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AbrahamVerghese_2011G-_医生的关怀_
A few months ago, a 40 year-old woman came to an emergency room in a hospital close to where I live, and she was brought in confused . 几个月前 一个40岁的女士来到急诊室 这个医院离我住的地方不远 她被带来时神智不清
emergency room:n.急诊室; confused:adj.困惑的; v.使糊涂; (confuse的过去分词和过去式)
Her blood pressure was an alarming 230 over 170. 血压处于警戒值 收缩压230, 舒张压170
blood pressure:n.[医]血压;
Within a few minutes, she went into cardiac collapse . 几分钟内她就心血管虚脱了
cardiac:n.强心剂;强胃剂;adj.心脏的;心脏病的;贲门的; collapse:vi.倒塌;瓦解;暴跌;vt.使倒塌,使崩溃;使萎陷;折叠;n.倒塌;失败;衰竭;
She was resuscitated , stabilized , whisked over to a CAT scan suite right next to the emergency room, because they were concerned about blood clots in the lung. 然后她被救醒,稳定下来 带到靠着急诊室旁边的 CAT扫描室 因为医生担心她的肺部有血块
resuscitated:使(某人或某物)恢复知觉;苏醒(resuscitate的过去式和过去分词); stabilized:adj.稳定的;减摇的;v.稳定(stabilize的过去分词); whisked:v.搅打,搅动;匆匆带走;迅速送走(whisk的过去分词和过去式) CAT scan:n.计算机层析成像扫描; suite:n.套房;一套家具;组曲(由三个或更多相关部分组成);套装软件; concerned:adj.有关的;关心的;v.关心;与…有关;(concern的过去时和过去分词) clots:n.血块(clot的复数);v.凝结(clot的第三人称单数形式);
And the CAT scan revealed no blood clots in the lung, but it showed bilateral , visible , palpable breast masses , breast tumors , that had metastasized widely all over the body. CAT扫描仪显示 肺部并没有血块 但是两侧胸部有清晰可见的肿块 是乳腺肿瘤 并且已经转移到 全身各部位
revealed:v.揭示;显示;露出;(reveal的过去分词和过去式) bilateral:adj.双边的;有两边的; visible:adj.明显的;看得见的;现有的;可得到的;n.可见物;进出口贸易中的有形项目; palpable:adj.明显的;可感知的;易觉察的; masses:n.民众;大量(mass的复数);包块;v.集中;聚集(mass的三单形式); tumors:n.肿瘤(tumor的复数); metastasized:v.(癌)转移;扩散;(metastasize的过去分词和过去式)
And the real tragedy was, if you look through her records, she had been seen in four or five other health care institutions in the proceeding years. 但真正的悲剧是,如果你查看她的纪录 会发现她已经 在过去几年里 辗转去过四五家医疗机构
tragedy:n.悲惨的事;不幸;灾难;悲剧作品; look through:浏览,温习;看穿,识破;从…中显露; health care:n.卫生保健; institutions:n.机构;慈善机构;风俗习惯,制度;(institution的复数) proceeding:n.进行;程序;诉讼;事项;v.开始;继续做;行进(proceed的现在分词);
Four or five opportunities to see the breast masses, touch the breast mass, intervene at a much earlier stage than when we saw her. 有四五次机会 发现这些乳腺肿瘤,触碰到它们 在早期就介入治疗 而不是我们发现的时候
intervene:vi.干涉;调停;插入;
Ladies and gentlemen, that is not an unusual story. 诸位 这不是个不寻常的故事
Unfortunately , it happens all the time. 不幸的是,这样的事一直在发生
Unfortunately:adv.不幸地;
I joke, but I only half joke, that if you come to one of our hospitals missing a limb , no one will believe you till they get a CAT scan, MRI or orthopedic consult . 我开个玩笑,不过只是半开玩笑 如果你缺胳膊少腿去了医院 没人会相信你丢了个肢体,除非你做了CAT扫描,磁共振成像 还有骨科诊断
limb:n.肢,臂;分支;枝干;v.切断…的手足;从…上截下树枝; orthopedic:adj.整形外科的(等于orthopaedic); consult:v.咨询;请教;商量;查阅;查询;参看;
I am not a Luddite . 我不是勒德分子
Luddite:n.鲁德分子;强烈反对提高机械化和自动化者;
I teach at Stanford. 我在斯坦福大学教书
I'm a physician practicing with cutting-edge technology . 我是个掌握尖端技术的内科医生
physician:n.[医]医师;内科医师; cutting-edge technology:尖端技术;前沿的技术;
But I'd like to make the case to you in the next 17 minutes that when we shortcut the physical exam, when we lean towards ordering tests instead of talking to and examining the patient , we not only overlook simple diagnoses that can be diagnosed at a treatable , early stage, but we're losing much more than that. 但我将在接下来的 17分钟里想向你们讲述的是 当我们缩短检查 给病人开一堆检查单 而不是与病人交流并检查时 我们不仅忽视了 处在早期可治疗阶段的简单诊断 也失去了更重要的东西
shortcut:n.近路;捷径;快捷方式(图标); physical:adj.[物]物理的;身体的;物质的;符合自然法则的;n.体格检查; lean towards:倾向:;倾向于;朝…倾斜;有…的倾向; patient:adj.有耐心的,能容忍的;n.病人;患者; overlook:v.忽略;俯视;视而不见;眺望; diagnoses:n.诊断;调查分析;评价(diagnosis的复数形式); diagnosed:v.诊断(疾病);判断(问题的原因);(diagnose的过去分词和过去式) treatable:adj.能治疗的;好对付的;能处理的;
We're losing a ritual . 我们失去了一种仪式感
ritual:n.仪式;惯例;礼制;adj.仪式的;例行的;礼节性的;
We're losing a ritual that I believe is transformative , transcendent , and is at the heart of the patient-physician relationship. 一种我认为是具有影响力并且至高无上的仪式感 这正是 医患关系的核心
