No matter how far away, hospice care at home has put an end to life.

The medical staff walked out of the hospital and into the patients' homes, sending every patient away without leaving any regrets for their families. This is the expectation of everyone who carries out family hospice care. Into the community, let medical staff face the shortcomings that medical care can't fill, and experience the bitterness of life more personally, but all kinds of warm feedback make all the hard work full of motivation and move on.

Zhang Xianzheng regarded himself as a native of Yilan, practiced integrating into local life, and explained his illness to patients with the unique tone of Yilan people. "Grandpa, grandma, long time no see, how do you feel? Different from what most people think of as a doctor, Zhang Xianzheng, director of the Family Medicine Department of Luodong Pok Oi Hospital of Roche Foundation, as a legal person of medical consortium, will take the initiative for at least three and a half days every week, carrying a diagnosis and treatment box and visiting patients all over Yilan County. Yanglan Plain has a vast territory, and sometimes it takes more than 40 minutes to drive. However, Zhang Xianzheng and the medical team did not feel bitter. Every time they make house calls, they always say hello loudly when the patient comes in.

Jumping into community medicine to carry out the mission of family medicine "If we give full play to the mission of family medicine, community medicine is something that family doctors will definitely do, right?" Zhang Xianzheng, 65, came to Luodong Pok Oi Hospital to serve and plunged into the field of community medical care. It has been 10 years.

Zhang Xianzheng, who specializes in family medicine and preventive medicine, believes that if we really want to know what unhealthy factors exist in our daily life and make people step by step into the abyss of disease, then the medical team should not just stay in hospitals, but should go deep into key places that affect the physical and mental health of the elderly, such as homes, community activity centers, vegetable markets, temple fairs and so on.

It is really a big challenge for doctors to walk out of the hospital gate. For example, in the hospital, Zhang Xianzheng rarely felt that patients attached importance to geographical relations, but when he entered the community, he was often asked, "Doctor, are you from Yilan?" Moreover, although these grandparents are ill, their brains are still very bright, and they will "verify" from the responses of medical staff. Zhang Xianzheng did not use the ancient place name "Dongguashan" to refer to his hometown Dongshan, revealing the stuffing and becoming a joke of his elders.

The business of community medical service is all-encompassing. In addition to health checks and visits, they also carry out health education publicity and evaluation, and sometimes even help employees to lose weight. Although things are complicated, in the real life scenes of people, we can feel the flow of love between people better. Sometimes, Zhang Xianzheng will tell patients that he will go abroad for a meeting next week. These elders who originally questioned that he was not a child of Yilan even joked: "Doctor, I will wait for you to come back! 」

There are always a lot of concerns about getting out of the comfort zone. For example, can doctors make correct and appropriate medical treatment without inspection instruments in hospitals? In other words, whether the patients' families can give enough support and care. However, Zhang Xianzheng realized from practical experience that everything has two sides, and family medical care is no exception.

The achievement of family hospice care is not complete, but the biggest advantage of family medical care is "home". "And this advantage, especially in palliative care at home.

He recalled that there was a peaceful grandmother at home. No matter how hard Zhang Xianzheng tried to adjust drugs, her reaction to drugs was always imperfect, which made Zhang Xianzheng feel quite depressed. Unexpectedly, although grandma suffered from illness, she always encouraged him to say, "doctor, don't blame yourself." This medicine still has some uses. I can still be in my own house. I think this is very good! " Don't worry. 」

"We are just doing our job, but we can get more support from patients. Zhang Xianzheng still remembers the gentle appearance of grandma cheering him up, which is also the unique stability of patients at home.

Another grandmother insisted that her daughter prepare a table of dishes until the week before she left. When the medical team comes to visit, the grandmother will struggle to move from the bedroom to the living room and enjoy it with the medical team. Zhang Xianzheng described that although it took a lot of twists and turns, the visit of medical staff was like the visit of children and grandchildren living in other places, full of deep feelings. Every time he leaves, Zhang Xianzheng will say to his grandmother, "What a terrible situation! (Kim is the pronunciation of Elantra, which means "true") "But he knows that it is not a complete perfection for grandma to entertain guests in her own home.

"Patients who need hospice care have little time left. Since there is no more active medical plan, why waste rest time in the hospital? Zhang Xianzheng said that the turning point of patients' willingness to return to a peaceful home is usually that patients want to spend the rest of their lives in the place they want to live, which is usually their familiar home. Perhaps the family members will have some hesitation, but as long as patients have the opportunity to show their wishes to their families, they will generally succeed.

Of course, the family members who are the main caregivers will definitely have a series of technical problems, such as: "The patient is very painful, how to solve it?" "Who should I discuss with if the patient has a temporary condition?" "Under what circumstances should I send the patient back to the hospital? Zhang Xianzheng said that in fact, as long as you have a knowledge of "going home", most technical problems can be solved.

At this time, the medical team and volunteers should give support and discussion from the professional and emotional aspects respectively. For example, you can use a patch to relieve pain, or you can bury a soft needle under the skin first, and then let your family learn how to apply an analgesic needle; As for psychological anxiety, it also depends on more frequent and in-depth care from social workers and volunteers.

