雙語·當呼吸化為空氣 我的第一個死亡病例 發(fā)生在一個周二

我的第一個死亡病例，發(fā)生在一個周二。
I lost my first patient on a Tuesday.

八十二歲的一個老太太，身材嬌小，自己收拾得很整潔，是普外科最健康的人。而我在普外科實習了一個月。（驗尸的時候，病理醫(yī)師得知她的年齡很是震驚：“她的器官年齡只有五十歲?。　保┧≡菏且驗檩p微腸梗阻導致的便秘。我們等了六天，希望她的腸子能自行恢復。希望落空后，我們做了個小手術來進行治療。周一晚上八點左右，我去病房查看，她神志清醒，狀態(tài)良好。我一邊和她聊天，一邊從口袋里掏出一日工作計劃，把最后一項（“術后檢查，哈維太太”）劃掉。我該回家休息一下了。
She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight p. m. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest.

午夜過后的某個時間，電話響了。病人不行了。幾個小時前那種略帶官僚主義的志得意滿突然被撕得粉碎，我從床上猛地坐起來，連珠炮似的發(fā)布指令：“一升鹽水靜脈輸液、心電圖、照胸片，馬上行動——我在去的路上了。”我給住院總醫(yī)生打了電話，她告訴我還要多做一些檢查，等我把情況搞得更清楚一些，再給她打電話。我沖到醫(yī)院，看見哈維太太呼吸困難，心跳加快，血壓陡降。無論我做什么，她也不見好轉。而當時我是唯一在值班的普外實習生，呼機一直在震，有些信息可以忽略（病人需要安眠藥物），有些沒法不管（急診室病人主動脈瘤斷裂）。我手忙腳亂，如同溺水的人，萬事纏身，黔驢技窮。哈維太太仍然沒有起色。我安排把她轉到重癥監(jiān)護室，拼命給她灌藥輸液來保命。接下來的幾個小時，我就狂奔在急診室那個面臨死亡威脅的病人和重癥監(jiān)護室那個生命垂危的病人之間。凌晨5:45，急診室的病人被推往手術室，哈維太太的情況也相對穩(wěn)定下來。我們動用了十二升點滴、兩個單位的血、一臺呼吸機、三個血壓增壓器，才得以維持她的生命。
Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45. a. m., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive.

等我終于走出醫(yī)院，已經是周二下午五點。哈維太太仍然不見好轉，也沒有惡化。晚上七點，電話又響了，哈維太太昏迷了，重癥監(jiān)護團隊正在嘗試心肺復蘇。我又狂奔回醫(yī)院，她再次死里逃生，真是命懸一線。這次我沒有回家，只是到醫(yī)院附近去吃了晚飯，以防萬一。
When I finally left the hospital, at five p. m. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven p. m., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case.

八點，手機響了：哈維太太去世了。
At eight p. m., my phone rang: Mrs. Harvey had died.

我回家去睡覺。
I went home to sleep.

我的情緒介于憤怒和悲傷之間。不管怎么說，哈維太太是從那一摞厚厚的文件中“脫穎而出”，才成為我的病人。第二天，我參加了她的尸檢，看著病理醫(yī)師把她開膛破肚，移走各種器官。我親自檢查那些器官，用雙手去撫摸，檢查我在她腸道上縫針打的結。從那以后，我再也不把任何病人簡單看作病歷上的文字了，而是把所有的文件和病歷都當作真正的病人來看待。
I was somewhere between angry and sad. For whatever reason, Mrs. Harvey had burst through the layers of paperwork to become my patient. The next day, I attended her autopsy, watched the pathologists open her up and remove her organs. I inspected them myself, ran my hands over them, checked the knots I had tied in her intestines. From that point on, I resolved to treat all my paperwork as patients, and not vice versa.