A Tale of America’s Two Healthcare Systems美國(guó)兩套醫(yī)療衛(wèi)生體系的故事

Walking into the main hospital building at NYU on my way to orientation on my first day， I passed through what’s known as the Hall of Portraits. This is a long bank of paintings in gilded frames hanging in a corridor off the main lobby at Tisch hospital. Every single one of the faces I saw in those portraits was that of a white man. Some wore glasses， some posed with microscopes， others held a pen in hand. Doubtless， these men in the pictures were physicians and surgeons who had made important scientific advancements in their respective fields over the past few centuries. They certainly would have benefited from the racist and sexist admission policies that had excluded people who looked like me from medicine for centuries.

入職紐約大學(xué)的第一天，我走進(jìn)附屬醫(yī)院主樓，穿過(guò)了人們所說(shuō)的專家走廊。專家走廊在紐約大學(xué)蒂施醫(yī)院的大廳外，墻上懸掛著一長(zhǎng)排用金色相框裝裱著的專家肖像畫。無(wú)一例外，這些肖像畫中全部都是白人男性。他們有人戴著眼鏡，有人在顯微鏡旁，有人則手握鋼筆。毋庸置疑，畫中的都是幾個(gè)世紀(jì)以來(lái)在各自領(lǐng)域做出杰出科學(xué)貢獻(xiàn)的內(nèi)科醫(yī)師和外科醫(yī)生。很顯然他們都是醫(yī)學(xué)界種族主義和性別歧視招生政策的受益者，而恰是這種政策將像我一樣的人隔絕在了醫(yī)學(xué)領(lǐng)域之外長(zhǎng)達(dá)數(shù)個(gè)世紀(jì)。

I was the very first Black woman faculty member in my department. It was 2010. I chose to keep my head high. I walked past the bank of portraits with a sense that my very presence was a rebuke to the white men in those paintings， that I did belong there. I reminded myself that it was important for me to be in these kinds of spaces so that Black students and residents could see someone who looked like them， came from the same communities as them， and cared deeply about our communities， who could mentor， motivate and inspire them.

我是所在系的第一位黑人女教職工，入職那一年是2010年。穿過(guò)專家走廊時(shí)，我昂首挺胸，我覺(jué)得，我的到來(lái)就是對(duì)畫像中白人男性的批判，仿佛我屬于這里。我提醒自己，能夠來(lái)到這里工作意義不同尋常，黑人醫(yī)學(xué)生和住院實(shí)習(xí)醫(yī)師將看到這里有人長(zhǎng)得和他們相似，和他們來(lái)自同一社群，深切地關(guān)心著我們這個(gè)群體，將帶給他們指導(dǎo)、激勵(lì)和鼓舞。

My days as faculty were divided up between my clinical shifts in the emergency department， supervising medical students and residents， and my academic work. On the academic side， I was giving lectures to students， running workshops with residents and engaging in educational research in ultrasound， focusing on how this technology could be better leveraged as a tool to teach anatomy and physiology1.

作為教職工，我的工作內(nèi)容包括急診部的臨床出診、指導(dǎo)醫(yī)學(xué)生和住院實(shí)習(xí)醫(yī)師，以及教學(xué)工作。在教學(xué)方面，我要給醫(yī)學(xué)生授課、與住院實(shí)習(xí)醫(yī)師開(kāi)展研討，同時(shí)，參與超聲方面的教學(xué)研究——主要研究如何更好地利用超聲技術(shù)來(lái)講授解剖與生理學(xué)。

The other three or four days of the week， I was a practicing physician at one of two ERs. The first was at NYU Tisch， the private hospital that was part of the university. The other was at Bellevue， the public hospital affiliated with the medical school. These two ERs sit right next door to each other.

一周中的另外三四天，我則作為執(zhí)業(yè)醫(yī)生在兩個(gè)急診室之一出診。一個(gè)在學(xué)校的私立醫(yī)院——紐約大學(xué)蒂施醫(yī)院，另一個(gè)在醫(yī)學(xué)院附屬的公立醫(yī)院——貝爾維尤醫(yī)院。兩個(gè)急診室正好相鄰。

Named for the family of billionaires who endowed the institution， Tisch hospital was highly resourced in every way. No patient had to share a room with anyone else， every patient was accounted for， and arranging follow-up appointments was a breeze. The people in the waiting room at Tisch were relatively wealthy， insured， with access to high-quality care outside the ER—and by extension， they were mostly white.

