“Let me die! Let me die! Let me die! ” – intubation to survive is too painful
Old Wang, who could not write or make a sound, expressed his strong will in silence with his mouth shape.
I am an ICU doctor.
Initially in the emergency room, I had already advised Lao Wang’s family: “Don’t intubate him, or leave it like this, anyway, carbon dioxide has been high enough to cause pulmonary encephalopathy, since he is in a coma, there is no pain, the family will stay with him and let him go like this. “
Old Wang is an “old patient” – repeatedly hospitalized in the respiratory department in the winter and discharged within a few days The “old slow-onset” patient who came in again.
The short period of time at home, is also sucking oxygen. When I couldn’t walk a few steps, my face turned purple. The chronic disease has progressed to this state, normal life has reached the end of the mountain, no painful death, is the relatively good end of the chronic disease of the elderly.
Lying on the bed in the emergency resuscitation room with an oxygen mask, Lao Wang is no longer conscious, the partial pressure of carbon dioxide reaches 110 mmHg, breathing instead does not seem too laborious, the sticky phlegm is blocked in the throat area, emitting a gut-wrenching rough phlegm sound.
This state may last a few hours, maybe a few days, and eventually, the old king will go to another world in a coma.
The family members were nervously discussing and re-negotiating at the door of the resuscitation room… … The old Wang family is a wealthy rural family, several children are quite filial, before a trip to send him to the hospital, are surrounded by the front and back, today you accompany, tomorrow I send food, a prosperous and cordial relationship between the children and grandchildren scene.
“Dr. Luo, we still intubate… … Old Wang’s oldest son came to me hesitantly and said. He was hesitant, as if he was sorry for my patient advice, humbly accepting and refusing to be corrected.
“Well, my grandson is getting married next week, and our family can’t even have a good funeral now, so we’ll have the tube inserted and let Dad wait for his grandson’s wedding and then go in style! “
I sighed helplessly, more than half an hour of persuasion, is considered a waste of time. So let the three sons sign the notification letter for tracheal intubation and go in to prepare for the operation.
When the old king woke up again, it was already a day later, lying in the ICU bed.
The effect of the ventilator was immediate for such a patient with respiratory failure. With the help of the ventilator, the carbon dioxide in Wang’s body was slowly discharged over the course of the day, dropping to 60 mm Hg. The high concentration of oxygen combined with positive pressure ventilation also resulted in a marked improvement in oxygen deficiency.
Old Wang woke up with the support of the machine.
He was lying on a strange bed with a gastric tube, tracheal intubation, catheter, deep vein, hands in restraints, and naked with a blanket. The old king woke up just like that. Bone thin hands, angrily patting the bed, expressing his displeasure. He couldn’t speak after the tube was inserted.
The various discomforts of the initial intubation can be alleviated with sedative drugs and analgesic drugs.
Seeing the old king so sad after waking up, his oldest son came sadly to ask: “Do not use some medicine, do not feel so uncomfortable, or he will look at me with his eyes open and feel very sad… … “
I sighed and increased the pumping rate of the sedative medication by a greater amount, and the old king then fell into a comatose and quiet state.
This state, which happens in front of an ICU doctor, has happened many, many, many times, so I have also told the family in detail during the intubation conversation: “intubation” Not just the insertion of a tracheal tube, but the beginning of a very cruel life. If intubation could solve Wang’s respiratory failure, why wouldn’t the doctor be happy to do it? But the end stage of chronic disease, the condition is not reversible, and frankly: there is no turning back from such cruelty!
But no matter how you tell it, a very cruel scenario usually has to really happen before you can perceive this kind of tangible pain.
The initial week passed, the old king’s grandson’s wedding took place as scheduled, and a few days later one afternoon, ICU visiting hours, the young man brought his bride to see the old king.
The bright red suit and bright makeup appeared in the ICU ward, a rare touch of warmth.
