Do nothing

In the blink of an eye, it's mid-December.This year's postgraduate entrance examination happened to be Christmas, which meant that Linglu didn't have much review time left.He began to devote himself wholeheartedly, reading and endorsing books most of the day.

Afraid of disturbing him, Yan Ke stopped watching TV when he returned to the apartment, so he quietly looked up information in the study.These days, he devoted himself to improving Yang Minghuan's quality of life, and the prescription had to be adjusted every now and then, but Yang Minghuan's condition was still not optimistic.Although the symptoms of sore throat, heart palpitations, and diarrhea have improved, the tumor that is compressing the airway is increasing, and Yang Minghuan's breathing becomes more and more difficult.Due to his weakness, his lungs also began to develop infections, and the lack of oxygen was even further exacerbated by coughing and producing sputum.

Yan Ke had no choice but to issue a critical illness notice to him, and asked his wife and son to talk repeatedly.The best way to relieve dyspnea is endotracheal intubation, but intubation is an invasive treatment that will cause great pain to the patient. Usually, it is necessary to administer painkillers and sedatives at the same time to keep the patient under anesthesia.

Yan Ke explained the principle of intubation to the family members.In fact, if you think about it, you know that usually a little saliva in the trachea will cause severe coughing, let alone inserting a breathing tube?So it is necessary to seek the opinions of the family members at this time, whether to insert or not to insert?

Yang Minghuan's body has deteriorated to such an extent that his wife has already guessed the reason.She also knew that Yang Minghuan's life was counting down, so she tactfully but firmly refused the intubation, hoping that Yang Minghuan would spend his last time with dignity.Yang Minghuan himself nodded.

With complicated feelings, Yan Ke asked the old lady to sign the "Consent to Refuse Invasive Treatment".

Yan Ke is on duty on Thursday.The intern who was supposed to accompany him on duty tonight was on leave for the postgraduate entrance examination, so Yan Ke sat alone in the office.Nothing to do at hand, but it was still early, Yan Ke walked around the ward again to check the conditions of all the patients.

Yang Minghuan was still panting badly. Although he had already inhaled oxygen, his blood oxygen saturation was still up and down.Yan Ke checked around the room and was walking towards the office, when he passed by Yang Minghuan's ward, he heard the ECG monitor beeping.Yang Minghuan's wife was standing up, deftly disabling the alarm temporarily.This is normal, because his blood pressure has been low recently, and there is no good way to deal with it.

Yan Ke went over to take a look. His blood oxygen was fine, and his blood pressure was low, so he could only lower it.

Due to difficulty in breathing, it was already difficult for Yang Minghuan to speak at this time, and he just kept breathing hard.He looked tired, his eyes half closed all the time, but he could only half lie and half sit because of the discomfort of holding his breath.These days he can only sleep an hour or two at night.

These days, the old lady and her son take turns staying with her at night.Obviously, the old lady's physical strength is also a little weak.Yan Ke looked at the old lady's haggard face, and couldn't help but said: "Auntie, if it doesn't work, why don't you transfer the old man to the ICU? Your family members can also relax."

The old lady stroked the dry and rough palm of the old man, and sighed: "He won't be able to get out after entering the ICU. And the ICU can only visit for half an hour a day, so I don't worry."

At this time, the old man turned his head slowly and looked at the old lady.The old lady straightened his messy hair and smiled slightly.

Yan Ke felt very heavy and couldn't help sighing.Just as she was about to leave, she suddenly heard the beeping of the ECG monitor, and the old lady got up again to turn off the alarm.

The beeping sound disappeared, only the sound of Yang Minghuan's hard breathing remained in the ward.

Yan Ke took two steps, suddenly felt a little worried, so he turned back.He glanced at the ECG monitor and found that the alarm just now was not because of low blood pressure, but because the blood oxygen saturation had dropped to 90%.

The blood oxygen of a normal person should be around 98%. When the blood oxygen is lower than 95%, the ECG monitoring will alarm.Yang Minghuan had this situation before, just adjust the flow of oxygen inhalation.However, the speed of oxygen inhalation should not be too fast. If the oxygen content in the body is too high, the body will cause respiratory depression by itself.

Yan Ke slightly increased the oxygen flow as usual, stood by the bed and looked at it for a while, wanting to wait for the blood oxygen to recover before leaving.Unexpectedly, the blood oxygen has not been able to increase, but still slowly decreased.The heart rate also exceeded 120 beats per minute, and the ECG monitoring alarmed again.

Yan Ke felt that something was wrong, so he took out his stethoscope and listened to it.There are obvious moist rales and wheezing sounds on the lungs, which are due to lung infection with phlegm in it.The heart was beating very fast, Yan Ke was not a cardiologist, so he couldn't hear anything at this time.

