雙語·當(dāng)呼吸化為空氣 所有的醫(yī)生都治病救人

所有的醫(yī)生都治病救人，而神經(jīng)外科醫(yī)生則在為病人保命與保住個(gè)性之間備受煎熬：每一次腦科手術(shù)，都不可避免地成為我們對自身本質(zhì)的一次操控；每一次和經(jīng)歷腦科手術(shù)的病人談話，也都迫使我們直面這個(gè)現(xiàn)實(shí)。另外，對于病人和家屬來說，腦科手術(shù)應(yīng)該是他們一生中最戲劇化的事情了，是一件會對人生產(chǎn)生重要影響的大事。如此緊要的關(guān)頭，問題不僅僅局限于生存還是死亡，還有到底怎樣的人生才值得一活。你愿意用失去說話的能力，來交換多幾個(gè)月的生命，默默無聲地度過余生嗎（也許你要替自己的母親做這個(gè)決定）？你愿意冒著喪失視力的危險(xiǎn)，來排除致命腦出血的哪怕一點(diǎn)點(diǎn)可能嗎？你愿意右手喪失行動能力，來停止抽搐嗎？你到底要讓孩子的神經(jīng)承受多少痛苦，才會更愿意選擇死亡呢？因?yàn)槟X部控制著我們對世界的感知和經(jīng)歷，任何神經(jīng)上的問題都迫使病人和家屬去思考（理想的狀況是，有醫(yī)生指導(dǎo)他們）：到底是什么，才賦予生命以意義，從而值得一活？
While all doctors treat diseases, neurosurgeons work in the crucible of identity: every operation on the brain is, by necessity, a manipulation of the substance of ourselves, and every conversation with a patient undergoing brain surgery cannot help but confront this fact. In addition, to the patient and their family, the brain surgery is usually the most dramatic event they have ever faced and, as such, has the impact of any major life event. At those critical junctures between, the question is not simply whether to live or die but what kind of life is worth living. Would you trade your ability—or your mother’s—to talk for a few extra months of mute life? The expansion of your visual blind spot in exchange for eliminating the small possibility of a fatal brain hemorrhage? Your right hand’s function to stop seizures? How much neurologic suffering would you let your child endure before saying that death is preferable? Because the brain mediates our experience of the world, any neurosurgical problem forces a patient and their family, ideally with a doctor as a guide, to answer this question: What makes life meaningful enough to go on living?

神經(jīng)外科令我不由自主地折服，這里沒有寬宥，必須追求完美。我想，這就像古希臘“arete”這個(gè)概念，是一種道德、情感、思維和身體上都至臻卓越的美德。神經(jīng)外科似乎提供了最艱難的挑戰(zhàn)，也最為直觀地面對意義、個(gè)性和死亡。神經(jīng)外科醫(yī)生的肩膀上擔(dān)負(fù)著沉重的責(zé)任，同時(shí)也是精通各個(gè)領(lǐng)域的“多面手”：神經(jīng)外科、重癥醫(yī)學(xué)、神經(jīng)內(nèi)科、放射學(xué)。我意識到，不僅要訓(xùn)練思維和雙手，還有眼睛，也許還有其他器官。這想法來勢洶洶，令我深陷其中不可自拔：也許，我也能像那些博學(xué)通才一樣，跋涉在情感、科學(xué)和精神難題最茂密的荊棘叢中，找到出口，或者殺出一條血路。
I was compelled by neurosurgery, with its unforgiving call to perfection; like the ancient Greek concept arete, I thought, virtue required moral, emotional, mental, and physical excellence. Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Concomitant with the enormous responsibilities they shouldered, neurosurgeons were also masters of many fields: neurosurgery, ICU medicine, neurology, radiology. Not only would I have to train my mind and hands, I realized; I’d have to train my eyes, and perhaps other organs as well. The idea was overwhelming and intoxicating: perhaps I, too, could join the ranks of these polymaths who strode into the densest thicket of emotional, scientific, and spiritual problems and found, or carved, ways out.

醫(yī)學(xué)院畢業(yè)后，我們這對新婚夫婦去加利福尼亞開始住院醫(yī)生生涯。我在斯坦福，露西在加州大學(xué)舊金山分校。醫(yī)學(xué)院正式成為過去，我們要真正承擔(dān)起責(zé)任了。我很快在醫(yī)院交了幾個(gè)好朋友，特別是和我同期的住院醫(yī)生維多利亞，還有比我們早來幾年的血管外科住院醫(yī)生杰夫。接下來七年的訓(xùn)練生涯中，我們將一起成長，一開始只是見證醫(yī)院里戲劇化的一幕幕，到后來自己開始擔(dān)任其中的主角。
After medical school, Lucy and I, newly married, headed to California to begin our residencies, me at Stanford, Lucy just up the road at UCSF. Medical school was officially behind us—now real responsibility lay in wait. In short order, I made several close friends in the hospital, in particular, Victoria, my co-resident, and Jeff, a vascular surgery resident a few years senior to us. Over the next seven years of training, we would grow from bearing witness to medical dramas to becoming leading actors in them.

