MTL - Since 1981 Health School-Chapter 495 To save or not to save multiple choice questions
Chapter 495 To save or not to save multiple choice questions
In fact, each of us has an internal organ that can produce "concentrated sulfuric acid", that is, the "pancreas".
It is hidden between the spleen and the duodenum. If it is accidentally injured by the outside world, it will leak deadly "concentrated sulfuric acid" and corrode the surrounding internal organs. The mortality rate after the onset is as high as 52%.
On the premise that this is still highly developed medicine in later generations, if in the 1980s, this number would have become 90%, or even more.
If it were in Africa in the 1980s, there would be almost no hope of surviving.
"Pancreatic fistula" simply means a leak of the pancreas.
Pancreatic juice with strong digestive ability flowed into the abdominal cavity through the leak, continuously corroding various tissues and blood vessels in the abdominal cavity like sulfuric acid.
The fragile blood vessels and intestines could not withstand its "attack" at all, and large holes were corroded one after another, which finally led to extensive bleeding in the stomach.
What's more frightening is that this kind of attack occurs at any time. As long as the patient is alive and the pancreas can continue to produce pancreatic juice, the damage will not stop.
This black old man is in the late stage of this stage. As the saying goes, even his stomach is rotten, and it is a miracle to survive.
Chen Qi specialized in liver, gallbladder and pancreas in his previous life, and has some experience in treating "pancreatic fistula".
But this kind of surgery has reached level 4+, which is not something that the temporary hospital in the refugee camp can handle, even if you go to Freetown National Hospital.
The refugee camp can only do some simple treatment, such as debridement, suture, disinfection and disinfection, and give some antipyretics and antidiarrheals.
Pancreatic fistula treatment requires plugging the leaks of the pancreas first, followed by anti-infection and nutritional support. Follow-up treatment requires almost constant stay in the ICU.
Next, the loopholes in the duodenum, jejunum, and colon corroded by pancreatic juice near the pancreas must be repaired.
Finally, the hole in the belly must be filled. It is impossible to expose the internal organs and intestines to the air for a long time. This is another big project.
It took less than half a year for the entire operation to be completed, and several operations could not be completed at all.
Not only is it time-consuming, labor-intensive and costly, but the process is quite thrilling and exciting. If there is even a little trouble, the patient will die if he can't stop it, and all the efforts will be in vain.
Luo Wei saw Chen Qi in a daze, and touched him quietly:
"Dean Chen, what should we do with this patient? Should we treat it? How?"
Gao Haishi has a different opinion:
"It can't be saved, even if it can be operated, the price to pay is too high, and these black people can't bear it at all."
Wang Jiliangshu was a little angry, and said disapprovingly:
"As a doctor, it is unreasonable to choose to ignore the death of patients and let them die. It is our bounden duty to treat the sick and save the sick. Otherwise, why should we doctors?"
Gao Haishi became anxious when he heard it:
"Whether to save someone depends on the situation. If you don't save when you can, it is a lack of medical ethics. But now this patient is obviously in a critical condition. It can be saved, and how can we operate in such a condition?" Woolen cloth?"
For a while, there was a lot of discussion in the tent, and the little doctors behind him were obviously divided into two schools of thought.
One group thinks that it is possible to try to rescue it, and at worst bring it back to the Friendship Hospital in Freetown. Anyway, Dean Chen is omnipotent.
The other faction thinks that rescue should be done in moderation, not to mention that the patient can't afford the money at all, so who will pay for the medical expenses?
There is another opinion that is more cruel, that the limited medical resources should be given to those who need it more. Such an old African man has lost the value of rescue.
Sitting there, Chen Qi unknowingly thought of a big discussion that had sparked across the country a few years ago.
It happened in Xi'an in the summer of 1982.
Fourth Military Medical University, Zhang Hua, a 24-year-old college student, was shopping when he met Wei Zhide, a 69-year-old excavator who was stunned by the toxic gas in the cesspit while working and fell into a cesspool more than three meters deep.
In order to rescue Wei Zhide, Zhang Hua jumped out of the cesspit to save others without hesitation.
But in the end, because he inhaled too much poisonous gas in the cesspit, he died and was not rescued.
Zhang Hua's deeds quickly spread throughout the country, arousing widespread concern in the society.
Some people think that Zhang Hua’s death is not worth it to save an old farmer who digs out dung. After all, it is not easy for the country to train a college student, and it was in that era when college students were very scarce.
"Wen Wei Po" received a letter from a college student, the letter said:
You should use your limited life to create value for the country that is greater than its own value, instead of exchanging the life of a 69-year-old farmer. It is always uneconomical to exchange gold for an equal amount of stones.
Then, a nationally sensational discussion began. Newspapers, magazines, and even TV stations were discussing whether it was worth it for Zhang Hua to rob the old peasants for their sacrifices.
Two different views began to collide fiercely.
If you look at it from the perspective of life.
