is a branch of medicine originated from the hospice care movement. It does not aim at curing diseases, but focuses on improving the quality of life of patients suffering from life-threatening diseases and helping their families to face the difficulties and problems of this period together.
It mainly provides physical, psychological and spiritual comfort and support for patients and their families by preventing and alleviating the pain of patients, especially controlling pain and other disease-related symptoms.
Soothing medicine can not only improve the quality of life of patients, but also may have a positive impact on the progress of diseases.
There have been studies on patients with advanced gastric cancer, and it has been found that patients who carry out soothing medicine not only live better but also live longer in the final stage of their lives than patients who continue to carry out various invasive examinations and treatments until the end of their lives.
The World Health Organization put forward the principle of soothing medicine in 1990:
Maintain life and regard dying as a normal process;
Do not accelerate or delay death;
Alleviate pain and other painful symptoms;
Provide physical, psychological, social and spiritual (i.e. Physical, mental, social and spiritual) support to patients until their death;
Provide grief and other assistance to the family during the patient’s serious illness and death.
Leave with dignity
Closely connected with soothing medicine is Hospice, which specifically refers to patients whose expected life is not more than six months. Through various means such as medicine, nursing, psychology, nutrition, religion and social support, they can die as comfortably, with dignity, preparation and peace as possible in the last time of life.
For patients with little time, The soothing medical team will help them set up hospice care. Our hospital has specially divided a hospice care ward in the tumor ward area. The spacious single room is quiet and elegant, minimizing unnecessary interference from medical staff to patients, and no more blood tests and invasive treatment will be carried out. If the patient believes in religion, religious clergy will comfort and pray for the patient and his family, so that the patient can enjoy the last time with his family as comfortably as possible.
For patients with a life expectancy of more than one week but less than six months, The relief medical team will help them to set up hospice care at home. The home will be prepared with hospice care medicine boxes, analgesics such as morphine and oxygen inhalation devices. Hospice care nurses will visit the home regularly and give appropriate drugs to relieve symptoms according to the patient’s condition, but they will not take blood tests again, and when the patient’s condition deteriorates, they will not trouble the patient to come to hospital again.
Soothing medicine does not have to wait until the final stage of life, But at an early stage of the disease, And can cooperate with other treatment methods to achieve the best for patients. For example, advanced cancer patients with multiple metastases, cancer metastasis causes local obstructive symptoms. At this time, chemotherapy is not promising to cure the disease, but it can still be used to relieve obstruction and achieve the purpose of improving the symptoms of patients.
Another example is the use of diuretics to reduce patients’ pulmonary edema and lower limb edema. Inhalation of oxygen, use of drugs to reduce respiratory secretions to improve patients’ dyspnea, use morphine to relieve pain, etc. are all treatment methods of soothing medicine. Therefore, soothing treatment is not to give up treatment or stop treatment, but to focus on improving patients’ symptoms and relieving pain.
Gradually accepted soothing medicine
Since its establishment as a discipline for 50 years, soothing medicine has gradually been widely accepted in western society.
In the United States, many hospitals have special soothing medical teams. When the competent doctors feel that the patients need them, they will be invited to consult.
Compared with clinical frontline doctors, We can spend more time communicating with patients and their families, introducing the disease condition and the future in detail, understanding the real thoughts, concerns and difficulties of patients and their families, helping patients and their families to understand the shift of treatment focus, establishing the treatment purpose recognized by both parties, and helping them to prepare and plan the next step more fully.
Many patients already have [Advance Directions] before admission, which clearly state their wishes when facing incurable diseases, including whether they are willing to perform extracardiac compression, tracheal intubation, central venous intubation, use of booster drugs, survival by gastric tube feeding, etc.
For patients without living wills, the relief medical team will discuss these contents with them, and after reaching a consensus, they will sign the wills [not to carry out cardiopulmonary resuscitation] in the medical records, so that when the patient’s condition deteriorates, all medical staff can understand the patient’s wish and avoid unnecessary human intervention and rescue of injuries.
In Asia, Japan was the first to carry out soothing medical care. After the inclusion of health insurance, Ninety-nine percent of the Japanese choose to die through palliative care. In Taiwan, palliative care is called “hospice care”. When doctors judge that the life of the terminal patient is only six months, legal procedures will be initiated. The patient will make a medical-related will in advance, give up invasive rescue and enter the hospice care stage.
It is time to reconsider how to face aging, disease and death.
In the country, even among the medical staff, there are still a considerable number of people who have a serious lack of understanding of this concept and discipline. However, among ordinary people, they only recognize [active rescue] and avoid death.
Of China’s 9 million deaths each year, 2.7 million die of cancer-the incidence of advanced cancer pain is as high as 80%.
In contrast to the millions of dying people in urgent need of care, there are few hospice care institutions. Take Beijing and Shanghai, the two most developed cities in China, for example, Shanghai has only 1,000 hospice care beds.
Dr. Ning Xiaohong and her team from the Department of Geriatric Medicine of Peking Union Medical College Hospital are trying to make soothing medical treatment in Union Medical College Hospital. Desheng Community Health Service Center in Xicheng District of Beijing is the only community hospital in Beijing that provides home soothing medical care.
Soothing the popularization of medical care requires the active participation of more doctors and hospitals, as well as the support of policies and regulations at the government level. However, it is even more important to carry out death education among the general public and change people’s blind superstition of [active rescue] and misconception of [soothing medical treatment is equivalent to leaving relatives behind and giving up treatment].
Why can’t we change our ideas, plan our last moment in advance, tell your relatives and doctors to choose soothing medical treatment in the face of incurable diseases, and live happily and die physically?