雙語·當(dāng)呼吸化為空氣 第二天一早我就要出院了

夕陽西下。第二天一早我就要出院了。我和腫瘤醫(yī)生約在那周晚些時候見面，但護(hù)士告訴我，我的腫瘤醫(yī)生晚上下班去接孩子之前，會來看看我。她叫艾瑪·海沃德，想在正式治療開始之前先打個招呼。我和艾瑪算是認(rèn)識，之前接過她的一些病人。但除了偶爾因為工作上的事情接洽一下之外，沒有過其他接觸。我的父母兄弟們也在病房里，各自待著，沒說什么。而露西一直坐在床邊，握著我的手。門開了，艾瑪走了進(jìn)來，她那身白大褂一看就知道穿了一整天，而且是很漫長的一天。但她的笑容很精神、很明朗。跟在她后面的是她的同事和一位高級?？谱≡簩嵙?xí)醫(yī)生。艾瑪只比我年長幾歲，深色的長發(fā)，不過有點(diǎn)灰白的跡象。反正和死神打交道的人，幾乎都有過早白頭的狀況。她拉了把椅子坐下。
The sun was setting. I would be discharged the next morning. An oncology appointment was set for later in the week, but the nurse told me my oncologist was going to drop by that night, before leaving to pick up her kids. Her name was Emma Hayward, and she wanted to say hello before the initial office visit. I knew Emma a little—I had treated some of her patients before—but we had never spoken beyond passing professional courtesies. My parents and brothers were scattered about the room, not saying much, while Lucy sat by the bed, holding my hand. The door opened and in she walked, her white coat showing the wear of a long day but her smile fresh. Trailing behind her were her fellow and a resident. Emma was only a few years older than I, her hair long and dark, but as is common to all those who spend time with death, streaked with gray. She pulled up a chair.

“你好，我叫艾瑪，”她說，“今天只能待一會兒，很抱歉。但我還是想過來，做個自我介紹。”
“Hi, my name is Emma,” she said. “I’m sorry to have to be so brief today, but I wanted to come by and introduce myself.”

我們握手。我的胳膊和輸液管糾纏在一起。
We shook hands, my arm entangled in the IV line.

“謝謝你過來，”我說，“我知道你要去接孩子。這些是我的家人。”她向露西點(diǎn)頭致意，接著又向我爸媽和兄弟們問好。
“Thanks for stopping by,” I said. “I know you have kids to pick up. This is my family.” She nodded hello at Lucy, at my brothers and parents.

“很遺憾，你遇到這種事情，”她說，“很遺憾你們遇到這種事情。過幾天我們再長談。我已經(jīng)讓那邊開始檢測你的腫瘤切片了，這樣治療也好有個方向?？赡苡没煟部赡懿挥?，要看檢測結(jié)果了?！?br>“I’m sorry this is happening to you,” she said. “To all of you. There will be a lot of time to talk in a couple days. I went ahead and had the lab start running some tests on your tumor sample, which will help guide therapy. Treatment may be chemotherapy or not, depending on the tests.”

十八個月前，我因為闌尾炎住院。那時候大家都不把我當(dāng)病人看，我還是他們的同事，甚至是我自己的醫(yī)療顧問。我覺得現(xiàn)在也應(yīng)該一樣。“我知道現(xiàn)在不是時候，”我開口了，“但過幾天想跟你談?wù)効ㄆ仗m-邁耶生存曲線。”
Eighteen months earlier, I’d been in the hospital with appendicitis. Then I’d been treated not as a patient but as a colleague, almost like a consultant on my own case. I expected the same here. “I know now’s not the time,” I proceeded, “but I will want to talk about the Kaplan-Meier survival curves.”

“不行，”她說，“絕對不行。”
“No,” she said. “Absolutely not.”