Zhang Xianzheng said that as life gradually comes to an end, people will become weaker every day, and the part that medical care can help will become less and less. At this time, how strong the psychological quality is for terminally ill patients is highly positively related to the quality of the last stage of life. "On their own turf, they have memories of hard work all their lives. Even if they can't move in bed, they can still have mental control. 」

Improving the exquisite volunteers in the family medical system is the key. Brother Wu, who joined the ranks of volunteers after leaving the army, gave warm and dignified care to the patients with meticulous observation. The participation of social workers and volunteers is absolutely indispensable for a successful family medical system. "Most patients are used to telling medical staff about their physical illness. And pour out psychological pain to volunteers. Zhang Xianzheng said that more than 10 volunteers from the Anning team of Luodong Pok Oi Hospital are the best backing for his heavy medical work.

"A qualified peace volunteer can be said to be an amphibious force in the field of volunteers. Brother Wu, who joined the ranks of volunteers after leaving the army, worked as a peace volunteer in Luodong Pok Oi Hospital for six years. He said that patients and their families are very sensitive, and volunteers must practice just the right smile and euphemism. Put yourself in their shoes. There are seven or eight kinds of pain alone. Physically, they have to face edema, poor breathing and stench. Psychologically, they have to face the fear and anxiety of death. What volunteers can do is to walk in the valley and give warm and dignified care to patients who suffer from illness alone.

"To gain trust, we must have a good observation. Brother Wu said that the most difficult thing to be a peaceful volunteer is to gain the trust of patients and their families, because there is no standard process for breaking ice and you must rely on your own careful observation. Don't underestimate volunteers making coffee, playing the piano and playing * * * in the hospice ward. These are basic skills, which can make patients or their families feel the trust in volunteers bit by bit. Brother Wu will also hold the patient's hand to make soothing essential oil to reduce the patient's insecurity; Or learn to sing Japanese songs to make the old people happy, and when they meet veterans, they can talk about their bravery together.

Sometimes, the knot between patients and their families can be resolved, which is also contributed by the discovery of volunteers. Brother Wu is deeply impressed. There is a male patient who is taken care of by his daughter, but there is little interaction between father and daughter. So he suggested to his daughter, "Would you like to shake hands with Dad? At first, my daughter said she didn't know if her father would like it, but when she reached out timidly, her father in the hospital bed immediately shed tears.

"Their observation is definitely more subtle than the medical staff. In case discussion, social workers, nurses and volunteers can often provide more psychological details of patients, so that doctors can understand the case more completely.

Let life come to a successful end and become a nutrient for progress. Zhang Xianzheng traveled thousands of miles to the government to provide family medical services for patients. After carrying out community medical care for many years, Zhang Xianzheng found that even if he worked hard, his medical team could not take care of all the patients in Yanglan Plain. He came up with a very "crazy" idea: "Most patients, the doctors I trust and rely on most in my life, are the clinic doctors next door to my house. Why not let these clinics do family peace? 」

In 20 18, he persuaded three local clinics in Yilan county18 to join the plan to provide patients at home with timely and frequent home medical services. What is touching is that these enthusiastic doctors in Yilan not only go to the same street to see patients before going to work every day, but also set up a line group, and the hotline keeps ringing and actively asks about nursing matters.

Zhang Xianzheng said that it is an important key for family members to insist that patients can find an effective consultation window immediately when conditions permit.

Although promoting such a plan can be described as burning money and brain, it is the implementation effect that makes him willing to take out his mobile phone to reply to LINE messages in every gap. Up to 90% of these patients who were cared for by doctors in nearby clinics died safely in their own homes.

Would you be sad if the patient you took care of left? Zhang Xianzheng nodded and said: "There will still be emotional fetters in separation, but sad emotions are accompanied by blessings. He will pay tribute to the medical team. Usually at this time, the family will tell him a lot of thoughts that are not said in their hearts. Most of the above are specific and profound descriptions, thank you.

"This is very important for the team, the family and me. Zhang Xianzheng said that once, he met another family member, and the patient had died for half a year. Family members with heavy hearts remember more stories and describe them in more detail. No matter what kind of physical torture the patient suffered at home, he still creates a bitter and sweet memory with his family. Zhang Xianzheng said that at these moments, he could clearly feel that his work did have an impact on patients and their families. It can send patients to the end of their lives well, and the families who stay behind can also rejuvenate them. Just like charging, it becomes the driving force to keep moving forward in your busy work.

Just like the original personality of Yilan people, Zhang Xian spent 10 years in Yilan. Once these elders believe that the medical team can be trusted, they will also give more attention and care than expected. "The interaction between people is sincere. When the patient feels your heart, he will give it to you. All kinds of things given to peaceful patients eventually became valuable nutrients and were irrigated into the hearts of medical staff.

Author/Youtai? Figure/Luodong Pok Oi Hospital of Roche Foundation, a legal person of medical consortium

This article is authorized by Taiwan Province Anning Care Foundation. See here for the original text. ※.