《梅奥住院医生成长手记》

聂卉

邁克尔.柯林斯（Michael J. Collins），美国作家、医生，生于芝加哥。柯林斯从圣母大学毕业后成为一名建筑工人，与一位同事的偶然聊天让他有了当医生的梦想，柯林斯选择重返校园，他考入了罗耀拉大学医学院，从此开启了另一种人生。他的著作《砖工变医生》（Blue Collar， Blue Scrubs， 2009）追溯了这段从建筑工人到成为一名医生的追梦历程。柯林斯从医学院毕业后进入世界顶尖的梅奥医疗研究中心，进行为期四年的住院医生培训，他将这段终生难忘的魔鬼式经历记录了下来，写成了《梅奥住院医生成长手记》（Hot Lights， Cold Steel， 2006）。从梅奥结业后柯林斯回到家乡芝加哥，成为一名骨科医生。现在他与妻子和12个子女一起生活在那里，业余时光用来写作和乐队演出。

迈克尔.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. 本文選自该书的第七章，讲述了自己竭尽全力却仍无法挽救病人时的内心痛苦与挣扎，略有删节。

2. sharp [?ɑ?（r）p] adj. 敏锐的，聪明的，机灵的

3. anatomy [??n?t?mi] n. 解剖；解剖学

New Oriental English .

作品赏析

多年以后，芝加哥的骨科医生柯林斯念念不忘的仍是他早年在梅奥医疗研究中心的四年魔鬼式住院医生培训。所谓 “梅奥虐我千万遍，我待梅奥如初恋”，这句话对写一本书来纪念这段岁月，并执意将其定义为美好时光的柯林斯医生来说，大概是不言自明的。

美国医生的高薪酬早已声名在外，这位柯林斯医生却用身家性命无时无刻不在反驳这条真理：“不是这样的！”捉襟见肘、疲于奔命、出生入死——这些凄惨壮烈的词语用来形容柯林斯似乎也稍显逊色。从圣母大学毕业的柯林斯成为一名建筑工人，但当医生的梦想从心灵的角落里燃起后，就煽动着这位不安于现状的年轻人开启了打鸡血的人生。柯林斯成功考入罗耀拉大学医学院学习，毕业后进入世界顶尖的梅奥医疗研究中心，进行为期四年的住院医生培训，医学院期间就已是大龄学生的他，课余都在停车场打工养家糊口，既没有搞过学术研究，也没有写过像样的论文，有的只是对医学的梦想和热情。走进高手如云的梅奥，这个迷恋手术刀的“呆瓜”一时觉得自己是件假冒伪劣产品，甚至直到四年住院医生结束时，他依然觉得自己能力不够。

但是，千万不要被这位医生的谦逊迷惑了双眼。柯林斯在罗耀拉大学医学院成绩非常优秀，他受过良好的专业培训，并且成功得到了系主任的推荐信。正是因为如此出色，他才得以来到梅奥，但谦逊却引导柯林斯始终如初学者般孜孜不倦。当然，梅奥的魔鬼式培训丝毫不会辜负这些佼佼者们。两年初级住院医生，两年高级住院医生，中间还有半年的基础科学培训，这就是梅奥住院医生要完成的全部内容。但要全部通关，顺利成为一名医生，鬼知道他们这四年要经历什么。以下是柯林斯医生的独家秘籍宝典。

通关第一步：累成狗。他们必须在骨科、门诊部、急诊部、肿瘤部、儿童部等科室轮番受教，要做的是打杂、查夜、缝合伤口、在手术台边握牵引器、半夜去开静脉监控，当然还要将每一项手术熟稔于心、应用于手，对于主治医生的命令，住院医生要说的永远是：“Yes， Sir ！” 伴随所有这些的是不眠不休连轴转的日日夜夜。传呼机一响，他们就要离开床、家人、吃了一半的晚餐，在任何时间从任何地方狂奔向急诊室。

但柯林斯做了更多。这个每天都极度缺乏睡眠的人，一个月中还要有几天凌晨四点起床，在梅奥查完房后，驱车145公里到另一个医院连续做24～36小时的兼职，因为住院医生的薪酬每小时只有2.5美元，这样他基本上连续工作14～21天才能休息一天。而在所有的空余时间，这位疯狂学霸除了陪家人，就全用来学习了。每天晚上他都如强迫症般看笔记到凌晨两三点，原因有三：一是因为他对自己的无知感到羞愧；二是因为他意识到病人的健康甚至生命都掌握在自己手里；三是因为他热爱这项工作。

