双语·当呼吸化为空气 最需要小心的 是价值观的不断变化

人一旦遭遇顽疾，最需要小心的，是价值观的不断变化。你努力思考自己到底看重些什么，答案也会接踵而至。感觉就像信用卡被人拿走了，我不得不学会讨价还价。你可能本来已经下定决心，自己宝贵的时间要投入到神经外科的工作中，但两个月以后，你的想法又会有所改变。再过两个月，你可能就想去吹吹萨克斯，然后每天去教堂，全心全意去敬拜上帝。死亡也许只是一生一次的短暂事件，但与绝症共存则是个长期的过程。
The tricky part of illness is that, as you go through it, your values are constantly changing. You try to figure out what matters to you, and then you keep figuring it out. It felt like someone had taken away my credit card and I was having to learn how to budget. You may decide you want to spend your time working as a neurosurgeon, but two months later, you may feel differently. Two months after that, you may want to learn to play the saxophone or devote yourself to the church. Death may be a one-time event, but living with terminal illness is a process.

我突然惊觉，自己已经经历了悲痛的五个阶段，就是老生常谈的“否认→愤怒→讨价还价→消沉→接受”。但我完全是反着来的。刚诊断出来的时候，我对死亡已经做足了准备。我甚至自我感觉良好，完全接受现实，有种万事俱备的笃定感。接着我开始消沉，因为我毕竟不大可能很快就死去。这当然是个好消息，但也令人困惑迷茫，甚至很奇怪地令我萎靡不振。抗癌技术的飞速发展以及各项相关数据，说明我也许可以再活十二个月，或者一百二十个月。本来，这种大病是应该让你完全看清自己和生命的。然而，我只是知道自己要死了——可我以前也是知道的呀。我所知的东西仍然一样，但已经不能像从前那样随意约见朋友，享受正常生活了。要是我确切地知道自己到底还剩多少个月或者多少年，前路也许会清晰很多。你要是告诉我，还剩三个月，那我就全部用来陪家人；还剩一年，我可能会写一本书；还有十年，我就回去救死扶伤。“活在当下”这种真理对我根本没有帮助：我这当下到底该怎么活啊？接着，在某个时刻，我又开始讨价还价，嗯，其实也不算讨价还价吧。我心里默默地说：“上帝啊，我读了《约伯记》，不能完全理解。但如果这是测试我信仰的方式，那你应该已经看到我的信仰很弱。可能你在熏牛肉三明治上留点那种辣芥末也能测试我的信仰呢？真的不用这么大费周章地给我来个‘核爆炸’吧，真的……”讨价还价之后，怒气就一阵阵涌上心头：“我这小半辈子都在努力奋斗，已经到了这份儿上了，居然得了癌症？”
It struck me that I had traversed the five stages of grief—the “Denial→Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward. On diagnosis, I’d been prepared for death. I’d even felt good about it. I’d accepted it. I’d been ready. Then I slumped into a depression, as it became clear that I might not be dying so soon after all, which is, of course, good news, but also confusing and strangely enervating. The rapidity of the cancer science, and the nature of the statistics, meant I might live another twelve months, or another 120. Grand illnesses are supposed to be life-clarifying. Instead, I knew I was going to die—but I’d known that before. My state of knowledge was the same, but my ability to make lunch plans had been shot to hell. The way forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d spend time with family. Tell me one year, I’d write a book. Give me ten years, I’d get back to treating diseases. The truth that you live one day at a time didn’t help: What was I supposed to do with that day? At some point, then, I began to do a little bargaining—or not exactly bargaining. More like: “God, I have read Job, and I don’t understand it, but if this is a test of faith, you now realize my faith is fairly weak, and probably leaving the spicy mustard off the pastrami sandwich would have also tested it? You didn’t have to go nuclear on me, you know. . . ” Then, after the bargaining, came flashes of anger: “I work my whole life to get to this point, and then you give me cancer?”

