I'm A Doctor In A COVID-19 Unit. Here's One Vital Step I Wish Everyone Would Take.
我是新冠病毒病房醫生。這裡有一個重要的步驟，我希望每個人都能採取。
Asha Shajahan, M.D. 沙傑汗①亞莎,醫學博士
HuffPost 赫芬頓郵報April 23, 2020, 12:30 AM GMT+8
2020年4月23日，格林威治標準時間上午12:30 +8
"Instead of guilt-ridden regretful thoughts ― 'I wish I knew what he would’ve wanted' ― we all have the power to know our family’s wishes now." (Photo: Taechit Taechamanodom via Getty Images)
“我們現在都有能力知道家人的願望，而不是充滿內疚和遺憾的想法——‘我希望我知道他想要什麼’。”(圖片:Taechit Taechamanodom，來自Getty Images)
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Earlier this week, a 30-year-old patient with COVID-19 passed away on a ventilator. He hadn’t laid out his end-of-life wishes ― what in the medical field are called advance directives. His father, devastated after seeing the numbers related to his condition, didn’t want any further treatment that would prolong the inevitable. His mother wanted to try everything that could possibly be done to save him. If the patient himself had been able to speak, he might have expressed what his wishes were and saved his family a heartbreaking conflict.
本週早些時候，一名30歲的COVID-19患者通過呼吸機去世。他並沒有列出他的臨終遺願——這在醫學領域被稱為預先指示。他的父親在看到與他病情相關的數字後悲痛欲絕，不想要任何會延長這種不可避免的情況的進一步治療。他的母親想盡一切辦法來救他。如果病人自己能夠說話，他可能已經表達了他的願望，並挽救了他的家庭一個令人心碎的衝突。
But he hadn’t planned to die.
但他並沒有打算死。
This tragic situation is all too common, a result of families failing to discuss emergencies and end-of-life wishes ahead of time. It’s especially stressful to make this kind of decision when the stakes are high, as they often are now amid the coronavirus pandemic. This is why it’s important to understand end-of-life treatment options and to make choices before a crisis occurs. Nobody wants to imagine the worst, but the worst is a callous reality.
這種悲慘的情況太普遍了，因為家庭沒有事先討論緊急情況和臨終願望。當風險很高的時候，尤其是在冠狀病毒大流行的時候，做出這樣的決定是特別有壓力的。這就是為什麼瞭解臨終治療方案和在危機發生前做出選擇是重要的。沒有人願意設想最壞的情況，但最壞的情況是無情的現實。
Out of the 55 patients on my COVID-19 unit in metro Detroit, only one had an advance care planning document. That patient was nonverbal after having a stroke at the age of 54. I phoned his sister, his designated legal guardian, and she read his advance care plan to me. “Doctor, tell him I love him,” she said. It was comforting to know that this patient had a designated advocate.
在底特律市區COVID-19病房的55個病人中，只有一個人有提前的護理計劃文件。那位病人在54歲時中風後就不再說話了。我給他的姐姐打電話，她是他指定的合法監護人，她把他的提前護理計劃念給我聽。“醫生，告訴他我愛他，”她說。知道這個病人有指定的辯護律師是令人欣慰的。
When I asked another patient about her advance directive, she laughed nervously and asked, “Is this a bad omen?” She was on four liters of oxygen, breathing heavily, but stable. She thought the conversation was taking place because she wasn’t going to make it.
當我問另一個病人關於她的預先指示時，她緊張地笑著問:“這是個壞兆頭嗎?”她用了四升氧氣，呼吸沉重，但情況穩定。她以為談話是在進行，因為她不可能成功。
Another gentleman told me, “I’m 62 years old and I have a lot more living to do!” His eyes were glassed over from his high fever and his hands clutched his chest as he tried not to cough. He was afraid that his age would prevent him from obtaining lifesaving measures, especially as some have suggested that older people are less worthy of being saved or even should be willing to die to preserve the American economy.
另一位先生告訴我，“我已經62歲了，我還有很多事情要做!”他的眼睛因為發高燒而蒙上了一層玻璃，雙手緊緊地抓著胸口，努力不咳嗽。他擔心他的年齡會阻止他獲得救生措施，尤其是一些人認為老年人不值得被拯救，甚至應該願意為了保護美國經濟而死。
During my last several night shifts, I continued talking to patients about advance directives. “Do you want to be resuscitated including being on a ventilator, having electric shock applied to your chest and chest compressions that can break your ribs?” I asked. “Would you want a feeding tube?” “If you were unable to make medical decisions, who do you want to make those decisions for you?”
在我最後幾次上夜班的時候，我一直在和病人談論事先的指示。“你想要通過呼吸機來複蘇嗎?你的胸部會被電擊嗎?你的胸部會被按壓嗎?你的肋骨會被壓斷嗎?””我問。“你想要餵食管嗎?”“如果你無法做出醫療決定，你想讓誰來幫你做這些決定?”