通关第二步：身经百炼，阅人无数。住院医生将学习在超负荷环境下应对各种突发情况，见识数不清的枪伤、截肢、断肠、车祸、死亡，当然，当那种哭笑不得、说不出口的病例来到你面前时，你也得装作再平常不过的样子。他们要帮病人拔出插在鼻子上的鱼钩，或者一边陪醉鬼胡扯一边缝合摔得惨不忍睹的伤口，有时还要把一位美丽姑娘的半个骨盆和一整条腿都切除掉。从在手术中仅仅划开一道刀口，到能独自承担一项手术，这一过程需要无数临床病例和密集的手术实践积累。

通关第三步：灵魂大作战。考验柯林斯的当然并不仅仅是专业知识、临床经验、体能或者睡眠不足。作为一名医生，每日与病人为伴，生命的脆弱和死神的强大无时无刻不在拷问着这位刚刚走进手术室的年轻住院医生。柯林斯无比热爱自己的职业，即使在家庭经济状况捉襟见肘的情况下，他担心的也并不是经济现状、职业前景，而是在面对每一个亟待拯救的生命时，自己是否有足够的能力帮助他们。“我想成为那个人们遇到人生的不公而要求帮助的那个人，我想成為直面人生不公并且将不公驱逐出境的那个人。”死神每一分每一秒都在发出挑衅，让这位住院医生无论何时、无论何地都要准备奔赴战场。然而有时即使做了所有正确的事情，尽了最大的努力，敌人依然胜出。

在脱下满身血迹的手术服，填写完死亡证明，独自一人时，那些尽最大努力仍然回天乏术的绝望，那些无法挽救病人生命的挫败感，就匆匆赶来折磨这位医生的灵魂。“还要做什么？还能做什么？”有一些问题永远没有答案。柯林斯医生慢慢明白医生最大的敌人并不是死神，而是自己。必须说服自己不是天使，而是为治愈患者而竭尽全力的医生；说服自己不是法官，在病人做了愚蠢的事情、打乱治疗计划时，去帮助他而不是对他的行为做出评判；说服自己坚持初心，在被死神和实用主义控场时，仍能时刻反省，用心去关心和体谅每一位病人。

你相信时光机吗？梦想就是一架时光机，带领我们成为未来更好的人。柯林斯最终以住院总医生的身份为这四年时光划上了完美的句号，但从梅奥到芝加哥任职的道路似乎并不比这四年的哪一刻轻松，因付不起搬家费，他必须在医院连续兼职48小时再飞回芝加哥，才能赶在搬家工人抵达时把钱如数奉上。大概也只有如此热血又无悔的战斗，才能无愧地给这段魔鬼岁月予以“美好”两个字。

现代社会改变了许多事物的量变周期，但“年轻”两个字仍然如永恒般耀眼。二三十岁的年纪，始终像在经历一场打怪升级的游戏，虽然可能不用像柯林斯医生一样练习从死神手里抢救生命，却拥有和命运一搏的最强战斗力。你的梦想实现了吗？你的战斗还在哪个阶段停步不前？是否沉迷在loser的自我定义中无法抽身？是否因沉重的工作怨气满天？是否终于认同了大家口中“梦想终会变得麻木”的托辞，就此打算带着遗憾过这一生？轻装上阵吧，把那些在追逐梦想路上的失落、疲惫和困惑通通打败，像谦逊又努力的柯林斯医生一样，奔赴时光机的另一端，向曾经的魔鬼时光致敬。

柯林斯住院医生独家通关秘籍，以上。

4. rupture [?r?pt??（r）] vt. 使破裂，使裂开

5. artery [?ɑ?（r）t?ri] n. [解] 动脉

6. morgue [m??（r）ɡ] n. 陈尸所；停尸室

7. OR：opertating room （手术室）的缩略语

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

9. scrub [skr?b] n. （医生做手术穿的）防护衣

10. IV：静脉注射的缩略语

11. tumble [?t?mb（?）l] vi. 倒塌，坍塌

12. acumen [??kj?m?n] n. 敏锐；聪明

13. trauma [?tr??m?] n. 外伤；伤口；（心理上、精神上的）创伤