The Anning Ward in Wenzhou Town: For the end of the elderly who returned to the “baby state”
The central health center of Ma Station Town opened three hospice wards.
The southernmost town in Zhejiang is 108 kilometers away from Wenzhou City and 28 kilometers of Cangnan County. It is surrounded by mountains on three sides and faces the sea.
Xia Min, the dean of the health center, is a native local native. After witnessing the pain of many patients with advanced cancer, she tried to open a tranquilized ward at a grass -roots medical institution such as the central hospital of the Malaysian Station.
Since January 2021, the Anning Healing Department of the Malaysia Station Central Health Center has officially received the patient. Most of the patients who admitted admission are over 65 years old, and the average hospitalization time is 15 days. Every month, four or five patients will complete the last journey of life here.
In Xia Min’s opinion, Anning therapy ward is like a “social uterus”, relieve pain, provide nutrition, warmth, and care for those old people who return to the “baby state”. Quiet and peaceful.
Although there are many problems such as insufficient professionalism, insufficient manpower, and losses, “it is still primary”, Xia Min is optimistic and he has a longer -term idea. In addition to improving the end -of -life care service, he also wanted to build a professional team, develop a family bed, and provide on -site dying care services.
On March 21, the building of the Malaysian Center Health Center. Photo by Beijing News reporter Li Cong
Farewell to experience every month
At 8 am on the morning of March 14th, the early stalls in Ma Station Town were stunned with white steam. The old people drove an electric tricycle to send their children to school. At this time, the handover shift of the medical staff of the Malaysian Central Health Center was also over.
There are 5 floors on the center of the Malaysian Station, and the 4th floor is originally an obstetrics and gynecology ward. With the opening of the town’s highway, the journey to Cangnan County Hospital was shortened from an hour to half an hour. Gradually, no one chose to have children in a health hospital.
The obstetrics and gynecology department was changed to an elderly department, and one -third of the later regions were transformed into a tranquilized ward. From the perspective of the medical care of the hospital, this is like a human life, and it has been moving forward in a single thread.
After walking out of the elevator on the 4th floor, you can see the nurse station. Everything is not different from other hospitals until he passes through a matte glass door with “Anning therapy”.
The beige corridor wall, solid wood flooring, will not “wither” green plants. If it is not a bed with blue and white striped sheets in the room, this area is not like a ward.
There are currently only three wards in Anning therapy area, which are called “warm”, “warmth” and “warmth”. There is a bed in each room, and there is a bunch of “never withering” bouquet under the door of each ward, “falling” a few butterflies.
On the same day, Zhou Juntong first went to the Anning Holiday Zone.
Zhou Juntong shuttled on both sides of this glass door daily, where there seemed to be an invisible line. On the one hand, it was because of the person who was hospitalized for chronic diseases for conditioning, and on the other hand, the end of the end of the survival cycle was less than three months. Restoring health, on the one hand, hopes to reduce pain and go to death peacefully.
On this day, she would send an old man to discharge.
This is the third day when Zhang Yuan, who was 91 -year -old lying on the Anning Ward. A month ago, he was diagnosed with advanced liver cancer. When the nephew was pushed to the hospital with a wheelchair, the old man was suffering from severe pain caused by abdominal perforation infections.
Vomiting is blood, heart rate is too fast, high pressure 70 low pressure 50, calculin original (a small molecular protein, high sensitivity to bacterial infections) and white blood cells, he moaned, hoping that the doctor could give him an ingredient analgesic relieving analgesic relief medicine.
Subsequently, Zhang Yuan lived in the tranquility care unit of the Malaysian Center Health Center. Faced with the crazy pain, the old man accepted 10mg of morphine injection every day, or two doses of morphine.
The old man does not know the words on the glass door of the hospital, and it is not clear what it means to treat Anning. He just felt that the single -person ward here was quiet, and the flower in the room was very beautiful. Doctors and nurses came to see him several times a day. More importantly, he didn’t hurt that.
But Zhou Juntong said that despite the control of pain, the elderly became more and more drowsiness due to severe abdominal infections.