He lifted the quilt and pressed Yang Minghuan's ankle.There is no edema in the lower limbs, and it does not look like left heart failure.These abnormalities appear to be of lung origin.Yan Ke called the nurse to suck his sputum, but not much sputum was sucked out, and Yang Minghuan's symptoms did not improve either.Now Yan Ke was in a hurry, so he quickly took a blood gas analysis for him, sent him for an emergency test, and invited the second-line doctor on duty to come over.

The test results have not yet come out, and the ECG monitoring shows that the blood oxygen saturation has dropped to 40%.After the second-line doctor learned about the condition, he quickly issued a rescue order, and then whispered to Yan Ke: "Hurry up and call his children over, I want to talk to them. This old man is probably dying."

Yan Ke's heart sank.

When Yang Minghuan's son arrived, blood gas results also came out: hypoxia, carbon dioxide retention, acidosis, hyperkalemia, all indicators were seriously deviated from normal values.Considering that the cause is airway blockage, since the family members refused to intubate, there is nothing to do except oxygen inhalation and correction of acidosis.

Yan Ke was by Yang Minghuan's bedside when the second-line doctor took the family members to the office to talk.Yang Minghuan stared at his eyes, and the extreme difficulty in breathing made him pant violently, and there was a hissing sound in his throat, and even without a stethoscope, he could hear that something was blocked.

His hands were bulging with blue veins, clutching the sheets desperately, and the crumpled sheets seemed to be a portrayal of his pain.Yan Ke was very sad in his heart, he didn't dare to respond to Yang Minghuan's desperate and pleading eyes, but he couldn't leave.At this time, he had to stay by Yang Minghuan's side, even if he couldn't do anything, as a doctor, he had to stay by his side.

No, this is not guarding, just watching him die.

The rescue by second-line doctors failed to relieve Yang Minghuan's pain.He began to writhe irritably, and the bed creaked when he shook it.This was also a torment for Yan Ke, he suddenly found that everything he had done before was in vain, Yang Minghuan would eventually suffocate to death, and die slowly in fear and great pain.

And he can't do anything.

After all, he is a terminal cancer patient, and he refuses to be intubated and transferred to the ICU, so the dyspnea caused by the tumor compressing the airway is nothing else...

and many more?

Looking at Yang Minghuan's shallow and short breathing, Yan Ke suddenly had a flash of inspiration.

morphine!

Doesn't morphine improve shallow and rapid breathing?Isn't morphine used abroad to relieve the dyspnea of ​​dying patients?

Yan Ke asked the nurse to look at Yang Minghuan, and ran to the office by himself.Since there is a second-line chief physician present, he must first ask his superiors for instructions before issuing medical orders.However, before he ran to the office, he suddenly remembered——

There are no relevant guidelines in the country.

At present, the drug instructions of all morphine preparations in China do not have the effect of "relieving dyspnea".In other words, if he uses morphine to treat dyspnea, it is actually an "off-label drug".

What's more, morphine may also cause respiratory depression...

Yan Ke's pace gradually slowed down.He remembered the conversation between the uncle and director Wang during the discussion of the death case.

"Since it hasn't been included in the guidelines, it may be difficult to win the lawsuit."

"We medical staff must first protect ourselves..."

Yan Ke felt a tightness in his chest, and quickly changed his mind - he might not be able to go to court!

Yang Minghuan's family are so sensible, as long as they explain clearly, they will definitely understand!As long as the family members understand, they won't sue. Isn't everyone happy?

Yan Ke was certain in his heart, and stepped up to the office.The second-line doctor just finished talking with the family members, and the family members are signing the "Consent to Abandon Rescue".Yan Ke and the second-line doctor met their gazes and were about to speak when a name popped into his mind.

Lu Wenfang.

The heart that had just settled down began to panic again.

Human nature is very complicated.

Good intentions may not necessarily lead to good results.

"What's wrong? What's the patient's condition?" The second-line doctor got up and walked towards the ward.

"...No." Yan Ke lowered his head and followed, struggling inwardly.

"Then what are you doing here if you don't look at the patient?" The second-line doctor glanced at him with reproach in his eyes.

When I came to the ward, the nurse reported that the values ​​were still going downhill.In fact, you don't need to look at the data, just look at Yang Minghuan's appearance to know how bad the situation is.The voice in his throat has changed from a thin hiss to a rough grunt, and his chest is also violently heaving. It is obvious that he is breathing with all his strength.But the cyanotic lips and the cold sweat on his head showed that all this was futile. It was difficult for him to inhale oxygen into his lungs, and he could only wait for the residual oxygen in his blood vessels to slowly run out.