transformative:adj.变化的,变形的;有改革能力的; transcendent:adj.卓越的;超常的;出类拔萃的;n.卓越的人;超绝物;
This may actually be heresy to say this at TED, but I'd like to introduce you to the most important innovation , 在TED讲这个内容可能有点逆势而行 但我想向各位介绍 在未来十年的
heresy:n.异端;异端邪说;异教; innovation:n.创新,革新;新方法;
I think, in medicine to come in the next 10 years, and that is the power of the human hand -- to touch, to comfort, to diagnose and to bring about treatment . 医学界 最重要的发明 这就是人类之手的力量－ 关怀,抚慰,诊断 和治疗
treatment:n.治疗;疗法;对待;处理;讨论;
I'd like to introduce you first to this person whose image you may or may not recognize . 首先我想介绍一个人 你们不一定认得出他
recognize:v.认识;认出;辨别出;承认;意识到;
This is Sir Arthur Conan Doyle. 他是亚瑟·柯南·道尔爵士
Since we're in Edinburgh , I'm a big fan of Conan Doyle. 既然这是爱丁堡,我本人是柯南·道尔的粉丝
Edinburgh:n.爱丁堡(英国城市名);
You might not know that Conan Doyle went to medical school here in Edinburgh, and his character, Sherlock Holmes, was inspired by Sir Joseph Bell. 也许有人听说过柯南·道尔是在爱丁堡 上的医学院 他创造的人物形象,福尔摩斯 是受到约瑟夫?贝尔的启发
inspired:adj.受到启发的; v.鼓舞; (inspire的过去分词和过去式) Joseph:n.连帽大氅;
Joseph Bell was an extraordinary teacher by all accounts. 约瑟夫?贝尔是个无可挑剔的杰出老师
extraordinary:adj.非凡的;特别的;离奇的;临时的;特派的;
And Conan Doyle, writing about Bell, described the following exchange between Bell and his students. 而柯南·道尔关于贝尔的著述 描绘了贝尔和他的学生 之间的交流
described:v.描述;形容;把…称为;做…运动;(describe的过去分词和过去式) exchange:n.交换;交流;交易所;兑换;v.交换;交易;兑换;
So picture Bell sitting in the outpatient department, students all around him, patients signing up in the emergency room and being registered and being brought in. 想像贝尔坐在门诊部 他的学生围坐着 病人在急诊室登记 然后挂号,被带进来
outpatient:n.门诊病人; patients:n.接受治疗者,病人;(patient的复数) registered:adj.登记过的;记名的;挂号的;v.登记;注册;(register的过去式和过去分词)
And a woman comes in with a child, and Conan Doyle describes the following exchange. 一个带小孩的女士进来了 柯南?道尔这样写道
describes:v.描述;形容;把…称为;画出…图形;(describe的第三人称单数)
The woman says, "Good Morning." 女人说:早上好
Bell says, "What sort of crossing did you have on the ferry from Burntisland?" 贝尔说:你从Burntisland坐渡船过来 一路如何？
She says, "It was good." 她说:挺好
And he says, "What did you do with the other child?" 贝尔说:你的另一个孩子怎么办了？
She says, "I left him with my sister at Leith." 她说,我拜托住在利斯的姐姐照顾了
And he says, "And did you take the shortcut down Inverleith Row to get here to the infirmary ?" 他说 那你来诊所有没有 从 Inverleith Row抄近路？
infirmary:n.医务室;医院;养老院;
She says, "I did." 她说没错
And he says, "Would you still be working at the linoleum factory?" 贝尔道,那你还打算在油毡厂干活吗？
linoleum:n.油布;油毯;漆布;
And she says, "I am." 她说是的
And Bell then goes onto explain to the students. 然后贝尔向他的学生解释说
He says, "You see, when she said, 'Good morning,' 当她说你好的时候
I picked up her Fife accent . 我听出她的法夫口音
accent:n.口音;重音;强调;特点;重音符号;v.强调;重读;带…口音讲话;
And the nearest ferry crossing from Fife is from Burntisland. 而离法夫最近的渡船是在Burntisland
And so she must have taken the ferry over. 所以我推测出她是从那里过来
You notice that the coat she's carrying is too small for the child who is with her, and therefore, she started out the journey with two children, but dropped one off along the way. 你也注意到她拿着的外套 对跟她一起小孩子来说太小了 所以她开始肯定带了两个孩子来了 路上放下一个
journey:n.旅行;行程;vi.旅行;
You notice the clay on the soles of her feet. 还有她鞋底上泥
clay:n.黏土;陶土; soles:n.[服装]鞋底,脚底; v.给(鞋等)上底(sole的三单形式);
Such red clay is not found within a hundred miles of Edinburgh, except in the botanical gardens. 爱丁堡方圆百里内没有这种红泥 除了植物园
botanical:adj.植物学的;n.植物性药材;
And therefore, she took a short cut down Inverleith Row to arrive here. 所以她肯定是从 Inverleith Row抄近路 来这儿的
a short cut:捷径;
And finally , she has a dermatitis on the fingers of her right hand, a dermatitis that is unique to the linoleum factory workers in Burntisland." 最后,她右手手指 有皮炎 这种皮炎是只见于 Burntisland的油毡厂工人
finally:adv.终于;最终;(用于列举)最后;彻底地; dermatitis:n.[皮肤]皮炎;皮肤炎; unique:adj.独特的,稀罕的;[数]唯一的;n.独一无二的人或物;
