Art of Alleviating Pain in Final Days of Cancer緩和癌癥晚期疼痛的藝術

王昊靈　周晟杰/文　王一宇/譯

“To cure sometimes， to relieve often， to comfort always” is a famous inscription on the gravestone of American doctor Edward Livingston Trudeau.

美國醫(yī)生愛德華·利文斯頓·特魯多的墓碑上刻著一句名言：“偶爾治愈，常常緩解，總去安慰。”

That mantra has been adopted by many doctors around the world， including Shanghainese doctor Cheng Wenwu， director of the Department of Integrated Therapy at Fudan University Shanghai Cancer Center， who in 2006 established the first palliative treatment and care department in a Chinese grade III， class A hospital—the countrys best.

世界各地的許多醫(yī)生都信奉這句口號，其中就包括上海的成文武醫(yī)生。他是復旦大學附屬腫瘤醫(yī)院綜合治療科主任，于2006年在一家三甲醫(yī)院（中國的一流醫(yī)院）成立了中國第一個姑息治療與護理?？啤?/p>

In 2008， a couple walked into Chengs office. The husband， a surgeon， suffered from advanced intestinal cancer with metastasizing tumors. He came to Cheng not to be cured but to deal with the pain of dying， as his days seemed to be numbered. Cheng promised to do his best， using painkillers to relieve the surgeons pain. When he died two months later， his wife found a letter of thanks left for Cheng， which said “Thank you Dr Cheng for letting me live my final days almost pain-free， and helping me walk to the end of my life peacefully and with dignity.”

2008年，一對夫婦走進成醫(yī)生的診室，其中的丈夫是一名外科醫(yī)生，患有晚期腸癌伴腫瘤轉移。他來找成醫(yī)生并非為了治愈，而是為了應對垂死之痛，因為他似乎已經時日無多。成醫(yī)生承諾會盡最大努力，他用止痛藥來緩解這位外科醫(yī)生的疼痛。兩個月后，患者去世，他的妻子發(fā)現了他留給成醫(yī)生的感謝信。信中寫道：“謝謝成醫(yī)生讓我?guī)缀鯖]有痛苦地度過了最后時日，也謝謝成醫(yī)生幫助我安寧地、有尊嚴地走到生命盡頭?！?/p>

“One distinguishing feature of palliative care is a greater focus on mental health and pain management than on curing patients illnesses，” said Cheng. “Actually， most cancers cant be cured， but what I can do is try to alleviate their symptoms and improve their quality of life.”

“姑息關懷的一個顯著特點是，比起治好患者的病，更注重患者的心理健康和疼痛管理?！背舍t(yī)生說，“事實上，大多數癌癥都無法治愈，但我能做的就是盡力緩和他們的癥狀，提高他們的生活質量?！?/p>

According to official statistics in 2008–2009， 28，000 cancer patients die every year in Shanghai， but there are only 60 palliative care beds in the entire city， including 12 in Chengs department. In 2004， after 14 years spent treating advanced liver cancer， Cheng enrolled at The University of Texas MD Anderson Cancer Center in the United States—one of the largest cancer centers in the world. A graduate of the Shanghai University of Traditional Chinese Medicine， Cheng witnessed how much his patients suffered during the final stages of their lives. He decided to study palliative care and rehabilitation in the US to learn how to alleviate some of that suffering.

根據2008年至2009年的官方統(tǒng)計，上海每年有28000名癌癥患者死亡，但整個城市只有60個姑息關懷床位，其中包括成醫(yī)生所在科室的12個床位。2004年，在治療了14年晚期肝癌后，成醫(yī)生進入全球最大的癌癥中心之一——美國得克薩斯大學MD安德森癌癥中心學習。畢業(yè)于上海中醫(yī)藥大學的成醫(yī)生，曾目睹自己的患者在生命最后階段所遭受的痛苦。因此，他決定到美國進修姑息關懷和康復醫(yī)學，學習如何緩和這種痛苦。

“I had a really eye-opening experience at MD Anderson， which introduced me to a brand-new concept of providing support systems to advanced cancer patients， such as setting different levels of care for different patients and providing tailor-made treatment plans，” Cheng said.

