雙語(yǔ)·當(dāng)呼吸化為空氣 我在婦產(chǎn)科的輪轉(zhuǎn)結(jié)束了

不久，我在婦產(chǎn)科的輪轉(zhuǎn)結(jié)束了，立刻就轉(zhuǎn)到腫瘤外科。同期的醫(yī)學(xué)生瑪麗和我一起輪班。輪班了幾個(gè)星期，在一個(gè)無(wú)眠的夜晚之后，她被分配去協(xié)助一臺(tái)“惠普爾手術(shù)”。這是很復(fù)雜的手術(shù)，需要調(diào)整腹部的很多器官，以便切除胰腺癌。在這種手術(shù)里，醫(yī)學(xué)生一般都要連續(xù)站上九個(gè)小時(shí)，通常只是旁觀，頂多幫忙拉拉勾。被選中去協(xié)助這種手術(shù)，是醫(yī)學(xué)生夢(mèng)寐以求的事情，因?yàn)檫^(guò)程極度復(fù)雜，能夠主刀的至少也要住院總醫(yī)生的級(jí)別。但這也是會(huì)累垮人的手術(shù)，是對(duì)普外科醫(yī)生技能的終極測(cè)試。手術(shù)開始后十五分鐘，我看到瑪麗站在走廊里哭?；萜諣柺中g(shù)開始時(shí)，醫(yī)生要從小小的切口放進(jìn)一個(gè)小小的攝像頭，看有沒(méi)有轉(zhuǎn)移瘤。因?yàn)槿绻┘?xì)胞大面積擴(kuò)散，那手術(shù)就沒(méi)用了，需要取消?，旣愓驹谑中g(shù)室里，想著要站上整整九個(gè)小時(shí)，心里一直在默默地祈禱：“我太累了——上帝啊，一定要有轉(zhuǎn)移啊。”的確有。病人被重新縫合，手術(shù)取消?，旣愊仁撬闪丝跉猓又撵`就不斷被愧疚侵蝕，越來(lái)越深，痛苦不堪?，旣悰_出手術(shù)室，她需要一個(gè)傾訴的對(duì)象，而我恰好出現(xiàn)在那里。
Not long after, my obgyn rotation ended, and it was immediately on to surgical oncology. Mari, a fellow med student, and I would rotate together. A few weeks in, after a sleepless night, she was assigned to assist in a Whipple, a complex operation that involves rearranging most abdominal organs in an attempt to resect pancreatic cancer, an operation in which a medical student typically stands still—or, at best, retracts—for up to nine hours straight. It’s considered the plum operation to be selected to help with, because of its extreme complexity—only chief residents are allowed to actively participate. But it is grueling, the ultimate test of a general surgeon’s skill. Fifteen minutes after the operation started, I saw Mari in the hallway, crying. The surgeon always begins a Whipple by inserting a small camera through a tiny incision to look for metastases, as widespread cancer renders the operation useless and causes its cancellation. Standing there, waiting in the OR with a nine-hour surgery stretching out before her, Mari had a whisper of a thought: I’m so tired—please God, let there be mets. There were. The patient was sewn back up, the procedure called off. First came relief, then a gnawing, deepening shame. Mari burst out of the OR, where, needing a confessor, she saw me, and I became one.

醫(yī)學(xué)院的第四年，我看著很多同學(xué)一個(gè)個(gè)選了要求不那么高的專業(yè)（比如放射科或皮膚科），并申請(qǐng)了住院醫(yī)生。我對(duì)此困惑不已，搜集了好幾個(gè)頂尖醫(yī)學(xué)院的數(shù)據(jù)，發(fā)現(xiàn)趨勢(shì)都一樣：讀完醫(yī)學(xué)院之后，大多數(shù)學(xué)生都傾向于選擇有利于“高品質(zhì)生活方式”的專業(yè)，上班時(shí)間比較人性化，工資比較高，壓力比較小。他們?cè)谏暾?qǐng)醫(yī)學(xué)院時(shí)寫就的雄心壯志，要么打了折扣，要么消失得無(wú)影無(wú)蹤。臨近畢業(yè)，我們按照耶魯?shù)膫鹘y(tǒng)，坐下來(lái)，修改我們畢業(yè)典禮上要說(shuō)的誓言。總之就是希波克拉底、邁蒙尼德、奧斯勒和其他幾個(gè)偉大醫(yī)學(xué)界前輩名言的合集。有幾個(gè)同學(xué)爭(zhēng)論說(shuō)，應(yīng)該去掉把病人利益置于自身利益之上的句子。（其他人不允許，討論沒(méi)能持續(xù)很長(zhǎng)時(shí)間。這些話沒(méi)有去掉。在我看來(lái)，這種自我中心論是完全與醫(yī)學(xué)精神相悖的，但話說(shuō)回來(lái)，也是完全合理的。的確，這世上99%的人選工作都是這樣的：薪水、工作環(huán)境、工作時(shí)間。事實(shí)本來(lái)就是如此，選擇工作的時(shí)候，當(dāng)然要把生活方式放在第一位，哪管什么使命的召喚。）
In the fourth year of medical school, I watched as, one by one, many of my classmates elected to specialize in less demanding areas (radiology or dermatology, for example) and applied for their residencies. Puzzled by this, I gathered data from several elite medical schools and saw that the trends were the same: by the end of medical school, most students tended to focus on “l(fā)ifestyle” specialties—those with more humane hours, higher salaries, and lower pressures—the idealism of their med school application essays tempered or lost. As graduation neared and we sat down, in a Yale tradition, to rewrite our commencement oath—a melding of the words of Hippocrates, Maimonides, Osler, along with few other great medical forefathers—several students argued for the removal of language insisting that we place our patients’ interests above our own. (The rest of us didn’t allow this discussion to continue for long. The words stayed. This kind of egotism struck me as antithetical to medicine and, it should be noted, entirely reasonable. Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job—not a calling.)

