A ‘Code Death’ for Dying Patients
Gary Waters/Getty Images而這作者這裡提出，我們應該有一個「Code Death」。
在20世紀初時，醫療還不發達，死亡就是人生必然的一部份，大家皆能坦然接受，看著以下文字，真讓我不斷點頭稱是，想想現在的醫療狀況，又是搖頭嘆氣。
Until the early 20th century, death was as natural a part of life as birth. It was expected, accepted and filled with ritual. No surprises, no denial, no panic. .... The patients were kept clean and as comfortable as possible until they drew their last breath.
現在的怪異醫療現狀下，醫生必需要儘全力，用盡一切儀器來阻擋死亡、插管、葉克膜等。
身為醫生的我們，必需重新學習，這「古老的死亡藝術」。就如同產婆幫產婦接生一樣，雙方要準備好面對最好的結果，也要能接納最不幸的噩耗。（這讓我想到最近的婦產科新聞，家長們只能接受好的，不能接納有殘疾的，有殘疾的十字架，就全部給婦產科醫師背了，這真是令同業的我不寒而慄）。
We physicians need to relearn the ancient art of dying. When planned for, death can be a peaceful, even transcendent experience. Just as a midwife devises a birth plan with her patient, one that prepares for the best and accommodates the worst, so we doctors must learn at least something about midwifing death.
文中詳述了，作者執行Code Death的過程，和家屬溝通好後，幫患者衣容整理好、拔管。讓家屬和患者能相處，醫護在旁協助最後的時光，住院醫師處理airway，intern處理藥物，醫學生準備面紙給家屬，當然還有呼吸治療師和護理人員。患者在拔管後一小時往生，數天，或是一週，最後的時光，留給自己的家人和朋友，而不是插管躺在ICU床上。
因此作者大聲疾呼，我們要再重新學習「Code Death」，因為它和搶救生命的「Code Blue」一樣重要。不只要學習救病人，也要學習讓病人善終。
It should become a protocol, aggressive and efficient. We need to teach it, practice it, and certify doctors every two years for it. Because helping patients die takes as much technique and expertise as saving lives.
Jessica Nutik Zitter is an attending physician at Alameda County Medical Center in Oakland, Calif. She is board-certified in both critical-care and palliative-care medicine.
後記：
這和柯P的生死學，有異曲同工之妙。最近診所一位住院3個月高齡患者回來了，狀況不是很好，血壓低，意識不清，多重疾病。透析過程中真是驚險，家屬還是不完全放棄。我心想，總是要和家屬談一下萬一狀況不好時怎麼辦？先生很了解，說應該的，馬上簽了DNR，診所內同仁也好配合。生死學，也許是我們都應該再學習的一門課啊！
有興趣的人可以看網看一下影片
生死的智慧：柯文哲 (Wen-je Ko) at TEDxTaipei 2013:
http://youtu.be/N0zhdMwD2Z8
