Team WADA 学生メンバーのアンダーソンアレックス誠治（Alex Seiji Anderson）です。この「Study with Ns. Rossi」という企画では、医療面接の練習を行っております。2024年10月26日に行った勉強会について、ご紹介させていただきます。
本日のお題はこちら
Setting: General Surgery
Doctor:
You have received an 82-year-old man with suspected Lung cancer from a GP. You examine him and find that he has stage 4 Lung cancer with multiple cerebral metastases. He declined all treatments. However, he informs you that his beloved Granddaughter will get married in 3 months’ time – but It seems likely it will be very difficult for him to attend. The patient asks for your help to help him to survive until his granddaughter’s wedding.
Task:
- Start to discuss about your opinion with this patient
- Explain to this patient and her family about his current condition and your
treatment plan
Doctor: Alex Seiji Anderson
Patient: James Strager (Ns. Rossi)
Observer: Hana Arai
実際の会話
名前と生年月日の確認
Alex:
I understand you‘re in a very difficult situation at this time.
Today, I’d like to discuss everything as openly as possible. Please feel free to ask any questions that might come up.
James:
I know my conditions are not good. I know I can’t survive so long, but my granddaughter will get married.
Before I die, I really want to attend the wedding. So, I wanna make sure…. I need your help.
Alex:
I understand. The goal is wonderful, and the hope to be at the wedding means a lot. I want to be your help by all means. However, I have to be honest with you.
James: Mu-huh.
Alex:
To begin with, your symptoms are advanced with stage 4 lung cancer, which has unfortunately spread to your brain.
※brain metastases (脳転移)を上手く言い換えられた気がします
Alex:
To my sadness, any intense treatments, either with surgery ‘’and’’ chemotherapy don’t seem to work, considering your age and situation.
※either A or Bなのに、And を使ってしまいました。
Alex:
Now, our focus is controlling pain and other symptoms that might come up. So, our options include drugs that control your pain and low-dose radiotherapy which is known as effective for symptoms that come from cancer.
At this moment, do you feel any pain or other symptoms?
James:
It’s not really much pain. Sometimes, yes, I do.
Just about management, it’s a challenging walk. I use a wheelchair.
When I go to the wedding, will someone help me?
I don’t need to stay there a whole day.
I just want to see the main ceremony and my daughter’s wedding in the church.
Do you think it’s possible?
Alex:
I understand your concern.
There are some options you can do for the wedding.
If you have somebody who can assist you with the wheelchair, it’s possible. Or, you can also attend the wedding online using zoom.
※まず、82歳の患者さんにzoomを提案すべきでない。そして、車いすを押してくれる人以外に、医療従事者を同席させたり、近所の病院と協力したり、場合によっては個人用救急車を契約する必要がある。
James:
No, no, no. I don’t want to.
I wanna attend the wedding physically.
Alex:
That makes sense. I understand the goal of attending the wedding is your top priority in your life, I respect it so much. Let’s discuss viable options then.
James: Mu-huh.
Alex: You mentioned somebody assisting you with the wheelchair. Is it your wife or other family members?
James:
No, my wife passed away. My son sometimes helps me push the chair. I’m not sure how much he can do. He is busy with his job. If I need help, I can’t do it myself, you see.
Alex:
It’s really understandable you get upset about the situation. But don’t worry ‘’not’’ too much. We have an excellent team of doctors, nurses, and physios.
※Don’t worry too much. なぜか、余分に‘’not‘’ を入れてしまった。
Alex:
We can offer some experts who can assist you with your daily lives. So, don’t be panic about that. There ‘’are’’ definitely somebody who can assist you.
※’’are’’ではなく、is
James:
Do you mean someone will come with me at the wedding?
Alex:
It’s possible.
Some organizations offer special plans dealing with complicated cases.
We can consult them to make your goal possible if you like.
※日本でもUKでも、NPO法人やホスピス団体などが、末期がん患者を支援するプログラムを提供しています。
James:
Okay….
I’m also worried about the medication.
Will someone give me morphine? Because I sometimes feel pain.
I can never sit in a chair for more than 3 hours.
I’m not sure if I’m in pain; someone will give me medication.
Alex:
Yes, we plan to prescribe the medication according to the severity of the pain.
Do you take other medicines now?
James:
When I was in the hospital, I took morphine. I’m not sure who’s gonna give it to me at home or during the wedding if I’m in pain.
Alex
I understand. Please don’t be worried about that. I can offer drugs that control symptoms.
Even if you do not come to the hospital, you can get adequate care at home. Does it sound clear?
James:
It’s okay. I have another question.
Another doctor said I couldn’t survive much longer.
Do you think that I can survive three months or more?
Alex:
To be honest, it might be difficult.
But we are here to help make the goal possible.
Let’s keep in touch and work together for the goal.
James:
Is there any treatment by which I can survive longer
Alex:
As I said earlier, it’s difficult to cure the cancer completely at this stage.
The only thing we can do is to manage your symptoms and other difficulties.
James:
So, there’s no treatment.
But I really wanna survive three months for the wedding.
Alex:
I understand.
At the end of the day, whether you can survive for three months dep on how you manage your symptoms and how much support you have.
At least, we can offer excellent team support for daily lives.
We’ll make a lot of efforts to make the goal possible.
James.:
Okay.
I just need to try to survive as long as possible.
Alex:
Thank you for understanding. Let’s keep in touch. Thank you.
良かった点
いきなり「根治的な治療ができない」と伝えるのではなく、前置きを工夫して患者さんに安心感を与えられた気がします。（たぶん笑？）
また、結婚式に参加したいという患者の希望になるべく寄り添う形で、いくつかの選択肢を提示することができました。
反省点
文法のミスが散見されました。(Either A or B, There is somebody, Don’t worry too much.)
そして、「３か月後の結婚式に私は間に合うか」という質問に何度も直面し、答えに困る場面もありました。結婚式に医療従事者が同伴できるか確信が持てなかったため、ごまかすしかありませんでした。
結婚式のzoom参加を提案したことは、ミスでした。
レッスン後
今回のお話は、ロッシ先生が実際に経験された事例で、最終的に患者さんは結婚式に出席できたそうです。（設定は多少異なりますが）
幸い、この患者さんは個人用救急車と契約し、介護施設から結婚式まで救急車で搬送されました。さらに、緊急時に対応できるスタッフを結婚式場に待機させ、バイパップマシンやモルヒネの量を管理したそうです。
加えて、患者さんの訴えをWishと言っていいのか、ロッシ先生と議論しました。一般的には、実現不可能な願いはWishと呼び、実現可能性のある願いにはHopeといいます。ロッシ先生は、患者さんが自分の願いをどの程度可能だと信じているかを考慮して、使い分けることが大事だとおっしゃっていました。
また、ロッシ先生は、文化によって結婚式の重要性が異なる点についても話してくださいました。特に、インド系移民は結婚式を大事にするそうです。数日間にわたって、儀式やパーティーをするのが当たり前だとか。
国際的な医師になるには、様々な文化の背景を知り、患者さんの価値観や人生観を理解することが重要だと改めて実感しました。
とても有意義な勉強会になりました！
文責: Alex Seiji Anderson
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