而我呢，會(huì)選神經(jīng)外科。這個(gè)選擇我已經(jīng)考慮了一段時(shí)間了。究其發(fā)端，是一天晚上，剛剛走出手術(shù)室，在一間病房里，我?guī)е木次罚犚粋€(gè)兒童神經(jīng)外科醫(yī)生與病人父母的談話。他們的孩子長(zhǎng)了個(gè)很大的腦瘤，那天晚上剛送到醫(yī)院，說(shuō)是頭痛。醫(yī)生不僅跟他們?cè)敿?xì)講述了臨床上的一些信息，也充滿人情味地表達(dá)了對(duì)這種不幸的同情，并為他們提供了指導(dǎo)。恰巧，孩子的媽媽是一名放射科醫(yī)生。腫瘤看上去是惡性的，媽媽已經(jīng)研究了掃描結(jié)果，現(xiàn)在她坐在日光燈下的塑料椅上，完全崩潰了。
As for me, I would choose neurosurgery as my specialty. The choice, which I had been contemplating for some time, was cemented one night in a room just off the OR, when I listened in quiet awe as a pediatric neurosurgeon sat down with the parents of a child with a large brain tumor who had come in that night complaining of headaches. He not only delivered the clinical facts but addressed the human facts as well, acknowledging the tragedy of the situation and providing guidance. As it happened, the child’s mother was a radiologist. The tumor looked malignant—the mother had already studied the scans, and now she sat in a plastic chair, under fluorescent light, devastated.

“好了，克萊爾?！贬t(yī)生輕輕開了口。
“Now, Claire,” the surgeon began, softly.

“有看上去那么糟糕嗎？”母親打斷了他，“你覺(jué)得是癌癥嗎？”
“Is it as bad as it looks?” the mother interrupted. “Do you think it’s cancer?”

“我也不知道。但我知道，我知道你也知道，就是你的生活即將改變——已經(jīng)改變了。這是一場(chǎng)長(zhǎng)途旅行，你明白嗎？你們必須相互陪伴支持，但需要的時(shí)候你也要好好休息。這種病要么讓你們更團(tuán)結(jié)親密，要么讓你們徹底決裂。所以，現(xiàn)在你們要給彼此前所未有的支持和陪伴。我不希望你們中任何一個(gè)整夜待在床前或者守在醫(yī)院不走，好嗎？”
“I don’t know. What I do know—and I know you know these things, too—is that your life is about to—it already has changed. This is going to be a long haul, you understand? You have got to be there for each other, but you also have to get your rest when you need it. This kind of illness can either bring you together, or it can tear you apart. Now more than ever, you have to be there for each other. I don’t want either of you staying up all night at the bedside or never leaving the hospital. Okay?”

他繼續(xù)說(shuō)起手術(shù)計(jì)劃，可能的結(jié)果和預(yù)后，現(xiàn)在需要做的決定，需要開始考慮但不用立刻就做的決定，還有他們暫時(shí)完全不需要擔(dān)心的決定。談話結(jié)束時(shí)，一家人并不輕松，但看起來(lái)似乎可以面對(duì)未來(lái)了。我一直注意著兩夫妻的臉，一開始毫無(wú)血色、呆滯遲鈍，幾乎是神游天外，后來(lái)神情越來(lái)越振作和集中。坐在那兒的我突然意識(shí)到，那些集合了生命、死亡與意義的問(wèn)題，那些所有人在某個(gè)時(shí)候都必須要面對(duì)的問(wèn)題，通常都發(fā)生在醫(yī)院里。當(dāng)一個(gè)人真正遇到這些問(wèn)題，這就變成了實(shí)踐，有著哲學(xué)和生物學(xué)上的雙重意義。人類是生命體，遵循自然法則，很遺憾的是，這些法則就包括一條：熵總是在增大的，生命是無(wú)常的。疾病，就是分子的順序打亂了；生命的基本要求是新陳代謝，而死亡，就是新陳代謝的終止。
He went on to describe the planned operation, the likely outcomes and possibilities, what decisions needed to be made now, what decisions they should start thinking about but didn’t need to decide on immediately, and what sorts of decisions they should not worry about at all yet. By the end of the conversation, the family was not at ease, but they seemed able to face the future. I had watched the parents’ faces—at first wan, dull, almost otherworldly—sharpen and focus. And as I sat there, I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a medical context. In the actual situations where one encounters these questions, it becomes a necessarily philosophical and biological exercise. Humans are organisms, subject to physical laws, including, alas, the one that says entropy always increases. Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.