蒂施醫(yī)院以捐建這座醫(yī)院的億萬(wàn)富翁家族的姓氏命名，醫(yī)療資源很充足。所有患者都有單獨(dú)診室，每人都有專人負(fù)責(zé)，預(yù)約復(fù)診也輕而易舉。相對(duì)來(lái)說(shuō)，蒂施醫(yī)院候診室中的患者相對(duì)富有且有醫(yī)療保險(xiǎn)，在急診室以外也能得到高質(zhì)量的醫(yī)療服務(wù)——由此可想而知，他們大多數(shù)都是白人。

My other shifts were spent at the Bellevue ER， part of the largest hospital in New York City and the oldest public hospital in the country. At Bellevue， patients came from every corner of the city—and the world. This was an ER with a reputation for being a place where no one would be turned away， regardless of their immigration status or ability to pay.

其余出診時(shí)間我都在貝爾維尤醫(yī)院急診室。貝爾維尤醫(yī)院是紐約最大的、美國(guó)最古老的醫(yī)院，患者來(lái)自紐約乃至全世界的各個(gè)角落。眾所周知，在貝爾維尤，無(wú)論患者移民身份如何，支付能力高低，沒(méi)有人被拒絕接診。

Bellevue was a chaotic place. The ER sits right next door to a large men’s shelter for people who are unhoused， which meant we were taking care of people struggling with lack of safe and adequate housing and a host of physical and mental health problems.

醫(yī)院環(huán)境十分嘈雜，急診室隔壁是一個(gè)大型的收容所，住滿了無(wú)家可歸的人。這也就意味著，我們接診的患者沒(méi)有安身之所，且有各種身心健康問(wèn)題。

I can still remember the pain-stricken features of a young Black man who came in with a broken leg that had become dangerously infected. He had been hit by a car several weeks back and had been taken to one of the other ERs in the city， where he was diagnosed with a tibia-fibula fracture2 in his leg. He had been discharged with a splint， but because the hospital staff there hadn’t arranged for proper follow-up for him， he had been sitting at home suffering in increasingly unbearable pain. Eventually， he came to us， where we diagnosed him with necrotizing fasciitis3， an infection of the tissues beneath the skin， a very serious and potentially life-threatening condition that could have been avoided if he’d only been able to see a doctor many weeks ago. We would often care for patients like this who had been “l(fā)ost to follow-up”， which meant that although they had been treated at the time of their emergency， they hadn’t been able to access care beyond that point.

我依然記得一位年輕黑人因?yàn)橐粭l斷腿重度感染進(jìn)入診室時(shí)臉上那備受疼痛煎熬的表情。他幾周以前被車撞倒，在紐約的另一家醫(yī)院急診室確診了腿部脛腓骨骨折，打上夾板后離開(kāi)了醫(yī)院。但由于醫(yī)院工作人員沒(méi)為他安排妥善的后續(xù)治療，他只能忍受著日益加劇的疼痛待在家中。最后來(lái)到我們醫(yī)院時(shí)，他已經(jīng)出現(xiàn)壞死性筋膜炎，皮下組織感染非常嚴(yán)重，甚至可能危及生命。要是幾周前他能夠得到診治，這種情形本可以避免。我們經(jīng)常接診這樣因醫(yī)院“未隨訪”而病情惡化的患者。換言之，盡管他們?cè)诩痹\時(shí)得到了救治，卻沒(méi)有條件獲得后續(xù)的必要醫(yī)療服務(wù)。

At the private hospital， although the patients presented as polite and well-spoken， I experienced a certain level of disrespect. I could sense as soon as I entered a room if my white patients were going to have problems with me; I had learned to detect a flicker of confusion in their eyes as they sized me up， trying to figure out how I fit in.

在私立醫(yī)院，盡管患者顯得禮貌客氣、言辭謙恭，我卻感受不到被尊重。一進(jìn)入診室我就能感知到我的白人患者會(huì)否對(duì)我挑剔。當(dāng)他們打量著我、暗自推斷我是否適合這項(xiàng)工作時(shí)，我能覺(jué)察到他們眼中閃過(guò)的一絲疑惑。

One time， the chief of service in the emergency department called to tell me there was a problem with one of my patients.

