TEDGlobal 2011
Abraham Verghese: A doctor's touch
阿布拉罕•韦尔盖塞：医生的关怀
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现代医学正失去一个旧式但有力的工具：人文关怀。作为医生和作家的阿布拉罕•韦尔盖塞批判如今的世界里病人只是一个个数据，他呼吁重新回到传统的一对一诊断方式。
Abraham Verghese - Physician and author
In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation. Full bio
In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation. Full bio
Double-click the English transcript below to play the video.
00:15
A few months ago,
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几个月前
00:17
a 40 year-old woman came to an emergency room
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一个40岁的女士来到急诊室
00:20
in a hospital close to where I live,
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这个医院离我住的地方不远
00:22
and she was brought in confused.
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她被带来时神智不清
00:24
Her blood pressure was an alarming
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血压处于警戒值
00:26
230 over 170.
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收缩压230, 舒张压170
00:29
Within a few minutes, she went into cardiac collapse.
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几分钟内她就心血管虚脱了
00:32
She was resuscitated, stabilized,
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然后她被救醒，稳定下来
00:35
whisked over to a CAT scan suite
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带到靠着急诊室旁边的
00:37
right next to the emergency room,
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CAT扫描室
00:39
because they were concerned about blood clots in the lung.
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因为医生担心她的肺部有血块
00:42
And the CAT scan revealed
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CAT扫描仪显示
00:44
no blood clots in the lung,
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肺部并没有血块
00:46
but it showed bilateral, visible, palpable breast masses,
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但是两侧胸部有清晰可见的肿块
00:51
breast tumors,
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是乳腺肿瘤
00:53
that had metastasized widely
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并且已经转移到
00:55
all over the body.
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全身各部位
00:57
And the real tragedy was, if you look through her records,
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但真正的悲剧是，如果你查看她的纪录
01:00
she had been seen
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会发现她已经
01:02
in four or five other health care institutions
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在过去几年里
01:04
in the preceding two years.
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辗转去过四五家医疗机构
01:06
Four or five opportunities
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有四五次机会
01:08
to see the breast masses, touch the breast mass,
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发现这些乳腺肿瘤，触碰到它们
01:10
intervene at a much earlier stage
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在早期就介入治疗
01:13
than when we saw her.
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而不是我们发现的时候
01:15
Ladies and gentlemen,
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诸位
01:17
that is not an unusual story.
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这不是个不寻常的故事
01:19
Unfortunately, it happens all the time.
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不幸的是，这样的事一直在发生
01:22
I joke, but I only half joke,
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我开个玩笑，不过只是半开玩笑
01:24
that if you come to one of our hospitals missing a limb,
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如果你缺胳膊少腿去了医院
01:27
no one will believe you till they get a CAT scan, MRI
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没人会相信你丢了个肢体，除非你做了CAT扫描，磁共振成像
01:30
or orthopedic consult.
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还有骨科诊断
01:32
I am not a Luddite.
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我不是勒德分子
01:34
I teach at Stanford.
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我在斯坦福大学教书
01:36
I'm a physician practicing with cutting-edge technology.
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我是个掌握尖端技术的内科医生
01:38
But I'd like to make the case to you
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但我将在接下来的
01:40
in the next 17 minutes
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17分钟里想向你们讲述的是
01:42
that when we shortcut the physical exam,
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当我们缩短检查
01:46
when we lean towards ordering tests
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给病人开一堆检查单
01:48
instead of talking to and examining the patient,
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而不是与病人交流并检查时
01:51
we not only overlook simple diagnoses
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我们不仅忽视了
01:54
that can be diagnosed at a treatable, early stage,
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处在早期可治疗阶段的简单诊断
01:57
but we're losing much more than that.
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也失去了更重要的东西
01:59
We're losing a ritual.
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我们失去了一种仪式感
02:01
We're losing a ritual that I believe is transformative, transcendent,
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一种我认为是具有影响力并且至高无上的仪式感
02:04
and is at the heart
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这正是
02:06
of the patient-physician relationship.
