無疑，今日的醫學生、實習醫生以至年青醫生，對抵抗壓力的能力，實在不能與上一代相比。有實習醫生的家長竟然向醫院投訴其兒女的工作量太多；某次我批評某實習醫生為何不參與病人急救，他竟然可以「發爛渣」哭起來並發狂起來，這在十多年根本就聞所未聞。可是，如果你要我評估，我就會覺得這是整個大趨勢所言，因為整個社會的抗壓能力，均未十年前廿年前差得多。醫學生以及醫生既然是社會的一部份，那麼抗壓力較弱這情況，理論上都不能倖免。
可是，網上言論以「抵受不住壓力」、「思想未成熟」、「一時衝動」等原因來評論其成因，我認為是過份天真與簡化。因為對我來說，離世的師妹，其實與張國榮一樣，都是因抑鬱症離世。
對於抑鬱症的病人來說，世界是灰的，一切都令他們透不過氣，做什麼也提不起勁，對身邊的事、物、人、情都失去興趣，覺得人生空虛無助，每天哭喪著臉，睡眠以及食慾都會受到影響，甚至覺得自己對世界是一項負累，為小事而感到無比內疚，最後不斷被自殺的念頭所佔據，甚至走上自毀的絕路。
無疑有很多人自殺是想引人注意，又或一時衝動，但更多的卻是因為受到疾病的困擾。抑鬱症是可以醫治的。所以對我們來說，師妹的病未醫好，所以就走上了離世的道路。
因抵受不住壓力而自殺，和因抑鬱症而自殺，其背後的「生理」physiological機制是不同的，後者是因為疾病所影響，現在我們相信是因腦神經信息傳導出現失衡；前者則是壓力應對（Stress Coping），而並非疾病問題。
我在二年級時，也曾經歷失去同學的痛楚。當時我不知道我身邊的同學因此會有什麼改變或成長。五年級時，我的同學身患沙士，徘徊死亡邊緣，我們不想再失去更多同學，我們一同哭過，一同流淚，當然，無人知道那天的眼淚，對今天已經作為醫生的我們有幾大的影響，甚至有任何的改變。
生命是無常的，素未謀面的師妹離世，提醒我們要珍惜眼前人，珍惜身邊的同窗朋友，尚有呼吸的一刻。悲慟失茫，是面對死亡的正常反應，人生就是由很多的無常所組成。逝去的生命不再復返，但關懷仍然可以延展至再生的人－－你的家人、你的朋友、你的病人，特別是正在與情緒病戰鬥的人。總有更正面的事我們可以做，問題是你會如何回應？
19個回應
十二月 13, 2008 at 5:32 am
Back then, I was depressed on and off and need supple. a few times thr the 5 years … smoked n without GF living in a public housing flat struggling with all those anatomy+physio+FM+Med (some of the supple.subjects) plus $ stresses ….
Now I m married and happy, ok well off gaining 6 digits pay/month … Praise God 4 His extraordinary grace to me.
CU MED Brothers and Sisters, Hang in there Always! There is always light at the end of your tunnel.
十二月 13, 2008 at 11:44 am
I wish you another hop from what you have ‘accumulated’so far.
十二月 13, 2008 at 12:09 pm
Being a staff at PWH for many many years, while also teaches at HKU, there are difference in the medical students.
whatever, the outcome, or my wishful outcome, is that students to grow into good doctors. Students may be good at exam, but not all are materials for caring doctors. It all starts from medical school.
It starts from the competition, compeition into medical school, competition to get in the front of regualr tests, competition to impress professors, and competition into some kind of training opportunities….
While we can’t change the culture, but, honestly, for all medical students, competition can be healthy and positive. what you need is a good tutor, an experienced and caring professor. (who may speak for you at the board meeting.) Most teachers are good teacher and can identify good students. Exam marks is not the only thing that counted for consideration to pass.
