醫(yī)者心聲：求醫(yī)先求己

“Why do you want to become a doctor？”

Money and status immediately sprang to mind， but I answered the medical-school application diplomatically. I wrote instead about how medicine was the perfect vehicle to make meaningful changes in the world， a powerful way to help others—the typical answers expected of an eager applicant.

I meant what I said； I really did want to have a job that helped people. If money and status were part of the picture， that would be the dream job.

Through the years， I have occasionally been very helpful， sometimes dramatically： once， a young man came into my office 1）doubled over， sweating and feverish. I sent him to the ER with a note 2）shrieking that he needed immediate surgery； he had developed testicular torsion that， if left a few hours longer， would have rendered him infertile for life—or dead. He got surgery that day. I was 3）elated. Score one for the clever doctor！

Often， my therapeutic usefulness is just to 4）validate a person’s suffering； I tell them they have a condition that others share（depression， 5）lupus， addiction） and that although treatments may be limited， they are not alone or “weird.” Sometimes it is the best medicine I can give that day.

But most of the time， my interventions have not been helpful. Many times I’ve filled out a disability form even though the person was not disabled， because it meant they’d receive more money for rent. Many times I wrote prescriptions， which helped6）abate someone’s anxiety or depression or pain only temporarily， because I could not do anything about their poverty. I was helpful initially—but not in the long run.

These interventions seemed to hinder my patients. They felt better but did not make the changes necessary to sustain that improvement. They did not leave their stressful jobs or their toxic relationship. They continued to isolate themselves， to eat poorly， to live in housing that， though 7）subsidized， kept them in neighbourhoods that triggered their addictions. They got hooked on pain pills. They couldn’t sleep， even with their 8）sedatives.

They came back wanting more. “I need something else， doc…” What was the latest medication or diet or technique？

I would scrape at the bottom of my toolkit.“Let’s try this new med！ Have you tried hypnosis， 9）eye movement desensitization and reprocessing（EMDR）， or emotional freedom therapy？”

Or I would scan the disability form for a new box I could check off， maybe for 10）transit tokens， so they could get $30 more a month. “Are you sure you aren’t 11）lactose intolerant？” I would say. I’d frown， wondering how I could justify this to the authorities. Who checked these forms， anyway？

The patient and I would have a few hopeful visits， and then the inevitable disappointment. “It’s not enough …”

Over the long term， my efforts seemed to generate more frustration and dissatisfaction than help. Each patient encounter reminded me of how helpless I was， even in my cloak of competence. When I wasn’t dealing with their complaints about me， I was furious with them， their ignorance and their weakness.

I became cynical， bored and resentful. Why were they asking for my help if they didn’t listen？ I ended up blaming patients for my misjudgments： Filling out a disability form 12）consigned them to an aimless life of poverty； writing a prescription got them physically or psychologically hooked for years.

I burned out. I changed the focus of my 13）family practice to addiction medicine， and when that didn’t work， I took 14）sick leave. The desire to help turned sour like a romance. The money and status were never enough to soothe the hopelessness and anger I felt each morning， when I looked at my day sheet of needy patients. I hated my perfect job.

I often saw other physicians in the same boat as me， trying to 15）mill through the same treacherous darkness， crazy with the latest fad that promised redemption. We even joined peer support groups—where we could 16）commiserate and try not to resent our patients and our own helplessness.

It was through such a group that I learned I couldn’t help anyone unless they were willing to help themselves first. If I was working harder than the patient， my help usually made things worse.

I practice now at a short-term addiction centre. With my clinical knowledge and experience， I can sometimes provide a diagnosis or treatment that is useful for a person. I might even aid in providing some temporary bridges or crutches （meds， shortterm financial relief）. But these are temporary aids.

There are limitations to what we each can do for another—regardless of what wizard’s wand we are holding.

Over time， I have learned to sit back and let others trudge through their own version of the human 17）muddle. I am most helpful if I haven’t burned out before someone is finally able to accept the encouragement and direction I can give.

When someone dips down into their depths and then 18）comes up for air， I want my hand to be there， waiting.

“為什么你想成為一名醫(yī)生？”

立刻浮現(xiàn)心頭的是金錢與地位，但是我在醫(yī)科大學(xué)申請表上的回答卻是一番“外交辭令”。我當(dāng)時(shí)寫的是醫(yī)學(xué)如何作為完美的工具讓世界發(fā)生有意義的改變，如何作為有力的手段幫助他人——一名志在必得的申請人該說的標(biāo)準(zhǔn)答案。

其實(shí)我說的真就是我想的，我真的想從事一份能夠幫助他人的工作。如果鈔票與地位是其中一部分，那就真是夢寐以求的工作了。

這么多年來，偶爾我也顯得助人有功，有時(shí)候挺戲劇性的：有那么一次，一位年輕人來到我的辦公室，彎著身子、大汗淋漓，而且高燒不止。我把他送到急診室，并附上診斷書，驚呼他需要立刻動(dòng)手術(shù)。他患上的是睪丸扭轉(zhuǎn)，要是延遲幾個(gè)小時(shí)，他很可能會終生不育，甚至死亡。他當(dāng)天就接受了手術(shù)。我感到很得意。我這個(gè)明智的醫(yī)生得記上一功！

