《梅奧住院醫(yī)生成長手記》

聶卉

邁克爾.柯林斯（Michael J. Collins），美國作家、醫(yī)生，生于芝加哥?？铝炙箯氖ツ复髮W(xué)畢業(yè)后成為一名建筑工人，與一位同事的偶然聊天讓他有了當(dāng)醫(yī)生的夢想，柯林斯選擇重返校園，他考入了羅耀拉大學(xué)醫(yī)學(xué)院，從此開啟了另一種人生。他的著作《磚工變醫(yī)生》（Blue Collar， Blue Scrubs， 2009）追溯了這段從建筑工人到成為一名醫(yī)生的追夢歷程?？铝炙箯尼t(yī)學(xué)院畢業(yè)后進(jìn)入世界頂尖的梅奧醫(yī)療研究中心，進(jìn)行為期四年的住院醫(yī)生培訓(xùn)，他將這段終生難忘的魔鬼式經(jīng)歷記錄了下來，寫成了《梅奧住院醫(yī)生成長手記》（Hot Lights， Cold Steel， 2006）。從梅奧結(jié)業(yè)后柯林斯回到家鄉(xiāng)芝加哥，成為一名骨科醫(yī)生?，F(xiàn)在他與妻子和12個(gè)子女一起生活在那里，業(yè)余時(shí)光用來寫作和樂隊(duì)演出。

邁克爾.柯林斯

Excerpts1）

I suddenly realized how unprepared I was for all this. Oh， I had to have been sharp2） to get a residency at the Mayo Clinic. I knew my anatomy3） and physiology. I did well on the National Boards. I had wonderful letters of recommendation from my deans. I came very well trained for the cognitive aspects of my work， but there was no training for the emotional aspects. Letters and board scores could never prepare me to lose the struggle to save a pregnant woman and her baby， or to watch a twenty-year-old girl slowly fry her brain.

No， I was not prepared for such things， and they were beginning to rip me apart. How， I wondered， can life go on？ How can my fellow residents and I continue to smile， to cut the lawn on our day off， to have children？

Of course， it would have been easier if we didnt care， and sometimes we actually pretended we didnt. We would try to do our job and be detached. But we didnt go into medicine to be detached. We went into medicine because we cared. But caring kept bringing us pain and frustration and anguish. We had been training for years to become surgeons. We had excelled in college.

We had excelled in medical school. Our lives had been one success after another until we woke up one day， and there we were， surgical residents at the world-famous Mayo Clinic. It was all so perfect. But before we could congratulate ourselves， scarcely before we learned where the surgeons locker room was， we discovered this was a profession that， like no other， quickly and ruthlessly and uncaringly proclaimed we were not perfect. People came to us with head injuries—and we couldnt help them. People came to us with gunshot wounds—and we couldnt heal them. People came to us with ruptured4） arteries5）—and we couldnt save them.

We kept confronting these terrible problems， and we kept failing， again and again and again—we， who had always succeeded， who had always known what to do， who had always been so sure of ourselves. Never before had we attempted anything so important， and never before had we failed so miserably.

Oh， sure， we tried to let conventional wisdom shield us. “Look，” wed tell ourselves， “you did exactly the right thing， exactly what the textbooks say you should do. Just because she died doesnt mean it was your fault.”

Thats what wed tell ourselves， but we didnt buy it. Medicine wasnt about following directions in a textbook. Thats not what we were supposed to do. What we were supposed to do was save people—and so often， it seemed， we didnt.

“You want the truth？” wed ask ourselves ruthlessly. “Heres the truth： A young woman came to you alive， breathing， fear in her eyes， wanting you to save her， and now shes lying on a metal cart in the morgue6） with a sheet over her. Theres your truth for you.”

So we would drag ourselves into the surgical waiting room， to the frightened， anxious eyes that had been waiting for us for the last three hours. The same eyes that looked to us with pleading and hope as we rushed their daughter to the OR7）. They knew before we said a word. They could see it in our struggle to speak.

