双语·当呼吸化为空气 所有的医生都治病救人

所有的医生都治病救人，而神经外科医生则在为病人保命与保住个性之间备受煎熬：每一次脑科手术，都不可避免地成为我们对自身本质的一次操控；每一次和经历脑科手术的病人谈话，也都迫使我们直面这个现实。另外，对于病人和家属来说，脑科手术应该是他们一生中最戏剧化的事情了，是一件会对人生产生重要影响的大事。如此紧要的关头，问题不仅仅局限于生存还是死亡，还有到底怎样的人生才值得一活。你愿意用失去说话的能力，来交换多几个月的生命，默默无声地度过余生吗（也许你要替自己的母亲做这个决定）？你愿意冒着丧失视力的危险，来排除致命脑出血的哪怕一点点可能吗？你愿意右手丧失行动能力，来停止抽搐吗？你到底要让孩子的神经承受多少痛苦，才会更愿意选择死亡呢？因为脑部控制着我们对世界的感知和经历，任何神经上的问题都迫使病人和家属去思考（理想的状况是，有医生指导他们）：到底是什么，才赋予生命以意义，从而值得一活？
While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of ourselves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and their family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures between, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability—or your mother’s—to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and their family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

神经外科令我不由自主地折服，这里没有宽宥，必须追求完美。我想，这就像古希腊“arete”这个概念，是一种道德、情感、思维和身体上都至臻卓越的美德。神经外科似乎提供了最艰难的挑战，也最为直观地面对意义、个性和死亡。神经外科医生的肩膀上担负着沉重的责任，同时也是精通各个领域的“多面手”：神经外科、重症医学、神经内科、放射学。我意识到，不仅要训练思维和双手，还有眼睛，也许还有其他器官。这想法来势汹汹，令我深陷其中不可自拔：也许，我也能像那些博学通才一样，跋涉在情感、科学和精神难题最茂密的荆棘丛中，找到出口，或者杀出一条血路。
I was compelled by neurosurgery, with its unforgiving call to perfection; like the ancient Greek concept arete, I thought, virtue required moral, emotional, mental, and physical excellence. Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realized; I’d have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating: perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.

医学院毕业后，我们这对新婚夫妇去加利福尼亚开始住院医生生涯。我在斯坦福，露西在加州大学旧金山分校。医学院正式成为过去，我们要真正承担起责任了。我很快在医院交了几个好朋友，特别是和我同期的住院医生维多利亚，还有比我们早来几年的血管外科住院医生杰夫。接下来七年的训练生涯中，我们将一起成长，一开始只是见证医院里戏剧化的一幕幕，到后来自己开始担任其中的主角。
After medical school, Lucy and I, newly married, headed to California to begin our residencies, me at Stanford, Lucy just up the road at UCSF. Medical school was officially behind us—now real responsibility lay in wait. In short order, I made several close friends in the hospital, in particular, Victoria, my co-resident, and Jeff, a vascular surgery resident a few years senior to us. Over the next seven years of training, we would grow from bearing witness to medical dramas to becoming leading actors in them.

第一年的住院医生，在生命与死亡这样厚重的背景下，真可谓卑微如蝼蚁。不过，就算这样，工作强度也是巨大的。第一天到医院，住院总医生就对我说：“神经外科的住院医生不仅仅是最好的外科医生，我们也是整个医院最好的医生。这就是你的目标。让我们为你骄傲吧。”科主任经过病房时说：“吃饭的时候记得用左手。你要学会左右开弓。”年资比较高的一位住院医生说：“给你小小提醒一下，总医生正在闹离婚，别跟他聊闲天。”带我的是个很开朗的医生，本来应该给我一些说明和指导，却只是交给我一份四十三个病人的名单：“我只需要跟你说一件事：他们可以一直给你带来更多伤害，但他们无法让时间停止向前。”说完他就走了。
As an intern in the first year of residency, one is little more than a paper pusher against a backdrop of life and death—though, even then, the workload is enormous. My first day in the hospital, the chief resident said to me, “Neurosurgery residents aren’t just the best surgeons— we’re the best doctors in the hospital. That’s your goal. Make us proud.” The chairman, passing through the ward: “Always eat with your left hand. You’ve got to learn to be ambidextrous.” One of the senior residents: “Just a heads-up—the chief is going through a divorce, so he’s really throwing himself into his work right now. Don’t make small talk with him.” The outgoing intern who was supposed to orient me but instead just handed me a list of forty-three patients: “The only thing I have to tell you is: they can always hurt you more, but they can’t stop the clock.” And then he walked away.

接下来的两天我都没离开医院，但不久以后，这些堆积如山、看上去不可能完成的文件整理工作，只需要花一个小时就能轻松解决了。不过，医院工作中，你归档的文件可不仅仅是文件，而是各种各样充满风险与胜利的病例。比如，八岁的马修，有一天因为头痛来看医生，结果发现下丘脑附近有个肿瘤。下丘脑控制着我们的基本需求：睡眠、饥饿、口渴和性需求……那附近的任何肿瘤如果不及时彻底地处理，都会让马修的余生生活在化疗和更多的手术之中，头上还需要插着导管过活……简单来说，会毁了他的童年。完全切除肿瘤就能避免上述情况，但可能有损伤下丘脑的风险，让他染上暴饮暴食之类的毛病。手术开始，医生从马修的鼻腔里伸进一个内窥镜，钻开他的颅骨。进去以后就看到一个清晰的平面，切除了肿瘤。几天后，马修就在病房里活蹦乱跳了，还从护士那里偷糖吃。他准备回家的那天晚上，我很开心地填着他那似乎永远也填不完的出院手续。
I didn’t leave the hospital for the first two days, but before long, the impossible-seeming, day-killing mounds of paperwork were only an hour’s work. Still, when you work in a hospital, the papers you file aren’t just papers: they are fragments of narratives filled with risks and triumphs. An eight-year-old named Matthew, for example, came in one day complaining of headaches only to learn that he had a tumor abutting his hypothalamus. The hypothalamus regulates our basic drives: sleep, hunger, thirst, sex. Leaving any tumor behind would subject Matthew to a life of radiation, further surgeries, brain catheters. . . in short, it would consume his childhood. Complete removal could prevent that, but at the risk of damaging his hypothalamus, rendering him a slave to his appetites. The surgeon got to work, passed a small endoscope through Matthew’s nose, and drilled off the floor of his skull. Once inside, he saw a clear plane and removed the tumor. A few days later, Matthew was bopping around the ward, sneaking candies from the nurses, ready to go home. That night, I happily filled out the endless pages of his discharge paperwork.