WhenBreathBecomesAir原版完整文件.docx

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1、ContentsCover7Ie PageCcpvrigKEditorS NOteEDigraDhFCrrWord by AbrdhGn WqhcsePiologuePart I: In PelfeCt Health I BeginPaIl II: CeaSe NOt till DeathEpilogue by LUCy KabnithiDediCaonAckncwkdgmcnfsAbout the AuthorEvents described are based on Dr. Kalanithi,s memory of real-world situations. However, tle

2、names of all patients discussed in this bookif given at allhave been changed. In addition, in each of the medical cases described, identifying detailssuch as patients, ages, genders, ethnicities, professions, familial relationships, places of residence, medical histories, and/or diagnoseshave been c

3、hanged. With one exception, the names of Dr. Kalanithi,s colleagues, friends, and treating physicians have also been changed. Any resemblance to persons living or dead resulting from changes to names or identifying details is entirely coincidental and unintentional.You that seek what life is in deat

4、h, Now find it air that once was breath. New names unknown, old names gone: Till time end bodies, but souls none.Reader! then make time, while you be, But steps to your eternity.Baron Brooke Fulke Greville, uCaelica 83”FOREWORDAbraham VergheseIt occurs to me, as I write this, that the foreword to th

5、is book might be better thouglit of as an afterword. Because when it comes to Paul Kalanithi, all sense of time is turned on its head. To begin withor, maybe, to end withI got to know Paul only after his death. (Bear with me.) I came to know him most intimately when he,d ceased to be.I met him one m

6、emorable afternoon at Stanford in early February 2014. He,d just published an op-ed titled “How Long Have I Got Left?” in The NeW Wrk Times, an essay that would elicit an overwhelming response, an outpouring from readers. In the ensuing days, it spread exponentially. (Im an infectious diseases speci

7、alist, so please forgive me for not using the word viral as a metaphor.) In the aftermath of that, he,d asked to come see me, to chat, to get advice about literary agents, editors, the publishing processhe had a desire to write a book, this book, the one you are now holding in your hands. I recall t

8、he sun filtering through the magnolia tree outside my office and lighting this scene: Paul seated before me, his beautiful hands exceedingly still, his prophet,s beard full, those dark eyes taking the measure of me. In my memory, the picture has a Wrmeer-Iike quality, a camera obscura sharpness. I r

9、emember thinking, Wu must remember thisf because what was falling on my retina was precious. And because, in the context of Paul,s diagnosis, I became aware of not just his mortality but my own.Mfe talked about a lot of things that afternoon. He was a neurosurgical chief resident. Mfe had probably c

10、rossed paths at some point, but we hadn,t shared a patient that we could recall. He told me he had been an English and biology major as an undergraduate at Stanford, and then stayed on for a master,s in English literature. We talked about his lifelong love of writing and reading. I was struck by how

11、 easily he could have been an English professorand, indeed, he had seemed to be headed down that path at one point in his life. But then, just like his namesake on the road to Damascus, he felt the calling. He became a physician instead, but one who always dreamed of coming back to literature in som

12、e form A book, perhaps. One day. He ought he had time, and why not? And yet now time was the very thing he had so little of.I remember his wry, gentle smile, a hint of mischief there, even though his face was gaunt and haggard. He,d been through the wringer with this cancer but a new biological ther

13、apy had produced a good response, allowing him to look ahead a bit. He said during medical school he,d assumed that he would become a psychiatrist, only to fall in love with neurosurgery. It was much more than a falling in love with the intricacies of the brain, much more than the satisfaction of tr

14、aining his hands to accomplish amazing featsit was a love and empathy for those who suffered, for what they endured and what he might bring to bear. I don,t think he told me this as much as I had heard about this quality of his from students of mine who were his acolytes: his fierce belief in the mo

15、ral dimension of his job. And then We talked about his dying.After that meeting, we kept in touch by email, but never saw each other again. It was not just that I disappeared into my own world of deadlines and responsibilities but also my strong sense that the burden was on me to be respectful of Ii

16、is time. It was up to Paul if he wanted to see me. I felt that the last thing he needed was the obligation to service a new friendship. I thought about him a lot, though, and about his wife. I wanted to ask him if he was writing. Ws he finding the time? For years, as a busy physician, Fd struggled t