And when Bell actually strips the patient, begins to examine the patient, you can only imagine how much more he would discern . 然后贝尔就让她脱了衣服 开始检查 你无法想像他是多么仔细地察看
strips:n.条(strip的复数); v.剥夺(stirp的三单形式); discern:v.识别;觉察出;了解;
And as a teacher of medicine, as a student myself, 作为一个医学老师,一个学生
I was so inspired by that story. 我深受这个故事启发
But you might not realize that our ability to look into the body in this simple way, using our senses, is quite recent. 也许你们还没有意识到 我们的这种利用各种感官 以一种简单的方式检查身体的能力 并没有太久历史
The picture I'm showing you is of Leopold Auenbrugger who, in the late 1700s, discovered percussion . 这张照片是利奥波德·奥恩布鲁格 他在18世纪末 发明了叩诊法
percussion:n.[临床]叩诊;振动;碰撞;敲打乐器;打击乐器组;
And the story is that Leopold Auenbrugger was the son of an innkeeper . 故事是这样的 利奥波德·奥恩布鲁格的父亲是个旅馆老板
innkeeper:n.客栈老板;旅馆主人;
And his father used to go down into the basement to tap on the sides of casks of wine to determine how much wine was left and whether to reorder . 他父亲常常去地下室的酒窖 敲敲酒桶 就能知道还有多少酒 要不要追加订单
casks:n.木桶,桶;vt.装入桶内; determine:v.决定;确定;测定;查明;形成;影响;裁决;安排; reorder:vt.再订购;重新整理;vi.再订购;n.再订购;
And so when Auenbrugger became a physician, he began to do the same thing. 所以当奥恩布鲁格成了内科医生 他也开始这么干
He began to tap on the chests of his patients, on their abdomens . 他开始敲病人的胸腔 还有腹部
abdomens:n.腹部;下腹;腹腔;
And basically everything we know about percussion, which you can think of as an ultrasound of its day -- organ enlargement , fluid around the heart, fluid in the lungs, abdominal changes -- 基本上我们对叩诊的认识 那是当时的超声波技术－ 器官扩大,心肺积水 异常变化－
basically:adv.主要地,基本上; ultrasound:n.超声;超音波; organ:n.[生物]器官;机构;风琴;管风琴;嗓音; enlargement:n.放大;放大的照片;增补物; fluid:adj.流动的;流畅的;不固定的;n.流体;液体; abdominal:adj.腹部的;有腹鳍的;
all of this he described in this wonderful manuscript "Inventum Novum," "New Invention," 他在手稿中纪录的一切 “新发明”
manuscript:n.[图情]手稿;原稿;adj.手写的;
which would have disappeared into obscurity , except for the fact that this physician, Corvisart, a famous French physician -- famous only because he was physician to this gentleman -- 很有可能因为它的晦涩而消失在历史中 多亏一位叫科维扎卡的内科医生 一位著名的法国内科医生 他著名是因为他是奥恩布鲁格的内科医生
disappeared:adj.消失的;消失了的;v.消失,失踪;(disappear的过去式和过去分词) obscurity:n.朦胧;阴暗;晦涩;身份低微;不分明;
Corvisart repopularized and reintroduced the work. 重新介绍和普及了这部著作
reintroduced:vt.再引入;再提出;再介绍;
And it was followed a year or two later by Laennec discovering the stethoscope . 一两年后 莱尼克发明了听诊器
stethoscope:vt.用听诊器诊断;n.[临床]听诊器;
Laennec, it is said, was walking in the streets of Paris and saw two children playing with a stick. 据说莱尼克走在巴黎的街上 看见两个小孩在玩一根棍子
One was scratching at the end of the stick, another child listened at the other end. 一个在挠棍子的一端 另一个听着另一端
scratching:v.划伤;擦伤;刮痕;(scratch的现在分词)
And Laennec thought this would be a wonderful way to listen to the chest or listen to the abdomen using what he called "the cylinder ." 莱尼克认为用他所谓的“圆筒” 听胸腔和腹腔 是个很不错的主意
cylinder:n.圆筒;汽缸;[数]柱面;圆柱状物;
Later he renamed it the stethoscope. 后来他重新命名为听诊器
renamed:v.重新命名;给…改名;(rename的过去分词和过去式)
And that is how stethoscope and auscultation was born. 这就是听诊器和听诊法的由来
auscultation:n.听诊;
So within a few years, in the late 1800s, early 1900s, all of a sudden , the barber surgeon had given way to the physician who was trying to make a diagnosis . 几年后 19世纪末,20世纪初 突然 理发医师被 进行诊断的内科医生取代
all of a sudden:突然地,出乎意料地; barber:vt.为…理发;修整;n.理发师;vi.当理发师; surgeon:n.外科医生; diagnosis:n.诊断;
If you'll recall , prior to that time, no matter what ailed you, you went to see the barber surgeon who wound up cupping you, bleeding you, purging you. 在那之前 不管你病得多么厉害,去了理发医师那儿 他们给你拔火罐 给你放血,给你冲洗
recall:v.记起;回想起;使想到;勾起;召回;n.记忆力;记性;回归请求;回收令; prior:adj.先前的; n.(小隐修院)院长; v.居先; no matter what:不管什么…; ailed:vt.使苦恼,使烦恼;vi.生病;n.病痛,苦恼; wound:n.创伤,伤口;v.使受伤;受伤,伤害; bleeding:n.出血;渗色;adj.流血的;同情的;v.出血;渗出;(bleed的现在分词) purging:v.清除,清洗;净化;涤荡;(purge的现在分词)