短暫的沉默。她怎么敢這么說話？我心想。在我這樣的醫(yī)生眼里，這種預(yù)測是很有必要的，我有權(quán)利知道啊。
A brief silence. How dare she? I thought. This is how doctors—doctors like me—understand prognostication. I have a right to know.

“我們后面再談治療方案，”她說，“還可以討論一下你回來工作的可能性，如果你愿意的話。傳統(tǒng)的化療方法是用順鉑、培美曲塞，可能還要加阿瓦斯丁，但是引起周圍神經(jīng)病變的概率很高。所以我們可能會把順鉑換成卡鉑，可以更好地保護(hù)你的神經(jīng)，因為你是個外科醫(yī)生。”
“We can talk about therapies later,” she said. “We can talk about your going back to work, too, if that’s what you’d like to do. The traditional chemotherapy combination—cisplatin, pemetrexed, possibly with Avastin, too—has a high rate of peripheral neuropathy, so we’d probably switch the cisplatin for carboplatin, which will protect your nerves better, since you’re a surgeon.”

回來工作？她在扯些什么啊？她是出現(xiàn)幻覺了，還是說我對自己的診斷大錯特錯了？還有，要是不對我的生存周期做個實際的估計，這些都怎么談??？過去幾天那種天旋地轉(zhuǎn)的眩暈感又席卷而來。
Go back to work? What is she talking about? Is she delusional? Or am I dead wrong about my prognosis? And how can we talk about any of this without a realistic estimate of survival? The ground, having already buckled and roiled over the past few days, did so again.

“細(xì)節(jié)我們后面再說吧，”她繼續(xù)道，“我知道，眼前這些就夠你消化的了。我現(xiàn)在來主要是想在周四之前先見見你們大家。那么今天，除了生存曲線之外，還有什么需要我?guī)兔Φ膯?？還有什么問題嗎？”
“We can do details later,” she continued, “as I know this is a lot to absorb. Mostly, I just wanted to meet you all before our appointment Thursday. Is there anything I can do, or answer—besides survival curves—today?”

“沒有了。”我還暈著呢，“謝謝你過來。真的很感謝。”
“No,” I said, my mind reeling. “Thanks so much for stopping by. I really appreciate it.”

“這是我的名片，”她說，“還有診室的電話。我們下次見面之前這兩天，要是遇到什么事，盡管打電話好了?！?br>“Here’s my card,” she said, “and there’s the clinic number. Feel free to call if anything comes up before we see you in two days.”

我的親朋好友很快尋遍了各自在醫(yī)療行業(yè)的人脈，看誰是美國最好的肺癌醫(yī)生。休斯敦和紐約有比較大的腫瘤中心，我是不是應(yīng)該去那樣的地方接受治療？至于怎么搬過去，或者暫時轉(zhuǎn)院之類的具體操作問題，就到時候再說了。結(jié)果大家很快得到答案：艾瑪是全國頂尖、世界知名的腫瘤醫(yī)生，在一個國家級的癌癥咨詢委員會做肺癌方面的專家；不僅如此，她還是個很會理解病人的好醫(yī)生，知道何時進(jìn)，何時退。我略略想了想冥冥中的一系列事件：我滿世界飄游，然后電腦隨機(jī)地進(jìn)行一通匹配，我就到這里做了住院醫(yī)生，最后被診斷出絕癥，又被分配到一個最好的醫(yī)生手里。
My family and friends quickly wired through our network of medical colleagues to find out who the best lung cancer oncologists in the country were. Houston and New York had major cancer centers; was that where I should be treated? The logistics of moving or temporarily relocating or what have you—that could be sorted out later. The replies came back quickly, and more or less unanimously: Emma not only was one of the best— a world-renowned oncologist who served as the lung cancer expert on one of the major national cancer advisory boards—but she was also known to be compassionate, someone who knew when to push and when to hold back. I briefly wondered at the string of events that had sent me looping through the world, my residency determined by a computerized match process, only to end up assigned here, with a freak diagnosis, in the hands of one of the finest doctors to treat it.