17、o find the time to write. I wanted to tell him that a famous writer, commiserating about thiseternal problem, once said to me, “If I were a neurosurgeon and I announced that I had to leave my guests to go in for an emergency craniotomy, no one would say a word. But if I said I needed to leave the gu

18、ests in the living room to go upstairs to write.9,1 wondered if Paul would have found tlis funny. After all, he could actually say he was going to do a craniotomy! It was plausible! And then he could go write instead.While Paul was writing this book, he published a short, remarkable essay in Stanfor

19、d Medicinef in an issue that was devoted to the idea of time. I had an essay in the same issue, my piece juxtaposed to his, though I learned of his contribution only when the magazine was in my hands. In reading his words, I had a second, deeper glimpse of something of which there had been a hint in

20、 the New Wrk Times essay: Paul,s writing was simply stunning. He could have been writing about anything, and it would have been just as powerful. But he wasnt writing about anythinghe was writing about time and what it meant to him now, in the context of his illness. Which made it all so incredibly

21、poignant.But here,s the thing I must come back to: the prose was unforgettable. Out of his pen he was spinning gold.I reread Paul,s piece again and again, trying to understand what he had brought about. First, it was musical. It had echoes of Galway Kinnell, almost a prose poem. (“If one day it happ

22、ens / you find yourself with someone you love / in a cafe at one end /of the Pont Mirabeau, at the zinc bar / where wine stands in upward opening glasses.” to quote a Kinnell line, from a poem I once heard him recite in a bookstore in Iowa City, never looking down at the paper.) But it also had a ta

23、ste of something else, something from an antique land, from a time before zinc bars. It finally came to me a few days later when I picked up his essay yet again: Pal,s writing was reminiscent of Thomas Browne,s. Browne had written Religio Medici in the prose of 1642, with all its archaic spellings a

24、nd speech. As a young physician, I was obsessed with that book, kept at it like a farmer trying to drain a bog that his father before him had failed to drain. It was a futile task, and yet I was desperate to learn its secrets, tossing it aside in frustration, then picking it up again, unsure that it

25、 had anything for me but, in sounding the words, sensing that it did. I felt that I lacked some critical receptor for the letters to sing, to impart their meaning. It remained opaque, no matter how hard I tried.Why, you ask? Why did I persevere? Who cares about Religio Medici?Wll, my hero William Os

26、ier cared, that,s who. Osier was the father of modern medicine, a man who died in 1919. He had loved the book. He kept it on his nightstand. He,d asked to be buried with a copy of Religio Medici. For the life of me, I didn,t get what Osier saw in it. After many triesand after some decadesthe book fi

27、nally revealed itself to me. (It helped that a newer edition had modern spellings.) The trick, I discovered, was to read it aloud, which made the cadence inescapable: Ne carry with us the wonders, We seek without us: There is all Africa, and her prodigies in us; we are that bold and adventurous piec

28、e of nature, which he that studies, wisely learns in a compendium, what others labour at in a divided piece and endless volume., When you come to the last paragraph of Paul,s book, read it aloud and you will hear that same long line, tle cadence you think you can tap your feet to.but as with Browne,

29、 you will be just off. Paul, it occurred to me, was Browne redux. (Or given that forward time is our illusion, perhaps it,s that Browne was Kalanithi redux. Yes, it,s head-spinning stuff.)And then Paul died. I attended his memorial in the Stanford church, a gorgeous space where I often go when it is

30、 empty to sit and admire the light, the silence, and where I always find renewal. It was packed for the service. I sat off to one side, listening to a series of moving and sometimes raucous stories from his closest friends, his pastor, and his brother. Yes, Paul was gone, but strangely, I felt I was

31、 coming to know him, beyond that visit in my office, beyond the few essays he,d written. He was taking form in those tales being told in the Stanford Memorial Church, its soaring cathedral dome a fitting space in which to remember this man whose body was now in the earth but who nevertheless was so

32、palpably alive. He took form in the shape of his lovely wife and baby daughter, his grieving parents and siblings, inthe faces of the legions of friends, colleagues, and former patients who filled that space; he was there at the reception later, outdoors in a setting where so many came together. I s

