雙語(yǔ)·當(dāng)呼吸化為空氣 保羅愿不愿意這樣呢

保羅愿不愿意這樣呢？
Was that what he wanted?

很快大家就意識(shí)到關(guān)鍵問(wèn)題：這種突然的呼吸衰竭可以逆轉(zhuǎn)嗎？
The key question quickly came into view: Could the sudden respiratory failure be reversed?

我們關(guān)心的是，保羅的病情會(huì)不會(huì)太嚴(yán)重，呼吸機(jī)一旦上去就撤不下來(lái)了。他會(huì)不會(huì)突發(fā)精神錯(cuò)亂，繼而器官衰竭，先是意識(shí)喪失，最后身體也跟著消亡？都是醫(yī)生，這種令人痛苦的場(chǎng)景我們都曾見證過(guò)。保羅提出了另一種方案，他可以選擇不插管，接受“舒適護(hù)理”，就算死亡也許來(lái)得更迅速，更篤定?！熬退阄覔芜^(guò)了這次，”他始終想著自己的腦癌，“未來(lái)也可能沒(méi)有任何意義?！彼麐寢尯芙^望地打斷他：“今晚別做任何決定好嗎，保比？”她說(shuō)，“咱們先好好休息?！北Ａ_明確表示不要進(jìn)行心肺復(fù)蘇，然后同意了母親的請(qǐng)求。
Of concern was whether Paul would remain too ill to ever come off the ventilator—would he be lost to delirium and then organ failure, first mind and then body slipping away? We’d witnessed this agonizing scenario as physicians. Paul explored the alternative: in lieu of intubation, he could choose “comfort care,” though death would come more surely and swiftly. “Even if I make it through this,” he said, thinking of the cancer in his brain, “I’m not sure I see a future that includes meaningful time.” His mother chimed in, desperately.“No decisions tonight, Pubby,” she said. “Let’s all get some rest.” After ensuring his “do not resuscitate” status, Paul agreed.

護(hù)士滿懷同情地多給了他幾條毯子。我關(guān)掉病房的日光燈。
Sympathetic nurses brought him extra blankets. I switched off the fluorescent lights.

保羅一覺(jué)睡到日出時(shí)分，他父親一直坐在旁邊守著。我到旁邊的房間小睡了一會(huì)兒，希望自己在精神上不要垮掉。因?yàn)槲抑?，接下?lái)也許就是我人生最艱難的一天。早上六點(diǎn)，我輕手輕腳回到保羅的病房，依然是昏暗的燈光，重癥監(jiān)護(hù)儀斷斷續(xù)續(xù)地響著。保羅睜開眼睛。我們又談了“舒適護(hù)理”的問(wèn)題，不準(zhǔn)備采取任何特別激進(jìn)的手段去阻止他病情的惡化。而且，他使勁大聲問(wèn)我能不能回家。他病得這么嚴(yán)重，我擔(dān)心這樣動(dòng)來(lái)動(dòng)去他會(huì)太痛苦，還可能在回家路上就會(huì)去世。但我還是說(shuō)，如果他現(xiàn)在最看重的事情就是回家，那我會(huì)盡一切努力帶他回去。我們互相點(diǎn)頭達(dá)成共識(shí)?，F(xiàn)在的方向應(yīng)該就是舒適護(hù)理了。或者，有沒(méi)有可能把這里變成家呢？在BiPAP呼吸的間隙，他給出了答案：“卡迪?！?br>Paul managed to doze until sunrise, his father sitting vigil while I napped briefly in an adjacent room hoping to preserve my mental strength, knowing that the following day might be the hardest of my life. I crept back to Paul’s room at six a. m ., the lights still low, the intensive-care monitors chiming intermittently. Paul opened his eyes. We talked again about “comfort care”—avoiding aggressive attempts to forestall his decline—and he wondered aloud whether he could go home. He was so ill that I worried he might suffer and die on the way. However, I said I would do everything possible to take him home if that were most important to him, nodding that yes, comfort care might be the direction we were headed. Or was there some way to recreate home here? Between BiPAP puffs, he answered: “Cady.”

卡迪很快就來(lái)了。我們的朋友維多利亞去家里把她接來(lái)了。懵懂的她歡天喜地地開始“看護(hù)”爸爸，舒舒服服地躺在保羅的右臂之中，拉扯自己小小的襪子，小手拍打著爸爸身上蓋的毯子，一會(huì)兒咧嘴微笑，一會(huì)兒牙牙學(xué)語(yǔ)，絲毫沒(méi)受BiPAP的影響。而這臺(tái)呼吸機(jī)繼續(xù)工作著，維持著保羅的生命。
Cady arrived in short order—our friend Victoria had retrieved her from home—and began her own unwitting, cheerful vigil, happily nestled in the crook of Paul’s right arm, tugging at her tiny socks, batting at his hospital blankets, smiling and cooing, unbothered by the BiPAP machine as it continued to blow, keeping Paul alive.

