病房里的婚禮

There wasnt going to be a happy ending. The patient had metastatic[轉移性的] cancer and had just gone through her third unsuccessful regimen[療程] of chemotherapy[化療]. Now it seemed that everywhere we looked， we found disease.

When she arrived in the intensive care unit[重癥監(jiān)護病房]， she was delirious[神智昏迷的]. I asked her the usual questions， about her medical history， and whether she wanted us to do CPR注1 if her heart were to stop beating， but she didnt answer. I was just setting the clipboard[帶夾子的寫字板] aside when she raised a hand and told me： “Doc， do everything you can. I need to make it to my daughters wedding.”

She was in a lot of pain. She had a tube down her nose draining[引流] her stomach.

“When is the wedding？” I asked.

“Next summer.”

I blinked[眨眼]. I blinked again. She didnt—she was looking right at me. At this point， I doubted shed make it through the hospitalization[住院治療]， let alone eight more months. I didnt know what I could say. I put the stethoscope[聽診器] against her chest and fell into silence.

I met Stefanie， her daughter， the next morning. She was 24， but was only eight when her mothers cancer was first diagnosed[診斷]. Stefanie had shared her home with cancer for many years， and had always seen her mother fight.

But she knew that this time was different. The oncology[腫瘤學] fellow who had been treating her mother as an outpatient[門診病人] was the one to tell her that her mother was dying. Stefanie broke down， but understood there was no use denying[否認] it. The dream of a family wedding under the summer sun turned sour[令人失望，變壞].

Stefanie called her fiance[未婚夫] that morning. Crying， she told him the news. But he turned things completely around. Without hesitation[猶豫] he told her， “I want her to be there， too，” and he promised not only to have the wedding done sooner， but to have it done right there in the ICU.

Our medical team was used to dealing with all kinds of crises[危機]： Handling a last-minute wedding was not one of them. While having more than one opinion on a medical team regarding[關于] how best to manage a patient is fairly routine[日常的]， we received no push back from anyone as we started to make arrangements for[安排某事] the wedding. Soon the whole team was involved. We sent a letter to the court[法院] to speed up the marriage certificate[結婚證]. A pastor[牧師] and harp[豎琴] player were booked. The hospital cafeteria[自助餐廳] baked a chocolate cake， and the nurses brought in flowers. In just a few days， we were ready.

My job was to make sure our patients pain was controlled while also avoiding the confusion[混亂狀態(tài)] that is a side effect[副作用] of narcotic[麻醉] medications. But miraculously[奇跡般地]， she didnt need pain medications for hours and was fully aware of everything that was going on. Looking at the bride[新娘] and groom[新郎] from her hospital bed， she seemed more comfortable than I had ever seen her before. The whole day had an unreal feel to it; everything felt like it slowed down. The sun shone through the windows and glistened[閃耀] on the bags of fluid[液體]. For once in the hospital， there were tears but no pain. It felt as if， after all these years of chasing our patient down， even the cancer took a break.

The next morning， the family decided to move her to hospice. No intubation[插管]， no CPR—nothing that would prolong[延長] life. It was all about trying to make the patient comfortable. （And yet， four months later， she is still alive.）

In todays efficiency[效率]obsessed[著迷] medical world， its easy to forget that healing patients isnt just about treating diseases and relieving[減輕] symptoms[癥狀]. There are things doctors and nurses can do， meaningful interventions[干涉]—like helping patients fulfill final goals or spend quality time注2 with their families—that cannot be documented[記錄] in a discharge summary[出院小結] or be converted[轉變] into a blip[評論] on a screen.

As a doctor， I never liked the word “miracle.”I preferred to think in terms of[以……措辭] “medical outliers[異常值].” And yet that day of the wedding did feel like a miracle. Doctors often share their patients sorrow[悲傷]， but rarely their joys. We had not discovered the cure to cancer， but we had achieved something powerful—freeing， if only temporarily[短暫地]， our patient from her disease.

One of the nurses， smiling through her tears， spoke to me after it was all over. “It was magical，”she said. “None of the patient alarms went off.”