现在，可能我终于来到“否认”这个阶段了。也许是完全的否认。也许在缺乏任何定论的情况下，我们应该假设自己能活很久。可能这是前进的唯一办法。
And now, finally, maybe I had arrived at denial. Maybe total denial. Maybe, in the absence of any certainty, we should just assume that we’re going to live a long time. Maybe that’s the only way forward.

现在，查出癌症九个月了，我几乎天天做手术到深夜，甚至到凌晨，一心一意要好好毕业。我的身体遭受了沉重打击。每天回到家，我都累得吃不下东西。而且慢慢在加大泰勒诺、非类固醇抗炎药和止吐剂的用量。我开始不停咳嗽，大概是肺部恶性肿瘤纤维化引起的。我告诉自己，只需要再坚持几个月，就可以结束这种马不停蹄的工作状态，顺利从住院医生毕业，安心做个相比之下更平静、更轻松的教授。二月份，我飞去威斯康星参加工作面试。他们的一切条件都正合我心：数百万美元的资金供我开设神经系统科学实验室；领导自己的临床医学团队；工作时间和内容都灵活，根据我的健康情况而定；终身教授职位；对露西也有很优厚的工作安排；高薪、美景、田园牧歌般的城市、完美的老板。“我了解你的健康状况，你和你的肿瘤医生应该也很亲密。”部门主管对我说，“如果你想继续在那边的治疗，我们就帮你来回飞。不过我们这儿也有一流的抗癌中心，你愿意的话就去看看。我还能不能再做点什么，让这个工作更有吸引力？”
I was operating until late at night or into the early morning, fixated on graduation, my diagnosis nine months in the past. My body was taking a beating. I was too tired to eat when I got home. I had been slowly upping the dose of Tylenol and NSAIDs and antiemetics. I had developed a persistent cough, presumably caused by scarring from the dead tumor in my lungs. I only had to keep up this relentless pace for a couple more months, I told myself, and then I would graduate from residency and settle into the comparatively calmer role of a professor. In February, I flew to Wisconsin for a job interview. They were offering everything I wanted: millions of dollars to start a neuroscience lab, head of my own clinical service, flexibility if I needed it for my health, a tenure-track professorship, appealing job options for Lucy, high salary, beautiful scenery, idyllic town, the perfect boss. “I understand about your health, and you probably have a strong connection with your oncologist,” the department chairman told me. “So if you want to keep your care there, we can fly you back and forth—though we do have a top-notch cancer center here, if you want to explore it. Is there anything else I can do to make this job more attractive?”

我想了想艾玛说过的话。我之前不相信自己能继续外科医生的事业，如今却已经成功重返手术台，这个转变是很有分量的，甚至有点宗教层面的意味。在我自己都不相信自己的时候，她还一直记挂着我的这个身份。我多年前立志成为医生时对自己提出的挑战，她做到了：审视灵魂，接受自己作为凡人的责任，让我重新找回自己。我已经抵达了很多神经外科住院医生的制高点，立志不仅要做个神经外科医生，还要做个神经系统科学家。这是每个学生梦寐以求的目标，但能实现的却寥寥无几。
I thought about what Emma had told me. I had gone from being unable to believe I could be a surgeon to being one, a transformation that carried the force of religious conversion. She had always kept this part of my identity in mind, even when I couldn’t. She had done what I had challenged myself to do as a doctor years earlier: accepted mortal responsibility for my soul and returned me to a point where I could return to myself. I had attained the heights of the neurosurgical trainee, set to become not only a neurosurgeon but a surgeonscientist. Every trainee aspires to this goal; almost none make it.

当晚晚饭后，主管开车送我回酒店。他在路边停了车。“我给你看个东西。”他说。我们下了车，站在医院门口，面前是冰封的湖水，对岸是科系办公室星星点点的灯光。“夏天，你可以游泳或者开船去上班。冬天呢，滑雪滑冰都可以。”
That night, the chairman was driving me back to my hotel after dinner. He stopped the car and pulled over. “Let me show you something,” he said. We got out and stood in front of the hospital, looking over a frozen lake, its far edge luminous with specks of light leaking from faculty houses. “In summer, you can swim or sail to work. In winter, you can ski or ice-skate.”