双语·当呼吸化为空气 我的住院医生同事杰夫和我一起合作治疗创伤

我的住院医生同事杰夫和我一起合作治疗创伤。每次创伤室那边有并发的脑损伤，他就叫我过去，我俩的行动一向很默契。他检查腹部，然后问我对病人的认知功能有什么判断。“嗯，他要是想，还是可以做参议员的，”有一次我如此回答，“不过只能去个比较小的州了。”杰夫大笑，从那时起，一个州的人口就成为我们描述脑损伤严重程度的指标。“他是怀俄明还是加利福尼亚？”杰夫这么问，决定给病人制订什么程度的治疗方案。或者我可能会说：“杰夫，我知道他的血压还很正常，但我要给他做手术，不然他就要从华盛顿变成爱达荷了，你能把他稳一稳吗？”
My fellow resident Jeff and I worked traumas to-gether. When he called me down to the trauma bay because of a concurrent head injury, we were always in sync. He’d assess the abdomen, then ask for my prognosis on a patient’s cognitive function. “Well, he could still be a senator,” I once replied, “but only from a small state.” Jeff laughed, and from that moment on, state population became our barometer for head-injury severity. “Is he a Wyoming or a California?”Jeff would ask, trying to determine how intensive his care plan should be. Or I’d say, “Jeff, I know his blood pressure is labile, but I gotta get him to the OR or he’s gonna go from Washing-ton to Idaho—can you get him stabilized?”

一天，我在餐厅吃着常吃的午餐，健怡可乐加冰激凌三明治。突然呼机响了，说马上要来一个重伤病人。我跑到创伤室，刚把冰激凌三明治藏在一台电脑后面，急救车就到了，急救员们推着轮床，连珠炮似的交代情况：“二十二岁，男性，摩托车事故，时速四十英里，鼻孔流出液体，疑似脑浆……”
In the cafeteria one day, as I was grabbing my typical lunch—a Diet Coke and an ice cream sandwich—my pager announced an incoming major trauma. I ran to the trauma bay, tucking my ice cream sandwich behind a computer just as the paramedics arrived, pushing the gurney, reciting the details: “Twenty-two-year-old male, motorcycle accident, forty miles per hour, possible brain coming out his nose. . . ”

我立刻开始工作，叫人给我拿了个插管托盘，检查其他的体征。安全插管之后，我检查了他身体多处的创伤：脸部淤青，皮肉擦伤，瞳孔放大。我们给他注射了很多甘露醇，减轻脑肿胀，急急忙忙地推他去照片子：颅骨碎裂，活动性大出血。我心里已经在规划开颅手术了，该怎么钻开颅骨，把血抽出来。他的血压突然下降了。我们又迅速把他推回创伤室。创伤团队的其他人刚刚赶到，他的心跳就停止了。在他周围，各种各样旋风般的行动迅速进行：很多导管插入他的股动脉，深入他的胸腔，静脉上注射着药物；与此同时，医生的拳头捶打着他的心脏部位，保持血液流通。三十分钟后，我们停了手，任他完成死亡的过程。大家都意见一致地低语：脑部受这么重的伤，死了其实更好。
I went straight to work, calling for an intubation tray, assessing his other vital functions. Once he was safely intubated, I surveyed his various injuries: the bruised face, the road rash, the dilated pupils. We pumped him full of mannitol to reduce brain swelling and rushed him to the scanner: a shattered skull, heavy diffuse bleeding. In my mind, I was already planning the scalp incision, how I’d drill the bone, evacuate the blood. His blood pressure suddenly dropped. We rushed him back to the trauma bay, and just as the rest of the trauma team arrived his heart stopped. A whirlwind of activity surrounded him: catheters were slipped into his femoral arteries, tubes shoved deep into his chest, drugs pushed into his IVs, and all the while, fists pounded on his heart to keep the blood flowing. After thirty minutes, we let him finish dying. With that kind of head injury, we all murmured in agreement, death was to be preferred.

我溜出创伤室，他的家人正好被领进去认尸。我突然想起来，我的健怡可乐，我的冰激凌三明治……创伤室又那么闷热。急诊室一个住院医生帮我打了掩护，我像个幽灵似的溜了回去，从那个我救不了的病人的尸体前，把冰激凌三明治“救”了出去。
I slipped out of the trauma bay just as the family was brought in to view the body. Then I remembered: my Diet Coke, my ice cream sandwich. . . and the sweltering heat of the trauma bay. With one of the ER residents covering for me, I slipped back in, ghostlike, to save the ice cream sandwich in front of the corpse of the son I could not.

在冰箱里冻了三十分钟，三明治算是“满血复活”了。我一边想，挺好吃的，一边把卡在牙缝里的巧克力碎屑给弄出来。而死者的家人正在那边做最后的道别。我在想，短暂的从医生涯以来，我的道德观，是后退了，还是进步了？
Thirty minutes in the freezer resuscitated the sandwich. Pretty tasty, I thought, picking chocolate chips out of my teeth as the family said its last goodbyes. I wondered if, in my brief time as a physician, I had made more moral slides than strides.