在這里不會出現(xiàn)幸福的大團圓結局。那個病人的癌細胞已經轉移擴散，而且剛做完的第三次化療效果也很不理想。現(xiàn)在，我們發(fā)現(xiàn)她似乎渾身上下都是病。

剛轉到重癥監(jiān)護病房（ICU）的時候，她已經神志不清了。我問了一些關于她病史的常規(guī)問題。我還問她如果她的心臟驟停，是否希望我們?yōu)樗鲂姆螐吞K術，但她不予回答。正當我要把寫字板放到一邊的時候，她舉起一只手，對我說：“醫(yī)生，請您盡一切努力幫我。我要參加我女兒的婚禮。”

她忍受著巨大的痛苦——她的鼻子下插著一根直接通到胃部的引流管。

“婚禮什么時候舉行？”我問道。

“明年夏天。”

我眨了下眼睛，再眨了一次。她沒眨眼——正定定地看著我。在這一刻，我懷疑她能否挺過這次住院治療，更別提撐到八個月以后了。我不知道該說什么好，于是我把聽診器放在她的胸膛上，然后陷入了沉默。

第二天早晨我見到了斯蒂芬妮，她的女兒。她今年24歲，八歲那年，她媽媽第一次被確診患上癌癥。多年來，癌癥的陰影籠罩著這個家。斯蒂芬妮總在一旁看著母親與病魔作斗爭。

但她知道這次不一樣。為她母親做門診治療的醫(yī)生告訴她，她母親將不久于人世。斯蒂芬妮幾近崩潰，但她知道否認毫無意義。在夏日陽光下舉辦家庭婚禮的夢想一下子被擊得粉碎。

那天早上，斯蒂芬妮給她的未婚夫打電話，哭著告訴他這個噩耗。但他完全扭轉了局面。他毫不猶豫地對斯蒂芬妮說：“我希望她也能參加我們的婚禮。”他承諾婚禮不但會盡快舉行，而且還要在重癥監(jiān)護病房里舉辦。

我們的醫(yī)療團隊處理過各種各樣的緊急事件，但讓一個生命垂危的人參加婚禮并不在其中。對于如何為病人提供最佳治療方案，一個醫(yī)療團隊常常會有不同的意見，但我們從籌備婚禮開始卻沒有受到任何阻力。沒過多久，整個團隊都參與了進來。我們給法院寄了一封信，催促他們盡快辦好結婚證。牧師和豎琴演奏家也都預約好了。醫(yī)院的自助餐廳烤了一個巧克力蛋糕，護士們帶來了鮮花。只用了幾天，一切就準備就緒。

我的工作是確保我們的病人疼痛得到緩解，同時還要避免由麻醉藥物帶來的副作用——精神錯亂。但奇跡般地，她在幾個小時里沒有服用任何止痛藥，而且在整個婚禮過程中都保持著絕對清醒。看著病床邊的新郎新娘，她似乎比以往任何時候都愜意。這一天讓人感覺很不真實，仿佛世間一切都放慢了腳步。陽光透過窗戶照射進來，在輸液袋上迸發(fā)出璀璨的光芒。這是第一次，醫(yī)院里流淌著的淚水沒有痛苦。似乎這么多年來一直追著病人跑的癌癥，也停下了腳步。

第二天早上，她的家人決定把她轉到臨終關懷醫(yī)院。沒有插管，沒有心肺復蘇術——沒有任何延長生命的醫(yī)療手段。那里的一切都是為了讓病人活得舒服些。（然而四個月后，她依然活著。）

在今天這個講求效率的醫(yī)療世界，我們很容易就忘了治病不僅僅是治好疾病和緩解癥狀。醫(yī)護人員還可以做其他一些事，采取一些有意義的干預措施——比如幫助病人實現(xiàn)最終目標，或者讓病人與家人一起共享天倫之樂——雖然這些措施都不會被記錄在出院小結上，也不會轉變成屏幕上的信息。

作為一名醫(yī)生，我一向不喜歡“奇跡”這個詞。我更愿意稱之為“醫(yī)療異常值”。然而那天的婚禮的確像是一個奇跡。醫(yī)生經常分擔病人的苦痛，卻甚少分享他們的快樂。雖然我們還沒發(fā)現(xiàn)治愈癌癥的方法，但我們已經得到了一種強有力的東西——讓我們的病人從疾病的痛苦中解脫出來，哪怕只是片刻。

婚禮結束后，其中一位護士笑中帶淚地對我說：“這真是太神奇了，（婚禮期間）沒有任何一個病人的呼叫器被按響。”