Abraham Verghese: A doctor's touch

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A few months ago,

Prije nekoliko mjeseci,

a 40 year-old woman came to an emergency room

40-godišnja žena je došla na hitni prijem

in a hospital close to where I live,

bolnice, blizu koje živim.

and she was brought in confused.

Dovezena je zbunjena.

Her blood pressure was an alarming

Njezin krvni tlak je bio zabrinjavajućih

230 over 170.

230 sa 170.

Within a few minutes, she went into cardiac collapse.

Za nekoliko minuta je doživjela srčani zastoj.

She was resuscitated, stabilized,

Oživljavana je i stabilizirana,

whisked over to a CAT scan suite

odvedena na CT

right next to the emergency room,

odmah uz hitni prijem,

because they were concerned about blood clots in the lung.

jer su bili zabrinuti zbog ugrušaka u plućima.

And the CAT scan revealed

I CT nije pokazao

no blood clots in the lung,

krvne ugruške u plućima,

but it showed bilateral, visible, palpable breast masses,

već obostrane, vidljive, palpabilne tvorbe u dojkama,

breast tumors,

tumore dojke,

that had metastasized widely

koji su opsežno metastazirali

all over the body.

po cijelom tijelu.

And the real tragedy was, if you look through her records,

A prava tragedija je bila to što, kada biste pogledali njezinu dokumentaciju,

she had been seen

je bila pregledana

in four or five other health care institutions

u četiri ili pet drugih zdravstvenih ustanova

in the preceding two years.

u prethodne dvije godine.

Four or five opportunities

Četiri ili pet prilika

to see the breast masses, touch the breast mass,

da se uoče tvorbe u dojkama, da se opipaju te tvorbe,

intervene at a much earlier stage

da se intervenira u puno ranijem stadiju

than when we saw her.

od onoga u kojem smo je mi vidjeli.

Ladies and gentlemen,

Dame i gospodo,

that is not an unusual story.

ovo nije neuobičajena priča.

Unfortunately, it happens all the time.

Nažalost, stalno se događa.

I joke, but I only half joke,

Obično se šalim, ali samo djelomice,

that if you come to one of our hospitals missing a limb,

da ako dođete u jednu od naših bolnica bez noge ili ruke,

no one will believe you till they get a CAT scan, MRI

nitko vam neće vjerovati dok se ne napravi CT, MRI

or orthopedic consult.

ili konzilijarni pregled ortopeda.

I am not a Luddite.

Nisam Ludit.

I teach at Stanford.

Predajem na Stanfordu.

I'm a physician practicing with cutting-edge technology.

Liječnik sam koji koristi naprednu tehnologiju.

But I'd like to make the case to you

Ali želim obraniti tezu

in the next 17 minutes

u sljedećih 17 minuta

that when we shortcut the physical exam,

da kada skratimo fizikalni pregled,

when we lean towards ordering tests

kada težište stavljamo na laboratorijske pretrage

instead of talking to and examining the patient,

umjesto na razgovor s pacijentom i na pregled,

we not only overlook simple diagnoses

ne samo da previdimo jednostavne dijagnoze

that can be diagnosed at a treatable, early stage,

koje mogu biti dijagnosticirane u izlječivom, ranom stadiju,

but we're losing much more than that.

nego gubimo mnogo više.

We're losing a ritual.

Gubimo ritual.

We're losing a ritual that I believe is transformative, transcendent,

Gubimo ritual za kojeg smatram da je preobražavajuć, transcendentalan,

and is at the heart

i čini suštinu

of the patient-physician relationship.

odnosa između pacijenta i liječnika.

This may actually be heresy to say this at TED,

Možda je hereza što ću ovo reći na TED-u,

but I'd like to introduce you

ali htio bih vas upoznati

to the most important innovation,

s najvažnijom inovacijom,

I think, in medicine

po mom mišljenju, u medicini

to come in the next 10 years,

koja će doći u sljedećih 10 godina.

and that is the power of the human hand --

To je moć ljudske ruke --

to touch, to comfort, to diagnose

da dodirne, utješi, dijagnosticira

and to bring about treatment.

i započne liječenje.

