Monday, 28 March 2016

2016.03.18 - 03.29 鬼佬華佗史密夫,外科手術成日do;醫道仁心口碑重,金刀一亮除病汙。






2016.03.18 - 03.29 鬼佬華佗史密夫,外科手術成日do;醫道仁心口碑重,金刀一亮除病汙。






瞓醒覺,精神好尐,繼續講古。話說:

三月十八日。朝早九點,阿珊、大小姐同我去到醫院,喺櫃檯登記後,就坐定定等嗌名。北岸醫院,似酒店多尐,由櫃檯、牆身、天花裝飾設計,到工作人員服飾,你都睇唔出係身在醫院。更加絕對冇白袍人搭住聽筒走嚟走去。咁樣應該可以降低病人對醫院嘅恐懼。

十點半,接咗我哋入等候病房,情形就好似照胃鏡一樣。等候,係一件好煩惱嘅事,等咗粒半鐘,呢粒半鐘真難捱。十二點,卒之就有麻醉䕶士入嚟。佢驗明正身,辦好手續,用一張好暖嘅氈冚任我。同至愛再次輕輕擁抱,我就瞓喺車仔牀,一路推入手術室。望住家人喺我視綫消失,真係有孤身走我路嘅感覺。

雙掩門推開,手術室前係個窄房,呢度就係麻醉室 Anesthetic bay,唔知點解,手術室都有個好大嘅鐘,而家係十二點半。冷氣好凍,我冚多張暖氈 。

後面門推開,麻醉師橋茵醫生走入嚟。趁門推開嗰一剎那,我望見手術室,其實係一個好大嘅大廳,我見到十個八個着住深藍色手術袍嘅人,正喺度佈置緊手術設備。佢自我介紹,並且解釋佢將會做尐乜嘢,我全部冇異議(可以咩?)。佢喺我右手臂近脈門處打兩支針,先將呢部份肌肉麻痺,就喺呢度揷入兩支針咀,再用膠布固定,以後麻醉針藥就由呢處注入。佢又話,再會喺我鎖骨上照辦煮碗,挿入三支針咀,手術後嘅 PCA 止痛針藥及營養液,就由呢處注入。不過我唔會睇到佢點樣做,因為當我全身麻醉後,佢先至會搞鎖骨呢三針。

原來搞下搞下都搞咗成粒鐘,手術室似乎準備得八八九九,士密夫醫生入嚟打招呼。大鐘搭正一點半,睇住橋茵醫生喺我手臂注入麻醉藥,我就即時冇咗畫面,真係快過打針。睇戲時,麻醉師會叫人數123,我麻醉過四次,冇一次係咁,尐編劇喺咪揾苯嘅呢?

其實,麻醉咗係好舒服,時間亦過得好快。以往三次我醒返,都似瞓醒覺,好舒服。但係今次醒返,就覺得周身唔自在。我記憶第一句說話聽到,就係有人用英文問我痛唔痛,「sore!」我迷迷糊糊咁答。又聽到有人嗌 「morphine」,此後斷斷續續有尐對話,都係 yes no questions,我瘟瘟燉,唔知有冇答錯。冇耐,我稍為清醒,知道全家都喺我身邊,先至知道自己已經入咗 ICU。大少大小姐見我瞓醒覺,又得知情況穩定,就開始講笑,又話唔好引我笑,因為一笑,肥腩就痛。我記得我冇乜點講嘢,只係同佢哋單眼。唔知幾耐,佢哋都返屋企,今晚,我一個人就會喺 ICU 呢度過夜。

而家回帶。個手術可能四點零搞掂,即係約三粒鐘,我就推咗入 ICU,阿珊知道消息,即刻趕嚟,五點半,全家就齊集 ICU 嘞。離開手術室嘅我,經已改造成為一個「差不多無謂人」,腹腔裏面,只剩低唔夠四分一個胃,所以又唔係咁「無謂」喎。本來連接胃部嘅十二指腸,而家同個胃部分離,並且封咗個入口,成為掘頭巷,不過仍然繼續佢接受嚟自肝膽胰酵素嘅功能,幫助消化食物。切一節小腸,一邊連住嗰四分一胃,另一邊就成為十二指腸及小腸嘅三义路口。點解唔直接將十二指腸連接胃部切口,而要搞到咁複雜呢。原來如果咁做,十二指腸嘅消化液就會流入食道,咁就好唔舒服喇。

內裏嘅改造,外邊人睇晤到,不過由胸骨劍凸開始一直落到肚臍嘅一道 6 吋疤痕,就盲嘅都睇到嘞。我左邊身由大髀至頸都貼住一粒粒電極,電線連住監視器,電視就顯示住生命數據:心電圖、心跳、血氧量⋯⋯。右手邊就好似橋茵醫生所講,手臂仲接住麻醉止痛藥,鎖骨就連住營養液 Intravenous Drip (IV)。仲有,肚臍右邊有條管,將腹腔嘅液體帶出體外。右邊鼻哥窿挿住鼻喉,一路伸入喉嚨直達胃部,傷口嘅液體就通過呢支管抽出。

五粒鐘,變成咁,你有乜感想?

今晚,我唔得閒諗尐咁深奧嘅人生哲理,喺嗎啡嘅影響下,如果乖乖哋唔係周身郁嘅話,我都唔算好痛,但係成個人就瘟瘟燉燉,似醒非醒,似瞓非瞓。牆上個鐘指住十點二,係一個  V 字,咁係咪幫我打氣呢?我瞓咗好一陣,掰大眼,個鐘又係 V 字,如是者,瞓瞓醒醒唔知幾多十次,個鐘都係 V 字!我開始懷疑我揩咗嗎啡,出現幻覺,點解時間停頓咗?

我瞓喺 ICU 病房,䕶士枱就喺門邊走廊。䕶士隔住玻璃,分分秒秒都可以望住我,每個鐘頭,䕶士都要埋嚟,有時量血壓,有時拮手指,總之多嘢搞,其實我都唔知自己有冇瞓過!轉頭望向左邊窗簾下透出外面少少光線,都唔知係夜晚定係清晨。一個冇晒時間概念,又唔知瞓到幾時嘅夜晚,原來好難過。

我望住 ICU 嘅走廊,昏暗嘅燈逐漸光起嚟,亦多咗䕶士,係交更嘅時候。哦,黑夜終於過去。此時,再望牆上個鐘,仍然係 V 字。唓!唔係乜嘢幻覺,原來只係一個壞鐘。計起嚟,我攤咗喺 ICU 足足十五粒鐘。

兩個䕶士要喺病人面前做好交接手續,講病歷,打過乜針,食過乜藥,有乜嘢喺當更時發生過嘅事等等,而接更䕶士又會向病人自我介紹。

三月十九日清晨。個天愈嚟愈光,走廊亦愈嚟愈多人。ICU 醫生埋嚟問我有幾痛,原來醫院用 1-10 度,畀病人自己去形容佢有幾痛,此後,呢個 rating,我一日畀人問幾次,此是後話。當時仍然覺痛,所以答「七」。佢可能係麻醉科,或者係 pain management 嘅醫生。佢將我最先做手術前右手臂嘅針咀拆咗,咁即係再冇定時定候供應嘅麻醉止痛藥注入喇,然後係鎖骨處預先裝好嘅針咀,接駁一條管,呢尐就係所謂 PCA 喇(Patient-controlled analgesia), 個主機鑲喺營養吊針架上面,一支家庭裝牙膏咁大嘅嗎啡針筒(好似小型玻璃膠),就擺喺自動注射器,並且鎖喺透明膠盒裏面。呢個透明盒要用鎖匙,及輸入我手帶密碼先至開得到,每次唧出劑量預先調校,此後,冇人可以擅自更改。醫生畀個控制器我掛喺右手腕,如果覺得痛,我就撳佢一嘢,定量嗎啡就由膠管引到鎖骨入口,經過血管,直達腹部神經,咁就止痛喇。真係好方便。

十點。有物理治療師埋牀,自我介紹一番後就要我起身。各位,此時,只係手術後十幾小時!物理小姐先要我「隊」一劑嗎啡,等個腩唔使咁痛。到落牀時,梗係要費一番周章,我左張龍右趙虎,論論盡盡,終於坐咗喺牀邊高身疏化,又唔係天旋地轉咁差,不個都係 wee wung wung 個隻。原來物理小姐要教我呼吸,佢擺咗一疊雪梨晨鋒報喺我枱面,然後叫我揭一頁就深吸一啖氣,忍住三秒,呼氣,再揭另一頁,如此類推。哦!咁即係深呼吸運動啫。受麻醉藥及肌肉鬆弛藥物影響,手術病人用以呼吸嘅肌肉後墮,而且收縮能力減弱,深呼吸運動,可以幫助清除肺內積水及防止肺氣腫。又因為擴展肺部,令橫隔膜、胸腔腹腔肌肉可以運動,幫助復元⋯⋯。呢尐係常識啫,難唔到我。不過有一樣我唔明,「點解要揭報紙呢?」我問。「係數住你做咗幾多吓!」噓,好彩我冇問點解唔揭澳洲人日報。

