双语·当呼吸化为空气 我们能看到的 只是生命的局部

毫无疑问，我们每个人最终能看到的，都只不过是生命的局部。医生看到一个方面，病人看到另一个方面，工程师、经济学家、潜水采集珍珠的人、酗酒的人、有线电视修理工、牧羊人、印度乞丐、牧师……看到的都不尽相同。没有什么人能完全包揽人类所有的认知。认知产生于我们所创造的，我们彼此之间的关系，以及我们与世界的关系之中，永远不可能完整全面。而终极真理凌驾于一切之上，在其存在之处，播种者与收割者可以一同欣喜狂欢，正如礼拜天的《圣经》布道的最后。因为，终极真理之中，有句话说得清楚明白：“那人撒种，这人收割。”我派你去收获你并未付出努力的东西；辛苦劳作都是别人的，你分享了他们的劳动果实。
In the end, it cannot be doubted that each of us can see only a part of the picture. The doctor sees one, the patient another, the engineer a third, the economist a fourth, the pearl diver a fifth, the alcoholic a sixth, the cable guy a seventh, the sheep farmer an eighth, the Indian beggar a ninth, the pastor a tenth. Human knowledge is never contained in one person. It grows from the relationships we create between each other and the world, and still it is never complete. And Truth comes somewhere above all of them, where, as at the end of that Sunday’s reading, the sower and reaper can rejoice together. For here the saying is verified that “One sows and another reaps.” I sent you to reap what you have not worked for; others have done the work, and you are sharing the fruits of their work.

我跳下CT台。这已经是重返外科的第七个月了。这将是我的最后一次CT，这之后我将结束住院医生生涯，成为一个父亲，我的葬礼也终有一天会成为现实。
I hopped out of the CT scanner, seven months since I had returned to surgery. This would be my last scan before finishing residency, before becoming a father, before my future became real.

“想看看吗，医生？”扫描人员问我。
“Wanna take a look, Doc?” the tech said.

“现在不看，”我说，“今天我还有很多工作。”
“Not right now,” I said. “I’ve got a lot of work to do today.”

已经下午六点了，我必须去查房、探视病人，做明天的手术室安排，看看各种扫描片子，向别人口述我的临床笔记，查查病人术后的情况……很多事等着做。晚上八点左右，我在神经外科的办公室坐下，旁边就是放射照片观测台。我打开来，看着第二天要做手术的病人的扫描片，是两个比较简单的脊椎病例。最终，我输入了自己的名字。片子出现在屏幕上，我不断缩放着，仿佛孩子在随意翻看画册，把新的片子和上次照的对比。一切看起来都没有变化，原来的那些肿瘤还是一个样。啊，等等。
It was already six p. m. I had to go see patients, organize tomorrow’s OR schedule, review films, dictate my clinic notes, check on my postops, and so on. Around eight p. m., I sat down in the neurosurgery office, next to a radiology viewing station. I turned it on, looked at my patients’ scans for the next day—two simple spine cases—and, finally, typed in my own name. I zipped through the images as if they were a kid’s flip-book, comparing the new scan to the last. Everything looked the same, the old tumors remained exactly the same. . . except, wait.

我滑动滚轮，再看了一下今天的片子。
I rolled back the images. Looked again.

一个新的肿瘤出现了，有点大，填满了我的右肺中叶。看上去竟有点像一轮几乎照亮了整个地平线的满月。再回去看原来照的片子，我能辨认出这个肿瘤非常微弱的迹象，原来只是幽灵一般的预兆，现在则完全变成了现实。
There it was. A new tumor, large, filling my right middle lobe. It looked, oddly, like a full moon having almost cleared the horizon. Going back to the old images, I could make out the faintest trace of it, a ghostly harbinger now brought fully into the world.