33、aw faces looking calm, smiling, as if they had witnessed something profoundly beautiful in the church. Perhaps my face was like that, too: we had found meaning in the ritual of a service, in the ritual of eulogizing, in the shared tears. There was further meaning residing in this reception where we

34、slaked our thirst, fed our bodies, and talked with complete strangers to whom we were intimately connected through Paul.But it was only when I received the pages that you now hold in your hands, two months after Paul died, that I felt I had finally come to know him, to know him better than if I had

35、been blessed to call him a friend. After reading the book you are about to read, I confess I felt inadequate: there was an honesty, a truth in the writing that took my breath away.Be ready. Be seated. See what courage sounds like. See how brave it is to reveal yourself in this way. But above all, se

36、e what it is to still live, to profoundly influence the lives of others after you are gone, by your words. In a world of asynchronous communication, where we are so often buried in our screens, our gaze rooted to the rectangular objects buzzing in our hands, our attention consumed by ephemera, stop

37、and experience this dialogue with my young departed colleague, now ageless and extant in memory. Listen to Paul. In the silences between his words, listen to what you have to say back. Therein lies his message. I got it. I hope you experience it, too. It is a gift. Let me not stand between you and P

38、aul.PROLOGUEWebster was much possessed by deathAnd saw the skull beneath the skin;And breastless creatures under groundLeaned backward with a Iipless grin.T. S. Eliot, tfWhispers of Immortality,I flipped through the CT SCan images, the diagnosis obvious: the lungs were matted with innumerable tumors

39、, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, d examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was dif

40、ferent: it was my own.I wasn,t in the radiology suite, wearing my scrubs and white coat. I was dressed in a patient,s gown, tethered to an IV pole, using the computer the nurse had left in my hospital room, with my wife, Lucy, an internist, at my side. I went through each sequence again: the lung wi

41、ndow, the bone window, the liver window, scrolling from top to bottom, then left to right, then front to back, just as I had been trained to do, as if I might find something that would change the diagnosis.Mfe lay together on the hospital bed.Lucy, quietly, as if reading from a script: “Do you think

42、 there,s any possibility that it,s something else?“No,” I said.Mfe held each other tightly like young lovers. In the past year we,d both suspected, but refused to believe, or even discuss, that a cancer was growing inside me.About six months before, I had started losing weight and having ferocious b

43、ack pain. When I dressed in the morning, my belt cinched one, then two notches tighter. I went to see my primary care doctor, an old classmate from Stanford. Her sister had died suddenly as a neurosurgery intern, after contracting a virulent infection, and so she,d taken a maternal watch on my healt

44、h. When I arrived, however, I found a different doctor in her officemy classmate was on maternity leave.Dressed in a thin blue gown on a cold examining table, I described the symptoms to her. “Of course, I said, if this were a boards exam questionthirty-five-year-old with unexplained weiglt loss and

45、 new- onset back painthe obvious answer would be (C) cancer. But maybe it,s just that Im working too hard. I don,t know. Fd like to get an MRI to be sure.“I think we should get X-rays first, she said. MRIs for back pain are expensive, and unnecessary imaging had lately become a major national point

46、of cost-saving emphasis. But the value of a scan also depends on what you are looking for: X-rays are largely useless for cancer. Still, for many docs, ordering an MRI at this early stage is apostasy. She continued: uX-rays aren,t perfectly sensitive, but it makes sense to start thereZ,“How about we

47、 get flexion-extension X-rays, thenmaybe the more realistic diagnosis here is isthmic SPondylOIiStheSis?From the reflection in the wall mirror, I could see her googling it.“Its a pars fracture affecting up to five percent of people and a frequent cause of back pain in the young.”“Okay, Ill order the

48、m, then.Thanks, I said.Why was I so authoritative in a surgeon,s coat but so meek in a patients gown? The truth was, I knew more about back pain than she didhalf of my training as a neurosurgeon had involved disorders of the spine. But maybe a spondy WQS more likely. It did affect a significant perc

49、ent of young adultsand cancer in the spine in your thirties? The odds of that couldn,t be more than one in ten thousand. Even if it were one hundred times more common than that, it,d still be less common than a spondy. Maybe I was just freaking myself out.The X-rays looked fine. Wfe chalked the symptoms up to hard work and an aging body, scheduled a follow-up appointment, and I went back to finish my last case of the day.