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，醫療小組在過道上停留了許久。實習醫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，他出現了便血癥狀。他被診斷出患結腸癌，癌細胞已經大范圍地擴散到肝臟和肺部。這位M先生，現在正處于化療的第二個療程。

“我們能做的不多，”實習醫師傷感地說道。我理解她的不安，但是作為主治醫師，我并不贊同她的看法。“我們一定還能做點什么，”我堅決地對小組成員們說道。雖然當我們圍繞在病床邊時，我內心也懷疑自己的話。

“如果知道我們要辦派對，我會事先準備些零食，”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。”小組成員們局促不安地笑了。

我問M先生是否有任何疑問，腫瘤醫師是否有講述不清楚的地方。“并沒有，”他指著旁邊的點滴泵說道。“我現在是癌癥專家——不信你問我，任何問題都可以！”他喝了一大口安素。“這巧克力味道真不錯，”他沖著成員們眨眼說道。那位實習醫師說得對，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。“好極了，”他答道，像拳擊手一樣活動著肩膀。“第一個療程去除掉一切癥狀，包括胃痛，便血。我覺得我徹底恢復了。”化療第一個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。……