双语·当呼吸化为空气 生病会改变全家人的生活

无论什么大病，都能完全改变一个病人以及全家人的生活。但脑部的疾病又有其独特的严重性。如果儿子去世了，父母的世界一定会天翻地覆，那么，如果病人是脑死亡，身体还温热，心脏还跳动，那岂不是更加不可理解？灾难的起源如同星球开始解体，当病人听到神经外科医生的诊断时，他们的眼神，就像解体的碎片——这个比喻最最恰切不过。有时候，消息太惊人了，脑子几乎会“短路”。这种现象被称为“心因性”综合征。有些人听到坏消息后会昏过去，这种综合征就是更为严重的情况。我母亲的父亲，在二十世纪六十年代的印度农村顶住重重压力，保障了女儿的教育。而我母亲只身一人在外面上大学的时候，听到坏消息，自己的好爸爸在长期住院之后最终去世，她当时就发作了心因性癫痫，一直持续到她回家参加葬礼。我的一个病人，刚被诊断出脑癌时，突然就倒地昏迷了。我做了一系列的化验、扫描、脑电图寻找原因，但没有结果。决定性的测试反而是最简单的：我把病人的手臂举起来，高过他的脸，然后松开。心因性昏迷的病人还有残存的决断力，会避免打到自己。治疗手段包括不断跟他说话，安慰他，直到他感受到你的言语，醒过来。
Any major illness transforms a patient’s—really, an entire family’s—life. But brain diseases have the additional strangeness of the esoteric. A son’s death already defies the parents’ ordered universe; how much more incomprehensible is it when the patient is brain-dead, his body warm, his heart still beating? The root of disaster means a star coming apart, and no image expresses better the look in a patient’s eyes when hearing a neurosurgeon’s diagnosis. Sometimes the news so shocks the mind that the brain suffers an electrical short. This phenomenon is known as a “psychogenic” syndrome, a severe version of the swoon some experience after hearing bad news. When my mother, alone at college, heard that her father, who had championed her right to an education in rural 1960s India, had finally died after a long hospitalization, she had a psychogenic seizure—which continued until she returned home to attend the funeral. One of my patients, upon being diagnosed with brain cancer, fell suddenly into a coma. I ordered a battery of labs, scans, and EEGs, searching for a cause, without result. The definitive test was the simplest: I raised the patient’s arm above his face and let go. A patient in a psychogenic coma retains just enough volition to avoid hitting himself. The treatment consists in speaking reassuringly, until your words connect and the patient awakens.

脑癌分两种：一是与生俱来的原发性肿瘤，另一种是转移性肿瘤，从身体别的地方迁移至此，比较普遍的是从肺部转移。手术无法治愈，但的确可以延长生命；对于大多数人来说，一旦得上脑癌，就意味着一年内死亡，可能两年。
Cancer of the brain comes in two varieties: primary cancers, which are born in the brain, and metastases, which emigrate from somewhere else in the body, most commonly from the lungs. Surgery does not cure the disease, but it does prolong life; for most people, cancer in the brain suggests death within a year, maybe two.

李太太快满六十了，眼睛是淡绿色的，两天前转到我这里。原来住的医院在她家附近，离这儿有一百六十多公里。她丈夫穿着格子衬衫，衬衫的下摆整齐地塞进洗得干净挺括的牛仔裤里。他站在她床边，不安地摆弄着手上的结婚戒指。自我介绍以后，我坐下来，她给我讲了自己的事：过去几天来，她一直觉得右手在麻麻地刺痛，然后就有点不听使唤了，后来发展到连衬衫扣子都扣不好。她去了当地的急诊，害怕是中风。在那里做了个核磁共振，就被送到这儿来了。
Mrs. Lee was in her late fifties, with pale green eyes, and had transferred to my service two days earlier from a hospital near her home, a hundred miles away. Her husband, his plaid shirt tucked into crisp jeans, stood by her bedside, fidgeting with his wedding ring. I introduced myself and sat down, and she told me her story: For the past few days, she had felt a tingling in her right hand, and then she’d begun to lose control of it, until she could no longer button her blouse. She’d gone to her local ER, fearing she was having a stroke. An MRI was obtained there, and she was sent here.

“有人给你解释核磁共振的结果吗？”我问。
“Did anyone tell you what the MRI showed?” I asked.

“没有。”烫手山芋被扔给我了，这种难以启齿的事情总是这样。一般来说，我们都要和肿瘤医师吵一架，让他负责把这种消息转达给病人。这事儿我都干了多少回了？嗯，我想，到此为止吧。
“No.” The buck had been passed, as it often was with difficult news. Oftentimes, we’d have a spat with the oncologist over whose job it was to break the news. How many times had I done the same? Well, I figured, it can stop here.

