A few months ago, a 40 year-old woman came to an emergency room in a hospital close to where I live, and she was brought in confused. Her blood pressure was an alarming 230 over 170. Within a few minutes, she went into cardiac collapse. She was resuscitated, stabilized, whisked over to a CAT scan suite right next to the emergency room, because they were concerned about blood clots in the lung. And the CAT scan revealed no blood clots in the lung, but it showed bilateral, visible, palpable breast masses, breast tumors, that had metastasized widely all over the body. And the real tragedy was, if you look through her records, she had been seen in four or five other health care institutions in the preceding two years. Four or five opportunities to see the breast masses, touch the breast mass, intervene at a much earlier stage than when we saw her.
幾個月前, 一位四十歲的婦人來到急診室 在我住處附近的一家醫院內 她被送進來時,身體狀況混亂 她的血壓拉警報 收縮壓230,舒張壓170 幾分鐘內,她的心臟衰竭 她被施以心肺復甦、穩定下來 快速送到電腦斷層掃瞄室 就在急診室旁 因為他們擔心肺部有血塊 電腦斷層掃瞄顯示 在肺部沒有血塊 但胸部兩邊,有許多明顯、觸即可知的腫塊 胸部腫瘤 已經轉移擴散 遍及全身 真正可悲的是,若你翻閱其病歷表記錄 她已在其他四、五家 醫療照護機構中接受過檢查 接著幾年下來 有四到五次的機會 可以發現那些胸部腫塊 甚至也摸的出更早期就出現的胸部腫塊 不用等到我們見到她
Ladies and gentlemen, that is not an unusual story. Unfortunately, it happens all the time. I joke, but I only half joke, that if you come to one of our hospitals missing a limb, no one will believe you till they get a CAT scan, MRI or orthopedic consult. I am not a Luddite. I teach at Stanford. I'm a physician practicing with cutting-edge technology. But I'd like to make the case to you in the next 17 minutes that when we shortcut the physical exam, when we lean towards ordering tests instead of talking to and examining the patient, we not only overlook simple diagnoses that can be diagnosed at a treatable, early stage, but we're losing much more than that. We're losing a ritual. We're losing a ritual that I believe is transformative, transcendent, and is at the heart of the patient-physician relationship. This may actually be heresy to say this at TED, but I'd like to introduce you to the most important innovation, I think, in medicine to come in the next 10 years, and that is the power of the human hand -- to touch, to comfort, to diagnose and to bring about treatment.
各位女士、各位先生 這不是一個非比尋常的故事 很遺憾的是,這事老是發生 我開玩笑;但只是半開玩笑 如果你斷了一肢手臂或腿來到全美任何一家醫院 沒有人會相信你,除非他們做了電腦斷層掃瞄、磁共振造影 或骨外科會診 我不是一個反科技的人(Luddite) 我在史丹佛授課 我是一個以尖端科技執業的醫生 但我在接下來的 17分鐘想向你們證實 當我們省略檢查身體的步驟 當我們依賴安排測試 而非跟病人談話、檢查病人 我們不只輕忽簡單的診斷 -- 在可療癒的初期階段就能被診斷 -- 而且我們錯失的還不只是那樣 我們遺失一項儀式 我們正失掉了一種我相信是能改變、能超越的儀式 這同時也是 醫病關係中的核心 在TED大會說這個,也許確實怪異, 但我想向你們推介 這個極重要的變革 我認為,在醫學方面 在下一個十年的來臨 是人類手的威力 -- 去碰觸、紓解、診斷 並且帶入治療
I'd like to introduce you first to this person whose image you may or may not recognize. This is Sir Arthur Conan Doyle. Since we're in Edinburgh, I'm a big fan of Conan Doyle. You might not know that Conan Doyle went to medical school here in Edinburgh, and his character, Sherlock Holmes, was inspired by Sir Joseph Bell. Joseph Bell was an extraordinary teacher by all accounts. And Conan Doyle, writing about Bell, described the following exchange between Bell and his students.
