Lintz K C, Penson R T, Cassem N, Harmon D C, Chabner B A, Lynch T J
Hematology-Oncology Department, Massachusetts General Hospital Cancer Center, Boston 02114-2617, USA.
Oncologist. 1999;4(1):70-6.
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum during which caregivers discuss a specific cancer patient, reflect on the important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members. In this article, the case presentation and verbatim dialogue from the rounds are discussed with an emphasis on staff psychosocial issues. The case presented was of a 32-year-old man, who developed small cell osteosarcoma and was treated at MGH. He died after undergoing multiple courses of relatively ineffective chemotherapy. The case is made all the more poignant because of the pleasures, hopes and stresses of having a child late in the course of his illness. Staff identified closely, both with him and his family, and their concern for him brought joy and meaning to their work, yet this complicated their ability to deal with his impending death. They felt that his unwillingness to admit defeat prevented them from saying goodbye to someone whom they loved and admired. Despite this, staff recognized that, ultimately, the patient's emotional needs and wishes had to be respected as a first priority and that constructive closure can be worked toward, if not achieved. In such situations, it is vital to have a colleague support system and a forum for discussion of such issues in order to defuse distress and reassure staff that they are doing all that can be done as professionals and caregivers.
1995年，马萨诸塞州总医院（MGH）的癌症患者肯尼斯·B·施瓦茨在去世前不久，在MGH创立了肯尼斯·B·施瓦茨中心。施瓦茨中心是一个非营利组织，致力于支持和推进富有同情心的医疗服务，为患者提供希望，为护理人员提供支持，并促进康复过程。该中心主办施瓦茨中心查房活动，这是一个每月一次的多学科论坛，护理人员在此讨论特定的癌症患者，反思患者、其家人和护理人员所面临的重要心理社会问题，并从同事那里获得见解和支持。在本文中，将讨论查房活动中的病例介绍和逐字对话，重点是工作人员的心理社会问题。所介绍的病例是一名32岁的男子，他患上了小细胞骨肉瘤并在MGH接受治疗。在接受了多个疗程效果相对不佳的化疗后，他去世了。由于他在患病后期迎来孩子所带来的喜悦、希望和压力，这个病例显得更加令人心酸。工作人员与他和他的家人感同身受，他们对他的关心给工作带来了快乐和意义，但这也使他们在面对他即将到来的死亡时难以应对。他们觉得他不愿认输，这让他们无法与自己所爱戴和钦佩的人道别。尽管如此，工作人员认识到，最终患者的情感需求和愿望必须作为首要任务得到尊重，并且即使无法实现，也可以朝着建设性的结局努力。在这种情况下，拥有同事支持系统和讨论此类问题的论坛至关重要，以便缓解痛苦，并让工作人员放心，他们作为专业人员和护理人员已经尽了一切所能。