物理小姐交低功課,就去第二間房。我鬼咁勤力,成份揭晒,又揭返轉頭,連都唔知佢識唔識嘅「腹式呼吸」、「胸式呼吸」都一一練習,原來真係唞大氣都會頭暈。佢再出現,「乜你仲揭緊?」「你冇叫我停噃。」「我預你做十五分鐘左右。」「⋯⋯」

阿珊嚟睇到我都嚇咗一驚,乜咁快就落咗牀!阿珊坐喺我對面望住我做呼吸運動。

冇事冇幹,就唔再住 ICU ,揭完報紙上返牀就要預備搬房喇。

下午一點。睇我嘅䕶士同埋大隻佬將我推走,牀尾仲放咗大少爺大少奶送嘅花。我住喺五樓南座嘅一間房,窗開向東北,因為地勢較高,風景好到不得了,就算我瞓喺牀都睇到窗外風景,算係咁喇。

我今日當然比噚日啱啱做完手術嗰陣好好多,但係都只不過係廿四小時左右,其實仍然好瘟燉,上咗病房後,阿珊佢就一直陪住我,我就只係攤喺牀,有一句冇一句同佢講嘢,一有尐痛,就自己唧嗎啡,唔使麻煩尐靚䕶士。令我想起以往病人痛到飛起,大嗌「姑娘,好痛呀。唔該打止痛針吖?」尐䕶士四圍䠮,忙到七彩,「等陣喇,忍下先喇。」叫痛聲此起彼落 ⋯⋯。咦,唔知香港醫院有冇尐咁嘅設備?

七點左右,佢要返屋企,又剩低我一支公喇。不過,我唔會太安定,每四粒鐘,就有人入嚟量血壓、探熱,又問你有幾痛。咁上下又入嚟換營養液、嗎啡針等等。其實,我都好難瞓得著,咁多條管喺身,又唔畀得佢哋繞嚟繞去,又要顧住唔好壓到尐傷口,瞓覺招式非常有限,就只得「肚腩朝天」呢一招。

三月二十日。第一個病房夜晚又過去,踏入秋天,太陽愈出愈遲,七點半,窗簾映出陽光,撳鐘叫人幫手打開窗廉,朝陽晨光由窗右角射入,左邊雲端一片紅霞仲未散去。乜真係靚得咁交關!其實,好多日出我都睇過,少年十五二十時嘅鳳凰山,尼泊爾 Sarangkot、喜馬拉雅 Kala Pathar、台灣阿里山⋯⋯,咁呢度北岸醫院有乜咁好睇?唔通經過改造,內裏嘅思維、諗法真係會唔同咗?

太陽出嚟,房外走廊亦熱鬧起嚟,人聲、推車聲,砰碐磅硠,  Pantry 預備緊早餐。早餐又冇我分,我喺 NBM(Nil by mouth ),有得聞(睇都睇唔到)冇得食。都係瞓唔着,不過仲可以睇下 iPad ,咁都冇咁悶。

冇耐,又有物理小姐埋嚟,今次佢先要我每5分鐘撳一次 PCA ,等個腩揩夠嗎啡,先至開始落地行。起身坐喺牀邊,都係一番掙扎。企得起身,推住掛滿晒嘢嘅轆架,開步行出走廊。我行咗兩三步,就已經攞返腳踏實地嘅感覺。行走廊?難倒我?南美洲印加古道都行過 ⋯⋯,話口未完,走廊頭行到走廊尾,兩隻腳仔,震過貓王。點到你唔服!震騰騰坐返上牀,今日功課係咁多。

又到黃昏時分。阿珊佢返屋企之前,都會先幫我搞掂個瞓覺架步,確保一切所需物品,都喺伸手可及嘅距離。升降牀、燈光、叫人鐘全部妥當,佢又要返屋企煮飯食,真難為佢。

剩返一支公,就同 iPhone 、iPad 玩喇。成日揩嗎啡,仲係瘟下瘟下,我齋睇唔回應。睇到攰就瞌埋眼,但係始終都瞓唔著。換咗夜間護士,佢地喺昏暗嘅走廊走動,攞住電筒推住儀器走入病房。為咗唔騷擾病人,佢哋唔會開房燈,摸黑幫病人探熱打針量血壓。即刻諗起克里米亞戰爭嘅南丁格爾,拎住油燈照顧傷病患者。我又要好大力咁捽住嚿木,因為我有幸得到高標準、合人道嘅醫療䕶理照顧,但係幸福唔係必然,睇程思華嘅〈地獄醫療逃亡實錄〉,其中提到:大陸醫療毫無「䕶理」觀念,一般病人根本完全接受唔到任何䕶理,家人要照顧病人一切所需,唔止食撒疴瞓,着衫沖涼等生活基礎必需外,仲要照顧埋醫療設備,營養液、傷口護理,都由家屬負責!絕對係魔鬼醫療制度!人哋160年前,已經咁重視專業䕶理,160年後,又話生產力,又話GDP,奢言大國崛起。咁多錢,去晒邊?點解人民要受呢尐苦?

最近同佢講起澳洲、大陸、香港三地嘅醫療制度評價,佢話好簡單,就係天堂、地獄、人間。

要睇思華嘅真實回憶可買呢本書:(先賣廣告)

地獄醫療逃亡實錄 - Jul 3, 2015 
作者: 程思華
出版社: 紅出版(青森文化) 
定價: HKD $78.00

蔣家受惠於英式政治制度,常懷感激之心。識得感恩,並唔係中國文化獨有,優良人類,不論富貧,就有呢種質素。七十年前香港,蔣家窮到搵個仙刮沙都冇,但係阿媽居然可以喺1947、1949 及1955 三年,喺贊育醫院(西邊街舊贊育),接受剖腹手術,令我及兄姊得以寄生呢個塵世。唔係話英國政府畀錢香港(雖然係喺1922年,由倫敦會傳教士所創立),嗰時啱啱打完仗,英國佬自己都好窮,好唔掂。而係個英式制度,以人為本,紓緩貧富矛盾。喺「各有各世界,各有各搵食」之餘,亦伸手支援弱者,咁樣,社會就和諧得多喇。不如問下神州,一個有質素而又安全嘅剖腹產子手術,今時今日,開價如何?一般蟻民,孭唔孭得起呢條數?

上世紀末,我離開英屬居留地,移居袋鼠國,大半個世紀,得以繼續享受此一制度之福,開心又放心。香港人個個都識講:「得人恩果千年記」,我常懷感恩,實應有之義,唔係一句「漢奸走狗」,就可以抹煞一個人嘅生命軌跡。我而家喺袋鼠國醫院病牀上寫嘅,就係我親身嘅感受。

三月二十一日。噚晚,已經少咗瘟瘟燉,但都係瞓得唔好。呢排,尐䕶士成日問我放咗屁未。南丁格爾唔講「發」咁粗魯,講「 passing wind」。咁就斯文得多嘞。原來有得發,係表示個消化系統正在復元中。唔講唔發,哈,一講就發出嚟喇,上午七點: 1st fart, yeah!我四圍話畀人聽:「我發咗喇」,「Wow, that's good」個個笑住同我講。各位試下同人講發咗,睇下得到乜嘢反應。

都只係手術後嘅第二日,傷口嘅痛,喺  PCA 嗎啡嘅控制下,經常保持喺 3 至 5 度之間,絕對唔算難受。最困擾嘅係條鼻喉,佢由右邊鼻窿經咽喉、食道,直入胃部,主要用嚟吸取傷口嘅分泌物,鼻喉外面連接一個盛載袋
,喉上面有個分义口,䕶士經常用針筒喺呢度抽出分泌物,然後記低抽出幾多分量。如果抽到好多,即係表示分泌物堆積喺度郁唔到。如果愈嚟愈乾,即係話分泌物識得向前行,咁表示個系統正在工作中。而家我條鼻喉已經愈嚟愈少嘢抽到,窈窕尐嘅靚䕶士有時都晤夠力掹個針筒!咁係好事嚟嘅!係就係,條鼻喉幫緊我,大家諗下,每次吞口水,我都感覺條喉存在,瞓低尤其辛苦,有時佢會惹到你咳,仲死。一咳,個傷口可以痛到 7 至 9 ,咁點瞓得安樂?

