双语·当呼吸化为空气 我的第一个死亡病例 发生在一个周二

我的第一个死亡病例，发生在一个周二。
I lost my first patient on a Tuesday.

八十二岁的一个老太太，身材娇小，自己收拾得很整洁，是普外科最健康的人。而我在普外科实习了一个月。（验尸的时候，病理医师得知她的年龄很是震惊：“她的器官年龄只有五十岁啊！”）她住院是因为轻微肠梗阻导致的便秘。我们等了六天，希望她的肠子能自行恢复。希望落空后，我们做了个小手术来进行治疗。周一晚上八点左右，我去病房查看，她神志清醒，状态良好。我一边和她聊天，一边从口袋里掏出一日工作计划，把最后一项（“术后检查，哈维太太”）划掉。我该回家休息一下了。
She was an eighty-two-year-old woman, small and trim, the healthiest person on the general surgery service, where I spent a month as an intern. (At her autopsy, the pathologist would be shocked to learn her age: “She has the organs of a fifty-year-old!”) She had been admitted for constipation from a mild bowel obstruction. After six days of hoping her bowels would untangle themselves, we did a minor operation to help sort things out. Around eight p. m. Monday night, I stopped by to check on her, and she was alert, doing fine. As we talked, I pulled from my pocket my list of the day’s work and crossed off the last item (post-op check, Mrs. Harvey). It was time to go home and get some rest.

午夜过后的某个时间，电话响了。病人不行了。几个小时前那种略带官僚主义的志得意满突然被撕得粉碎，我从床上猛地坐起来，连珠炮似的发布指令：“一升盐水静脉输液、心电图、照胸片，马上行动——我在去的路上了。”我给住院总医生打了电话，她告诉我还要多做一些检查，等我把情况搞得更清楚一些，再给她打电话。我冲到医院，看见哈维太太呼吸困难，心跳加快，血压陡降。无论我做什么，她也不见好转。而当时我是唯一在值班的普外实习生，呼机一直在震，有些信息可以忽略（病人需要安眠药物），有些没法不管（急诊室病人主动脉瘤断裂）。我手忙脚乱，如同溺水的人，万事缠身，黔驴技穷。哈维太太仍然没有起色。我安排把她转到重症监护室，拼命给她灌药输液来保命。接下来的几个小时，我就狂奔在急诊室那个面临死亡威胁的病人和重症监护室那个生命垂危的病人之间。凌晨5:45，急诊室的病人被推往手术室，哈维太太的情况也相对稳定下来。我们动用了十二升点滴、两个单位的血、一台呼吸机、三个血压增压器，才得以维持她的生命。
Sometime after midnight, the phone rang. The patient was crashing. With the complacency of bureaucratic work suddenly torn away, I sat up in bed and spat out orders: “One liter bolus of LR, EKG, chest X-ray, stat—I’m on my way in.” I called my chief, and she told me to add labs and to call her back when I had a better sense of things. I sped to the hospital and found Mrs. Harvey struggling for air, her heart racing, her blood pressure collapsing. She wasn’t getting better no matter what I did; and as I was the only general surgery intern on call, my pager was buzzing relentlessly, with calls I could dispense with (patients needing sleep medication) and ones I couldn’t (a rupturing aortic aneurysm in the ER). I was drowning, out of my depth, pulled in a thousand directions, and Mrs. Harvey was still not improving. I arranged a transfer to the ICU, where we blasted her with drugs and fluids to keep her from dying, and I spent the next few hours running between my patient threatening to die in the ER and my patient actively dying in the ICU. By 5:45. a. m., the patient in the ER was on his way to the OR, and Mrs. Harvey was relatively stable. She’d needed twelve liters of fluid, two units of blood, a ventilator, and three different pressors to stay alive.

等我终于走出医院，已经是周二下午五点。哈维太太仍然不见好转，也没有恶化。晚上七点，电话又响了，哈维太太昏迷了，重症监护团队正在尝试心肺复苏。我又狂奔回医院，她再次死里逃生，真是命悬一线。这次我没有回家，只是到医院附近去吃了晚饭，以防万一。
When I finally left the hospital, at five p. m. on Tuesday evening, Mrs. Harvey wasn’t getting better—or worse. At seven p. m., the phone rang: Mrs. Harvey had coded, and the ICU team was attempting CPR. I raced back to the hospital, and once again, she pulled through. Barely. This time, instead of going home, I grabbed dinner near the hospital, just in case.

八点，手机响了：哈维太太去世了。
At eight p. m., my phone rang: Mrs. Harvey had died.

我回家去睡觉。
I went home to sleep.

我的情绪介于愤怒和悲伤之间。不管怎么说，哈维太太是从那一摞厚厚的文件中“脱颖而出”，才成为我的病人。第二天，我参加了她的尸检，看着病理医师把她开膛破肚，移走各种器官。我亲自检查那些器官，用双手去抚摸，检查我在她肠道上缝针打的结。从那以后，我再也不把任何病人简单看作病历上的文字了，而是把所有的文件和病历都当作真正的病人来看待。
I was somewhere between angry and sad. For whatever reason, Mrs. Harvey had burst through the layers of paperwork to become my patient. The next day, I attended her autopsy, watched the pathologists open her up and remove her organs. I inspected them myself, ran my hands over them, checked the knots I had tied in her intestines. From that point on, I resolved to treat all my paperwork as patients, and not vice versa.