雙語·當呼吸化為空氣 生病會改變全家人的生活

無論什么大病，都能完全改變一個病人以及全家人的生活。但腦部的疾病又有其獨特的嚴重性。如果兒子去世了，父母的世界一定會天翻地覆，那么，如果病人是腦死亡，身體還溫熱，心臟還跳動，那豈不是更加不可理解？災難的起源如同星球開始解體，當病人聽到神經(jīng)外科醫(yī)生的診斷時，他們的眼神，就像解體的碎片——這個比喻最最恰切不過。有時候，消息太驚人了，腦子幾乎會“短路”。這種現(xiàn)象被稱為“心因性”綜合征。有些人聽到壞消息后會昏過去，這種綜合征就是更為嚴重的情況。我母親的父親，在二十世紀六十年代的印度農(nóng)村頂住重重壓力，保障了女兒的教育。而我母親只身一人在外面上大學的時候，聽到壞消息，自己的好爸爸在長期住院之后最終去世，她當時就發(fā)作了心因性癲癇，一直持續(xù)到她回家參加葬禮。我的一個病人，剛被診斷出腦癌時，突然就倒地昏迷了。我做了一系列的化驗、掃描、腦電圖尋找原因，但沒有結果。決定性的測試反而是最簡單的：我把病人的手臂舉起來，高過他的臉，然后松開。心因性昏迷的病人還有殘存的決斷力，會避免打到自己。治療手段包括不斷跟他說話，安慰他，直到他感受到你的言語，醒過來。
Any major illness transforms a patient’s—really, an entire family’s—life. But brain diseases have the additional strangeness of the esoteric. A son’s death already defies the parents’ ordered universe; how much more incomprehensible is it when the patient is brain-dead, his body warm, his heart still beating? The root of disaster means a star coming apart, and no image expresses better the look in a patient’s eyes when hearing a neurosurgeon’s diagnosis. Sometimes the news so shocks the mind that the brain suffers an electrical short. This phenomenon is known as a “psychogenic” syndrome, a severe version of the swoon some experience after hearing bad news. When my mother, alone at college, heard that her father, who had championed her right to an education in rural 1960s India, had finally died after a long hospitalization, she had a psychogenic seizure—which continued until she returned home to attend the funeral. One of my patients, upon being diagnosed with brain cancer, fell suddenly into a coma. I ordered a battery of labs, scans, and EEGs, searching for a cause, without result. The definitive test was the simplest: I raised the patient’s arm above his face and let go. A patient in a psychogenic coma retains just enough volition to avoid hitting himself. The treatment consists in speaking reassuringly, until your words connect and the patient awakens.

腦癌分兩種：一是與生俱來的原發(fā)性腫瘤，另一種是轉移性腫瘤，從身體別的地方遷移至此，比較普遍的是從肺部轉移。手術無法治愈，但的確可以延長生命；對于大多數(shù)人來說，一旦得上腦癌，就意味著一年內死亡，可能兩年。
Cancer of the brain comes in two varieties: primary cancers, which are born in the brain, and metastases, which emigrate from somewhere else in the body, most commonly from the lungs. Surgery does not cure the disease, but it does prolong life; for most people, cancer in the brain suggests death within a year, maybe two.

李太太快滿六十了，眼睛是淡綠色的，兩天前轉到我這里。原來住的醫(yī)院在她家附近，離這兒有一百六十多公里。她丈夫穿著格子襯衫，襯衫的下擺整齊地塞進洗得干凈挺括的牛仔褲里。他站在她床邊，不安地擺弄著手上的結婚戒指。自我介紹以后，我坐下來，她給我講了自己的事：過去幾天來，她一直覺得右手在麻麻地刺痛，然后就有點不聽使喚了，后來發(fā)展到連襯衫扣子都扣不好。她去了當?shù)氐募痹\，害怕是中風。在那里做了個核磁共振，就被送到這兒來了。
Mrs. Lee was in her late fifties, with pale green eyes, and had transferred to my service two days earlier from a hospital near her home, a hundred miles away. Her husband, his plaid shirt tucked into crisp jeans, stood by her bedside, fidgeting with his wedding ring. I introduced myself and sat down, and she told me her story: For the past few days, she had felt a tingling in her right hand, and then she’d begun to lose control of it, until she could no longer button her blouse. She’d gone to her local ER, fearing she was having a stroke. An MRI was obtained there, and she was sent here.

“有人給你解釋核磁共振的結果嗎？”我問。
“Did anyone tell you what the MRI showed?” I asked.

“沒有。”燙手山芋被扔給我了，這種難以啟齒的事情總是這樣。一般來說，我們都要和腫瘤醫(yī)師吵一架，讓他負責把這種消息轉達給病人。這事兒我都干了多少回了？嗯，我想，到此為止吧。
“No.” The buck had been passed, as it often was with difficult news. Oftentimes, we’d have a spat with the oncologist over whose job it was to break the news. How many times had I done the same? Well, I figured, it can stop here.