And, oh yes, if you wanted, he would give you a haircut -- short on the sides, long in the back -- and pull your tooth while he was at it. 当然如果你愿意的话 他也给你理个发－两边短后边长 还顺便给你拔个牙
He made no attempt at diagnosis. 完全没有诊断环节
attempt:n.企图,试图;攻击;v.企图,试图;尝试;
In fact, some of you might well know that the barber pole , the red and white stripes , represents the blood bandages of the barber surgeon, and the receptacles on either end represent the pots in which the blood was collected. 也许有些人还记得 理发店的标志,红白条纹 象征理发医师的绷带 两侧的容器 象征收集血液的壶
pole:n.磁极;电极;柱子;杆子;v.用篙撑船;摆船; stripes:n.条子布;条纹布(stripe复数形式);v.给…加条纹(stripe的三单形式); represents:v.代表;维护…的利益;相当于;(represent的第三人称单数) receptacles:n.插座;[植]花托(receptacle的复数);
But the arrival of auscultation and percussion represented a sea change , a moment when physicians were beginning to look inside the body. 但听诊法和叩诊法的出现 意味着一个大变化 内科医生开始能探视人体内部
represented:v.代表; (represent的过去式和过去分词) sea change:翻天覆地的变化; physicians:n.[内科]内科医生(physician的复数);
And this particular painting, I think, represents the pinnacle , the peak , of that clinical era. 这幅画,我认为 代表这那个医疗时代的顶峰
pinnacle:n.高峰;小尖塔;尖峰;极点;vt.造小尖塔;置于尖顶上;置于高处; peak:n.高峰; v.达到高峰; adj.最高度的; clinical:adj.临床的;诊所的;
This is a very famous painting: "The Doctor" by Luke Fildes. 这是个非常著名的油画 卢克?菲尔德斯的《医生》
Luke Fildes was commissioned to paint this by Tate, who then established the Tate Gallery . 此画是卢克?菲尔德斯受泰特之托 泰特建立了泰特美术馆
commissioned:adj.受委任的;v.正式委托;任命…为军官;(commission的过去式和过去分词) established:adj.已确立的;著名的;v.建立;创立;设立;(establish的过去分词和过去式) Gallery:n.画廊;走廊;旁听席;地道;v.在…修建走廊;挖地道;
And Tate asked Fildes to paint the painting of social importance. 他请卢克.菲尔德斯画一幅 表现社会重要现状的画
And it's interesting that Fildes picked this topic. 有趣的是菲尔德斯选择了这个主题
Fildes' oldest son, Philip, died at the age of nine on Christmas Eve after a brief illness. 菲尔德斯的大儿子,菲利普 9岁的时候因为一点小病痛 死在了平安夜
Christmas Eve:圣诞夜,平安夜
And Fildes was so taken by the physician who held vigil at the beside for two, three nights, that he decided that he would try and depict the physician in our time -- almost a tribute to this physician. 菲尔德斯被这位守夜守了两三夜的 医生深深感动 于是他决定试着描绘 这个时代的医生－ 几乎是对这位医生的赞颂
vigil:n.守夜;监视;不眠;警戒; depict:vt.描述;描画; tribute:n.礼物;[税收]贡物;颂词;(尤指对死者的)致敬,悼念,吊唁礼物;
And hence the painting "The Doctor," a very famous painting. 因此《医生》这幅著名的画
hence:adv.因此;今后;
It's been on calendars , postage stamps in many different countries. 出现在很多国家的挂历上和邮票上
calendars:n.日历;挂历;日程表;记事本;(calendar的复数) postage:n.邮资,邮费;
I've often wondered, what would Fildes have done had he been asked to paint this painting in the modern era, in the year 2011? 我常想,菲尔德斯会怎么办 如果他被要求在这个时代 画那幅画 在2011年？
Would he have substituted a computer screen for where he had the patient? 他是不是得把患者 换成电脑屏幕？
substituted:adj.取代的,代替的;v.代替;用…代替(substitute的过去式);
I've gotten into some trouble in Silicon Valley for saying that the patient in the bed has almost become an icon for the real patient who's in the computer. 我因为说病床上的病人 基本上只是 电脑里真正病人的图标 而和硅谷惹上麻烦
Silicon Valley:n.硅谷(美国加利福尼亚州一处计算机和电子公司聚集地,有时用以指任何计算机公司聚集地);
I've actually coined a term for that entity in the computer. 事实上我为计算机里的那个实体（病人）创造了个新词
entity:n.实体;存在;本质;
I call it the iPatient. iPatient
The iPatient is getting wonderful care all across America. 全美国的iPatient都得到很好的治疗
The real patient often wonders, where is everyone? 真的病人倒在奇怪 人都哪里去了？
When are they going to come by and explain things to me? 他们什么时候来给我解释这些玩意儿？
Who's in charge? 谁负责啊？
There's a real disjunction between the patient's perception and our own perceptions as physicians of the best medical care. 病人和医生对最佳医疗的认识 有着很大的距离
disjunction:n.分离;析取;分裂;折断; perceptions:n.认知;观念(perception的复数);理解;
I want to show you a picture of what rounds looked like when I was in training. 我想给你们展示 我当时的临床实习 是什么样的
The focus was around the patient. 重点都是病人
We went from bed to bed. The attending physician was in charge. 我们一张病床一张病床走过去 当值的医生负责