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医患关系的核心
02:08
This may actually be heresy to say this at TED,
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在TED讲这个内容可能有点逆势而行
02:11
but I'd like to introduce you
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但我想向各位介绍
02:13
to the most important innovation,
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在未来十年的
02:15
I think, in medicine
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医学界
02:17
to come in the next 10 years,
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最重要的发明
02:19
and that is the power of the human hand --
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这就是人类之手的力量－
02:21
to touch, to comfort, to diagnose
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关怀，抚慰，诊断
02:24
and to bring about treatment.
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和治疗
02:26
I'd like to introduce you first to this person
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首先我想介绍一个人
02:29
whose image you may or may not recognize.
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你们不一定认得出他
02:31
This is Sir Arthur Conan Doyle.
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他是亚瑟·柯南·道尔爵士
02:33
Since we're in Edinburgh, I'm a big fan of Conan Doyle.
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既然这是爱丁堡，我本人是柯南·道尔的粉丝
02:36
You might not know that Conan Doyle went to medical school
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也许有人听说过柯南·道尔是在爱丁堡
02:38
here in Edinburgh,
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上的医学院
02:40
and his character, Sherlock Holmes,
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他创造的人物形象，福尔摩斯
02:42
was inspired by Sir Joseph Bell.
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是受到约瑟夫･贝尔的启发
02:45
Joseph Bell was an extraordinary teacher by all accounts.
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约瑟夫･贝尔是个无可挑剔的杰出老师
02:48
And Conan Doyle, writing about Bell,
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而柯南·道尔关于贝尔的著述
02:51
described the following exchange
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描绘了贝尔和他的学生
02:53
between Bell and his students.
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之间的交流
02:55
So picture Bell sitting in the outpatient department,
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想像贝尔坐在门诊部
02:58
students all around him,
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他的学生围坐着
03:00
patients signing up in the emergency room
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病人在急诊室登记
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and being registered and being brought in.
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然后挂号，被带进来
03:05
And a woman comes in with a child,
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一个带小孩的女士进来了
03:07
and Conan Doyle describes the following exchange.
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柯南･道尔这样写道
03:10
The woman says, "Good Morning."
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女人说：早上好
03:14
Bell says, "What sort of crossing did you have
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贝尔说：你从Burntisland坐渡船过来
03:17
on the ferry from Burntisland?"
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一路如何？
03:20
She says, "It was good."
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她说：挺好
03:22
And he says, "What did you do with the other child?"
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贝尔说：你的另一个孩子怎么办了？
03:25
She says, "I left him with my sister at Leith."
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她说，我拜托住在利斯的姐姐照顾了
03:28
And he says,
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他说
03:30
"And did you take the shortcut down Inverleith Row
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那你来诊所有没有
03:32
to get here to the infirmary?"
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从 Inverleith Row抄近路？
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She says, "I did."
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她说没错
03:36
And he says, "Would you still be working at the linoleum factory?"
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贝尔道，那你还打算在油毡厂干活吗？
03:40
And she says, "I am."
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她说是的
03:42
And Bell then goes on to explain to the students.
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然后贝尔向他的学生解释说
03:44
He says, "You see, when she said, 'Good morning,'
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当她说你好的时候
03:47
I picked up her Fife accent.
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我听出她的法夫口音
03:49
And the nearest ferry crossing from Fife is from Burntisland.
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而离法夫最近的渡船是在Burntisland
03:52
And so she must have taken the ferry over.
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所以我推测出她是从那里过来
03:55
You notice that the coat she's carrying
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你也注意到她拿着的外套
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is too small for the child who is with her,
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对跟她一起小孩子来说太小了
04:00
and therefore, she started out the journey with two children,
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所以她开始肯定带了两个孩子来了
04:03
but dropped one off along the way.
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路上放下一个
04:06
You notice the clay on the soles of her feet.
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还有她鞋底上泥
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Such red clay is not found within a hundred miles of Edinburgh,
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爱丁堡方圆百里内没有这种红泥
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except in the botanical gardens.
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除了植物园
04:14
And therefore, she took a short cut down Inverleith Row
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所以她肯定是从 Inverleith Row抄近路
04:17
to arrive here.
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来这儿的
04:19
And finally, she has a dermatitis
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最后，她右手手指
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on the fingers of her right hand,
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有皮炎
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a dermatitis that is unique
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这种皮炎是只见于
04:25
to the linoleum factory workers in Burntisland."
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Burntisland的油毡厂工人
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And when Bell actually strips the patient,
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然后贝尔就让她脱了衣服
04:30
begins to examine the patient,
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开始检查
04:32
you can only imagine how much more he would discern.
