双语·当呼吸化为空气 我居然感觉好些了

我居然感觉好些了。
And I felt better.

活检后一个星期，护理师艾丽克西斯打电话给我通报情况。没有可以采取针对性治疗的突变，这样化疗就成了唯一的选择。已经安排好周一开始。我问具体用什么化疗药物，她说这个问题必须跟艾玛谈。艾玛正和孩子一起在太浩湖玩，不过周末会抽空给我个电话。第二天是星期六，艾玛的电话来了。我问她对化疗用药有什么想法。
A week after the biopsy, Alexis, the nurse practitioner, called. There were no new targetable mutations, so chemotherapy was the only option, and it was being set up for Monday. I asked about the specific agents and was told I’d have to talk to Emma. She was en route to Lake Tahoe with her kids, but she’d give me a call over the weekend. The next day, a Saturday, Emma called. I asked her what she thought about chemotherapy agents.

“嗯，”她说，“你有什么具体想法吗？”
“Well,” she said. “Do you have specific thoughts?”

“我觉得主要问题是要不要加阿瓦斯丁吧，”我说，“我知道最近有研究说这个药没有好处，副作用还比较严重，有的抗癌中心逐渐弃用了。我觉得那只是一个研究而已，之前那么多数据都证明是有用的，我比较倾向于还是要用。如果我反应不好，再弃用也不迟。你觉得这样行吗？”
“I guess the main question is whether to include Avastin,” I said.“I know the most recent study suggested no benefit and worse side effects, and some cancer centers are turning away from it. In my mind, that’s just one study among a lot of prior data supporting its use, so I’d lean toward including it. We can discontinue it if I have a bad reaction to it. If that seems sensible to you.”

“嗯，没什么问题。后期加的话还要过保险公司那一关，比较难。所以前期就使用比较好。”
“Yeah, that sounds about right. Insurance companies also make it hard to add it later, so that’s another reason to use it up front.”

“谢谢你打电话来。我就不耽误你享受湖边的美景了。”
“Thanks for calling. I’ll let you get back to enjoying the lake.”

“好的，但我还要再多说一句，”她略有迟疑，“很高兴咱们可以一起制订你的医疗计划，因为你是个医生，你什么都懂，而且这也是你自己的命。但是，如果你什么时候想让我单独来做你的医生了，我也是很乐意的。”
“Okay. But there’s one thing.” She paused. “I’m totally happy for us to make your medical plan together; obviously, you’re a doctor, you know what you’re talking about, and it’s your life. But if you ever want me to just be the doctor, I’m happy to do that, too.”

我还从来没想过，可以不负责自己的医疗计划。我还理所当然地以为所有的病人都是久病成医。我还记得医学生时期的我，刚刚开始进入医学实践，对什么都懵懂无知，经常会让病人解释他们自己的病症和治疗手段，问他们为什么出现蓝色脚趾的症状，这个粉色的药片是干什么的。但正式成为医生之后，我从未要求病人自己做决定，我对他们有责任。我意识到，自己现在也在做同样的事，心中那个作为医生的自我在对那个作为病人的自我负责。也许我真的被哪个希腊的天神诅咒了，但放弃对自己病情的控制仿佛是完全不可能的事，就算可能，那也太不负责任了。
I hadn’t ever considered that I could release myself from the responsibility of my own medical care. I’d just assumed all patients became experts at their own diseases. I remembered how, as a green medical student, knowing nothing, I would often end up asking patients to explain their diseases and treatments to me, their blue toes and pink pills. But as a doctor, I never expected patients to make decisions alone; I bore responsibility for the patient. And I realized I was trying to do the same thing now, my doctor-self remaining responsible for my patient-self. Maybe I’d been cursed by a Greek god, but abdicating control seemed irresponsible, if not impossible.

化疗开始的周一，露西、我母亲和我一起去了输液中心。我安好一个静脉注射的针头，找了把舒服的椅子坐好，开始了漫长的等待。化疗的混合药物需要四个半小时才能全部输完。整个过程中，我要么打盹，要么读书，有时候又百无聊赖地看着身边的露西和妈妈，偶尔聊两句，打破沉默。病房里的其他病人健康和精神状况各不相同：有的头发已经秃了，有的发型还很不错，有的形容憔悴，有的活泼爽朗，有的不修边幅，有的衣冠楚楚。不过所有人都静静地躺着，任凭注射管里那些毒副作用剧烈的药物慢慢输入伸展的手臂。我每三周来接受一次治疗。
Chemotherapy began on Monday. Lucy, my mother, and I went to the infusion center together. I had an IV placed, settled into an easy chair, and waited. The drug cocktail would take four and a half hours to infuse. I passed the time napping, reading, and sometimes blankly staring, with Lucy and my mother next to me, interrupting the silence with occasional small talk. The other occupants of the room were in various states of health—some bald, some well-coiffed, some withered, some sprightly, some disheveled, some dapper. All lay still, silent, with IV tubing dripping poison into outstretched arms. I was to return every three weeks for treatment.

第二天我就有反应了。非常强烈的疲乏感，深入骨髓，全身无力。本来特别能唤起愉悦感的进食，对我来说就像喝海水一样折磨。突然间，所有我喜欢的东西都变咸了。露西给我做了贝果面包加奶油奶酪做早餐，吃起来就像盐碱地里那种经常被动物舔舐的盐块。我只吃了两口就放到一边。看书也让我筋疲力尽。本来答应了要为两本重要的神经外科教科书写个几章，阐述我和V的研究是否有临床治疗的潜力，现在也被搁置了。一整天，我都只能靠看电视和强制进食来打发时光。几周以后，逐渐形成了一种模式：不舒服的感觉会慢慢减轻，等恢复常态的时候，恰好又到下次治疗的时间了。
I began to feel the effects the next day, a deep fatigue, a profound bone-weariness setting in. Eating, normally a source of great pleasure, was like drinking seawater. Suddenly, all of my joys were salted. For breakfast, Lucy made me a bagel with cream cheese; it tasted like a salt lick. I set it aside. Reading was exhausting. I had agreed to write a few chapters on the therapeutic potential of my research with V for two major neurosurgical text-books. That, too, I set aside. The days passed, television and forced feedings marking the time. A pattern developed over the weeks: the malaise would slowly ease, normalcy returning just in time for the next treatment.

就这么循环往复着。我因为一些轻微的并发症在医院进进出出，也就排除了任何重返工作岗位的可能。神经外科认为我无论从国家标准还是地方标准来说，都已经符合毕业的条件。毕业典礼安排在一个周六，露西预产期的前两周左右。
The cycles continued; I shuffled in and out of the hospital with minor complications, which were just enough to preclude any return to work. The neurosurgery department determined that I had met all national and local criteria for graduation; the ceremony was scheduled for a Saturday, about two weeks before Lucy’s due date.

那一天来了。我站在卧室里，为毕业典礼穿衣打扮，这毕竟是七年住院医生生涯的高潮。但突然之间，强烈的恶心感气势汹汹地袭来。感觉不像化疗引起的通常的恶心。那种恶心一般像潮水一样涌来，也像潮水一样迅速退却。我开始不断呕吐出绿色的胆汁，那种粉笔一样的味道和胃酸大不相同。这是内脏深处涌上来的。
The day arrived. As I stood in our bedroom, dressing for graduation—the culmination of seven years of residency—a piercing nausea struck me. This was unlike the usual nausea of chemotherapy, which washed over you like a wave and, like a wave, could be ridden. I began uncontrollably vomiting green bile, its chalky taste distinct from stomach acid. This was from deep in my gut.