“在MD安德森癌癥中心學習的經歷讓我大開眼界，我了解到了為晚期癌癥患者提供支持體系的新理念，比如為不同的患者安排不同級別的護理，提供量身定制的治療計劃?！背舍t(yī)生說。

Following his studies in the US， Cheng returned to Shanghai to practice and promote what he learned， including a proposal to the centers director to create a palliative care department. Two years later， that proposal became a reality. The integrated therapy department accepts all patients suffering from malignant tumors， including those have been turned away by other doctors.

在美國完成進修后，成醫(yī)生回到上海，實踐并推廣他所學的知識，包括向醫(yī)院領導提議成立姑息關懷科。兩年后，這一提議成為現實。綜合治療科接收患有各類惡性腫瘤的患者，包括被其他醫(yī)生拒之門外的患者。

Incorporating new concepts and basic guidelines from overseas， Cheng also localized the department by applying Chinese traditional medicine to patients care. “We didnt simply copy the Western model，” he said. “We enhanced it with traditional Chinese medicine， which can alleviate many symptoms Western medicine cant. My process is to take the first step and then reassess a patients condition before proceeding further. Some are cured， which I think is the essence of palliative care. Miracles happen here sometimes.”

除了吸收國外的新理念和基本方針，成醫(yī)生還將中醫(yī)應用于患者護理，從而實現了科室的本地化?！拔覀儾皇呛唵蔚卣瞻嵛鞣侥Ｊ??！彼f，“我們用中醫(yī)來強化西方模式，這樣就能夠緩和西醫(yī)無法緩和的許多癥狀。我的做法是先邁出第一步，然后重新評估患者的病情，再采取下一步行動。有些患者已經治愈了，我認為這是姑息關懷的精髓。奇跡有時會在這里發(fā)生?！?/p>

Xu Haiquan from Suzhou， Jiangsu Province， is one of those miracles. Two years ago， Cheng treated Xu who suffered from malignant mesothelioma. When the patient arrived， one of his symptoms was pleural effusion， or water on the lungs. To make Xu more comfortable， Cheng began by draining the fluid from his lungs. After draining more than 10，000 milliliters of fluid， he applied traditional Chinese medicine to strengthen his vital qi （energy flow） and body resistance. Amazingly， his condition greatly improved. “Even I did not expect that amazing outcome， because Xu had previously tried many Western treatments，” Cheng said. “It seems traditional Chinese medicine helped his immune system destroy cancerous cells.”

來自江蘇省蘇州市的徐海全（音譯）就是其中一個奇跡。兩年前，成醫(yī)生接診了這位患有惡性間皮瘤的患者。初診時，他的癥狀之一是胸腔積液，也稱肺積水。為了讓他舒服，成醫(yī)生先從他的肺部引流積液。排出超過10000毫升積液后，成醫(yī)生又用中醫(yī)來增強他的正氣（能量流）和身體抵抗力。令人驚訝的是，患者的病情大大好轉?！拔乙矝]想到會有如此驚人的效果，因為患者之前曾嘗試過許多西醫(yī)療法。” 成醫(yī)生說，“看來中醫(yī)幫助他的免疫系統(tǒng)消滅了癌細胞?！?/p>

Wu Yuese is another miracle. Wu lived with lung cancer for nine years， and in 2011 came to Cheng who applied traditional Chinese medicine during his chemotherapy treatments. “Its import-ant to escape from cancers darkness and have a good attitude，” said Wu. “Finding a good doctor isnt easy.” Wu conceded he initially feared palliative care and didnt want Cheng to treat him. “I then told myself I had to try， and if I didnt feel comfortable， I would leave，” he said. “Fortunately， I stuck it out， and thanks to Dr Cheng Im still alive.”

吳越瑟（音譯）是另一個奇跡。2011年，已患肺癌九年的他找到成醫(yī)生。在他化療期間，成醫(yī)生采用了中醫(yī)療法。“逃離癌癥陰霾，保持良好心態(tài)是很重要的?！眳窍壬f，“找到一個好醫(yī)生不容易?！彼渤姓J最初害怕接受姑息關懷，不想讓成醫(yī)生為他治療。“然后我告訴自己必須嘗試一下，如果覺得不舒服就停下。”他說，“幸運的是，我堅持了下來，多虧了成醫(yī)生，我還活著?！?/p>

Like many Chinese， Wu misunderstood the nature of palliative medicine. “Palliative care isnt about foregoing treatment，” Cheng said. “Initially， we deal with patients symptoms and relieve them of pain， then we determine the best course of action.” According to the World Health Organization， palliative care is a method that improves the quality of life of those with life-threatening illnesses—as well as their families—via early identification， assessments and addressing physical， psychosocial and spiritual issues.