物理小姐又嚟,今次起身落牀都爽手好多,推住個架行出房外,已經冇話暈陀陀,簡直只係一件餅。物理小姐跟住我行咗個匝,見我冇乜問題,就去下一場,我見行得咁過癮,點會畀佢停,一於兜住走廊係咁行。初初見到人都笑吓打吓招呼,一次兩次三次n次,再見到,微笑就算喇。我諗,咁樣行嚟行去,唔知會唔會阻住人做嘢呢?如是者,卒之行咗半粒鐘,見肚腩有些微感覺,又係時候收工上牀喇。

如常,攤喺牀上都唔會十分安靜,靚護士咁上下就會嚟招呼你。我鎖骨揷住嘅喉管,係可以喺嗰度抽血,抽血時只需擰螺絲駁住針筒即可,我完全冇感覺。對比以前,餐餐要喺手臂、手指拮針,現代醫學,真係造福人群。

阿珊佢返屋企後,又係我獨自胡思亂想嘅十幾粒鐘。

三月二十二日。瞌下、醒下, mee mee more more 又天光喇,第三個病房夜晚,咁又過去。已經可以自己落牀,第一件事企起身,睇下自己尐喉有冇打晒 kick ,然後掹咗揷穌,咁你就可以推住個架四圍走嘞。首先執返好間房,將枱仔推返去窗邊,降低返張牀⋯⋯等等,自己刷牙洗面都冇問題。

噚日行得咁過癮,今日繼續行,而且開咗個 sport tracker,紀錄下時間距離都好噃。我推住個架。行行重行行,卒之,我用一粒鐘行咗 2.3 k。今日比噚日行得耐,靚護士度度都見到我,又要收慢腳步,又要因住會 kick 倒我,都唔知好嬲定好笑。

今日照顧我嘅係男護士威廉,佢生得高大,可能慣喺群雌粥粥,連自己乸乸哋都唔係好覺,佢好有能力,有佢照顧,我好放心。

今日係大日子,噚日史密夫醫生嚟巡房,決定今日可以拆除兩條喉:鼻喉同埋尿喉。所有喉管都係喺麻醉後揷入身體,而家拆除,只須企喺度就得嘞。拆呢兩條喉,嗰種痛嘅感覺都好難受,當然拆咗之後嗰種舒暢,亦係不可言寓喇。噓⋯⋯舒服晒。

冇咗鼻喉,靚仔返晒,仲可以大力洗面、擤鼻。冇咗尿喉,咁就要去廁所喇,䕶士叫我記住,當有第一篤尿,即刻向佢報告。冇咗尿袋,個架都輕尐,推起上嚟又輕鬆尐。

下晝,凱莉䕶士嚟探訪我。記否?佢係我哋第一次見史密夫醫生同時出現嘅人物。凱莉䕶士係一個聯絡人,係以獨立身份介入呢件事,唔會偏側於任何一方,佢聯絡所有有關專業:手術、麻醉、醫院⋯⋯等,並且監察服務質素,確保病者得到合理水平嘅服務。澳洲醫療,我又要感恩一番喇。

下午四點十分,望穿秋水嘅嘢終於到嚟,買細開細, 1st pee 終於出現,即係話拆尿喉之後一切正常。咦,望穿「秋水」,而家就係秋天,真係應景。

如常,佢返屋企之前,又幫我搞好個竇先。七點鐘,又剩返我一個人,面對漫漫長夜。黑夜,係思想跳躍嘅地方,愈係孤獨,思想跳躍得愈快、愈古怪。

我個人冇秘密,我將我全真嘅經驗擺出嚟,唔覺得係乜嘢一回事。好多人話我樂觀、正面,其實我只係面對現實,事件會走向邊度,人力焉能控制?唔係你好樂觀咁想中六合彩,你就會中,你悲觀你樂觀都冇用,完全唔影響結果,因為仲有好多,我哋不能控制嘅因素影響緊件事。周潤發〈我愛扭紋柴〉開場就講:「既然笑又要騎,喊又要騎,咁梗係笑騎騎着數喇。」生命一日一日咁流逝,一日嘅悲傷,就減咗一日嘅快樂,何苦?不過,我只係普通人一個,針拮,我會痛;醫生話我有尐咁嘢,唔通我會笑咩?周潤發阿媽已經入咗三毫子落木馬氹氹轉,機器已開動,亦唔可以暫停,痛楚過後,悲傷過後,就要快尐騎上木馬,仲要笑住咁騎,「笑騎騎,至着數」,唔係,好快氹氹轉又夠鐘,想再騎都冇得騎。木馬,再入三毫子可以玩過,人生呢個氹氹轉,入幾錢可以再玩?周潤發話呢尐係三毫子哲學,我信到十足。

識我嘅人,都知道我毫不隱藏,我從來唔係努力用功讀書個隻款,因為咁最舒服,之所以哎唷都順順利利,要大大力捽木,運氣係最大元素。歷史上好多鬥士都好大劑:秋瑾、陸皓東,你想做邊個?仲有,嗰尐傑出乜乜,傑出物物,全部都要慘過梁天來至可以入選。1991年,羅富國師範生斌仔跳彈牀導致全身癱瘓,二十二年被困輪椅,全城叫佢做生命鬥士。我諗(估吓咋)如果有得揀,佢會寧願一世做CM仔,都唔會揀做鬥士囉。

蘇軾話:「人皆養子望聰明,我被聰明誤一生。 惟願生兒愚且魯,無災無難到公卿。」一千年前嘅說話,到而家,仍然有效。

睇咗一篇文,教徒唔啱睇。佢話碳元素,唔會出現喺原生形成嘅星體表面,而會壓係地心。不過星體爆炸後,釋放碳元素,太空中,碎片再次聚合,第二次(or 第n次)再次形成星球,表面就可能會有碳元素。地球所有生物組成都含碳,即係話,我哋身體所有元素,曾經都係星塵 star dust,我呢個身體,就係星塵既聚合物。唔理真假,咁已經好浪漫。「鬥士」就冇我份嘞,有機會就喺呢個二手星球四圍遊,回復星塵本色,於願足矣。

夜晚瞓唔着,思路果然活躍。

三月二十三日。手術後第五日,少咗兩條喉,真係輕鬆得多,今日推住個架,一粒鐘行咗2k半,似乎愈行愈順,連肚腩都冇乜痛。行行下見到史密夫醫生,咁就順便喺走廊當巡埋房,佢見我行得走得,睇埋䕶理報告,即刻決定再進一步,聽日會幫我做個 Blue Dye Test。

病房習慣早上沖涼然後換過新袍、新牀單等。記得喺病房第二日,已經畀人摷起身沖涼。因為成身都係喉管,冲一個涼,實在非常論盡,不過,佢唔會「幫你」冲 shower you,佢會「幫你忙 」assists you。嗰日,我揸住個花洒都唔知淋邊度,「尐傷口濕唔濕得水?」我問。䕶士話,邊度都得!卒之,我攞住花酒,由頭淋到落腳,各位,第一個沖涼,只係離手術唔夠48小時。

今日呢個涼,我已經可以自己搞掂,毋須幫忙。活力好咗,精神亦好好多,傷口嘅痛用 PCA 完全可以控制。我諗,而可都可以見人喇。前幾日,我拒人千里,非常唔好意思,而家有人想傾下偈,無任歡迎喇。

晚上就收到越洋電話,真開心。

三月二十四日。又一個大日子,Blue dye test。係乜嚟?而家我個上消化道有三個傷口,傷口用線連住,就等肌肉自己埋口,喺佢埋口前食嘢,食物就會滲入腹腔,引致發炎,好大劑哩!咁我哋點知佢埋晒口?今日一早,靚護士攞咗支染料嚟,原來只不過係用嚟染啫喱嘅食用顏色,藍色最易睇,所以用佢。用一杯水開,成杯嗗晒落肚。我腹腔仲有條管,如果系統有滲漏,腹腔呢條管就會見到藍色液體。

飲咗染料就只有等,我邊等邊行,今日喺病房走廊又行咗三公里。每次我經過靚䕶士身邊,佢都望下條腹腔管。冇耐,我行完,又冲晒涼,就坐定定睇住條管。咦,我忽然見到管裏面有陣陣幽幽嘅淺藍色!吓,唔通漏水?我叫靚獲士嚟睇,佢話如果係漏水,顏色會好深色 ⋯⋯ hang on ,原來條管有條綠色綫,就喺管內透出幽幽藍色,並唔係滲漏,佢話,測試合格。即係話,個系統預備開工。開乜嘢工?飲食囉!

