雙語·當(dāng)呼吸化為空氣 住院醫(yī)生生涯第四年

住院醫(yī)生生涯第四年，我開始在斯坦福一個(gè)實(shí)驗(yàn)室工作。這個(gè)實(shí)驗(yàn)室主要致力于基礎(chǔ)運(yùn)動(dòng)神經(jīng)學(xué)和神經(jīng)假體技術(shù)的研發(fā)，后者能夠讓癱瘓的人用思維控制電腦光標(biāo)或機(jī)器手臂。實(shí)驗(yàn)室的領(lǐng)導(dǎo)，電氣工程和神經(jīng)生物學(xué)的教授，也是第二代印度移民，我的同胞，大家都親切地稱他為“V”。V比我年長(zhǎng)七歲，但我倆就像手足兄弟。他的實(shí)驗(yàn)室在讀取大腦信號(hào)方面早已經(jīng)取得世界上首屈一指的領(lǐng)先地位，但在他的悉心指導(dǎo)下，我另辟蹊徑。我開始了一個(gè)相反的項(xiàng)目：將信號(hào)寫入大腦。畢竟，要是你的機(jī)器臂無法感知握住酒杯的力度，那你會(huì)打碎很多很多的酒杯。不過，把信號(hào)寫入大腦（也稱“神經(jīng)調(diào)控”），當(dāng)然遠(yuǎn)遠(yuǎn)不止拿酒杯那么簡(jiǎn)單。如果能夠控制神經(jīng)放電，那么可以想見，目前很多神經(jīng)學(xué)和精神科上的不治之癥或棘手頑疾都能找到治愈的辦法，從重度抑郁，到亨廷頓舞蹈癥，到精神分裂，到妥瑞氏綜合征，到強(qiáng)迫癥……實(shí)在是有無限的可能。我先把手術(shù)放到一邊，開始學(xué)習(xí)應(yīng)用基因療法的新科技，做了一系列“首開先河”的試驗(yàn)。
In my fourth year, I began work in a Stanford lab dedicated to basic motor neuroscience and the development of neural prosthetic technology that would allow, say, paralyzed people to mentally control a computer cursor or robot arm. The head of the lab, a professor of electrical engineering and neurobiology, a fellow second-generation Indian, was affectionately called “V” by everyone. V was seven years older than I, but we got on like brothers. His lab had become a world leader in reading out brain signals, but under V’s mentorship, I embarked on. I began a project to do the reverse: to write signals into the brain. After all, if your robot arm can’t feel how hard it’s grasping a wineglass, you will break a lot of wineglasses. The implications of writing signals into the brain, or “neuromodulation,” however, were far more wide-reaching than that: being able to control neural firing would conceivably allow treatment of a host of currently untreatable or intractable neurological and psychiatric diseases, from major depression to Huntington’s to schizophrenia to Tourette’s to OCD. . . the possibilities were limitless. Putting surgery aside now, I set to work learning to apply new techniques in gene therapy in a series of “first of its kind” experiments.

在實(shí)驗(yàn)室待了一年，V和我坐下來進(jìn)行每周的例會(huì)。我逐漸喜歡上了這樣的交談。V和我認(rèn)識(shí)的其他科學(xué)家不一樣，說起話來柔聲細(xì)語，對(duì)人們有著深深的關(guān)愛，對(duì)臨床醫(yī)學(xué)也有著很深的使命感。他常常向我坦白，說希望自己也能做個(gè)外科醫(yī)生。我逐漸了解到，科學(xué)，實(shí)在是最充滿政治性、競(jìng)爭(zhēng)最激烈、最你死我活的行業(yè)，處處布滿了走捷徑的誘惑。
After I’d been there for a year, V and I sat down for one of our weekly meetings. I had grown to love these chats. V was not like other scientists I knew. He was soft-spoken and cared deeply about people and the clinical mission, and he often confessed to me that he wished he’d been a surgeon himself. Science, I had come to learn, is as political, competitive, and fierce a career as you can find, full of the temptation to find easy paths.