我既不愤怒，也不恐惧。本来就是如此。这是大千世界中的一个事实，就像太阳与地球的距离。我开车回家，告诉了露西。那是星期四的晚上，我们和艾玛的见面要等到下周一。露西和我坐在客厅，各自打开笔记本电脑，列出了接下来要做的事情：活检、体检、化疗。这次的治疗肯定更艰难、更痛苦，而活得久一些的可能性更为渺茫。我又想起艾略特写过的诗句：“可是在我背后的冷风中，我听见／白骨在碰撞，得意的笑声从耳边传到耳边。”也许未来几个星期，几个月，甚至永远，我都无法再重返神经外科了。但我们觉得，这一切都可以等到周一再来考虑。今天是星期四，我已经做好了明天手术室的安排；我决定，要去当最后一天的住院医生。
I was neither angry nor scared. It simply was. It was a fact about the world, like the distance from the sun to the earth. I drove home and told Lucy. It was a Thursday night, and we wouldn’t see Emma again until Monday, but Lucy and I sat down in the living room, with our lap-tops, and mapped out the next steps: biopsies, tests, chemotherapy. The treatments this time around would be tougher to endure, the possibility of a long life more remote. Eliot again:“But at my back in a cold blast I hear / the rattle of the bones, and chuckle spread from ear to ear.” Neurosurgery would be impossible for a couple of weeks, perhaps months, perhaps forever. But we decided that all of that could wait to be real until Monday. Today was Thursday, and I’d already made tomorrow’s OR assignments; I planned on having one last day as a resident.

第二天早上五点二十分，我在医院门口下了车，深深吸了口气，闻着桉树的气味。好像还有什么气味……是松树吗？以前都没注意到呢。我把住院医生们集合到一起，准备上午的各项工作。我们先回顾了前一晚发生的事情，入院的病人，新的扫描片子，然后去查房，之后还开了“M&M”会，也就是定期召开的关于发病率与死亡率的会议，神经外科医生们会聚集到一起，检讨一段时间内犯的错误和处理得不好的病例。开完会，我又跟病人R先生多待了几分钟。他得了一种罕见病，叫格斯特曼综合征。我切除他脑内的肿瘤后，R先生开始显露出一系列行为缺陷：读写能力缺失，说不出每根手指的具体名称，不会算术，分不清左右。这种事我之前只碰到过一次，还是八年前做医学生，刚刚进入神经外科实习时跟过的一个病例。和那个病人一样，R先生也是精神愉快，情绪高昂，我怀疑这会不会也是症状之一，只是从来没人当作症状描述出来而已。不过R先生正在好转：他的语言能力几乎已经恢复正常，算术能力也只是有一点点偏差。他完全康复的可能性很大。
As I stepped out of my car at the hospital at five-twenty the next morning, I inhaled deeply, smelling the eucalyptus and. . . was that pine? Hadn’t noticed that before. I met the resident team, assembled for morning rounds. We reviewed overnight events, new admissions, new scans, then went to see our patients before M & M, or morbidity and mortality conference, a regular meeting in which the neurosurgeons gathered to review mistakes that had been made and cases that had gone wrong. Afterward, I spent an extra couple of minutes with a patient, Mr.R. He had developed a rare syndrome, called Gerstmann’s, where, after I’d removed his brain tumor, he’d begun showing several specific deficits: an inability to write, to name fingers, to do arithmetic, to tell left from right. I’d seen it only once before, as a medical student eight years ago, on one of the first patients I’d followed on the neurosurgical service. Like him, Mr. R was euphoric—I wondered if that was part of the syndrome that no one had described before. Mr. R was getting better, though: his speech had returned almost to normal, and his arithmetic was only slightly off. He’d likely make a full recovery.

