雙語·當呼吸化為空氣 天下太平 一切順利

接下來的幾個小時，天下太平，一切順利。梅麗莎在休息室睡著了。我努力辨認加西亞病歷上那些難以辨認的潦草字跡，跟讀天書似的。我最終還是看明白了，她全名叫艾琳娜·加西亞，這是第二次懷孕，沒有做產(chǎn)前保健，也沒有醫(yī)療保險。我寫下她正在服的藥，提醒自己待會兒要去查一下。我在醫(yī)生休息室找到一本課本，了解了一點早產(chǎn)的知識。早產(chǎn)兒如果活了下來，還是有很大概率會遭遇腦溢血和腦癱。不過，三十年前，我哥哥蘇曼早產(chǎn)八周，現(xiàn)在已經(jīng)正式成為一名神經(jīng)內(nèi)科醫(yī)師了。我走到護士身邊，請她教我看顯示器上那些彎彎曲曲的圖像。在我眼里，這跟醫(yī)生寫在病歷上的字一樣難以辨認，但顯然可以預(yù)測接下來是平安無事還是大難臨頭。她點點頭，開始指導我看宮縮數(shù)據(jù)和胎兒心跳對宮縮做出的反應(yīng)：“這邊，仔細看看，就能看到——”
For the next several hours, things progressed smoothly. Melissa slept in the lounge. I tried decoding the indecipherable scribbles in Garcia’s chart, which was like reading hieroglyphics, and came away with the knowledge that her first name was Elena, this was her second pregnancy, she had received no prenatal care, and she had no insurance. I wrote down the names of the drugs she was getting and made a note to look them up later. I read a little about premature labor in a textbook I found in the doctors’ lounge. Preemies, if they survived, apparently incurred high rates of brain hemorrhages and cerebral palsy. Then again, my older brother, Suman, had been born almost eight weeks premature, three decades earlier, and he was now a practicing neurologist. I walked over to the nurse and asked her to teach me how to read those little squiggles on the monitor, which were no clearer to me than the doctors’ handwriting but could apparently foretell calm or disaster. She nodded and began talking me through reading a contraction and the fetal hearts’ reaction to it, the way, if you looked closely, you could see—

她停下來，神情非常憂慮，一言不發(fā)地站起來，沖進艾琳娜的病房，然后又沖出來，抓起電話，呼叫了梅麗莎。一分鐘后，梅麗莎趕到了，睡眼惺忪地看了一眼圖表，也沖進了病房。我急匆匆地跟在她后面。她打開翻蓋手機，給主治醫(yī)生打電話，連珠炮似的說著各種術(shù)語，我只能聽懂一部分，也大概了解了情況：雙胞胎情況很危險，唯一能保住的辦法，就是緊急剖腹產(chǎn)。
She stopped. Worry flashed across her face. Without a word, she got up and ran into Elena’s room, then burst back out, grabbed the phone, and paged Melissa. A minute later, Melissa arrived, blearyeyed, glanced at the strips, and rushed into the patient’s room, with me trailing behind. She flipped open her cellphone and called the attending, rapidly talking in a jargon I only partially understood. The twins were in distress, I gathered, and their only shot at survival was an emergency C-section.

我不由自主地跟著一大群心急火燎的人進了手術(shù)室。他們讓艾琳娜仰臥在手術(shù)臺上，藥物注入她的血管。一個護士手忙腳亂地往她隆起的腹部抹了抗菌溶液，主治醫(yī)生、住院醫(yī)生和我用酒精沖洗了手和前臂。我模仿著他們迅速的動作，默默地聽著他們低聲咒罵。麻醉師給病人插管，而主刀的主治醫(yī)生則煩躁不安。
I was carried along with the commotion into the operating room. They got Elena supine on the table, drugs running into her veins. A nurse frantically painted the woman’s swollen abdomen with an antiseptic solution, while the attending, the resident, and I splashed alcohol cleanser on our hands and forearms. I mimicked their urgent strokes, standing silently as they cursed under their breath. The anesthesiologists intubated the patient while the senior surgeon, the attending, fidgeted.

“快點，”他說，“我們時間不多，動作要更快！”
“C’mon,” he said. “We don’t have a lot of time. We need to move faster!”

