双语·当呼吸化为空气 我还是去不成毕业典礼了

说到底，我还是去不成毕业典礼了。
I would not be going to graduation, after all.

我需要马上静脉注射，防止脱水。于是露西开车带我去了急救中心，开始复水过程。呕吐变成了腹泻。急救处的住院医生布兰德和我友好地交流了一会儿，我详细叙述了自己的医疗史，历数了所有的用药。最后我们讨论了分子疗法取得的进步，特别是我在用的特罗凯这种药。眼前的医疗计划很简单：一直用静脉注射的方式保持我不脱水，直到我状态恢复，可以正常用嘴喝水。那天晚上，我住进了医院病房。但护士在看我的用药单时，我注意到上面没有特罗凯。我请她打电话给住院医生，改正这个疏忽。这种事也是常有的。毕竟我同时在吃十几种药呢。随时随地滴水不漏是很难的。
I needed IV fluids to avoid dehydration, so Lucy drove me to the emergency department and rehydration began. The vomiting gave way to diarrhea. The medical resident, Brad, and I chatted amicably, and I relayed my medical history, covering all my medications, and we ended up discussing advances in molecular therapies, especially the drug I was taking, Tarceva. The medical plan was simple: keep me hydrated with intravenous fluids until I could drink enough by mouth. That evening, I was admitted to a hospital room. But when the nurse reviewed my medication list, I noticed Tarceva was not on it. I asked her to call the resident to correct the oversight. These things happen. I was taking a dozen medications, after all. Keeping track was not easy.

午夜过去很久，布兰德出现了。
It was well past midnight when Brad appeared.

“听说你对自己用的药有疑问？”他问道。
“I heard you had a question about your medications?” he asked.

“是啊，”我说，“没有开特罗凯。你补开一下，不介意吧？”
“Yeah,” I said. “Tarceva wasn’t ordered. Do you mind ordering it?”

“我决定不让你再服特罗凯了。”
“I decided to take you off it.”

“为什么啊？”
“Why is that?”

“你的肝酶太高，不能再吃了。”
“Your liver enzymes are too high to take it.”

我有点摸不着头脑。我的肝酶已经高了好几个月了。如果这是个问题，之前为什么没讨论过呢？不管怎么说，这肯定是搞错了。“艾玛，就是我的肿瘤医生，你的上司，也看过这些指标了。她想让我继续吃。”
I was confused. My liver enzymes had been high for months; if this was an issue, why hadn’t we discussed it before? In any case, this was clearly a mistake. “Emma—my oncologist, your boss—has seen these numbers, and she wants to keep me on it.”

如果例行公事，住院医生做出治疗决策都是不用主治医生从旁指导的。不过现在我向他转述了艾玛的意见，他肯定会让步吧。
Residents routinely have to make medical decisions without the attending’s input. But now that he had Emma’s opinion, surely he would capitulate.

“但这个可能就是你胃肠道问题的原因。”
“But it might be causing your GI problems.”

我更摸不着头脑了。一般来说，转述了主治医生的命令，就不会再讨论下去了。“我已经吃了一年了，没有任何问题，”我说，“你觉得现在的问题是特罗凯突然引起的，不是化疗？”
My confusion deepened. Usually invoking the attending’s orders ends the discussion. “I’ve been taking it for a year without any problems,”I said. “You think Tarceva is causing this all of a sudden, and not the chemotherapy?”

“有可能。”
“Maybe, yeah.”

我的困惑升级成了愤怒。这孩子，才从医学院毕业两年，和我的助理住院医生一般年纪，居然跟我叫板？嗯，如果他是对的，那就另当别论，但他现在说的这些毫无道理啊。“呃，今天下午我是不是提过，不吃那个药的话，我的骨转移癌就会很活跃，引起剧痛？我不是想小题大做，以前练拳击的时候我也骨折过，但现在痛得比那时候厉害多了。从一到十打分的话，现在是十分痛。我很有可能很快就会痛得忍不住尖叫起来。”
Confusion yielded to anger. Some kid two years out of med school, no older than my junior residents, was really arguing with me? It’d be one thing if he were right, but he wasn’t making any sense. “Um, didn’t I mention this afternoon that without that pill, my bone metastases become active and produce excruciating pain? I don’t mean to sound dramatic, but I’ve broken bones boxing, and this is far more painful. As in, ten-out-of-ten pain. As in, I-Will-Actually-Soon-Be-Screaming pain.”

“嗯，考虑到这个药的半衰期，估计还要等个一天左右才会出现这种情况。”
“Well, given the half-life of the drug, that probably won’t happen for a day or so.”

看得出来，在布兰德眼里，我不是个病人，是个“问题”：需要尽快解决，在任务栏前面的方框里画个勾。
I could see that in Brad’s eyes I was not a patient, I was a problem: a box to be checked off.

“听我说，”他继续道，“如果你不是你，这场对话根本就不可能发生。我会直接给你停药，然后让你自己来证明，病症都是这个药造成的。”
“Look,” he continued, “if you weren’t you, we wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.”

怎么回事？下午我们不是相谈甚欢的吗？我回想起医学院时期遇到的一个病人，她说自己去医生那儿看病，都会穿最贵的袜子。这样等她换上病号服，不穿鞋的时候，医生也能看到她的袜子，知道她是个体面人，会以很尊重的态度来对待她。（啊，原来问题在这里——我穿的是医院发的袜子，这么多年了一直占着这个小便宜！）
What had happened to our amicable chat this afternoon? I thought back to med school, when a patient had told me that she always wore her most expensive socks to the doctor’s office, so that when she was in a patient’s gown and shoeless, the doctor would see the socks and know she was a person of substance, to be treated with respect. (Ah, there’s the problem—I was wearing hospital-issue socks, which I had been stealing for years!)

“不管怎么说，特罗凯是特殊的药，需要专科训练医生或者主治医生的意见。你真的想让我大半夜的为这事叫醒别人吗？不能等到早上再说？”
“Anyway, Tarceva is a special drug, and it requires a fellow or attending to sign off on it. Do you really want me to wake someone up for this? Can’t it wait till morning?”