雙語·當呼吸化為空氣 原來如此

原來如此。
And there it was.

如果他要完成對我的義務，就需要在“待辦事項”上加上一條：給上司打電話，難為情地暴露自己的錯誤。他又在值夜班。住院醫(yī)生培訓的規(guī)定迫使很多培訓項目都設置了輪班工作制。輪來輪去地，有些人也就變成了“滑輪”，巧妙地利用制度去推卸責任。如果他再拖延幾小時，我就是別人的問題了。
Meeting his obligation to me meant adding one more thing to his todo list: an embarrassing phone call with his boss, revealing his error. He was working the night shift. Residency education regulations had forced most programs to adopt shift work. And along with shift work comes a kind of shiftiness, a subtle undercutting of responsibility. If he could just push it off for a few more hours, I would become somebody else’s problem.

“這藥我一般是凌晨五點吃的，”我說，“我們倆應該都明白，‘等到早上再說’的意思是等到早上查房完再說，也就是說基本上要到下午了，對吧？”
“I usually take it at five a. m.,” I said. “And you know as well as I do that ‘waiting till morning’ means letting someone deal with it after morning rounds, which will be more like the afternoon. Right?”

“好吧，好吧。”他說著走出了病房。
“Okay, fine,” he said, and left the room.

到了早上，我發(fā)現(xiàn)他還是沒開藥。
When morning arrived, I discovered that he had not ordered the medication.

艾瑪打了個電話來問好，說她會解決特羅凱的問題。她祝我早日康復，很抱歉整個星期都不在。僅僅一天的時間，我的病情就開始惡化，腹瀉迅速加重。我一直在輸液防止脫水，但補水速度跟不上脫水速度。我的腎功能開始衰竭。接下來做檢查時，我的血清鈉濃度已經(jīng)快達到致命的地步。我被轉移到重癥監(jiān)護室，因為脫水，我的軟腭和咽頭都有部分壞死，從我嘴里脫落出來。我身體劇痛，意識飄忽不定，一會兒清醒，一會兒糊涂，來了一大堆專家搶救我：重癥護理人員、腎病專科醫(yī)生、腸胃病專科醫(yī)生、內(nèi)分泌醫(yī)生、傳染病專家、神經(jīng)外科醫(yī)生、一般腫瘤科醫(yī)生、胸腔腫瘤科醫(yī)生、耳鼻喉科專家。懷孕三十八周的露西每天都守在我身邊，還偷偷搬進了我原來的值班室，離重癥監(jiān)護室就幾步路的距離，這樣她晚上好隨時來看看我。她和我爸爸也對病情發(fā)表了一些看法。
Emma dropped in to say hello and told me she would sort out the Tarceva order. She wished me a speedy recovery and apologized for the fact that she was heading out of town for a week. Over the course of the day I began to deteriorate, my diarrhea rapidly worsening. I was being rehydrated, but not quickly enough. My kidneys began to fail. My mouth became so dry I could not speak or swallow. At the next lab check, my serum sodium had reached a near-fatal level. I was transferred to the ICU. Part of my soft palate and pharynx died from dehydration and peeled out of my mouth. I was in pain, floating through varying levels of consciousness, while a pantheon of specialists was brought together to help: medical intensivists, nephrologists, gastroenterologists, endocrinologists, infectious disease specialists, neurosurgeons, general oncologists, thoracic oncologists, otolaryngologists. Lucy, thirty-eight weeks pregnant, stayed with me by day and secretly moved into my old call room, steps from the ICU, so she could check on me at night. She and my father also lent their voices.

清醒的時候，我能很清楚地聽到大家嘈雜的聲音，眾說紛紜的意見。這在醫(yī)學上被稱為“WICOS”（Who Is the Captain of the Ship，誰是船長）問題：到底誰掌舵，誰說了算？腎病專家不同意重癥醫(yī)生的意見，重癥醫(yī)生和內(nèi)分泌專家起爭執(zhí)，內(nèi)分泌專家和腫瘤醫(yī)生意見相左，腫瘤醫(yī)生和腸胃病學家爭論不休。我感覺到自己也應該負起責任，所以在偶爾清醒的時候，會把目前病情的一些細節(jié)打出來，并且在露西的幫助下，努力引導所有的醫(yī)生，不要偏離事實，進行準確的解讀。后來，半睡半醒之間，我依稀聽到父親和露西跟每個醫(yī)生團隊討論我的病情。我們覺得目前還是應該以靜脈點滴為主，一直到化療的影響消失。但每個團隊的專家必須去挖掘屬于他們專業(yè)的可能性，多做一些檢查，主張自己贊成的療法。不過有的看上去真的沒有必要，而且很欠考慮。各種采樣檢查都做了，約了很多掃描照片，開了很多藥。我開始搞不清治療的進展，時間概念也模糊起來。我要求他們向我解釋這些治療計劃，但聽著聽著對方的聲音就漸漸變得沉悶飄散，常常是醫(yī)生說著說著，我就眼前一黑，幾乎都聽不全。我萬分盼望艾瑪在場掌控著一切。
During lucid moments, I was acutely aware that with this many voices, cacophony results. In medicine, this is known as the WICOS problem: Who Is the Captain Of the Ship? The nephrologists disagreed with the ICU doctors, who disagreed with the endocrinologists, who disagreed with the oncologists, who disagreed with the gastroenterologists. I felt the responsibility of my care: during bouts of consciousness, I typed out the sequential details of my current illness and, with Lucy’s help, tried to corral all the doctors to keep the facts and interpretations straight. Later, while half asleep, I could dimly hear my father and Lucy discussing my condition with each team of doctors. We suspected that the main plan should just be to treat me with fluids until the effects of the chemotherapy wore off. But each group of specialists had to allow for more esoteric possibilities and advocate tests and treatments for them, some of which seemed unnecessary and ill-advised. Samples were taken, scans were ordered, medications were given; I began losing track of events and time. I requested that these plans be explained to me, but sentences would become slippery, voices would dampen and muffle, and darkness would descend in the midst of doctors’ speeches as I wobbled in and out of coherence. I desperately wished Emma were there, in charge.