These questions aren’t easy to answer, especially when you are already sick and terrified in a lonely hospital bed.
這些問題不容易回答，尤其是當你已經生病了，在孤獨的病床上感到恐懼的時候。
It’s especially stressful to make this kind of decision when the stakes are high, as they often are now. ... This is why it’s important to understand end-of-life treatment options and to make choices before a crisis occurs. Nobody wants to imagine the worst, but the worst is a callous reality. 當風險很高的時候，尤其是現在，做這樣的決定是很有壓力的。這就是為什麼瞭解臨終治療方案和在危機發生前做出選擇是重要的。沒有人願意設想最壞的情況，但最壞的情況是無情的現實。
“I don’t know what he would want ― making this decision for him is too stressful,” the sister of one 37-year-old patient said tearfully. This patient didn’t have advance directives in place. His sister now had the emotional burden of deciding his care. She too was fighting COVID-19 but from home. Her brother was on a ventilator, unable to communicate. To say it’s an overwhelming situation to be in is an understatement.
“我不知道他想要什麼——對他來說，做這個決定壓力太大了，”一名37歲患者的姐姐淚流滿面地說。這個病人沒有預先的指示。他的妹妹現在有了決定照顧他的感情負擔。她也在戰鬥，不過是在家裡。她的弟弟靠呼吸機呼吸，無法交流。說這是一個壓倒性的情況是一個保守的說法。
As often as we address advance directives for others, many of us in health care have not thought of our own mortality. I hadn’t. Too often, this conversation is saved for a Medicare wellness visit with an outpatient doctor at the age of 65. A review of studies from 2011 to 2016, conducted by researchers at the University of Pennsylvania, found that only about one-third of American adults had advance directives.
當我們經常為他人提出預先指示時，我們許多從事衛生保健工作的人並沒有想到我們自己的死亡。我沒有。通常情況下，這個對話是為65歲的門診醫生的醫療保健訪問保留的。賓夕法尼亞大學(University of Pennsylvania)的研究人員對2011年至2016年的研究進行了回顧，發現只有約三分之一的美國成年人擁有事先指令。
But this is a talk everyone should have, not only at the magic age of 65. In my COVID-19 unit, patients have ranged from age 18 to 103. It’s doubtful the 18-year-old had thought much about her mortality prior to this.
但這是每個人都應該做的演講，不僅僅是在神奇的65歲。在我的COVID-19單元，病人的年齡從18歲到103歲不等。在此之前，這位18歲的女孩是否考慮過自己的死亡是值得懷疑的。
So while we are social distancing in our homes, it’s time to have that conversation that most of us have avoided ― or didn’t even know we needed to have. Make an end-of-life plan, write it down, and have it available to discuss with your doctor. Even better, reach out to a lawyer and learn how to make your wishes legally sound so if there is any kind of dispute between family members, there will be a clear path forward.
因此，當我們在家裡與人保持距離時，是時候進行我們大多數人都避免或甚至不知道我們需要進行的談話了。制定一個臨終計劃，把它寫下來，和你的醫生討論一下。更好的辦法是，去找律師，學習如何讓你的願望在法律上聽起來合理，這樣如果家庭成員之間有任何爭端，就會有一條清晰的前進道路。
Recently, for the first time, I picked an advocate for myself, thought about my resuscitation wishes and even considered my own funeral. It wasn’t easy but it was important ― both for my own good and for the emotional well-being of my family.
最近，我第一次為自己選擇了一個擁護者，考慮了我的復甦願望，甚至考慮了我自己的葬禮。這並不容易，但很重要——這對我自己和我的家人都有好處。
Instead of guilt-ridden regretful thoughts ― “I wish I knew what he would’ve wanted” ― we all have the power to know our family’s wishes now. Talking about death is horribly uncomfortable, but perhaps this pandemic is the harsh nudge we need. Discussing advance directives prior to getting ill can save a lot of emotional pain and help to lessen the fears that surround death.
我們現在都有能力知道家人的願望，而不是充滿內疚和遺憾的想法——“我希望我知道他想要什麼”。談論死亡是可怕的不舒服，但也許這次大流行是我們需要的嚴厲提醒。在生病之前討論預先的指示可以避免很多情感上的痛苦，並有助於減輕圍繞死亡的恐懼。
If you won’t do it for you, do it for your family. It will lessen their burden when and if, God forbid, you fall sick.
如果你不想為自己做，那就為你的家人做吧。如果你生病了，這將減輕他們的負擔。
Dr. Asha Shajahan is a primary care physician in metro Detroit who is treating inpatient and outpatient COVID-19 patients as well as homeless people who may have the virus. She is a Media and Medicine fellow at Harvard University.Asha Shajahan醫生是底特律市區的一名初級保健醫師，她負責治療住院和門診的新冠病毒患者，以及可能感染了這種病毒的無家可歸的人。她是哈佛大學的媒體和醫學研究員。