“Grandpa.” The groomsman called out to the old king. “Call grandpa, let him look at you. ” he demanded of the bride, tugging on her hand.
“Grandpa,” the bride looked fearfully at the bony old man in the bed, living on a ventilator, living surrounded by tubes, dying for a life that looked beyond what most What’s more, all around them were such silent beings: intubated, attached to the ventilator, lying on their sides like curled-up bodies in their mothers’ wombs, like fetuses attached to their mothers by umbilical cords. Only, the dying life is on its way to death.
The monitors beeped around. Most of the family members who visit regularly have become accustomed to this.
“Doctor, can you wake him up? ” the groom demanded timidly. The old king suddenly opened his eyes and began angrily patting the bed. He wasn’t unconscious and the sedation was starting to taper off, it was just that surviving continuously in this space where he didn’t know if it was day or night, his sleep cycles were so chaotic that you didn’t know when he would come out of his silence and suddenly fall into a violent struggle.
The bright bride took a step back, covered her mouth, and fled the ICU ward.
“Let’s just do a tracheotomy. ” the oldest son of the oldest king signed off on the next day. The family meeting had already taken place, and after the family’s collective resolution, the oldest signed on behalf of the whole family in full.
“Tracheotomy is not this surgery itself, but this survival state is going to be maintained for a long time, have you thought it through? ” I again added emphasis to my tone.
“Money is not too much of a problem, Dad’s new agricultural cooperative can reimburse 65%. The family has several small factories, to say that the remaining 35% can not get out, it will give people laugh. “
“Uncle and uncle have said, to save, dad is gone, there is no dad in the world, the family has economic conditions, can not see him so over. “
“Another grandson in a month, came back from the United States, has not had the opportunity to see grandfather. “
The boss’s reasons are too good to be doubted. The economy is generous, public pressure and “not the right time”. The second and third did not speak, nodding frequently.
“He will live a miserable life, can not eat, can not get out of bed, can not talk. I pointed to a patient not far away, a stroke patient who had survived in a vegetative state for more than a year.
“That’s what the family said, and we’ve already discussed it, so we’ll just sign off on it. “The old king’s oldest son wincingly glanced at the hospital bed and quickly signed the informed consent form. After how many times in and out of ICU visiting hours, it didn’t seem too hard to accept such survival in the eyes of a few of them, after all, others were living like that.
I knew that Old Wang would stay in the ICU for a long time after his tracheotomy, months, or years, until another infection, shock, kidney failure, or whatever other irresistible complications came out.
As a mature doctor, I know how to communicate with the family normally and do my best to ensure the quality of life. But as a mature doctor, I also know that there is nothing a doctor can do in the face of such a family resolution.
I sighed that in this complex human society, death is definitely not the business of one person and definitely not the business of a family. I understand this family very well, so I sigh even more for the state of Wang, who is destined to become a “bed-pressing” patient in the ICU.
The silent question can only be left in my own chest with indignation: Do the children even have to decide the time of death? Is it for his own sake to keep him alive?
After the tracheotomy, Lao Wang became a long-term member of the ICU.
Lung function was so poor that he had to be connected to a ventilator 24 hours a day, so his range of motion, then, was limited to the bed. He could not speak and eating was nearly impossible because of the effects of the trocar, and the gastric tube became a long-term tube, forever inserted in his nostrils. At one point a gastrostomy was discussed, but a resolution to the family negated it.
Every 2 hours, the nurse would turn and change the old king’s position.
It cannot be denied that medical technology is unparalleled, with enteral nutrition, balanced internal environment, and enhanced care. Old Wang survived day by day in that small space. Not only has he gained weight, his face is rosy, and there is not a single bedsore.
Every afternoon, when his children came to visit him, they would say, “Oh my! I look so much better than before. ” This is true. High-energy nutrient solution is instilled directly into the jejunal nutrition tube, and the intestines, which have no feelings but function, fully absorb heat calories and nutrients. The ventilator helps the weakened lungs expel carbon dioxide from the body.