我首先想介紹你們這個人 他的照片你們也許認得,也許不認得 這是亞瑟‧柯南‧道爾先生( Sir Arthur Conan Doyle) 從我們在愛丁堡,我就是個超級柯南‧道爾迷 你們可能不曉得柯南‧道爾進入醫學院 在愛丁堡這兒 而他筆下的人物夏洛克‧福爾摩斯(Sherlock Holmes) 是以喬瑟夫‧貝爾 (Sir Joseph Bell)為創作靈感 根據各方說法,喬瑟夫‧貝爾是一位超凡出色的老師 柯南‧道爾描寫貝爾 描述下述 貝爾和其學生間的交流
So picture Bell sitting in the outpatient department, students all around him, patients signing up in the emergency room and being registered and being brought in. And a woman comes in with a child, and Conan Doyle describes the following exchange. The woman says, "Good Morning." Bell says, "What sort of crossing did you have on the ferry from Burntisland?" She says, "It was good." And he says, "What did you do with the other child?" She says, "I left him with my sister at Leith." And he says, "And did you take the shortcut down Inverleith Row to get here to the infirmary?" She says, "I did." And he says, "Would you still be working at the linoleum factory?" And she says, "I am."
想像貝爾坐在門診部 學生們包圍住他 病人在急診室填寫資料 然後被登記並領入 一位女士帶著一個孩子進來 柯南‧道爾描寫下述的交談 那女人說:「早安」 貝爾問:「從奔提斯蘭(Burntisland) 搭渡輪過海行程怎樣啊?」 她回答:「一切平順。」 他接著問:「你的另一個小孩呢?」 她回答:「我留他在里斯(Leith)我姊姊家。」 他接著問: 「你走捷徑往印佛里斯(Inverleith Row) 來到醫院這兒的嗎?」 她回應:「是的。」 他接著問:「你仍是在油蠟地板工廠工作嗎?」 她回應:「是的。」
And Bell then goes on to explain to the students. He says, "You see, when she said, 'Good morning,' I picked up her Fife accent. And the nearest ferry crossing from Fife is from Burntisland. And so she must have taken the ferry over. You notice that the coat she's carrying is too small for the child who is with her, and therefore, she started out the journey with two children, but dropped one off along the way. You notice the clay on the soles of her feet. Such red clay is not found within a hundred miles of Edinburgh, except in the botanical gardens. And therefore, she took a short cut down Inverleith Row to arrive here. And finally, she has a dermatitis on the fingers of her right hand, a dermatitis that is unique to the linoleum factory workers in Burntisland." And when Bell actually strips the patient, begins to examine the patient, you can only imagine how much more he would discern. And as a teacher of medicine, as a student myself, I was so inspired by that story.
貝爾接著轉向學生解說 他說:「你們瞧,在她說『早安』時 我學起她的Fife(位於蘇格蘭東方)口音 從Fife來最近的渡輪旅程是由奔提斯蘭(Burntisland) 因而,她必定乘渡輪而來。 你們有注意到她拿著的那件外套 對和她一道來的那孩子而言,太小了 因此,她開始是和兩個孩童同行 但在途中放下一個小孩 你們注意看她雙腳底下的土 這樣的紅土在愛丁堡方圓一百英里內看不到 除了在植物園 由此可知,她走捷徑往印佛里斯(Inverleith Row) 來到這兒的 最後一點,她有皮膚炎 在她右手的手指 該皮膚炎是好發於 奔提斯蘭(Burntisland)油蠟地板工廠的工人。」 而其實,當貝爾讓病人脫去衣物 開始檢查病人, 你能想像到,他會覺察出的又更多 身為一位醫學老師,也身為一位學生 這故事激發我的靈感
But you might not realize that our ability to look into the body in this simple way, using our senses, is quite recent. The picture I'm showing you is of Leopold Auenbrugger who, in the late 1700s, discovered percussion. And the story is that Leopold Auenbrugger was the son of an innkeeper. And his father used to go down into the basement to tap on the sides of casks of wine to determine how much wine was left and whether to reorder. And so when Auenbrugger became a physician, he began to do the same thing. He began to tap on the chests of his patients, on their abdomens. And basically everything we know about percussion, which you can think of as an ultrasound of its day -- organ enlargement, fluid around the heart, fluid in the lungs, abdominal changes -- all of this he described in this wonderful manuscript "Inventum Novum," "New Invention," which would have disappeared into obscurity, except for the fact that this physician, Corvisart, a famous French physician -- famous only because he was physician to this gentleman -- Corvisart repopularized and reintroduced the work.