“好，”我說，“我們要好好談談了。要是你不介意的話，能不能跟我說說你現(xiàn)在的想法？聽病人聊聊對我總是很有幫助的，免得我待會兒說不清楚?！?br>“Okay,” I said. “We have a lot to talk about. If you don’t mind, can you tell me what you understand is happening? It’s always helpful for me to hear, to make sure I don’t leave anything unanswered.”

“嗯，我以為是中風了。但我猜……不是？”
“Well, I thought I was having a stroke, but I guess. . . I’m not?”

“猜得對。你沒有中風?！蔽衣杂羞t疑。我能看到她上周的生活和即將來臨的生活之間那巨大的鴻溝。她和她丈夫看上去都沒做好迎接腦瘤的準備。到底又有誰準備好過呢？于是我放緩速度，稍微說得含蓄了些：“從核磁共振看，你腦部有包塊，所以才有那樣的癥狀。”
“That’s right. You aren’t having a stroke.” I paused. I could see the vastness of the chasm between the life she’d had last week and the one she was about to enter. She and her husband didn’t seem ready to hear brain cancer— is anyone?—so I began a couple steps back. “The MRI shows a mass in your brain, which is causing your symptoms.”

沉默。
Silence.

“你想看看核磁共振圖像嗎？”
“Do you want to see the MRI?”

“想?！?br>“Yes.”

我從病床邊的電腦上調出那些圖像，指出她的鼻子、眼睛、耳朵，教她看。接著我向上滾動到腫瘤的位置，黑色的壞死核周圍包裹著邊緣起伏的白色圓環(huán)。
I brought up the images on the bedside computer, pointing out her nose, eyes, and ears to orient her. Then I scrolled up to the tumor, a lumpy white ring surrounding a black necrotic core.

“那個是什么？”她問。
“What’s that?” she asked.

有很多可能。也許是感染。做了手術才知道。
Could be anything. Maybe an infection. We won’t know till after surgery.

我仍然想回避這個問題，好讓他們暫時不那么憂心忡忡，心理負擔稍微輕一些。
My inclination to dodge the question still persisted, to let their obvious worries float in their heads, unpinned.

“做完手術才知道，”我開口，“但很像腦腫瘤?！?br>“We can’t be sure until after surgery,” I began, “but it looks very much like a brain tumor.”

“是癌癥嗎？”
“Is it cancer?”

“剛才說了，要取下來交給病理師，做了活檢才知道。但是，如果讓我來猜測，我可能會說是。”
“Again, we won’t know for certain until it is removed and examined by our pathologists, but, if I had to guess, I would say yes.”

從掃描結果來看，我心里早就確診了是惡性膠質瘤，很有侵略性的腦癌，最糟糕的那種。但我說得很委婉輕柔，隨時察言觀色，看李太太和她丈夫的反應行事。我剛才已經(jīng)說了有腦癌的可能，估計其他的話他們也記不得多少了。如果是一大碗悲劇，最好一勺一勺慢慢地喂。很少有病人要求一口氣吃完，大多數(shù)都需要時間去消化。他們沒有問手術預后的情況。這和創(chuàng)傷科不一樣，在那里你只有十分鐘時間解釋并做出重大的決定，在這里我可以慢慢把事情講清楚。我詳細地說了接下來幾天可能要面對的情況：圍繞著手術要干些什么；我們只會剃掉她的一點點頭發(fā)，這樣稍微修飾一下還是美美的；手術之后她的手臂可能會有點虛弱無力，但后面會恢復的；如果一切順利的話，三天后她就能出院了；這好比馬拉松的第一步；一路上要注意休息，這很重要；也不用刻意去記我剛才說的任何東西，反正我們都會再過一遍的。
Based on the scan, there was no doubt in my mind that this was glioblastoma—an aggressive brain cancer, the worst kind. Yet I proceeded softly, taking my cues from Mrs. Lee and her husband. Having introduced the possibility of brain cancer, I doubted they would recall much else. A tureen of tragedy was best allotted by the spoonful. Only a few patients demanded the whole at once; most needed time to digest. They didn’t ask about prognosis—unlike in trauma, where you have only about ten minutes to explain and make a major decision, here I could let things settle. I discussed in detail what to expect over the next couple of days: what the surgery entailed; how we’d shave only a small strip of her hair to keep it cosmetically appealing; how her arm would likely get a little weaker afterward but then stronger again; that if all went well, she’d be out of the hospital in three days; that this was just the first step in a marathon; that getting rest was important; and that I didn’t expect them to retain anything I had just said and we’d go over everything again.