雙語(yǔ)·當(dāng)呼吸化為空氣 我給課程主管打了電話(huà)

我給課程主管打了電話(huà)，說(shuō)我準(zhǔn)備好了，要回去了。他非常激動(dòng)。維多利亞也和我促膝長(zhǎng)談，討論如何讓我重新融入團(tuán)隊(duì)，迅速適應(yīng)工作。我要求隨時(shí)給我配一個(gè)后備的住院醫(yī)生，以防萬(wàn)一。另外，我一天只能處理一個(gè)病例。等病人出了手術(shù)室，我就不管了，也不會(huì)值班。我們需要保守前進(jìn)，一步一步來(lái)。手術(shù)安排出來(lái)了，我被派去做一個(gè)顳葉切除術(shù)，這是我最喜歡的手術(shù)之一。一般來(lái)說(shuō)，癲癇是海馬體異常放電引起的，而海馬體就在顳葉的深處。切除海馬體，癲癇就治愈了。但這項(xiàng)手術(shù)還是很復(fù)雜的，需要手法輕柔地將海馬體從腦膜上切除。覆蓋著大腦的透明腦膜非常脆弱，就在腦干附近。
I called up the program director to tell him I was ready to return. He was thrilled. Victoria and I talked about how best to reintroduce me and get me back up to speed. I requested that a fellow resident be available to back me up at all times in case something went awry. Furthermore, I would do only one case per day. I wouldn’t manage the patients outside the OR or be on call. We’d proceed conservatively. The OR schedule came out, and I was assigned to a temporal lobectomy, one of my favorite operations. Commonly, epilepsy is caused by a misfiring hippocampus, which is located deep in the temporal lobe. Removing the hippocampus can cure the epilepsy, but the operation is complex, requiring gentle dissection of the hippocampus off the pia, the delicate transparent covering of the brain, right near the brain stem.

手術(shù)前一晚，我熟讀各種手術(shù)教科書(shū)，復(fù)習(xí)解剖圖和手術(shù)步驟。我睡得很不安穩(wěn)，腦子里一直浮現(xiàn)著頭顱的角度，鋸子鋸開(kāi)顱骨的情景，切除顳葉之后反射在骨膜上的燈光。我起了床，穿上襯衫，打好領(lǐng)帶。（幾個(gè)月前我把所有的刷手衣都還了，以為這輩子都用不上了。）我來(lái)到醫(yī)院，十八個(gè)星期以來(lái)頭一次換上那身熟悉的藍(lán)色衣服。我和病人聊了聊，確定沒(méi)什么最后的問(wèn)題了，就開(kāi)始手術(shù)的準(zhǔn)備。病人插了管，主治醫(yī)生和我也消好毒，準(zhǔn)備開(kāi)始了。我拿起手術(shù)刀，劃開(kāi)病人耳朵上方的皮膚，慢慢地進(jìn)行每一步，努力確保毫無(wú)遺漏，不犯任何錯(cuò)誤。我一邊進(jìn)行電凝止血，一邊繼續(xù)切到骨頭的部位，然后鉤起皮瓣。一切都感覺(jué)很熟悉，肌肉記憶并未消退。我拿起鉆子，在顱骨上鉆了三個(gè)洞。主治醫(yī)生在旁邊噴水，給鉆子降溫。我又換了開(kāi)顱器，也就是從側(cè)面切割的鉆頭，把幾個(gè)洞連了起來(lái)，鉆開(kāi)一大片頭骨?！斑青币宦?，我把頭骨撬開(kāi)，銀閃閃的硬腦膜就出現(xiàn)在眼前。值得高興的是，我沒(méi)有犯很多初學(xué)者常犯的錯(cuò)誤，鉆子沒(méi)有傷到這片區(qū)域。我拿了一把鋒利的手術(shù)刀，割開(kāi)硬腦膜，也沒(méi)有傷到大腦。接連的成功讓我放松下來(lái)，我略微在硬腦膜上縫了幾針，把它勒起來(lái)，免得進(jìn)行主要步驟的時(shí)候礙事。大腦在輕輕地跳動(dòng)，發(fā)著微光。巨大的腦靜脈縱貫顳葉頂部，這情景原始而質(zhì)樸。我熟悉的大腦啊，一個(gè)溝壑縱橫的桃子，正在召喚著我。
I spent the night prior poring through surgical text-books, reviewing the anatomy and steps of the operation. I slept restlessly, seeing the angle of the head, the saw against the skull, the way the light reflects off the pia once the temporal lobe is removed. I got out of bed and put on a shirt and tie. (I had returned all my scrubs months ago, assuming I’d never need them again.) I arrived at the hospital and changed into the familiar blue garb for the first time in eighteen weeks. I chatted with the patient to make sure there were no lastminute questions, then began the process of setting up the OR. The patient was intubated, the attending and I were scrubbed and ready to begin. I picked up the scalpel and incised the skin just above the ear, proceeding slowly, trying to make sure I forgot nothing and made no mistakes. With the electrocautery, I deepened the incision to the bone, then elevated the skin flap with hooks. Everything felt familiar, muscle memory kicking in. I took the drill and made three holes in the skull. The attending squirted water to keep the drill cool as I worked. Switching to the craniotome, a sideways-cutting drill bit, I connected the holes, freeing up a large piece of bone. With a crack, I pried it off. There lay the silvery dura. Happily, I hadn’t damaged it with the drill, a common beginner’s mistake. I used a sharp knife to open the dura without injuring the brain. Success again. I began to relax. I tacked back the dura with small stitches to keep it out of the way of the main surgery. The brain gently pulsed and glistened. The huge Sylvian veins ran across the top of the temporal lobe, pristine. The familiar peach convolutions of the brain beckoned.