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你无法想像他是多么仔细地察看
04:35
And as a teacher of medicine, as a student myself,
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作为一个医学老师，一个学生
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I was so inspired by that story.
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我深受这个故事启发
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But you might not realize
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也许你们还没有意识到
04:42
that our ability to look into the body
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我们的这种利用各种感官
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in this simple way, using our senses,
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以一种简单的方式检查身体的能力
04:46
is quite recent.
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并没有太久历史
04:48
The picture I'm showing you is of Leopold Auenbrugger
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这张照片是利奥波德·奥恩布鲁格
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who, in the late 1700s,
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他在18世纪末
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discovered percussion.
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发明了叩诊法
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And the story is that Leopold Auenbrugger
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故事是这样的
04:58
was the son of an innkeeper.
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利奥波德·奥恩布鲁格的父亲是个旅馆老板
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And his father used to go down into the basement
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他父亲常常去地下室的酒窖
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to tap on the sides of casks of wine
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敲敲酒桶
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to determine how much wine was left
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就能知道还有多少酒
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and whether to reorder.
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要不要追加订单
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And so when Auenbrugger became a physician,
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所以当奥恩布鲁格成了内科医生
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he began to do the same thing.
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他也开始这么干
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He began to tap on the chests of his patients,
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他开始敲病人的胸腔
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on their abdomens.
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还有腹部
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And basically everything we know about percussion,
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基本上我们对叩诊的认识
05:21
which you can think of as an ultrasound of its day --
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那是当时的超声波技术－
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organ enlargement, fluid around the heart, fluid in the lungs,
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器官扩大，心肺积水
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abdominal changes --
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异常变化－
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all of this he described in this wonderful manuscript
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他在手稿中纪录的一切
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"Inventum Novum," "New Invention,"
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“新发明”
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which would have disappeared into obscurity,
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很有可能因为它的晦涩而消失在历史中
05:37
except for the fact that this physician, Corvisart,
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多亏一位叫科维扎卡的内科医生
05:40
a famous French physician --
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一位著名的法国内科医生
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famous only because he was physician to this gentleman --
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他著名是因为他是奥恩布鲁格的内科医生
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Corvisart repopularized and reintroduced the work.
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重新介绍和普及了这部著作
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And it was followed a year or two later
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一两年后
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by Laennec discovering the stethoscope.
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莱尼克发明了听诊器
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Laennec, it is said, was walking in the streets of Paris
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据说莱尼克走在巴黎的街上
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and saw two children playing with a stick.
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看见两个小孩在玩一根棍子
05:59
One was scratching at the end of the stick,
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一个在挠棍子的一端
06:02
another child listened at the other end.
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另一个听着另一端
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And Laennec thought this would be a wonderful way
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莱尼克认为用他所谓的“圆筒”
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to listen to the chest or listen to the abdomen
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听胸腔和腹腔
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using what he called "the cylinder."
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是个很不错的主意
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Later he renamed it the stethoscope.
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后来他重新命名为听诊器
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And that is how stethoscope and auscultation was born.
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这就是听诊器和听诊法的由来
06:16
So within a few years,
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几年后
06:18
in the late 1800s, early 1900s,
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19世纪末，20世纪初
06:20
all of a sudden,
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突然
06:22
the barber surgeon had given way
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理发医师被
06:25
to the physician who was trying to make a diagnosis.
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进行诊断的内科医生取代
06:28
If you'll recall, prior to that time,
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在那之前
06:30
no matter what ailed you, you went to see the barber surgeon
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不管你病得多么厉害，去了理发医师那儿
06:33
who wound up cupping you,
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他们给你拔火罐
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bleeding you, purging you.
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给你放血，给你冲洗
06:37
And, oh yes, if you wanted,
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当然如果你愿意的话
06:39
he would give you a haircut -- short on the sides, long in the back --
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他也给你理个发－两边短后边长
06:42
and pull your tooth while he was at it.
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还顺便给你拔个牙
06:44
He made no attempt at diagnosis.
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完全没有诊断环节
06:46
In fact, some of you might well know
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也许有些人还记得
06:48
that the barber pole, the red and white stripes,
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理发店的标志，红白条纹
06:51
represents the blood bandages of the barber surgeon,
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象征理发医师的绷带
06:54
and the receptacles on either end
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两侧的容器
06:56
represent the pots in which the blood was collected.
