雙語·當呼吸化為空氣 最需要小心的 是價值觀的不斷變化

人一旦遭遇頑疾，最需要小心的，是價值觀的不斷變化。你努力思考自己到底看重些什么，答案也會接踵而至。感覺就像信用卡被人拿走了，我不得不學會討價還價。你可能本來已經(jīng)下定決心，自己寶貴的時間要投入到神經(jīng)外科的工作中，但兩個月以后，你的想法又會有所改變。再過兩個月，你可能就想去吹吹薩克斯，然后每天去教堂，全心全意去敬拜上帝。死亡也許只是一生一次的短暫事件，但與絕癥共存則是個長期的過程。
The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.

我突然驚覺，自己已經(jīng)經(jīng)歷了悲痛的五個階段，就是老生常談的“否認→憤怒→討價還價→消沉→接受”。但我完全是反著來的。剛診斷出來的時候，我對死亡已經(jīng)做足了準備。我甚至自我感覺良好，完全接受現(xiàn)實，有種萬事俱備的篤定感。接著我開始消沉，因為我畢竟不大可能很快就死去。這當然是個好消息，但也令人困惑迷茫，甚至很奇怪地令我萎靡不振?？拱┘夹g(shù)的飛速發(fā)展以及各項相關(guān)數(shù)據(jù)，說明我也許可以再活十二個月，或者一百二十個月。本來，這種大病是應(yīng)該讓你完全看清自己和生命的。然而，我只是知道自己要死了——可我以前也是知道的呀。我所知的東西仍然一樣，但已經(jīng)不能像從前那樣隨意約見朋友，享受正常生活了。要是我確切地知道自己到底還剩多少個月或者多少年，前路也許會清晰很多。你要是告訴我，還剩三個月，那我就全部用來陪家人；還剩一年，我可能會寫一本書；還有十年，我就回去救死扶傷?！盎钤诋斚隆边@種真理對我根本沒有幫助：我這當下到底該怎么活??？接著，在某個時刻，我又開始討價還價，嗯，其實也不算討價還價吧。我心里默默地說：“上帝啊，我讀了《約伯記》，不能完全理解。但如果這是測試我信仰的方式，那你應(yīng)該已經(jīng)看到我的信仰很弱?？赡苣阍谘Ｈ馊髦紊狭酎c那種辣芥末也能測試我的信仰呢？真的不用這么大費周章地給我來個‘核爆炸’吧，真的……”討價還價之后，怒氣就一陣陣涌上心頭：“我這小半輩子都在努力奮斗，已經(jīng)到了這份兒上了，居然得了癌癥？”
It struck me that I had traversed the five stages of grief—the “Denial→Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all, which is, of course, good news, but also confusing and strangely enervating. The rapidity of the cancer science, and the nature of the statistics, meant I might live another twelve months, or another 120. Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die—but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day? At some point, then, I began to do a little bargaining—or not exactly bargaining. More like: “God, I have read Job, and I don’t understand it, but if this is a test of faith, you now realize my faith is fairly weak, and probably leaving the spicy mustard off the pastrami sandwich would have also tested it? You didn’t have to go nuclear on me, you know. . . ” Then, after the bargaining, came flashes of anger: “I work my whole life to get to this point, and then you give me cancer?”

現(xiàn)在，可能我終于來到“否認”這個階段了。也許是完全的否認。也許在缺乏任何定論的情況下，我們應(yīng)該假設(shè)自己能活很久?？赡苓@是前進的唯一辦法。
And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.