我站在主治醫(yī)生旁邊，看他用手術(shù)刀劃開那女人的肚子，在她的肚臍下面留下一道彎彎曲曲的長切口，就在她那隆起的子宮頂端的下面。我努力跟上每一個步驟，迅速在腦子里搜索課本上的解剖示意圖。手術(shù)刀所到之處，皮開肉綻。醫(yī)生滿懷信心地切開韌性很足、包裹著肌肉的白色腹直肌筋膜，接著用雙手掰開筋膜和下面的肌肉，甜瓜一樣的子宮開始出現(xiàn)在視野里。他把子宮也割開，一張小小的臉蛋出現(xiàn)了，接著又被淹沒在血泊中。醫(yī)生伸手進去，拉出一個，又拉出另一個。兩個嬰兒渾身發(fā)紫，幾乎一動不動，雙目緊閉，像過早掉出窩的小鳥。他們的皮膚是半透明的，能看到下面的骨頭，似乎不是兩個真正的孩子，更像誰信筆畫的素描。他們太小了，比醫(yī)生的手大不了多少，抱都抱不住，立刻被交給在一邊待命的新生兒重癥監(jiān)護醫(yī)生，迅速進了新生兒重癥監(jiān)護室。
I was standing next to the attending as he sliced open the woman’s belly, making a single long curvilinear incision beneath her belly button, just below the apex of her protuberant womb. I tried to follow every movement, digging in my brain for textbook anatomical sketches. The skin slid apart at the scalpel’s touch. He sliced confi-dently through the tough white rectus fascia covering the muscle, then split the fascia and the underlying muscle with his hands, revealing the first glimpse of the melon-like uterus. He sliced that open as well, and a small face appeared, then disappeared amid the blood. In plunged the doctor’s hands, pulling out one, then two purple babies, barely moving, eyes fused shut, like tiny birds fallen too soon from a nest. With their bones visible through translucent skin, they looked more like the preparatory sketches of children than children themselves. Too small to cradle, not much bigger than the surgeon’s hands, they were rapidly passed to the waiting neonatal intensivists, who rushed them to the neonatal ICU.

燃眉之急算是解決了，手術(shù)的步調(diào)慢了下來，大家都趨于平靜，沒剛才那么混亂了。電刀燒灼切口，止住了小規(guī)模噴濺的鮮血，皮肉燒焦的味道緩緩飄散開來。子宮縫合，縫起來的傷口如同一排牙齒，咬合在一起。
With the immediate danger averted, the pace of the operation slowed, frenzy turning to something resembling calm. The odor of burnt flesh wafted up as the cautery arrested little spurts of blood. The uterus was sutured back together, the stitches like a row of teeth, biting closed the open wound.

“教授，腹膜需要閉合嗎？”梅麗莎說，“我最近讀到資料說不用閉合?！?br>“Professor, do you want the peritoneum closed?” Melissa asked. “I read recently that it doesn’t need to be.”

“上帝造物時閉合的，不要人為去分開，”主治醫(yī)生說，“至少只能暫時分開。我喜歡把東西恢復到原來的樣子——我們還是把它縫合了吧。”
“Let no man put asunder what God has joined,” the attending said. “At least, no more than temporarily. I like to leave things the way I found them—let’s sew it back up.”

腹膜是包覆腹腔的一層薄膜。不知道為什么，我完全錯過了剛才腹膜被切開的過程，現(xiàn)在也完全找不到它在哪里。在我眼里，這傷口就是一大堆雜亂無章的組織，然而在外科醫(yī)生看來，這一切都是井然有序的，如同雕塑家看一塊未經(jīng)雕琢的大理石。
The peritoneum is a membrane that surrounds the abdominal cavity. Somehow I had completely missed its opening, and I couldn’t see it at all now. To me, the wound looked like a mass of disorganized tissue, yet to the surgeons it had an appreciable order, like a block of marble to a sculptor.

梅麗莎要了腹膜縫線，把鉗子伸進傷口，扯出肌肉和組織之間一層透明的組織。突然間，腹膜和上面的大洞就這樣清晰地展現(xiàn)在我的眼前。她縫合了腹膜，繼續(xù)處理肌肉和筋膜，把它們用一根粗針和套環(huán)縫法縫合起來。主治醫(yī)生走了。最后，皮膚也做了縫合處理。梅麗莎問我想不想來縫最后兩針。我顫抖著雙手，將針穿過皮下組織。拉緊縫線時，我看到針有微微的彎曲。皮膚被扯到一邊，一團脂肪擠了出來。
Melissa called for the peritoneal stitch, reached her forceps into the wound, and pulled up a transparent layer of tissue between the muscle and the uterus. Suddenly the peritoneum, and the gaping hole in it, was clear. She sewed it closed and moved on to the muscle and fascia, putting them back together with a large needle and a few big looping stitches. The attending left, and finally, the skin was sutured together. Melissa asked me if I wanted to place the last two stitches. My hands shook as I passed the needle through the subcutaneous tissue. As I tightened down the suture, I saw that the needle was slightly bent. The skin had come together lopsided, a glob of fat poking through.

梅麗莎嘆了口氣?！安黄秸彼f，“你弄到皮層了——看到這條薄薄的白色東西沒？”
Melissa sighed. “That’s uneven,” she said. “You have to just catch the dermal layer—you see this thin white stripe?”