Too often these days, rounds look very much like this, where the discussion is taking place in a room far away from the patient. 现如今 临床实习更像这样 讨论是在一个 远离病人的房间进行的
The discussion is all about images on the computer, data. 讨论的场面都是电脑,数据
images:n.印象;声誉;形象;画像;雕像;(image的第三人称单数和复数)
And the one critical piece missing is that of the patient. 最重要的部分－病人 却缺失了
critical:adj.鉴定的;[核]临界的;批评的,爱挑剔的;危险的;决定性的;评论的;
Now I've been influenced in this thinking by two anecdotes that I want to share with you. 我想跟你们分享两个故事 我本人深受影响
influenced:v.影响;对…起作用;支配;左右;(influence的过去分词和过去式) anecdotes:n.奇闻轶事(anecdote的复数);
One had to do with a friend of mine who had a breast cancer , had a small breast cancer detected -- had her lumpectomy in the town in which I lived. 一个是跟我一个患有乳腺癌的朋友有关 在发现一个小的乳腺肿瘤后 她在我住的那个城市做了手术切除
cancer:n.癌症;恶性肿瘤; detected:v.发现;查明;侦察出;(detect的过去分词和过去式) lumpectomy:n.乳房肿瘤切除术;
This is when I was in Texas. 这是我在德克萨斯的时候
And she then spent a lot of time researching to find the best cancer center in the world to get her subsequent care. 然后她花了很多时间 寻找世界上最好的癌症中心 接受后续治疗
subsequent:adj.后来的,随后的;
And she found the place and decided to go there, went there. 她找到了然后去了
Which is why I was surprised a few months later to see her back in our own town, getting her subsequent care with her private oncologist . 几个月后我很惊讶地 看见她回来了 在她的私人医生那里接受术后康复
oncologist:n.肿瘤学家;肿瘤医师;
And I pressed her, and I asked her, "Why did you come back and get your care here?" 我问她 你问什么回来接受康复？
And she was reluctant to tell me. 她不是很愿意吐露
reluctant:adj.不情愿的;勉强的;顽抗的;
She said, "The cancer center was wonderful. 她说,”那个癌症中心非常棒
It had a beautiful facility , giant atrium , valet parking, a piano that played itself, a concierge that took you around from here to there. 设施一流 大堂超级大,服务生停车 自动弹奏的钢琴 有人待你到处溜达“
facility:n.设施;设备;特别装置;特色;场所;天资; giant:n.巨人;伟人;巨兽;adj.巨大的;特大的 atrium:n.中庭,天井前厅;[解剖]心房; valet:n.贴身男仆; vt.为...管理衣物; vi.清洗汽车; concierge:n.门房;看门人;
But," she said, "but they did not touch my breasts." 但是 “他们根本没碰我的胸部”
Now you and I could argue that they probably did not need to touch her breasts. 现在我们可以说 他们也许没有必要碰她的胸部
They had her scanned inside out. 可以扫描嘛
They understood her breast cancer at the molecular level; they had no need to touch her breasts. 他们可以从分子层面了解她的乳腺癌 没有必要碰
molecular:adj.[化学]分子的;由分子组成的;
But to her, it mattered deeply. 但对她来说,这很重要
It was enough for her to make the decision to get her subsequent care with her private oncologist who, every time she went, examined both breasts including the axillary tail, examined her axilla carefully, examined her cervical region , her inguinal region , did a thorough exam. 这足够让她决定 从她私人医生那里接受康复 她去私人医生那里 医生会检查两侧乳房包括腋窝端 很仔细地检查腋窝 检查她的子宫颈和腹股沟 一个全面的检查
axillary:adj.[植]腋生的;腋窝的;叶腋的;n.[鸟]腋羽; cervical:adj.颈的;子宫颈的; region:n.地区;范围;部位; inguinal:adj.[解剖][动]腹股沟的;鼠蹊部的; thorough:adj.彻底的;十分的;周密的;
And to her, that spoke of a kind of attentiveness that she needed. 对她来说,这表达了她所需要的关注
attentiveness:n.注意力;专注;
I was very influenced by that anecdote. 这件事深深影响了我
I was also influenced by another experience that I had, again, when I was in Texas, before I moved to Stanford. 另外还有一个我的经历同样对我有影响 也是我在德克萨斯的时候,还没搬到斯坦福
I had a reputation as being interested in patients with chronic fatigue . 我有个名声在外 就是非常关注患有 慢性疲劳的病人
chronic:adj.慢性的;长期的;习惯性的; fatigue:n.疲劳;劳累;厌倦;(金属或木材的)疲劳;v.疲劳;使疲乏;(士兵)担任杂役;
This is not a reputation you would wish on your worst enemy. 这不是个坏名声
I say that because these are difficult patients. 我这么说是因为他们都不容易
They have often been rejected by their families, have had bad experiences with medical care and they come to you fully prepared for you to join the long list of people who's about to disappoint them. 他们多被家人拒绝 有很不如意的医疗经历 他们早准备好了 你是许多人之后 下一个另他们失望的人
rejected:adj.被拒的;不合格的;v.拒绝,驳回;(reject的过去式和过去分词)
