雙語(yǔ)·當(dāng)呼吸化為空氣 我居然感覺(jué)好些了

我居然感覺(jué)好些了。
And I felt better.

活檢后一個(gè)星期，護(hù)理師艾麗克西斯打電話給我通報(bào)情況。沒(méi)有可以采取針對(duì)性治療的突變，這樣化療就成了唯一的選擇。已經(jīng)安排好周一開(kāi)始。我問(wèn)具體用什么化療藥物，她說(shuō)這個(gè)問(wèn)題必須跟艾瑪談。艾瑪正和孩子一起在太浩湖玩，不過(guò)周末會(huì)抽空給我個(gè)電話。第二天是星期六，艾瑪?shù)碾娫拋?lái)了。我問(wèn)她對(duì)化療用藥有什么想法。
A week after the biopsy, Alexis, the nurse practitioner, called. There were no new targetable mutations, so chemotherapy was the only option, and it was being set up for Monday. I asked about the specific agents and was told I’d have to talk to Emma. She was en route to Lake Tahoe with her kids, but she’d give me a call over the weekend. The next day, a Saturday, Emma called. I asked her what she thought about chemotherapy agents.

“嗯，”她說(shuō)，“你有什么具體想法嗎？”
“Well,” she said. “Do you have specific thoughts?”

“我覺(jué)得主要問(wèn)題是要不要加阿瓦斯丁吧，”我說(shuō)，“我知道最近有研究說(shuō)這個(gè)藥沒(méi)有好處，副作用還比較嚴(yán)重，有的抗癌中心逐漸棄用了。我覺(jué)得那只是一個(gè)研究而已，之前那么多數(shù)據(jù)都證明是有用的，我比較傾向于還是要用。如果我反應(yīng)不好，再棄用也不遲。你覺(jué)得這樣行嗎？”
“I guess the main question is whether to include Avastin,” I said.“I know the most recent study suggested no benefit and worse side effects, and some cancer centers are turning away from it. In my mind, that’s just one study among a lot of prior data supporting its use, so I’d lean toward including it. We can discontinue it if I have a bad reaction to it. If that seems sensible to you.”

“嗯，沒(méi)什么問(wèn)題。后期加的話還要過(guò)保險(xiǎn)公司那一關(guān)，比較難。所以前期就使用比較好?！?br>“Yeah, that sounds about right. Insurance companies also make it hard to add it later, so that’s another reason to use it up front.”

“謝謝你打電話來(lái)。我就不耽誤你享受湖邊的美景了?！?br>“Thanks for calling. I’ll let you get back to enjoying the lake.”

“好的，但我還要再多說(shuō)一句，”她略有遲疑，“很高興咱們可以一起制訂你的醫(yī)療計(jì)劃，因?yàn)槟闶莻€(gè)醫(yī)生，你什么都懂，而且這也是你自己的命。但是，如果你什么時(shí)候想讓我單獨(dú)來(lái)做你的醫(yī)生了，我也是很樂(lè)意的。”
“Okay. But there’s one thing.” She paused. “I’m totally happy for us to make your medical plan together; obviously, you’re a doctor, you know what you’re talking about, and it’s your life. But if you ever want me to just be the doctor, I’m happy to do that, too.”

我還從來(lái)沒(méi)想過(guò)，可以不負(fù)責(zé)自己的醫(yī)療計(jì)劃。我還理所當(dāng)然地以為所有的病人都是久病成醫(yī)。我還記得醫(yī)學(xué)生時(shí)期的我，剛剛開(kāi)始進(jìn)入醫(yī)學(xué)實(shí)踐，對(duì)什么都懵懂無(wú)知，經(jīng)常會(huì)讓病人解釋他們自己的病癥和治療手段，問(wèn)他們?yōu)槭裁闯霈F(xiàn)藍(lán)色腳趾的癥狀，這個(gè)粉色的藥片是干什么的。但正式成為醫(yī)生之后，我從未要求病人自己做決定，我對(duì)他們有責(zé)任。我意識(shí)到，自己現(xiàn)在也在做同樣的事，心中那個(gè)作為醫(yī)生的自我在對(duì)那個(gè)作為病人的自我負(fù)責(zé)。也許我真的被哪個(gè)希臘的天神詛咒了，但放棄對(duì)自己病情的控制仿佛是完全不可能的事，就算可能，那也太不負(fù)責(zé)任了。
I hadn’t ever considered that I could release myself from the responsibility of my own medical care. I’d just assumed all patients became experts at their own diseases. I remembered how, as a green medical student, knowing nothing, I would often end up asking patients to explain their diseases and treatments to me, their blue toes and pink pills. But as a doctor, I never expected patients to make decisions alone; I bore responsibility for the patient. And I realized I was trying to do the same thing now, my doctor-self remaining responsible for my patient-self. Maybe I’d been cursed by a Greek god, but abdicating control seemed irresponsible, if not impossible.

