医学人文

“Please, keep resuscitating my son!” The story of Gabriel

“请不要放弃我的儿子！”——Gabriel的故事

“有时治愈，常常帮助，总是安慰”

I never met Gabriel, but I had the privilege of hearing his story from one of my attendings. Gabriel was a 15-yearold boy who was admitted to the pediatric intensive care unit （PICU） after a serious farming accident. His head computed tomography （CT） showed severe cerebral edema and complete brainstem herniation. Boluses of epinephrine and fluid were being given frequently.Despite Gabriel’s critical condition, his mother fervently hoped for a miracle and refused to give up on her child.Gabriel’s pastor and the hospital spiritual care team came by to pray and comfort the family. It was clear from the family’s prayers that they had an unshakable faith in God.Meanwhile, Child Life （a group of specialists who help infants, children and youth cope with acute and chronic illness, trauma, injury, loss and bereavement） was preparing Gabriel’s younger siblings for the reality that their brother would most likely die, and soon. The siblings spent the evening painting, singing at Gabriel’s bedside, and doing crafts to build memories.

我从未见过Gabriel，但有幸从我的一位主治医生那里听到了他的故事。Gabriel是名15岁男孩，在一次严重的耕作事故后，住进了儿科重症监护病房（PICU）。其头颅CT显示严重的脑水肿和完全性脑干疝，常需推注肾上腺素和液体抢救。尽管Gabriel病情危重，但其母亲渴望奇迹，拒绝放弃。Gabriel的牧师和医院精神关怀者前来为他祈祷，并安慰家人。从这家人的祈祷中可以清楚地看出，其是上帝虔诚的信徒。与此同时，儿童生命组织（一个帮助婴儿、儿童和青少年以应对急慢性疾病、创伤、伤害、丧亲的专家小组）正为Gabriel的兄弟姐妹做准备，以应对他们的兄弟很可能很快去世的现实。兄弟姐妹整个晚上都在Gabriel床边绘画作图、浅唱低吟，并做手工来建立记忆。

As more hours ticked by, the clinical picture grew grimmer. Gabriel’s mother was in anguish as the team proposed stopping the life-sustaining infusions. Lying beside her son, she cried out, “Please keep resuscitating him. Please keep doing everything you can to save my son! We cannot lose him. ” As the PICU fellow reviewed Gabriel’s CT scan and all of the ongoing support, the family began to internalize the information. Seeing their shock and fear, the attending physician gathered Gabriel’s parents and sat with them in the quiet room. Calmly and clearly, he conveyed the prognosis with compassion.“One of the most tragic things in life is to allow somebody we love very much to die, especially a son or daughter, ” he said. “It goes against our every instinct as a parent but the ultimate act of love towards your son now is to let him go. This is what is best for Gabriel. Continuing to resuscitate him will only delay the inevitable. He will not survive. Our team is strongly recommending that we stop all treatments and let him die. We can assure you that he will not suffer and that we will be with you at every step. ”

随时间推移，病情越发严峻。当医务人员提议停止维持生命的输液时，Gabriel的母亲痛苦万分。她躺在儿子身边，大声哭喊道：“请继续抢救他。请不要停下来，请尽全力救救我的儿子！我们不能失去他。”当PICU的住院医向家属回顾了Gabriel的CT扫描和所有正在进行的支持治疗时，家属慢慢接受了事实。看到他们即震惊又恐惧，主治医生将Gabriel的父母请到一间安静的房间里。他和他们坐在一起，平静、清晰并充满同情地表达了他对Gabriel预后的判断。他说：“生命中最悲痛的事件之一就是眼看着深爱的人，尤其是子女，离去。这违背了父母的本能，但现在对Gabriel来说最好最终的爱是让他离开。继续无谓的抢救只会拖延不可避免的结局，他难以幸存。我们医护强烈建议停止所有治疗，让他离去。我们可以向你保证，他不会感到痛苦，我们执行的每一步都与你在一起。”

Past midnight, after the social worker and spiritual care team had left, Gabriel’s mom asked the bedside nurse if anyone could again pray with her and her family. The nurse knew the on-call intensivist’s sensitivity to spiritual wellness and asked if he would be willing. As the attending gathered with them at the bedside, Gabriel’s heartbeat was slowing down. The intensivist did not pray for a miraculous recovery, but instead acknowledged the suffering of both Gabriel and his family and prayed for comfort, strength and peace. It was not a hope for a cure but rather a hope that Gabriel would have a dignified death.Soon after, with Gabriel surrounded by his family, the team withdrew all life-sustaining measures. Gabriel died peacefully.