十二月 15, 2008 at 10:25 am
TO DR FAT:
“抑鬱症是可以醫治的。”<=我一個blog友佢都有醫,但醫極都唔好,仲由17粒藥/per day加到22粒!!
d藥既副作用令佢好辛苦!!!
請問其實有幾多%既病人係可以醫好呢???
to another dr,
“Being a staff at PWH for many many years,”<=真係估唔到wor!!!!
“whatever, the outcome, or my wishful outcome, is that students to grow into good doctors.”<=相信呢個唔單止係another dr既wishful outcome,好多人(尤其係病人)都會有呢個想法!!!!
唔知我下面既比喻有冇錯呢???
ms就好似小朋友,dr就好似大人!!!
如果我地想呢班小朋友將來長大成為dr時係caring,係好dr.我地係咪應該多d care下呢班小朋友,等佢地可以o係一個caring, support下既環境長大???
如果o係小朋友最需要人關心既時候冇人理佢地,但到佢地大左,我地淨係識得話佢地唔caring,我地對佢地會唔會太harsh???
another dr,多謝你一直以o黎對小妹既賞識,您曾經話過小妹作為一個病人,可以improve system.
其實小妹只係一個行外人,可以做既野,真係唔多!!!我只可以將自己既經歷/睇到既野寫出,希望將來既dr唔好重轁覆轍,令更多病人受害!!!
another dr,您係行內人,而且仲係一個caring dr!您先係可以make changes!!!大家都唔可以改變個制度,但您既caring絶對可以感染年輕/將來既dr!!!
所以最後,小妹還是懇請another dr早日開blog,透過文字去將您既caring感染更多年輕/將來既dr!!!寫blog,唔同出紙,係好free,唔洗要good at先寫得!!!(如果要gd at blog先寫得,小妹個blog第一個就執了!!!)
to all dr:
希望你地都可以盡量care下自己既師弟師妹,希望佢地可以o係一個caring既環境長大,好該hk將來有望可以有更多caring dr!!!
畢竟今日實在有太多鐵石心腸,麻木不仁,o係病人傷口上撒鹽既dr!!!(今次我冇指明道姓,請大家唔好作太多聯想,謝謝!!)
十二月 15, 2008 at 11:02 am
“好該hk將來有望可以有更多caring dr!!!”<=sorry打錯,係讓instead of 該!!!
“好讓hk將來有望可以有更多caring dr!!!”
十二月 15, 2008 at 11:08 am
Thank you ms.patientball, I am no good at typing chinese, and dr.fat and dr,stardust are much better than my wriiting skills.
Most dr learnt technical knowledge from textbook , update journals, and patient manners from seniors. But the major advance to push a doctor has to come from looking after patients.
Why would some patient be more inspiring and motivate doctors to treat them? why is that doctors given up in their duties?
Most doctors are perfectionsit to start with, but somehow, many be discouraged and become underperformed.
I am sure dr fat will be some changes, we all do, a patient is not just a patient,treat your doctor as colleague and stimulate their thoughts, I think your disappointment comes from the beautiful expectation that doctors can cure, which unofrtunately is not the case.
just borrow your site again,Dr fat and any MS, I am sure you have watched dr redbeard. I suggest the 2006 japanese series dr koto’s clinic. very touching and inspiring.
十二月 15, 2008 at 1:28 pm
dr fat,唔好意思,因為another dr始終唔肯開blog,我又唯有借用你個blog去回應佢!!!
another dr,
謝謝您既回覆,多謝您記得我係女仔!!!
“I am no good at typing chinese,”<=咁打eng!!!如果你打eng,我仲多個學eng既機會!!!eng news冇心機睇,但如果您用eng寫blog,我點都死d心機出o黎!!!
“treat your doctor as colleague “<=dr咁超班,點敢高擧??!!! “佢地讀5年醫+1年實習+專科訓練” 好巴閉ga!!!
“stimulate their thoughts”<=好多dr都有自已一套諗法,stimulate談何容易!!!???特別係o哥d成日將 “呢d我地要讀5年醫+1年實習+專科訓練先識” 掛o係咀唇既dr!!!!