“I … I am so sorry to tell you that …”

And afterward wed sit on the bench in the doctors locker room， and take a deep breath and slowly let it out—but we couldnt exhale everything. Wed sit there， hands folded and heads bent， too lethargic8） to pull off our bloody scrubs9）， too tired to go to bed， too dispirited to start that IV10） the nurses had called for two hours ago； our minds slowly going out of focus， slowly retreating from the horrors of the past few hours.

And if we were one of the lucky ones， wed go off duty at eight or nine， after morning rounds. Wed drive home through avenues of early-morning sunlight flashing at us through the trees， hurting our eyes， like looking into the revolving lights on an ambulance. Wed come home to our wives who needed us. Wed mumble our hellos， brush past them， and tumble11） into a dreamless sleep.

But more likely we did not have the day off. We had another full day ahead of us. And we had no time to think about what we did the night before. If the patient was still alive， there were other， newer challenges ahead….

We were learning that all the training and all the caring in the world were not going to solve every problem. This wasnt medical school. We werent going to ace every exam. Silver-haired professors werent going to pat us on the head and marvel at our intellectual acumen12）. We werent going to win every battle.

“Sometimes theres just too much trauma13），” Joe said.

There certainly had been for me.

1. 本文選自該書的第七章，講述了自己竭盡全力卻仍無法挽救病人時(shí)的內(nèi)心痛苦與掙扎，略有刪節(jié)。

2. sharp [?ɑ?（r）p] adj. 敏銳的，聰明的，機(jī)靈的

3. anatomy [??n?t?mi] n. 解剖；解剖學(xué)

New Oriental English .

作品賞析

多年以后，芝加哥的骨科醫(yī)生柯林斯念念不忘的仍是他早年在梅奧醫(yī)療研究中心的四年魔鬼式住院醫(yī)生培訓(xùn)。所謂 “梅奧虐我千萬遍，我待梅奧如初戀”，這句話對寫一本書來紀(jì)念這段歲月，并執(zhí)意將其定義為美好時(shí)光的柯林斯醫(yī)生來說，大概是不言自明的。

美國醫(yī)生的高薪酬早已聲名在外，這位柯林斯醫(yī)生卻用身家性命無時(shí)無刻不在反駁這條真理：“不是這樣的！”捉襟見肘、疲于奔命、出生入死——這些凄慘壯烈的詞語用來形容柯林斯似乎也稍顯遜色。從圣母大學(xué)畢業(yè)的柯林斯成為一名建筑工人，但當(dāng)醫(yī)生的夢想從心靈的角落里燃起后，就煽動(dòng)著這位不安于現(xiàn)狀的年輕人開啟了打雞血的人生?？铝炙钩晒既肓_耀拉大學(xué)醫(yī)學(xué)院學(xué)習(xí)，畢業(yè)后進(jìn)入世界頂尖的梅奧醫(yī)療研究中心，進(jìn)行為期四年的住院醫(yī)生培訓(xùn)，醫(yī)學(xué)院期間就已是大齡學(xué)生的他，課余都在停車場打工養(yǎng)家糊口，既沒有搞過學(xué)術(shù)研究，也沒有寫過像樣的論文，有的只是對醫(yī)學(xué)的夢想和熱情。走進(jìn)高手如云的梅奧，這個(gè)迷戀手術(shù)刀的“呆瓜”一時(shí)覺得自己是件假冒偽劣產(chǎn)品，甚至直到四年住院醫(yī)生結(jié)束時(shí)，他依然覺得自己能力不夠。