上午很快过去了。我刷手消毒，准备做最后一次手术。突然间，我感觉到这个时刻意义重大。这真的是我最后一次刷手了？也许真的走到头了。我看着肥皂水顺着手臂流下来，然后流回水槽里。我走进手术室，穿好手术衣，给病人盖上无菌布，专门扯了扯四个角，确保没有褶皱。我希望这台手术完美无缺。我割开他背部下方的皮肤。这个男人已经上了年纪，脊椎退化，压迫神经根，造成严重的疼痛。我拨开脂肪，筋膜出现，感觉到凸起的椎骨。我割开筋膜，又顺利地割开肌肉，直到眼前的伤口中只剩下闪着亮光的宽阔椎骨，干净纯粹，不沾一丝血迹。主治医生进来了，我正在切除椎骨后面的椎板，那里有增生，再加上下面的韧带，一起压迫着神经。
The morning passed, and I scrubbed for my last case. Suddenly the moment felt enormous. My last time scrubbing? Perhaps this was it. I watched the suds drip off my arms, then down the drain. I entered the OR, gowned up, and draped the patient, making sure the corners were sharp and neat. I wanted this case to be perfect. I opened the skin of his lower back. He was an elderly man whose spine had degenerated, compressing his nerve roots and causing severe pain. I pulled away the fat until the fascia appeared and I could feel the tips of his vertebrae. I opened the fascia and smoothly dissected the muscle away, until only the wide, glistening vertebrae showed up through the wound, clean and bloodless. The attending wandered in as I began to remove the lamina, the back wall of the vertebrae, whose bony overgrowths, along with ligaments beneath, were compressing the nerves.

“看着挺好，”主治医生说，“如果你想去今天的会，我找同事进来接手做完。”我的背痛又开始了。我之前怎么不再吃点消炎药呢？不过，这台手术应该很快了，我快做完了。
“Looks good,” he said. “If you want to go to today’s conference, I can have the fellow come in and finish.” My back was beginning to ache. Why hadn’t I taken an extra dose of NSAIDs beforehand? This case should be quick, though. I was almost there.

“不用，”我说，“我想把这台手术做完。”
“Naw,” I said. “I want to finish the case.”

主治医生也刷手消毒进来了，我们一起切除了增生。他开始拨弄韧带，下面是硬膜，里面有脊髓液和神经根。这一步最容易犯的错误，就是在硬膜上弄个洞。我负责处理另一侧。突然，我眼角的余光瞥见，他的手术用具旁边有一抹蓝色——硬膜开始破裂了。
The attending scrubbed in, and together we completed the bony removal. He began to pick away at the ligaments, beneath which lay the dura, which contained spinal fluid and the nerve roots. The most common error at this stage is tearing a hole in the dura. I worked on the opposite side. Out of the corner of my eye, I saw near his instrument a flash of blue—the dura starting to peek through.

“小心！”我说。此时他手上的器具已经夹到硬膜了。清澈的脊髓液开始填满伤口。一年多了，我还是第一次遇到漏液的情况。修补这个漏洞又需要一个小时。
“Watch out!” I said, just as the mouth of his instrument bit into the dura. Clear spinal fluid began to fill the wound. I hadn’t had a leak in one of my cases in more than a year. Repairing it would take another hour.

“把刀头拿出来，”我说，“漏液了。”
“Get the micro set out,” I said. “We have a leak.”

等我们修补完这个漏洞，把压迫神经的软组织切除之后，我的双肩火辣辣地痛。主治医生脱掉手术衣，向我道歉又道谢，离开了，留下我收尾。一层层组织整齐地合到一起。我又开始用尼龙线一针一针缝合皮肤。大多数外科医生都会选择缝合器，但我一直觉得尼龙线的感染率比较低。这个病人，这“最后一役”，要按我的想法来做。皮肤完美地缝合，没有拉扯褶皱，仿佛这台手术从未发生过。
By the time we finished the repair and removed the compressive soft tissue, my shoulders burned. The attending broke scrub, offered his apologies and said his thanks, and left me to close. The layers came together nicely. I began to suture the skin, using a running nylon stitch. Most surgeons used staples, but I was convinced that nylon had lower infection rates, and we would do this one, this final closure, my way. The skin came together perfectly, without tension, as if there had been no surgery at all.