最后诊断

2010年7月18日 | 标签:

在医院,死亡天天可见。大多数时侯,你不是死在自家的床上,就是死在医院的床上。而且,医院的那张床不知死过多少人,那被单不知盖过多少具尸体。床和被单不是一次性的,尽管每次用时都消过毒。但如果你睡在医院的床上,盖着医院的被单,想想是不是有点咯应。但这个地方,有时你又不得不去。

今天的这个故事,和一次特殊的死亡有关。这种类型的死亡一般不会频繁发生,换句话说,就是极少发生,几率大概是万分之三左右。可我刚上班没多久便遇到了,这个产妇在孩子出生后不久便死了。死因据说是“羊水栓塞”,注意,我说的是“据说”,因为我总结了一下,各大医院,只要发生产妇分娩后迅速死亡,往往会给个“羊水栓塞”的诊断,因为“羊水栓塞”病情极为凶险,很难预防,出现后产妇各脏器迅速衰竭,难以控制,属于难以避免的死亡,而非医护人员的责任事故,这样医院比较容易开脱,顶多赔点钱了事。但光医院自己说是“羊水栓塞”也不能让死者家属信服,打官司的时侯,还得依靠病理诊断。

说到病理诊断,我又得插两句。不知道在坐的有几位喜欢看阿瑟.黑利的小说,前几年阿瑟.黑利去世了。他的大多作品我都看了,《航空港》,《汽车城》,《大饭店》,《烈药》,《最后诊断》等等,这些作品非常深入的向读者展示了各行各业的内幕,当然少不了医疗行业,其中《最后诊断》讲的就是医院病理科的故事。病理科总是和病人身上的组织或尸体打交道,陌生人如果刚踏进这个科室的门,感官上会非常的不适,瓶瓶罐罐里总是泡着形形色色的被疾病侵蚀的机体,生命的所有丑陋在这儿都可以见到,在这儿呆的时间长了,一定会影响你的人生观的。是的,人生不仅不过如此,人生的结局还如此可怕,健全的离开这个世界简直是奢侈。

病理医生给出的诊断可以被称为“最后诊断”或“金诊断”,当医生的临床诊断同病理科的诊断冲突时,那就得听病理科的。大多时候,病理科的诊断对制定疾病的治疗方案极其重要,随便举个例子,就拿乳腺癌说吧,有些怀疑乳腺癌的,又不能确诊的,就把病人拉上手术台,切一点疑似病变组织,立即送到病理科做冰冻切片染色,观察是否有癌细胞。这时,病人就躺在手术台上,周围围着一帮医生护士,静静地等着病理科的那个决定命运的电话,如果顺利的话,半个多小时电话就来了。有时病人马上送回病房,所有人一脸轻松,没事。大多数时侯,都接着手术,切割+清扫。因为乳腺癌的发病和雌激素的水平过高有关,早期的手术还要把患者的卵巢给割了,没了它就基本没了雌激素,不容易复发。过两天,你再看到这个病人,“唰”的一下,老了。真的,是“唰”的一下。这个术式太残忍,根本不顾忌患者的生活质量,没几年就基本淘汰了。

又扯远了一点,回到“羊水栓塞”。病理科诊断“羊水栓塞”的证据是,尸检后,在别的组织发现“羊水颗粒”(那是羊水通过血液循环到那里的),尤其是在肺组织发现“羊水颗粒”就可确诊。但是,在这个国家,医院只要想去“运作”,担当法官角色的法医(很多是做病理检查的)也可被搞定。但无论和医院是否有关,大多还是要赔钱的,主要是为了避免被定为“医疗事故”。


(肺组织病理切片,中间黑色箭头所指的就是肺组织中的羊水物质)

回到那个死去的产妇,生前是个营业员,留下一个女孩,当时因为和医院没达成赔偿协议,孩子留在医院,我还负责照管这个小孩一段时间。这个孩子贼能吃,因为没有母乳,只吃配方奶,没两天,就把一袋奶粉给灭了了。护士开玩笑说她是“饿死鬼”投胎。我还见过这孩子的父亲,带个眼镜,很文静的男人,隔一段时间就来看他女儿,没多说话。

