《梅奧住院醫生成長手記》

聶卉

邁克爾.柯林斯（Michael J. Collins），美國作家、醫生，生于芝加哥。柯林斯從圣母大學畢業后成為一名建筑工人，與一位同事的偶然聊天讓他有了當醫生的夢想，柯林斯選擇重返校園，他考入了羅耀拉大學醫學院，從此開啟了另一種人生。他的著作《磚工變醫生》（Blue Collar， Blue Scrubs， 2009）追溯了這段從建筑工人到成為一名醫生的追夢歷程。柯林斯從醫學院畢業后進入世界頂尖的梅奧醫療研究中心，進行為期四年的住院醫生培訓，他將這段終生難忘的魔鬼式經歷記錄了下來，寫成了《梅奧住院醫生成長手記》（Hot Lights， Cold Steel， 2006）。從梅奧結業后柯林斯回到家鄉芝加哥，成為一名骨科醫生。現在他與妻子和12個子女一起生活在那里，業余時光用來寫作和樂隊演出。

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的內心痛苦與掙扎，略有刪節。

2. sharp [?ɑ?（r）p] adj. 敏銳的，聰明的，機靈的

3. anatomy [??n?t?mi] n. 解剖；解剖學

New Oriental English .

作品賞析

多年以后，芝加哥的骨科醫生柯林斯念念不忘的仍是他早年在梅奧醫療研究中心的四年魔鬼式住院醫生培訓。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念這段歲月，并執意將其定義為美好時光的柯林斯醫生來說，大概是不言自明的。

美國醫生的高薪酬早已聲名在外，這位柯林斯醫生卻用身家性命無時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。從圣母大學畢業的柯林斯成為一名建筑工人，但當醫生的夢想從心靈的角落里燃起后，就煽動著這位不安于現狀的年輕人開啟了打雞血的人生。柯林斯成功考入羅耀拉大學醫學院學習，畢業后進入世界頂尖的梅奧醫療研究中心，進行為期四年的住院醫生培訓，醫學院期間就已是大齡學生的他，課余都在停車場打工養家糊口，既沒有搞過學術研究，也沒有寫過像樣的論文，有的只是對醫學的夢想和熱情。走進高手如云的梅奧，這個迷戀手術刀的“呆瓜”一時覺得自己是件假冒偽劣產品，甚至直到四年住院醫生結束時，他依然覺得自己能力不夠。

但是，千萬不要被這位醫生的謙遜迷惑了雙眼。柯林斯在羅耀拉大學醫學院成績非常優秀，他受過良好的專業培訓，并且成功得到了系主任的推薦信。正是因為如此出色，他才得以來到梅奧，但謙遜卻引導柯林斯始終如初學者般孜孜不倦。當然，梅奧的魔鬼式培訓絲毫不會辜負這些佼佼者們。兩年初級住院醫生，兩年高級住院醫生，中間還有半年的基礎科學培訓，這就是梅奧住院醫生要完成的全部內容。但要全部通關，順利成為一名醫生，鬼知道他們這四年要經歷什么。以下是柯林斯醫生的獨家秘籍寶典。

通關第一步：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、在手術臺邊握牽引器、半夜去開靜脈監控，當然還要將每一項手術熟稔于心、應用于手，對于主治醫生的命令，住院醫生要說的永遠是：“Yes， Sir ！” 伴隨所有這些的是不眠不休連軸轉的日日夜夜。傳呼機一響，他們就要離開床、家人、吃了一半的晚餐，在任何時間從任何地方狂奔向急診室。

但柯林斯做了更多。這個每天都極度缺乏睡眠的人，一個月中還要有幾天凌晨四點起床，在梅奧查完房后，驅車145公里到另一個醫院連續做24～36小時的兼職，因為住院醫生的薪酬每小時只有2.5美元，這樣他基本上連續工作14～21天才能休息一天。而在所有的空余時間，這位瘋狂學霸除了陪家人，就全用來學習了。每天晚上他都如強迫癥般看筆記到凌晨兩三點，原因有三：一是因為他對自己的無知感到羞愧；二是因為他意識到病人的健康甚至生命都掌握在自己手里；三是因為他熱愛這項工作。

通關第二步：身經百煉，閱人無數。住院醫生將學習在超負荷環境下應對各種突發情況，見識數不清的槍傷、截肢、斷腸、車禍、死亡，當然，當那種哭笑不得、說不出口的病例來到你面前時，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，有時還要把一位美麗姑娘的半個骨盆和一整條腿都切除掉。從在手術中僅僅劃開一道刀口，到能獨自承擔一項手術，這一過程需要無數臨床病例和密集的手術實踐積累。

通關第三步：靈魂大作戰。考驗柯林斯的當然并不僅僅是專業知識、臨床經驗、體能或者睡眠不足。作為一名醫生，每日與病人為伴，生命的脆弱和死神的強大無時無刻不在拷問著這位剛剛走進手術室的年輕住院醫生。柯林斯無比熱愛自己的職業，即使在家庭經濟狀況捉襟見肘的情況下，他擔心的也并不是經濟現狀、職業前景，而是在面對每一個亟待拯救的生命時，自己是否有足夠的能力幫助他們。“我想成為那個人們遇到人生的不公而要求幫助的那個人，我想成為直面人生不公并且將不公驅逐出境的那個人。”死神每一分每一秒都在發出挑釁，讓這位住院醫生無論何時、無論何地都要準備奔赴戰場。然而有時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服，填寫完死亡證明，獨自一人時，那些盡最大努力仍然回天乏術的絕望，那些無法挽救病人生命的挫敗感，就匆匆趕來折磨這位醫生的靈魂。“還要做什么？還能做什么？”有一些問題永遠沒有答案。柯林斯醫生慢慢明白醫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生；說服自己不是法官，在病人做了愚蠢的事情、打亂治療計劃時，去幫助他而不是對他的行為做出評判；說服自己堅持初心，在被死神和實用主義控場時，仍能時刻反省，用心去關心和體諒每一位病人。

你相信時光機嗎？夢想就是一架時光機，帶領我們成為未來更好的人。柯林斯最終以住院總醫生的身份為這四年時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，他必須在醫院連續兼職48小時再飛回芝加哥，才能趕在搬家工人抵達時把錢如數奉上。大概也只有如此熱血又無悔的戰斗，才能無愧地給這段魔鬼歲月予以“美好”兩個字。

現代社會改變了許多事物的量變周期，但“年輕”兩個字仍然如永恒般耀眼。二三十歲的年紀，始終像在經歷一場打怪升級的游戲，雖然可能不用像柯林斯醫生一樣練習從死神手里搶救生命，卻擁有和命運一搏的最強戰斗力。你的夢想實現了嗎？你的戰斗還在哪個階段停步不前？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生一樣，奔赴時光機的另一端，向曾經的魔鬼時光致敬。

柯林斯住院醫生獨家通關秘籍，以上。

4. rupture [?r?pt??（r）] vt. 使破裂，使裂開

5. artery [?ɑ?（r）t?ri] n. [解] 動脈

6. morgue [m??（r）ɡ] n. 陳尸所；停尸室

7. OR：opertating room （手術室）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. （醫生做手術穿的）防護衣

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）創傷