雙語·當(dāng)呼吸化為空氣 這時的我已經(jīng)懂點(diǎn)基本規(guī)則了

手術(shù)以后，我們又談了話，這次我們聊了化療、放療和預(yù)后。這時的我已經(jīng)懂點(diǎn)基本規(guī)則了。首先，具體的數(shù)據(jù)是研究室里用的，病房里沒必要說。標(biāo)準(zhǔn)數(shù)據(jù)，也就是卡普蘭-邁耶曲線，對部分存活了一段時間的病人進(jìn)行了跟蹤檢測。我們就是用這個曲線來衡量治療的進(jìn)展，來判斷病情的嚴(yán)重程度。惡性膠質(zhì)瘤的曲線下降得特別快，手術(shù)兩年之后只有5%的病人還活著。其次，話要說得準(zhǔn)確，這非常重要，但還是必須留下希望的空間。我不會說“存活期是十一個月”或者“你有95%的機(jī)會在兩年內(nèi)死亡”，而是說：“大多數(shù)病人都活了好幾個月到好幾年。”在我看來，這可能是更誠實的說法。問題在于，你不能跟任何一個病人準(zhǔn)確地說她到底位于曲線的什么位置：是六個月以后死亡呢，還是六十個月以后？我覺得，當(dāng)不能準(zhǔn)確判斷的時候，說出具體時間是非常不負(fù)責(zé)任的行為。那些把具體時間說出來的庸醫(yī)（“醫(yī)生說我還能活六個月”），我一直想知道，他們都是誰??？統(tǒng)計學(xué)是誰教的？
After surgery, we talked again, this time discussing chemo, radiation, and prognosis. By this point, I had learned a couple of basic rules. First, detailed statistics are for research halls, not hospital rooms. The standard statistic, the Kaplan-Meier curve, measures the number of patients surviving over time. It is the metric by which we gauge progress, by which we understand the ferocity of a disease. For glioblastoma, the curve drops sharply until only about 5 percent of patients are alive at two years. Second, it is important to be accurate, but you must always leave some room for hope. Rather than saying, “Median survival is eleven months” or “You have a ninety-five percent chance of being dead in two years,” I’d say, “Most patients live many months to a couple of years.” This was, to me, a more honest description. The problem is that you can’t tell an individual patient where she sits on the curve: Will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be accurate. Those apocryphal doctors who gave specific numbers(“The doctor told me I had six months to live”): Who were they, I wondered, and who taught them statistics?

聽到消息后，大多數(shù)病人都是一言不發(fā)（畢竟，英語里的“病人”，“patient”這個詞，最初的含義之一，就是“毫無怨言地承受苦難的人”）。不管是出于自尊還是震驚，一般都是一片沉默，所以，交流的方式就變成握住病人的手。少數(shù)的一些馬上就堅強(qiáng)起來（一般是病人的伴侶，不是本人）：“我們會抗?fàn)?，打敗這鬼東西的，大夫?！笨?fàn)幍奈淦鞲饔胁煌?，有的祈禱，有的砸錢，有的求助草藥，有的輸入造血干細(xì)胞。在我看來，這種堅強(qiáng)往往不堪一擊，不切實際的樂觀往往下一秒就是排山倒海的絕望。不管怎么說，面對這種手術(shù)，有戰(zhàn)士一樣的斗志總是好的。手術(shù)室里，正在腐爛的深灰色腫瘤如同毫不留情的侵略者，入侵如同豐滿桃子一般而又溝回錯綜的人腦。我感到真切的憤怒（弄死你，你這混蛋。我往往小聲咒罵）。割除腫瘤給人很大的滿足感，就算我清楚那些微小的癌細(xì)胞已經(jīng)在整個看起來還很健康的腦部擴(kuò)散開來。不過這種幾乎無法避免的復(fù)發(fā)，就等到時候再去考慮吧。一勺一勺地慢慢喂。開誠布公地與別人聯(lián)結(jié)，并不意味著要一下子打開天窗把亮話全說了，而是要注意病人的接受程度，站在他們的立場，盡量引導(dǎo)他們走得遠(yuǎn)一些。
Patients, when hearing the news, mostly remain mute. (One of the early meanings of patient, after all, is “one who endures hardship without complaint.”) Whether out of dignity or shock, silence usually reigns, and so holding a patient’s hand becomes the mode of communication. A few immediately harden (usually the spouse, rather than the patient): “We’re gonna fight and beat this thing, Doc.”The armament varies, from prayer to wealth to herbs to stem cells. To me, that hardness always seems brittle, unrealistic optimism the only alternative to crushing despair. In any case, in the immediacy of surgery, a warlike attitude fit. In the OR, the dark gray rotting tumor seemed an invader in the fleshy peach convolutions of the brain, and I felt real anger (Got you, you fucker, I muttered). Removing the tumor was satisfying—even though I knew that microscopic cancer cells had already spread throughout that healthy-looking brain. The nearly inevitable recurrence was a problem for another day. A spoonful at a time. Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.

然而，開誠布公的聯(lián)結(jié)，也是有代價的。
Yet openness to human relationality also carried a price.

住院醫(yī)生生涯第三年的一天傍晚，我遇到杰夫，血管外科的那個朋友，也和我一樣，工作起來充滿熱情，要求很高，很專業(yè)。我們都注意到對方意志消沉并坦誠地指了出來?！澳阆日f吧。”他說。我講起一個孩子的死亡。因為鞋子顏色不對，被人當(dāng)頭一槍，但他就差一點(diǎn)點(diǎn)就能活下來了……最近遇到太多手術(shù)都無能為力的致命腦瘤，我簡直把這個孩子活下去的希望當(dāng)作自己的救命稻草。結(jié)果他沒活下來。杰夫欲言又止，我等著他的傾訴。結(jié)果他大笑起來，朝我胳膊打了一拳，說：“嗯，我反正是學(xué)會了：要是對我自己的工作感到沮喪，就找個神經(jīng)外科的聊聊，心里一下子就舒坦了。”
One evening in my third year, I ran into Jeff, my friend in vascular surgery, a similarly intense and demanding profession. We each noted the other’s despondency. “You go first,” he said. And I described the death of a child, shot in the head for wearing the wrong color shoes, but he had been so close to making it. . . Amid a recent spate of fatal, inoperable brain tumors, my hopes had been pinned on this kid pulling through, and he hadn’t. Jeff paused, and I awaited his story. Instead, he laughed, punched me in the arm, and said, “Well, I guess I learned one thing: if I’m ever feeling down about my work, I can always talk to a neurosurgeon to cheer myself up.”

那天晚上我開車回家，此前我還語氣輕柔地向一個媽媽解釋說，她剛出生的孩子天生沒有腦部，不久就會死亡。我打開了車上的收音機(jī)，NPR正在報道加州的持續(xù)干旱。突然間，淚水就順著臉頰滑落下來。和病人一起共度這些時刻，當(dāng)然是要付出感情代價的，但也有回報啊。我沒有哪一天哪一秒質(zhì)疑過自己為什么選擇這份工作，或者問自己到底值不值得。那是一種召喚，保衛(wèi)生命的召喚，不僅僅是保衛(wèi)生命，也是保衛(wèi)別人的個性，甚至說保衛(wèi)靈魂也不為過。這種召喚的神圣之處，是顯而易見的。
Driving home later that night, after gently explaining to a mother that her newborn had been born without a brain and would die shortly, I switched on the radio; NPR was reporting on the continuing drought in California. Suddenly, tears were streaming down my face. Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness.

我意識到，在給病人的腦部做手術(shù)之前，我必須首先了解他的思想：他的個性，他的價值觀，他為了什么活著，要遭遇什么樣的災(zāi)難，才能合理地終止這條生命。我是如此渴望成功，也為此付出了很大的代價，有些無法避免的失敗讓我感到幾乎無法承受的負(fù)疚感。正是這些包袱，讓行醫(yī)變得神圣而完全無法想象：背負(fù)起別人的十字架，你總有時候會被重負(fù)壓垮。
Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.

住院醫(yī)生生涯進(jìn)行到一半，會抽點(diǎn)時間來接受額外的訓(xùn)練。神經(jīng)外科是個很特別的醫(yī)學(xué)分支，光在神經(jīng)外科上出色是不夠的，還要成為對一切都精通的多面手。要做個好的神經(jīng)外科醫(yī)生，必須迎接挑戰(zhàn)，在其他領(lǐng)域也出類拔萃。有時候跨界跨得很廣，比如桑杰·古普塔，既是神經(jīng)外科醫(yī)生，又是記者。不過大多數(shù)時候，醫(yī)生還是會選擇和醫(yī)學(xué)有關(guān)的領(lǐng)域。最嚴(yán)苛而又最能取得盛名的道路，是成為神經(jīng)外科醫(yī)生兼神經(jīng)科學(xué)家。
Midway through residency, time is set aside for additional training. Perhaps unique in medicine, the ethos of neurosurgery—of excellence in all things—maintains that excellence in neurosurgery alone is not enough. In order to carry the field, neurosurgeons must venture forth and excel in other fields as well. Sometimes this is very public, as in the case of the neurosurgeon-journalist Sanjay Gupta, but most often the doctor’s focus is on a related field. The most rigorous and prestigious path is that of the neurosurgeon-neuroscientist.