但你可能不了解 我們以這樣簡單的方式 使用我們的感官,來檢查身體 是相當近代的方法 我讓你們看的這張圖像是李奧波得‧奧恩布魯格(Leopold Auenbrugger) 在18世紀末 他發現「叩診法」 故事是李奧波得‧奧恩布魯格(Leopold Auenbrugger) 是一位旅館老闆的兒子 他的父親過去常會到地下室 輕敲酒桶側面 以判定還剩多少酒 決定是否要再訂酒 因此當李奧波得(Auenbrugger)成為一名醫生 他開始效法其父之舉 他開始輕敲病患的胸膛 他們的腹部 基本上,我們對叩診的了解 你可以想成是那個時代的超音波 -- 器官腫大、心臟周圍的流體、肺中流體 腹部變化 -- 所有叩診法門他都敍述在這本精采的手冊 《創新發明(Inventum Novum拉丁文)》 這本書本會如石沈大海,無人聞問 要不是這名醫生柯比沙特(Corvisart) 他是位有名的法國醫生 -- 出名只因為他是這位男士的醫生 -- 柯比沙特(Corvisart)重新宣揚並採用這法門
And it was followed a year or two later by Laennec discovering the stethoscope. Laennec, it is said, was walking in the streets of Paris and saw two children playing with a stick. One was scratching at the end of the stick, another child listened at the other end. And Laennec thought this would be a wonderful way to listen to the chest or listen to the abdomen using what he called "the cylinder." Later he renamed it the stethoscope. And that is how stethoscope and auscultation was born. So within a few years, in the late 1800s, early 1900s, all of a sudden, the barber surgeon had given way to the physician who was trying to make a diagnosis.
約一、兩年後,接著 雷涅克(Laennec)發明了聽診器 據說,雷涅克(Laennec)當時走在巴黎的街道 看到二個小孩玩著一根棍子 一個小孩在一端刮著 另一個小孩在另一頭聽著 雷涅克(Laennec)認為這會是一種妙法 來聽診胸部或腹部 用他稱之為「圓筒」的東西 稍後他為其重新命名為聽診器(stethoscope) 這就是聽診器和聽診問世的原由 所以在幾年內 在十九世紀末、二十世紀初 倏然 「理髮師兼外科手術師」已被 試圖作診斷的醫生取代
If you'll recall, prior to that time, no matter what ailed you, you went to see the barber surgeon who wound up cupping you, bleeding you, purging you. And, oh yes, if you wanted, he would give you a haircut -- short on the sides, long in the back -- and pull your tooth while he was at it. He made no attempt at diagnosis. In fact, some of you might well know that the barber pole, the red and white stripes, represents the blood bandages of the barber surgeon, and the receptacles on either end represent the pots in which the blood was collected. But the arrival of auscultation and percussion represented a sea change, a moment when physicians were beginning to look inside the body.
如果回想在那以前 無論什麼讓你不適、痛苦,你向「理髮師兼外科手術師」求助 他們到頭來對你拔罐 放血、通腸 當然,若你想的話 他會幫你理髮 -- 兩旁短,後面長 -- 順便拔掉你的牙 他無心診斷 事實上,你們某些人也很可能知道 理髮師的紅白相間圓筒招牌 代表「理髮師兼外科手術師」的血液繃帶 而底座的托盆 則相當於承接血液的鍋盆 但聽診和叩診的問世 意味著瞬息巨大的轉變 醫生開始檢察人體內部的時期開始
And this particular painting, I think, represents the pinnacle, the peak, of that clinical era. This is a very famous painting: "The Doctor" by Luke Fildes. Luke Fildes was commissioned to paint this by Tate, who then established the Tate Gallery. And Tate asked Fildes to paint a painting of social importance. And it's interesting that Fildes picked this topic. Fildes' oldest son, Philip, died at the age of nine on Christmas Eve after a brief illness. And Fildes was so taken by the physician who held vigil at the bedside for two, three nights, that he decided that he would try and depict the physician in our time -- almost a tribute to this physician. And hence the painting "The Doctor," a very famous painting. It's been on calendars, postage stamps in many different countries. I've often wondered, what would Fildes have done had he been asked to paint this painting in the modern era, in the year 2011? Would he have substituted a computer screen for where he had the patient?