午夜过后，社工和精神护理团队离开后，Gabriel的妈妈问床边的护士，是否有人能再次与她和她的家人一起祈祷。护士知道住院总对精神健康很关注愿意提供帮助，问他是否愿意。当主治医生与Gabriel的家人在床边见面时，Gabriel的心跳正在减慢。ICU医生并未祈祷奇迹般的康复，但承认Gabriel和他的家人所遭受的痛苦，并为他们祈祷安慰、勇气和宁静。这不是期望治愈，而是希望Gabriel能有尊严的离去。不久后，在Gabriel家人的围观下，医护拆除了所有维持生命的措施，Gabriel平静地离去。

A year later, the family came for the PICU’s annual remembrance ceremony. Recalling the prayers, paintings, and singing, Gabriel’s family expressed gratitude that his suffering was not prolonged. They thanked the team for providing compassionate care.

一年后，家人来PICU参加Gabriel离世的年度纪念。回顾当时祈祷、绘画和浅唱低吟，Gabriel的家人对他的痛苦未延长致谢，感谢医务人员提供具有同情心的治疗。

Some might say that medicine failed this family or that medicine reached its limits. Even though science has progressed rapidly with innovative discoveries, medicine has never been just about treatments and cures. Proximity, simply being with families and bearing witness in times of intense suffering and tragedy, often mean so much more than we might realize. During a code, dozens of medical staff flock to the scene, the frenzy palpable. When the hoped-for miracle does not occur, the contrast between before and after is stark.The medical team tends to scatter, and the rooms of dying patients fall quiet. Families can be left feeling abandoned. In trying not to impose our values on others or perhaps due to our own discomfort with death and suffering, we often shy away from difficult conversations and reserve these areas of care to palliative care teams, social workers or hospital chaplains.As a trainee, I have felt awkward, unqualified and fearful about inserting myself into a family’s pain. However, the wonderful support given to Gabriel’s family by spiritual care, Child Life and the PICU staff demonstrates that there is always a role for every member of the team to continue providing support and comfort. Preparing for death is not admitting defeat, but a way of caring well for our patients and their loved ones. It is a great privilege to share these intimate moments with families. Instead of meeting our patients’ most important needs and requests with silence and space, Gabriel’s story has taught me that the art of medicine can be beautifully displayed through small courageous acts of understanding, compassion and shared humanity.

也许你会说，医生未能拯救这个孩子，辜负了这个家庭的期望，或者说医学力有不逮。尽管科学随着创新的层出不穷而迅速发展，但医学从来就不只是治疗和治愈。亲近，简单地与家人不离不弃，一起见证巨大的悲痛和苦难，往往比我们想象的要重要得多。报警声响起时，数十个医护蜂拥而至，忙乱吵闹可想而知。医务人员不遗余力，自然期望创造奇迹，结果大失所望，内心的波澜不言而喻。当医护纷纷离开，病房顿时沉寂安静，只有患者还在死亡边缘苦苦挣扎，家属可能有被遗忘冷落的悲凉感。为了不至于把我们的价值观强加于他人，也或许因我们不愿面对死亡和苦难，我们往往回避艰难的对话，将这些关怀领域留给姑息治疗团队、社工或医院牧师。作为一名住院医师，置身于一个家庭的痛苦，让我感到尴尬、茫然和无助。然而，“精神关怀”、“儿童生活”和PICU工作人员给予Gabriel家庭的惊人支持，充分说明每位医务成员都能持续帮助和安慰。平静地接受离去并不是承认失败，而是一种很好地关爱患者及其亲人的方式，与家人共度这些亲密的时刻是我们的荣幸。Gabriel的故事让我明白了一个道理，与其面对绝症患者的不情之请缄默不语、保持距离，不如通过理解、同情和分享人性细微处的勇气来彰显医学之美。

1.大家先帮我看看，有没有啥不合适的，需要修改的，帮我指出一下

2.作者从未见过Gabriel，但有幸从他的一位主治医生那里听到了Gabriel的故事。后来说“作为一名住院医师，置身于一个家庭的痛苦，让我感到尴尬、茫然和无助”以及“Gabriel的故事让我明白了一个道理”，是说我的那个主治医师的感受？