但是，千萬不要被這位醫(yī)生的謙遜迷惑了雙眼?？铝炙乖诹_耀拉大學(xué)醫(yī)學(xué)院成績非常優(yōu)秀，他受過良好的專業(yè)培訓(xùn)，并且成功得到了系主任的推薦信。正是因?yàn)槿绱顺錾?，他才得以來到梅奧，但謙遜卻引導(dǎo)柯林斯始終如初學(xué)者般孜孜不倦。當(dāng)然，梅奧的魔鬼式培訓(xùn)絲毫不會辜負(fù)這些佼佼者們。兩年初級住院醫(yī)生，兩年高級住院醫(yī)生，中間還有半年的基礎(chǔ)科學(xué)培訓(xùn)，這就是梅奧住院醫(yī)生要完成的全部內(nèi)容。但要全部通關(guān)，順利成為一名醫(yī)生，鬼知道他們這四年要經(jīng)歷什么。以下是柯林斯醫(yī)生的獨(dú)家秘籍寶典。

通關(guān)第一步：累成狗。他們必須在骨科、門診部、急診部、腫瘤部、兒童部等科室輪番受教，要做的是打雜、查夜、縫合傷口、在手術(shù)臺邊握牽引器、半夜去開靜脈監(jiān)控，當(dāng)然還要將每一項(xiàng)手術(shù)熟稔于心、應(yīng)用于手，對于主治醫(yī)生的命令，住院醫(yī)生要說的永遠(yuǎn)是：“Yes， Sir ！” 伴隨所有這些的是不眠不休連軸轉(zhuǎn)的日日夜夜。傳呼機(jī)一響，他們就要離開床、家人、吃了一半的晚餐，在任何時(shí)間從任何地方狂奔向急診室。

但柯林斯做了更多。這個(gè)每天都極度缺乏睡眠的人，一個(gè)月中還要有幾天凌晨四點(diǎn)起床，在梅奧查完房后，驅(qū)車145公里到另一個(gè)醫(yī)院連續(xù)做24～36小時(shí)的兼職，因?yàn)樽≡横t(yī)生的薪酬每小時(shí)只有2.5美元，這樣他基本上連續(xù)工作14～21天才能休息一天。而在所有的空余時(shí)間，這位瘋狂學(xué)霸除了陪家人，就全用來學(xué)習(xí)了。每天晚上他都如強(qiáng)迫癥般看筆記到凌晨兩三點(diǎn)，原因有三：一是因?yàn)樗麑ψ约旱臒o知感到羞愧；二是因?yàn)樗庾R到病人的健康甚至生命都掌握在自己手里；三是因?yàn)樗麩釔圻@項(xiàng)工作。

通關(guān)第二步：身經(jīng)百煉，閱人無數(shù)。住院醫(yī)生將學(xué)習(xí)在超負(fù)荷環(huán)境下應(yīng)對各種突發(fā)情況，見識數(shù)不清的槍傷、截肢、斷腸、車禍、死亡，當(dāng)然，當(dāng)那種哭笑不得、說不出口的病例來到你面前時(shí)，你也得裝作再平常不過的樣子。他們要幫病人拔出插在鼻子上的魚鉤，或者一邊陪醉鬼胡扯一邊縫合摔得慘不忍睹的傷口，有時(shí)還要把一位美麗姑娘的半個(gè)骨盆和一整條腿都切除掉。從在手術(shù)中僅僅劃開一道刀口，到能獨(dú)自承擔(dān)一項(xiàng)手術(shù)，這一過程需要無數(shù)臨床病例和密集的手術(shù)實(shí)踐積累。

通關(guān)第三步：靈魂大作戰(zhàn)?？简?yàn)柯林斯的當(dāng)然并不僅僅是專業(yè)知識、臨床經(jīng)驗(yàn)、體能或者睡眠不足。作為一名醫(yī)生，每日與病人為伴，生命的脆弱和死神的強(qiáng)大無時(shí)無刻不在拷問著這位剛剛走進(jìn)手術(shù)室的年輕住院醫(yī)生?？铝炙篃o比熱愛自己的職業(yè)，即使在家庭經(jīng)濟(jì)狀況捉襟見肘的情況下，他擔(dān)心的也并不是經(jīng)濟(jì)現(xiàn)狀、職業(yè)前景，而是在面對每一個(gè)亟待拯救的生命時(shí)，自己是否有足夠的能力幫助他們。“我想成為那個(gè)人們遇到人生的不公而要求幫助的那個(gè)人，我想成為直面人生不公并且將不公驅(qū)逐出境的那個(gè)人?！彼郎衩恳环置恳幻攵荚诎l(fā)出挑釁，讓這位住院醫(yī)生無論何時(shí)、無論何地都要準(zhǔn)備奔赴戰(zhàn)場。然而有時(shí)即使做了所有正確的事情，盡了最大的努力，敵人依然勝出。