突然，我視力的余光有些模糊，只好放下工具，從手術(shù)臺(tái)旁后退。眼前的黑暗逐漸擴(kuò)大，蠶食著我的視力，一種輕飄飄的感覺(jué)占據(jù)了全身。
Suddenly, the edges of my vision dimmed. I put down my instruments and stepped back from the table. The blackness encroached farther as a feeling of lightness overcame me.

“抱歉，先生，”我對(duì)主治醫(yī)生說(shuō)，“我有點(diǎn)暈，可能需要躺下。我的助理住院醫(yī)生杰克會(huì)完成這臺(tái)手術(shù)?！?br>“Sorry, sir,” I told the attending, “I’m feeling a little faint. I think I need to lie down. Jack, my junior resident, will finish the case.”

杰克很快就趕來(lái)了，我離開(kāi)了手術(shù)室，到休息室喝了點(diǎn)橙汁，躺在沙發(fā)上。二十分鐘后，感覺(jué)好些了。“神經(jīng)心源性暈厥。”我低聲自言自語(yǔ)。自主神經(jīng)系統(tǒng)突然引發(fā)短暫的心律不齊。說(shuō)得通俗點(diǎn)，就是神經(jīng)出了毛病。這是菜鳥(niǎo)才會(huì)出的問(wèn)題，和我想象中重返手術(shù)室的情景可不一樣。我走到更衣室，把臟了的刷手衣扔進(jìn)臟衣籃，穿上便服。離開(kāi)的時(shí)候，我抓了一摞干凈的刷手衣，告訴自己，明天會(huì)更好。
Jack arrived quickly, and I excused myself. I sipped some orange juice in the lounge, lying on the couch. After twenty minutes, I began to feel better. “Neurocar-diogenic syncope,” I whispered to myself. The auto-nomic nervous system briefly shutting down the heart. Or, as it’s more commonly known, a case of the nerves. A rookie problem. This was not how I’d envisioned my return to the OR. I went to the locker room, threw my dirty scrubs in the laundry, and put on my civilian clothes. On the way out, I grabbed a stack of clean scrubs. Tomorrow, I told myself, would be a better day.

的確是這樣。所有病例感覺(jué)都很熟悉，隨著日子一天天過(guò)去，似乎越來(lái)越平穩(wěn)順暢了。第三天，我給一個(gè)病人的脊椎做退變椎間盤(pán)移除手術(shù)。盯著那凸出的椎間盤(pán)，我記不起之前到底是怎么做的了。負(fù)責(zé)監(jiān)督我的同事建議用咬骨鉗一點(diǎn)一點(diǎn)地來(lái)處理。
It was. Every day, each case felt familiar but moved a little more slowly. On day three, I was removing a degenerated disc from a patient’s spine. I stared at the bulging disc, not remembering my exact move. The fellow supervising me suggested taking small bites with a rongeur.

“嗯，我知道一般的方法，”我含糊地說(shuō)，“但還有別的辦法……”
“Yeah, I know that’s how it’s usually done,” I mumbled, “but there’s another way. . . ”

我一邊用咬骨鉗一點(diǎn)點(diǎn)弄了二十分鐘，一邊在腦子里尋找之前學(xué)過(guò)的更為優(yōu)雅從容的方法。進(jìn)行到下一節(jié)脊椎時(shí)，我在電光石火間想起來(lái)了。
I nibbled away for twenty minutes, my brain searching for the more elegant way I had learned to do this. At the next spinal level, it came back to me in a flash.

“剝離器！”我大聲說(shuō)，“骨錘、超薄咬骨鉗?！?br>“Cobb instrument!” I called out. “Mallet. Kerrison.”

三十秒內(nèi)，整個(gè)退變椎間盤(pán)就被移除了。
I had the whole disc removed in thirty seconds.

“這就是我的辦法。”我說(shuō)。
“That’s how I do this,” I said.