双语·当呼吸化为空气 这时的我已经懂点基本规则了

手术以后，我们又谈了话，这次我们聊了化疗、放疗和预后。这时的我已经懂点基本规则了。首先，具体的数据是研究室里用的，病房里没必要说。标准数据，也就是卡普兰-迈耶曲线，对部分存活了一段时间的病人进行了跟踪检测。我们就是用这个曲线来衡量治疗的进展，来判断病情的严重程度。恶性胶质瘤的曲线下降得特别快，手术两年之后只有5%的病人还活着。其次，话要说得准确，这非常重要，但还是必须留下希望的空间。我不会说“存活期是十一个月”或者“你有95%的机会在两年内死亡”，而是说：“大多数病人都活了好几个月到好几年。”在我看来，这可能是更诚实的说法。问题在于，你不能跟任何一个病人准确地说她到底位于曲线的什么位置：是六个月以后死亡呢，还是六十个月以后？我觉得，当不能准确判断的时候，说出具体时间是非常不负责任的行为。那些把具体时间说出来的庸医（“医生说我还能活六个月”），我一直想知道，他们都是谁啊？统计学是谁教的？
After surgery, we talked again, this time discussing chemo, radiation, and prognosis. By this point, I had learned a couple of basic rules. First, detailed statistics are for research halls, not hospital rooms. The standard statistic, the Kaplan-Meier curve, measures the number of patients surviving over time. It is the metric by which we gauge progress, by which we understand the ferocity of a disease. For glioblastoma, the curve drops sharply until only about 5 percent of patients are alive at two years. Second, it is important to be accurate, but you must always leave some room for hope. Rather than saying, “Median survival is eleven months” or “You have a ninety-five percent chance of being dead in two years,” I’d say, “Most patients live many months to a couple of years.” This was, to me, a more honest description. The problem is that you can’t tell an individual patient where she sits on the curve: Will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be accurate. Those apocryphal doctors who gave specific numbers(“The doctor told me I had six months to live”): Who were they, I wondered, and who taught them statistics?

听到消息后，大多数病人都是一言不发（毕竟，英语里的“病人”，“patient”这个词，最初的含义之一，就是“毫无怨言地承受苦难的人”）。不管是出于自尊还是震惊，一般都是一片沉默，所以，交流的方式就变成握住病人的手。少数的一些马上就坚强起来（一般是病人的伴侣，不是本人）：“我们会抗争，打败这鬼东西的，大夫。”抗争的武器各有不同，有的祈祷，有的砸钱，有的求助草药，有的输入造血干细胞。在我看来，这种坚强往往不堪一击，不切实际的乐观往往下一秒就是排山倒海的绝望。不管怎么说，面对这种手术，有战士一样的斗志总是好的。手术室里，正在腐烂的深灰色肿瘤如同毫不留情的侵略者，入侵如同丰满桃子一般而又沟回错综的人脑。我感到真切的愤怒（弄死你，你这混蛋。我往往小声咒骂）。割除肿瘤给人很大的满足感，就算我清楚那些微小的癌细胞已经在整个看起来还很健康的脑部扩散开来。不过这种几乎无法避免的复发，就等到时候再去考虑吧。一勺一勺地慢慢喂。开诚布公地与别人联结，并不意味着要一下子打开天窗把亮话全说了，而是要注意病人的接受程度，站在他们的立场，尽量引导他们走得远一些。
Patients, when hearing the news, mostly remain mute. (One of the early meanings of patient, after all, is “one who endures hardship without complaint.”) Whether out of dignity or shock, silence usually reigns, and so holding a patient’s hand becomes the mode of communication. A few immediately harden (usually the spouse, rather than the patient): “We’re gonna fight and beat this thing, Doc.”The armament varies, from prayer to wealth to herbs to stem cells. To me, that hardness always seems brittle, unrealistic optimism the only alternative to crushing despair. In any case, in the immediacy of surgery, a warlike attitude fit. In the OR, the dark gray rotting tumor seemed an invader in the fleshy peach convolutions of the brain, and I felt real anger (Got you, you fucker, I muttered). Removing the tumor was satisfying—even though I knew that microscopic cancer cells had already spread throughout that healthy-looking brain. The nearly inevitable recurrence was a problem for another day. A spoonful at a time. Openness to human relationality does not mean revealing grand truths from the apse; it means meeting patients where they are, in the narthex or nave, and bringing them as far as you can.

