As patients, we want both expertise and progress. What nobody wants to face is that these are contradictory desires. In the words of one British public report, “There should be no learning curve as far as patient safety is concerned.” But that is entirely wishful thinking.引自 EDUCATION OF A KNIFE
Palliative specialists are experts in the care of dying patients—specifically in improving the quality of their lives rather than prolonging their lives. One might think we wouldn’t need a specialty for this, but there’s evidence that these specialists really are better at it. Dying patients often have pain. Many have nausea. Some have such poor lung function that, although they take in enough oxygen to survive, they live with a constant, terrifying breathlessness—a feeling that they are drowning and just cannot get enough air. These are patients with untreatable disease, and yet palliative specialists have been remarkably successful at helping them. 引自 A QUEASY FEELING
The key is simply that they take suffering seriously, as a problem in itself. In medicine, we’re used to seeing such symptoms only as clues in a puzzle about where the disease is and what we can do about it. And, as a rule, fixing what’s physically wrong—taking out the infected appendix, setting the broken bone, treating the pneumonia—is precisely the way to relieve suffering. (I wouldn’t be a surgeon if I thought otherwise.) 引自 A QUEASY FEELING
修机器。
But not always—and nowhere is this more apparent than with nausea. Most of the time, nausea is not a sign of pathology but a normal response to something like travel or pregnancy—or even to a beneficial treatment like chemotherapy or antibiotics or general anesthesia. The patient, we say, is “fine,” but the suffering is no less.引自 A QUEASY FEELING
Perhaps the most striking observation palliative specialists make, however, is that there is a distinction between symptom and suffering. As the physician Eric J. Cassell points out in his book The Nature of Suffering and the Goals of Medicine, for some patients simply receiving a measure of understanding—of knowing what the source of the misery is, seeing its meaning in a different way, or just coming to accept that we cannot always tame nature—can be enough to control their suffering. A doctor can still help, even when medications have failed.引自 A QUEASY FEELING
