In the traditional Chinese concept, "death" has always been a taboo subject, but from life to death, it is a process that everyone must go through, without exception.
Where will we be in the last months of our lives? Will we be given the medical services and care we need? And how do we "close the curtain" with dignity? Such thinking seems to have gone beyond traditional medicine to become a social issue of human nature and ethics.
↑Beijing Geriatric Hospital's Care Ward by Zhang Ni
The Ward Closest to Death
Warmly colored walls, a warm photo wall ...... If you are not told in advance, it is difficult to associate the care ward of Beijing Geriatric Hospital with the word "death". The word "death" is not a word that can be associated with the care ward of the Beijing Geriatric Hospital without being told in advance.
But unlike ordinary wards, this place receives patients who have no hope of treatment and whose lives can be expected. Many are patients with advanced cancer, heart and lung failure, and kidney failure.
Compared to the hectic scene in other wards, the care ward is quieter and slower. More often than not, it is the medical staff who take the patient's hand and gently inquire about the day's physical condition.
How is your appetite? How is the mental state? These subtle changes they will observe and record. From time to time, the nurses will also talk to the family, explaining the precautions.
↑Jiang Hongning examines a patient (Photo courtesy of Beijing Geriatric Hospital)
In May 2010, the hospice ward at Beijing Geriatric Hospital was officially opened, making it one of the first tertiary hospitals in the city to specialize in this type of care.
Jiang Hongning, who was born in 1972, has been the director of the ward since it was first established, and has been at it for nearly 10 years, during which time more than a thousand patients have been sent away.
The name of the ward specifically avoids the word "terminal", but the medical staff working here are arguably the closest to death.
In the words of the head nurse, Mao Chunmei, it's often the case that a patient who was being cared for yesterday dies the next day. Young nurses who are new to the job often can't handle it.
But even so, Jiang Hongning and his team remain steadfast in this ward. The number of doctors in the ward has increased from a minimum of just two to five, the number of nurses has reached 15, and the number of beds has expanded from the initial 18 to 35.
"Death is something that everyone has to face and there is no way to avoid the topic. Both patients and their families need medical institutions that can provide them with such help. Carrying out hospice care is actually a symbol of social progress." Jiang Hongning said.
↑The care ward has a special room for talking. Zhang Ni photo
The hardest thing is to fight depression and fear
In the care ward of the Beijing Geriatric Hospital, there are specially set up talking rooms and function rooms. Among them, a treadmill and a dynamic bicycle are also specially placed in the function room.
"I like sports very much, and over time I found that this is a way to release pressure, so I will also encourage doctors, nurses, caregivers and even family members in the department to come over and exercise a little bit when they have time, so that they don't get too depressed."
In addition to healthcare professionals, patients and family members themselves can likewise have psychological problems. Some patients are admitted to the hospital with physical pain, but also varying degrees of anxiety, depression, and even suicidal tendencies.
How to minimize the impact of negative emotions has become an ongoing issue for the hospital.
↑ Fitness equipment in the function room can help reduce stress. Zhang Ni photo
"How to arrange the ward to make it more cozy and comfortable? What kind of medical staff to have? We thought of all these questions that we could think of." Deng Baofeng, director of the nursing department, said.
Deng Baofeng even considers their individual personality traits when selecting nurses for the ward. If they are too young, they may not be able to withstand the atmosphere of the ward, so she chose to "old, young" with even the nurses are cheerful and outgoing personality.
Over the years, in the care ward, in addition to professional doctors and nurses to take care of patients, the hospital is also equipped with pharmacists, psychological counselors and other professionals. In addition, social workers and other social forces regularly volunteer at the hospital, in order to minimize the psychological burden on patients and their families, and to combat the fear and depression caused by death.
↑The corridors of the ward are specially designed with a cozy photo wall.
Medical staff: the process of sending patients away is also a learning process
In the hospice ward, patients will not be discharged from the hospital as recovered as patients in ordinary wards, and if measured from this perspective, doctors and nurses are destined to not be able to reap the sense of fulfillment that comes from curing patients. But for them, the process of sending patients away is also learning.
"The patients who live here have different identities and experiences, and some of the elderly often have fun chatting with us and telling us stories as their energy allows."
"Sometimes family members return to the hospital long after the patient has passed away to say 'thank you' to all the healthcare staff, and although it didn't cure the elderly, it was very rewarding to be able to provide some help and comfort in the final stages of their lives. "
Mao Chunmei said that because she has seen so many partings, she and her colleagues have slowly begun to think about life over the years, how a person should live, how to cherish the moment.
↑ Each room in the care ward is named after a flower.
Hospice services are still facing development difficulties
From life to death is a process that all people must go through, and how to let everyone go with dignity is not just a purely medical issue, but a social one.
Data show that China's elderly population over 60 years old has reached 250 million, accounting for 18% of the total population, and there are 40 million disabled and partially disabled elderly. However, in contrast, there is a serious shortage of geriatric medical institutions, rehabilitation institutions, nursing care institutions, and hospice care (hospice) institutions.
On the one hand, there is a huge demand gap, and on the other hand, healthcare organizations themselves face constraints and difficulties in carrying out hospice care.
Nowadays, public hospitals in Beijing still charge for hospice services in accordance with Beijing's bed fee standards. But in fact, hospice care also provides a series of humane services, which are not within the scope of the fee, so under the existing mechanism, they are provided by the hospital free of charge.
"Patients enter the private medical institutions, to bear all the expenses themselves, but if you want to enter the public hospitals, but also face the problem of tight beds." Yang Aimin said.
And in terms of professional team building, hospice care in China is also in its infancy.
In the view of Chen Zheng, vice president of the Chinese Geriatrics Society and vice president of the China Life Care Association, there is still no unified standard for hospice medical services in China, and various medical institutions are "crossing the river by groping for stones", and the implementation of standardization and formalization is the focus of future work.
"In some developed countries, end-of-life care has become a specialty, there are specialized hospice physicians, our country still has a relatively large gap to catch up." Chen Zheng said.
↑ The care ward at Beijing Geriatric Hospital. By Zhang Ni
The taboo against talking about "death" is changing
The urgent need for reality has also attracted attention at the national level.
In October 2017, the first batch of national hospice pilots were launched in five cities (districts), including Haidian District in Beijing. In May this year, the National Health Commission issued another Notice, specifying that the second batch of pilots was launched in 71 cities (districts), including Shanghai and Xicheng District in Beijing.
This, improve the standards and norms, the development and introduction of hospice access to the guiding standards, clear hospice medication guidance, expert **** knowledge, etc. are listed as priorities.
"Payment methods and standards are key elements to explore. Whether to charge for beds, or to pay for the program? Long-term care insurance or health insurance? If you go with Medicare, under what circumstances can you get into a hospice? What level of hospitals should they be admitted to? All of these should have accurate assessment criteria." Yang Aimin emphasized.
In addition, in his view, another core issue is to establish a system of hospice care, tertiary, secondary, community and also home bed settings should be included.
"Chinese people in the past the traditional concept is very taboo to talk about 'death', but it is everyone has to face the problem, now the concept is changing, the future of the service will gradually follow." Yang Aimin said.