雙語(yǔ)·當(dāng)呼吸化為空氣 我們能看到的 只是生命的局部

毫無(wú)疑問(wèn)，我們每個(gè)人最終能看到的，都只不過(guò)是生命的局部。醫(yī)生看到一個(gè)方面，病人看到另一個(gè)方面，工程師、經(jīng)濟(jì)學(xué)家、潛水采集珍珠的人、酗酒的人、有線電視修理工、牧羊人、印度乞丐、牧師……看到的都不盡相同。沒(méi)有什么人能完全包攬人類所有的認(rèn)知。認(rèn)知產(chǎn)生于我們所創(chuàng)造的，我們彼此之間的關(guān)系，以及我們與世界的關(guān)系之中，永遠(yuǎn)不可能完整全面。而終極真理凌駕于一切之上，在其存在之處，播種者與收割者可以一同欣喜狂歡，正如禮拜天的《圣經(jīng)》布道的最后。因?yàn)?，終極真理之中，有句話說(shuō)得清楚明白：“那人撒種，這人收割?！蔽遗赡闳ナ斋@你并未付出努力的東西；辛苦勞作都是別人的，你分享了他們的勞動(dòng)果實(shí)。
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臺(tái)。這已經(jīng)是重返外科的第七個(gè)月了。這將是我的最后一次CT，這之后我將結(jié)束住院醫(yī)生生涯，成為一個(gè)父親，我的葬禮也終有一天會(huì)成為現(xiàn)實(shí)。
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.

“想看看嗎，醫(yī)生？”掃描人員問(wèn)我。
“Wanna take a look, Doc?” the tech said.

“現(xiàn)在不看，”我說(shuō)，“今天我還有很多工作?！?br>“Not right now,” I said. “I’ve got a lot of work to do today.”

已經(jīng)下午六點(diǎn)了，我必須去查房、探視病人，做明天的手術(shù)室安排，看看各種掃描片子，向別人口述我的臨床筆記，查查病人術(shù)后的情況……很多事等著做。晚上八點(diǎn)左右，我在神經(jīng)外科的辦公室坐下，旁邊就是放射照片觀測(cè)臺(tái)。我打開(kāi)來(lái)，看著第二天要做手術(shù)的病人的掃描片，是兩個(gè)比較簡(jiǎn)單的脊椎病例。最終，我輸入了自己的名字。片子出現(xiàn)在屏幕上，我不斷縮放著，仿佛孩子在隨意翻看畫冊(cè)，把新的片子和上次照的對(duì)比。一切看起來(lái)都沒(méi)有變化，原來(lái)的那些腫瘤還是一個(gè)樣。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.

我滑動(dòng)滾輪，再看了一下今天的片子。
I rolled back the images. Looked again.

一個(gè)新的腫瘤出現(xiàn)了，有點(diǎn)大，填滿了我的右肺中葉?？瓷先ゾ褂悬c(diǎn)像一輪幾乎照亮了整個(gè)地平線的滿月。再回去看原來(lái)照的片子，我能辨認(rèn)出這個(gè)腫瘤非常微弱的跡象，原來(lái)只是幽靈一般的預(yù)兆，現(xiàn)在則完全變成了現(xiàn)實(shí)。
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.

我既不憤怒，也不恐懼。本來(lái)就是如此。這是大千世界中的一個(gè)事實(shí)，就像太陽(yáng)與地球的距離。我開(kāi)車回家，告訴了露西。那是星期四的晚上，我們和艾瑪?shù)囊?jiàn)面要等到下周一。露西和我坐在客廳，各自打開(kāi)筆記本電腦，列出了接下來(lái)要做的事情：活檢、體檢、化療。這次的治療肯定更艱難、更痛苦，而活得久一些的可能性更為渺茫。我又想起艾略特寫過(guò)的詩(shī)句：“可是在我背后的冷風(fēng)中，我聽(tīng)見(jiàn)／白骨在碰撞，得意的笑聲從耳邊傳到耳邊?！币苍S未來(lái)幾個(gè)星期，幾個(gè)月，甚至永遠(yuǎn)，我都無(wú)法再重返神經(jīng)外科了。但我們覺(jué)得，這一切都可以等到周一再來(lái)考慮。今天是星期四，我已經(jīng)做好了明天手術(shù)室的安排；我決定，要去當(dāng)最后一天的住院醫(yī)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.