At 9 am, the windows of the ward can be seen, and the fog in the mountains has not been exhausted. “Grandpa, get up and wear clothes.” Zhou Juntong bent down and shouted tentatively.
Zhang Yuan, who was closed with the eyes, immediately responded. I didn’t know where the strength came suddenly. He supported his right hand on the bed and sat up.
Zhou Juntong stunned, and suddenly his nose was sore. She knew that the old man who had already been died was still breath, thinking that he went home to accept the last farewell of his loved ones.
At 3:30 in the afternoon, Zhou Juntong received a call from the death of the elderly. At that time, she hadn’t had time to finish the discharge of the discharge of the elderly.
Such farewell, she experiences almost every month.
The nurse chief Zhou Juntong is trimming his nails for the patient. Interviewee confidence
Start in the dispute
The Malaysian Center Health Center is preparing to create a tranquility treatment area in 2019.
The dean Xia Min grew up in Ma Station Town since he was a child. In childhood, my sister was bleeding from gastrointestinal tract. He was young and asked for medical treatment around his younger sister, which also laid his ambition to study medicine. After going out for many years, he returned to his hometown town and worked here for more than 20 years.
“I don’t know how to deal with the pain of patients with late cancer.”
He always remembers a patient, and it was also a friend of his father. Due to the pain of cancer, the patient rolled around in the bed of the hospital, and the shouting made people feel fear. Xia Min, who was at the meeting, asked the doctor to prescribe painkillers to the patient, but the doctor believed that the patient should be transferred from the treatment.
Xia Min understood the cautiousness and concerns of doctors in clinical use of painkillers, but in the face of a large number of patients such as the end -stage patients who endured pain in pain, “I really don’t know what to do.” He frowned.
In addition to the pain of the patient, there are many things in Xia Min’s confusion. For example, when the hospital announces “no treatment significance”, where should the patient go, how can the patient’s pain relieve at home, what should I do if the family’s long -term care of the patient’s tiredness?
Xia Min believes that a place is needed to support the end of the dying patient. The grass -roots health center is the most suitable place.
When Xia Min had such an idea, it coincided with the need to declare special specialties at the center of the Ma Station Center.
Without patients, no data, no operation, Xia Minquan led by the review experts from the mouth of the Wenzhou Health and Health Commission. The theoretical knowledge was all learned from the Internet. Unexpectedly, he was approved in the end. “This is a livelihood project, which shows that everyone is very supportive.”
However, inside the hospital, when the Anning Care Hard began to prepare, he did not get “full votes”.
The first is the opposition from seniority. Zhou Jun admitted that her resistance came from “unknown”. Most of the patients in the Anning Ward are less than three months, and the risk of nursing risks and high pressure is a new challenge for nurses.
Doctors are worried that this department cannot show the value of scientific research and worry about performance assessment and income.
Colleagues from other departments do not understand. There are 32 beds on the 4th floor of the Malaysian Center Health Center. The newly established Anning therapy area occupies one -third of the space, but only 3 beds can be provided. Highlights.
To this end, the hospital has issued regulations to tilt and subsidize the Anning therapy Department to a certain degree of policy tilt and subsidies. Care related training.
At the end of 2019, the Malaysia Station Central Health Center referred to the setting of 300,000 yuan with reference to the Anning Ward of other hospitals, and built three plants, activity rooms, farewell rooms, interviewing courses and dining rooms.
Here, the director is also the director of the elderly, and the head nurse is also the head of the elderly. The practicing physician is the inpatient department. Under the combination of multiple departments across the entire hospital, the Anning therapy team formed.
On March 21, the Central Hospital of Malaysia Station was in peace therapy area. Photo by Beijing News reporter Li Cong
Non -“standard” rescue
In January 2021, the Anning Hard Hard Hard healing was treated with the first patient, just 30 years old, Chen Wencheng.
Chen Wencheng, who suffered from liver cancer, was sentenced to “death penalty” by the hospital in Shanghai, and his wife took him back to his hometown. Because of the familiarity with Xia Min, Chen Wencheng lived in the Malaysian Center Health Center.