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象征收集血液的壶
06:59
But the arrival of auscultation and percussion
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但听诊法和叩诊法的出现
07:02
represented a sea change,
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意味着一个大变化
07:04
a moment when physicians were beginning to look inside the body.
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内科医生开始能探视人体内部
07:07
And this particular painting, I think,
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这幅画，我认为
07:10
represents the pinnacle, the peak, of that clinical era.
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代表这那个医疗时代的顶峰
07:13
This is a very famous painting:
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这是个非常著名的油画
07:15
"The Doctor" by Luke Fildes.
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卢克･菲尔德斯的《医生》
07:18
Luke Fildes was commissioned to paint this by Tate,
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此画是卢克･菲尔德斯受泰特之托
07:21
who then established the Tate Gallery.
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泰特建立了泰特美术馆
07:23
And Tate asked Fildes to paint a painting
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他请卢克.菲尔德斯画一幅
07:25
of social importance.
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表现社会重要现状的画
07:27
And it's interesting that Fildes picked this topic.
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有趣的是菲尔德斯选择了这个主题
07:30
Fildes' oldest son, Philip,
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菲尔德斯的大儿子，菲利普
07:33
died at the age of nine on Christmas Eve
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9岁的时候因为一点小病痛
07:36
after a brief illness.
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死在了平安夜
07:38
And Fildes was so taken by the physician
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菲尔德斯被这位守夜守了两三夜的
07:41
who held vigil at the bedside for two, three nights,
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医生深深感动
07:45
that he decided that he would try and depict
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于是他决定试着描绘
07:47
the physician in our time --
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这个时代的医生－
07:49
almost a tribute to this physician.
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几乎是对这位医生的赞颂
07:51
And hence the painting "The Doctor," a very famous painting.
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因此《医生》这幅著名的画
07:54
It's been on calendars, postage stamps in many different countries.
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出现在很多国家的挂历上和邮票上
07:57
I've often wondered, what would Fildes have done
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我常想，菲尔德斯会怎么办
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had he been asked to paint this painting
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如果他被要求在这个时代
08:02
in the modern era,
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画那幅画
08:04
in the year 2011?
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在2011年？
08:07
Would he have substituted a computer screen
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他是不是得把患者
08:11
for where he had the patient?
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换成电脑屏幕？
08:13
I've gotten into some trouble in Silicon Valley
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我因为说病床上的病人
08:15
for saying that the patient in the bed
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基本上只是
08:17
has almost become an icon
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电脑里真正病人的图标
08:20
for the real patient who's in the computer.
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而和硅谷惹上麻烦
08:23
I've actually coined a term for that entity in the computer.
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事实上我为计算机里的那个实体（病人）创造了个新词
08:26
I call it the iPatient.
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iPatient
08:28
The iPatient is getting wonderful care all across America.
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全美国的iPatient都得到很好的治疗
08:31
The real patient often wonders,
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真的病人倒在奇怪
08:33
where is everyone?
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人都哪里去了？
08:35
When are they going to come by and explain things to me?
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他们什么时候来给我解释这些玩意儿？
08:38
Who's in charge?
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谁负责啊？
08:40
There's a real disjunction between the patient's perception
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病人和医生对最佳医疗的认识
08:43
and our own perceptions as physicians of the best medical care.
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有着很大的距离
08:46
I want to show you a picture
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我想给你们展示
08:48
of what rounds looked like
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我当时的临床实习
08:50
when I was in training.
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是什么样的
08:52
The focus was around the patient.
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重点都是病人
08:54
We went from bed to bed. The attending physician was in charge.
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我们一张病床一张病床走过去 当值的医生负责
08:57
Too often these days,
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现如今
08:59
rounds look very much like this,
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临床实习更像这样
09:01
where the discussion is taking place
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讨论是在一个
09:03
in a room far away from the patient.
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远离病人的房间进行的
09:06
The discussion is all about images on the computer, data.
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讨论的场面都是电脑，数据
09:09
And the one critical piece missing
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最重要的部分－病人
09:11
is that of the patient.
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却缺失了
09:13
Now I've been influenced in this thinking
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我想跟你们分享两个故事
09:16
by two anecdotes that I want to share with you.