跟住就係將最後嗰兩條管拆埋:鎖骨上嘅管,所以再唔使吊營養液,拆埋 PCA ,就唔使揩嗎啡,如果痛就食必理痛喇。呵,我而家係個釋放出嚟嘅自由人, Kin Freeman!靚䕶士真醒目,即刻攞盒蘋果汁過我嘆,整乜鬼咁好飲。

又咁啱,有營意師來訪,佢好似好忙咁,畀咗疊紙我,再略作解釋就走咗喇,無非都係小食多餐嘅道理,常識嚟啫。我星期二會再見佢一次。

䕶士已經通知廚房,晚餐預埋我嗰份。我個胃細咗咁多,又啱啱至瞓醒開工,有幾日嘅餐都係 clear fluid meal。呢一餐:

Beef Consommé
Apple juice
Orange juice
Jelly
Mango sorbet 
Coffee or/ and tea

西餐寫到好巴閉,其實除咗牛肉湯外,其他都係一盒盒嘅預製食物。不過冇食咁多日嘢,乜嘢都好食喇。總之甩晒尐管,唔使推住個架,享受自由再臨嘅感受喇。此後幾日嘅三餐都係大同小異。如果醫院食物都只係咁,我嘅三餐應該唔難服侍。

三月二十五日 Good Friday。因為門口個 NBM 牌已經冇咗,每朝六點零就有人敲門,問你咖啡或茶,我其實多數一般飲品都係冇問題嘅,不過都飲清尐,我會要杯清茶。

冇晒喉管,梗係瞓得舒服尐,又瞓唔瞓得着呢?又真係一樣:唔係幾好瞓。

早餐過後,第一日唔使推住個架。今日假期,成層樓都好靜,窗外望落多層停車場,都係小貓三四隻。真奇怪,假期唔使病嘅咩?

今次靚護士又有要求,如果開到大便,就通知佢,「you want to see it?」我問 ,「No, just tell me 」。又到英文題,買大,南丁格爾會點講?叫 open bowels。果然開大,第一個 poo 就係中午開出,個系統走上軌道喇。

今日喺走廊一粒鐘行咗 3.78 km,唔使推住架,梗係零捨自由自在。慣晒嘞,行完就沖涼、換牀單,跟住就 hea 住等阿珊嚟陪我。

三月二十六日。

噚日輕裝行路,好過癮,今日行行吓,唔覺意行咗過隔籬醫生 suits,原來由病房穿過電梯大堂就係醫生房。丫型走廊兩邊就係各個專科醫生嘅房間,會議室、接見室,走廊頭尾就有兩個大客廳。今日假期一個人都冇,嘩,呢度好行得多,我一粒鐘行咗5.78 Km,好舒服。

今日下晝,要移除最後一樣釘喺我身上嘅嘢。三月十八日,手術過後,醫生要將劏開咗嘅肚皮縫合,醫生由肚腩底部縫起,外面見唔到綫,再喺開口處加上黏貼劑(萬能膠?)為左加固表皮埋口,就再加上類似釘書釘嘅 clips ,我肚腩就有21粒 clips, 再冚上防水 dressing ,就可以推出手術室。

而家瞓喺牀,打開個肚皮。靚䕶士一手執剪鉗,一手執夾,開工嘞。先將釘書釘由中間剪斷,再逐一掹出兩頭,咁又唔係好痛嘅,畀針拮咁喇,不過要連拮四五十下,有時仲要搖下至出得嚟。噚日耶穌受難日,我無意同上主相比,當然亦係蚊髀恐龍髀,冇得比。少少苦楚等於激勵喇。

好嘞,靚護士終於還我一個清白之軀,只剩下一道永不磨滅嘅傷痕,長留肚腩,作為歷史印記。

呢度處理傷口嘅方法,同我固有觀念好唔同。我哋一定要將傷口冚實,以防污染。喺呢度則盡量打開,等佢快尐乾乾爽爽。就算我最大嘅傷口,第二日,已經將防水膠貼撕出,沖涼時仲可以直接用花洒沖洗傷口,抹乾之後,冇遮冇掩,着上袍就算數,有時有傷囗滲些少血,亦只係用膠貼仔求其貼住就算數。個道理就係傷口打開、乾爽,就快尐好返。我諗,如果污染得緊要嘅地方,細菌亂飛,冚唔冚傷口呢?

三月二十七日。今日一早換班,䕶士阿拉臣嚟嚟照顧我,房個白板仔 your plan of care 一欄寫住: Monitor Wound,即係已經冇乜好做喇。阿拉臣對我講,你好似渡緊假喎,咁嘅假期,邊個想要?

早餐有些少驚喜,居然有隻復活蛋。叫做食咗三日 fluid meals ,又奶又朱古力又啫喱,夜晚仲有些微肚瀉,不過係OK嘅。洗面時照下鏡,真係瘦咗。

天氣好差,大小姐去教會前嚟陪咗我成粒鐘,兩父女都係噏得嘅人,佢講佢教會、工作、學校、男朋友。我就講葉繼歡、張子強⋯⋯ 。我發覺佢都好鐘意聽香港掌故。講古仔,我得喎。我地天南也北,非常暢快,本來想同大小姐行出醫院散下步行,點知落起大雨,行唔郁。咁啱,史密夫醫生嚟巡房,佢見我咁嘅款,就決定趕我出院,我梗係想往耐尐,起碼傷口都有人睇住吖嘛。再者,營養師要星期二至返工,希望出院前再見一見佢。好嘞:二月二十九日星期二出院。

今日以為有街行,點知大雨滂沱,行不得也哥哥。

三月二十八日。今日居然改 meal plan , 我升呢改食 soft meal,今早有炒蛋,粗麥皮。可惜胃口唔多好。行完走廊仲唔停咁打開思噎,要食粒丸仔至搞返掂。午餐時,胃口返返嚟,居然成個餐搞掂晒。又係嗰句,慢慢嚟,點到你急。

最後一日留宿醫阮,聽日就返屋企喇。十八號入院做手術,十九號喺 ICU,二十號上病房,二十九號返屋企,總共頭尾十二日。你睇我飛時卜,部落,寫得輕鬆,其實,一個月嚟,心情跌宕,七上八落;夜闌人靜,思潮起伏,其中心緒,如人飲水,冷暖自知。

當我需要支持,至愛就千里迢迢飛返嚟,夙夜憂嘆,無微照顧,佢仲唔係上天派嚟照顧我嘅天使?新抱仔、一對仔女,佢哋都周身唔得閒,一有時間,即刻嚟陪我,慌死我悶親。雖然憂心忡忡,但係經常掛住笑面,喺佢地身上,我強烈感受到一代一代延續落去嘅巨大動力。  

當然大大力多謝咁關心我嘅各方好友,飛時卜、電郵、whatsapp⋯⋯ 不時慰問,感激不盡。親移玉步,大駕光臨既老友,天南地北嘅閒談,正正係心緒鬱悶嘅靈丹妙藥,助我紓愁解困,再三頓首喇。

借程思華詩一首:

鳥鳴林茂碧雲天
牀畔花妍艷色鮮
摯友盈門頻訊問
守䕶有神勿藥沾

到我嘞。原來今年係「問我」四十周年,黃霑已經作古,我借佢嘅歌詞表心聲:「面對世界一切,那怕會如何,全心保存真的我」。乜嘢係真我?大家知喇,「訪名山,渡大川,尋幽徑,探古城。」簡單尐就係:有得玩就玩,食得幾多得幾多。咦,下個 trip 幾時出發呢?

Anyway 我真真確確相信我係到達人生另一階段,咁就揀左  The Byrds 呢首歌:

"Turn! Turn! Turn!"  ----  The Byrds
( to everything there is a season)

**** To everything - turn, turn, turn
There is a season - turn, turn, turn
And a time to every purpose under heaven

A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep

**** To everything........

A time to build up, a time to break down
A time to dance, a time to mourn
A time to cast away stones
A time to gather stones together

**** To everything........

A time of love, a time of hate
A time of war, a time of peace
A time you may embrace
A time to refrain from embracing

**** To everything........

A time to gain, a time to lose
A time to rend, a time to sew
A time for love, a time for hate
A time for peace, I swear it's not too late!

**** To everything........

再噏過

嚤囉

PS 

當然要多謝史密夫醫生仁心仁術,程思華又一詩:

鬼佬華佗史密夫
外科手術成日do
醫術仁心口碑重
金刀一亮除病汙

Sunday, 20 March 2016

2016.02.25 - 03.18 照鏡紅斑現,引刀一塊正坤乾;至愛天天見,南北猛噏暖心田

2016.02.25 - 03.18 照鏡紅斑現,引刀一塊正坤乾;至愛天天見,南北猛噏暖心田。



柯拿,大家好,

成日講:世事難料,幾時到你估,乜嘢事都可以隨時發生,絕不事前通知。

過去年零時間,因為舖頭嘅原因,成日都好似唔多實在,運動又疏懶,睇住個腩日益膨脹,連著咗成三十年嘅 Texwood Khaki 短褲,終於都著唔落。 所以過去寫過好多篇嘢,都話要搞搞個腩。點估到,原來終於要用個咁 radical 嘅方法⋯⋯!

