美国国家公共电台 NPR Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

 

STEVE INSKEEP, HOST:

Doctors are describing a group of opioid addicts¹ as the sickest of the sick. These are IV drug users, mostly heroin² addicts who get infections in their hearts. They're being wheeled into hospitals around the country. Treating these patients is creating an ethical³ dilemma⁴ for doctors, and we have more this morning from Jack⁵ Rodolico of New Hampshire Public Radio.

JACK RODOLICO, BYLINE⁶: Christopher Milford lives in East Boston, Mass. In his late 20s, he got high on some Oxycontin his friend gave him. By his early 30s, he was shooting heroin and Suboxone. Milford would reuse the same needle for a week or more. And one day out of the blue, he was so sick he couldn't get out of bed.

CHRISTOPHER MILFORD: Felt like the worst flu I ever got in my life, almost felt like a dream. I started doing weird⁷ things like putting PlayStation controllers in the sink in the bathroom. It was just weird, off the wall.

RODOLICO: Milford had endocarditis, essentially⁸ an abscess on one of his heart valves. He spent seven weeks in the hospital on IV antibiotics⁹ then things got worse. He went back home. He kept shooting drugs, and he got endocarditis two more times. Milford eventually quit drugs. But after six months sober, he was smoking a cigarette one day, and he kept dropping it. A few minutes later, he couldn't talk.

MILFORD: I wrote stroke on a piece of paper, handed it to my mother. She called the ambulance. I couldn't talk. It was scary, scariest feeling in the world. And that's why I'm talking like I am.

RODOLICO: Milford's stroke wasn't half the damage endocarditis did to him. He would undergo two heart surgeries to implant¹⁰ a pacemaker and replace his infected valve. At the time, he was 35 years old.

JONATHAN EDDINGER: So this is surgeries for endocarditis that's associated with IV drug use.

RODOLICO: Jonathan Eddinger is a cardiologist at Catholic Medical Center in Manchester, N.H. He's showing me spreadsheets he made to track patients like Chris Milford. He says IV drug abusers who undergo heart valve replacement¹¹ surgery have about a 1 percent mortality rate at his hospital. But those patients are likely to keep using drugs when they leave. So Eddinger wondered how long did they survive outside the hospital?

EDDINGER: Like, it's frustrating¹² because I don't have a decent way of tracking them and knowing what's happening to them because we'd like to know how they're doing.

RODOLICO: To figure out how they were doing, Eddinger did something a little unusual. He took lists of patients going back five years, and he started Googling their names.

EDDINGER: What I did is I went, and I used the internet to figure out if they died afterwards in follow-up.

RODOLICO: Eddinger looked for obituaries¹³ for the hospital's patients who had their heart valves replaced. All of these patients were IV drug abusers, and he learned 25 percent had died. And the spreadsheets show something else troubling. These folks were super expensive to treat.

So the folks that come in with endocarditis two or three times are costing...

EDDINGER: Yes.

RODOLICO: ...Half a million...

EDDINGER: Half a million dollars. That's exactly right.

RODOLICO: In 2011, this New Hampshire hospital treated three IV drug abusers with endocarditis. Last year, they saw 51. Most were young in their 20s and 30s, and most were on Medicaid. Hospitals around the country are seeing this same trend, but no one is tracking the total numbers. And that means no one's adding up the total tab.

Nancy Teixeira, the director of Catholic Medical Center's cardiovascular surgical¹⁴ unit says the treatment for endocarditis doesn't always work if the patient is an IV drug abuser.

NANCY TEIXEIRA: Well, we've had people come in, get their valves done, go back out and use. And they either die or they show up in extremis because they've used again, and now they've re-infected their new valve. And they're right back at square one.

RODOLICO: Teixeira is left struggling with some thorny¹⁵ questions like how many times should you replace the same heart valve? There are no ethical guidelines for treating this patient population. So Catholic Medical Center is one of the first to write some. The guidelines call for setting patients up with drug treatment, says Dan Daly a medical ethicist¹⁶ with St. Anselm College who helped write them. Daly says what the guidelines are not is some kind of moral test.

DAN DALY: This is not the patient proving to the medical team that they are worthy¹⁷ of a new valve, that they are worthy of the surgery that we wanted to make sure that that could not happen.

RODOLICO: Dr. Jerome Kassirer is the former editor of The New England Journal of Medicine. He says whatever Catholic Medical Center comes up with, will probably be helpful for doctors and nurses around the country who are making this up as they go.

JEROME KASSIRER: There's always an incentive¹⁸ to do right for every individual patient, and as a consequence, they're going to opt¹⁹ for treating the patient as if the patient wasn't addicted²⁰.

RODOLICO: Chris Milford's addiction²¹ is what caused his endocarditis, and endocarditis is what drove him to quit drugs. He's two years sober and still trying to regain²² his voice.

MILFORD: The damage is already done, but I've been clean ever since and no desire to start using drugs at all.