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我本人深受影响
09:19
One had to do with a friend of mine who had a breast cancer,
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一个是跟我一个患有乳腺癌的朋友有关
09:22
had a small breast cancer detected --
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在发现一个小的乳腺肿瘤后
09:25
had her lumpectomy in the town in which I lived.
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她在我住的那个城市做了手术切除
09:27
This is when I was in Texas.
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这是我在德克萨斯的时候
09:29
And she then spent a lot of time researching
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然后她花了很多时间
09:32
to find the best cancer center in the world
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寻找世界上最好的癌症中心
09:35
to get her subsequent care.
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接受后续治疗
09:37
And she found the place and decided to go there, went there.
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她找到了然后去了
09:40
Which is why I was surprised a few months later
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几个月后我很惊讶地
09:43
to see her back in our own town,
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看见她回来了
09:46
getting her subsequent care with her private oncologist.
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在她的私人医生那里接受术后康复
09:49
And I pressed her, and I asked her,
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我问她
09:51
"Why did you come back and get your care here?"
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你问什么回来接受康复？
09:54
And she was reluctant to tell me.
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她不是很愿意吐露
09:56
She said, "The cancer center was wonderful.
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她说，”那个癌症中心非常棒
09:59
It had a beautiful facility,
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设施一流
10:01
giant atrium, valet parking,
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大堂超级大，服务生停车
10:03
a piano that played itself,
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自动弹奏的钢琴
10:05
a concierge that took you around from here to there.
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有人待你到处溜达“
10:08
But," she said,
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但是
10:10
"but they did not touch my breasts."
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“他们根本没碰我的胸部”
10:14
Now you and I could argue
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现在我们可以说
10:16
that they probably did not need to touch her breasts.
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他们也许没有必要碰她的胸部
10:18
They had her scanned inside out.
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可以扫描嘛
10:20
They understood her breast cancer at the molecular level;
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他们可以从分子层面了解她的乳腺癌
10:23
they had no need to touch her breasts.
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没有必要碰
10:25
But to her, it mattered deeply.
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但对她来说，这很重要
10:28
It was enough for her to make the decision
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这足够让她决定
10:32
to get her subsequent care with her private oncologist
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从她私人医生那里接受康复
10:35
who, every time she went,
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她去私人医生那里
10:37
examined both breasts including the axillary tail,
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医生会检查两侧乳房包括腋窝端
10:40
examined her axilla carefully,
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很仔细地检查腋窝
10:42
examined her cervical region, her inguinal region,
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检查她的子宫颈和腹股沟
10:44
did a thorough exam.
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一个全面的检查
10:46
And to her, that spoke of a kind of attentiveness that she needed.
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对她来说，这表达了她所需要的关注
10:50
I was very influenced by that anecdote.
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这件事深深影响了我
10:52
I was also influenced by another experience that I had,
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另外还有一个我的经历同样对我有影响
10:55
again, when I was in Texas, before I moved to Stanford.
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也是我在德克萨斯的时候，还没搬到斯坦福
10:58
I had a reputation
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我有个名声在外
11:00
as being interested in patients
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就是非常关注患有
11:02
with chronic fatigue.
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慢性疲劳的病人
11:05
This is not a reputation you would wish on your worst enemy.
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这不是个坏名声
11:09
I say that because these are difficult patients.
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我这么说是因为他们都不容易
11:12
They have often been rejected by their families,
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他们多被家人拒绝
11:15
have had bad experiences with medical care
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有很不如意的医疗经历
11:17
and they come to you fully prepared
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他们早准备好了
11:20
for you to join the long list of people
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你是许多人之后
11:22
who's about to disappoint them.
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下一个另他们失望的人
11:24
And I learned very early on with my first patient
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我从第一个病人身上就早早认识到
11:27
that I could not do justice
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我无法公平地
11:29
to this very complicated patient
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去查看这位复杂病人的
11:31
with all the records they were bringing
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所有纪录
11:33
in a new patient visit of 45 minutes.
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一个新病人只有45分钟
11:35
There was just no way.
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无可奈何
11:37
And if I tried, I'd disappoint them.