Nian and Nian's life are all life, there is no distinction between high and low. So years are worth dying for.
In terms of contribution to society.
The time to contribute to society is more, and it may be more important, and young people demand less from society.
But it is a social animal, and it must be integrated into the society to realize its own value and contribute to society.
Year is out of touch with society to a certain extent, and will not contribute to society, but only ask for it from society.
Of course, this kind of debate is often based on the public saying that the public is right, and the woman is saying that the woman is right. It doesn't matter what is right or wrong.
Similarly, there is also a dilemma of "rescue or not" that is often placed in front of doctors.
For example, a middle-aged man with a severe cough and a lot of weight loss went to the hospital for an examination. He had advanced lung cancer and multiple metastases throughout his body.
The patient was in great pain. Not only did he have a severe cough, but he also had severe chest pains, and he was frightened to death.
But the patient has a strong desire to survive. He hopes that the doctor will save him, ask for an operation, and demand to try his best to treat him.
The problem is that the patient’s family conditions are not good, the family does not have much money, and there is no medical insurance.
Such patients, do you save them or not?
If you don’t want to save him, let him go back and eat whatever he wants, and figure it out.
Doing this seems extremely inhumane and lacks medical ethics. It can even be used as a "do not save".
At the same time, the dean will still be upset that you won't accept such a "high-quality" patient? Have money or not? Do you don’t want the bonus this month, or do you want to give up the bonus at the end of the year?
But you are saved, let alone whether surgery can be done, chemotherapy and radiotherapy, and expensive drugs, the treatment cost starts at hundreds of thousands.
In the end, I ended up with no money, no family, and debts all over the road, which made the family's life completely difficult.
Then you are a doctor, do you save such patients or not?
Another example:
A pregnant woman gave birth, but the fetus could not be born for a long time. At this time, an emergency cesarean section was needed.
But the family members have concerns, or think that the cesarean section is too expensive, or because they don't trust the doctor, they just don't sign.
On the one hand, the pregnant woman yelled at everyone in the delivery room that the delay in delivery of the fetus has caused distress in the uterus, and two dead bodies may be killed at any time.
The family members refused to sign, and the doctor was unable to carry out the next step of treatment. Legally and procedurally, the doctor was not allowed to directly perform a cesarean section.
At this time you are an obstetrician, can you save it?
You won't save? You are a doctor who knows that if you don’t save the mother and the fetus will die, if you don’t save it, what about your medical ethics? What about your humanity? Where is your conscience?
But you saved someone, but the family members didn’t sign it, and the final result was death because of the delay for too long. Then you violated the diagnosis and treatment norms and the wishes of the family members. This is a proper medical malpractice.
The family members can sue you, and your doctor will lose money. (real case scenario)
If you meet a dean who doesn’t eat, you may lose your license to practice medicine, and your life is over.
In this situation, you are a doctor, save or not?
Another example:
You are the 120 emergency doctor. After receiving the emergency call, you get in the ambulance and rush to the patient's home.
Then you are busy treating patients, when it is very urgent,
Suddenly a neighbor barged in from the side, saying that he also had an asthmatic patient in need of first aid, and asked to borrow the oxygen tank and electrode defibrillator from the 120 car.
You are a doctor, do you borrow it?
You said to lend out the first aid tools and machines, you are rescuing the patient yourself, so don’t you care about the patient in your hand? Who is responsible when the patient dies?
But you said you didn’t want to borrow it, that’s fine, the neighbor with asthma died in the end, and your 120 emergency doctor would be treated as desperate, improper operation, and finally suspended and fined. (real case scenario)
Faced with such a dilemma, you are a 120 doctor, do you choose to borrow or not? To save or not to save?
The same is true for the old black man in front of him.
You say you don’t save it, you are a doctor, and you see that the patient’s condition is so critical that he is about to die, and there is still a possibility of surgical treatment, so you die? What about your medical ethics?
If Chen Qi said to give up now, there is no cure, believe it or not, he would be despised by many young doctors, and their confidence and awareness of practicing medicine would be hit.
But if you want to talk about treatment, there are not enough surgical conditions, not enough medicines, and not enough cooperation with the team.
Do you want to give up all the limited medicine and medical resources to this black old man? For example, there are only a few antibiotics, and this old man used them all. Will others use them?
Another key point is, who will pay?
To save or not to save, this is also a dilemma.
Seeing that the little doctors were arguing more and more loudly, and many people began to blush, Chen Qi had no choice but to stop it.
"Okay, okay, everyone, stop arguing, save or not, treat or die, and now none of you can convince the other, so let me ask you a few questions."
"Now that the diagnosis is clear, pancreatic fistula, do you know what is pancreatic fistula? What is the mortality rate? Wang Jiliang, please answer."
Wang Jiliang is not a major in surgery, so he hesitated to answer:
"Um, um, pancreatic fistula is a hole or gap formed after the pancreatic duct ruptures. Pancreatic juice flows out through non-physiological channels, causing the surrounding tissue to melt. The mortality rate, um, should be high, right?"
