雙語·當(dāng)呼吸化為空氣 我做了住院總醫(yī)生

我做了住院總醫(yī)生，幾乎所有的責(zé)任都落在肩上，成功的機(jī)會比過去更多，失敗的可能也大得空前。失敗的痛苦讓我明白，專業(yè)技術(shù)上的出類拔萃，其實(shí)是道德要求。光有一顆善心是不夠的，關(guān)鍵還是要靠技術(shù)。有時候一兩毫米的差距，可能就是悲劇與勝利的分水嶺。
As a chief resident, nearly all responsibility fell on my shoulders, and the opportunities to succeed—or fail— were greater than ever. The pain of failure had led me to understand that technical excellence was a moral requirement. Good intentions were not enough, not when so much depended on my skills, when the difference between tragedy and triumph was defined by one or two millimeters.

有一天，馬修再次入院了。這個得了腦瘤的小男孩，幾年前住院的時候真是人見人愛。當(dāng)時，他的下丘腦在腫瘤切割手術(shù)的過程中受到了微微的損傷。當(dāng)時那個俏皮可愛的八歲男孩，現(xiàn)在變成了一個十二歲的怪獸。他一刻不停地暴飲暴食，常常充滿暴力地拳打腳踢。他母親的手臂上全是青紫的抓痕。最后馬修被送進(jìn)了專門的機(jī)構(gòu)，就因?yàn)槟且缓撩椎膿p傷，他變成了一個魔鬼。每次手術(shù)都是家人和醫(yī)生共同做的決定，認(rèn)為利大于弊，才會進(jìn)行。但這樣的事情仍然令人心碎。沒人愿意去想，當(dāng)馬修二十歲的時候，體重高達(dá)三百磅，會是什么樣子。
One day, Matthew, the little boy with the brain tumor who had charmed the ward a few years back, was re-admitted. His hypothalamus had, in fact, been slightly damaged during the operation to remove his tumor; the adorable eight-year-old was now a twelve-year-old monster. He never stopped eating; he threw violent fits. His mother’s arms were scarred with purple scratches. Eventually Matthew was institutionalized: he had become a demon, summoned by one millimeter of damage. For every surgery, a family and a surgeon decide together that the benefits outweigh the risks, but this was still heart-breaking. No one wanted to think about what Matthew would be like as a three-hundred-pound twenty-year-old.

有一天，我把一條九厘米長的電極放進(jìn)病人腦中，治療帕金森綜合征引起的震顫。目標(biāo)是丘腦底核，躺在腦中的一個杏仁形狀的小東西，不同的部分支持著不同的功能：動作、認(rèn)知和情感。手術(shù)室里，我們打開電流對震顫進(jìn)行評估。我們?nèi)级⒅∪说淖笫?，一致認(rèn)為震顫的情況要好一些了。
Another day, I placed an electrode nine centimeters deep in a patient’s brain to treat Parkinson’s tremor. The target was the subthalamic nucleus, a tiny almond-shaped structure deep in the brain. Different parts of it subserve different functions: movement, cognition, emotion. In the operating room, we turned on the current to assess the tremor. With all our eyes on the patient’s left hand, we agreed the tremor looked better.

接著，病人困惑地開了口，蓋過我們紛紛表示肯定的低語：“我感覺……特別悲傷?！?br>Then the patient’s voice, confused, rose above our affirmative murmurs: “I feel. . . overwhelmingly sad.”

“關(guān)電流！”我說。
“Current off !” I said.

“哦，現(xiàn)在沒感覺了?！辈∪苏f。
“Oh, now the feeling is going away,” the patient said.

“那我們再試一下電流和阻抗，好嗎？好，打開電流……”
“Let’s recheck the current and impedance, okay? Okay. Current on. . .”

“不，一切都……就是覺得……好悲傷，又黑暗，又……悲傷。”
“No, everything. . . it just feels. . . so sad. Just dark and, and. . . sad.”

“把電極拿出來！”
“Electrode out!”

我們抽出電極，重新插進(jìn)去，這次往右邊移動了兩毫米。震顫消失了。謝天謝地，病人感覺也不錯。
We pulled the electrode out and reinserted it, this time two millimeters to the right. The tremor went away. The patient felt, thankfully, fine.

一天深夜，我和神經(jīng)外科一個主治醫(yī)生一起動手術(shù)，糾正腦干畸形的枕骨下顱骨切除術(shù)。這是最要求優(yōu)雅精確的手術(shù)，這個部位大概是全身最難動手術(shù)的部位。要到達(dá)那里就很需要技巧了，不管你經(jīng)驗(yàn)多么豐富。但那天晚上，我覺得無比流暢，那些器械就像我手指的延伸：皮膚、肌肉和骨頭似乎都是自己打開的，然后眼前就出現(xiàn)了那黃黃的、閃著亮光的、凸起的小東西，藏在腦干深處的包塊。
Once, I was doing a late-night case with one of the neurosurgery attendings, a suboccipital craniectomy for a brain-stem malformation. It’s one of the most elegant surgeries, in perhaps the most difficult part of the body— just getting there is tricky, no matter how experienced you are. But that night, I felt fluid: the instruments were like extensions of my fingers; the skin, muscle, and bone seemed to unzip themselves; and there I was, staring at a yellow, glistening bulge, a mass deep in the brain stem. Suddenly, the attending stopped me.

突然，主治醫(yī)生叫我停下。
“Paul, what happens if you cut two millimeters deeper right here?”

“保羅，要是你再往深處多切兩毫米，會有什么后果？”他指了指相應(yīng)的部位。
He pointed.

我腦中掠過一幅幅神經(jīng)解剖學(xué)的幻燈片。
Neuroanatomy slides whirred through my head.

“復(fù)視？”
“Double vision?”

“不是，”他說，“閉鎖綜合征?！比绻叶嗲辛诉@兩毫米，病人就會全身癱瘓，只剩下眼睛可以眨一眨。主治醫(yī)生的眼睛沒離開顯微鏡?！拔抑灾?，是因?yàn)槲业谌巫鲞@個手術(shù)的時候，就發(fā)生了這個情況?！?br>“No,” he said. “Locked-in syndrome.” Another two millimeters, and the patient would be completely paralyzed, save for the ability to blink. He didn’t look up from the microscope. “And I know this because the third time I did this operation, that’s exactly what happened.”