Neurosurgery joke

The department admitted an 85-year-old woman who suffered from cerebral hemorrhage, was in a coma, her pupils were unequal, and her reflection of light disappeared. CT shows that the amount of bleeding has reached the point where "minimally invasive drilling and drainage" is needed. The doctor communicated with all the family members accompanying him in the hospital at the first time, but the family members disagreed with the operation and expressed their willingness to bear all the consequences.

The old lady's son has been dead for many years and has lived with her grandson for a long time. After her illness, her daughter and grandson took turns to take care of her. Because the old lady's bleeding has affected her respiratory function, the doctor had to take ventilator-assisted breathing to maintain her life.

The premise of ventilator-assisted breathing is to establish the artificial airway needed for assisted breathing, and the old lady's family chose to intubate through oral tube. After a week of tracheal intubation, the doctor suggested that the family members must do tracheotomy, which was also rejected by the family members.

Family members said: under the existing treatment measures, the longer the life can be maintained, the better. If not, we will treat the elderly. If it really doesn't work, our relatives and friends will not say anything when we take it home.

Case 2:

An old lady in her 90 s was transferred from the emergency intensive care unit. She was intubated and assisted by a ventilator. The old lady has lived in the emergency department for more than ten days, and just took a fancy to the "superior" condition that we can have an escort here.

Due to long-term tracheal intubation, there are obvious red marks on the old lady's fixed intubation and adhesive tape on her face. If it continues, I am afraid it will fester. Moreover, when inserting sputum suction tube, it is obvious that the end of tracheal intubation is not smooth.

The doctor advised the family members to perform tracheotomy as soon as possible to ensure the smooth respiratory tract and normal mechanical ventilation. Family members asked: if the old man's trachea is cut open, can the patient survive? Will you wake up?

The doctor gave a vivid example to the problem of family members. The doctor said: the process of treating a disease is similar to that of a child going to school. From primary school, junior high school, high school to university, every stage is a necessary process. Then you said that when you go to high school, you will definitely be admitted to the university. Obviously, this is uncertain and no one can guarantee it. The final result depends on the students' own learning situation. According to the situation of the old lady, it's time to go to high school. If you stay in junior high school and refuse to take a step forward to senior high school, you won't even have a chance to enter college. Do you think this is true?

The doctor's words reached this point, and the family said that they could understand. But they resolutely refused to take any further treatment measures and did not give up the treatment of the old lady. They asked the doctor to do his best to keep the old lady alive under the existing conditions. As for the day to last, it depends on fate.

Comments:

I don't know when the number of elderly patients with cerebral hemorrhage over 80 years old admitted to the department has increased. These patients are more or less, light or heavy, accompanied by the decline of heart and other organs. They dare not give a quick infusion and pat their backs hard. Even when they start oral care, they are afraid that they will accidentally touch those teeth that are already loose and swaying from side to side. They are like a precious jade, which can only be seen from a distance, but they dare not touch it. They are afraid that if they accidentally touch them, they will be smashed to pieces, so doctors and nurses must think twice before they do anything, and double their special treatment.

Because of age, elderly patients with cerebral hemorrhage are more difficult to recover and more prone to serious complications than young people. In the case of cerebral hemorrhage involving respiratory function, the ventilator must be given auxiliary support to maintain the oxygen saturation at a normal level. However, ventilator-assisted breathing needs to establish a perfect artificial airway, or through oral intubation or cervical tracheotomy. Under normal circumstances, after communication between doctors and their families, their families will choose tracheal intubation with little trauma and pain to the elderly, instead of trying tracheotomy that requires a knife.

However, tracheal intubation is only an emergency measure that has to be taken in a temporary emergency. If the patient is in a coma and can't pull out the tracheal intubation in a short time, in order to ensure the long-term patency of the respiratory tract, tracheotomy will eventually be taken.

Whether the person lying down is really conscious or not, the relatives living around him should still live seriously, and make a difficult choice between persistence and giving up at the ferry of life.

It is said that it is a choice, but the family members already have their own plans. Facing the elderly over 80 years old, their choices are almost surprisingly consistent, that is, on the premise that the most basic rescue measures can save their lives, they will not take any further treatment plan proposed by doctors until the end of their lives, or until the day when they voluntarily give up treatment.

Under the condition of continuous operation of the ventilator, the vital signs of the elderly can be temporarily in a relatively stable state. However, a few days passed and a week passed, and the patient's condition did not improve significantly. Has been in a coma with closed eyes, no intention to open your eyes, take a look at your loved ones, take a look at the world that has kept him alive for nearly a century. They don't seem to miss the days when they used passive sputum suction and passive breathing again and again to stay a little longer. They don't want to go through the hardships they have never experienced before in the difficult period at the end of their lives. They lie quietly in bed, stubbornly living in their own unknown world, and let their relatives around them cry hard.

Cerebral hemorrhage, a disease that is difficult to wake up after coma, but it is easy to leave sequelae. Under the premise of actively cooperating with doctors to complete various treatment plans, young people can't see obvious effects in a short time, not to mention that the patients are so old that their families no longer cooperate with doctors to complete treatment plans.

We often comfort patients' families. The situation of coma patients in neurosurgery depends on whether it works, not by day, but by week or even by month. Because in the first few days of onset, due to the gradual aggravation of brain edema, the patient's condition will not improve significantly, but there will be more and more signs.

Facing the characteristics of the disease, choose a doctor to treat the stagnant family members in the plan. What do you take to make the old man's condition better?

Since I have chosen not to continue the doctor's treatment plan, why should I let the old man suffer from another illness?

Perhaps some family members will say that letting the elderly stay for a few more days is to let the children around them do their filial piety in the last period of their lives in order to feel at ease.

Some people may say: if we don't treat the elderly and don't let them stay in the hospital for a few days, our relatives and neighbors will laugh at our children for being unfilial.

However, there are many kinds of filial piety. If life cannot be reversed, it can only be extended by mechanical ventilation. Isn't it filial piety for the elderly to expect to leave without pain?

It is not important to accept outsiders' opinions with peace of mind. Sincerely being good for the elderly who have worked hard all their lives and having a clear conscience is the greatest filial piety and comfort for the elderly.

These old people who rely on various instruments and pipes to maintain their lives are unconsciously and passively bearing all this. If the old man can choose for himself, is he willing to live so meaningless?

Qiong Yao said: "Life is like a spark that burns to the last moment of life. When I die, I will float to the ground like a snowflake and turn to dust! "

Yes, when you are alive, you can live a wonderful life, just like living happily. Leave quietly. Don't give your family trouble, and don't let yourself lose dignity. If all the pipes are replaced by a completely weightless shell, it is better to float to the ground and turn into dust. Is this more humane to the elderly?