双语·当呼吸化为空气 住院医生生涯第六年

住院医生生涯第六年，我又变成全职医生，只在休息日和闲暇时候才去V的实验室做研究，而这样的日子屈指可数。大多数人，甚至包括你最亲密的同事，都不太能理解神经外科住院医生是个怎么样的“黑洞”。我最喜欢的一名护士，有一天一直加班到晚上十点，协助我们完成了一台难度很大、时间很长的手术。她对我说：“谢天谢地，我明天休息，你也是吗？”
In my sixth year, I returned to the hospital full-time, my research in V’s lab now relegated to days off and idle moments, such as they were. Most people, even your closest colleagues, don’t quite understand the black hole that is neurosurgical residency. One of my favorite nurses, after sticking around until ten p. m. one night to help us finish a long and difficult case, said to me, “Thank God I have tomorrow off. Do you, too?”

“不是啊。”
“Um, no.”

“但是至少你可以晚点来上班什么的，对吧？你一般什么时候到？”
“But at least you can come in later or something, right? When do you usually get in?”

“早上六点。”
“Six a. m.”

“不可能，真的吗？”
“No. Really?”

“真的啊。”
“Yep.”

“每天都是？”
“Every day?”

“每天都是。”
“Every day.”

“周末也是？”
“Weekends, too?”

“你别问了。”
“Don’t ask.”

住院医中流传着一句话：日子很长，但年岁很短。神经外科住院医生的一天，一般从早上六点开始，一直持续到手术结束。具体何时结束，则部分取决于你在手术室的手脚麻利程度。
In residency, there’s a saying: The days are long, but the years are short. In neurosurgical residency, the day usually began at six a. m. and lasted until the operating was done, which depended, in part, on how quick you were in the OR.

住院医生的手术技能高低，要从技巧和速度两个方面来判断。你不能粗枝大叶，也不能慢吞吞。从你第一次缝合伤口开始，要是花太多时间去死磕精确，助理们就会在一边讽刺：“哎哟喂，我们遇到个整形外科的！”或者：“你的策略我明白：等你把伤口的前一半缝完，后一半自己就愈合了！事半功倍——实在是高！”住院总医生会对新手建议：“现在就要锻炼速度，技巧可以后面再培养。”手术室里，大家的眼睛总是盯着钟表。这是为了病人：他被麻醉多久了？长时间的手术中，神经可能被破坏，肌肉可能会崩溃，肾脏可能会衰竭。也是为了所有人：我们今晚到底什么时候能出手术室？
A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy, and you can’t be slow. From your first wound closure onward, spend too much time being precise and the scrub tech will announce, “Looks like we’ve got a plastic surgeon on our hands!” Or:“I get your strategy: by the time you finish sewing the top half of the wound, the bottom will have healed on its own! Half the work—very smart!” A chief resident will advise a junior, “Learn to be fast now. You can learn to be good later.” In the OR, everyone’s eyes are always on the clock. For the patient’s sake: How long has he been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, kidneys can fail. For everyone else’s sake: What time are we getting out of here tonight?

我发现有两种节省时间的策略，可能最好的类比就是“龟兔赛跑”。兔子要多快有多快，手如疾风，器械哐啷作响，掉到地上；划开皮肤的时候，就像“唰”一下打开窗帘，骨粉还未尘埃落定，颅骨瓣就已经放在托盘上了。结果就是，切口可能这儿那儿的多个一厘米，因为位置找得不是特别准确。而乌龟呢，正相反，小心谨慎，步步为营，没有多余的动作，反复测量后来个“一刀准”。不需要反思或重复任何手术动作，一切都细致精准，井井有条。要是兔子的小错误太多，一直要调整补救，那么乌龟获胜。如果乌龟花太多时间去计划每一个步骤，那么兔子获胜。手术室里的时间很有趣，不管你是发疯般向前冲，还是稳扎稳打不紧不慢，都感觉不到时间的流逝。海德格尔曾说过：无聊，就是感受到时间的流逝。那么，手术的感觉是完全相反的：全神贯注的工作让时钟的指针失去了意义，随便怎么走都行。两个小时也可能就像短短的一分钟。等最后一针缝完，给伤口上了药，正常的时间突然又开始了。你耳边几乎会听到飞快的“嗖嗖”声。然后你就开始想：病人什么时候醒过来？下个病人什么时候推进来？我今晚什么时候能回家？
I could see that there were two strategies to cutting the time short, perhaps best exemplified by the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. As a result, the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise, on the other hand, proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything moves in a precise, orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins. The funny thing about time in the OR, whether you race frenetically or proceed steadily, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite: the intense focus made the arms of the clock seem arbitrarily placed. Two hours could feel like a minute. Once the final stitch was placed and the wound was dressed, normal time suddenly restarted. You could almost hear an audible whoosh. Then you started wondering: How long until the patient wakes up? How long until the next case is rolled in? And what time will I get home tonight?

一直要到最后一台手术做完，我才会感觉到一天的漫长和自己沉重疲乏的脚步。离开医院之前还有几项行政任务，真像铁砧在敲打我疲惫的神经。
It wasn’t until the last case finished that I felt the length of the day, the drag in my step. Those last few administrative tasks before leaving the hospital were like anvils.

不能等到明天吗？
Could it wait until tomorrow?

不能。
No.

一声长叹。地球自转不停，太阳又要升起了。
A sigh, and Earth continued to rotate back toward the sun.