I'd like to introduce you first to this person

Prvo bih vas želio upoznati s ovom osobom,

whose image you may or may not recognize.

čiju sliku možda prepoznajete.

This is Sir Arthur Conan Doyle.

Ovo je Sir Arthur Conan Doyle.

Since we're in Edinburgh, I'm a big fan of Conan Doyle.

S obzirom da smo u Edinburgu, veliki sam obožavatelj Conana Doylea.

You might not know that Conan Doyle went to medical school

Mozda ne znate da je Conan Doyle išao na medicinski fakultet

here in Edinburgh,

ovdje u Edinburgu,

and his character, Sherlock Holmes,

i njegov lik, Sherlock Holmes,

was inspired by Sir Joseph Bell.

je bio nadahnut Sirom Josephom Bellom.

Joseph Bell was an extraordinary teacher by all accounts.

Joseph Bell je bio izuzetan učitelj u svakom pogledu.

And Conan Doyle, writing about Bell,

I Conan Doyle, pišući o Bellu,

described the following exchange

je opisao sljedeći razgovor

between Bell and his students.

između Bella i njegovih studenata.

So picture Bell sitting in the outpatient department,

Zamislite Bella kako sjedi u ambulanti,

students all around him,

studenti oko njega,

patients signing up in the emergency room

pacijenti se upisuju na hitni prijem

and being registered and being brought in.

registriraju se i uvode unutra.

And a woman comes in with a child,

I ulazi jedna žena s djetetom,

and Conan Doyle describes the following exchange.

i Conan Doyle opisuje sljedeći razgovor.

The woman says, "Good Morning."

Žena kaže, „Dobro jutro.”

Bell says, "What sort of crossing did you have

Bell kaže, “Kakav vam je bio prijelaz

on the ferry from Burntisland?"

trajektom od Burntislanda?”

She says, "It was good."

Ona odogovori, “Bio je dobar.”

And he says, "What did you do with the other child?"

Potom on kaže, „Što ste napravili s drugim djetetom?”

She says, "I left him with my sister at Leith."

Ona kaže, „Ostavila sam ga kod svoje sestre u Leithu.”

And he says,

I on kaže,

"And did you take the shortcut down Inverleith Row

„Jeste li išli prečacem kroz Inverleith Row

to get here to the infirmary?"

da dođete ovdje u ambulantu?”

She says, "I did."

Ona kaže, „Jesmo.”

And he says, "Would you still be working at the linoleum factory?"

I on kaže, „Da li možda još radite u tvornici linoleuma?”

And she says, "I am."

Ona kaže, „Radim.”

And Bell then goes on to explain to the students.

Bell je potom objasnio studentima.

He says, "You see, when she said, 'Good morning,'

Kaže, „Vidite, kada je rekla ‘Dobro jutro.’

I picked up her Fife accent.

primjetio sam njezin naglasak iz Fifa.

And the nearest ferry crossing from Fife is from Burntisland.

A najbliži trajekt koji dolazi iz Fifea kreće iz Burntislanda.

And so she must have taken the ferry over.

Tako da je morala doći trajektom.

You notice that the coat she's carrying

Primjetite da je kaput kojeg drži

is too small for the child who is with her,

premalen za dijete koje je s njom,

and therefore, she started out the journey with two children,

stoga je počela put s dvoje djece,

but dropped one off along the way.

ali je ostavila jedno putem.

You notice the clay on the soles of her feet.

Primjetite glinu na njenim tabanima.

Such red clay is not found within a hundred miles of Edinburgh,

Tako crvenu glinu ne možete naći stotinama kilometara od Edinburga,

except in the botanical gardens.

osim u botaničkim vrtovima.

And therefore, she took a short cut down Inverleith Row

Stoga je išla prečacem kroz Inverleith Row

to arrive here.

da bi stigla ovdje.