第二天早上五點(diǎn)二十分，我在醫(yī)院門口下了車，深深吸了口氣，聞著桉樹的氣味。好像還有什么氣味……是松樹嗎？以前都沒(méi)注意到呢。我把住院醫(yī)生們集合到一起，準(zhǔn)備上午的各項(xiàng)工作。我們先回顧了前一晚發(fā)生的事情，入院的病人，新的掃描片子，然后去查房，之后還開(kāi)了“M&M”會(huì)，也就是定期召開(kāi)的關(guān)于發(fā)病率與死亡率的會(huì)議，神經(jīng)外科醫(yī)生們會(huì)聚集到一起，檢討一段時(shí)間內(nèi)犯的錯(cuò)誤和處理得不好的病例。開(kāi)完會(huì)，我又跟病人R先生多待了幾分鐘。他得了一種罕見(jiàn)病，叫格斯特曼綜合征。我切除他腦內(nèi)的腫瘤后，R先生開(kāi)始顯露出一系列行為缺陷：讀寫能力缺失，說(shuō)不出每根手指的具體名稱，不會(huì)算術(shù)，分不清左右。這種事我之前只碰到過(guò)一次，還是八年前做醫(yī)學(xué)生，剛剛進(jìn)入神經(jīng)外科實(shí)習(xí)時(shí)跟過(guò)的一個(gè)病例。和那個(gè)病人一樣，R先生也是精神愉快，情緒高昂，我懷疑這會(huì)不會(huì)也是癥狀之一，只是從來(lái)沒(méi)人當(dāng)作癥狀描述出來(lái)而已。不過(guò)R先生正在好轉(zhuǎn)：他的語(yǔ)言能力幾乎已經(jīng)恢復(fù)正常，算術(shù)能力也只是有一點(diǎn)點(diǎn)偏差。他完全康復(fù)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.

上午很快過(guò)去了。我刷手消毒，準(zhǔn)備做最后一次手術(shù)。突然間，我感覺(jué)到這個(gè)時(shí)刻意義重大。這真的是我最后一次刷手了？也許真的走到頭了。我看著肥皂水順著手臂流下來(lái)，然后流回水槽里。我走進(jìn)手術(shù)室，穿好手術(shù)衣，給病人蓋上無(wú)菌布，專門扯了扯四個(gè)角，確保沒(méi)有褶皺。我希望這臺(tái)手術(shù)完美無(wú)缺。我割開(kāi)他背部下方的皮膚。這個(gè)男人已經(jīng)上了年紀(jì)，脊椎退化，壓迫神經(jīng)根，造成嚴(yán)重的疼痛。我撥開(kāi)脂肪，筋膜出現(xiàn)，感覺(jué)到凸起的椎骨。我割開(kāi)筋膜，又順利地割開(kāi)肌肉，直到眼前的傷口中只剩下閃著亮光的寬闊椎骨，干凈純粹，不沾一絲血跡。主治醫(yī)生進(jìn)來(lái)了，我正在切除椎骨后面的椎板，那里有增生，再加上下面的韌帶，一起壓迫著神經(jīng)。
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.

“看著挺好，”主治醫(yī)生說(shuō)，“如果你想去今天的會(huì)，我找同事進(jìn)來(lái)接手做完?！蔽业谋惩从珠_(kāi)始了。我之前怎么不再吃點(diǎn)消炎藥呢？不過(guò)，這臺(tái)手術(shù)應(yīng)該很快了，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，”我說(shuō)，“我想把這臺(tái)手術(shù)做完。”
“Naw,” I said. “I want to finish the case.”

主治醫(yī)生也刷手消毒進(jìn)來(lái)了，我們一起切除了增生。他開(kāi)始撥弄韌帶，下面是硬膜，里面有脊髓液和神經(jīng)根。這一步最容易犯的錯(cuò)誤，就是在硬膜上弄個(gè)洞。我負(fù)責(zé)處理另一側(cè)。突然，我眼角的余光瞥見(jiàn)，他的手術(shù)用具旁邊有一抹藍(lán)色——硬膜開(kāi)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！”我說(shuō)。此時(shí)他手上的器具已經(jīng)夾到硬膜了。清澈的脊髓液開(kāi)始填滿傷口。一年多了，我還是第一次遇到漏液的情況。修補(bǔ)這個(gè)漏洞又需要一個(gè)小時(shí)。
“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.

“把刀頭拿出來(lái)，”我說(shuō)，“漏液了?！?br>“Get the micro set out,” I said. “We have a leak.”

等我們修補(bǔ)完這個(gè)漏洞，把壓迫神經(jīng)的軟組織切除之后，我的雙肩火辣辣地痛。主治醫(yī)生脫掉手術(shù)衣，向我道歉又道謝，離開(kāi)了，留下我收尾。一層層組織整齊地合到一起。我又開(kāi)始用尼龍線一針一針縫合皮膚。大多數(shù)外科醫(yī)生都會(huì)選擇縫合器，但我一直覺(jué)得尼龍線的感染率比較低。這個(gè)病人，這“最后一役”，要按我的想法來(lái)做。皮膚完美地縫合，沒(méi)有拉扯褶皺，仿佛這臺(tái)手術(shù)從未發(fā)生過(guò)。
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.