双语·当呼吸化为空气 住院医生生涯第四年

住院医生生涯第四年，我开始在斯坦福一个实验室工作。这个实验室主要致力于基础运动神经学和神经假体技术的研发，后者能够让瘫痪的人用思维控制电脑光标或机器手臂。实验室的领导，电气工程和神经生物学的教授，也是第二代印度移民，我的同胞，大家都亲切地称他为“V”。V比我年长七岁，但我俩就像手足兄弟。他的实验室在读取大脑信号方面早已经取得世界上首屈一指的领先地位，但在他的悉心指导下，我另辟蹊径。我开始了一个相反的项目：将信号写入大脑。毕竟，要是你的机器臂无法感知握住酒杯的力度，那你会打碎很多很多的酒杯。不过，把信号写入大脑（也称“神经调控”），当然远远不止拿酒杯那么简单。如果能够控制神经放电，那么可以想见，目前很多神经学和精神科上的不治之症或棘手顽疾都能找到治愈的办法，从重度抑郁，到亨廷顿舞蹈症，到精神分裂，到妥瑞氏综合征，到强迫症……实在是有无限的可能。我先把手术放到一边，开始学习应用基因疗法的新科技，做了一系列“首开先河”的试验。
In my fourth year, I began work in a Stanford lab dedicated to basic motor neuroscience and the development of neural prosthetic technology that would allow, say, paralyzed people to mentally control a computer cursor or robot arm. The head of the lab, a professor of electrical engineering and neurobiology, a fellow second-generation Indian, was affectionately called “V” by everyone. V was seven years older than I, but we got on like brothers. His lab had become a world leader in reading out brain signals, but under V’s mentorship, I embarked on. I began a project to do the reverse: to write signals into the brain. After all, if your robot arm can’t feel how hard it’s grasping a wineglass, you will break a lot of wineglasses. The implications of writing signals into the brain, or “neuromodulation,” however, were far more wide-reaching than that: being able to control neural firing would conceivably allow treatment of a host of currently untreatable or intractable neurological and psychiatric diseases, from major depression to Huntington’s to schizophrenia to Tourette’s to OCD. . . the possibilities were limitless. Putting surgery aside now, I set to work learning to apply new techniques in gene therapy in a series of “first of its kind” experiments.

在实验室待了一年，V和我坐下来进行每周的例会。我逐渐喜欢上了这样的交谈。V和我认识的其他科学家不一样，说起话来柔声细语，对人们有着深深的关爱，对临床医学也有着很深的使命感。他常常向我坦白，说希望自己也能做个外科医生。我逐渐了解到，科学，实在是最充满政治性、竞争最激烈、最你死我活的行业，处处布满了走捷径的诱惑。
After I’d been there for a year, V and I sat down for one of our weekly meetings. I had grown to love these chats. V was not like other scientists I knew. He was soft-spoken and cared deeply about people and the clinical mission, and he often confessed to me that he wished he’d been a surgeon himself. Science, I had come to learn, is as political, competitive, and fierce a career as you can find, full of the temptation to find easy paths.

而V是非常值得信任的，他总会选择脚踏实地地向前（而且常常很自谦）。大多数科学家都争先恐后地在最负盛名的期刊上发表文章，以求扬名科学界。而V则坚持认为，我们唯一的职责，就是要坚定地维护科学的真实性，决不妥协。我从来没遇到过这么成功却又这么坚持善良美好人性的人。V实在是个不折不扣的完美楷模。
One could count on V to always choose the honest (and, often, selfeffacing) way forward. While most scientists connived to publish in the most prestigious journals and get their names out there, V maintained that our only obligation was to be authentic to the scientific story and to tell it uncompromisingly. I’d never met someone so successful who was also so committed to goodness. V was an actual paragon.

我面对他坐下，看见他脸上没有笑容，只有痛苦。他叹了口气，说：“我需要你马上变回一个外科医生。”
Instead of smiling as I sat down across from him, he looked pained. He sighed and said, “I need you to wear your doctor hat right now.”

“好吧。”
“Okay.”

“他们说我得了胰腺癌。”
“They tell me I have pancreatic cancer.”

“V……好吧，跟我详细说说。”
“V. . . okay. Tell me the story.”

他诉说了体重逐渐下降、消化不良，和最近的“预防性”CT检查。在这个阶段照CT实在太不符合标准流程了。结果发现胰脏有包块。我们讨论了接下来要怎么办，不久的将来要面对可怕的“惠普尔”手术（我告诉他“你会感觉像被卡车撞了”）；哪些外科医生是这方面最顶尖的；这个病会对他的妻儿造成什么影响；还有长期缺席的话，怎么来管理这个实验室。胰腺癌的预后非常糟糕，但当然无从得知这对V来说意味着什么。
He laid out his gradual weight loss, indigestion, and his recent“precautionary” CT scan—a truly nonstandard procedure at this point—which showed a pancreatic mass. We discussed the way forward, the dreaded Whipple operation in his near future (“You are going to feel like a truck hit you,” I told him), who the best surgeons were, the impact the illness would have on his wife and children, and how to run the lab during his prolonged absence. Pancreatic cancer has a dismal prognosis, but of course there was no way to know what that meant for V.

他略显踟蹰。“保罗，”他说，“你觉得我的生命有意义吗？我做了正确的选择吗？”
He paused. “Paul,” he said, “do you think my life has meaning? Did I make the right choices?”

真是令人震惊。我眼中的道德模范在面对死亡时，竟然也会问这些问题。V的手术、化疗和放疗过程很艰难，但很成功。一年后他重返工作岗位，而我也即将回到医院继续临床工作。他的头发变得花白稀疏，眼中原本飞扬的神采也变得黯淡无光。我们最后一次每周例会时，他看着我，说：“你知道吗？从今天开始，我才感觉一切都值得。是啊，为了我的孩子我什么都愿意承受，但从今天开始，我才觉得一切痛苦都是值得的。”我们这些医生让病人经历了人间地狱般的痛苦，而我们对此的了解是多么贫乏啊。
It was stunning: even someone I considered a moral exemplar had these questions in the face of mortality. V’s surgery, chemotherapy, and radiation treatments were trying, but a success. He was back at work a year later, just as I was returning to my clinical duties in the hospital. His hair had thinned and whitened, and the spark in his eyes had dulled. During our final weekly chat, he turned to me and said, “You know, today is the first day it all seems worth it. I mean, obviously, I would’ve gone through anything for my kids, but today is the first day that all the suffering seems worth it.” How little do doctors understand the hells through which we put patients.