几天后，我听说医学院的一个朋友劳里被车撞了，一个神经科医生做了手术，试图救她的命。她昏迷过去，又醒了过来，第二天去世了。我不想再往下听了。以前听这种事情，总是一句简单的“车祸丧生”就不会再去想其他的，现在那样的日子一去不复返了。现在听到一句“车祸丧生”，就像打开了潘多拉的魔盒，各种各样的画面一起涌上来：轮床急速向前，创伤室的地上鲜血淋漓，导管插入她的喉咙，拳头不断捶打她的胸腔。我仿佛看见一双手，我的手，剃着劳里的头发，手术刀割开她的头颅；耳边有钻子的嗡嗡声，骨头的焦煳味，钻开时飞扬的微尘，撬开她一小块头骨时那裂开的声音。她的头发被剃掉了一半，她的头部完全被拆解了。她再也无法变成完整的自己了，她的朋友和家人都认不出她了。也许她身上还插了胸管，一条腿上做了牵引……
A few days later, I heard that Laurie, a friend from medical school, had been hit by a car and that a neurosurgeon had performed an operation to try to save her. She’d coded, was revived, and then died the following day. I didn’t want to know more. The days when someone was simply “killed in a car accident” were long gone. Now those words opened a Pandora’s box, out of which emerged all the images: the roll of the gurney, the blood on the trauma bay floor, the tube shoved down her throat, the pounding on her chest. I could see hands, my hands, shaving Laurie’s scalp, the scalpel cutting open her head, could hear the frenzy of the drill and smell the burning bone, its dust whirling, the crack as I pried off a section of her skull. Her hair half shaven, her head deformed. She failed to resemble herself at all; she became a stranger to her friends and family. Maybe there were chest tubes, and a leg was in traction. . .

我没有询问细节。毕竟已经见过太多了。
I didn’t ask for details. I already had too many.

那一刻，我心里突然涌现出自己毫无同情心的一幕又一幕：我对病人万分担忧的心情不管不顾，急着劝他们出院；别的事情忙不过来的时候，我忽略病人的痛苦；我观察病人的病状，记下来，做出自以为准确的各种诊断，却并没有看到深层的病因——后来这些病人总是不断出现在我的回忆中，满怀复仇的怒火，不屈不挠。
In that moment, all my occasions of failed empathy came rushing back to me: the times I had pushed discharge over patient’s worries, ignored patients’ pain when other demands pressed. The people whose suffering I saw, noted, and neatly packaged into various diagnoses, the significance of which I failed to recognize—they all returned, vengeful, angry, and inexorable.

我怕自己即将成为托尔斯泰笔下那种很典型的医生，沉浸于空洞的形式主义，诊断时只会生搬硬套，完全忽略更大程度上的人性意义。（“医生们来看她，有时各人单独地来，有时大家举行会诊，用法语、德语、拉丁语说很多的话，他们互相批评，按照他们看得出来的病征开出各种各样的药方，但是他们当中没有一个人想到那个简单的道理，就是他们完全不能够了解娜塔莎病中的痛苦。”）一位刚被诊断出脑瘤的母亲来找我。她很困惑、很恐惧，完全不知所措。当时的我筋疲力尽，全然不把她放在心上。我匆忙地回答了她的问题，向她保证手术一定会很成功，也安慰自己说没时间详细地解答她所有的问题。但我为什么没有抽出时间呢？曾经有个脾气特别暴躁的兽医病人，拒绝众多医生、护士和理疗师的劝告，结果，他背上的伤口破裂了，正如我们警告的那样。我当时在手术室，被叫了出去，帮他缝好裂开的伤口。他痛得嗷嗷大叫，我心想：他活该。
I feared I was on the way to becoming Tolstoy’s stereotype of a doctor, preoccupied with empty formalism, focused on the rote treatment of disease—and utterly missing the larger human significance. (“Doctors came to see her singly and in consultation, talked much in French, German, and Latin, blamed one another, and prescribed a great variety of medicines for all the diseases known to them, but the simple idea never occurred to any of them that they could not know the disease Natasha was suffering from.”) A mother came to me, newly diagnosed with brain cancer. She was confused, scared, overcome by uncertainty. I was exhausted, disconnected. I rushed through her questions, assured her that surgery would be a success, and assured myself that there wasn’t enough time to answer her questions fairly. But why didn’t I make the time? A truculent vet refused the advice and coaxing of doctors, nurses, and physical therapists for weeks; as a result, his back wound broke down, just as we had warned him it would. Called out of the OR, I stitched the dehiscent wound as he yelped in pain, telling myself he’d had it coming.