“好，”我说，“我们要好好谈谈了。要是你不介意的话，能不能跟我说说你现在的想法？听病人聊聊对我总是很有帮助的，免得我待会儿说不清楚。”
“Okay,” I said. “We have a lot to talk about. If you don’t mind, can you tell me what you understand is happening? It’s always helpful for me to hear, to make sure I don’t leave anything unanswered.”

“嗯，我以为是中风了。但我猜……不是？”
“Well, I thought I was having a stroke, but I guess. . . I’m not?”

“猜得对。你没有中风。”我略有迟疑。我能看到她上周的生活和即将来临的生活之间那巨大的鸿沟。她和她丈夫看上去都没做好迎接脑瘤的准备。到底又有谁准备好过呢？于是我放缓速度，稍微说得含蓄了些：“从核磁共振看，你脑部有包块，所以才有那样的症状。”
“That’s right. You aren’t having a stroke.” I paused. I could see the vastness of the chasm between the life she’d had last week and the one she was about to enter. She and her husband didn’t seem ready to hear brain cancer— is anyone?—so I began a couple steps back. “The MRI shows a mass in your brain, which is causing your symptoms.”

沉默。
Silence.

“你想看看核磁共振图像吗？”
“Do you want to see the MRI?”

“想。”
“Yes.”

我从病床边的电脑上调出那些图像，指出她的鼻子、眼睛、耳朵，教她看。接着我向上滚动到肿瘤的位置，黑色的坏死核周围包裹着边缘起伏的白色圆环。
I brought up the images on the bedside computer, pointing out her nose, eyes, and ears to orient her. Then I scrolled up to the tumor, a lumpy white ring surrounding a black necrotic core.

“那个是什么？”她问。
“What’s that?” she asked.

有很多可能。也许是感染。做了手术才知道。
Could be anything. Maybe an infection. We won’t know till after surgery.

我仍然想回避这个问题，好让他们暂时不那么忧心忡忡，心理负担稍微轻一些。
My inclination to dodge the question still persisted, to let their obvious worries float in their heads, unpinned.

“做完手术才知道，”我开口，“但很像脑肿瘤。”
“We can’t be sure until after surgery,” I began, “but it looks very much like a brain tumor.”

“是癌症吗？”
“Is it cancer?”

“刚才说了，要取下来交给病理师，做了活检才知道。但是，如果让我来猜测，我可能会说是。”
“Again, we won’t know for certain until it is removed and examined by our pathologists, but, if I had to guess, I would say yes.”

从扫描结果来看，我心里早就确诊了是恶性胶质瘤，很有侵略性的脑癌，最糟糕的那种。但我说得很委婉轻柔，随时察言观色，看李太太和她丈夫的反应行事。我刚才已经说了有脑癌的可能，估计其他的话他们也记不得多少了。如果是一大碗悲剧，最好一勺一勺慢慢地喂。很少有病人要求一口气吃完，大多数都需要时间去消化。他们没有问手术预后的情况。这和创伤科不一样，在那里你只有十分钟时间解释并做出重大的决定，在这里我可以慢慢把事情讲清楚。我详细地说了接下来几天可能要面对的情况：围绕着手术要干些什么；我们只会剃掉她的一点点头发，这样稍微修饰一下还是美美的；手术之后她的手臂可能会有点虚弱无力，但后面会恢复的；如果一切顺利的话，三天后她就能出院了；这好比马拉松的第一步；一路上要注意休息，这很重要；也不用刻意去记我刚才说的任何东西，反正我们都会再过一遍的。
Based on the scan, there was no doubt in my mind that this was glioblastoma—an aggressive brain cancer, the worst kind. Yet I proceeded softly, taking my cues from Mrs. Lee and her husband. Having introduced the possibility of brain cancer, I doubted they would recall much else. A tureen of tragedy was best allotted by the spoonful. Only a few patients demanded the whole at once; most needed time to digest. They didn’t ask about prognosis—unlike in trauma, where you have only about ten minutes to explain and make a major decision, here I could let things settle. I discussed in detail what to expect over the next couple of days: what the surgery entailed; how we’d shave only a small strip of her hair to keep it cosmetically appealing; how her arm would likely get a little weaker afterward but then stronger again; that if all went well, she’d be out of the hospital in three days; that this was just the first step in a marathon; that getting rest was important; and that I didn’t expect them to retain anything I had just said and we’d go over everything again.