“I think your disappointment comes from the beautiful expectation that doctors can cure, which unofrtunately is not the case.”<=dr,今次您估錯了!!!!
“doctors can cure”<=sorry我自懂事都冇呢個咁beautiful既expectation!!!或者我個人太實際!!!beautiful expectation唔會/甚少o係我個腦出現!!!
而1998年,當我親眼見到媽媽喊住咁o係教學醫院求dr去幫患肝癌正好辛苦彌留緊既爸爸打嗎啡時,dr係借左聾耳陳隻耳,乜都聽唔到,就咁走左!!!
“時日太快,無知的小孩一晚長大”,o哥晚我真係長大唔少!!!!o哥晚令我好清楚教學醫院既dr係d乜人!!!!
2008係爸爸走左10週年,10年o黎不斷問: “到底嗎啡係咪好貴???點解dr唔肯幫爸爸打,攪到佢要o係一邊痛,一邊叫,一d尊嚴都冇下走左??” (another dr,您可以答我第一個問題嗎??)
大家覺唔覺得對爸爸,對我,教學醫院既dr都太狠太毒????
o係現今社會仲有 “”doctors can cure”應該係未長大既小朋友,而且一定唔會係我!
明知山有虎偏向虎山行,唔係因為犯賤/膽生毛/想攪到自己腳跛,只係因為當年gp refer我去咋!!!而且HA係出名跟地址!!!住沙田,去教學醫院睇醫生=IS A MUST!
再講當年去睇醫生,純粹想知點解會腳痛左咁多年(1996開始,2005去ORT已痛了9年!)
只係估唔到會遇到一個以為OT=萬能既人渣[羅永年]!!!(教學醫院ort仲有大把dr有OT=萬能,呢個超低能想法,不過唔係個個人渣啫!!!)
更估唔到雖然有半月板撕裂,但可以跑(係著高踭鞋跑電梯!)跳踎跪既腳腳會斷送o係人渣手上!!!!
我既disappointment 絶對唔係 “comes from the beautiful expectation that doctors can cure, which unofrtunately is not the case. “, 因為由始至終我完全冇呢個expectation,試問又點會因而disappointed呢??
pre op前既腳腳咁叻,因為人渣既超低能想法而變成disabled,記得23/4/2007痛症科dr仲要同我講: “如果痛症超過5年(2006 OT我已10年)同埋又有舊患(我有半月板撕裂),手術後都會有神經痛!”
我唔知cu o係mbchb時有冇教痛症科dr所講既野,但我知道hku o係mbbs有教!!!
如果cuo係mbchb都有教,人渣唔單止係超低能,仲係超無能!!!
除左唔理術後會有神經痛,而夾硬要我ot外,人渣仲o係我排板度label我係 “RA NOT ON TREATMENT”去discharge liability!!!
面對呢d超低能+超無能既人渣,冇anger/disappointment既病人,係咪應該攞去研究???
十二月 15, 2008 at 3:45 pm
1.I am sorry for your leg. can you walk now?
2. Many doctors still hesitate using morphine, it takes many years to change the teaching.
3. no one should die in pain, I am sorry for your father,your mother and your request were very reasonable. mMny MOs or doctors do not think from the patients point, a major problem of modern medicine. Your voice or anger can change someone, keep letting these doctors know your anger.
Neuropathic pain is a possibility, not a must, do not expect it to happen.
I guess your feeling are being heard by many colleagues who follow dr fat’s blog.
十二月 15, 2008 at 5:17 pm
another dr,
謝謝回覆!!!
更謝謝您為小妹的爸爸+小妹隻腳難過.
又再證明左您一個仁心仁術的dr!!!我越o黎越鍾意您la!!!!
放心la, 人渣仲未有咁大能耐,令我行唔到!!!佢只係令我由meniscal tear(complex tear of anterior horn)變成arthrofibrosis!!!(不過對只做過meniscal repair既patient o黎講,呢個都已經係一個v uncommon complication!!!)而對一個冇”mechanical symptoms”既meniscal tear既病人o黎講呢個唔單止係一個v uncommon complication,而且仲係一個unnecessary+preventable complication!!!