The curtains of the ward were tightly pulled, and the abundant sunlight in the seaside town could not come in.
Zhou Juntong remembers the advanced liver cancer patient, “he can’t accept it (sick) because he is still young.”
Chen Wencheng did not eat or drink, his complexion was yellow, and he was only 40 kg when he was thinner. Due to severe ascites, lying flat will compress the organs, so he can only sit half and lie on the bed. He didn’t speak or watch his mobile phone, and often looked ahead.
This is the first patient of Zhou Juntong’s care and tranquility department. In addition to completing the necessary care work, Zhou Juntong tried to chat with Chen Wencheng, but did not receive any response.
However, tumor complications will not give anyone buffer time. On the evening of the sixth day of admission, Chen Wencheng’s stomach veins ruptured and bleeding, and the respiratory tract obstructed, and he quickly faced suffocation.
Chen Wencheng’s wife decided to rescue. Li Run and nurses of the inpatient department of tracheal intubation, cardiopulmonary resuscitation, defibrillation, and the inpatient department of peace therapy in the ward react. However, due to the severe liver failure, Chen Wencheng announced his death due to the invalid rescue of the next day.
According to a 2014 study, cardiopulmonary resuscitation was initially developed for acute diseases (such as myocardial infarction). Among patients with patients with malignant tumors, the probability of successful rescue was not more than 10%.
Recalling the original approach, Zhou Junchong admitted that in the end, creative rescue such as tracheal intubation would increase the pain of patients, and conflict with the principle of Anning therapy. However, the patients and patients’ families were not ready to face death, and the medical staff were not ready.
“Unless the family members say that they do not need to be rescued, they are like instincts.” Seeing big bleeding, Zhou Juntong subconsciously predict whether the patient’s breathing is blocked, and immediately consider the tracheal intubation or other treatment methods.
Although this was a less “standard” tranquility, Chen Wencheng’s family members sent Jinqi a few days later, thanking all the medical staff in the Anning Hospital of the Malaysia Station Central Health Center.
When each patient is admitted to the hospital, the doctor Li Run will explain to the patient’s family what it means to treat Anning, and ask if you are not ready to have a sudden disease, no longer accept the heart and lung resulption.
Of course, this “ready” is not consistent. “Need to talk with your family many times. When you are admitted to the hospital, you have to talk with your family once a little change.” Li Run said.
It is too short than the estimated survival cycle. For example, when unexpected major bleeding, even if there will be additional pain, family members will still change their minds to choose to rescue. In a quiet and slow “decline” process, family members can accept the abandonment and rescue. Patients need time, and family members need time.
On March 21, the tranquility care unit of the Malaysian Center Health Center. Photo by Beijing News reporter Li Cong
Analing is the first step
For the majority of the tranquility and care team of the Malaysian Station Center, it is the first time to contact the end of the contact, “still a little ignorant.”
Xia Min always lamented, “When we first did it, we didn’t know much about it. If you want to do it well, it is not professional enough.” But one is “the patient can always be here in the last few days.”
There are three standards in the treatment area of Anning therapy: patients and direct relatives know the content of Anning therapy services and voluntarily accept the Anning therapy services provided by the undergraduate; the patient estimates that the survival period is less than three months; (People often need to take care of).
Throughout 2021, the Anning Hospital of Malaysia Station Central Healing Hospital received a total of 50 people. Some were introduced, some were found by themselves, and some were transferred from higher -level hospitals.
Pain management is the first step in Anning therapy. There is no analgesic on “body”, and “heart” and “spirit” cannot be mentioned.
Prior to the formal establishment of Anning therapy area, in 2020, the Malaysian Station Central Health Center had treated some end -of -the -terminal patients rejected by other hospitals.
The “explosive pain” of the late cancer is a problem that Li Run was facing, and some patients had symptoms of numbness and convulsions. Li Run admitted that at that time, there was no fully awareness of cancer pain, and he still referred to the dose of ordinary people in the medication. Therefore, the effect of pain treatment was not particularly good.