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如果我尝试了，我会令他们失望
11:40
And so I hit on this method
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所以我的做法是
11:42
where I invited the patient
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第一次会诊的时候
11:44
to tell me the story for their entire first visit,
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我让病人们给我讲述他们的情况
11:47
and I tried not to interrupt them.
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我尝试不去打断
11:50
We know the average American physician
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我们知道美国医生平均
11:52
interrupts their patient in 14 seconds.
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14秒后就打断病人说话
11:55
And if I ever get to heaven,
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如果我能进天堂
11:57
it will be because I held my piece for 45 minutes
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肯定是因为我能倾听上45分钟
12:00
and did not interrupt my patient.
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而没打断他们
12:02
I then scheduled the physical exam for two weeks hence,
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然后我会在两周后安排体检
12:05
and when the patient came for the physical,
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当病人来的时候
12:07
I was able to do a thorough physical,
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我就能做一个彻底的体检
12:09
because I had nothing else to do.
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因为这就是我能做的
12:11
I like to think that I do a thorough physical exam,
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我想我做彻底的检查
12:14
but because the whole visit was now about the physical,
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是因为这个会诊就是为了体检
12:17
I could do an extraordinarily thorough exam.
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我可以做一个格外细致的检查
12:20
And I remember my very first patient in that series
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我记得我第一个慢性疲劳病人
12:24
continued to tell me more history
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在他的体检会诊过程中
12:26
during what was meant to be the physical exam visit.
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给我讲述更多她的历史
12:29
And I began my ritual.
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我开始了我的仪式
12:31
I always begin with the pulse,
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我总是从测脉搏开始
12:33
then I examine the hands, then I look at the nail beds,
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然后检查手，接下来是甲床
12:36
then I slide my hand up to the epitrochlear node,
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然后是滑车上淋巴结
12:38
and I was into my ritual.
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由此进入我的仪式
12:40
And when my ritual began,
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当仪式开始
12:42
this very voluble patient
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这个健谈的病人
12:44
began to quiet down.
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开始安静下来
12:46
And I remember having a very eerie sense
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我记得感受到一种神秘的畏惧感
12:49
that the patient and I
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当我和病人
12:52
had slipped back into a primitive ritual
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都进入到这种原始性的仪式
12:54
in which I had a role
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其中我有我的角色
12:56
and the patient had a role.
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而病人有病人的角色
12:58
And when I was done,
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当我完成的时候
13:00
the patient said to me with some awe,
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病人怀着敬畏对我说
13:02
"I have never been examined like this before."
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“我从来没有被这样检查过”
13:05
Now if that were true,
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如果这是真的话
13:07
it's a true condemnation of our health care system,
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是对医疗保健系统的一个真实的谴责
13:09
because they had been seen in other places.
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因为他们从来没在别的地方经历过
13:12
I then proceeded to tell the patient,
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等病人穿戴完毕
13:14
once the patient was dressed,
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我接着告诉他
13:16
the standard things that the person must have heard in other institutions,
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他肯定在其他医疗机构都听过的内容：
13:19
which is, "This is not in your head.
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“这不是你想像的
13:21
This is real.
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这是真的
13:23
The good news, it's not cancer, it's not tuberculosis,
318
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好消息是，得的不是癌症，不是肺结核
13:26
it's not coccidioidomycosis or some obscure fungal infection.
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不是球孢子菌病或者什么真菌感染
13:29
The bad news is we don't know exactly what's causing this,
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坏消息是我们不清楚是什么导致的
13:32
but here's what you should do, here's what we should do."
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你应该做这些，我应该做这些”
13:35
And I would lay out all the standard treatment options
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我会列出病人在其他地方也听过的
13:38
that the patient had heard elsewhere.
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所有标准治疗的选项
13:41
And I always felt
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我总觉得
13:43
that if my patient gave up the quest
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如果我的病人放弃追着
13:45
for the magic doctor, the magic treatment
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某个神奇医生，神奇疗法
13:48
and began with me on a course towards wellness,
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而转投我开始走向健康
13:51
it was because I had earned the right
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那是因为我一丝不苟的检查
13:53
to tell them these things
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为我赢得了
13:55
by virtue of the examination.
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告诉他们这些的权利
13:57
Something of importance had transpired in the exchange.
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通过交流一些重要的信息已经透露
14:01
I took this to my colleagues
332
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我将此讲给
14:03
at Stanford in anthropology
333
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在斯坦福大学人类学的同事们
14:05
and told them the same story.