現(xiàn)在，查出癌癥九個月了，我?guī)缀跆焯熳鍪中g(shù)到深夜，甚至到凌晨，一心一意要好好畢業(yè)。我的身體遭受了沉重打擊。每天回到家，我都累得吃不下東西。而且慢慢在加大泰勒諾、非類固醇抗炎藥和止吐劑的用量。我開始不?？人?，大概是肺部惡性腫瘤纖維化引起的。我告訴自己，只需要再堅持幾個月，就可以結(jié)束這種馬不停蹄的工作狀態(tài)，順利從住院醫(yī)生畢業(yè)，安心做個相比之下更平靜、更輕松的教授。二月份，我飛去威斯康星參加工作面試。他們的一切條件都正合我心：數(shù)百萬美元的資金供我開設(shè)神經(jīng)系統(tǒng)科學實驗室；領(lǐng)導(dǎo)自己的臨床醫(yī)學團隊；工作時間和內(nèi)容都靈活，根據(jù)我的健康情況而定；終身教授職位；對露西也有很優(yōu)厚的工作安排；高薪、美景、田園牧歌般的城市、完美的老板?！拔伊私饽愕慕】禒顩r，你和你的腫瘤醫(yī)生應(yīng)該也很親密?！辈块T主管對我說，“如果你想繼續(xù)在那邊的治療，我們就幫你來回飛。不過我們這兒也有一流的抗癌中心，你愿意的話就去看看。我還能不能再做點什么，讓這個工作更有吸引力？”
I was operating until late at night or into the early morning, fixated on graduation, my diagnosis nine months in the past. My body was taking a beating. I was too tired to eat when I got home. I had been slowly upping the dose of Tylenol and NSAIDs and antiemetics. I had developed a persistent cough, presumably caused by scarring from the dead tumor in my lungs. I only had to keep up this relentless pace for a couple more months, I told myself, and then I would graduate from residency and settle into the comparatively calmer role of a professor. In February, I flew to Wisconsin for a job interview. They were offering everything I wanted: millions of dollars to start a neuroscience lab, head of my own clinical service, flexibility if I needed it for my health, a tenure-track professorship, appealing job options for Lucy, high salary, beautiful scenery, idyllic town, the perfect boss. “I understand about your health, and you probably have a strong connection with your oncologist,” the department chairman told me. “So if you want to keep your care there, we can fly you back and forth—though we do have a top-notch cancer center here, if you want to explore it. Is there anything else I can do to make this job more attractive?”

我想了想艾瑪說過的話。我之前不相信自己能繼續(xù)外科醫(yī)生的事業(yè)，如今卻已經(jīng)成功重返手術(shù)臺，這個轉(zhuǎn)變是很有分量的，甚至有點宗教層面的意味。在我自己都不相信自己的時候，她還一直記掛著我的這個身份。我多年前立志成為醫(yī)生時對自己提出的挑戰(zhàn)，她做到了：審視靈魂，接受自己作為凡人的責任，讓我重新找回自己。我已經(jīng)抵達了很多神經(jīng)外科住院醫(yī)生的制高點，立志不僅要做個神經(jīng)外科醫(yī)生，還要做個神經(jīng)系統(tǒng)科學家。這是每個學生夢寐以求的目標，但能實現(xiàn)的卻寥寥無幾。
I thought about what Emma had told me. I had gone from being unable to believe I could be a surgeon to being one, a transformation that carried the force of religious conversion. She had always kept this part of my identity in mind, even when I couldn’t. She had done what I had challenged myself to do as a doctor years earlier: accepted mortal responsibility for my soul and returned me to a point where I could return to myself. I had attained the heights of the neurosurgical trainee, set to become not only a neurosurgeon but a surgeonscientist. Every trainee aspires to this goal; almost none make it.

當晚晚飯后，主管開車送我回酒店。他在路邊停了車。“我給你看個東西。”他說。我們下了車，站在醫(yī)院門口，面前是冰封的湖水，對岸是科系辦公室星星點點的燈光?！跋奶?，你可以游泳或者開船去上班。冬天呢，滑雪滑冰都可以。”
That night, the chairman was driving me back to my hotel after dinner. He stopped the car and pulled over. “Let me show you something,” he said. We got out and stood in front of the hospital, looking over a frozen lake, its far edge luminous with specks of light leaking from faculty houses. “In summer, you can swim or sail to work. In winter, you can ski or ice-skate.”