化療開(kāi)始的周一，露西、我母親和我一起去了輸液中心。我安好一個(gè)靜脈注射的針頭，找了把舒服的椅子坐好，開(kāi)始了漫長(zhǎng)的等待?；煹幕旌纤幬镄枰膫€(gè)半小時(shí)才能全部輸完。整個(gè)過(guò)程中，我要么打盹，要么讀書，有時(shí)候又百無(wú)聊賴地看著身邊的露西和媽媽，偶爾聊兩句，打破沉默。病房里的其他病人健康和精神狀況各不相同：有的頭發(fā)已經(jīng)禿了，有的發(fā)型還很不錯(cuò)，有的形容憔悴，有的活潑爽朗，有的不修邊幅，有的衣冠楚楚。不過(guò)所有人都靜靜地躺著，任憑注射管里那些毒副作用劇烈的藥物慢慢輸入伸展的手臂。我每三周來(lái)接受一次治療。
Chemotherapy began on Monday. Lucy, my mother, and I went to the infusion center together. I had an IV placed, settled into an easy chair, and waited. The drug cocktail would take four and a half hours to infuse. I passed the time napping, reading, and sometimes blankly staring, with Lucy and my mother next to me, interrupting the silence with occasional small talk. The other occupants of the room were in various states of health—some bald, some well-coiffed, some withered, some sprightly, some disheveled, some dapper. All lay still, silent, with IV tubing dripping poison into outstretched arms. I was to return every three weeks for treatment.

第二天我就有反應(yīng)了。非常強(qiáng)烈的疲乏感，深入骨髓，全身無(wú)力。本來(lái)特別能喚起愉悅感的進(jìn)食，對(duì)我來(lái)說(shuō)就像喝海水一樣折磨。突然間，所有我喜歡的東西都變咸了。露西給我做了貝果面包加奶油奶酪做早餐，吃起來(lái)就像鹽堿地里那種經(jīng)常被動(dòng)物舔舐的鹽塊。我只吃了兩口就放到一邊。看書也讓我筋疲力盡。本來(lái)答應(yīng)了要為兩本重要的神經(jīng)外科教科書寫個(gè)幾章，闡述我和V的研究是否有臨床治療的潛力，現(xiàn)在也被擱置了。一整天，我都只能靠看電視和強(qiáng)制進(jìn)食來(lái)打發(fā)時(shí)光。幾周以后，逐漸形成了一種模式：不舒服的感覺(jué)會(huì)慢慢減輕，等恢復(fù)常態(tài)的時(shí)候，恰好又到下次治療的時(shí)間了。
I began to feel the effects the next day, a deep fatigue, a profound bone-weariness setting in. Eating, normally a source of great pleasure, was like drinking seawater. Suddenly, all of my joys were salted. For breakfast, Lucy made me a bagel with cream cheese; it tasted like a salt lick. I set it aside. Reading was exhausting. I had agreed to write a few chapters on the therapeutic potential of my research with V for two major neurosurgical text-books. That, too, I set aside. The days passed, television and forced feedings marking the time. A pattern developed over the weeks: the malaise would slowly ease, normalcy returning just in time for the next treatment.

就這么循環(huán)往復(fù)著。我因?yàn)橐恍┹p微的并發(fā)癥在醫(yī)院進(jìn)進(jìn)出出，也就排除了任何重返工作崗位的可能。神經(jīng)外科認(rèn)為我無(wú)論從國(guó)家標(biāo)準(zhǔn)還是地方標(biāo)準(zhǔn)來(lái)說(shuō)，都已經(jīng)符合畢業(yè)的條件。畢業(yè)典禮安排在一個(gè)周六，露西預(yù)產(chǎn)期的前兩周左右。
The cycles continued; I shuffled in and out of the hospital with minor complications, which were just enough to preclude any return to work. The neurosurgery department determined that I had met all national and local criteria for graduation; the ceremony was scheduled for a Saturday, about two weeks before Lucy’s due date.

那一天來(lái)了。我站在臥室里，為畢業(yè)典禮穿衣打扮，這畢竟是七年住院醫(yī)生生涯的高潮。但突然之間，強(qiáng)烈的惡心感氣勢(shì)洶洶地襲來(lái)。感覺(jué)不像化療引起的通常的惡心。那種惡心一般像潮水一樣涌來(lái)，也像潮水一樣迅速退卻。我開(kāi)始不斷嘔吐出綠色的膽汁，那種粉筆一樣的味道和胃酸大不相同。這是內(nèi)臟深處涌上來(lái)的。
The day arrived. As I stood in our bedroom, dressing for graduation—the culmination of seven years of residency—a piercing nausea struck me. This was unlike the usual nausea of chemotherapy, which washed over you like a wave and, like a wave, could be ridden. I began uncontrollably vomiting green bile, its chalky taste distinct from stomach acid. This was from deep in my gut.