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告诉他们这个故事
14:07
And they immediately said to me,
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他们立刻对我说
14:09
"Well you are describing a classic ritual."
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“你描述了一个经典仪式”
14:11
And they helped me understand
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他们帮助我理解了
14:13
that rituals are all about transformation.
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仪式意味着转变
14:16
We marry, for example,
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举例说，我们结婚
14:18
with great pomp and ceremony and expense
340
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用舞会，仪式和花费
14:21
to signal our departure
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来宣告
14:23
from a life of solitude and misery and loneliness
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2000
孤独寂寞的悲惨生活
14:25
to one of eternal bliss.
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变成永恒的幸福
14:28
I'm not sure why you're laughing.
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我不知道你们为什么笑
14:30
That was the original intent, was it not?
345
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我们结婚原本是这么希望的，是吧？
14:32
We signal transitions of power
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我们通过仪式表达
14:34
with rituals.
347
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力量的转变
14:36
We signal the passage of a life with rituals.
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我们用仪式表达生命
14:38
Rituals are terribly important.
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仪式非常重要
14:40
They're all about transformation.
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全部都与转变有关
14:42
Well I would submit to you
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我想告诉你这种仪式
14:44
that the ritual
352
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一个人
14:46
of one individual coming to another
353
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来到另一个人面前
14:48
and telling them things
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告诉他一些
14:50
that they would not tell their preacher or rabbi,
355
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3000
连神父都不告诉的的事
14:53
and then, incredibly on top of that,
356
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除此之外
14:55
disrobing and allowing touch --
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还换衣解带并让他触碰
14:58
I would submit to you that that is a ritual of exceeding importance.
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我想告诉你们这是个极度重要的仪式
15:02
And if you shortchange that ritual
359
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如果你在仪式上玩花样
15:04
by not undressing the patient,
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比如不解衣服
15:06
by listening with your stethoscope on top of the nightgown,
361
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隔着睡裙听诊
15:09
by not doing a complete exam,
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或者检查不完整
15:11
you have bypassed on the opportunity
363
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你已经错过了
15:13
to seal the patient-physician relationship.
364
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在医患关系上留下鉴印的机会
15:17
I am a writer,
365
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我是个作家
15:19
and I want to close by reading you a short passage that I wrote
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4000
我想以我写的一段话结尾
15:23
that has to do very much with this scene.
367
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它与这个场景契合
15:25
I'm an infectious disease physician,
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我是个传染病医生
15:27
and in the early days of HIV, before we had our medications,
369
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3000
在HIV传染早期，还没有治疗方法的时候
15:30
I presided over so many scenes like this.
370
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我经历过如此之多的这样的场景
15:34
I remember, every time I went to a patient's deathbed,
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我记得，每次去医院或者病人家里的
15:37
whether in the hospital or at home,
372
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临死的卧床
15:39
I remember my sense of failure --
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4000
我总有种失败感－
15:43
the feeling of I don't know what I have to say;
374
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2000
一种无话可说的感觉
15:45
I don't know what I can say;
375
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我不知道说什么好
15:47
I don't know what I'm supposed to do.
376
932000
2000
我不知道做什么好
15:49
And out of that sense of failure,
377
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带着那种失败感
15:51
I remember, I would always examine the patient.
378
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3000
我记得，我总会检查病人
15:54
I would pull down the eyelids.
379
939000
2000
看看眼皮
15:56
I would look at the tongue.
380
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2000
看看舌头
15:58
I would percuss the chest. I would listen to the heart.
381
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3000
敲敲胸部 听听心跳
16:01
I would feel the abdomen.
382
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按压腹腔
16:03
I remember so many patients,
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我记得很多病人
16:06
their names still vivid on my tongue,
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他们的名字仍犹如在耳
16:08
their faces still so clear.
385
953000
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他们的脸庞仍历历在目
16:10
I remember so many huge, hollowed out, haunted eyes
386
955000
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我记得很多大而空洞的眼睛
16:14
staring up at me as I performed this ritual.
387
959000
3000
在我进行仪式的时候盯着我
16:17
And then the next day,
388
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次日
16:19
I would come, and I would do it again.