我有好多經歷,所以我鍾意講古,唔止講,仲要寫低佢,時時話返畀我自己聽,我曾經做過尐乜嘢。好,開始講古:

2014年初。一次檢查,醫生發現我有幽門螺旋菌 Helicobacter pylori。呢隻嘢,我梗識佢,因為佢同澳州有關。上世紀八十年代前,一般醫學界認為:個胃有胃酸保護,咁重酸性,細菌好難喺胃部生存。袋鼠國有兩個醫生,佢哋唔信邪,1984 年,佢哋專登搵咗呢隻菌,其中一個醫生 Barry Marshall 仲「嗗」一聲,將細菌沖水吞服,一於以身試「發」,佢哋以為約一年時間,就會嚟料,點知只係三日後,馬素醫生果然發咗 ⋯⋯ 胃炎。由此,佢哋證實引發胃炎、胃潰瘍嘅原兇就係呢隻菌。當然進一步研究更指出,如果經常發炎,細胞病變嘅機率亦會增加!佢哋嘅硏究刊登喺 1985 年嘅澳洲醫學期刊 The Medical Journal of Australia,呢個係當年嘅醫學界一大突破,亦因此救返無數生命。2005 年,獲頒諾貝爾醫學獎,記咗佢哋一個大功勞。

我認識嘅呢隻菌,而家居然同我住埋同一個皮囊。不過,知道咗有菌就易搞喇,我只需要食一個療程嘅抗生素就搞掂佢哋。覆診時,醫生話:而家菌就冇嘞,不過個胃發過炎,又有胃酸倒流歷史,況且個胃都用咗幾十年,照下胃鏡,驗驗佢都好喎。不過又唔係咁緊張嘅,去完旅行返嚟至驗身都冇問題。咁樣,2014年初,我就去咗厄瓜多爾,加拉巴哥斯群島,尋找達爾文蹤影;又去咗秘魯,探索印加古道,訪尋馬丘比丘,得睹印加古文明遺蹟,去咗一個月。呢個南美之旅,我滿意到不得了。

有道:「蒼天雖無言,示之總有象。」好多時,冥冥中自有安排。佢又慌死你懵閉閉,走漏眼,仲處處留些少明示暗示過你。不過,凡夫俗子,硬係多嘢搞,硬係唔上心,更重要嘅,係慧根唔夠。呢尐明示暗示,就如水過鴨背,點滴不留。到後來先至猛然回頭,狂拍大髀,呵!乜原來係咁解嘅咩?!

南美旅行返嚟冇耐,我舖頭嘅商場易手,賣咗畀大陸資金,商場政策改變。加上呢一區,愈嚟愈多講㷛冬瓜嘅新移民,佢哋唔係我嘅客。我睇唔好個市,如果再簽五年租約,風險好大,當然租金亦傾唔埋欄,於是,年中,毅然退出做咗二十年嘅商場。為咗繼續箍住班舊客,就喺附近租咗間屋繼續營業。

睇返轉頭,2014 年,真係好大變化。五月廿九號租約期滿,隨即搬去「新舖」繼續開工。咁都只不過係轉換工作環境啫,對我嚟講,並唔係乜嘢新生事物。不過,我嘅人生第一次,就喺個幾月之後登場:2014年7月12日上午10點35分,人生嘅第一次全身麻醉 --- 照腸鏡 colonoscopy!

(拉開講一筆,本文所提到嘅事,全部都可以喺我個 blog 度搵到,所以略去故事詳情。要重溫可上 「嚤囉仔手記 kinfaichiangessays.blogspot.com.au ,每篇標題前都有日期。)

照完腸鏡,吉人天相,乜事都冇。覆診時又知多一樣嘢,原來照腸鏡同時係可以照埋胃鏡,我 2014 年頭已經想做照胃鏡!咁好機會,我竟然錯過咗,呢次冇照個胃,咁就嘥咗兩樣嘢:第一就梗係嘥咗麻醉喇,因為如果再做胃鏡,就要麻醉多一次。第二就係醫療保險嘅五百蚊墊底。不過又咁講,如果可以趕及喺年底之前照胃鏡,又可以唔使再交 500蚊,因為墊底費係逐年計。但係,我都冇咁做,因為雖然「舖頭」係比以前清閒,但係又忙於搞旅遊巴士司機牌,又去跟車學嘢,總之就多嘢搞。由年底到2015年初,仲實牙實齒去揸旅遊車、做導遊。2015年初嘅大事,就係要預備五月嘅土耳其、巴爾幹嘅旅行,咁就更加冇「閒情」去照胃鏡喇。講真,全身器官中,我最擔心嘅,就係個胃,尤其係食道。話雖如此,不過一路都食得瞓得,從冇話痾嘔肚痛,照胃鏡都係常規檢查,令自己安心而已,一於去完旅行至算喇。卒之,我玩咗個幾月,呢個一戰歷史之旅,又係一個滿意到痺嘅旅行。

其實,呢個皮囊都用咗大半個世紀,尐關節郁起上嚟, kick lik Kwark lark 會響,呢個情形,實在都有好幾年喇。前兩三年,手㬹、膊頭成日冤冤痛,雖然不至影響生活,但係都好唔舒服。所以醫生開咗非類固醇消炎藥 NSAIDS 過我,呢隻嘢非常有效,我知佢會傷害胃黏膜,所以要同胃藥一齊食,而且只係痛至食,一旦冇痛,就要停藥。除此之外,呢隻藥其實非常安全,我喺克羅地亞踩單車,都有幾日要啪粒 NSAIDS 止痛。2015 年尾,右手㬹冤痛影響長時間踩單車,卒之要去醫生度打支類固醇針消炎止痛。好嘞,得到手㬹好咗尐,整 side yard carport 時又拉傷咗左邊膊頭。照辦煮碗,又去醫生度打針,今次可能傷得緊要尐,復原得好慢。其實,我已經預備晒 2016 年旅行大計,機票、火車、住宿等都全部訂妥,其中有十幾日,計劃喺蒙古踩單車。而家個膊頭咁嘅款,點踩車!唔知三個月可唔可以好返?我十五十六。我有買旅行保險嘅習慣,退一萬步,萬一踩唔到單車,再改行程都得,一切損失,有旅行保險照住 ⋯⋯。

2016 年初,就要專心搞返掂個膊頭,仲要操返單車,唔夠 Fit ,點去旅行踩車?咦,丟低咗年幾兩年嘅胃鏡,幾時照?睇嚟,都係一樣樣嚟,而家當務之急,係要搞返掂個膊頭,照鏡就遲一步至算喇。

二月初,送羊迎猴,我嘅乙未羊年就咁過去。袋鼠國,新年照開工,我個車房舖頭都有尐生意嘅。星期五,係送鞋日,我將做好嘅鞋送去客人屋企,多數係嘉寧福區,就係我舊時商場舖頭附近。⋯⋯,咦,橫掂都經過商場,我睇開嘅診所就喺商場裏面。忽然,我心血來潮,今日不如喺附近食埋晏晝,順便睇埋醫生都好喎。拎起電話,預約個時間睇醫生。

呢個「心血來潮」,原來係人生咁大嘅交义點。冥冥中,真係有安排!諗起呢首歌:

夏韶聲

交叉點

作詞:鄭國江
作曲:N.Tsuyoshi

命途命途滿是得失分界線
每步每步都似踏進交叉點
當初不信命運但信機會
直到今天自信的心仍是不會變

只盼可以抓緊光陰一寸寸
往日那份衝勁自信不會斷
艱苦險惡道路續上一段段
論到得失未到終點誰又可計算

用自信心完成每一天
過去了似未能還完
爭勝心是長遠

苦困皆自願 心願自信定能圓
一切皆自願 只管耕耘成敗不去算

步伐也許難如往常那麼顛
過去已是永遠也是
只在今天共明天

苦困皆自願 心願自信定能圓
不理多辛酸 只管耕耘成敗不去算
今天陽光正暖 我的心更暖

唱完歌,繼續講古:

好快送完鞋,他他條條食個晏,兩點十五分準時睇醫生。道明來意話要照胃鏡,我畀埋個專科醫生個名佢,呢個GP,我睇咗佢廿幾年,佢知我病歷,冇托手㬹,仲話,雖然冇痛冇盛,呢個年紀, look see 真真都係應該,即刻寫介紹信過我。我亦手快腳快, 即刻約咗呢個腸胃科專科醫生,佢就係兩年前幫我照腸鏡嘅 Dr Tim。

一個禮拜後見添醫生,佢係寡言嘅人,說話唔多,句句到題。佢問我見點?「其實冇乜特別,只係多咗胃氣 ⋯⋯ blah blah blah」,佢知我有胃酸倒流嘅歷史,二話不說,撳咗我個肚幾下,就幫我約時間去醫院照胃鏡。足足拖咗兩年,喺我嘅心血來潮下,終於有胃鏡照嘞。

