雙語·當(dāng)呼吸化為空氣 我還是去不成畢業(yè)典禮了

說到底，我還是去不成畢業(yè)典禮了。
I would not be going to graduation, after all.

我需要馬上靜脈注射，防止脫水。于是露西開車帶我去了急救中心，開始復(fù)水過程。嘔吐變成了腹瀉。急救處的住院醫(yī)生布蘭德和我友好地交流了一會(huì)兒，我詳細(xì)敘述了自己的醫(yī)療史，歷數(shù)了所有的用藥。最后我們討論了分子療法取得的進(jìn)步，特別是我在用的特羅凱這種藥。眼前的醫(yī)療計(jì)劃很簡(jiǎn)單：一直用靜脈注射的方式保持我不脫水，直到我狀態(tài)恢復(fù)，可以正常用嘴喝水。那天晚上，我住進(jìn)了醫(yī)院病房。但護(hù)士在看我的用藥單時(shí)，我注意到上面沒有特羅凱。我請(qǐng)她打電話給住院醫(yī)生，改正這個(gè)疏忽。這種事也是常有的。畢竟我同時(shí)在吃十幾種藥呢。隨時(shí)隨地滴水不漏是很難的。
I needed IV fluids to avoid dehydration, so Lucy drove me to the emergency department and rehydration began. The vomiting gave way to diarrhea. The medical resident, Brad, and I chatted amicably, and I relayed my medical history, covering all my medications, and we ended up discussing advances in molecular therapies, especially the drug I was taking, Tarceva. The medical plan was simple: keep me hydrated with intravenous fluids until I could drink enough by mouth. That evening, I was admitted to a hospital room. But when the nurse reviewed my medication list, I noticed Tarceva was not on it. I asked her to call the resident to correct the oversight. These things happen. I was taking a dozen medications, after all. Keeping track was not easy.

午夜過去很久，布蘭德出現(xiàn)了。
It was well past midnight when Brad appeared.

“聽說你對(duì)自己用的藥有疑問？”他問道。
“I heard you had a question about your medications?” he asked.

“是啊，”我說，“沒有開特羅凱。你補(bǔ)開一下，不介意吧？”
“Yeah,” I said. “Tarceva wasn’t ordered. Do you mind ordering it?”

“我決定不讓你再服特羅凱了。”
“I decided to take you off it.”

“為什么?。俊?br>“Why is that?”

“你的肝酶太高，不能再吃了?！?br>“Your liver enzymes are too high to take it.”

我有點(diǎn)摸不著頭腦。我的肝酶已經(jīng)高了好幾個(gè)月了。如果這是個(gè)問題，之前為什么沒討論過呢？不管怎么說，這肯定是搞錯(cuò)了?！鞍敚褪俏业哪[瘤醫(yī)生，你的上司，也看過這些指標(biāo)了。她想讓我繼續(xù)吃?！?br>I was confused. My liver enzymes had been high for months; if this was an issue, why hadn’t we discussed it before? In any case, this was clearly a mistake. “Emma—my oncologist, your boss—has seen these numbers, and she wants to keep me on it.”

如果例行公事，住院醫(yī)生做出治療決策都是不用主治醫(yī)生從旁指導(dǎo)的。不過現(xiàn)在我向他轉(zhuǎn)述了艾瑪?shù)囊庖?，他肯定?huì)讓步吧。
Residents routinely have to make medical decisions without the attending’s input. But now that he had Emma’s opinion, surely he would capitulate.

“但這個(gè)可能就是你胃腸道問題的原因。”
“But it might be causing your GI problems.”

我更摸不著頭腦了。一般來說，轉(zhuǎn)述了主治醫(yī)生的命令，就不會(huì)再討論下去了?！拔乙呀?jīng)吃了一年了，沒有任何問題，”我說，“你覺得現(xiàn)在的問題是特羅凱突然引起的，不是化療？”
My confusion deepened. Usually invoking the attending’s orders ends the discussion. “I’ve been taking it for a year without any problems,”I said. “You think Tarceva is causing this all of a sudden, and not the chemotherapy?”

“有可能?！?br>“Maybe, yeah.”

我的困惑升級(jí)成了憤怒。這孩子，才從醫(yī)學(xué)院畢業(yè)兩年，和我的助理住院醫(yī)生一般年紀(jì)，居然跟我叫板？嗯，如果他是對(duì)的，那就另當(dāng)別論，但他現(xiàn)在說的這些毫無道理啊。“呃，今天下午我是不是提過，不吃那個(gè)藥的話，我的骨轉(zhuǎn)移癌就會(huì)很活躍，引起劇痛？我不是想小題大做，以前練拳擊的時(shí)候我也骨折過，但現(xiàn)在痛得比那時(shí)候厲害多了。從一到十打分的話，現(xiàn)在是十分痛。我很有可能很快就會(huì)痛得忍不住尖叫起來?！?br>Confusion yielded to anger. Some kid two years out of med school, no older than my junior residents, was really arguing with me? It’d be one thing if he were right, but he wasn’t making any sense. “Um, didn’t I mention this afternoon that without that pill, my bone metastases become active and produce excruciating pain? I don’t mean to sound dramatic, but I’ve broken bones boxing, and this is far more painful. As in, ten-out-of-ten pain. As in, I-Will-Actually-Soon-Be-Screaming pain.”

“嗯，考慮到這個(gè)藥的半衰期，估計(jì)還要等個(gè)一天左右才會(huì)出現(xiàn)這種情況。”
“Well, given the half-life of the drug, that probably won’t happen for a day or so.”

看得出來，在布蘭德眼里，我不是個(gè)病人，是個(gè)“問題”：需要盡快解決，在任務(wù)欄前面的方框里畫個(gè)勾。
I could see that in Brad’s eyes I was not a patient, I was a problem: a box to be checked off.

“聽我說，”他繼續(xù)道，“如果你不是你，這場(chǎng)對(duì)話根本就不可能發(fā)生。我會(huì)直接給你停藥，然后讓你自己來證明，病癥都是這個(gè)藥造成的。”
“Look,” he continued, “if you weren’t you, we wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.”

怎么回事？下午我們不是相談甚歡的嗎？我回想起醫(yī)學(xué)院時(shí)期遇到的一個(gè)病人，她說自己去醫(yī)生那兒看病，都會(huì)穿最貴的襪子。這樣等她換上病號(hào)服，不穿鞋的時(shí)候，醫(yī)生也能看到她的襪子，知道她是個(gè)體面人，會(huì)以很尊重的態(tài)度來對(duì)待她。（啊，原來問題在這里——我穿的是醫(yī)院發(fā)的襪子，這么多年了一直占著這個(gè)小便宜?。?br>What had happened to our amicable chat this afternoon? I thought back to med school, when a patient had told me that she always wore her most expensive socks to the doctor’s office, so that when she was in a patient’s gown and shoeless, the doctor would see the socks and know she was a person of substance, to be treated with respect. (Ah, there’s the problem—I was wearing hospital-issue socks, which I had been stealing for years!)

“不管怎么說，特羅凱是特殊的藥，需要專科訓(xùn)練醫(yī)生或者主治醫(yī)生的意見。你真的想讓我大半夜的為這事叫醒別人嗎？不能等到早上再說？”
“Anyway, Tarceva is a special drug, and it requires a fellow or attending to sign off on it. Do you really want me to wake someone up for this? Can’t it wait till morning?”