而我認為這張獨特的畫作 象徵著臨床時代的巔峰高點 這是一幅很有名的彩畫 《醫生》由路克‧菲爾德茲(Luke Fildes) 路克‧菲爾德茲受塔特(Tate)所託 此人當時創立英國塔特美術館(Tate Gallery) 塔特要求菲爾德茲繪出 「社會的重要性」的畫 而有趣的是,菲爾德茲選擇了這個主題 菲爾德茲之長子菲力普(Philip) 在九歲時的聖誕節前夕 在一場短暫的病後歸天 而菲爾德茲深深感念醫師的舉措 -- 這位醫生在一旁守護兩、三夜 他便決定嘗試描繪 美國那時代的醫生 -- 可說是對該醫生致敬意 因而此畫作《醫生》頗負盛名 在很多國家的日曆或月曆和郵票上都可以看到 我常在想,菲爾德茲會怎麼做 要是他被要求畫這幅畫 在現代? 在2011年? 他會改繪畫「電腦銀幕」 在「病人」的位置嗎?
I've gotten into some trouble in Silicon Valley for saying that the patient in the bed has almost become an icon for the real patient who's in the computer. I've actually coined a term for that entity in the computer. I call it the iPatient. The iPatient is getting wonderful care all across America. The real patient often wonders, where is everyone? When are they going to come by and explain things to me? Who's in charge? There's a real disjunction between the patient's perception and our own perceptions as physicians of the best medical care.
在矽谷(Silicon Valley)我已惹上一些麻煩 因我說在病榻的病人 已幾乎成了雕像 在電腦內的是真正的病人 事實上,我給電腦內的實體造了個詞 我稱其為「iPatient」 全美「iPatient」得到無微不至的看照 真正的病人常奇怪 人都上哪去了? 他們何時才會來向我說明我的情況? 誰負責的? 確實有分歧存在於病人的觀感 和身為最佳醫療保健醫師的我們自己的觀感
I want to show you a picture of what rounds looked like when I was in training. The focus was around the patient. We went from bed to bed. The attending physician was in charge. Too often these days, rounds look very much like this, where the discussion is taking place in a room far away from the patient. The discussion is all about images on the computer, data. And the one critical piece missing is that of the patient.
我要讓你們看張照片 關於巡診是怎麼一回事 當我還在受訓時 焦點是投注在病人身上 我們一張病床巡過一張病床,由主治醫生負責 這些日子大多數 巡診八九不離十看起來就像這樣 病情討論的地點 就在遠離病人的小會議室 討論的內容不外乎是電腦影像、數據資料 而遺漏了關鍵的那部分 就是病人
Now I've been influenced in this thinking by two anecdotes that I want to share with you. One had to do with a friend of mine who had a breast cancer, had a small breast cancer detected -- had her lumpectomy in the town in which I lived. This is when I was in Texas. And she then spent a lot of time researching to find the best cancer center in the world to get her subsequent care. And she found the place and decided to go there, went there. Which is why I was surprised a few months later to see her back in our own town, getting her subsequent care with her private oncologist.
現在我有這種想法,而且我已經受兩件 發生在我周遭的事所影響,我要跟你們分享。 一件是與我的那位曾罹患胸癌的友人有關 其被偵察到有小型胸癌 在我過去居住的城市中,進行她的乳房腫瘤切除 這是當我還在德州時發生的事 而且她那時花了好多時間研究 為了找出世界最佳癌症中心 獲得後續照護 她找到那個地方、決定去那並到了那裡。 那是為何我會訝異,在幾個月後 看到她重返我們自己的城市 接受私人腫瘤專家的後續照護
And I pressed her, and I asked her, "Why did you come back and get your care here?" And she was reluctant to tell me. She said, "The cancer center was wonderful. It had a beautiful facility, giant atrium, valet parking, a piano that played itself, a concierge that took you around from here to there. But," she said, "but they did not touch my breasts." Now you and I could argue that they probably did not need to touch her breasts. They had her scanned inside out. They understood her breast cancer at the molecular level; they had no need to touch her breasts.
