学文网The medical team hung back in the hallway before entering the patient’s room. The intern had just presented the case―a 50-year-old man who’d never seen a doctor until three months before， when he noticed blood in his 1）stool. It turned out he had extensive 2）colon cancer that had already spread to the liver and lungs. The man， Mr. M， was now admitted for his second cycle of chemotherapy.
“Nothing much for us to do，” the intern said grimly. I understood her unease， but as the 3）attending physician， I couldn’t 4）second her opinion.“There’s always something for us to do，” I told the team 5）gamely. Inside， though， as we gathered in a semicircle around the bed， I doubted my words.
“If I’d known we were having a party， I’d have gotten some snacks，” said Mr. M with a lopsided grin， slim and young-looking in his Yankees cap.“All I got is 6）Ensure， if anyone’s drinking.” My team smiled nervously.
I asked Mr. M if he had any questions， if there was anything the 7）oncologists hadn’t fully explained. “Nope，” he said， as he gestured to the IV pump at his side. “I’m the cancer expert now―ask me anything！” He took a swig of his Ensure. “And the chocolate ain’t bad，”he said， winking at the team. The intern was right； there really wasn’t anything for us to do. For lack of a better topic， I asked him how he was feeling. “Great，” he replied， rolling his shoulders like a boxer. “That first chemo got rid of everything―the pains in my stomach， the blood in the toilet. I’m totally back to normal.”It was a 8）stupendous success that one round of chemotherapy had resolved his symptoms， but something in the conviction of his voice didn’t sit right with me. I changed tactics， asking what sort of work he did. “I just finished my first season as a park ranger in Brooklyn.” He cracked his 9）knuckles. “If they like me， they’ll hire me back next season.” Next season？ The team around me shuffled awkwardly. Carefully， I asked him what he understood of his diagnosis.
“Well，” he said， shoving the baseball cap further back on his head. “I know that it’s traveled to the liver and my lungs. I know that it’s serious， but it’s not the fatal type.” Not the fatal type？ I could feel the weight of his statement ricochet like a ball bearing through each member of the team. Delicately， I asked if he knew what it meant to have cancer in other parts of his body.“Means I got to do chemo every month，” he said， patting the IV pump.
And had the oncologists explained what the chemotherapy could achieve？
Mr. M rubbed a nonexistent moustache with two fingers. “I ain’t never really thought about that，”he said slowly. “I guess it’s supposed to make me better.”
I slowed my pace of speaking to match his， gently explaining that while chemotherapy might shrink the tumors and make him more comfortable， it would not be able to take the cancer away completely. That at Stage IV， the cancer could not be cured.
“I knew that，”hesaid ， almost defensively. “They told me that.” He swung his legs over the side of the bed so that he was sitting up straight in front of me， the crisp whites of his eyes just inches from mine. “So， Doc，” he said， letting the back of one hand fall into the palm of the other with an audible slap， “how much time I got？”
The din of the hospital seemed to dissipate， leaving a wincing silence in the room. I closed my eyes for a moment―a reflex that sometimes happens when I need to gather my courage. There are few situations more horrible than having to tell another human being that he or she is going to die. And it doesn’t get any easier with experience. I started to tell him that every person is different， that it’s impossible to give an exact number. But five medical trainees stood behind me. If I evaded the question， or relied on euphemisms， I would fail them and fail our patient. “According to the books，” I said， “for people with Stage IV cancer， the average…” I stopped. Even after having told this to countless patients， I still had trouble. “The average is about 6 to 12 months.” There. I’d gotten it out. And now the numbers lay there―harsh and unforgiving. I quickly added that some people live longer， but some live less time， that it was difficult to predict.
Mr. M’s left eyebrow inched up his forehead， 10）corrugating the skin directly above it. “So you’re saying that if I’ve always wanted to go to Vegas I should do it now？” His voice wasn’t accusing， or even disappointed. It just sounded thoughtful. I told him I wished I could give him better news.
“I’m a lousy gambler，” he said with a shrug. “But maybe I’ll do better now， knowing there’s nothing to lose.” A 11）pensive stillness suffused the room， and we all seemed to find our own spots on the floor to focus on. Finally， collective breaths were exhaled， and as if by unspoken agreement the moment of silence drew to a close. In quieter voices， we discussed the future―when Mr. M might start to feel ill， what he should say to his employer， advance directives. We agreed to continue the conversation the next day， after he’d had more time to think.
When we reassembled in the hallway outside， the intern slumped against the wall， visibly drained. The team awkwardly shifted papers and 12）stethoscopes. The intern shook her head slowly， but couldn’t seem to put her feelings into words. We’d all known Mr. M’s prognosis before we entered the room. But now that it had been put into words―given life， as it were―it was a 13）palpable， disquieting presence among us. It trailed us as we made our way silently down the hall.
