我還能活多久？

The medical team hung back in the hallway before entering the patient’s room. The intern had just presented the case—a 50-year-old man who’d never seen a doctor until three months before， when he noticed blood in his 1）stool. It turned out he had extensive 2）colon cancer that had already spread to the liver and lungs. The man， Mr. M， was now admitted for his second cycle of chemotherapy.

“Nothing much for us to do，” the intern said grimly. I understood her unease， but as the 3）attending physician， I couldn’t 4）second her opinion.“There’s always something for us to do，” I told the team 5）gamely. Inside， though， as we gathered in a semicircle around the bed， I doubted my words.

“If I’d known we were having a party， I’d have gotten some snacks，” said Mr. M with a lopsided grin， slim and young-looking in his Yankees cap.“All I got is 6）Ensure， if anyone’s drinking.” My team smiled nervously.

I asked Mr. M if he had any questions， if there was anything the 7）oncologists hadn’t fully explained. “Nope，” he said， as he gestured to the IV pump at his side. “I’m the cancer expert now—ask me anything！” He took a swig of his Ensure. “And the chocolate ain’t bad，”he said， winking at the team. The intern was right； there really wasn’t anything for us to do. For lack of a better topic， I asked him how he was feeling. “Great，” he replied， rolling his shoulders like a boxer. “That first chemo got rid of everything—the pains in my stomach， the blood in the toilet. I’m totally back to normal.”It was a 8）stupendous success that one round of chemotherapy had resolved his symptoms， but something in the conviction of his voice didn’t sit right with me. I changed tactics， asking what sort of work he did. “I just finished my first season as a park ranger in Brooklyn.” He cracked his 9）knuckles. “If they like me， they’ll hire me back next season.” Next season？ The team around me shuffled awkwardly. Carefully， I asked him what he understood of his diagnosis.

“Well，” he said， shoving the baseball cap further back on his head. “I know that it’s traveled to the liver and my lungs. I know that it’s serious， but it’s not the fatal type.” Not the fatal type？ I could feel the weight of his statement ricochet like a ball bearing through each member of the team. Delicately， I asked if he knew what it meant to have cancer in other parts of his body.“Means I got to do chemo every month，” he said， patting the IV pump.

And had the oncologists explained what the chemotherapy could achieve？

Mr. M rubbed a nonexistent moustache with two fingers. “I ain’t never really thought about that，”he said slowly. “I guess it’s supposed to make me better.”

I slowed my pace of speaking to match his， gently explaining that while chemotherapy might shrink the tumors and make him more comfortable， it would not be able to take the cancer away completely. That at Stage IV， the cancer could not be cured.

“I knew that，”hesaid ， almost defensively. “They told me that.” He swung his legs over the side of the bed so that he was sitting up straight in front of me， the crisp whites of his eyes just inches from mine. “So， Doc，” he said， letting the back of one hand fall into the palm of the other with an audible slap， “how much time I got？”

The din of the hospital seemed to dissipate， leaving a wincing silence in the room. I closed my eyes for a moment—a reflex that sometimes happens when I need to gather my courage. There are few situations more horrible than having to tell another human being that he or she is going to die. And it doesn’t get any easier with experience. I started to tell him that every person is different， that it’s impossible to give an exact number. But five medical trainees stood behind me. If I evaded the question， or relied on euphemisms， I would fail them and fail our patient. “According to the books，” I said， “for people with Stage IV cancer， the average…” I stopped. Even after having told this to countless patients， I still had trouble. “The average is about 6 to 12 months.” There. I’d gotten it out. And now the numbers lay there—harsh and unforgiving. I quickly added that some people live longer， but some live less time， that it was difficult to predict.

Mr. M’s left eyebrow inched up his forehead， 10）corrugating the skin directly above it. “So you’re saying that if I’ve always wanted to go to Vegas I should do it now？” His voice wasn’t accusing， or even disappointed. It just sounded thoughtful. I told him I wished I could give him better news.

“I’m a lousy gambler，” he said with a shrug. “But maybe I’ll do better now， knowing there’s nothing to lose.” A 11）pensive stillness suffused the room， and we all seemed to find our own spots on the floor to focus on. Finally， collective breaths were exhaled， and as if by unspoken agreement the moment of silence drew to a close. In quieter voices， we discussed the future—when Mr. M might start to feel ill， what he should say to his employer， advance directives. We agreed to continue the conversation the next day， after he’d had more time to think.

When we reassembled in the hallway outside， the intern slumped against the wall， visibly drained. The team awkwardly shifted papers and 12）stethoscopes. The intern shook her head slowly， but couldn’t seem to put her feelings into words. We’d all known Mr. M’s prognosis before we entered the room. But now that it had been put into words—given life， as it were—it was a 13）palpable， disquieting presence among us. It trailed us as we made our way silently down the hall.