我打破砂鍋似的追問她: 「為何你回來這兒接受照護?」 而她不情不願的告訴我。 她說:「那間癌症中心是好極了 有完備的設施 有寬敞的中庭、代客泊車 自動彈奏的鋼琴 領著你四處逛的接待 但......」,她說: 「但他們不觸碰我的胸部。」 此時你和我會爭論 他們大可能不用觸碰她的胸部 他們將她由裡到外掃瞄 他們了解她胸癌的分子狀態 他們不需觸碰她的胸部
But to her, it mattered deeply. It was enough for her to make the decision to get her subsequent care with her private oncologist who, every time she went, examined both breasts including the axillary tail, examined her axilla carefully, examined her cervical region, her inguinal region, did a thorough exam. And to her, that spoke of a kind of attentiveness that she needed. I was very influenced by that anecdote.
但對她而言,卻是很重要 足以讓她作出決定 聘用她私人的腫瘤專家作後續照護 每次那腫瘤專家看診 檢查兩邊胸部,包括腋窩尾部 仔細地檢查她的腋窩 檢查她的頸部、她的腹股溝區域 作全面徹底的檢查 而且對她而言,這表明了她需要的關注 我深受那件事影響
I was also influenced by another experience that I had, again, when I was in Texas, before I moved to Stanford. I had a reputation as being interested in patients with chronic fatigue. This is not a reputation you would wish on your worst enemy. I say that because these are difficult patients. They have often been rejected by their families, have had bad experiences with medical care and they come to you fully prepared for you to join the long list of people who's about to disappoint them. And I learned very early on with my first patient that I could not do justice to this very complicated patient with all the records they were bringing in a new patient visit of 45 minutes. There was just no way. And if I tried, I'd disappoint them.
另一個經歷也讓我心有所感 同樣,我還在德州,未搬到史丹佛時 眾所周知 我關注於 慢性疲勞症的病患 就是你最難纏的敵人,你也不願其被冠上這樣的名號 我這麼說,是因為這些是棘手的病人 他們往往無法得到家人的體諒 他們歷經不佳的醫療對待 他們來到你這兒已作好打算 把你列入那長串名單中 會讓他們失望的人之一 我在很早時就由我的首位病人了解 我無法充分審視 這位經歷曲折複雜的病人 憑著隨著他們走的病歷記錄 以及由和一位新病人45分鐘的門診知道的 真的沒辦法 若我這麼做,我會令他們失望
And so I hit on this method where I invited the patient to tell me the story for their entire first visit, and I tried not to interrupt them. We know the average American physician interrupts their patient in 14 seconds. And if I ever get to heaven, it will be because I held my piece for 45 minutes and did not interrupt my patient. I then scheduled the physical exam for two weeks hence, and when the patient came for the physical, I was able to do a thorough physical, because I had nothing else to do. I like to think that I do a thorough physical exam, but because the whole visit was now about the physical, I could do an extraordinarily thorough exam.
所以我想到了這個方法 我鼓勵病人 在他們首次到診時,告訴我他們的病史 我試著不去打斷他們 我們曉得美國醫師 平均14秒打斷他們的病人的話 而若我真到了天堂 那是因為我靜候不語45分鐘 且不打斷病人說話 然後我排定兩週後的身體檢查 當那病人到診檢查身體 我能執行一個徹底的身體檢查 因為那是我能做的 我喜歡認為自己執行一個徹底的身體檢查 但因此時這整個回診是有關身體檢查 我可以執行徹徹底底的檢查
And I remember my very first patient in that series continued to tell me more history during what was meant to be the physical exam visit. And I began my ritual. I always begin with the pulse, then I examine the hands, then I look at the nail beds, then I slide my hand up to the epitrochlear node, and I was into my ritual. And when my ritual began, this very voluble patient began to quiet down. And I remember having a very eerie sense that the patient and I had slipped back into a primitive ritual in which I had a role and the patient had a role. And when I was done, the patient said to me with some awe, "I have never been examined like this before." Now if that were true, it's a true condemnation of our health care system, because they had been seen in other places.
