雙語(yǔ)·當(dāng)呼吸化為空氣 高強(qiáng)度的工作安排當(dāng)然有負(fù)面影響

高強(qiáng)度的工作安排當(dāng)然有負(fù)面影響。雖然官方規(guī)定的最長(zhǎng)工作時(shí)間不超過(guò)每周八十八小時(shí)，但我們每周基本上要工作一百個(gè)小時(shí)。事情總是做不完的。我累得眼眶泛淚，腦袋生疼，凌晨?jī)牲c(diǎn)還在牛飲能量飲料。工作的時(shí)候我倒是精神百倍，但一走出醫(yī)院，筋疲力盡的感覺(jué)立刻就會(huì)擊中我。我踉踉蹌蹌地穿過(guò)停車場(chǎng)，總要先在車?yán)锎蛞粫?huì)兒盹，然后再開(kāi)十五分鐘的車回家，癱倒在床。
The schedule took a toll. As residents, we were working as much as one hundred hours a week; though regulations officially capped our hours at eighty-eight, there was always more work to be done. My eyes watered, my head throbbed, I downed energy drinks at two a. m. At work, I could keep it together, but as soon as I walked out of the hospital, the exhaustion would hit me. I staggered through the parking lot, often napping in my car before driving the fifteen minutes home to bed.

不是所有住院醫(yī)生都能承受住這種壓力。有一個(gè)就接受不了別人的指責(zé)，也承擔(dān)不起這么重的責(zé)任。他是個(gè)相當(dāng)有天賦的外科醫(yī)生，但一犯了錯(cuò)誤就難以面對(duì)、無(wú)法承認(rèn)。一天，我和他坐在休息室里，他哀求我挽救他的事業(yè)。
Not all residents could stand the pressure. One was simply unable to accept blame or responsibility. He was a talented surgeon, but he could not admit when he’d made a mistake. I sat with him one day in the lounge as he begged me to help him save his career.

“你唯一需要做的，”我說(shuō)，“就是直視我的眼睛，說(shuō)：‘我很抱歉。剛剛發(fā)生的事情是我的錯(cuò)。我不會(huì)再讓它發(fā)生了?！?br>“All you have to do,” I said, “is look me in the eye and say, ‘I’m sorry. What happened was my fault, and I won’t let it happen again.’ ”

“但是是護(hù)士——”
“But it was the nurse who—”

“不。你必須說(shuō)出來(lái)，發(fā)自內(nèi)心地說(shuō)。再試試?！?br>“No. You have to be able to say it and mean it. Try again.”

“但是——”
“But—”

“不。說(shuō)出來(lái)?！?br>“No. Say it.”

我們就這樣持續(xù)了一個(gè)小時(shí)，我終于知道，他完了。
This went on for an hour before I knew he was doomed.

沉重的壓力讓另一個(gè)住院醫(yī)生也出局了。她選擇離開(kāi)，找了份不那么繁重的咨詢工作。
The stress drove another resident out of the field entirely; she elected to leave for a less taxing job in consulting.

其他人甚至要付出更高的代價(jià)。
Others would pay even higher prices.

隨著我的技術(shù)日益精進(jìn)，我的責(zé)任也重大起來(lái)。我學(xué)習(xí)如何判斷哪些病人的命救得了，哪些難逃一死，哪些不能僅憑我的判斷來(lái)決定。我也會(huì)犯錯(cuò)誤。我把一個(gè)病人緊急送往手術(shù)室，只來(lái)得及保住他的心跳，但他再也說(shuō)不出話來(lái)了，要通過(guò)管道進(jìn)食，過(guò)上了自己決不接受的生活……我覺(jué)得這是比病人死亡更可怕的失敗。衰退的機(jī)能、無(wú)意識(shí)的新陳代謝，雖然存在，但已經(jīng)成為不可承受的重?fù)?dān)，一般都要被送往某個(gè)機(jī)構(gòu)，無(wú)法接受也不知如何是好的家人，探望得越來(lái)越少，直到褥瘡或肺炎無(wú)可避免地奪走他的生命。有些人堅(jiān)守在此生，睜大雙眼想活下去，探索各種各樣的可能性。但很多人沒(méi)有這樣做，或者說(shuō)做不到。而神經(jīng)外科醫(yī)生必須學(xué)會(huì)去裁決。
As my skills increased, so too did my responsibility. Learning to judge whose lives could be saved, whose couldn’t be, and whose shouldn’t be requires an unattainable prognostic ability. I made mistakes. Rushing a patient to the OR to save only enough brain that his heart beats but he can never speak, he eats through a tube, and he is condemned to an existence he would never want. . . I came to see this as a more egregious failure than the patient dying. The twilight existence of unconscious metabolism becomes an unbearable burden, usually left to an institution, where the family, unable to attain closure, visits with increasing rarity, until the inevitable fatal bedsore or pneumonia sets in. Some insist on this life and embrace its possibility, eyes open. But many do not, or cannot, and the neurosurgeon must learn to adjudicate.

我選擇醫(yī)療事業(yè)，部分原因是想追尋死神：抓住他，掀開(kāi)他神秘的斗篷，與他堅(jiān)定地四目相對(duì)。神經(jīng)外科對(duì)我的吸引力，不僅僅在于大腦與意識(shí)的交纏，更在于生與死的糾葛。我以為，在生與死的空間中，我一定能找到一個(gè)舞臺(tái)，不僅能憑憐憫和同情來(lái)采取行動(dòng)，自身還能得到升華，盡可能地遠(yuǎn)離所謂的物質(zhì)追求，遠(yuǎn)離自我那些微不足道的小事，直達(dá)生命的核心，直面生死的抉擇與掙扎……在那里，一定能找到某種超然卓越的存在吧？
I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life-and-death decisions and struggles. . . surely a kind of transcendence would be found there?

但在住院醫(yī)生的生涯中，別的什么東西漸漸在我眼前展現(xiàn)。腦部損傷如同永不停歇的密集炮火將我包圍，我開(kāi)始懷疑，離探索的前沿如此之近，這些時(shí)刻熾熱強(qiáng)烈的光也許會(huì)讓我對(duì)它們自然的特性視而不見(jiàn)，如同為了學(xué)習(xí)天文學(xué)直接凝視太陽(yáng)。在病人們的關(guān)鍵時(shí)刻，我還沒(méi)有達(dá)到與他們同在的境界，只能說(shuō)是這些關(guān)鍵時(shí)刻的參與者。我看過(guò)了太多的痛苦，更糟糕的是，我開(kāi)始習(xí)以為常。一個(gè)溺水，或者說(shuō)“溺血”的人，會(huì)努力去調(diào)整自己，學(xué)會(huì)漂浮，學(xué)會(huì)游泳，甚至開(kāi)始享受人生，和醫(yī)生護(hù)士交心，因?yàn)樗麄兒湍憬壴谕粭l船上，陷在同樣的風(fēng)浪中。
But in residency, something else was gradually unfolding. In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun. I was not yet with patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it. Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide.