雙語·當呼吸化為空氣 我在圣地亞哥參加一個會議

我在圣地亞哥參加一個會議，電話響了，是和我同期的住院醫(yī)生維多利亞。
I was at a conference in San Diego when my phone rang. My coresident, Victoria.

“保羅？”
“Paul?”

出事了。我胃里一陣抽搐。
Something was wrong. My stomach tightened.

“怎么了？”我說。
“What’s up?” I said.

沉默。
Silence.

“小維？”
“Vic?”

“杰夫，他自殺了?！?br>“It’s Jeff. He killed himself.”

“什么？”
“What?”

杰夫在中西部醫(yī)院的外科訓練快要告一段落了，我倆都忙得跟苦力似的……一直沒聯(lián)系。我努力回想我倆上一次聊天，但想不起來了。
Jeff was finishing his surgical fellowship in the Mid-west, and we were both so punishingly busy. . . we’d lost touch. I tried to recall our last conversation and couldn’t.

“他，嗯——應該是遇到很棘手的并發(fā)癥，他的病人死了。昨晚他爬到醫(yī)院樓頂，跳樓了。其他的我也不知道了?！?br>“He, uh—he apparently had a difficult complication, and his patient died. Last night he climbed onto the roof of a building and jumped off. I don’t really know anything else.”

我想再問點什么，憋了半天沒想出來。我只能想象那種排山倒海般的負罪感，如同洶涌的大浪，在樓頂把他拋起又甩了下去。
I searched for a question to bring understanding. None was forthcoming. I could only imagine the overwhelming guilt, like a tidal wave, that had lifted him up and off that building.

我絕望地想，要是那天晚上我能陪著他走出醫(yī)院的門就好了。我多么希望我倆能像以前一樣，彼此同情，互相安慰。我曾跟杰夫談過我一路走來對生命的理解，和對我們選擇的這種生活的理解，我多么希望能再聽聽他睿智而機巧的忠告。死神不會放過我們?nèi)魏稳?。我們和病人，活著，呼吸著，作為正在新陳代謝的生命體，這都是命運的安排。大多數(shù)人從生到死，都是被動的——這是你和你身邊的人需要接受的現(xiàn)實。但杰夫和我，多年勤學苦練，積極地與死神糾纏扭打，像雅各布和天使搏斗；在這個過程中，也不斷直面和拷問生命的意義。我們背負著無形的枷鎖，肩負著生死攸關(guān)的責任。也許病人鮮活的生命就握在我們手中，但死神總是最后的勝者。就算你是完美的，這個世界卻不是。秘訣在于，支撐我們繼續(xù)下去的秘訣在于，明白打從發(fā)牌的那一刻起，你已必輸無疑，你會手滑，你會判斷失誤，但即便如此也要拼盡全力為病人奮戰(zhàn)到底。你永遠無法到達完美的境地，但通過不懈的努力奮斗和追求，你能看見那無限接近完美的漸進曲線。
I wished, desperately, that I could’ve been walking with him out the door of the hospital that evening. I wished we could’ve commiserated as we used to. I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel. Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—it’s something that happens to you and those around you. But Jeff and I had trained for years to actively engage with death, to grapple with it, like Jacob with the angel, and, in so doing, to confront the meaning of a life. We had assumed an onerous yoke, that of mortal responsibility. Our patients’lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.

第二部　至死方休
PART II　Cease Not till Death

如果我編書，就要匯編一部人類死亡記錄，同時附上以下注解：教會別人死亡的人，同時也能教會人生活。
If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live.

——《探究哲理即是學習死亡》，米歇爾·德·蒙田
—Michel de Montaigne,“That to Study Philosophy Is to Learn to Die”

醫(yī)院病床上，露西和我相擁流淚。CT掃描的圖像仍然在電腦屏幕上閃爍。我作為醫(yī)生的身份特性已經(jīng)不重要了。癌癥入侵了多個器官系統(tǒng)，診斷結(jié)果已是一目了然。病房里靜悄悄的。露西說她愛我。我說：“我不想死。”我叮囑她要再嫁，一想到她可能孤身一人，我就無法忍受。我告訴她我們應該立刻重新申請抵押貸款。我們陸陸續(xù)續(xù)打電話告知親友們這個噩耗。過了一會兒，維多利亞到病房來了，我們討論了掃描結(jié)果，和未來可能采取的治療方案。她說起重返住院醫(yī)生崗位的流程，我示意她別說了。
Lying next to Lucy in the hospital bed, both of us crying, the CT scan images still glowing on the computer screen, that identity as a physician—my identity—no longer mattered. With the cancer having invaded multiple organ systems, the diagnosis was clear. The room was quiet. Lucy told me she loved me. “I don’t want to die,” I said. I told her to remarry, that I couldn’t bear the thought of her being alone. I told her we should refinance the mortgage immediately. We started calling family members. At some point, Victoria came by the room, and we discussed the scan and the likely future treatments. When she brought up the logistics of returning to residency, I stopped her.

“維多利亞，”我說，“我再也不可能以醫(yī)生的身份回到這家醫(yī)院了，你不覺得嗎？”
“Victoria,” I said, “I’m never coming back to this hospital as a doctor. Don’t you think?”

我生命的一個章節(jié)似乎已經(jīng)結(jié)束，也許整本生命之書都已臨近尾聲。我不再是牧師或牧人，可以協(xié)助生死的過渡；我發(fā)現(xiàn)自己就是那茫然困惑、不知所措、需要度化的綿羊。重大疾病不是要改變?nèi)松?，而是要將你的人生打得粉碎。感覺仿佛神跡降臨，強烈的光突然刺進眼睛，照射出真正重要的事情；其實更像有誰剛剛用燃燒彈炸毀了你一心一意前進的道路?，F(xiàn)在我必須繞道而行。
One chapter of my life seemed to have ended; perhaps the whole book was closing. Instead of being the pastoral figure aiding a life transition, I found myself the sheep, lost and confused. Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters— and more like someone had just firebombed the path forward. Now I would have to work around it.

弟弟吉旺來到我床前。“你已經(jīng)很成功了，”他說，“你知道的，對嗎？”
My brother Jeevan had arrived at my bedside. “You’ve accomplished so much,” he said. “You know that, don’t you?”

我嘆了口氣。他當然是好意，但這些話非?？斩?，沒有意義。我之前的人生一直在積累潛力，現(xiàn)在這些潛力都將是無用的了。我本來有那么多計劃，那么接近事業(yè)巔峰。現(xiàn)在我體力不支，重病纏身，我想象的未來和個人的身份認同轟然崩塌。我面對著我那些病人曾經(jīng)面對過的，有關(guān)“存在”的窘境。
I sighed. He meant well, but the words rang hollow. My life had been building potential, potential that would now go unrealized. I had planned to do so much, and I had come so close. I was physically debilitated, my imagined future and my personal identity collapsed, and I faced the same existential quandaries my patients faced.

肺癌確診了。我精心計劃和辛苦創(chuàng)造的未來消失得無影無蹤。我在工作中那么熟悉的死神，現(xiàn)在親自來做私人拜訪了。我們終于狹路相逢，正面交鋒。然而，我似乎一點也認不出面前這位死神。多年來我治療過無數(shù)病人，如今自己站在這個十字路口，我本應該看到和跟隨他們密集的腳印，然而眼前卻是一片白色沙漠，空空蕩蕩，艱險殘酷，荒無人煙，閃著刺眼的光，仿佛一場暴風雨過境，抹去了所有熟悉的痕跡。
The lung cancer diagnosis was confirmed. My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we were, finally face-toface, and yet nothing about it seemed recognizable. Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.