年半前,我照過腸鏡,哎唷都有些少經驗。照胃比照腸簡單得多,唔使食瀉藥,唔使提早節食,只需要六小時前禁水禁食就得嘞。照鏡前一晚,仲同大小姐去韓國餐館食人蔘燉雞𠻹。

二月二十五日。今日要全身麻醉,成日都唔揸得車,仲一定要有人接返屋企。大少爺、大少奶一早就嚟接我,時間尚早,中途,仲可以食個早餐。我梗係冇得食,連水都冇得飲。其實唔使飲,唔使食,有時間同阿仔、新抱仔一齊,傾偈都飽喇,使乜食呢又。

十一點,喺麥覺理大學醫院,換好晒手術袍,十二點左右,麻醉師喺我右手手背揷上針筒,鼻哥戴上呼吸管,一陣涼氣由手背透上手臂,靚女䕶士畀個灰色圓型中間通窿嘅硬膠我咬住,我諗,內窺鏡就由呢度放入去。靚女䕶士向我微笑⋯⋯,畫面突然消失 ⋯⋯。睜開眼,係天花板,牆上個鐘指住十二點半。單嘢搞咗半粒鐘,䕶士要我攤多陣至畀我落地。十五分鐘左右,自己換返衫,行返出去休息室,而家可以坐喺高身單人梳化唞下。成朝未食嘢,䕶士捧出公司治及咖啡,一來醫肚,其實最緊要,係用嚟觀察我哋麻醉後嘅反應。飲完食完都冇事嘅話,咪就係冇事囉。臨走前,添醫生打電話嚟,話佢睇到胃壁有發炎嘅紅斑,仲幫我約埋下星期五去佢診所睇報告。

大小姐今日係佢實習嘅最後一日,做完晒實習嘅嘢,佢兩點左右就嚟醫院接我。麻醉過嘅人唔准自己走,䕶士帶我出去等候大廳,交畀大小姐,大小姐就車我返屋企喇。⋯⋯ 發炎紅斑?乜嘢嚟㗎?要等下個禮拜五睇報告就知喇。⋯⋯ 乜嚟呢?

二月二十六日,星期五。又係派鞋日,朝早做埋幾個雕字,執好要送嘅 jobs,預備中午後出發。iPhone 有短訉聲,係添醫生診所打嚟,個心一沉,即刻回電,係添醫生太太嘅聲「你喺邊呀?點解唔聽電話?醫生想見你,十二點四十五前到診所。」我梗問乜事咁急,答案又梗係預期嘅「醫生會話你知,即刻嚟喇。」個醫生搵得你咁急,唔通趕住請你飲杯茶,食個麭咩,嗰時我個心諗乜嘢,唔使畫公仔畫出腸,大家都感受得到喇啩。

睇下個鐘,就嚟十一點。我即刻打多幾個電話,希望聯絡多尐客,快快趣將尐 jobs 還返畀客人。我有個預感,可能有一段長時間唔使開工。

未入到添醫生診所,就聽到添太太,亦係佢嘅秘書嘅聲音,佢係唔停得口嘅人。我一入去,坐喺佢辦公枱旁邊。「你終於嚟喇,點解唔聽我電話?」「係咪好大劑?」我直接問。「添醫生會話你知,我唔講得」。我都明白,收口。⋯⋯⋯⋯。靜咗一陣,佢嘅個性格,點忍得住頸,佢開口:「乜你冇 symptoms 嘅咩?有冇肚痛、肚痾、冇胃口、出血 ⋯⋯ ?」佢咁講,我都估到八八九九嘞啩,我答:「真係乜都冇喎。」「咁點解要照鏡呢?」「又真係心血來潮喎。」⋯⋯。

坐入診症室,如常,添醫生唔會講嘢住,就只係對住尐報告,打字入自己個 laptop,似乎係將新資料撮要入我嘅個人病歷裏面。冇耐,佢抬起頭,一邊將內窺鏡影到嘅相畀我睇,一邊對我講:「真係好難睇到,少尐經驗,甚至眨下眼都會走雞 ⋯⋯⋯⋯ 。」睇佢眼角神情,佢似乎對自己嘅發現非常自豪,雖然佢係好有經驗嘅專科醫生,對病人經常保持平靜嘅情緒,可能今次佢覺得「咁都畀我睇到」,就難掩滿意之情。佢繼續解釋,噚日喺胃壁睇到嘅紅斑係胃黏膜發炎,Tim 醫生專喺最可疑嘅地方採集標本,總共割咗十二粒出嚟化驗,化驗結果今朝出嚟。有六粒係正常,有四粒變緊,仲有兩粒已經變咗 Adenocarcinoma。

我聽咗梗係好唔開心喇,不過又唔係震驚嗰隻,講真,揸車嚟診所時已經作最壞打算,同添醫生太太嘅對話已經好清楚喇啩,而家只係醫生正式話畀我知而已。跟住落嚟最緊要問嘅,就係跟住要做尐乜。

添醫生即刻幫我寫介紹信畀外科醫生,又寫紙要我即刻去驗血同埋做 CT scan ⋯⋯。添太太仲親自幫我打電話預約排快期。呢個下晝,我唔得閒驚,亦冇時間諗埋尐無謂嘢嚟自己嚇自己。診所附近就有化驗所,好彩早餐後滴水未進,即刻驗咗血先,二十分鐘搞掂。不過做CT scan 就要之前要飲一大支水喎,喺街邊買咗支水,一路揸車一路飲,半粒鐘都唔使,就去到嘉寜福 Scan 診所。

之所以要做電腦掃描,係要睇下其他部份有冇異常。幾乎等都唔使點等,就入咗掃描室。換上環保不織膠袍,瞓喺撿查牀上,放射師喺我右手臂插上針筒,注入碘顯影劑,一陣微暖由手臂散出,好快,成身都感覺到呢種溫暖,不過,係冷冰冰嘅溫暖!眼前係個大冬甩,我舉高雙手扶住個冬甩,張牀喺個冬甩圈出出入入,我又要聽住指示呼吸,冬甩中間一排燈仔一味喺度轉,摩打喺我耳邊轟轟聲 ⋯⋯。

而家瞓喺鐵牀上,我終於有時間感性一下,我今朝仲係一個健健康康嘅人,大佬,仲開緊工,幾個鐘頭後,烏啄啄變咗一個病人!呢個病,仲唔係少嘢嗰隻。我成日話「世事難料,絶唔會事前通知」,有冇講錯呢!此時,胸口有一股悒悒悶悶嘅感覺, 要吸一大啖氣嚟紓緩。Hah 唔知係咪古人所講嘅「悲從中來」呢?

「悲」係醫唔到病嘅,而家亦唔得閒悲住,下晝仲有好多嘢要做。做完掃描都未夠三點,掃描報告四點鐘可以攞得,趁有一個鐘頭時間,即刻送埋鞋畀尐客,客人都喺附近,好快一一搞掂,隨即返去攞埋掃描報告,去埋嘉寧福診所,一五一十將情形話畀 GP 聽。至此,今日要做嘅,都大致完成。

坐返上車,舒一口氣。今日兩手空空出嚟,五個鐘頭後,攞住一疊二疊報告、文件返屋企。到而家,其實,件事已經好清楚喇啩,條路係點,亦都明明白白擺喺眼前。跟住要做嘅,就係通知家中至愛,whatsApp 大小姐、大少爺、大少奶,今晚,我安排一個庭會議。仔女新抱,我好有信心,佢哋喺情緒上絶對可以應付呢個消息。最擔心嗰個,係陪伴咗我近半個世紀嘅至至愛,佢而家身在香港,我應該點樣同佢講?佢喺香港已經煩緊外父嘅事,而家聽到呢個消息,佢又會點反應?真頭痕。

大少、大少奶今晚要同客人開會,趁呢個機會,我同大小姐已經交代一切。黃昏七點半,家庭會議開始,一如所料,大家都好正面去接受呢單嘢,大少奶家姐係醫生,即刻將所有資料通知佢,等佢畀尐專業意見。我哋一路講,家姐醫生一路餵料過嚟,其實氣氛都幾輕鬆,大家積極而正面,我沉浸喺關懷之中,實在好溫暖。正當大家七嘴八舌之際,我提出呢個問題:「點樣通知媽媽?」全部收晒聲,你眼望我眼⋯⋯。

打破沉默嗰個梗係我,因為我最瞭解佢。其實我已經有個打算。我相信,佢係一個好硬淨嘅人,愈係困難,佢愈能夠沉著應對,但係佢亦有一個特點,就係反應過快,同埋即時嘅反應有時候會 over react 咗。呢個消息咁埋身,佢即時會點反應,我預計唔到。不過,如果佢喺接到呢個消息嗰一剎那,有人喺身邊支持緊,咁我就放心好多。佢對人真心,喺香港好多真心老友,其實好容易就搵到支持到佢嘅人。不過,我搵咗李小姐同簡小姐,因為歷練關係,呢兩位小姐見慣世面,隨機靈活應變,不作第三人想。

我嘅提議,大家當然舉腳贊成。事不宜遲,即刻 whatsApp 電話兩位小姐。我係男人,有尐女人嘅睇法,我真係猜唔透,估唔到兩位小姐都有相同嘅憂慮:「如果佢知道你唔係第一個通知佢,佢會點諗?」呢一層,我真係冇考慮到,但係我都堅持要咁做,因為佢始終明白我咁做嘅動機。兩位小姐唔太認同,但係都照我計劃行事:一於約佢,共三個人,聽日(廿七號)香港三點左右,下午茶,到時,我就會同埋大小姐、大少奶 FaceTime 佢。大計已定,都冇乜好做,返屋企瞓覺。瞓喺牀,諗返今日:二月二十六日,星期五,我要記住呢一日,我真係做咗好多嘢。跟住大覺索,咦,又冇話失眠喎。

星期六。一早再要送 jobs 畀尐客。有個客住得稍為遠些少,佢唔想我嘥油費,「使乜咁急?下周我自己嚟攞都得啫。」但我堅持要送。去到佢屋企,搞掂交收之後,佢直接問我:「Tell me, Kin . Are you sick  ?」原來我嘅古怪行徑,人哋係睇得出嘅。我係冇秘密嘅人,我照講可也。佢講咗一輪鼓勵嘅說話,雖然老土,但係好有心,我好多謝佢。 跟住,佢講:「Kin, can I pray for you?」「Oh sure, thank you .」好少鬼佬矮過我,佢係其中一個。佢走埋嚟,左手搭任我右膊,我條件反射,又用我嘅左手搭返佢右膊,佢開始為我祈禱。內容梗係求主賜福,令我早日康復,跟住「in the name of  Jesus ⋯⋯」,我唔係教徒,睇得多,我都識一齊講「Amen 」。唔理乜嘢宗教,有人誠心為我禱告,內心實在感到溫暖。返歸,將件事講畀家人聽,大家都好感動。不過大小姐就笑我,人哋搭我肩為我祈禱,我只需低頭,而唔使搭返人膊頭,佢話個畫面好搞笑!乜咁嘅咩?

一個朝早,終於將所有 jobs 搞掂晒,順便敬告所有客人,由今日起,五個星期內我都唔再接 job 。希望之後,可以盡快再次服務街坊。

噚日,我仲食咗一個大早餐。今早冇晒胃口,煎咗嗰個番茄都食唔落,要倒咗落垃圾桶,我未試過咁樣嘥食物,下晝肚餓,但係都係只食得落一包即食河粉。原來我以為自己睇得開,裏面深藏嘅情緒,可能真係無法控制。原來真係食乜都冇晒味。

我哋黃昏六㸃,即係香港三點。大少奶、大小姐同我,齊集大少爺屋企,大少今日要開工,未克參與行動。三點二十六分,李小姐 whatsApp 話行動可以開始。

首先由大少奶出動,先問吓佢喺香港係咪好頻撲,又講下 shopping;再由大小姐講自己實習嘅㸃點滴滴。到我講,我先叫佢戴上耳機,就一五一十,將要講嘅嘢都講晒,佢間中問些少問題,雖然冇乜聲,都感覺得到佢係好 shock ,但係聽得出佢神色鎮定。聽完後,佢話會盡快返嚟 ⋯⋯。行動結束。之後,再 whatsApp 兩位小姐,確認一切妥當,大家都放心晒。在此,再次多謝香港兩位小姐支援,感激萬分。我有咁多人誠心支持,心情又真係好返好多。哦,有尐肚餓𠻹,三支公去唐餐館食個晚飯。哈,原來係大少奶最𩟔得,我見大家都放開懷抱,胃口又好返尐喎。

星期日。大小姐驚我一個人會太悶,連每個星期日做開嘅教會領唱,都叫人幫住先,今日,成日陪住我。中午,佢仲叫埋占士陪我食咗個越南午餐。佢同占士各有各忙,好難得有個星期日,我做人老豆,梗係好通氣,放佢哋一個下晝。大小姐好乖,話返嚟陪我食晚飯,詐嗲係我拿手好戲,我唔會 say no。

喺見外科醫生前,我哋都要做尐功課,今晚約咗史提拉,佢係經驗老到嘅外科䕶士。根據佢嘅經驗,呢個情況都應該係初起,而且係局部嘅。因為佢係行內人,我問佢識唔識呢個外科醫生?佢雖然唔識,但睇資料,史提拉認為佢係合適人選。而家網上訊息發達,我哋都摷過佢嘅 profile ,發現佢做好多減肥手術,我哋乜都唔識,可能認為做「減肥」,會唔會有尐「不務正業」嘅感覺?史提拉解釋,呢尐「減肥」,一尐都唔少嘢,行內叫 Sleeve Gastrectomy ,實在就係將部份胃部切去。既然佢係切胃專家,做呢個手術就係佢嘅本行,絕對適合。佢嘅睇法同家姐醫生好相似。佢仲解釋咗好多有關手術嘅問題,又教我哋喺見醫生時要問尐乜嘢,同埋尐專有名詞點講。多謝史提拉,佢令我對呢個情況,有一個較有系統詳盡嘅概念。能夠知多尐,先至可以開懐咁接受現實。多謝晒。

三月一日,踏入袋鼠國嘅秋天,新嘅季節,打開新的一頁,為實踐新嘅生活,努力!過去兩三日,我哋都喺澳、港兩地分頭做功課,為三月一日見外科醫生做好準備。早上七點幾,我同大小姐企喺機場 A 出口。如常,佢一個人推住四五件行李行出嚟,行李超晒磅,都唔知點解航空公司畀佢過。見到面,緊緊擁抱,一切盡在不言中。好開心佢仲帶住笑容,我低估咗佢控制情緒嘅能力。

下晝兩點半,史密夫醫生診所。醫生約四十幾歳啩,好斯文,據佢嘅 profile 講,工餘時間,佢仲係一個義務救生員!生得高大,都好運動型。我哋自我介紹後,就問准醫生,大小姐會將說話內容打入 iPhone 記低。以下就係大小姐嘅記錄:


Meeting with 史密夫醫生 with the present of Kin, Shan, Harching and 凱莉䕶士

1 March 2016
2:30pm

史密夫醫生 St Leonard's clinic

What's the situation
How is my oesophagus
What is the proceWhat's the situation
How is my oesophagus
What is the procedure
What will the procedure involve
Do I need to do any pre or post treatment (eg chemo, radiation)
If so, what will that entail?
What is the cost?

--------

Dad:
Countdown to 2013- had some reflux and when I eat I get gassy
2014- colonoscopy (found nothing)
No symptoms really, just gassy
I take Mobic for my shoulder
1 month of taking it every day
No surgery in the past

Doctor :
Oesophagus
Fundus
Atrium
Biopsy of the different parts of the stomach and found in the ATRIUM there were some tiny bits of cancer.

From the pictures, he didn't find a big lump or anything, just some early changes perhaps.
That's a good thing!

It doesn't appear that it's spread. The main way to treat it is to do an operation that involves removing all or most of the stomach, staying in hospital for ten days and then changes to your diet.

Metaplasia happens sometimes- (early cancerous changes everywhere, then you have to remove the whole stomach.)
If this is confined to the bottom part, then you only have to remove the bottom part and it makes it easier for you to eat in the long term.

From what I can see, there doesn't appear to be any cancer anywhere else. No malignancy in the upper part, it doesn't appear he's done any biopsy from the fundus (do another endoscopy and take some biopsy up here to make sure if we leave some stomach it'll be okay).

Lots of the time, patients have much larger cancer than yours, those patients need to do chemo prior. Your cancer appears to be very, very early you can make a strong argument for not needing to give chemo.

What we would do instead is remove it, remove lymph glands. Whenever we do surgery for stomach cancer we remove these too; it helps improve the cure rate and helps give information about whether we should do chemo or not.

Remove the cancer THEN see if we need to do chemo after. Worthwhile visiting the oncologist who looks after it.

Strong argument for just surgery.

You should visit the oncologist beforehand.

Dad:
I always think there's something wrong with my oesophagus...

Dr:

No. It looks fantastic!

No pre cancerous change. The redness is nothing. It's fine.

Process:

Endoscopy tomorrow, we're going to map the stomach, take lots and lots of biopsies because we want to do an operation that can leave a portion of your stomach.

Cut, cut; bring small intestine up because it stops bile from coming up.

Mum:

Is it early stage... Pancreas and kidney can create cancer too...
Do we need to check all the organs...

Dr:

A good quality CT is enough.
When you take biopsy they can tell it hasn't come from anywhere else. They can tell it's come from the stomach.

Sometimes it's hard because symptoms hard to see.

The test tomorrow is to find the spread: that is the mapping
(Intestinal metaplasia; if there's any displasia then we would have to do a different surgery)

You've done the CT.
Sometimes you do a PET scan, but I don't think you have to; you can talk to the oncologist if you'd like to regarding that.