And I learned very early on with my first patient that I could not do justice to this very complicated patient with all the records they were bringing and a new patient visit of 45 minutes. 我从第一个病人身上就早早认识到 我无法公平地 去查看这位复杂病人的 所有纪录 一个新病人只有45分钟
not do justice to:处理不公; complicated:adj.复杂的;难懂的;v.使复杂化;(complicate的过去分词和过去式)
There was just no way. 无可奈何
And if I tried, I'd disappoint them. 如果我尝试了,我会令他们失望
And so I hit on this method where I invited the patient to tell me the story for their entire first visit, and I tried not to interrupt them. 所以我的做法是 第一次会诊的时候 我让病人们给我讲述他们的情况 我尝试不去打断
interrupt:v.中断;打断;插嘴;妨碍;n.中断;
We know the average American physician interrupts their patient in 14 seconds. 我们知道美国医生平均 14秒后就打断病人说话
interrupts:n.中断(interrupt的复数);v.打断(interrupt的三单形式);
And if I ever get to heaven, it will be because I held my piece for 45 minutes and did not interrupt my patient. 如果我能进天堂 肯定是因为我能倾听上45分钟 而没打断他们
I then scheduled the physical exam for two weeks hence, and when the patient came for the physical, 然后我会在两周后安排体检 当病人来的时候
I was able to do a thorough physical, because I had nothing else to do. 我就能做一个彻底的体检 因为这就是我能做的
I like to think that I do a thorough physical exam, but because the whole visit was now about the physical, 我想我做彻底的检查 是因为这个会诊就是为了体检
I could do an extraordinarily thorough exam. 我可以做一个格外细致的检查
extraordinarily:adv.非常;格外地;非凡地;
And I remember my very first patient in that series continued to tell me more history during what was meant to be the physical exam visit. 我记得我第一个慢性疲劳病人 在他的体检会诊过程中 给我讲述更多她的历史
series:n.系列,连续;[电]串联;级数;丛书;
And I began my ritual. 我开始了我的仪式
I always begin with the pulse , then I examine the hands, then I look at the nail beds, then I slide my hand up to the epitrochlear node , and I was into my ritual. 我总是从测脉搏开始 然后检查手,接下来是甲床 然后是滑车上淋巴结 由此进入我的仪式
pulse:n.脉冲;脉搏;脉率;强劲的音乐节拍;v.搏动;跳动;震动;洋溢着; node:n.节点;结点;茎节;(根或枝上的)节;
And when my ritual began, this very voluble patient began to quiet down. 当仪式开始 这个健谈的病人 开始安静下来
voluble:adj.健谈的;缠绕的;易旋转的;
And I remember having a very eerie sense that the patient and I had slipped back into a primitive ritual in which I had a role and the patient had a role. 我记得感受到一种神秘的畏惧感 当我和病人 都进入到这种原始性的仪式 其中我有我的角色 而病人有病人的角色
eerie:adj.可怕的;怪异的; slipped:adj.打滑的;v.滑倒;滑落;脱落;(slip的过去分词和过去式) primitive:adj.原始的,远古的;简单的,粗糙的;n.原始人;
And when I was done, the patient said to me with some awe , "I have never been examined like this before." 当我完成的时候 病人怀着敬畏对我说 “我从来没有被这样检查过”
awe:vt.使敬畏;使畏怯;n.敬畏;
Now if that were true, it's a true condemnation of our health care system, because they had been seen in other places. 如果这是真的话 是对医疗保健系统的一个真实的谴责 因为他们从来没在别的地方经历过
condemnation:n.谴责;定罪;非难的理由;征用;
I then proceeded to tell the patient, once the patient was dressed, the standard things that the person must have heard in other institutions, which is, "This is not in your head. 等病人穿戴完毕 我接着告诉他 他肯定在其他医疗机构都听过的内容: “这不是你想像的
proceeded:v.继续做;接着做;继而做;行进;前往;(proceed的过去分词和过去式) standard:n.标准;水准;旗;度量衡标准;adj.标准的;合规格的;公认为优秀的;
This is real. 这是真的
The good news, it's not cancer, it's not tuberculosis , it's not coccidioidomycosis or some obscure fungal infection . 好消息是,得的不是癌症,不是肺结核 不是球孢子菌病或者什么真菌感染
tuberculosis:n.肺结核;结核病; coccidioidomycosis:n.[医]球孢子菌病; obscure:n.朦胧; adj.无名的; v.使模糊; fungal:adj.真菌的(等于fungous); infection:n.感染;传染;(身体某部位的)感染;传染病;
The bad news is we don't know exactly what's causing this, but here's what you should do, here's what we should do." 坏消息是我们不清楚是什么导致的 你应该做这些,我应该做这些”
And I would lay out all the standard treatment options that the patient had heard elsewhere . 我会列出病人在其他地方也听过的 所有标准治疗的选项
options:n.选择; v.得到或获准进行选择; (option的三单形式) elsewhere:adv.在别处;到别处;
And I always felt that if my patient gave up the quest for the magic doctor, the magic treatment and began with me on a course towards wellness , it was because I had earned the right to tell them these things by virtue of the examination. 我总觉得 如果我的病人放弃追着 某个神奇医生,神奇疗法 而转投我开始走向健康 那是因为我一丝不苟的检查 为我赢得了 告诉他们这些的权利
