Newsletter No. 440

2 No. 440, 19.6.2014 「 很多研究指出,病人都希望临终一段时间不需要受苦, 可以舒舒服服、无牵无挂,在家人陪伴下安详离世。事 实上,现在医学发达,很多医疗程序都可以延长人的寿 命——呼吸困难可以借助人工呼吸机,不能吞咽可以插胃 喉或喂管,但从纾缓治疗的角度,这些程序很大可能会为 病人带来不适,且治疗效果成疑,所延长的可能只不过是 濒死过程而已。」那打素护理学院 陈裕丽 教授( 右 )说。世 界卫生组织定义纾缓治疗为整合病患生理、心理、社交和 灵性层面的照顾,是帮助长期或末期病患者积极生活至 最后一刻的支援系统,但在香港这概念尚未普及。 陈教授说,过往十年,香港首十项死因已经不是意外,而 是慢性疾病。长期病患面对的问题会由生理慢慢转移到 其他层面。「我接触过一位六十多岁的肺气肿患者,说自 己已两年没有外出走动。因为一个以前抽着烟的大男人, 现在要背着氧气机过活,和自己昔日形象反差太大。他不 敢面对亲戚朋友,变得孤立起来,更开始质疑自己的存在 价值:究竟我苟活下去还有什么意义?」 兼顾身、心、社需要 纾缓治疗鼓励病人维持正常社交,喝早茶见朋友,也可到 日间中心活动。待病情发展到中期,病人易倦,外出意欲 减低,才要增加覆诊次数及让医护人员上门家访,照顾病 人及家人需要。直至最后几个月,病人或会因为某些急症 必须入院,才是要上病床的时候,家属可以在纾缓病房长 时间陪伴患者。 对回天乏术的末期病人来说,需要的已经不是「病」的治 愈,而是「痛」的缓解。所以纾缓治疗不是跟死神搏斗,也 不是放弃生命,而是重新审视维持生命治疗,如心肺复苏 法、插胃喉、静脉注射、使用呼吸机等对病人所带来的利 弊,以及尽可能及时纾缓身体各种不适症状,如疼痛、呕 吐、气促,维护病人尊严,让他们平静、安详地走过生命晚 期阶段。 为晚晴做好准备 为了让患者更安心面对未来病情发展,同时减轻亲属日后 代病人下决定的重担,纾缓治疗的软件之一是「预前照顾 计划」,提倡病人在仍有自决能力时,表明当病情到了末 期时个人对治疗及护理照顾的意愿,例如是否希望使用 维生治疗来延长生命,让病者家属了解其个人意愿等。医 护人员在教导和协助病人订立预前计划担当重要角色。 那打素护理学院院长 李子芬 教授( 左 )说:「一般人错认 为不该向病者提起敏感话题,所以我们教导学生怎样用 正确的沟通方法,与病者打开话题。学生一开始觉得难以 启齿,但最后发现病人其实根本不忌讳,只是等待谁先开 口。」 肯定生命意义 面对生死,总让人思考甚至质疑人生的意义和目的。那打 素护理学院指导学生使用「生命回顾」的概念,帮助病患 找回人生价值。李院长说:「病人离开之时应对自己有正 面评价。很多人自觉一事无成,但或许忘记了,辛苦养大 孩子也是项了不起的工程。」学院的老年学理学学士课程 设计了一份功课,安排学生到院舍,聆听患有长期病患的 长者讲述自己人生故事,制成「生命纪录册」,让他们宏 观俯瞰生命的不同阶段,不再沉溺于不愉快回忆。 跨科全队照顾 纾缓治疗除了是整合身心社灵的「全人照顾」、照顾病患 同时关心家属的「全家照顾」,更是结合医、护、牧灵、社 工、营养、心理及义工的「全队照顾」,合力把病人的痛苦 减到最少。「所以学院的老年学课程也是一个跨科合作, 除了有驻学院的医护人员、心理学家、社会学家和社工指 导学生,还邀请职业治疗师、物理治疗师为客席讲师, 有时会请牧师与学员探讨灵性课题,」李院长说。 据陈教授说,纾缓治疗在香港发展了二十年,现时全港约 有十五间医院设有纾缓病房。李院长认为,香港医护人 员现时面对的大多数是慢性疾病,纾缓服务不应只由纾 缓治疗科提供,而是所有医护人员都应具备有关的知识 及技巧,「现在纾缓治疗是个专科,但这个专科应该普 及化,因为所有病人都需要维持生命的尊严和生活的品 质。」 Research shows that patients at the end of their lives want their final days to be pain-free, peaceful, and with the presence of family members. Medical technology prolongs life—those who cannot breathe can be kept alive on a breathing machine, and those who have swallowing problems can adopt tube feeding. However, from a palliative point of view, these procedures are probably prolonging the dying process and at the same time causing more discomfort to the patients,’ said Prof. Helen Chan ( right ) of the Nethersole School of Nursing. The World Health Organization defines palliative care as an integration of the physical, psychosocial and spiritual aspects of patient care, and a support system to help patients live as actively as possible until death. However, it is not a concept widely known and understood in Hong Kong. According to Professor Chan, the top 10 causes of death in Hong Kong have switched from accidents to chronic diseases in the past 10 years. People living with chronic physical conditions are at risk of developing other aspects of suffering. ‘A 60-year-old patient with chronic obstructive pulmonary disease told me that he had not stepped out of his home for two years. Once a macho smoker, he is now inseparable from his oxygen machine. He feels he cannot face his friends and relatives anymore and becomes increasingly isolated. Spiritually, he begins to have existential concern: what on earth am I here for?’ Addressing Physical and Psychosocial Concerns Patients who receive palliative care are encouraged to go on to enjoy a normal social life, see friends and do exercise in day centres. In a later stage when they feel too weak to go out, it is the time they need to increase visits to hospital, while nurses will provide home-based care to address their needs and their families. They don’t need to stay in hospital until the last few months, where the presence of an accompanying family member is always allowed. 纾缓治疗:安恬 at the 医疗科技日新月异,战胜不少病魔,但面对死亡这一课题,是否就束手无策? 或许「可一不可再」就是生命最宝贵的一点,所以大家会为人生不同阶段作出周详计划和准备, 讲究「好活」,让生命添上感叹号。那么「好死」又可以如何定义? 医护人员又如何让病人为生命画上完满的句号? Modern medicine has been so successful that almost every disease has a cure. But when it comes to death, is it really true that nothing can be done? We only live once, and that’s why we are busy planning for a ‘good life’. But is there such a thing as a ‘good death’? What roles do health care providers play in helping patients to secure a good ending? Finding Care ‘ 边注边读 Marginalia 编采写载,不经不觉二十期过去,又是学年结束,与读者暂别的时 候。一个阶段终结,总会来点回顾点算。本期内容不谋而合,都略 带这种意味。那打素护理学院的师生接受专访,谈到如何扶持末 期病人安详走过世上最后一程,当中就利用制作生命纪录册, 点算一生的哀乐起跌。掌一公营大学的财政,必须以学生和同事 的利益为依归而时刻点算,上任将近一年的财务长 陈林月萍 挥着 算盘,与我们分享个中体会。都市人在外进餐频仍,吃得是否健 康,往往无暇计较,晨兴书院餐厅体贴入微,推出营养餐单,为我 们点算清楚。 暑期过后,本刊将在8月19日恢复出版。除了版面设计更新, 「人事动态」一栏会以新模式出现,还会推出新栏目,与读者趣 谈资讯科技,职场心得。 John Lubbock (1834 – 1913)在其书《生命之用》说:「休息不是 无所事事,炎夏永昼,有时躺在草地上,在树下听流水淙淙,看白 云飘飘,绝非浪费时间。」无论你怎样过这个夏天,希望大家重返 校园时,身心都能焕然一新。 Research, writing, editing, printing – 20 issues have passed, almost imperceptibly. The academic year has come to a close and it’s time to bid a temporary farewell to our readers. Every ending calls for a review of things achieved. Coincidentally the contents of this issue are in line with that. The students and teachers of the Nethersole School of Nursing spoke to us on how to accompany terminally ill patients on their last journeys. One way is to compile a ‘life story book’ that takes stock of a patient’s joys and sorrows in life. Someone in charge of a public university’s finances must in her calculations put the interests of its members first. The University Bursar who’s been in office for almost a year, Salome Chan , shares her insights. For city dwellers who dine out frequently, it’s easy to lose track of their