Such “maintenance therapy” is simple enough for mature ICU doctors: enough calories, enough fluids, stable internal environment, and prevention of nosocomial infections.
The only sad thing is: Wang is a conscious man.
“Let me die”. During the long hours, Lao Wang wrote these three words more than once.
“Dad, you’re confused, how can we do it? “Initially, his son held his hand and advised him to cooperate with the treatment. The sons are very filial and come to see him every afternoon to wash his feet, cut his nails and shave his beard. The sons would carefully do these cleaning tasks, which had already been done once by the ICU nurses, for him again.
It takes a bit of stamina to do these things for an old man. Aging skin, full of flakes and hyperpigmentation, thick and curved nails, stiff and puffy joints. That’s not the joyful feeling of bathing a newborn baby.
“Let me die”. The old king, who could not write or make a sound, expressed his strong will in silence with his mouth shape. Sometimes he would spend the day with his eyes closed, and sometimes he tossed furiously in bed until he was exhausted.
For a long time, Wang’s family and our bedside doctor discussed the future in depth, and also held an “extended family meeting” including uncles and aunts. The final answer to the doctor was.
The final answer to the doctor was: “In this state, we definitely can’t do it by pulling out the ventilator, but the treatment must be done actively. “
If the condition worsens in the future, there are other big problems, we will no longer toss, CPR or something, is definitely not done. “
Grandson from the United States has come to pass, the New Year has passed, the heavy grandson was born …….
Time passed like that day by day. The old king accepted his fate in a long time, this small space, the last stop of his life, he can no longer see the sun, can not taste the delicious, can not walk on the grass, can not hum.
Day after day, in the afternoon, his sons came to scrub his body, wash his feet and cut his nails. At first they talked to him, and later, did it in silence, whether the old king resisted or was silent.
“Dr. Luo, you treated him well, he looks so good now, no bed sores at all, we have the financial ability, always let dad live one more day. “The old Wang family’s eldest son and the ICU doctors and nurses are familiar with, he often praised the nursing staff Lao Shen, and secretly send packets of cigarettes or something.
“But I must not be like this in the future when I am old. ” he went on to say.
I really couldn’t understand such a logically confusing choice, so I had to respond to him vaguely and politely.
Once, a volunteer from a social work organization asked to come to the ICU for a volunteer activity. I didn’t think she could do it for a long time, so I reluctantly let her sit next to Wang and helped her turn on the radio to play the opening of the play for the patients.
She left before the opening song was finished, looking extremely nervous and sad as she left.
“What’s wrong? I asked her.
“I don’t think I can stand it, I probably won’t come later. ” The volunteer walked away without looking back.
Yes! In fact, I understand that in the reality of the situation, Chinese people are not willing and able to face the dying and death up close. It is not her personal problem.
Later, of course, Old Wang still went to the end, and a year and four months later, Old Wang died.
Seeing his thin body wrapped in sheets, finally able to leave the ICU, I felt a sense of relief. He was finally relieved. In the last year and four months of his survival, what kind of life he lived.
For a while, the doctors wouldn’t even go near his bed except to check on him.
“Let me die”.
“Let me die”.
“Let me die”.
The grim and painful expression, the dry lips kept on silently demanding.
A large family with many children and grandchildren and a good relationship, at the end, solemnly sent him to the morgue together. And no one cried out in pain.
“Old Wang is lucky! His grandchildren are full of children and grandchildren, and he lived to a high age of 89. See four generations together. “After cleaning Old Wang’s body for the last time, caregiver Lao Shen covered his restored calm face with a sheet and pushed him out the door with a flat cart.
In order to thank the old Wang’s son sent over the cigarettes, caregiver Lao Shen politely said a big truth.
But between the looks, I clearly see the old Shen’s words are not sincere.
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