醫(yī)療團(tuán)隊(duì)一次次地來(lái)查房，在病房外討論保羅的病情，他的父母和我也加入討論。保羅的急性呼吸衰竭，應(yīng)該是由癌癥急劇惡化引起的。他血液的二氧化碳濃度還在上升，要救命的話，需要立刻插管。作為病人家屬的我們矛盾萬(wàn)分：保羅的腫瘤醫(yī)生打電話來(lái)，滿懷希望地認(rèn)為這種急性的問(wèn)題能夠得到緩解，但在場(chǎng)的醫(yī)生就沒(méi)那么樂(lè)觀了。我懇求他們，盡量準(zhǔn)確地預(yù)測(cè)他從這次急性衰竭中恢復(fù)的可能。
The medical team came by on rounds, discussing Paul’s case outside the room, where his family and I joined them. Paul’s acute respiratory failure was likely rapid cancer progressing. His carbon dioxide level was rising still—a hardening indication for intubation. The family was torn: Paul’s oncologist had phoned in, hopeful that the acute problem could be ameliorated, but the physicians present were less optimistic. I entreated them to weigh in with as much conviction as possible on the chance of reversing his abrupt decline.

“他不想接受只是保命的治療，”我說(shuō)，“如果他還能度過(guò)一些有意義的時(shí)光，他想把面罩摘下來(lái)，好好抱抱卡迪?！?br>“He doesn’t want a Hail Mary,” I said. “If he doesn’t have a chance of meaningful time, he wants to take the mask off and hold Cady.”

我回到保羅床邊。他看著我，蓋著BiPAP面罩的鼻梁之上，那雙深色的眼睛炯炯有神。他用輕柔而堅(jiān)定的聲音，清楚明白地說(shuō)：“我準(zhǔn)備好了?！?br>I returned to Paul’s bedside. He looked at me, his dark eyes alert above the nose bridge of the BiPAP mask, and said clearly, his voice soft but unwavering, “I’m ready.”

準(zhǔn)備好了。他的意思是：準(zhǔn)備好撤除呼吸輔助設(shè)備，準(zhǔn)備好注射嗎啡，準(zhǔn)備好去世了。
Ready, he meant, to remove the breathing support, to start morphine, to die.

一家人都聚集在一起。保羅做了決定后，我們抓緊珍貴的分分秒秒，表達(dá)了我們的愛(ài)與尊重。保羅的眼中淚光閃爍。他感謝了父母，并且讓我們保證，他寫的東西能以某種形式出版。他最后一次對(duì)我說(shuō)“我愛(ài)你”。主治醫(yī)生走進(jìn)來(lái)，用盡量堅(jiān)強(qiáng)的語(yǔ)氣對(duì)他說(shuō)：“保羅，你去世以后，你的家人會(huì)傷心崩潰，但他們一定會(huì)振作起來(lái)，因?yàn)槟憬o他們樹立了勇敢的榜樣?！奔曋Ａ_，蘇曼說(shuō)：“安心地去吧，我的弟弟?！蔽覐?qiáng)忍著心碎，最后一次和他同床共枕。
The family gathered together. During the precious minutes after Paul’s decision, we all expressed our love and respect. Tears glistened in Paul’s eyes. He expressed gratitude to his parents. He asked us to ensure that his manuscript be published in some form. He told me a last time that he loved me. The attending physician stepped in with strengthening words: “Paul, after you die, your family will fall apart, but they’ll pull it back together because of the example of bravery you set.” Jeevan’s eyes were trained on Paul as Suman said, “Go in peace, my brother.” With my heart breaking, I climbed into the last bed we would share.

我想起那些年我倆一起相擁過(guò)的床。八年前，還是醫(yī)學(xué)生的我們也是這樣躺在一張單人床上，旁邊是我生命垂危的祖父。他在家里，病入膏肓。我們沒(méi)有過(guò)完蜜月就回來(lái)分擔(dān)照顧他的重?fù)?dān)。每過(guò)幾個(gè)小時(shí)就起床喂他吃藥。我看著保羅俯下身子，湊近去聽祖父小聲提出的要求，對(duì)他的愛(ài)又加深了幾分。然而那時(shí)的我們又怎能想象眼前的場(chǎng)景，竟然在如此近的將來(lái)，我們就一起躺在保羅自己臨終的床上。二十二個(gè)月以前，我們?cè)谕患裔t(yī)院另一層樓的一張病床上相擁而泣過(guò)，當(dāng)時(shí)保羅剛剛被確診癌癥。八個(gè)月以前，也是在這家醫(yī)院，我們一起躺在我的病床上?？ǖ铣錾恕Ｎ液捅Ａ_都在睡覺(jué)，互相枕著對(duì)方的手臂，那是卡迪出生后我的第一個(gè)長(zhǎng)長(zhǎng)的好覺(jué)。我想起家中那張空空如也的舒服的床，想起十二年前在紐黑文與保羅墜入愛(ài)河。那時(shí)我特別驚訝，兩個(gè)人的身體四肢竟然如此契合，從那時(shí)起，我們都是互相擁抱時(shí)睡得最好。我用自己擁有的一切祈禱，愿他此刻也感受到和我一樣的舒適與安心。
I thought of other beds we’d shared. Eight years prior as medical students, we’d slept similarly ensconced in a twin bed next to my grandfather as he lay dying at home, having cut our honeymoon short to help with caregiving duties. We awakened every few hours to give him medications, my love for Paul deepening as I watched him lean in and listen closely to my grandfather’s whispered requests. We’d never have imagined this scene, Paul’s own deathbed, so near in our future. Twenty-two months ago, we’d cried in a bed on another floor of this same hospital as we learned of Paul’s cancer diagnosis. Eight months ago, we’d been together here in my hospital bed the day after Cady was born, both napping, the first good, long sleep I’d had since her birth, wrapped in each other’s arms. I thought of our cozy bed empty at home, remembered falling in love in New Haven twelve years earlier, surprised right away by how well our bodies and limbs fit together, and thought of how ever since, we’d both slept best when entwined. I hoped with all I had that he felt that same restful comfort now.

