みなさんこんにちは。
先日、ある本を読みました。
今回はその本のご紹介。
本のタイトルは「医師の感情 平静の心がゆれるとき」
この本との出会い
これを手に取ったのは、自分自身が診療においてとても深く、そして鋭く傷つくような出来事があったからです。
他に誰かそのような経験をしていないのか？
みんなこういう時にどうやって感情を処理しているんだろう？
でも普段、医師というものは感情は押し殺さないといけない、ましてやそれを公に晒すわけにもいかない職種であり、勿論そのようなものはないと思っていました。
そして、成人を相手に医師をしている限り「人は必ず死ぬ」ということはわかりつつもそれにあらがうことが我々の使命であり、スタートの時点で厳密にいえば自己矛盾をすでに抱えているのです。
百歩譲って、医師の使命を「人をどう生かすか」ではなく「人にどのような死を迎えさせてあげることができるか」という言葉に読み替えたとして、決して我々がどんなに努力したとしても、結果論の一点で誰からも感謝されないことが往々にしてあるのです。
でも何故か、その時は「検索してみよう」の頭に切り替わり、「医師 感情」で検索してみたんです。そしたらこの本がたまたま検索されてきたんです。
読んでみて、何かを結論を出すものじゃないけれど、同じ感情を抱く人がいることを知ることができ、なんだか安心した、というかスッキリしたんです。
自分だけじゃない、みんなそう思っているんだと確信できる内容でした。
本の内容
ネタバレにならない程度の概要です。
筆者はアメリカの医師である。
レジデンシーとして勤務し始めた医師が、その職務の中で驚き、戸惑い、嫌悪を抱き、その中で自分なりの道を決めていく過程を、時に生い立ちを振り返りながら記録している本であり、その日本語訳です。
医師の抱える「燃え尽き症候群」のことも触れており、実際この著者もさいなまれ、つらい状況に陥った出来事が書いてありました。
ストリーメインですが、テンポよく読める内容であっというまに読破できる内容です。
私の思ったこと
稚拙な感想ですが、
- 医師も揺れていいんだ！
- もしかしたらアメリカの医師は日本の医師よりももっと挟まれがちなのかも
- いろいろ経験して、あるべき自分のポジションをとっていくんだ
こんな感じです。
私は、医師はロボットのように、当たり前のことをガイドライン通りに、漏れなく行って、ステレオタイプな病状説明をする、すなわち「誰がやっても同じ」ように医療をしないといけないものだと思っていました。
特に若手の時代には上級医との差を縮めるため、背伸びをして、「標準医療」にこだわる傾向があります。相手に見え隠れする個々の事情・病状を見ずに・・・。
しかし、標準的な医療を提供するということは、言葉を換えれば画一的な医療を提供するということで、徐々にそのやり方は壁にぶち当たります。少なくとも私はそうでした。
直観に任せて標準的医療をモディファイ（修正）するのか、断行するのか。
ここで医師はまず二分されます。
私は前者を選びました。それが今思うと一つ目の「ゆれる」ことなんです。
患っている患者は単一の病態と背景ではなく、多様性をもちます。そこで画一的な医療のみに固執することは、それはある意味「多様性からの逃避」「思考の停止」なのです。
そしてそのうえで、患者に共感し、患者の心とともに揺れてあげること、これが二つ目の「ゆれる」ことです。
その視点を持った時、日本というのはある意味恵まれた医療国だと思います。
日本においてはその医療保険制度から、病気の前に人は平等です。
よって、それが何歳でも、どんな属性でも、犯罪者でも、それは関係なく、「一人の病める人」なわけです。医師は、純粋にその人の病気についてだけ考えて必要な医療を施す環境を与えられています。
しかし、アメリカではその保険制度から、医療を施していいかどうか、どこまで施せるのか、というところに予め上限が定められているわけです。「〇〇の治療をすれば助かることがわかっている」のにもかかわらず、それを施せない辛さが存在しているようでした。
作中作者は、それほど協調はしませんでしたが、進路についても匂わせています。
色々経験し、結果そこから自分の無理なく歩める道を選びだしています。
医師はまずはある程度はGeneralにすすみ、その後特化していく集団です。
それぞれの選択は、能動的に選ぶこともあれば、環境から受動的に選ぶこともあります。
内科系/外科系、とか、手技系/思考系、とか、急性期/慢性期、とか様々軸がそこにはあります。自分の嗜好だけでなく先輩方の考え方や時にはその時の出会いに選択は依存されます。
後からそれが必然、ととれるようになるまで、その選択は必要不可欠なものなのです。
さいごに
以上、書籍のご紹介でした。
もしかしたら深読みかもしれません。
でも、不条理にさいなまれたとき、この本に共感するのではなく、あなたにこの本が共感してくれることを感じると思います。
是非、一読ください。
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