雙語·當(dāng)呼吸化為空氣 我的體重開始下降

大概六個月前，我的體重開始下降，背上疼痛難忍。早上穿褲子的時候，皮帶先是緊了一個扣，接著緊了兩個。我去找我的初級保健醫(yī)生，也是我在斯坦福的老同學(xué)。她的哥哥是在神經(jīng)外科住院醫(yī)生崗位上猝死的，就因為沒在意一些病毒感染的征兆，所以她特別關(guān)注我的健康狀況，像我媽似的。不過，等我到了她的診室，卻發(fā)現(xiàn)里面坐著另一個醫(yī)生。我同學(xué)休產(chǎn)假去了，真的要做媽媽了。
About six months before, I had started losing weight and having ferocious back pain. When I dressed in the morning, my belt cinched one, then two notches tighter. I went to see my primary care doctor, an old classmate from Stanford. Her brother had died suddenly as a neurosurgical resident, after ignoring signs of a virulent infection, and so she’d taken a maternal watch on my health. When I arrived, however, I found a different doctor in her office—my classmate was on maternity leave.

我穿了一件薄薄的藍(lán)色體檢服，躺在冰冷的檢查臺上，向這位新醫(yī)生描述我的癥狀。“當(dāng)然，”我說，“如果這是醫(yī)生資格考試中的問題，三十五歲，體重莫名其妙地下降，初發(fā)性背痛，那明顯該選C——癌癥。但也說不定只是我工作太拼命了。我也不知道。想做個核磁共振確定一下。”
Dressed in a thin blue gown on a cold examining table, I described the symptoms to her. “Of course,” I said, “if this were a boards exam question—thirty-five-year-old with unexplained weight loss and new-onset back pain—the obvious answer would be cancer. But maybe it’s just that I’m working too hard. I don’t know. I’d like to get an MRI to be sure.”

“我覺得還是先照X光吧。”她說。背痛要做的核磁共振價格不菲，而且最近全國上下都在不斷強(qiáng)調(diào)，為了節(jié)省醫(yī)療成本，不要做這種不必要的檢查。但醫(yī)學(xué)掃描的價值，要看你找的是什么：X光基本上是查不出癌癥的。不過，很多醫(yī)生還是覺得，這么早就做核磁共振簡直有愧醫(yī)者之心。她說：“X光是沒有那么敏感，但也是個合理的開始。”
“I think we should get X-rays first,” she said. MRIs for back pain are expensive, and unnecessary imaging had lately become a major national point of cost-saving emphasis. But the value of a scan also depends on what you are looking for: X-rays are largely useless for cancer. Still, for many docs, ordering an MRI at this early stage is apostasy. She continued: “X-rays aren’t perfectly sensitive, but it makes sense to start there.”

“那我們做個屈伸X光，看看更現(xiàn)實的診斷是不是峽部脊椎滑脫？”
“How about we get flexion-extension X-rays, then— maybe the more realistic diagnosis here is isthmic-spondylolisthesis?”

墻上有面鏡子，我能看到她正在谷歌上搜索我說的術(shù)語。
From the reflection in the wall mirror, I could see her Googling it.

“一種椎弓骨折，發(fā)病率大概是5%，年輕人背痛經(jīng)常是這個原因。”
“It’s a pars fracture affecting up to five percent of people and a frequent cause of back pain in the young.”

“好，那我就約你說的那個X光。”
“Okay, I’ll order them, then.”

“謝謝。”我說。
“Thanks,” I said.