如果人渣有咁大能耐令我行唔到,我相信medical council就會真正做到佢地o哥句口號-”行公義 Ensuring Justice 守專業 Maintaining Professionalism 護社
Protecting the Public “.haha!!!!
您放心la,我可以行,但唔可以跑!!!如果用極速,我可以快過散步/正常步速既正常人ga!!!!
只係以往可以著高踭鞋跑電梯/追巴士/追lift既日子或者會成為過去式!!!所以,而家只有o係有正常人追巴士+我再用用極速,我先有機會搭到就快開車既巴士!!!
如果行平路,應該冇乜人會發現,我隻腳有事!!!但行斜路,就會limping!!所以16/11/2008同表妹影畢業相,舅母見到我limping,就同媽媽講: “佢隻腳都好耐la wor,仲係咁ar!”聽唔到媽媽點答,但o哥刻我好想搵窿捐!!!
我既feeling heard by many colleagues又點呢???教學醫院ort班 “人” 都聽過la,因為已經有好dr幫我傳話了(雖然我唔知係邊個,但想o係度同好dr講句:多謝!!!) 但到今日咪依然死口唔認!!!而家medical council仲要幫埋佢地,話人渣冇失當!!!更加唔洗旨意教學醫院ort班 “人” 會認衰!!!
我而家個i/c好mind病人唔信佢,好想同病人有dr-patient rapport!!佢i/c左我1年多了,仲好full satisfy我!!!
對而家個i/c信任係有,但rapport應該未有,因為到今日佢地仲死口唔認!!!
1年多了,持續繃緊既關係相信大家都好辛苦!!!但o係佢地死口唔認,我又唔肯放低執着,試問又可以點呢???
其實自己都有諗過而家個i/c o係自己個case已盡晒力,係咪唔應該再執着要佢地去認,因為即使我點執着,佢地都唔會認.再執着落去,似乎對大家都唔好!!!但始終都係放唔低,因為仲好想sorry呢個字可以由佢地個口度出!!!
dr-patient rapport對ort dr同我真係好難!!!
十二月 15, 2008 at 5:28 pm
自殺，除一般人說的因「抵受不住壓力」、「思想未成熟」、「一時衝動」、「引人注意」等，或肥醫生說的「因抑鬱症」外，有其他可能性嗎？
十二月 15, 2008 at 6:24 pm
“酒後失去判斷力”, “幻聽” 亦可以
十二月 20, 2008 at 8:18 am
或者這樣問：自殺，可以是一個真的想自殺、也有能力為自己的生命作決定的人，清醒時非輕率地決定而做的、自主的行動嗎？抑或大家認為那是沒可能，就如王老五不可能是已婚漢呢？
十二月 20, 2008 at 11:25 am
sorry 唔係express anger!!
只係多事八卦既小妹想就kc既回應發下 “up 風”
我認為有可能,好可能好多當事人都經過心思熟慮.
sorry唔係想鼓吹自殺/揶揄冇能力自殺既人.
to a certain extent可以自殺係一種福氣!至少有能力為自己解脫!
十二月 21, 2008 at 1:31 am
因為無左RECENT COMMENTS既WIDGET…就選擇這一篇來覆先:
Not so old CU MED Brother:
I need supple too, and take several attempts for each MRCP paper. Sometimes med student finds meaningless and even existential distress while being a MS, well, to be honest, future prospect of MS is still very attractive, doctor still enjoy high social status and stable salary, hopefully it can be a stimulation to some materialist-oriented MS…
another doctor: I totally agree with you, a good and inspiring tutor can help medical students to grow, I feel regret because I get no tutor / mentor during my secondary school / church life / medicine life.
Patient’s ball.
When I say, “cancer is curable”, does not mean “no one will die from cancer”.
