双语·当呼吸化为空气 高强度的工作安排当然有负面影响

高强度的工作安排当然有负面影响。虽然官方规定的最长工作时间不超过每周八十八小时，但我们每周基本上要工作一百个小时。事情总是做不完的。我累得眼眶泛泪，脑袋生疼，凌晨两点还在牛饮能量饮料。工作的时候我倒是精神百倍，但一走出医院，筋疲力尽的感觉立刻就会击中我。我踉踉跄跄地穿过停车场，总要先在车里打一会儿盹，然后再开十五分钟的车回家，瘫倒在床。
The schedule took a toll. As residents, we were working as much as one hundred hours a week; though regulations officially capped our hours at eighty-eight, there was always more work to be done. My eyes watered, my head throbbed, I downed energy drinks at two a. m. At work, I could keep it together, but as soon as I walked out of the hospital, the exhaustion would hit me. I staggered through the parking lot, often napping in my car before driving the fifteen minutes home to bed.

不是所有住院医生都能承受住这种压力。有一个就接受不了别人的指责，也承担不起这么重的责任。他是个相当有天赋的外科医生，但一犯了错误就难以面对、无法承认。一天，我和他坐在休息室里，他哀求我挽救他的事业。
Not all residents could stand the pressure. One was simply unable to accept blame or responsibility. He was a talented surgeon, but he could not admit when he’d made a mistake. I sat with him one day in the lounge as he begged me to help him save his career.

“你唯一需要做的，”我说，“就是直视我的眼睛，说：‘我很抱歉。刚刚发生的事情是我的错。我不会再让它发生了。’”
“All you have to do,” I said, “is look me in the eye and say, ‘I’m sorry. What happened was my fault, and I won’t let it happen again.’ ”

“但是是护士——”
“But it was the nurse who—”

“不。你必须说出来，发自内心地说。再试试。”
“No. You have to be able to say it and mean it. Try again.”

“但是——”
“But—”

“不。说出来。”
“No. Say it.”

我们就这样持续了一个小时，我终于知道，他完了。
This went on for an hour before I knew he was doomed.

沉重的压力让另一个住院医生也出局了。她选择离开，找了份不那么繁重的咨询工作。
The stress drove another resident out of the field entirely; she elected to leave for a less taxing job in consulting.

其他人甚至要付出更高的代价。
Others would pay even higher prices.

随着我的技术日益精进，我的责任也重大起来。我学习如何判断哪些病人的命救得了，哪些难逃一死，哪些不能仅凭我的判断来决定。我也会犯错误。我把一个病人紧急送往手术室，只来得及保住他的心跳，但他再也说不出话来了，要通过管道进食，过上了自己决不接受的生活……我觉得这是比病人死亡更可怕的失败。衰退的机能、无意识的新陈代谢，虽然存在，但已经成为不可承受的重担，一般都要被送往某个机构，无法接受也不知如何是好的家人，探望得越来越少，直到褥疮或肺炎无可避免地夺走他的生命。有些人坚守在此生，睁大双眼想活下去，探索各种各样的可能性。但很多人没有这样做，或者说做不到。而神经外科医生必须学会去裁决。
As my skills increased, so too did my responsibility. Learning to judge whose lives could be saved, whose couldn’t be, and whose shouldn’t be requires an unattainable prognostic ability. I made mistakes. Rushing a patient to the OR to save only enough brain that his heart beats but he can never speak, he eats through a tube, and he is condemned to an existence he would never want. . . I came to see this as a more egregious failure than the patient dying. The twilight existence of unconscious metabolism becomes an unbearable burden, usually left to an institution, where the family, unable to attain closure, visits with increasing rarity, until the inevitable fatal bedsore or pneumonia sets in. Some insist on this life and embrace its possibility, eyes open. But many do not, or cannot, and the neurosurgeon must learn to adjudicate.

我选择医疗事业，部分原因是想追寻死神：抓住他，掀开他神秘的斗篷，与他坚定地四目相对。神经外科对我的吸引力，不仅仅在于大脑与意识的交缠，更在于生与死的纠葛。我以为，在生与死的空间中，我一定能找到一个舞台，不仅能凭怜悯和同情来采取行动，自身还能得到升华，尽可能地远离所谓的物质追求，远离自我那些微不足道的小事，直达生命的核心，直面生死的抉择与挣扎……在那里，一定能找到某种超然卓越的存在吧？
I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking. Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death. I had thought that a life spent in the space between the two would grant me not merely a stage for compassionate action but an elevation of my own being: getting as far away from petty materialism, from self-important trivia, getting right there, to the heart of the matter, to truly life-and-death decisions and struggles. . . surely a kind of transcendence would be found there?

但在住院医生的生涯中，别的什么东西渐渐在我眼前展现。脑部损伤如同永不停歇的密集炮火将我包围，我开始怀疑，离探索的前沿如此之近，这些时刻炽热强烈的光也许会让我对它们自然的特性视而不见，如同为了学习天文学直接凝视太阳。在病人们的关键时刻，我还没有达到与他们同在的境界，只能说是这些关键时刻的参与者。我看过了太多的痛苦，更糟糕的是，我开始习以为常。一个溺水，或者说“溺血”的人，会努力去调整自己，学会漂浮，学会游泳，甚至开始享受人生，和医生护士交心，因为他们和你绑在同一条船上，陷在同样的风浪中。
But in residency, something else was gradually unfolding. In the midst of this endless barrage of head injuries, I began to suspect that being so close to the fiery light of such moments only blinded me to their nature, like trying to learn astronomy by staring directly at the sun. I was not yet with patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it. Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others who are clinging to the same raft, caught in the same tide.