Newsletter No. 440

2 No. 440, 19.6.2014 「 很多研究指出，病人都希望臨終一段時間不需要受苦， 可以舒舒服服、無牽無掛，在家人陪伴下安詳離世。事 實上，現在醫學發達，很多醫療程序都可以延長人的壽 命——呼吸困難可以借助人工呼吸機，不能吞嚥可以插胃 喉或餵管，但從紓緩治療的角度，這些程序很大可能會為 病人帶來不適，且治療效果成疑，所延長的可能只不過是 瀕死過程而已。」那打素護理學院 陳裕麗 教授（ 右 ）說。世 界衞生組織定義紓緩治療為整合病患生理、心理、社交和 靈性層面的照顧，是幫助長期或末期病患者積極生活至 最後一刻的支援系統，但在香港這概念尚未普及。 陳教授說，過往十年，香港首十項死因已經不是意外，而 是慢性疾病。長期病患面對的問題會由生理慢慢轉移到 其他層面。「我接觸過一位六十多歲的肺氣腫患者，說自 己已兩年沒有外出走動。因為一個以前抽着煙的大男人， 現在要背着氧氣機過活，和自己昔日形象反差太大。他不 敢面對親戚朋友，變得孤立起來，更開始質疑自己的存在 價值：究竟我苟活下去還有甚麼意義？」 兼顧身、心、社需要 紓緩治療鼓勵病人維持正常社交，喝早茶見朋友，也可到 日間中心活動。待病情發展到中期，病人易倦，外出意欲 減低，才要增加覆診次數及讓醫護人員上門家訪，照顧病 人及家人需要。直至最後幾個月，病人或會因為某些急症 必須入院，才是要上病床的時候，家屬可以在紓緩病房長 時間陪伴患者。 對回天乏術的末期病人來說，需要的已經不是「病」的治 癒，而是「痛」的緩解。所以紓緩治療不是跟死神搏鬥，也 不是放棄生命，而是重新審視維持生命治療，如心肺復蘇 法、插胃喉、靜脈注射、使用呼吸機等對病人所帶來的利 弊，以及盡可能及時紓緩身體各種不適症狀，如疼痛、嘔 吐、氣促，維護病人尊嚴，讓他們平靜、安詳地走過生命晚 期階段。 為晚晴做好準備 為了讓患者更安心面對未來病情發展，同時減輕親屬日後 代病人下決定的重擔，紓緩治療的軟件之一是「預前照顧 計劃」，提倡病人在仍有自決能力時，表明當病情到了末 期時個人對治療及護理照顧的意願，例如是否希望使用 維生治療來延長生命，讓病者家屬了解其個人意願等。醫 護人員在教導和協助病人訂立預前計劃擔當重要角色。 那打素護理學院院長 李子芬 教授（ 左 ）說：「一般人錯認 為不該向病者提起敏感話題，所以我們教導學生怎樣用 正確的溝通方法，與病者打開話題。學生一開始覺得難以 啟齒，但最後發現病人其實根本不忌諱，只是等待誰先開 口。」 肯定生命意義 面對生死，總讓人思考甚至質疑人生的意義和目的。那打 素護理學院指導學生使用「生命回顧」的概念，幫助病患 找回人生價值。李院長說：「病人離開之時應對自己有正 面評價。很多人自覺一事無成，但或許忘記了，辛苦養大 孩子也是項了不起的工程。」學院的老年學理學學士課程 設計了一份功課，安排學生到院舍，聆聽患有長期病患的 長者講述自己人生故事，製成「生命紀錄冊」，讓他們宏 觀俯瞰生命的不同階段，不再沉溺於不愉快回憶。 跨科全隊照顧 紓緩治療除了是整合身心社靈的「全人照顧」、照顧病患 同時關心家屬的「全家照顧」，更是結合醫、護、牧靈、社 工、營養、心理及義工的「全隊照顧」，合力把病人的痛苦 減到最少。「所以學院的老年學課程也是一個跨科合作， 除了有駐學院的醫護人員、心理學家、社會學家和社工指 導學生，還邀請職業治療師、物理治療師為客席講師， 有時會請牧師與學員探討靈性課題，」李院長說。 據陳教授說，紓緩治療在香港發展了二十年，現時全港約 有十五間醫院設有紓緩病房。李院長認為，香港醫護人 員現時面對的大多數是慢性疾病，紓緩服務不應只由紓 緩治療科提供，而是所有醫護人員都應具備有關的知識 及技巧，「現在紓緩治療是個專科，但這個專科應該普 及化，因為所有病人都需要維持生命的尊嚴和生活的品 質。」 