和許多中國人一樣，吳先生之前誤解了姑息醫(yī)學的本質?！肮孟㈥P懷不等于放棄治療?！背舍t(yī)生說，“我們先是緩解患者的癥狀，減輕他們的痛苦。然后，我們確定最佳治療方案?！笔澜缧l(wèi)生組織表示，姑息關懷可通過早期識別、評估和解決身體、心理及精神問題，改善絕癥患者及其家屬的生活質量。

Cheng said Xu and Wu are exceptions to the reality that most patients he treats dont survive. “In my career， I have witnessed the death of about 1，500 patients.” Cheng said. “If half my patients are still alive after one year， thats good news. If 10 percent of them are still alive after five years， thats even better. What I do is offer a supportive system to help patients and their families cope.”

成醫(yī)生說，現實是他接診的大多數患者最終還是走向了死亡，徐先生和吳先生是例外?！霸谖业穆殬I(yè)生涯中，我親眼目睹了大約1500名患者的死亡。”他說，“如果我的患者半數能活到一年后，那便是個好消息。如果他們中的10%在五年后還活著，那就更好了。我所做的就是提供一個支持體系，幫助患者及其家屬應對病情?！?/p>

Cheng may be the only doctor in China who provides supportive services for bereaved families of his deceased patients. “The longest bereavement case Ive had lasted three and a half months，” said Cheng. “He was an old man who lost his wife and was devastated.” Every week or two， the old man came to Chengs outpatient clinic and chatted with him about the treatment his wife received and how she was able to die peacefully. These chats were clearly therapeutic. “One year later， he remarried and sent me candies from his wedding，” Cheng said.

成醫(yī)生可能是中國唯一為去世患者的家屬提供支持服務的醫(yī)生。“我參與最久的喪親支持個案持續(xù)了三個半月?！背舍t(yī)生說，“一位失去妻子的老人精神崩潰?！泵扛粢粌芍埽@位老人就會來看成醫(yī)生的門診，與成醫(yī)生聊聊妻子接受的治療，以及她是如何安寧離世的。這一次次聊天顯然很有療效?！耙荒旰?，他再婚了，還給我送來了喜糖?！背舍t(yī)生說。

Every day at 7：30 am， Cheng checks on patients with his colleagues， and visits them a second time before the end of the day. “All my patients endure critical illnesses that can quickly change，” he said. “Each days second round enables me to quickly respond to any changes. Moreover， the second visit is a more casual opportunity for me to address humanistic concerns.” During those second visits， Cheng chats with his patients about personal matters such as feelings and wishes.

每天早上七點半，成醫(yī)生會和同事一起查房，下班前還會查看一次。“我所有的病人都患有危重癥，病情可能迅速變化。”他說，“每天的第二輪查房能使我快速應對一切變化。而且，第二輪查房是個放松的時機，便于我提供人性關懷?！痹诘诙啿榉科陂g，成醫(yī)生會與患者聊聊個人話題，比如感受和愿望。

Every night before going to sleep， Cheng enjoys reading auction records and antique picture books. “Ancient artworks always make me feel peaceful，” he said， “I think its best for doctors to combine science and art， like telling patients the truth in an artistic way. Every patient is like an excellent textbook. If we learn something new from every patient we treat， we will be more successful treating future patients.”

每天晚上睡覺前，成醫(yī)生喜歡閱讀拍賣筆錄和古董繪本?！肮糯囆g品總能讓我靜下心來?！彼f，“我認為醫(yī)生最好將科學和藝術結合起來，比如用具有藝術性的方式告知患者病情真相。每位患者都像一本優(yōu)秀的教科書。如果我們能從自己治療的每一位患者身上學到新東西，那么我們未來就能更成功地治療患者?！?/p>

（譯者為“《英語世界》杯”翻譯大賽獲獎者；單位：北京大學國際法學院）