Gao Haishi next to him is a surgeon. At this time, he interjected: "The mortality rate is over 90%."
"So tall?" Wang Jiliang was obviously a little surprised.
"Yes, it's so high, and if you want to treat pancreatic fistula, you need to do at least 4 operations. This is on the premise that it goes well. During the operation, you need a lot of drugs to maintain, and you need to do a lot of examinations. How much does it cost?"
Chen Qi thought about it for a while, this kind of pancreatic fistula operation, plus ICU and operation fees, etc., add up to less than 100,000 RMB, so you want to leave.
If it is a big dog hospital like Mayo, millions of dollars are easy.
Now it is 1987, the labor cost is cheap, but your medicine is expensive.
All the medicines are imported, there are also medical devices such as gaskets to block the gap in the intestines, artificial omentum, etc. What do you want without a $100,000?
Even if you use all domestic drugs and the omentum is transplanted from itself, it will cost at least tens of thousands of RMB.
In Huaguo in 1987, how many families could afford tens of thousands? How many years has it been since the reform and opening up? I just had my fill, okay?
Wang Jiliang was stunned when he heard that at least this much money was required. He is a small doctor, and his monthly income is less than 100 yuan, okay?
"This, so much money, everyone can, you can think of a way."
Chen Qi burst out laughing, of course he didn't mean to be ironic, young people are always naive, with more ideals than reality.
"How do you think of a way? I will operate on this black old man for nothing, and I won't take any money, but medicines and surgical instruments always cost money, right? Let's not say much, 50,000 yuan, who will pay for it? ?Okay, let’s do a fundraiser, come on, Wang Jiliang, tell me, how much are you willing to contribute?”
Wang Jiliang blushed and said firmly:
"I, I am willing to contribute a month's work, and I will donate 82 yuan."
Chen Qi nodded:
"82 yuan, a huge amount of money, well, even if everyone is equally enlightened, 100 comrades in our Friendship Hospital donate 82 yuan each, that's only 8200 yuan, the gap is still huge, what do you think? Don't count on the hospital, Our hospital has no public account, no small treasury, no money.
Okay, even if I, Chen Qi, fill all the gaps and use all the medicines out of my own pocket, it is still a problem whether the operation of this black old man can be successful, and whether the infection and nutrition can be overcome is also a problem.
We used the method of moral kidnapping to force everyone to donate so much money. We gave all the precious medicines to the old man alone, leaving other patients with no cure, and finally lost their last hope. Just to **** an old man from a primitive tribe.
Is it worth it? "
Chen Qi paused after speaking, looking at the pensive faces of the little doctors, wanted to see how they chose?
Doctors are science students. What doctors need is enough reason and calmness. Hospitals don’t need doctors who are hot-headed and act impulsively.
This is a cruel reality, whether to save or not, how to choose, this tests the wisdom of a doctor.
There is also a degree of cruelty.
An indifferent and ruthless doctor is not a good doctor.
But a doctor who spends more money on a cowardly patient, spends money all the time, and treats the family bankrupt, will not be a good doctor either.
Wang Jiliang thought for a long time, and finally sighed.
I saw him take out 2 white flour steamed buns and a bottle of mineral water from his backpack, walked over and put them beside the black old man.
"Old man, eat, this is delicious food, maybe this is the last meal of your life, you should walk decently."
"Walk decently!"
As soon as these words came out, Chen Qi knew that the young Wang Jiliang had figured it out.
Chen Qi walked over and patted Wang Jiliang on the shoulder:
“When you are in love, let go when it’s time to let go, and break up with dignity. The same is true for treating and saving lives. You have to consider the patient’s prognosis, economic conditions, family members’ wishes, etc., all of which need to be considered comprehensively by our doctors.
If you are already terminally ill, then let go when it is time to let go, and let the patient go a little more decently, this is the best choice. Excessive treatment, unrealistic treatment, and treatment that bankrupt the patient's family and wives and children are not the right choice for our doctors. "
Wang Jiliang was very depressed, and smiled wryly and returned:
"I understand, thank you, Dean Chen."
The black old man tremblingly picked up the white-faced steamed bun, took a bite, then smiled with difficulty, and waved his hands to let the family members carry it away.
Actually, he knew his situation, his internal organs and intestines were all exposed, and it was impossible to survive.
Being able to eat a bite before he died, and it was a delicacy he had never eaten in his life, he was already satisfied.
Death, in this devil-like chaotic world, is not the worst choice...
Some readers commented that the African plot is not interesting, so the author followed the public opinion. Originally, there were still 100 chapters to be written for the African chapter, but now he decided to use up all the manuscripts and return to China. There are still 9 chapters left. Khan, I haven't figured out what to do when I return to China. I'm so flustered, I have to make plans quickly.
(end of this chapter)