RODOLICO: What's unclear is how many more people are still stuck in a cycle of IV drug abuse that's causing deadly infections, driving a complex ethical debate and swelling²³ a massive price tag. For NPR News, I'm Jack Rodolico.

1 addicts   

有…瘾的人( addict的名词复数 )； 入迷的人

参考例句：

• a unit for rehabilitating drug addicts 帮助吸毒者恢复正常生活的机构
• There is counseling to help Internet addicts?even online. 有咨询机构帮助网络沉迷者。 来自超越目标英语 第3册

2 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

3 ethical   

adj.伦理的，道德的，合乎道德的

参考例句：

• It is necessary to get the youth to have a high ethical concept.必须使青年具有高度的道德观念。
• It was a debate which aroused fervent ethical arguments.那是一场引发强烈的伦理道德争论的辩论。

4 dilemma   

n.困境，进退两难的局面

参考例句：

• I am on the horns of a dilemma about the matter.这件事使我进退两难。
• He was thrown into a dilemma.他陷入困境。

5 jack   

n.插座，千斤顶，男人；v.抬起，提醒，扛举；n.（Jake）杰克

参考例句：

• I am looking for the headphone jack.我正在找寻头戴式耳机插孔。
• He lifted the car with a jack to change the flat tyre.他用千斤顶把车顶起来换下瘪轮胎。

6 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

7 weird   

adj.古怪的，离奇的；怪诞的，神秘而可怕的

参考例句：

• From his weird behaviour,he seems a bit of an oddity.从他不寻常的行为看来，他好像有点怪。
• His weird clothes really gas me.他的怪衣裳简直笑死人。

8 essentially   

adv.本质上，实质上，基本上

参考例句：

• Really great men are essentially modest.真正的伟人大都很谦虚。
• She is an essentially selfish person.她本质上是个自私自利的人。

9 antibiotics   

n.（用作复数）抗生素；（用作单数）抗生物质的研究；抗生素，抗菌素( antibiotic的名词复数 )

参考例句：

• the discovery of antibiotics in the 20th century 20世纪抗生素的发现
• The doctor gave me a prescription for antibiotics. 医生给我开了抗生素。

10 implant   

vt.注入，植入，灌输

参考例句：

• A good teacher should implant high ideals in children.好教师应该把高尚理想灌输给孩子们。
• The operation to implant the artificial heart took two hours.人工心脏植入手术花费了两小时。

11 replacement   

n.取代，替换，交换；替代品，代用品

参考例句：

• We are hard put to find a replacement for our assistant.我们很难找到一个人来代替我们的助手。
• They put all the students through the replacement examination.他们让所有的学生参加分班考试。

12 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

13 obituaries   

讣告，讣闻( obituary的名词复数 )

参考例句：

• Next time I read about him, I want it in the obituaries. 希望下次读到他的消息的时候，是在仆告里。
• People's obituaries are written while they're still alive? 人们在世的时候就有人给他们写讣告？

14 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

15 thorny   

adj.多刺的，棘手的

参考例句：

• The young captain is pondering over a thorny problem.年轻的上尉正在思考一个棘手的问题。
• The boys argued over the thorny points in the lesson.孩子们辩论功课中的难点。

16 ethicist   

n.伦理学家，道德学家

参考例句：

• They are used to resolving conflicting principles, says Dick Willems, a Dutch doctor and ethicist. 荷兰的医生，伦理学家DickWillems说，他们惯于解决相冲突的原则。
• They are used to resolving conflicting principles, says Dick Willems gold, a Dutch doctor and ethicist. 一个荷兰医生与道德家，认为他们习惯了解决有冲突的原则。

17 worthy   

adj.(of)值得的，配得上的；有价值的

参考例句：

• I did not esteem him to be worthy of trust.我认为他不值得信赖。
• There occurred nothing that was worthy to be mentioned.没有值得一提的事发生。

18 incentive   

n.刺激；动力；鼓励；诱因；动机

参考例句：

• Money is still a major incentive in most occupations.在许多职业中，钱仍是主要的鼓励因素。
• He hasn't much incentive to work hard.他没有努力工作的动机。

19 opt   

vi.选择，决定做某事

参考例句：

• They opt for more holiday instead of more pay.他们选择了延长假期而不是增加工资。
• Will individual schools be given the right to opt out of the local school authority?各个学校可能有权选择退出地方教育局吗？

20 addicted   

adj.沉溺于....的，对...上瘾的

参考例句：

• He was addicted to heroin at the age of 17.他17岁的时候对海洛因上了瘾。
• She's become addicted to love stories.她迷上了爱情小说。

21 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

22 regain   

vt.重新获得，收复，恢复

参考例句：

• He is making a bid to regain his World No.1 ranking.他正为重登世界排名第一位而努力。
• The government is desperate to regain credibility with the public.政府急于重新获取公众的信任。

23 swelling   

n.肿胀

参考例句：

• Use ice to reduce the swelling. 用冰敷消肿。
• There is a marked swelling of the lymph nodes. 淋巴结处有明显的肿块。