多數(shù)情況下，我的治療有效性只是用于確認(rèn)病人的痛苦而已。我告訴他們，他們的癥狀（情緒低落、狼瘡還有癮癥）其他人也有，盡管醫(yī)療手段有限，但是他們不是唯一的患者，并非“異類”。有些時(shí)候，這便是我當(dāng)天能開出的最好的藥方了。

但是大多時(shí)候，我的診斷介入并沒有幫助。很多時(shí)候，那個(gè)人還沒有到傷殘的地步，我開出的診斷單就已經(jīng)將其判定為“殘疾”，因?yàn)檫@意味著他們可以獲得援助，得到更多的錢來支付房租。很多時(shí)候我寫下處方單，只能暫時(shí)地幫助緩解病人的焦慮、沮喪或者疼痛，因?yàn)槲覍λ麄兩硖幍呢毨Ь车責(zé)o能為力。起初我還是能幫助解決問題的，但是不能長久持續(xù)。

這些診斷似乎為我的病人的生活前景設(shè)置了障礙。他們感覺好點(diǎn)了，但卻沒能作出必要的改變來讓事情繼續(xù)往好的方向發(fā)展。他們還是從事原來高壓的工作，或是持續(xù)著那段荼毒心靈的戀愛關(guān)系。他們繼續(xù)離群索居，飲食不佳，住在盡管有政府房屋補(bǔ)貼但卻要與癮君子為鄰的區(qū)域里。他們對止痛藥上癮，就算服了鎮(zhèn)靜劑也還是無法入眠。

他們回來找我提出更多的要求。“我需要一些其他的東西，醫(yī)生……”最新的處方、食譜或技術(shù)是什么？

我會絞盡腦汁，“讓我們試試這款新藥！你嘗試過催眠、眼動(dòng)脫敏和再加工治療，還有情感釋放治療法嗎？”

或者我會審視他們的殘疾鑒定表，看看在哪個(gè)病癥選項(xiàng)上能再打個(gè)勾——或許只是為了多得車費(fèi)，這樣他們每個(gè)月可以多拿30美元。“你確定你不是乳糖不耐癥？”我會這樣說。我還會皺眉，思考怎樣對政府官員作出合理解釋。不過，誰會檢查這些表格呢？

我和病人會滿帶希望去申請，然后難免失望而歸。“這還不夠……”

在很長的一段時(shí)間里，比起幫助，我的努力似乎帶來更多的挫折和不滿。每一次會診，病人都提醒著我自己是多么的無能，甚至在我能力范圍之內(nèi)亦如此。當(dāng)我不是在處理他們對我的投訴，我就在對他們、對他們的無知和軟弱感到生氣。

我變得冷漠憤世、厭倦惱怒。如果他們不聽我的建議，為什么還要向我求助呢？最后我把自己的錯(cuò)誤判斷怪在病人的頭上：填一張殘疾鑒定表，將他們推向毫無目標(biāo)的貧苦生活當(dāng)中；給他們開一張?zhí)幏絾?，讓他們年?fù)一年在身體上或者精神上無法擺脫依賴。

我感到精疲力竭。我從普通醫(yī)療轉(zhuǎn)向?qū)Ｗ⒊砂a性藥物這一專科，當(dāng)那樣還不能解決我的問題，我就請病假。就像愛情故事激情不再一樣，我助人的欲望日漸變味。當(dāng)我看著那張記錄當(dāng)天我要會診的貧困病人名單時(shí)，名利不足以撫平每天早上感到的絕望與憤怒。我痛恨我這份完美的工作。

我經(jīng)?？吹狡渌麅?nèi)科醫(yī)生陷入與我相似的境地，試圖挺過這種自欺欺人的黑暗煎熬，對最新流行風(fēng)潮癡迷不已，滿懷希望從中求解脫。我們甚至參加同僚互助小組——在那里我們可以互相同情，并試著不去厭惡我們的病人和自身的無助感。

正是通過這種互組小組，我明白到，除非病人首先愿意幫助自己，不然我?guī)筒涣巳魏稳?。病人不努力，光靠醫(yī)生用勁的話，那我提供的幫助通常只會讓事情變得更糟。

我現(xiàn)在在短期癮癥中心工作。我的醫(yī)學(xué)理論和臨床經(jīng)驗(yàn)讓我在一些時(shí)候能夠?yàn)椴∪颂峁┯杏玫脑\斷或治療。我還能夠提供臨時(shí)性的橋接器和支架（起到藥物的作用，或是緩解短期的財(cái)政緊張）。但這一切都只是暫時(shí)性的援助。

我們能為別人做的事情畢竟有限——無論我們手上拿著什么樣的魔杖。

這么多年來，我明白到要放手讓人們從自己的生活泥潭中走出來。如果我在變得暴躁不堪之前最終能讓人接受我給出的鼓勵(lì)和指引，我就最能幫上忙了。

當(dāng)一個(gè)深陷困境的人能探出頭來掙扎喘息，我希望我會伸手在那兒，等著，拉他們一把。