在走进病房之前，医疗小组在过道上停留了许久。实习医师刚刚介绍了这宗病案――一位50岁的老人，以前从未生过大病，直到三个月前，他出现了便血症状。他被诊断出患结肠癌，癌细胞已经大范围地扩散到肝脏和肺部。这位M先生，现在正处于化疗的第二个疗程。
“我们能做的不多，”实习医师伤感地说道。我理解她的不安，但是作为主治医师，我并不赞同她的看法。“我们一定还能做点什么，”我坚决地对小组成员们说道。虽然当我们围绕在病床边时，我内心也怀疑自己的话。
“如果知道我们要办派对，我会事先准备些零食，”M先生歪嘴笑着说，他戴着洋基队棒球帽，显得清瘦且年轻。“如果谁想喝点什么，我这只有安素。”小组成员们局促不安地笑了。
我问M先生是否有任何疑问，肿瘤医师是否有讲述不清楚的地方。“并没有，”他指着旁边的点滴泵说道。“我现在是癌症专家――不信你问我，任何问题都可以！”他喝了一大口安素。“这巧克力味道真不错，”他冲着成员们眨眼说道。那位实习医师说得对，我们确实无能为力。一时找不到更好的话题，于是我问他感觉如何。“好极了，”他答道，像拳击手一样活动着肩膀。“第一个疗程去除掉一切症状，包括胃痛，便血。我觉得我彻底恢复了。”化疗第一个疗程就消解了他的症状，这是极其惊人的效果，但是他声音中那坚定的语气总让我觉得不对劲。我换个提问方式，问他是做什么工作的。“我在布鲁克林刚做完一个季度的公园管理员。”他扳了下手指关节。“如果他们觉得我不错，下个季度还会雇我。”下个季度？站在旁边的小组成员们都尴尬地挪了挪脚步。我小心地询问他对自己的诊断结果到底了解多少。
“嗯，”他往后拉了拉棒球帽。“我知道癌细胞扩散到了肝脏和肺部。我明白情况很严重，但是不足以致命。”不足以致命？我可以感受到，他这话的重量像弹球般在我们每个成员的脸上碾过。我小心翼翼地问他是否明白这意味着身体其他部位也发生了癌变。“我只知道每个月都必须去化疗，”他说道，轻轻地拍了拍点滴泵。
难道肿瘤医师们没有解释化疗的效力吗？
M先生两个手指摩擦着并没有胡子的下巴。“我其实没有认真想过这些，”他慢慢说道。“我只是觉得化疗会渐渐使我好起来。”
我放慢语速，和缓地解释道，尽管化疗能缩小肿瘤，使他免受那么多痛苦，但是并不能完全根治癌症。癌症第四期，并无方法治愈。
“我知道，”他说道，几乎带着警觉的语气。“他们告诉过我。”他把双腿挪到床边，这样他刚好坐在我面前，他眼睛距离我不过几英尺，干涩的眼白清晰可见。“那么，医生，” 他一只手的手背啪一声拍在另一只手的掌心内，“我还有多少时间？”
医院的喧闹似乎在那一刻消失了，整个病房内一片死寂。我闭上眼片刻――这是每当我需要鼓起勇气时的一种习惯。再没有什么事情比告知某人死期将至更加可怕了。无论我经历过多少次这样的情形，我仍然无法应付自如。我开始向他解释每个病人情况不同，给出确切的数字几乎是不可能的。但是五个实习医师还站在我身后。如果我回避问题或者是委婉回答，不仅会让他们失望，也会令病人失望。“据书上所说，”我说道，“癌症第四期患者，一般……”我停顿了。即使已经和无数患者说过很多次，我仍然没能一次说完。“一般还有半年到一年的时间。”就这样，我最终说了出来。此时，那些数字摆在那里――显得残酷无情。我马上补充道，有些人活得更久些，有些则没能活得那么久，这些都无法预料。
M先生抬高眉毛，额头上出现了皱纹。“所以你的意思是如果我想去维加斯，我现在应该马上去？”他的语气并不是责问，也不是失望，倒是令人深思。我对他说真希望自己可以告诉他更好的消息。
“我是个差劲的赌徒，”他耸耸肩说道。“但是现在这样或许更好，我知道自己没什么可失去的了。”一种略带哀伤的静默充斥着病房，我们只能转而凝视着地板上一个点。最后，大家都松了一口气，不约而同打破了寂静。我们压低声音开始讨论不久的将来――M先生再次发病时，他应该怎么和雇主说，给他一些预先指示。我们决定第二天再继续谈话，这样他能有更多的时间考虑这些问题。
当我们再次聚在病房外的走道上，实习医师斜靠在墙上，明显已经筋疲力尽。小组成员们都整理着手中的文件或是拨弄着听诊器。实习医师慢慢地摇了摇头，却无法诉说出自己的感受。我们在走进病房前就都已了解了M先生的病情。但现在说出来以后――就仿佛赋予了它生命一样――这是一个显而易见，令人不安的存在，就这样悄悄地，一路尾随着我们下楼直至大厅。