在脫下滿身血跡的手術(shù)服，填寫完死亡證明，獨(dú)自一人時(shí)，那些盡最大努力仍然回天乏術(shù)的絕望，那些無法挽救病人生命的挫敗感，就匆匆趕來折磨這位醫(yī)生的靈魂。“還要做什么？還能做什么？”有一些問題永遠(yuǎn)沒有答案?？铝炙贯t(yī)生慢慢明白醫(yī)生最大的敵人并不是死神，而是自己。必須說服自己不是天使，而是為治愈患者而竭盡全力的醫(yī)生；說服自己不是法官，在病人做了愚蠢的事情、打亂治療計(jì)劃時(shí)，去幫助他而不是對他的行為做出評判；說服自己堅(jiān)持初心，在被死神和實(shí)用主義控場時(shí)，仍能時(shí)刻反省，用心去關(guān)心和體諒每一位病人。

你相信時(shí)光機(jī)嗎？夢想就是一架時(shí)光機(jī)，帶領(lǐng)我們成為未來更好的人。柯林斯最終以住院總醫(yī)生的身份為這四年時(shí)光劃上了完美的句號，但從梅奧到芝加哥任職的道路似乎并不比這四年的哪一刻輕松，因付不起搬家費(fèi)，他必須在醫(yī)院連續(xù)兼職48小時(shí)再飛回芝加哥，才能趕在搬家工人抵達(dá)時(shí)把錢如數(shù)奉上。大概也只有如此熱血又無悔的戰(zhàn)斗，才能無愧地給這段魔鬼歲月予以“美好”兩個(gè)字。

現(xiàn)代社會改變了許多事物的量變周期，但“年輕”兩個(gè)字仍然如永恒般耀眼。二三十歲的年紀(jì)，始終像在經(jīng)歷一場打怪升級的游戲，雖然可能不用像柯林斯醫(yī)生一樣練習(xí)從死神手里搶救生命，卻擁有和命運(yùn)一搏的最強(qiáng)戰(zhàn)斗力。你的夢想實(shí)現(xiàn)了嗎？你的戰(zhàn)斗還在哪個(gè)階段停步不前？是否沉迷在loser的自我定義中無法抽身？是否因沉重的工作怨氣滿天？是否終于認(rèn)同了大家口中“夢想終會變得麻木”的托辭，就此打算帶著遺憾過這一生？輕裝上陣吧，把那些在追逐夢想路上的失落、疲憊和困惑通通打敗，像謙遜又努力的柯林斯醫(yī)生一樣，奔赴時(shí)光機(jī)的另一端，向曾經(jīng)的魔鬼時(shí)光致敬。

柯林斯住院醫(yī)生獨(dú)家通關(guān)秘籍，以上。

4. rupture [?r?pt??（r）] vt. 使破裂，使裂開

5. artery [?ɑ?（r）t?ri] n. [解] 動(dòng)脈

6. morgue [m??（r）ɡ] n. 陳尸所；停尸室

7. OR：opertating room （手術(shù)室）的縮略語

8. lethargic [l??θɑ?（r）d??k] adj. 沒精打采的，懶洋洋的

9. scrub [skr?b] n. （醫(yī)生做手術(shù)穿的）防護(hù)衣

10. IV：靜脈注射的縮略語

11. tumble [?t?mb（?）l] vi. 倒塌，坍塌

12. acumen [??kj?m?n] n. 敏銳；聰明

13. trauma [?tr??m?] n. 外傷；傷口；（心理上、精神上的）創(chuàng)傷