第一年的住院醫(yī)生，在生命與死亡這樣厚重的背景下，真可謂卑微如螻蟻。不過，就算這樣，工作強(qiáng)度也是巨大的。第一天到醫(yī)院，住院總醫(yī)生就對我說：“神經(jīng)外科的住院醫(yī)生不僅僅是最好的外科醫(yī)生，我們也是整個(gè)醫(yī)院最好的醫(yī)生。這就是你的目標(biāo)。讓我們?yōu)槟泸湴涟??！笨浦魅谓?jīng)過病房時(shí)說：“吃飯的時(shí)候記得用左手。你要學(xué)會左右開弓?！蹦曩Y比較高的一位住院醫(yī)生說：“給你小小提醒一下，總醫(yī)生正在鬧離婚，別跟他聊閑天。”帶我的是個(gè)很開朗的醫(yī)生，本來應(yīng)該給我一些說明和指導(dǎo)，卻只是交給我一份四十三個(gè)病人的名單：“我只需要跟你說一件事：他們可以一直給你帶來更多傷害，但他們無法讓時(shí)間停止向前?！闭f完他就走了。
As an intern in the first year of residency, one is little more than a paper pusher against a backdrop of life and death—though, even then, the workload is enormous. My first day in the hospital, the chief resident said to me, “Neurosurgery residents aren’t just the best surgeons— we’re the best doctors in the hospital. That’s your goal. Make us proud.” The chairman, passing through the ward: “Always eat with your left hand. You’ve got to learn to be ambidextrous.” One of the senior residents: “Just a heads-up—the chief is going through a divorce, so he’s really throwing himself into his work right now. Don’t make small talk with him.” The outgoing intern who was supposed to orient me but instead just handed me a list of forty-three patients: “The only thing I have to tell you is: they can always hurt you more, but they can’t stop the clock.” And then he walked away.

接下來的兩天我都沒離開醫(yī)院，但不久以后，這些堆積如山、看上去不可能完成的文件整理工作，只需要花一個(gè)小時(shí)就能輕松解決了。不過，醫(yī)院工作中，你歸檔的文件可不僅僅是文件，而是各種各樣充滿風(fēng)險(xiǎn)與勝利的病例。比如，八歲的馬修，有一天因?yàn)轭^痛來看醫(yī)生，結(jié)果發(fā)現(xiàn)下丘腦附近有個(gè)腫瘤。下丘腦控制著我們的基本需求：睡眠、饑餓、口渴和性需求……那附近的任何腫瘤如果不及時(shí)徹底地處理，都會讓馬修的余生生活在化療和更多的手術(shù)之中，頭上還需要插著導(dǎo)管過活……簡單來說，會毀了他的童年。完全切除腫瘤就能避免上述情況，但可能有損傷下丘腦的風(fēng)險(xiǎn)，讓他染上暴飲暴食之類的毛病。手術(shù)開始，醫(yī)生從馬修的鼻腔里伸進(jìn)一個(gè)內(nèi)窺鏡，鉆開他的顱骨。進(jìn)去以后就看到一個(gè)清晰的平面，切除了腫瘤。幾天后，馬修就在病房里活蹦亂跳了，還從護(hù)士那里偷糖吃。他準(zhǔn)備回家的那天晚上，我很開心地填著他那似乎永遠(yuǎn)也填不完的出院手續(xù)。
I didn’t leave the hospital for the first two days, but before long, the impossible-seeming, day-killing mounds of paperwork were only an hour’s work. Still, when you work in a hospital, the papers you file aren’t just papers: they are fragments of narratives filled with risks and triumphs. An eight-year-old named Matthew, for example, came in one day complaining of headaches only to learn that he had a tumor abutting his hypothalamus. The hypothalamus regulates our basic drives: sleep, hunger, thirst, sex. Leaving any tumor behind would subject Matthew to a life of radiation, further surgeries, brain catheters. . . in short, it would consume his childhood. Complete removal could prevent that, but at the risk of damaging his hypothalamus, rendering him a slave to his appetites. The surgeon got to work, passed a small endoscope through Matthew’s nose, and drilled off the floor of his skull. Once inside, he saw a clear plane and removed the tumor. A few days later, Matthew was bopping around the ward, sneaking candies from the nurses, ready to go home. That night, I happily filled out the endless pages of his discharge paperwork.