We'll meet up over the next few days.

Mum:

We'd love to do the operation ASAP so the test is tomorrow and the result?

Dr:

Wait two days for the results.

Hopefully we can do the operation next week.

(Oncologist is away.... All of them)

Worthwhile for Doctor to speak with them over the phone instead since they're all away.

Recovery wait for stomach cancer:

Hospital for 10 days and when you leave you'll have small frequent meals
Normal food
5-6 meals a day and energy levels may be low, not much pain.

You could probably still work, walk around, you'll probably want a nap for 2-3 weeks.

Eating and drinking wise you won't be able to have a big meal, and you'll find that you'll feel things are heavy.

You may lose weight but your energy levels WILL come back around four months on.

Survival rate:

Cure rate with a very early gastric cancer is around 90%. You are very lucky.
We see lots, and maybe only one in thirty we'll find this early.

Stomach cancer generally is difficult to cure because it's often diagnosed late.
But most patients aren't actually diagnosed this early.
It can be relatively aggressive yes but MOST IMPORTANTLY Is the spread and the stage.

Yours is very early.

You have GASTRITIS that turns into metaplasia, displasia and then cancer
Helicobacter can give you gastritis.

Lots of Asians can stomach cancer in general.

The anti inflammatory medication has nothing to do with it

Bacon and pork is fine; the problem is mainly from Japan (where they eat a lot of smoked and pickled food in Japan and Korea) NOT from helicobacter.

Beer and coffee is fine.

You can definitely backpack and cycle!

It's normal to be anxious but this is lucky and good. This is very early.

GASTROSCOPY TOMORROW
consent form
I'm going to be the one doing the Gastroscopy.

------ end --------

大小姐果然犀利,攞住 iPhone 將所有對話都記低。其實,史密夫醫生都已經有手術計劃,不過為咗更加準確,聽日,三月二日,佢會幫我做多次胃鏡,主要係睇清楚受感染部位,佢稱之謂 mapping,咁就可以決定手術範圍。

三月二日,上午七點,北岸私家醫院內窺鏡部門。一個星期內第二次麻醉,北岸醫院又真係幾唔同,個大堂似酒店多過似醫院。等候麻醉前已經有私人病房,其他設備都比較精美。已經係第三次做內窺鏡,程序都大同小異,駕輕就熟喇。推入麻醉室,麻醉師拮針前,史密夫醫生嚟同我打招呼,後面雙掩門打開,原來就係照鏡嘅地方喇。一如既往,麻醉師打針後,就即時冇咗畫面,到掰大眼時,已經喺返私人病房。又係一如以往,瞓醒後就有三文治、咖啡做早餐。今次有尐唔同,就係 breakfast in bed。仲有,前兩次照鏡,阿珊佢都唔喺我身邊,今次可以陪住我嘆報紙食早餐,非常溫暖。

三月四日。呢個係手術前嘅覆診,以下係大小姐嘅記錄:

2nd meeting with 史密夫醫生 with the present of Kin, Shan, Harching

4 March 2016 Friday
3:30pm

史密夫醫生 St Leonard's clinic

All the results are good!
Remember that this is where the cancer is (lower part). It's very subtle. Usually it's big on most people yours is very early. We took biopsies from everywhere except the bottom because it's gonna be removed anyway. We don't have to take all the stomach.

It's the best scenario.

It's called a radical subtotal gastrectomy. There's good room for food.
That's subtotal- we're not taking all the stomach. Radical means we're
going to take a lot of the lymph glands around. If they have any cancer around we will get rid of it all.

It'll take about five hours under general anesthetic. You'll get an epidural catheter in your back so you'll be comfortable when you wake up. You'll spend 2 weeks in hospital probably.
One week after the operation you'll have something to drink and eat then you'll gradually be eating normal foods.

Start on liquids like soups then soft food like pasta and congee. No rice for a while; after three weeks you can start again. Small frequent meals like six or so when you go home.
When you're in hospital you'll see a dietician.

This will take four to five months to get over. You'll always know you've had a gastrectomy, you'll feel a little different. You'll lose some weight and not put it all back on again. Your energy levels will come back and then you can do base camp again,
This won't affect you for the rest of your life in any big way.

Dad:
First week?

Dr:
You'll have a tube in your nose and side and catheter. Those will come out after the first couple of days. You'll be up walking straight after with it all attached to you. This is a big operation. But the likelihood of any significant complication is low. You're very fit for your age.

Surgical complications are making sure everything heals up nicely. I wouldn't expect any problems to occur for you. You'll be monitored at all times. I'll see you every day until you're right to go.

Mum:
Is that the only/best option?

Dr:
Well there are different operations:

One option would be to do an operation like this called a bilroth 2 operation-
Where you join the bowl to the stomach like this...
This is easier but for the patient it's not as good.

The one we want does the best functional result. In terms of treatment
of the cancer we need to remove it all and we need to remove the lymph
glands.

There's no other real option so any other option would be a compromise.
Let's say you were 85 and we only removed the cancer and not try and
cure you. We could do it endoscopically. That would not cure your
cancer.

Ours is the internationally accepted option as the best option.
Two reasons we take a lot of stomach

1. These can spread under the mucosa for a while
2. When we take the lymph glands we take the main blood supply which
means we have to take a lot of it

Mum:
So it won't come back?

Dr:
Priority number
1 is do a good cancer operation
2 is don't put the patient in danger
3 is get a good functional result so in five years you can enjoy your life

Mum:
My dad did an operation too, and it spread. So I'm quite nervous

Dr:
Gastric cancer typically (your father's story is not uncommon it can
come back) but most patients don't have such an early subtle lesion.
You're very lucky.
This is a nice conversation. Many times I'm operating on big ones which have already gone into the lymph gland.

If you were fat we'd do a keyhole. But you don't get a good dissection on the lymph nodes. Also, if you have the availability of an epidural then the benefits of keyhole aren't that great anyway.

On balance for most people I would do this as an open.

Mum:
After the op? Does he need another round of chemo or radio?

Dr:
Well I don't know. Usually if it was big we would give pre and post op chemo.
Let's say we do yours and there is some in one or two lymph nodes. Maybe you'd need some post op chemo and maybe radio.
There is some evidence in Japanese literature where they give post chemo. Most of my patients are either white or Chinese. Sometimes the oncologists will apply the Japanese chemo therapy to the Chinese patients. Nonetheless that's how the oncologists do it.

With stomach cancer there's a European literature and there's an eastern literature (mainly Japanese). What we will do is when we have the pathology then we will talk to the oncologists and see what they think.

Ching:
You've spoken to the oncologists?

Dr:
Yeah! They say it's early. I spoke to the oncologist  after the surgery and he will talk to you about all his stuff.

Friday 18th? That's the earliest I can get the whole day. The hospital sometimes gets you to come up to a pre admission clinic and they show you around blood test chest x-Ray etc...

On the day of op just come in in the morning. During this period just take it easy. Do everything normally. The hospital to call you but just be fasted from the night before as
with your GASTROSCOPY.

It's so small some people can miss it!
In hospital you'll see a dietician and there will be plenty of
information about what to eat and so on and so forth.

---- end -----

以一個普通人嘅常識去瞭解呢件事,史密夫醫生嘅解釋已經好詳細。謝過醫生,再喺櫃檯搞埋尐手續,診所會繼續跟進入院、麻醉師 ⋯⋯⋯⋯ 等等,而我就照常生活,等候三月十八日嘅來臨。

醫生話,手術後會瘦,而且唔會容易肥返。估唔到我減極都減唔到嘅肚腩,會用呢個方法搞掂佢!果然夠晒 radical 。佢又話能量水平會返返嚟,甚至可以再去 base camp !我大大力捽住嚿木,承佢貴言。

由二月四日嘅覆診到十八號,足足有兩個禮拜時間。心情都有上上落落,靜思時,間唔中會有古怪念頭飛嚟飛去,此乃人之常情,對我亦唔算乜嘢困擾。至愛嘅關心,我當然感受得到。大少爺大少奶大小姐,佢哋咁上下又會發個短訊畀我,大小姐又盡量抽時間喺屋企食晚飯、睇電視。再唔講阿珊就24小時陪住我。湊啱個個有時間,又會出外飲茶晚餐。其間乜都講得,毫無忌諱。老實講,我哋呢家人,都算係咁喇。

其實我嘅感覺,我個身體係完全乜事都冇,係知道消息嗰兩三日,就真係冇晒胃口,情緒真係好影響人。如果唔係心血來潮,烏啄啄走去照胃鏡,到今日,甚至一年以後,我都可能唔知呢件事發生緊。好感恩。

⋯⋯⋯⋯。

三月十八日。大家都準備好。等我瞓醒

再噏過

嚤囉