雙語·當呼吸化為空氣 住院醫(yī)生生涯第六年

住院醫(yī)生生涯第六年，我又變成全職醫(yī)生，只在休息日和閑暇時候才去V的實驗室做研究，而這樣的日子屈指可數(shù)。大多數(shù)人，甚至包括你最親密的同事，都不太能理解神經(jīng)外科住院醫(yī)生是個怎么樣的“黑洞”。我最喜歡的一名護士，有一天一直加班到晚上十點，協(xié)助我們完成了一臺難度很大、時間很長的手術(shù)。她對我說：“謝天謝地，我明天休息，你也是嗎？”
In my sixth year, I returned to the hospital full-time, my research in V’s lab now relegated to days off and idle moments, such as they were. Most people, even your closest colleagues, don’t quite understand the black hole that is neurosurgical residency. One of my favorite nurses, after sticking around until ten p. m. one night to help us finish a long and difficult case, said to me, “Thank God I have tomorrow off. Do you, too?”

“不是啊。”
“Um, no.”

“但是至少你可以晚點來上班什么的，對吧？你一般什么時候到？”
“But at least you can come in later or something, right? When do you usually get in?”

“早上六點?！?br>“Six a. m.”

“不可能，真的嗎？”
“No. Really?”

“真的啊。”
“Yep.”

“每天都是？”
“Every day?”

“每天都是?！?br>“Every day.”

“周末也是？”
“Weekends, too?”

“你別問了?！?br>“Don’t ask.”

住院醫(yī)中流傳著一句話：日子很長，但年歲很短。神經(jīng)外科住院醫(yī)生的一天，一般從早上六點開始，一直持續(xù)到手術(shù)結(jié)束。具體何時結(jié)束，則部分取決于你在手術(shù)室的手腳麻利程度。
In residency, there’s a saying: The days are long, but the years are short. In neurosurgical residency, the day usually began at six a. m. and lasted until the operating was done, which depended, in part, on how quick you were in the OR.

住院醫(yī)生的手術(shù)技能高低，要從技巧和速度兩個方面來判斷。你不能粗枝大葉，也不能慢吞吞。從你第一次縫合傷口開始，要是花太多時間去死磕精確，助理們就會在一邊諷刺：“哎喲喂，我們遇到個整形外科的！”或者：“你的策略我明白：等你把傷口的前一半縫完，后一半自己就愈合了！事半功倍——實在是高！”住院總醫(yī)生會對新手建議：“現(xiàn)在就要鍛煉速度，技巧可以后面再培養(yǎng)。”手術(shù)室里，大家的眼睛總是盯著鐘表。這是為了病人：他被麻醉多久了？長時間的手術(shù)中，神經(jīng)可能被破壞，肌肉可能會崩潰，腎臟可能會衰竭。也是為了所有人：我們今晚到底什么時候能出手術(shù)室？
A resident’s surgical skill is judged by his technique and his speed. You can’t be sloppy, and you can’t be slow. From your first wound closure onward, spend too much time being precise and the scrub tech will announce, “Looks like we’ve got a plastic surgeon on our hands!” Or:“I get your strategy: by the time you finish sewing the top half of the wound, the bottom will have healed on its own! Half the work—very smart!” A chief resident will advise a junior, “Learn to be fast now. You can learn to be good later.” In the OR, everyone’s eyes are always on the clock. For the patient’s sake: How long has he been under anesthesia? During long procedures, nerves can get damaged, muscles can break down, kidneys can fail. For everyone else’s sake: What time are we getting out of here tonight?

我發(fā)現(xiàn)有兩種節(jié)省時間的策略，可能最好的類比就是“龜兔賽跑”。兔子要多快有多快，手如疾風，器械哐啷作響，掉到地上；劃開皮膚的時候，就像“唰”一下打開窗簾，骨粉還未塵埃落定，顱骨瓣就已經(jīng)放在托盤上了。結(jié)果就是，切口可能這兒那兒的多個一厘米，因為位置找得不是特別準確。而烏龜呢，正相反，小心謹慎，步步為營，沒有多余的動作，反復(fù)測量后來個“一刀準”。不需要反思或重復(fù)任何手術(shù)動作，一切都細致精準，井井有條。要是兔子的小錯誤太多，一直要調(diào)整補救，那么烏龜獲勝。如果烏龜花太多時間去計劃每一個步驟，那么兔子獲勝。手術(shù)室里的時間很有趣，不管你是發(fā)瘋般向前沖，還是穩(wěn)扎穩(wěn)打不緊不慢，都感覺不到時間的流逝。海德格爾曾說過：無聊，就是感受到時間的流逝。那么，手術(shù)的感覺是完全相反的：全神貫注的工作讓時鐘的指針失去了意義，隨便怎么走都行。兩個小時也可能就像短短的一分鐘。等最后一針縫完，給傷口上了藥，正常的時間突然又開始了。你耳邊幾乎會聽到飛快的“嗖嗖”聲。然后你就開始想：病人什么時候醒過來？下個病人什么時候推進來？我今晚什么時候能回家？
I could see that there were two strategies to cutting the time short, perhaps best exemplified by the tortoise and the hare. The hare moves as fast as possible, hands a blur, instruments clattering, falling to the floor; the skin slips open like a curtain, the skull flap is on the tray before the bone dust settles. As a result, the opening might need to be expanded a centimeter here or there because it’s not optimally placed. The tortoise, on the other hand, proceeds deliberately, with no wasted movements, measuring twice, cutting once. No step of the operation needs revisiting; everything moves in a precise, orderly fashion. If the hare makes too many minor missteps and has to keep adjusting, the tortoise wins. If the tortoise spends too much time planning each step, the hare wins. The funny thing about time in the OR, whether you race frenetically or proceed steadily, is that you have no sense of it passing. If boredom is, as Heidegger argued, the awareness of time passing, then surgery felt like the opposite: the intense focus made the arms of the clock seem arbitrarily placed. Two hours could feel like a minute. Once the final stitch was placed and the wound was dressed, normal time suddenly restarted. You could almost hear an audible whoosh. Then you started wondering: How long until the patient wakes up? How long until the next case is rolled in? And what time will I get home tonight?

一直要到最后一臺手術(shù)做完，我才會感覺到一天的漫長和自己沉重疲乏的腳步。離開醫(yī)院之前還有幾項行政任務(wù)，真像鐵砧在敲打我疲憊的神經(jīng)。
It wasn’t until the last case finished that I felt the length of the day, the drag in my step. Those last few administrative tasks before leaving the hospital were like anvils.

不能等到明天嗎？
Could it wait until tomorrow?

不能。
No.

一聲長嘆。地球自轉(zhuǎn)不停，太陽又要升起了。
A sigh, and Earth continued to rotate back toward the sun.