quest:n.追求;寻找;vi.追求;寻找;vt.探索; wellness:n.健康; by virtue of:由于,凭借;
Something of importance had transpired in the exchange. 通过交流一些重要的信息已经透露
transpired:v.公开;为人所知;发生;(植物)水分蒸发;(transpire的过去式和过去分词)
I took this to my colleagues at Stanford in anthropology and told them the same story. 我将此讲给 在斯坦福大学人类学的同事们 告诉他们这个故事
colleagues:n.同事;同行(colleague的复数); anthropology:n.人类学;人类学家;
And they immediately said to me, "Well you are describing a classic ritual." 他们立刻对我说 “你描述了一个经典仪式”
describing:v.描述;形容;把…称为;做…运动;(describe的现在分词) classic:n.名著;优秀的典范;adj.最优秀的;第一流的;有代表性的;典型的;
And they helped me understand that rituals are all about transformation . 他们帮助我理解了 仪式意味着转变
transformation:n.转变;(用于南非)民主改革;
We marry, for example, with great pomp and ceremony and expense to signal our departure from a life of solitude and misery and loneliness to one of eternal bliss . 举例说,我们结婚 用舞会,仪式和花费 来宣告 孤独寂寞的悲惨生活 变成永恒的幸福
pomp:n.盛况;浮华;壮丽;夸耀; ceremony:n.典礼,仪式;礼节,礼仪;客套,虚礼; expense:n.费用;开支;花费;开销; departure:n.离开;出发;违背; solitude:n.孤独;隐居;荒僻的地方; misery:n.痛苦,悲惨;不幸;苦恼;穷困; eternal:adj.永恒的;不朽的; bliss:n.幸福;极乐;
I'm not sure why you're laughing. 我不知道你们为什么笑
That was the original intent , was it not? 我们结婚原本是这么希望的,是吧？
original:n.原件;原作;原物;原型;adj.原始的;最初的;独创的;新颖的; intent:n.意图;目的;含义;adj.专心的;急切的;坚决的;
We signal transitions of power with rituals. 我们通过仪式表达 力量的转变
transitions:n.过渡,转变(transition的复数形式);转场效果;转换滤镜;
We signal the passage of a life with rituals. 我们用仪式表达生命
Rituals are terribly important. 仪式非常重要
They're all about transformation. 全部都与转变有关
Well I would submit to you that the ritual of one individual coming to another and telling them things that they would not tell their preacher or rabbi , and then, incredibly on top of that, disrobing and allowing touch -- 我想告诉你这种仪式 一个人 来到另一个人面前 告诉他一些 连神父都不告诉的的事 除此之外 还换衣解带并让他触碰
submit:vt.使服从;主张;呈递;vi.提交;服从; individual:n.个人;有个性的人;adj.单独的;个别的; preacher:n.牧师;传教士;鼓吹者; rabbi:n.拉比(犹太人的学者);法师;犹太教律法专家;先生; incredibly:adv.难以置信地;非常地; disrobing:v.脱去(某人)的衣服;脱衣服;脱去制服(或礼服)(disrobe的现在分词)
I would submit to you that that is a ritual of exceeding importance. 我想告诉你们这是个极度重要的仪式
exceeding:adj.超越的; v.超过(数量); (exceed的现在分词)
And if you shortchange that ritual by not undressing the patient, by listening with your stethoscope on top of the nightgown , by not doing a complete exam, you have bypassed on the opportunity to seal the patient-physician relationship. 如果你在仪式上玩花样 比如不解衣服 隔着睡裙听诊 或者检查不完整 你已经错过了 在医患关系上留下鉴印的机会
shortchange:vt.欺骗;(找钱时故意)少找零钱; undressing:v.(给…)脱衣服(undress的现在分词) nightgown:n.睡衣(等于dressinggown或nightdress); bypassed:v.绕道,忽视(bypass的过去分词);
I am a writer, and I want to close by reading you a short passage that I wrote that has to do very much with this scene. 我是个作家 我想以我写的一段话结尾 它与这个场景契合
I'm an infectious disease physician, and in the early days of HIV , before we had our medications , 我是个传染病医生 在HIV传染早期,还没有治疗方法的时候
infectious:adj.传染的;传染性的;易传染的; disease:n.病,[医]疾病;弊病;vt.传染;使…有病; early days:初期;为时尚早;前期; HIV:n.艾滋病病毒; medications:n.药;药物;(medication的复数)
I presided over so many scenes like this. 我经历过如此之多的这样的场景
presided:v.主持(preside的过去式);
I remember, every time I went to a patient's deathbed , whether in the hospital or at home, 我记得,每次去医院或者病人家里的 临死的卧床
deathbed:n.临终之时;临死所卧之床;adj.临终时作的;
I remember my sense of failure -- the feeling of I don't know what I have to say; 我总有种失败感－ 一种无话可说的感觉
I don't know what I can say; 我不知道说什么好
I don't know what I'm supposed to do. 我不知道做什么好
supposed:adj.误信的;所谓的;v.认为;假设;设想;(suppose的过去分词和过去式)
And out of that sense of failure, 带着那种失败感
I remember, I would always examine the patient. 我记得,我总会检查病人
I would pull down the eyelids . 看看眼皮
pull down:下拉;断开; eyelids:n.[解剖]眼睑;[解剖]眼皮(eyelid的复数);