然而，开诚布公的联结，也是有代价的。
Yet openness to human relationality also carried a price.

住院医生生涯第三年的一天傍晚，我遇到杰夫，血管外科的那个朋友，也和我一样，工作起来充满热情，要求很高，很专业。我们都注意到对方意志消沉并坦诚地指了出来。“你先说吧。”他说。我讲起一个孩子的死亡。因为鞋子颜色不对，被人当头一枪，但他就差一点点就能活下来了……最近遇到太多手术都无能为力的致命脑瘤，我简直把这个孩子活下去的希望当作自己的救命稻草。结果他没活下来。杰夫欲言又止，我等着他的倾诉。结果他大笑起来，朝我胳膊打了一拳，说：“嗯，我反正是学会了：要是对我自己的工作感到沮丧，就找个神经外科的聊聊，心里一下子就舒坦了。”
One evening in my third year, I ran into Jeff, my friend in vascular surgery, a similarly intense and demanding profession. We each noted the other’s despondency. “You go first,” he said. And I described the death of a child, shot in the head for wearing the wrong color shoes, but he had been so close to making it. . . Amid a recent spate of fatal, inoperable brain tumors, my hopes had been pinned on this kid pulling through, and he hadn’t. Jeff paused, and I awaited his story. Instead, he laughed, punched me in the arm, and said, “Well, I guess I learned one thing: if I’m ever feeling down about my work, I can always talk to a neurosurgeon to cheer myself up.”

那天晚上我开车回家，此前我还语气轻柔地向一个妈妈解释说，她刚出生的孩子天生没有脑部，不久就会死亡。我打开了车上的收音机，NPR正在报道加州的持续干旱。突然间，泪水就顺着脸颊滑落下来。和病人一起共度这些时刻，当然是要付出感情代价的，但也有回报啊。我没有哪一天哪一秒质疑过自己为什么选择这份工作，或者问自己到底值不值得。那是一种召唤，保卫生命的召唤，不仅仅是保卫生命，也是保卫别人的个性，甚至说保卫灵魂也不为过。这种召唤的神圣之处，是显而易见的。
Driving home later that night, after gently explaining to a mother that her newborn had been born without a brain and would die shortly, I switched on the radio; NPR was reporting on the continuing drought in California. Suddenly, tears were streaming down my face. Being with patients in these moments certainly had its emotional cost, but it also had its rewards. I don’t think I ever spent a minute of any day wondering why I did this work, or whether it was worth it. The call to protect life—and not merely life but another’s identity; it is perhaps not too much to say another’s soul—was obvious in its sacredness.

我意识到，在给病人的脑部做手术之前，我必须首先了解他的思想：他的个性，他的价值观，他为了什么活着，要遭遇什么样的灾难，才能合理地终止这条生命。我是如此渴望成功，也为此付出了很大的代价，有些无法避免的失败让我感到几乎无法承受的负疚感。正是这些包袱，让行医变得神圣而完全无法想象：背负起别人的十字架，你总有时候会被重负压垮。
Before operating on a patient’s brain, I realized, I must first understand his mind: his identity, his values, what makes his life worth living, and what devastation makes it reasonable to let that life end. The cost of my dedication to succeed was high, and the ineluctable failures brought me nearly unbearable guilt. Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight.

住院医生生涯进行到一半，会抽点时间来接受额外的训练。神经外科是个很特别的医学分支，光在神经外科上出色是不够的，还要成为对一切都精通的多面手。要做个好的神经外科医生，必须迎接挑战，在其他领域也出类拔萃。有时候跨界跨得很广，比如桑杰·古普塔，既是神经外科医生，又是记者。不过大多数时候，医生还是会选择和医学有关的领域。最严苛而又最能取得盛名的道路，是成为神经外科医生兼神经科学家。
Midway through residency, time is set aside for additional training. Perhaps unique in medicine, the ethos of neurosurgery—of excellence in all things—maintains that excellence in neurosurgery alone is not enough. In order to carry the field, neurosurgeons must venture forth and excel in other fields as well. Sometimes this is very public, as in the case of the neurosurgeon-journalist Sanjay Gupta, but most often the doctor’s focus is on a related field. The most rigorous and prestigious path is that of the neurosurgeon-neuroscientist.