Yang Minghuan's eyes were blank, and he stared blankly ahead.When he saw Yan Ke, there was hope again in his eyes.He stared at Yan Ke, and although he couldn't speak, he still asked with his eyes: Is there any other way?Is there any help for me?

Yan Ke was in a mess.The old man in front of him once endured the pain and enlightened him when he was at a low point.And now he has to put aside his pain for self-preservation.Not to mention that this kind of behavior is close to revenge, even as an ordinary doctor, facing an ordinary patient, can he do nothing and watch the patient die in extreme pain with peace of mind?

If Yang Minghuan had known that he was this kind of person, he would have disdain to have a close friendship with him.

Rubbish.

Scum.

Why are good people not rewarded?

He is such a nice person, why did he meet a trash doctor like me?

Deep in the brain, there was a sudden familiar throbbing pain.There seemed to be a string in the ear, vibrating vigorously, and the pain spread like ripples.

Yan Ke's tinnitus started to ring, and even Yang Minghuan's breathing could not be heard.But Yang Minghuan still stared wide-eyed, looking at him helplessly, longingly, with a glimmer of hope in despair... pleadingly.

Yan Ke finally succumbed to guilt, and pulled the second-line doctor to whisper about the morphine.The second line shook his head immediately, his lips turned up and down, but Yan Ke couldn't hear what he was saying.

Probably vetoing it.

Yan Ke opened his mouth and heard his own voice.

"...I'll be responsible for whatever happens."

The second line looked at him in surprise, and said a few more words.He barely heard one sentence:

"...The responsibility is not yours alone..."

Yan Ke was taken aback.My heart sank.

That's right, if the family members really come back to make trouble...the whole department will be implicated.

It hasn't been long since Lu Wenfang's incident, is he going to cause trouble for everyone again?

The old lady and her son also caught up.Seeing Yang Minghuan's painful appearance, the old lady covered her mouth and began to sob, and her son also had a sad face.

Yan Ke turned his face away guiltily, and his emotions fell to the bottom.At the same time, it was as if a bee had got into his brain, flapping its wings non-stop, stirring his brain into a homogenous paste.

Forget it.

Anyway, I'm just a scumbag, why do I still pretend to be benevolent and righteous?

Stop pretending.Yang Minghuan must have seen through it a long time ago. If I was willing to help him, why didn't I do it now?Obviously it's just a matter of getting an injection, it's so simple, just pick up the syringe and inject an injection into his blood vessel...

Obviously it can alleviate his pain.

But don't do it.

The self-blame and guilt are all fake, it must have been played for him before he died.

No, it should be played for the family members, after all, what he fears most is the family members making trouble.Let them see that when the patient is in pain, I am also in pain, and I am also very sad.It's not that I don't want to save him, it's that I can't do it, even my superiors can't do it, I've tried my best.

... scum.

Yan Ke raised his head and saw the old lady walking to the bed, holding Yang Minghuan's hand firmly.I saw their son walking outside the ward, talking on the phone with his mouth open.Seeing the nurse and the second-line doctor look at each other, their faces were full of helplessness.

Everyone has given up.Only Yang Minghuan was still dying, but he didn't know that every breath he took was prolonging his pain.He has no end but death.

There are many bees and countless pairs of wings in my mind.The strings in the ears are stretched tighter and tighter, and the sound of fibers tearing can be heard.

An hour later, Yang Minghuan's son said something silently, and then the nurse began to dismantle the instruments on Yang Minghuan's body.

Several people came in and silently moved Yang Minghuan onto the cart.

Panting silently, Yang Minghuan looked helplessly at Yan Ke for the last time before being taken away by his relatives.

Go home and die.

Second-line doctors left.The cleaning lady rests at night, so no one removes, washes and disinfects the sheets and quilt covers.The crumpled bed still retains the traces of the old man's dying struggle, which is white and dazzling.

Yan Ke returned to the office and began to fill in the medical records.The quality of the keyboard is surprisingly good today, without any knocking sounds.

After writing the medical records, he went to the nurse.He wanted to tell the nurse that he was tired and was going to the duty room to sleep for a while.But he suddenly felt that he could not make a sound, so he took a pen to write on the paper, and then held it up for the nurse to see.

The nurse knew the relationship between the patient and Yan Ke, so she nodded in understanding.

Yan Ke walked slowly towards the duty room, feeling dizzy, and he thought it was fine, so that he would fall asleep as soon as he touched the pillow.

I will definitely not lose sleep today.Get a good night's sleep.

Yang Minghuan's bed was vacant, and he could accept new patients.