389
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我会再来，再做
16:21
And I wanted to read you this one closing passage
390
966000
3000
我想给各位读的结束语
16:24
about one patient.
391
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是关于一位病人的
16:26
"I recall one patient
392
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2000
“我记得一位病人
16:28
who was at that point
393
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当时的他
16:30
no more than a skeleton
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瘦骨嶙峋
16:32
encased in shrinking skin,
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如同干柴
16:34
unable to speak,
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无法言语
16:36
his mouth crusted with candida
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嘴里长满念珠菌
16:38
that was resistant to the usual medications.
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这种真菌对普通药物具有抗药性
16:41
When he saw me
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当他看见我时
16:43
on what turned out to be his last hours on this earth,
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已是他活在人世的最后几个小时
16:45
his hands moved as if in slow motion.
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他的手像慢镜头一样移动
16:48
And as I wondered what he was up to,
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我想他要表达点什么
16:50
his stick fingers made their way
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他的干柴一样的手指
16:52
up to his pajama shirt,
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伸向他的睡衣
16:54
fumbling with his buttons.
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要解开扣子
16:57
I realized that he was wanting
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我意识到
16:59
to expose his wicker-basket chest to me.
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他是想给我们看他骨瘦如柴的胸膛
17:02
It was an offering, an invitation.
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那是个邀请
17:05
I did not decline.
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我没有拒绝
17:07
I percussed. I palpated. I listened to the chest.
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我叩诊 触诊 听诊了胸腔
17:10
I think he surely must have known by then
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我认为他一定知道
17:12
that it was vital for me
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那对我的重要
17:14
just as it was necessary for him.
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就想对他的必要一样
17:16
Neither of us could skip this ritual,
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谁也不能省略这个仪式
17:19
which had nothing to do with detecting rales in the lung,
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不是为了听肺部的水泡
17:22
or finding the gallop rhythm of heart failure.
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或是心脏衰弱的跳动
17:25
No, this ritual was about the one message
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不，这个仪式
17:28
that physicians have needed to convey to their patients.
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是医生向患者传达的一个信息
17:31
Although, God knows, of late, in our hubris,
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虽然后来因为我们的傲慢
17:33
we seem to have drifted away.
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我们把它弄丢了
17:35
We seem to have forgotten --
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我们好像忘了－
17:37
as though, with the explosion of knowledge,
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虽然有了知识大爆炸
17:39
the whole human genome mapped out at our feet,
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整个人类的基因组被绘制出来
17:42
we are lulled into inattention,
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我们渐渐变得冷漠
17:44
forgetting that the ritual is cathartic to the physician,
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忘记了仪式是医生的泻药
17:47
necessary for the patient --
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病人很需要－
17:49
forgetting that the ritual has meaning
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我们忘了仪式具有意义
17:51
and a singular message to convey to the patient.
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并且将信息传达给病人
17:55
And the message, which I didn't fully understand then,
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这个信息虽然我当时传递给了病人
17:58
even as I delivered it,
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但我并没有完全理解
18:00
and which I understand better now is this:
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现在我更好地理解了：
18:03
I will always, always, always be there.
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我会永远，永远，永远在这里
18:06
I will see you through this.
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我会陪你经历这一切
18:08
I will never abandon you.
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我永远不会抛弃你
18:10
I will be with you through the end."
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我会陪你到最后
18:12
Thank you very much.
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谢谢
18:14
(Applause)
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（掌声）
ABOUT THE SPEAKER
Abraham Verghese - Physician and authorIn our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation.
Why you should listen
Before he finished medical school, Abraham Verghese spent a year on the other end of the medical pecking order, as a hospital orderly. Moving unseen through the wards, he saw the patients with new eyes, as human beings rather than collections of illnesses. The experience has informed his work as a doctor -- and as a writer. "Imagining the Patient’s Experience" was the motto of the Center for Medical Humanities & Ethics, which he founded at the University of Texas San Antonio, where he brought a deep-seated empathy. He’s now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns.
He’s also a best-selling writer, with two memoirs and a novel, Cutting for Stone, a moving story of two Ethiopian brothers bound by medicine and betrayal.
He says: “I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it's only at the bedside that I can figure out what is important.”
In 2011, Verghese was elected to the Institute of Medicine, which advises the government and private institutions on medicine and health on a national level.
Abraham Verghese | Speaker | TED.com