我記得我那首位病人在一聯串檢查中 繼續告訴我更多的病史 在安排用來作身體檢查的看診時間 我開始診斷儀式 我總是由把脈開始 然後我檢查其雙手,接著我檢視其指甲肉床 然後我的手上移去觸診上滑車淋巴結 我熱衷於診斷的儀式 我的診斷儀式開始時 這位滔滔不絶的病人 開始安靜無聲 我記得有種奇異的氛圍 我和病人 不知不覺地進入原始的儀式 在儀式中我有個任務 病人有一個任務 我完成儀式時 病人語帶敬畏的對我說: 「我之前從未被像這樣子檢查過。」 若那真是如此 我們的醫療照護體制就責無旁貸 因為他們已在其他地方就診過
I then proceeded to tell the patient, once the patient was dressed, the standard things that the person must have heard in other institutions, which is, "This is not in your head. This is real. The good news, it's not cancer, it's not tuberculosis, it's not coccidioidomycosis or some obscure fungal infection. The bad news is we don't know exactly what's causing this, but here's what you should do, here's what we should do." And I would lay out all the standard treatment options that the patient had heard elsewhere.
我接著告訴病人 待他穿好衣衫時 所謂的「制式標準」──那人必定在其他醫療機構已有所聞 就是:「這不是你腦袋想的; 這是真的。 好消息是,這不是癌症;這不是結核病 不是球黴菌症或某種不知名的黴菌感染。 壞消息是,我們不曉得究竟是什麼導致的 但這兒是你應做的;這兒是我們該做的。」 我會列出所有的標準治療供選擇 病人在別處已有所聞
And I always felt that if my patient gave up the quest for the magic doctor, the magic treatment and began with me on a course towards wellness, it was because I had earned the right to tell them these things by virtue of the examination. Something of importance had transpired in the exchange. I took this to my colleagues at Stanford in anthropology and told them the same story. And they immediately said to me, "Well you are describing a classic ritual." And they helped me understand that rituals are all about transformation.
我總認為 若我的病人放棄尋求 巫醫、巫術治療 並開始與我進行一項創造健康的療程 是因為我已得其精髓 藉著檢查的過程 告知他們這些事情 某個東西的重要性在交流中已昭然若揭 我把這與我在 史丹佛人類學的同事分享 並告訴他們同樣的故事 他們立刻對我說: 「嗯,你說的是一種古典的儀式。」 且他們幫助我了解 儀式是關於徹底改觀或轉變
We marry, for example, with great pomp and ceremony and expense to signal our departure from a life of solitude and misery and loneliness to one of eternal bliss. I'm not sure why you're laughing. That was the original intent, was it not? We signal transitions of power with rituals. We signal the passage of a life with rituals. Rituals are terribly important. They're all about transformation. Well I would submit to you that the ritual of one individual coming to another and telling them things that they would not tell their preacher or rabbi, and then, incredibly on top of that, disrobing and allowing touch -- I would submit to you that that is a ritual of exceeding importance. And if you shortchange that ritual by not undressing the patient, by listening with your stethoscope on top of the nightgown, by not doing a complete exam, you have bypassed on the opportunity to seal the patient-physician relationship.
舉例來說,人們結婚 由場面壯觀、儀式隆重及大手筆的花費 以宣告脫離 寂寞、悲慘和孤單的生活 投身永恆美滿幸福人生 我不知道為何你們在笑 這是初始的意圖對吧? 我們發出權力交接的訊號 透過儀式 我們發出人生邁入新階段的訊號,透過儀式 儀式非常的重要 關乎徹底轉變 我向你們主張 這個儀式 一個人來到另一人面前 告訴他們事情 那是他們不會對牧師或拉比(rabbi)吐露的話 難以置信尤勝之的是 脫去衣物和允許觸碰 -- 我向你們主張,那是一項極為重要的儀式 若你跳過儀式,當為而不為 不脫去病人衣物 而用你的聽診器在睡袍上聽診 不執行全套的檢查 你已錯過機會 建立醫生與病人之間聯結
I am a writer, and I want to close by reading you a short passage that I wrote that has to do very much with this scene. I'm an infectious disease physician, and in the early days of HIV, before we had our medications, I presided over so many scenes like this. I remember, every time I went to a patient's deathbed, whether in the hospital or at home, I remember my sense of failure -- the feeling of I don't know what I have to say; I don't know what I can say; I don't know what I'm supposed to do. And out of that sense of failure, I remember, I would always examine the patient. I would pull down the eyelids. I would look at the tongue. I would percuss the chest. I would listen to the heart. I would feel the abdomen. I remember so many patients, their names still vivid on my tongue, their faces still so clear. I remember so many huge, hollowed out, haunted eyes staring up at me as I performed this ritual. And then the next day, I would come, and I would do it again.
