双语·当呼吸化为空气 我对意义、生命与死亡三者关系的理解

医学院的经历，让我加深了对意义、生命与死亡三者关系的理解，变得更为敏锐。我亲眼见证了自己读本科时写下的那些与人性关联的文字，在医患关系中变成了现实。作为医学生，我们要直面死亡与痛苦，我们以后的工作就是照顾病患，同时又暂不会感受到责任带来的真正冲击，这些充其量只是冰山一角而已。医学院的头两年，基本上就是上课、社交、学习和阅读，就是在继续本科的生活而已。然而，我在医学院的第一年认识了女友露西（就是我后来的妻子），她能看透学术生活究竟意味着什么。她内心的爱几乎无穷无尽，这也教会了我一些东西。有一天，她在我公寓的沙发上，研究着心电图的那些波动起伏，经过冥思苦想后，她正确地指出了其中致命的心律不齐的状况。然后她忽然明白过来了，并在一瞬间流下了眼泪：从这张不知从何而来的“练习用”心电图可以看出，这位病人已经不在人世了。纸上这些弯弯曲曲的线条，不只是简单的线条，还是从心颤再到心跳停止的全过程，这些会让看懂的人心痛落泪。
Medical school sharpened my understanding of the relationship between meaning, life, and death. I saw the human relationality I had written about as an under-graduate realized in the doctorpatient relationship. As medical students, we were confronted by death, suffering, and the work entailed in patient care, while being simultaneously shielded from the real brunt of responsibility, though we could spot its specter. Med students spend the first two years in classrooms, socializing, studying, and reading; it was easy to treat the work as a mere extension of undergraduate studies. But my girl-friend Lucy, whom I met in the first year of medical school (and who would later become my wife), understood the subtext of the academics. Her capacity to love was barely finite, and a lesson to me. One night on the sofa in my apartment, while studying the reams of wavy lines that make up EKGs, she puzzled over, then correctly identified, a fatal arrhythmia. All at once, it dawned on her and she began to cry: wherever this “practice EKG” had come from, the patient had not survived. The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating to asystole, and they could bring you to tears.

露西和我在耶鲁医学院上学时，谢普·纽兰德还在开课，但当时我只是拜读过他的一些作品。纽兰德是著名的外科医生兼哲学家，写了一本极具开创性的书，探讨死亡，名为《我们如何死去》，在我读高中时出版。但一直到进了医学院，我才得以捧读此书。在我读过的书里，少有像这本一样，能直接而全面地指出生存的基本事实：一切生物，不管是金鱼，还是可爱的小孩，都难逃一死。晚上，我在房间里聚精会神地拜读这本书，印象最深的是他对祖母病情的描述，一件事情竟然能如此淋漓尽致地展现身体上、医学上和精神上的混杂纠葛。纽兰德回忆起孩提时代常常玩的一个游戏——伸出手指去戳祖母的皮肤，看什么时候才能恢复原状。这是她慢慢变老的一个征兆。后来祖母又新添了呼吸急促的毛病，这些都说明她“逐渐走向充血性心力衰竭……老化的血液从老化的肺、老化的组织中能运送的氧气大大减少”。但“最明显的是”，他接着写道，“是她慢慢失去了生命力……祖母停止了祷告，也基本上停止了其他所有事情”。祖母因为中风最终去世时，纽兰德想起托马斯·布朗的《一个医生的信仰》：“我们无从得知降生世上将遭遇怎样的冲突与痛苦，但通常来说我们很难脱身其外。”
Lucy and I attended the Yale School of Medicine when Shep Nuland still lectured there, but I knew him only in my capacity as a reader. Nuland was a renowned surgeon-philosopher whose seminal book about mortality, How We Die, had come out when I was in high school but made it into my hands only in medical school. Few books I had read so directly and wholly addressed that fundamental fact of existence: all organisms, whether goldfish or grandchild, die. I pored over it in my room at night, and remember in particular his description of his grandmother’s illness, and how that one passage so perfectly illuminated the ways in which the personal, medical, and spiritual all intermingled. Nuland recalled how, as a child, he would play a game in which, using his finger, he indented his grandmother’s skin to see how long it took to resume its shape—a part of the aging process that, along with her newfound shortness of breath, showed her “gradual slide into congestive heart failure. . . the significant decline in the amount of oxygen that aged blood is capable of taking up from the aged tissues of the aged lung.” But “what was most evident,” he continued, “was the slow drawing away from life. . . By the time Bubbeh stopped praying, she had stopped virtually everything else as well.” With her fatal stroke, Nuland remembered Sir Thomas Browne’s Religio Medici: “With what strife and pains we come into the world we know not, but ’tis commonly no easy matter to get out of it.”

我花了那么多时间，在斯坦福研究文学，在剑桥探索医学史，想要对死亡的特性有更好的了解，结果却更觉疏离，始终懵懵懂懂，不得其道。而纽兰德的描述，才让我“绝知此事要躬行”。我转而学医，就是想去探寻死亡的双重神秘。死亡既带着浓烈的个人色彩，同时又丝毫不带个人色彩。这种截然相反的特性，无论从死亡的体验上，还是从其生理表现上，都表现得很充分。
I had spent so much time studying literature at Stanford and the history of medicine at Cambridge, in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me. Descriptions like Nuland’s convinced me that such things could be known only face-to-face. I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal.

我记得，纽兰德在《我们如何死去》的开头，写了一个年轻的医学生，独自待在手术室，面对一个心跳停止的病人。绝望之下，他为病人开胸，试图人工恢复他的心跳，那可真的是要起死回生。病人最终撒手人寰，最后纽兰德的导师找到了他，发现他浑身是血，垂头丧气。
I remember Nuland, in the opening chapters of How We Die, writing about being a young medical student alone in the OR with a patient whose heart had stopped. In an act of desperation, he cut open the patient’s chest and tried to pump his heart manually, tried to literally squeeze the life back into him. The patient died, and Nuland was found by his supervisor, covered in blood and failure.Medical school had changed by the time I got there, to the point where such a scene was simply unthinkable: as medical students, we were barely allowed to touch patients, let alone open their chests. What had not changed, though, was the heroic spirit of responsibility amid blood and failure. This struck me as the true image of a doctor.

我进医学院的时候，情况已然不同。上述的场景完全不可想象。我们这些医学生根本连碰都不准碰病人，更别说给他们开胸了。不过，没有改变的，是在鲜血和沮丧之间极富英雄主义精神的责任感。在我看来，这才是一个医生真正的形象。
The first birth I witnessed was also the first death.