一個(gè)小時(shí)后，面罩摘了，監(jiān)視器也撤了，嗎啡流進(jìn)保羅的靜脈輸液管。他的呼吸很穩(wěn)，但也很淺，看上去挺舒服的樣子。盡管如此，我還是問(wèn)他，要不要多打點(diǎn)嗎啡。他點(diǎn)點(diǎn)頭，閉上雙眼。保羅的媽媽就坐在旁邊，爸爸的手放在他頭頂。最后，他陷入了昏迷。
An hour later, the mask and monitors were off, and morphine was flowing through Paul’s IV. He was breathing steadily but shallowly, and he appeared comfortable. Nonetheless, I asked him whether he needed more morphine, and he nodded yes, his eyes closed. His mother sat close; his father’s hand rested atop his head. Finally, he slipped into unconsciousness.

九個(gè)多小時(shí)，保羅的父母、兄弟、弟妹、女兒和我，我們這些家人全都圍坐在身邊，看顧著不省人事的他。他的昏迷愈發(fā)加深，偶爾呼吸一兩下，眼瞼緊閉，臉上是如釋重負(fù)的表情。他長(zhǎng)長(zhǎng)的手指溫柔地蓋在我手上，保羅的父母先是把卡迪放在搖籃里，接著又把她安放在病床上，搖搖她，哄哄她，讓她甜甜地入睡。病房里彌漫著濃濃的愛(ài)，就像多年來(lái)一家人團(tuán)聚的很多節(jié)日與周末。我撫摸著保羅的頭發(fā)，低語(yǔ)著：“你是個(gè)勇敢的圣騎士?！薄笆ヲT士”是我對(duì)他的昵稱。接著我在他耳邊安靜地唱起一首歌謠，是我倆過(guò)去幾個(gè)月來(lái)一起編的，旋律簡(jiǎn)單，朗朗上口，中心思想就是“謝謝你愛(ài)我”。關(guān)系很近的表親和叔叔也來(lái)了醫(yī)院，接著我們的牧師趕到了。一家人分享著特別有愛(ài)的趣事和只有彼此才懂的笑話。接著我們相繼哭起來(lái)，憂心忡忡地端詳保羅和彼此的臉。我們沉浸在此時(shí)此刻的珍貴與痛苦中，這是與保羅最后的團(tuán)聚時(shí)光。
For more than nine hours, Paul’s family—his parents, brothers, sisterin-law, daughter, and I—sat vigil as Paul, unconscious, now drew increasingly halting, infrequent breaths, his eyelids closed, his face unburdened. His long fingers rested softly in mine. Paul’s parents cradled Cady and then put her in the bed again to snuggle, nurse, nap. The room, saturated with love, mirrored the many holidays and weekends we had all spent together over the years. I stroked Paul’s hair, whispering, “You’re a brave Paladin”—my nickname for him—and singing quietly into his ear a favorite jingle we’d made up over the previous months, its core message being “Thank you for loving me.”A close cousin and uncle arrived, and then our pastor. The family shared loving anecdotes and inside jokes; then we all took turns weeping, studying Paul’s face and each other’s with concern, steeped in the preciousness and pain of this time, our last hours all together.

夜幕降臨，病房暗下來(lái)，一盞低低的壁燈發(fā)出溫暖的光。保羅的呼吸更為緩慢艱難，沒(méi)有節(jié)奏。他的整個(gè)身體都很平靜，四肢也放松了。快到九點(diǎn)的時(shí)候，他的嘴唇微微張開，合上雙眼。他深深吸了一口氣，又長(zhǎng)長(zhǎng)地呼出。這是他最后一次呼吸。
As the room darkened into night, a low wall lamp glowing warmly, Paul’s breaths became faltering and irregular. His body continued to appear restful, his limbs relaxed. Just before nine o’clock, his lips apart and eyes closed, Paul inhaled and then released one last, deep, final breath.