雙語·當(dāng)呼吸化為空氣 我對意義、生命與死亡三者關(guān)系的理解

醫(yī)學(xué)院的經(jīng)歷，讓我加深了對意義、生命與死亡三者關(guān)系的理解，變得更為敏銳。我親眼見證了自己讀本科時寫下的那些與人性關(guān)聯(lián)的文字，在醫(yī)患關(guān)系中變成了現(xiàn)實。作為醫(yī)學(xué)生，我們要直面死亡與痛苦，我們以后的工作就是照顧病患，同時又暫不會感受到責(zé)任帶來的真正沖擊，這些充其量只是冰山一角而已。醫(yī)學(xué)院的頭兩年，基本上就是上課、社交、學(xué)習(xí)和閱讀，就是在繼續(xù)本科的生活而已。然而，我在醫(yī)學(xué)院的第一年認(rèn)識了女友露西（就是我后來的妻子），她能看透學(xué)術(shù)生活究竟意味著什么。她內(nèi)心的愛幾乎無窮無盡，這也教會了我一些東西。有一天，她在我公寓的沙發(fā)上，研究著心電圖的那些波動起伏，經(jīng)過冥思苦想后，她正確地指出了其中致命的心律不齊的狀況。然后她忽然明白過來了，并在一瞬間流下了眼淚：從這張不知從何而來的“練習(xí)用”心電圖可以看出，這位病人已經(jīng)不在人世了。紙上這些彎彎曲曲的線條，不只是簡單的線條，還是從心顫再到心跳停止的全過程，這些會讓看懂的人心痛落淚。
Medical school sharpened my understanding of the relationship between meaning, life, and death. I saw the human relationality I had written about as an under-graduate realized in the doctorpatient relationship. As medical students, we were confronted by death, suffering, and the work entailed in patient care, while being simultaneously shielded from the real brunt of responsibility, though we could spot its specter. Med students spend the first two years in classrooms, socializing, studying, and reading; it was easy to treat the work as a mere extension of undergraduate studies. But my girl-friend Lucy, whom I met in the first year of medical school (and who would later become my wife), understood the subtext of the academics. Her capacity to love was barely finite, and a lesson to me. One night on the sofa in my apartment, while studying the reams of wavy lines that make up EKGs, she puzzled over, then correctly identified, a fatal arrhythmia. All at once, it dawned on her and she began to cry: wherever this “practice EKG” had come from, the patient had not survived. The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating to asystole, and they could bring you to tears.

露西和我在耶魯醫(yī)學(xué)院上學(xué)時，謝普·紐蘭德還在開課，但當(dāng)時我只是拜讀過他的一些作品。紐蘭德是著名的外科醫(yī)生兼哲學(xué)家，寫了一本極具開創(chuàng)性的書，探討死亡，名為《我們?nèi)绾嗡廊ァ?，在我讀高中時出版。但一直到進了醫(yī)學(xué)院，我才得以捧讀此書。在我讀過的書里，少有像這本一樣，能直接而全面地指出生存的基本事實：一切生物，不管是金魚，還是可愛的小孩，都難逃一死。晚上，我在房間里聚精會神地拜讀這本書，印象最深的是他對祖母病情的描述，一件事情竟然能如此淋漓盡致地展現(xiàn)身體上、醫(yī)學(xué)上和精神上的混雜糾葛。紐蘭德回憶起孩提時代常常玩的一個游戲——伸出手指去戳祖母的皮膚，看什么時候才能恢復(fù)原狀。這是她慢慢變老的一個征兆。后來祖母又新添了呼吸急促的毛病，這些都說明她“逐漸走向充血性心力衰竭……老化的血液從老化的肺、老化的組織中能運送的氧氣大大減少”。但“最明顯的是”，他接著寫道，“是她慢慢失去了生命力……祖母停止了禱告，也基本上停止了其他所有事情”。祖母因為中風(fēng)最終去世時，紐蘭德想起托馬斯·布朗的《一個醫(yī)生的信仰》：“我們無從得知降生世上將遭遇怎樣的沖突與痛苦，但通常來說我們很難脫身其外。”
Lucy and I attended the Yale School of Medicine when Shep Nuland still lectured there, but I knew him only in my capacity as a reader. Nuland was a renowned surgeon-philosopher whose seminal book about mortality, How We Die, had come out when I was in high school but made it into my hands only in medical school. Few books I had read so directly and wholly addressed that fundamental fact of existence: all organisms, whether goldfish or grandchild, die. I pored over it in my room at night, and remember in particular his description of his grandmother’s illness, and how that one passage so perfectly illuminated the ways in which the personal, medical, and spiritual all intermingled. Nuland recalled how, as a child, he would play a game in which, using his finger, he indented his grandmother’s skin to see how long it took to resume its shape—a part of the aging process that, along with her newfound shortness of breath, showed her “gradual slide into congestive heart failure. . . the significant decline in the amount of oxygen that aged blood is capable of taking up from the aged tissues of the aged lung.” But “what was most evident,” he continued, “was the slow drawing away from life. . . By the time Bubbeh stopped praying, she had stopped virtually everything else as well.” With her fatal stroke, Nuland remembered Sir Thomas Browne’s Religio Medici: “With what strife and pains we come into the world we know not, but ’tis commonly no easy matter to get out of it.”

我花了那么多時間，在斯坦福研究文學(xué)，在劍橋探索醫(yī)學(xué)史，想要對死亡的特性有更好的了解，結(jié)果卻更覺疏離，始終懵懵懂懂，不得其道。而紐蘭德的描述，才讓我“絕知此事要躬行”。我轉(zhuǎn)而學(xué)醫(yī)，就是想去探尋死亡的雙重神秘。死亡既帶著濃烈的個人色彩，同時又絲毫不帶個人色彩。這種截然相反的特性，無論從死亡的體驗上，還是從其生理表現(xiàn)上，都表現(xiàn)得很充分。
I had spent so much time studying literature at Stanford and the history of medicine at Cambridge, in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me. Descriptions like Nuland’s convinced me that such things could be known only face-to-face. I was pursuing medicine to bear witness to the twinned mysteries of death, its experiential and biological manifestations: at once deeply personal and utterly impersonal.

我記得，紐蘭德在《我們?nèi)绾嗡廊ァ返拈_頭，寫了一個年輕的醫(yī)學(xué)生，獨自待在手術(shù)室，面對一個心跳停止的病人。絕望之下，他為病人開胸，試圖人工恢復(fù)他的心跳，那可真的是要起死回生。病人最終撒手人寰，最后紐蘭德的導(dǎo)師找到了他，發(fā)現(xiàn)他渾身是血，垂頭喪氣。
I remember Nuland, in the opening chapters of How We Die, writing about being a young medical student alone in the OR with a patient whose heart had stopped. In an act of desperation, he cut open the patient’s chest and tried to pump his heart manually, tried to literally squeeze the life back into him. The patient died, and Nuland was found by his supervisor, covered in blood and failure.Medical school had changed by the time I got there, to the point where such a scene was simply unthinkable: as medical students, we were barely allowed to touch patients, let alone open their chests. What had not changed, though, was the heroic spirit of responsibility amid blood and failure. This struck me as the true image of a doctor.

我進醫(yī)學(xué)院的時候，情況已然不同。上述的場景完全不可想象。我們這些醫(yī)學(xué)生根本連碰都不準(zhǔn)碰病人，更別說給他們開胸了。不過，沒有改變的，是在鮮血和沮喪之間極富英雄主義精神的責(zé)任感。在我看來，這才是一個醫(yī)生真正的形象。
The first birth I witnessed was also the first death.