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. 紓緩治療：安恬 at the 醫療科技日新月異，戰勝不少病魔，但面對死亡這一課題，是否就束手無策？ 或許「可一不可再」就是生命最寶貴的一點，所以大家會為人生不同階段作出周詳計劃和準備， 講究「好活」，讓生命添上感嘆號。那麼「好死」又可以如何定義？ 醫護人員又如何讓病人為生命畫上完滿的句號？ 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 ‘ 邊註邊讀 Marginalia 編採寫載，不經不覺二十期過去，又是學年結束，與讀者暫別的時 候。一個階段終結，總會來點回顧點算。本期內容不謀而合，都略 帶這種意味。那打素護理學院的師生接受專訪，談到如何扶持末 期病人安詳走過世上最後一程，當中就利用製作生命紀錄冊， 點算一生的哀樂起跌。掌一公營大學的財政，必須以學生和同事 的利益為依歸而時刻點算，上任將近一年的財務長 陳林月萍 揮着 算盤，與我們分享箇中體會。都市人在外進餐頻仍，吃得是否健 康，往往無暇計較，晨興書院餐廳體貼入微，推出營養餐單，為我 們點算清楚。 暑期過後，本刊將在8月19日恢復出版。除了版面設計更新， 「人事動態」一欄會以新模式出現，還會推出新欄目，與讀者趣 談資訊科技，職場心得。 John Lubbock （1834 – 1913）在其書《生命之用》說：「休息不是 無所事事，炎夏永晝，有時躺在草地上，在樹下聽流水淙淙，看白 雲飄飄，絕非浪費時間。」無論你怎樣過這個夏天，希望大家重返 校園時，身心都能煥然一新。 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. ———————■■■——————— 目錄 Contents 紓緩治療：安恬地揮別生命 2 Finding Care at the End of Life 校園消息 Campus News 4 舌尖上的中大 CUHK f+b 6 博文貫珍 The Galleria 6 宣布事項 Announcements 7 人事動態 Ins and Outs 8 陳林月萍如是說 Thus Spake Salome Chan 10 現代紓緩治療「身、心、社、靈」的核心概念，萌芽於上 世紀六十年代一位英國女士 桑德絲 。 桑德絲1938年入讀牛津大學。隨後二戰爆發，她選擇受 訓為護士。1948年她遇上年輕癌症病人塔斯馬，兩人情 投意合。塔斯馬是波蘭猶太人，從華沙逃到英國，住在 倫敦一家醫院，徘徊死亡邊緣。 塔斯馬的痛苦煎熬對桑德絲衝擊很大。有天她和塔斯 馬談論到揮之不去的死亡陰影，忽然醒悟了：「我意識到 病人不僅需要減輕疼痛，更需要全面細緻的照顧。人都 需要空間來回歸本我。我提出了『整體痛』這個概念， 因為見到病人垂死之際忍受着肉體、精神、心理還有社 交痛楚，都亟待紓緩。自此我就投入到這項事業。」 1967年，桑德絲在倫敦郊外成立了第一家現代寧養院—— 聖克里斯多福寧養院，掀起了現代安寧療護運動。 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. 紓緩治療之母——桑德絲 Founder of Palliative Care — Dame Cicely Saunders 我們必須關心生命的品質，一如我們關心 生命的長度。——桑德絲女爵 We have to concern ourselves with the quality of life as well as its length. — Dame Cicely Saunders Copyright© St. Christopher’s Hospice, London