有次，急診部的部門主管打電話來(lái)說(shuō)我的一位患者很不高興。

“Really？” I asked. “What’s going on？”

“是嗎？”我問(wèn)，“怎么了？”

The chief explained that this patient had complained he hadn’t seen the supervising doctor yet.

主管解釋說(shuō)，這位患者抱怨他到現(xiàn)在還沒(méi)有見(jiàn)到主管醫(yī)師。

“But I was just with that patient，” I explained. “I saw him， examined him and recommended treatment.”

“可我剛剛還和這個(gè)患者在一起。”我解釋道，“我過(guò)去給他做了檢查并且給出了治療建議。”

It didn’t take us long to figure out what had happened. Although I had spent a full 20 minutes with this patient， this white man had refused to believe that a Black woman could be his supervising doctor.

沒(méi)過(guò)多久，我們就搞清楚了是怎么回事。盡管我花了整整20分鐘時(shí)間為他看診，這位白人男性卻不肯相信一位黑人女性竟會(huì)是他的主管醫(yī)師。

To this day， only 9% of the discharged patients at Tisch are Black， compared with 26% from Bellevue. Across the nation， studies show that Black patients are two to three times less likely than white patients to be seen at private academic medical centers， which have a reputation for providing superior care.

到今天為止蒂施醫(yī)院的康復(fù)出院患者中只有9%是黑人，這個(gè)數(shù)據(jù)在貝爾維尤醫(yī)院是26%。放眼全國(guó)，研究顯示，黑人患者在以提供高端醫(yī)療服務(wù)著稱的私立教學(xué)醫(yī)療中心就診的比例是白人患者的1/3到一半。

Working at NYU， we knew that when EMS picked up unhoused patients in an ambulance， they would never bring those patients to the private hospital. They only brought them to the public hospital. This was the unspoken rule. We all knew that interns weren’t allowed to work at Tisch ER because that would mean a wealthy private patient might complain of inadequate care. Instead， if you were an intern， you went to work at the Bellevue ER， where the assumption was that people would be grateful for your help， no matter how inexperienced you were.

在紐約大學(xué)，我們都知道，當(dāng)一位無(wú)家可歸的患者被接上救護(hù)車時(shí)，他不可能被送到私立醫(yī)院，只會(huì)被送往公立醫(yī)院。這是不成文的規(guī)定。從所周知，實(shí)習(xí)醫(yī)生不可能進(jìn)入蒂施醫(yī)院急診室實(shí)習(xí)，因?yàn)樗搅⑨t(yī)院里富有的病患可能會(huì)投訴照護(hù)不周。相反，假如一位實(shí)習(xí)醫(yī)生進(jìn)入貝爾維尤醫(yī)院急診室，可以預(yù)見(jiàn)的是，無(wú)論他多么缺乏經(jīng)驗(yàn)，患者都會(huì)感激他的幫助。

I always felt disconnected at Tisch. It didn’t matter how friendly or accepting my colleagues were， the institution had always been clear about who mattered （or didn’t） to them. After all， I was one of only two Black faculty members on staff in my department of more than 100 faculty. This brought with it a different kind of exhaustion. Although we had far more resources than any other hospital where I’d ever worked， it could never feel like home.

在蒂施我經(jīng)常感到格格不入。無(wú)論同事們多么友善包容，蒂施對(duì)于誰(shuí)重要（或誰(shuí)不重要）一向劃分得涇渭分明。畢竟，我只是所在部門超過(guò)100位教職工中僅有的2位黑人員工之一。這就伴隨著另一種疲憊感。盡管蒂施擁有的資源比我工作過(guò)的其他任何一家醫(yī)院都要多，但在這兒我永遠(yuǎn)不會(huì)有歸屬感。

（譯者為“《英語(yǔ)世界》杯”翻譯大賽獲獎(jiǎng)?wù)撸?/p>

1 anatomy and physiology解剖與生理學(xué)。

2 tibia-fibula fracture脛腓骨骨折。" 3 necrotizing fasciitis壞死性筋膜炎。