我是一個作家 我要念一段我寫的文章來結束今天演說 與這場景大為相關 我是一名傳染性疾病的醫師 在愛滋病的早期,在有醫療資源前 我負責很多諸如此類的場合 我記得,每次我走到病人的床榻 無論是在醫院或在家中 我記得我的挫折感 -- 我不知道我必須說些什麼的那種感覺 我不曉得我能說什麼 我不清楚我應該要做些什麼 擺脫那種挫敗感 我記得,我總會檢查病人 我會下拉其眼瞼 我會檢視其舌頭 我會輕叩其胸膛,我會聆聽其心臟 我會觸摸其腹部 我記得諸多的病人 他們的名字我仍然叫得出來 他們的臉龐依然如此清晰 我記得一雙雙斗大、凹陷、愁困的眼睛 當我執行這項儀式盯著我 接著,第二天 我會再來並重覆執行這項儀式
And I wanted to read you this one closing passage about one patient. "I recall one patient who was at that point no more than a skeleton encased in shrinking skin, unable to speak, his mouth crusted with candida that was resistant to the usual medications. When he saw me on what turned out to be his last hours on this earth, his hands moved as if in slow motion. And as I wondered what he was up to, his stick fingers made their way up to his pajama shirt, fumbling with his buttons. I realized that he was wanting to expose his wicker-basket chest to me. It was an offering, an invitation. I did not decline.
我要向你們朗讀這篇尾聲的小節 與某個病患有關 「我回想起某個病人 在那一刻 他瘦骨嶙峋 被一層萎縮的皮包覆著 無法說話 他的嘴覆蓋著念珠菌 那對一般的醫療藥品有抗藥力 當他看到我時 正是他在這個地球停滯的最後幾小時 他的雙手彷彿是以慢速在移動 當我奇怪他正想做什麼時 他如枝條般的手指慢慢地 移向他的睡衣 摸索著衣扣 我了解他正想要 讓我看他那如柳條所編織出的胸膛。 這是一項提供、一項邀約 我沒拒絶
I percussed. I palpated. I listened to the chest. I think he surely must have known by then that it was vital for me just as it was necessary for him. Neither of us could skip this ritual, which had nothing to do with detecting rales in the lung, or finding the gallop rhythm of heart failure. No, this ritual was about the one message that physicians have needed to convey to their patients. Although, God knows, of late, in our hubris, we seem to have drifted away. We seem to have forgotten -- as though, with the explosion of knowledge, the whole human genome mapped out at our feet, we are lulled into inattention, forgetting that the ritual is cathartic to the physician, necessary for the patient -- forgetting that the ritual has meaning and a singular message to convey to the patient.
我輕敲、觸摸、耹聽其胸膛 我想他那時想必已知曉 這對我而言是極為重要的 正如對他而言是必要的 我倆皆不會略過這項儀式 這無關乎診察肺中的羅音(rale) 也無關於發現心臟衰竭的馬奔律動(gallop rhythm) 不,這儀式是關於一個訊息 醫師有必要傳達給他們的病人 雖然,天知道,近來,在我們的傲慢驕盈中 我們似乎已漸行漸遠 我們似乎已忘卻 -- 彷彿,隨著知識的爆炸 整個人類基因體攤開在我們的腳前 我們漫不經心 忘了對醫師而言,這項儀式是淨化導引 對病人是種需要 -- 忘了儀式的意義 有微妙的訊息要傳遞給病人
And the message, which I didn't fully understand then, even as I delivered it, and which I understand better now is this: I will always, always, always be there. I will see you through this. I will never abandon you. I will be with you through the end."
那時,我尚不完全明白訊息的含意 當在我傳達它時 而現在我對它有較佳理解: 「我將永遠、永遠、永遠在那裡, 我將助你渡過此關; 我將永不離棄你, 我會伴著你直到穿越終點。」
Thank you very much.
非常感謝你們
(Applause)
(掌聲)