当然,后事办妥,孩子被接回家了。再也没见了。

故事不能就此结束,否则感觉不像是个故事。

一晃,到了12年后的前年。我回家,到二姐的办公室。二姐神神秘秘地对我说:“晶晶最近有情况,学习不专心”。晶晶是我的外甥,上6年级。我说:“他能有什么事啊?”二姐说:“他跟班上的一个女生经常偷偷打电话,我通过其他学生了解,这两个人还经常一起上下学。还有,在他书包里还发现一张同学留得字条,说周末有个聚会,约晶晶去,里面还特别提及那个女生也参加”。我说:“他要真这样,那也没办法,你也不能让他不去想啊”。二姐说:“还有,那个女生没妈啊,她妈好像在你们医院生小孩时去世的”。我听后,一身鸡皮疙瘩。一算,确实,我外甥也是那年出生的,就问:“她妈以前干什么的?”“商业大厦的营业员”。哎,这个女生肯定是那个我曾经照看过的女孩。我姐还说,她爸到现在还没结婚,这孩子一直由她姑姑帮着抚养,而且她称她姑姑为“妈妈”。

据二姐说在“妈妈”这个称谓上,这个女孩很洒脱,她提到妈妈时从不难过,她说,别人都有妈妈,我是姑姑带大的,我就喊她妈妈。

确实,没有一点记忆,倒不见得是个坏事。

隔了两天,晚上,我约外甥到公园转转。路上,我问他:“你们班是不是有个女生,生下来就没见过她妈”。外甥一愣,然后笑了笑(我注意了他的表情),说:“有啊,你怎么知道的?”。“这就别问了,她妈去世的时侯,我在场,她出生后我还带过她,不知道她现在什么样?”。“正好,前几天拍了毕业合影,在家”。“好的,过下到你家看看”。“行,但你不要和我妈讲”

到了他家后,我俩进了他房间,把门反锁上,外甥把照片找出来,指了指她,我一看,哎,12岁了,很阳光的女生,感觉比同年龄的孩子要大,有点像她妈。

这时,二姐在门外喊,你俩个躲在里面干嘛?

  1. Nana
    2010年7月18日21:53

    太神奇了。

    好贴。同意小师妹。。:)

  2. 大宝
    2010年7月19日02:03

    半夜看了头皮发麻吖!!!

  3. yanhu
    2010年7月19日11:50

    @Nana

    确实有点神奇,主要城市不大

    喜欢看这种东西,我就写,正在策划写2篇关于“误诊”的故事;关键文字要“软”,比《科学美国人》还要软,要让从来不了解这个行业的人大概知道我在讲些什么

  4. yanhu
    2010年7月19日11:53

    @大宝

    隔行如隔山,见多了,就不怕了

    深更半夜,让我独自面对一具尸体,我也有点怕;但如果身边还有一个人的话,我就不怕了;如果那个人是女生的话,我就会表现的非常勇敢 :)

  5. 民老头
    2010年7月25日15:51

    当医生挺好的。我其实特别适合当医生,责任心强、心眼好、逻辑能力还可以、勤奋用功。我没当大夫是因为从小在医院长大,又在医学院的附小上学,看见大学生们成天抱着那么厚的书,要背下来,没完没了,而且当了医生后太累,我就害怕了。现在我挺后悔的,我愿意去当医生,但没有机会了,等我退休以后,如果有条件,我要去学学,看看有没有机会到落后的农村去行医,他们太需要了。还有,更现实一点,如果我将来有了能力,我要给医院投大把的钱,能开办一家医院最好,不行就投给协和医院。这家医院的大夫,无论是医德还是技术,都堪称国内标杆。
    你啥时候混泡网的?我们认识吗?

  6. yanhu
    2010年7月25日17:34

    @民老头

    你好!

    想想以前背那些东西真辛苦啊,有些内容不知背了多少遍才记住,其它专业学生的生活丰富多彩,医学生就整天背、背、背

    上班更辛苦,觉总是不够睡,还提心吊胆,总怕出事。所以吓得我都毕业了,到现在还不敢找工作,怕累啊

    别投协和了,他们不缺钱,最需要人员和资金的是农村和偏远地区

    我好像是去年年底来泡网的。我们不认识 ^_^

  7. 民老头
    2010年7月25日18:02

    @yanhu

    协和挺却钱的呀,硬件太差了。大夫收入也不高,我是说,相对于他们的价值,薪水太低了。最难得可贵的是,他们不欺负病人,不乱收费。生个孩子,顺产的话,才一千多块,比区里的妇幼保健院还便宜。偏远地区当然是最缺钱的,但是,唉。。。
    部队的医院才不缺钱。

  8. yanhu
    2010年7月25日18:10

    @民老头

    不好意思,不太了解协和的情况,只知道身边大医院的医生一点都不缺钱,他们的生活还是不错的。但付出还是挺大的,昨天带一个熟人的孩子去检查听力问题,一个50多岁的博导,周末还上班,门口排着一帮病人。

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