I would look at the tongue. 看看舌头
I would percuss the chest. I would listen to the heart. 敲敲胸部 听听心跳
I would feel the abdomen. 按压腹腔
I remember so many patients, their names still vivid on my tongue, their faces still so clear. 我记得很多病人 他们的名字仍犹如在耳 他们的脸庞仍历历在目
vivid:adj.生动的;鲜明的;鲜艳的;
I remember so many huge, hollowed out, haunted eyes staring up at me as I performed this ritual. 我记得很多大而空洞的眼睛 在我进行仪式的时候盯着我
hollowed:空心的;凹陷的; staring:adj.凝视的,目不转睛的;显眼的;v.凝视;盯着看;显眼;(stare的现在分词) performed:v.表演;执行;履行;演出;工作,运转(好/不好)(perform的过去分词和过去式)
And then the next day, 次日
I would come, and I would do it again. 我会再来,再做
And I wanted to read you this one closing passage about one patient. 我想给各位读的结束语 是关于一位病人的
'"I recall one patient who was at that point no more than a skeleton encased in shrinking skin, unable to speak, his mouth crusted with candida that was resistant to the usual medications. “我记得一位病人 当时的他 瘦骨嶙峋 如同干柴 无法言语 嘴里长满念珠菌 这种真菌对普通药物具有抗药性
no more than:adv.只是;仅仅; skeleton:n.骨架,骨骼;纲要;骨瘦如柴的人;adj.骨骼的;骨瘦如柴的;概略的; encased:adj.包装的;被包住的;v.盖住;包起;装箱(encase的过去分词); shrinking:v.(使)缩水,收缩,缩小,退缩;(shrink的现在分词) crusted:adj.生了外皮的;有沉淀的;陈旧的;陈年的; candida:n.假丝酵母;念珠菌属;坎迪德(女子名); resistant:adj.抵抗的,反抗的;顽固的;n.抵抗者;
When he saw me on what turned out to be his last hours on this earth, his hands moved as if in slow motion . 当他看见我时 已是他活在人世的最后几个小时 他的手像慢镜头一样移动
slow motion:adj.缓慢的;慢动作的;高速度摄影的;
And as I wondered what he was up to, his stick fingers made their way up to his pajama shirt, fumbling with his buttons. 我想他要表达点什么 他的干柴一样的手指 伸向他的睡衣 要解开扣子
pajama:n.睡衣;宽长裤; fumbling:adj.笨拙的;支支吾吾的;v.摸索(fumble的ing形式);
I realized that he was wanting to expose his wicker-basket chest to me. 我意识到 他是想给我们看他骨瘦如柴的胸膛
expose:v.揭露,揭发;使曝光;显示;
It was an offering, an invitation . 那是个邀请
invitation:n.邀请,引诱
I did not decline . 我没有拒绝
decline:v.下降;衰退;减少;谢绝;n.下降;
I percussed. I palpated . I listened to the chest. 我叩诊 触诊 听诊了胸腔
palpated:v.摸认;[医]触诊;adj.[动]有触须的;(palpated是palpate的过去分词);
I think he surely must have known by then that it was vital for me just as it was necessary for him. 我认为他一定知道 那对我的重要 就想对他的必要一样
vital:adj.至关重要的;生死攸关的;有活力的;
Neither of us could skip this ritual, which had nothing to do with detecting rales in the lung, or finding the gallop rhythm of heart failure . 谁也不能省略这个仪式 不是为了听肺部的水泡 或是心脏衰弱的跳动
had nothing to do with:与…无关; detecting:n.检测;检定;v.发现;探知(detect的现在分词);adj.探测的; rales:n.[临床]罗音;水泡音;肺的诊音(rale的复数); gallop:n.疾驰;飞奔;vi.飞驰;急速进行;急急忙忙地说;vt.使飞跑;迅速运输; rhythm:n.节奏;韵律; heart failure:n.心力衰竭;
No, this ritual was about the one message that physicians have needed to convey to their patients. 不,这个仪式 是医生向患者传达的一个信息
convey:vt.传达;运输;让与;
Although, God knows, of late, in our hubris , we seem to have drifted away. 虽然后来因为我们的傲慢 我们把它弄丢了
hubris:n.傲慢;狂妄自大; drifted:v.漂流;漂移;缓缓移动;缓慢行走;(drift的过去分词和过去式)
We seem to have forgotten -- as though, with the explosion of knowledge, the whole human genome mapped out at our feet, we are lulled into inattention , 我们好像忘了－ 虽然有了知识大爆炸 整个人类的基因组被绘制出来 我们渐渐变得冷漠
explosion:n.爆炸;爆发;激增; genome:n.基因组;染色体组; lulled:vt.使平静;使安静;哄骗;vi.平息;减弱;停止;n.间歇;暂停;暂时平静; inattention:n.不注意;疏忽;粗心;
forgetting that the ritual is cathartic to the physician, necessary for the patient -- forgetting that the ritual has meaning and a singular message to convey to the patient. 忘记了仪式是医生的泻药 病人很需要－ 我们忘了仪式具有意义 并且将信息传达给病人
cathartic:adj.导泻的;通便的;n.[药]泻药;[药]通便药; singular:adj.单数的;单一的;非凡的;异常的;n.单数;
And the message, which I didn't fully understand then, even as I delivered it, and which I understand better now is this: 这个信息虽然我当时传递给了病人 但我并没有完全理解 现在我更好地理解了:
I will always, always, always be there. 我会永远,永远,永远在这里
I will see you through this. 我会陪你经历这一切
I will never abandon you. 我永远不会抛弃你
abandon:n.狂热;放任;v.遗弃;放弃;
I will be with you through the end." 我会陪你到最后
Thank you very much. 谢谢
(Applause) （掌声）