There is barriers for doctor to start strong opioid medication, like morphine or methadone to control pain for terminal cacner patients. Part of it related to lack of knowledge, part of it related to so called troublesome relatives. Not many doctors have exposed to palliative medicine. And if the relatives are troublesome, doctor’s focus will stay in “prolonging life” rather than “promoting comfort”.
KC / MS:
To define suicide, the simplest definition is someone to take his life away himself. The decision can be made under a sound condition, or in confusion stage, in emotion or well planned ahead. However, worth to note is that, DEPRESSION still accounts the marjority number of successful suicide case.
十二月 22, 2008 at 1:53 am
“cancer is curable”, does not mean “no one will die from cancer”<=絶對同意!因為兩樣野唔係MUTUALLY EXCLUSIVE!!!除左CA, DEPRESSION應該都係一個CURABLE BUT STILL MANY PEOPLE DIE FROM IT!!!!
1998到2008, 10年了, “lack of knowledge”+ “Not many doctors have exposed to palliative medicine”而家應該有改善ar ma!? 不過,知識空白/knowledge deficiency/麻木不仁既dr無論過左幾多年,都應該分別不大!!!
“troublesome relatives”<= 見到摯親彌留時,一面叫,一面痛,先去request 嗎啡既家屬,也算troublesome relatives嗎???若是的話,小妹無話可說!!!
唔知道troublesome relative係醫學界既定義係乜野(sorry 我冇大醫生讀咁多書,所以連troublesome都唔識解!!!!)
講開唔識解,其實小妹自27/4/2006人渣巡房後,我一直都想問到底有medical background既人係點定義個 “幫” 字呢???
記得27/4/2006因effusion入院,28/4/2006人渣巡房時,我問佢: “我隻腳做完手術仲衰過未做wor,到底你幫我定害我ga???”當時人渣好大聲話自己幫我解決我既問題!!!!
乜原來整跛我隻腳後,仲要老屈我係 “RA NOT ON TREATMENT”都算係幫咩???到底係我讀得書少,唔識解/解錯左個幫字既意思呢???得閒似乎要去睇下辭海去睇下個幫字係整解先!!! 但我始終覺得,有medical background既人對某d字既定義,實非外行人,尤其係我呢d冇乜讀過書既蟻民,所能理解!!!!
與其話 “if the relatives are troublesome, doctor’s focus will stay in “prolonging life” rather than “promoting comfort””, 不如話某醫院既入職條件係為病人/病人家屬增加傷痛or製造更多更大既傷口!!!!特首就話佢要做好呢份工,人地就係我要整大呢個傷口!!!話唔定人地將o係傷口撒鹽視為己任tim!!!
十二月 22, 2008 at 2:14 pm
testing,因為blog友仔話佢留唔到言!
十二月 22, 2008 at 5:21 pm
That is a very fundamental question:
講開唔識解,其實小妹自27/4/2006人渣巡房後,我一直都想問到底有medical background既人係點定義個 “幫” 字呢???
記得27/4/2006因effusion入院,28/4/2006人渣巡房時,我問佢: “我隻腳做完手術仲衰過未做wor,到底你幫我定害我ga???”當時人渣好大聲話自己幫我解決我既問題!!!!
I wish I have the answer.
What is “幫”? and how much does a “幫” 字worth?
why should one “幫”another human fellow?
十二月 23, 2008 at 3:25 pm
to another dr:
謝謝醫生回覆.
您提出3個問題令我恍然大悟!!!
您提出3個問題某程度上對cmc事件有d啓示!
十二月 23, 2008 at 5:04 pm
肥醫生：
這裏的depression是指憂鬱（情緒）還是指憂鬱症，account for是否指「因…引致」，是在死者生前還是在死後被判斷呢？
還有，「因病離世」令人（最少令我）想起類似「患流感的人不由自主地打噴嚏」那種不自由主、不為已願、總之自殺是「病魔」指使那人作的決定而非出於那人「真正」的意願。肥醫生是想帶出這種意思嗎？