The Knife's Edge: The Heart and Mind of a Cardiac Surgeon

In progress
Publish Date
Jan 1, 2019
Stephen Westaby
swinging sixties 1960s 英国“摇摆伦敦”新浪潮青年运动。 The whole riveting story of modern heart surgery evolved during my lifetime, and I was proud to be part of it. 作者的职业生涯经历了现代心脏外科的革命:心肺机(使开胸手术修补心脏问题成为可行)、心脏移植、人造心脏、ECMO等各种技术和医疗实践均在这一阶段出现并发展成熟。当然,代价是技术试错和完善过程中死亡的患者生命()。 现今的文化和(NHS)培养体系下成长出来的新一代英国医学生过于怯弱,不可能再进行那种程度的大胆创新。 《Do Not Harm》里提到 NICE(National Institute of Clinical Excellence) 决策 NHS 是否愿意为某种药物或治疗方法付费的依据:QALY。在2016年对于末期绝症患者,这个值是 5万英镑 per QALY (Quality Adjusted Life Year, 质量调整寿命年)。我觉得这种方式没有任何问题。医保永远不可能满足所有人。 swoop, scoop and run: Termed “scoop and run,” this strategy involves administering only Basic Life Support (BLS) at the trauma site before rushing patients to a hospital while they are still in their “platinum minutes”. 现代急救体系可以在危重病人送到医院前的黄金时间内提供高级生命支持(Prehospital advanced life support) Bart Simpson Because of a freak sporting accident, some qualities possessed by the vast majority of people were lost to me for a while, which proved an unexpected but substantial boost to a career at the sharp end – life perpetually on the ‘knife’s edge’. // what ?
Chapter 1. Family
Play-Doh These have been summarised in the medical literature as the ‘dark triad’ of psychopathy, Machiavellianism – the callous attitude in which the ends are held to justify the means – and narcissism, which manifests as the excessive self- absorption and sense of superiority that goes with egoism and an extreme need for attention from others. This dark triad emanates from placing personal goals and self-interest above the needs of other people ‘Tight on beds’ means not enough nurses. In the NHS, every intensive care bed must have a dedicated nurse. In other countries they double up quite safely to get the work done, but here we just cancel operations as if they were appointments with the hairdresser // NHS的官僚主义: 为了提高医疗服务质量制定的规则在实际上让病人等待手术时间更久:必须等待ICU有空余护士才能做手术。(术后需要进ICU) // 甚至 ICU 病人情况稳定后也要等待普通病床有床位时才能转出。有时因为普通病床没有空位,病人直接从ICU出院回家。 This was not how it used to be. When we fought to build the department, just three heart surgeons would perform 1,500 heart operations each year and we’d cover the chest surgery between us. Now in the same modest facilities we had five heart surgeons performing half that number of cases, alongside another three chest surgeons operating on the lungs. This was the price of progress – twice as many highly trained professionals doing much less work amid a disintegrating infrastructure. 进步的代价。NHS(以及所有其它现代国家公立医疗机构)的“働き方改革”,让医生和护士工作时间更加接近普通上班族(减少加班)。今天的医生选择医疗职业初衷是作为一个普通职业,而不是出于救死扶伤的道德感召。
Chapter 2. Sadness
ortic dissection is a dire emergency, where the main artery supplying the whole body suffers a sudden tear through the innermost of its three layers. This exposes the middle layer, which usually splits along its entire length under the high pressure, all the way from just above the valve down to the leg arteries. Branches to the vital organs can be sheared off, interrupting their blood supply and causing stroke, dead gut, pulseless legs or failing kidneys. Worse still, the split aorta is likely to rupture at any time, causing sudden death. Aortic dissection: 主动脉夹层(ja: 大動脈解離):非常危险。