After the establishment of the Anning Healing Department, after a period of study and exploration, he became more decisive in medication.
For ordinary people, 100 mg of morphine across the day is a mortality dose, and for the “explosive pain” of patients with bone metastatic cancer, some patients’ analgesics will even use 600 mg. “How pain do you say? There is no ceiling effect. “
A large number of analgesic drugs taken in the current period establish tolerance in the body, the measurement of painkillers continuously improves, and the side effects of vomiting and constipation will allow the actual feelings of the patient’s current.
In addition to analgesic, in daily care, Zhou Juntong often reminds the nurse not to add pain to patients, such as blood vessel puncture must be successful once. There was a patient with swelling and blood vessels in his hands and feet. In order to ensure a return blood, Zhou Juntong could only adventure to choose the blood vessels at the patient’s right thumb joint for puncture.
To meet the individual needs of patients, including psychological guidance, and achieve their wish, it is a higher level of peace treatment services.
In terms of treatment, Li Run believes that he can meet the patient’s wishes within the controllable range. For example, some patients with conscious consciousness are unwilling to get injections on the same day, then they can not be injected appropriately; or patients feel that they are very tired, and they can be suspended for a day of treatment.
Li Run, a doctor at the Malaysian Center Health Center, is communicating with the patient’s family. Interviewee confidence
The word “cancer” is still taboo
“It is very complicated to let the dying patients know and accept their condition,” said Zhou Jun child.
Whether to talk to patients with the end of the end of the end, how to talk about it, this is a problem that the family members of the patient must face, and it is also the ethical predicament that medical staff will face. In most cases, informing whether, medical staff will obey the opinions of the patient’s family.
In Zhou Jun’s heart, the most ideal state is that after the patient was admitted to the hospital, he used medical methods to reduce pain, and through their company and psychological guidance, let the patient accept their condition, relieve anxiety and fear, complete the final wish, and leave regrets without leaving regrets. Go to another world.
In fact, all the patients’ family members who entered Anning therapy ward know that death is close to the next few months or a few days.
But most patients don’t know. When they were sent to the Anning Ward, they would ask, “When can I get discharged?” I didn’t even understand when I left: “Obviously it is a minor illness, how can I not cure it?”
At this time, Zhou Juntong would be poor, and he could only comfort him while comforting. “It’s almost fast.” What she can do is to go to the ward a few more a day, chat with these patients, help them trim nails, checked them, and so on.
The word “cancer” is still taboo. In communication with colleagues, Zhou Junchong will use “liver C” to replace “liver cancer”. When it comes to the word, her voice suddenly became very light, even if she was not in the ward at the time.
On the wall of Anning’s Corridor Corridor, a person’s life course diagram was drawn with clock stickers. At six in the morning, it was the ground. At 9 am, it was the first enrollment of the school. At 3 o’clock in the afternoon, the family was established.
This is the element of the Chinese physician Xu Lichun when visiting Ruian Hospital. She thinks that this will give patients a hint that human life always ends.
Patient Cai Xiang is an exception. He is in his fifties, tall and cheerful. He is the “old friend” of the medical care staff of Anning. He is the “best quality” patient in Zhou Jun’s mouth -sober consciousness, accurate cognition of his condition, and high acceptance of death.
In 2020, Cai Xiang’s diagnosis of malignant tumors in the lungs was estimated to have a year of survival. That year, he needed to go to the hospital for inflammation and anti -cough medicine because of inflammation in the lungs. Cai Xiang is often very proud, “I have lived for more than a year and I have earned it.”
On April 11, 2021, when Zhou Juntong saw Cai Xiang again, he was lying on a flat car, and the cancer cells metastasized to the spine. “We are afraid that this time is not good.” He stood up and joked with a smile, and finally distorted his face due to chest pain.
Cai Xiang has lived in the ordinary ward outside the glass door on the 4th floor many times, and has also seen the treatment of the Anning Ward. He told Zhou Juntong that his child had grown up and nothing was concerned.
In the last time, Cai Xiang also tried his best to maintain it. When Zhou Juntong went to turn over or handle the excrement, he would be politely said that letting his wife comes.
