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想看你的肌腱嗎?醒著動手術 醫病關係新紀元

2017-04-20 16:07紐時賞析

Going Under the Knife, With Eyes and Ears Wide Open

"Do you want to see your tendons?”

Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility.

“That’s pretty neat,” the patient, Esther Voynow, managed to gasp.

「你想看看你的肌腱嗎?」

專門處理手部和腕部的外科醫師阿西夫.伊爾亞斯準備為他的病人縫合傷口。但他先讓她有機會看她放射性疼痛的來源:看起來像淡粉色彩帶糖的一束肌腱。他用一件細長的外科手術器材把肌腱往外推,以展示新獲解放的彈性。

病人艾絲瑟.瓦伊瑙幾乎喘不過氣地說:「真不錯。」

非文中新聞事件,圖為用腹腔鏡進行切肝手術。 聯合報系資料照/記者謝梅芬攝影
非文中新聞事件,圖為用腹腔鏡進行切肝手術。 聯合報系資料照/記者謝梅芬攝影
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The operation Ilyas performed, called a De Quervain’s release, is usually done with the patient under anesthesia. But Voynow, her medical inquisitiveness piqued and her distaste for anesthesia pronounced, had chosen to remain awake, her forearm rendered numb with only an injection of a local anesthetic.

More surgery is being performed with the patient awake and looking on, for both financial and medical reasons. But as surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. Patients can become unnerved by a seemingly ominous silence, or put off by what passes for office humor. Doctors are only beginning to realize that when a patient is alert, it is just not OK to say, “Oops!” or “I wasn’t expecting that,” or even “Oh, my God, what are you doing?!”

伊爾亞斯做的手術稱為狹窄性肌腱滑膜炎(俗稱媽媽手)緩解術,手術時病患通常會麻醉。但瓦伊瑙受到醫學好奇心驅使,加上很不喜歡麻醉,選擇保持清醒,只打了一針局部麻醉針,讓前臂失去知覺。

基於費用和醫學考量,愈來愈多手術是在病人保持清醒和注視下進行。但是在接受手術的病人選擇睜大眼睛之際,醫生與病人之間的行為準則卻沒跟上這種新做法的腳步。病人可能因為似乎予人不祥之感的沉默而緊張,或是因為所謂的辦公室幽默而覺得尷尬。醫師們也才剛剛開始明白,當病人處於警覺狀態時,可不能說「糟糕!」或「我沒預料到」,甚至「哇,我的老天啊,你在做什麼?!」

“For a thousand years, we talked about the operating theater,” said Dr. Mark Siegler, a medical ethicist at the University of Chicago and an author of a recent study on surgeon-patient communication during awake procedures, published in The American Journal of Surgery. “And for the first time, in recent years the patient has joined the cast.”

Choosing to watch your own surgery is one more manifestation of the patient autonomy movement, in which patients, pushing back against physician paternalism, are eager to involve themselves more deeply in their own medical treatment.

芝加哥大學的醫學倫理專家馬克.席格勒說:「我們談手術劇場已談了一千年,這幾年,病人才頭一次加入演員陣容。」他最近在「美國外科手術期刊」上發表了一篇有關清醒手術過程中醫病溝通的研究報告。

選擇看著自己的手術進行,是病人自主運動的又一表現,在這個運動中,病人反抗醫師的家長式作風,樂於更深入參與自身的治療。

A few studies suggest that some patients feel less anxious about staying awake during surgery, despite possible gruesome sights, than they do about being sedated.

Voynow did not need a preoperative physical exam, blood work, an IV drip or even an attending anesthesiologist. As nurses wheeled her on a gurney out of the O.R., she looked pleasantly surprised. “I’ve had root canals that were worse,” she said.

一些研究顯示,部分病人覺得在手術時保持清醒,反而不像被麻醉那麼讓人焦慮,儘管可能會看到駭人的景象。

瓦伊瑙不需要術前身體檢查、驗血、靜脈注射,甚至一位麻醉主治醫師。當護理師用輪床把她推出手術室時,她顯得既意外又愉快,她說:「這還沒有我接受過的一些根管治療可怕呢。」

文/Jan Hoffmann

譯/田思怡

英語國際觀

紐時賞析

精選紐約時報精彩報導譯為中文並刊出原文,配合賞析導讀,讓讀者除了學英語也能深入了解全球文化。

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