而V是非常值得信任的，他總會(huì)選擇腳踏實(shí)地地向前（而且常常很自謙）。大多數(shù)科學(xué)家都爭(zhēng)先恐后地在最負(fù)盛名的期刊上發(fā)表文章，以求揚(yáng)名科學(xué)界。而V則堅(jiān)持認(rèn)為，我們唯一的職責(zé)，就是要堅(jiān)定地維護(hù)科學(xué)的真實(shí)性，決不妥協(xié)。我從來沒遇到過這么成功卻又這么堅(jiān)持善良美好人性的人。V實(shí)在是個(gè)不折不扣的完美楷模。
One could count on V to always choose the honest (and, often, selfeffacing) way forward. While most scientists connived to publish in the most prestigious journals and get their names out there, V maintained that our only obligation was to be authentic to the scientific story and to tell it uncompromisingly. I’d never met someone so successful who was also so committed to goodness. V was an actual paragon.

我面對(duì)他坐下，看見他臉上沒有笑容，只有痛苦。他嘆了口氣，說：“我需要你馬上變回一個(gè)外科醫(yī)生。”
Instead of smiling as I sat down across from him, he looked pained. He sighed and said, “I need you to wear your doctor hat right now.”

“好吧?！?br>“Okay.”

“他們說我得了胰腺癌。”
“They tell me I have pancreatic cancer.”

“V……好吧，跟我詳細(xì)說說?！?br>“V. . . okay. Tell me the story.”

他訴說了體重逐漸下降、消化不良，和最近的“預(yù)防性”CT檢查。在這個(gè)階段照CT實(shí)在太不符合標(biāo)準(zhǔn)流程了。結(jié)果發(fā)現(xiàn)胰臟有包塊。我們討論了接下來要怎么辦，不久的將來要面對(duì)可怕的“惠普爾”手術(shù)（我告訴他“你會(huì)感覺像被卡車撞了”）；哪些外科醫(yī)生是這方面最頂尖的；這個(gè)病會(huì)對(duì)他的妻兒造成什么影響；還有長(zhǎng)期缺席的話，怎么來管理這個(gè)實(shí)驗(yàn)室。胰腺癌的預(yù)后非常糟糕，但當(dāng)然無從得知這對(duì)V來說意味著什么。
He laid out his gradual weight loss, indigestion, and his recent“precautionary” CT scan—a truly nonstandard procedure at this point—which showed a pancreatic mass. We discussed the way forward, the dreaded Whipple operation in his near future (“You are going to feel like a truck hit you,” I told him), who the best surgeons were, the impact the illness would have on his wife and children, and how to run the lab during his prolonged absence. Pancreatic cancer has a dismal prognosis, but of course there was no way to know what that meant for V.

他略顯踟躕?！氨Ａ_，”他說，“你覺得我的生命有意義嗎？我做了正確的選擇嗎？”
He paused. “Paul,” he said, “do you think my life has meaning? Did I make the right choices?”

真是令人震驚。我眼中的道德模范在面對(duì)死亡時(shí)，竟然也會(huì)問這些問題。V的手術(shù)、化療和放療過程很艱難，但很成功。一年后他重返工作崗位，而我也即將回到醫(yī)院繼續(xù)臨床工作。他的頭發(fā)變得花白稀疏，眼中原本飛揚(yáng)的神采也變得黯淡無光。我們最后一次每周例會(huì)時(shí)，他看著我，說：“你知道嗎？從今天開始，我才感覺一切都值得。是啊，為了我的孩子我什么都愿意承受，但從今天開始，我才覺得一切痛苦都是值得的。”我們這些醫(yī)生讓病人經(jīng)歷了人間地獄般的痛苦，而我們對(duì)此的了解是多么貧乏啊。
It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality. V’s surgery, chemotherapy, and radiation treatments were trying, but a success. He was back at work a year later, just as I was returning to my clinical duties in the hospital. His hair had thinned and whitened, and the spark in his eyes had dulled. During our final weekly chat, he turned to me and said, “You know, today is the first day it all seems worth it. I mean, obviously, I would’ve gone through anything for my kids, but today is the first day that all the suffering seems worth it.” How little do doctors understand the hells through which we put patients.