“We are still primary now”
“We are still very primitive.” Xia Min had a sober understanding of the treatment of Anning in the hospital.
According to the World Health Organization International Cancer Research Agency, in 2020, China has reached 3 million due to cancer. As early as 2016, when the National Committee of the Chinese People’s Political Consultative Conference held a symposium in Beijing, some members mentioned that less than 1%of the dying patients in my country who can enjoy Anning therapy services are currently enjoying the treatment of tranquility care services.
Since the establishment of Beijing Songtang’s Higong Care Hospital, the first domestic caring agency in 1987, the ending care service has slowly moved forward in China. There is a huge gap between huge demand and actual supply, and it is more obvious in towns and rural areas at the grassroots level.
“Lack of professional psychological counseling” is recognized by the Anning therapy team of the Malaysian Center Health Center. There is a large gap between the conventional humanistic care and systemic psychological construction of clinical medicine. Annun therapy can only relieve physiological pain, and there is a long way to go to relieve psychological pain.
Building a tranquility care unit also puts forward higher requirements for the medical strength of the hospital. Xia Min said that Anning therapy should not only rely on comfort, nor does it completely abandon treatment. For example, patients should not go so early. Once complications or electrolyte disorders occur, those who need to be treated should be treated as soon as possible.
In addition, losses are bottlenecks restricting the development of the Anning therapy industry. At the center of the Malaysian Station, taking patients with the middle and late period of lung cancer with complications as an example, the cost of each hospitalized patient was 7,000 yuan each time, and patients only need to pay more than 1,000 yuan for patients after the actual sales of medical insurance. Subsequently, the medical insurance paid according to DRGS (DRGS) and allocated 3,000 yuan to 4,000 yuan to the health centers. Therefore, every time a patient is treated, the hospital will “lose” 1,000 yuan to 2,000 yuan.
Through Xia Min’s efforts to negotiate, in 2022, local medical insurance initially decided to settle a daily settlement every day at 350 yuan. Li Run feels that the price is still not enough. They have calculated that the nutritional support and analgesic drugs of the end of the patients need at least 500 yuan per day.
In the face of losses, Xia Min has a long way to see. Anning therapy itself can bring a certain brand effect, and it can also drive the occupancy rate of patients with chronic diseases. Anning therapy area is losing money, but it does not lose it with the elderly pathogens.
“The end of dying is a problem faced by everyone. We take out a part of the funds to do this. Now we can’t see the benefits, but after a few years, the whole society must see it, and the value is reflected.” Xia Min is optimistic.
During the groping, the peace therapy area of the Malaysian Center Health Center is slowly developing.
To better improve the content of the end -care service content such as physiological care, psychological care, pain management, nutritional support, etc., to meet the wishes of patients and patients’ family members, it is the common wish of all medical staff in Anning therapy area on the 4th floor.
Xia Min is preparing to absorb more talents and build a professional team. At the same time, increase the number of beds in Anning therapy, develop family beds, and provide on -site services; cooperate with higher -level hospitals; increase outpatient clinics to promote the Anning therapy ward and expand cognition; also prepare new types of new types such as music therapy, aromatherapy, spa, and other new types Healing service. The Malaysian Center Health Center is opening a new path.
Although everyone in the Anning Healing Department of the Malaysian Central Health Center has several positions, everyone has their own planning for the development of Anning therapy area. Zhou Juntong wanted to go to the course of Anning therapy. Li Run was preparing to further study cancer pain management. Yin Tingting of the Department of Public Health was preparing for psychological counseling related examinations. Xu Lichun also tried how to use acupuncture and pain.
Six kilometers away from the Malaysian Center Health Center, the waves patted the coast as tirelessly as tirelessly hundreds of years ago. In addition to ten meters, there is a 11 -story new hospital building. After completion, there will be a whole floor as a peace therapy area.
(Zhang Yuan, Chen Wencheng, and Cai Xiang are all pseudonyms)
Beijing News reporter Li Cong editor Yuan Guoli school against Fu Chunzheng