dietary intake. The Morningside College cafeteria has thoughtfully launched a healthy menu that counts your intake for you. The Newsletter will be back after the summer holidays, on 19 August. Besides a new layout design, the ‘Ins and Outs’ section will take on a new format. New columns will also be launched to share with readers technological information and job experiences. John Lubbock (1834–1913) said in his book The Use of Life , ‘Rest is not idleness, and to lie sometimes on the grass under trees on a summer’s day, listening to the murmur of the water, or watching the clouds float across the sky, is by no means a waste of time.’ No matter how you spend the summer, we hope you will be revitalized when you come back to campus again. ———————■■■——————— 目录 Contents 纾缓治疗:安恬地挥别生命 2 Finding Care at the End of Life 校园消息 Campus News 4 舌尖上的中大 CUHK f+b 6 博文贯珍 The Galleria 6 宣布事项 Announcements 7 人事动态 Ins and Outs 8 陈林月萍如是说 Thus Spake Salome Chan 10 现代纾缓治疗「身、心、社、灵」的核心概念,萌芽于上 世纪六十年代一位英国女士 桑德丝 。 桑德丝1938年入读牛津大学。随后二战爆发,她选择受 训为护士。1948年她遇上年轻癌症病人塔斯马,两人情 投意合。塔斯马是波兰犹太人,从华沙逃到英国,住在 伦敦一家医院,徘徊死亡边缘。 塔斯马的痛苦煎熬对桑德丝冲击很大。有天她和塔斯 马谈论到挥之不去的死亡阴影,忽然醒悟了:「我意识到 病人不仅需要减轻疼痛,更需要全面细致的照顾。人都 需要空间来回归本我。我提出了『整体痛』这个概念, 因为见到病人垂死之际忍受着肉体、精神、心理还有社 交痛楚,都亟待纾缓。自此我就投入到这项事业。」 1967年,桑德丝在伦敦郊外成立了第一家现代宁养院—— 圣克里斯多福宁养院,掀起了现代安宁疗护运动。 Modern palliative care with its emphasis on the psychological and spiritual aspects of patient care was started by Dame Cicely Saunders in the UK, in the 1960s. Saunders began her university education in Oxford in 1938, but when the Second World War broke out, she took up nursing. In 1948 she met a young Polish Jew, David Tasma, who had an inoperable cancer. They became fond of each other. David Tasma had escaped from the Warsaw ghetto and was dying in a London hospital. Tasma’s pain, loneliness and anguish had a profound effect on Saunders. As Saunders and Tasma talked about this looming death, Saunders had a revelation: ‘I realized that we needed not only better pain control but better overall care. People needed the space to be themselves. I coined the term “total pain”, from my understanding that dying people have physical, spiritual, psychological, and social pain that must be treated. I have been working on that ever since.’ This pioneering woman opened the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London in 1967. This sparked the modern hospice movement. 纾缓治疗之母——桑德丝 Founder of Palliative Care — Dame Cicely Saunders 我们必须关心生命的品质,一如我们关心 生命的长度。——桑德丝女爵 We have to concern ourselves with the quality of life as well as its length. — Dame Cicely Saunders Copyright© St. Christopher’s Hospice, London

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