在走進病房之前，醫(yī)療小組在過道上停留了許久。實習(xí)醫(yī)師剛剛介紹了這宗病案——一位50歲的老人，以前從未生過大病，直到三個月前，他出現(xiàn)了便血癥狀。他被診斷出患結(jié)腸癌，癌細胞已經(jīng)大范圍地擴散到肝臟和肺部。這位M先生，現(xiàn)在正處于化療的第二個療程。

“我們能做的不多，”實習(xí)醫(yī)師傷感地說道。我理解她的不安，但是作為主治醫(yī)師，我并不贊同她的看法?！拔覀円欢ㄟ€能做點什么，”我堅決地對小組成員們說道。雖然當(dāng)我們圍繞在病床邊時，我內(nèi)心也懷疑自己的話。

“如果知道我們要辦派對，我會事先準(zhǔn)備些零食，”M先生歪嘴笑著說，他戴著洋基隊棒球帽，顯得清瘦且年輕。“如果誰想喝點什么，我這只有安素?！毙〗M成員們局促不安地笑了。

我問M先生是否有任何疑問，腫瘤醫(yī)師是否有講述不清楚的地方?！安]有，”他指著旁邊的點滴泵說道。“我現(xiàn)在是癌癥專家——不信你問我，任何問題都可以！”他喝了一大口安素?！斑@巧克力味道真不錯，”他沖著成員們眨眼說道。那位實習(xí)醫(yī)師說得對，我們確實無能為力。一時找不到更好的話題，于是我問他感覺如何?！昂脴O了，”他答道，像拳擊手一樣活動著肩膀?！暗谝粋€療程去除掉一切癥狀，包括胃痛，便血。我覺得我徹底恢復(fù)了?！被煹谝粋€療程就消解了他的癥狀，這是極其驚人的效果，但是他聲音中那堅定的語氣總讓我覺得不對勁。我換個提問方式，問他是做什么工作的。“我在布魯克林剛做完一個季度的公園管理員?！彼饬讼率种戈P(guān)節(jié)?！叭绻麄冇X得我不錯，下個季度還會雇我?！毕聜€季度？站在旁邊的小組成員們都尷尬地挪了挪腳步。我小心地詢問他對自己的診斷結(jié)果到底了解多少。

“嗯，”他往后拉了拉棒球帽?！拔抑腊┘毎麛U散到了肝臟和肺部。我明白情況很嚴(yán)重，但是不足以致命。”不足以致命？我可以感受到，他這話的重量像彈球般在我們每個成員的臉上碾過。我小心翼翼地問他是否明白這意味著身體其他部位也發(fā)生了癌變?！拔抑恢烂總€月都必須去化療，”他說道，輕輕地拍了拍點滴泵。

難道腫瘤醫(yī)師們沒有解釋化療的效力嗎？

M先生兩個手指摩擦著并沒有胡子的下巴。“我其實沒有認(rèn)真想過這些，”他慢慢說道。“我只是覺得化療會漸漸使我好起來?！?/p>

我放慢語速，和緩地解釋道，盡管化療能縮小腫瘤，使他免受那么多痛苦，但是并不能完全根治癌癥。癌癥第四期，并無方法治愈。

“我知道，”他說道，幾乎帶著警覺的語氣。“他們告訴過我?！彼央p腿挪到床邊，這樣他剛好坐在我面前，他眼睛距離我不過幾英尺，干澀的眼白清晰可見。“那么，醫(yī)生，” 他一只手的手背啪一聲拍在另一只手的掌心內(nèi)，“我還有多少時間？”

醫(yī)院的喧鬧似乎在那一刻消失了，整個病房內(nèi)一片死寂。我閉上眼片刻——這是每當(dāng)我需要鼓起勇氣時的一種習(xí)慣。再沒有什么事情比告知某人死期將至更加可怕了。無論我經(jīng)歷過多少次這樣的情形，我仍然無法應(yīng)付自如。我開始向他解釋每個病人情況不同，給出確切的數(shù)字幾乎是不可能的。但是五個實習(xí)醫(yī)師還站在我身后。如果我回避問題或者是委婉回答，不僅會讓他們失望，也會令病人失望?！皳?jù)書上所說，”我說道，“癌癥第四期患者，一般……”我停頓了。即使已經(jīng)和無數(shù)患者說過很多次，我仍然沒能一次說完。“一般還有半年到一年的時間?！本瓦@樣，我最終說了出來。此時，那些數(shù)字?jǐn)[在那里——顯得殘酷無情。我馬上補充道，有些人活得更久些，有些則沒能活得那么久，這些都無法預(yù)料。

M先生抬高眉毛，額頭上出現(xiàn)了皺紋。“所以你的意思是如果我想去維加斯，我現(xiàn)在應(yīng)該馬上去？”他的語氣并不是責(zé)問，也不是失望，倒是令人深思。我對他說真希望自己可以告訴他更好的消息。

“我是個差勁的賭徒，”他聳聳肩說道?！暗乾F(xiàn)在這樣或許更好，我知道自己沒什么可失去的了。”一種略帶哀傷的靜默充斥著病房，我們只能轉(zhuǎn)而凝視著地板上一個點。最后，大家都松了一口氣，不約而同打破了寂靜。我們壓低聲音開始討論不久的將來——M先生再次發(fā)病時，他應(yīng)該怎么和雇主說，給他一些預(yù)先指示。我們決定第二天再繼續(xù)談話，這樣他能有更多的時間考慮這些問題。

當(dāng)我們再次聚在病房外的走道上，實習(xí)醫(yī)師斜靠在墻上，明顯已經(jīng)筋疲力盡。小組成員們都整理著手中的文件或是撥弄著聽診器。實習(xí)醫(yī)師慢慢地?fù)u了搖頭，卻無法訴說出自己的感受。我們在走進病房前就都已了解了M先生的病情。但現(xiàn)在說出來以后——就仿佛賦予了它生命一樣——這是一個顯而易見，令人不安的存在，就這樣悄悄地，一路尾隨著我們下樓直至大廳。