今が生死

88歳の男性患者さんが昨夜亡くなった。彼は進行胃がんで何も食べられない状況で
あった。彼は大病院から来た患者さんで、そこで進行胃がんと診断され、手術を勧
められた。もし手術をしなければ、胃の幽門輪が詰まってしまい何も食べられなくな
るし、沢山の腹水も溜まってくると説明された。しかし彼と奥さんは手術を拒否し
た。その大病院から手術をしないなら退院するか小さな病院に転院してくださいと言
われて紹介で我々の病院に転院し手術も抗がん剤も使わないで治療していくことに
なった。彼が我々の病院に来た時には幽門輪は完全につまっており、腹水が沢山溜
まっていた。彼は大病院にいた時に手術のチャンスを逃してしまい、すでにどのよう
な治療法もなかった。我々は水と電解質液の点滴とチューブを使って閉塞している胃の
中から貯留液を排出してやるだけであった。家族は若し血圧が下がっても薬を使って
血圧を上げたりしないで、自然のままにしてくださいと希望しており、血圧が下がったま
ま静かに息を引き取った。私はなぜ手術を拒否したのですかと聞かなかった。通常、
手術をして幽門輪を閉塞させないようにすれば、もっと長く生きられた筈だ。私は多く
の患者さんが進行がんでも手術して長く元気でいるのを見てきているので、彼が手術を
拒否したのは本当に残念なことだと思った。

A 88 years male patient died last night. He was suffered by advanced gastric
cancer and couldn’t eat anything. He came from the big hospital where he
was diagnosed as advanced gastric cancer and was recommended to operate. He
was advised as follow , if he didn’t operate, the antrum ring was closed
and couldn’t eat anything and would have much ascites. But he and his wife refused
to operate. The docor of big hospital said to them to discharge or move another small
hospital if they didn’t operate. And he was introduced to our small
hospital to care without operation or anticancer drugs. When he came to our
hospital his gastric antrum ring was completely obstructed and his abdomen was filled with much ascites.
As he had missed the chance of operation when he was in the big
hospital, there were any method of therapy. We gave him drop infusion of
water and electrolytes, and drainaged the juices from obstructed stomach using tube.

His family didn’t want to raise up the blood pressure using the drugs if
his blood pressure went down. They hoped natural causes, and died quietly
last night. I didn’t ask them why they refused to operate . Usually if the
patient had operation and hadn’t obstruction of antrum ring, he might live
more long life . I lamented that he refused the operation, because I knew
many patients who were operated even advanced cancer had been alive healthy long lives.