And finally, she has a dermatitis

I naposljetku, ima dermatitis

on the fingers of her right hand,

na prstima desne ruke,

a dermatitis that is unique

dermatitis koji je jedinstven

to the linoleum factory workers in Burntisland."

radnicima tvornice linoleuma u Burntislandu.”

And when Bell actually strips the patient,

A kada Bell još i skine pacijenticu,

begins to examine the patient,

počne pregledavati pacijenticu,

you can only imagine how much more he would discern.

možete i sami zamisliti koliko bi još zaključaka mogao donijeti.

And as a teacher of medicine, as a student myself,

A kao učitelj medicine, i kao student,

I was so inspired by that story.

bio sam jako nadahnut ovom pričom.

But you might not realize

Ali možda ne shvaćate

that our ability to look into the body

da je naša sposobnost da pogledamo u tijelo

in this simple way, using our senses,

na ovaj jednostavan način, koristeći naša osjetila,

is quite recent.

počela tek nedavno.

The picture I'm showing you is of Leopold Auenbrugger

Slika koju vam pokazujem, prikazuje Leopolda Auenbruggera,

who, in the late 1700s,

koji je krajem 18. stoljeća

discovered percussion.

otkrio perkusiju.

And the story is that Leopold Auenbrugger

A priča kaže da je Leopold Auenbrugger

was the son of an innkeeper.

bio sin gostioničara.

And his father used to go down into the basement

Njegov otac bi išao u podrum

to tap on the sides of casks of wine

i kuckao bi po stijenkama vinskih bačvi

to determine how much wine was left

da odredi koliko je vina ostalo

and whether to reorder.

i da li treba još naručiti.

And so when Auenbrugger became a physician,

Kada je Auenbrugger postao liječnik

he began to do the same thing.

počeo je raditi istu stvar.

He began to tap on the chests of his patients,

Počeo je lupkati po prsima pacijenata

on their abdomens.

i po njihovim trbusima.

And basically everything we know about percussion,

I praktički sve što znamo o perkusiji,

which you can think of as an ultrasound of its day --

koju možete zamisliti kao ultrazvuk svog doba,

organ enlargement, fluid around the heart, fluid in the lungs,

povećanje organa, tekućina oko srca, tekućina u plućima,

abdominal changes --

promjene u trbuhu,

all of this he described in this wonderful manuscript

sve je to opisao u ovom predivnom rukopisu

"Inventum Novum," "New Invention,"

„Inventum Novum”, „Novi izum”,

which would have disappeared into obscurity,

koji bi otišao u zaborav

except for the fact that this physician, Corvisart,

da ga ovaj liječnik, Corvisart,

a famous French physician --

poznati francuski liječnik,

famous only because he was physician to this gentleman --

poznat jedino zato što je bio liječnik ovog gospodina,

Corvisart repopularized and reintroduced the work.

Corvisart je ponovno popularizirao i predstavio ovaj rad.

And it was followed a year or two later

Godinu-dvije nakon toga je popraćen

by Laennec discovering the stethoscope.

Laennecovim otkrićem stetoskopa.

Laennec, it is said, was walking in the streets of Paris

Priča se da je Laennec hodao ulicama Pariza

and saw two children playing with a stick.

i vidio dvoje djece kako se igraju sa štapom.

One was scratching at the end of the stick,

Jedan je strugao jedan kraj štapa,

another child listened at the other end.

dok je drugo dijete slušalo na drugom kraju.

And Laennec thought this would be a wonderful way

I Laennec je pomislio kako bi ovo bio divan način

to listen to the chest or listen to the abdomen

slušanja prsa ili trbuha

using what he called "the cylinder."

koristeći „cilindar”, kako ga je nazvao.

Later he renamed it the stethoscope.

Kasnije ga je preimenovao u stetoskop.

And that is how stethoscope and auscultation was born.

I tako su se rodili stetoskop i auskultacija.

So within a few years,

Tako da je unutar nekoliko godina,

in the late 1800s, early 1900s,

krajem 19. i početkom 20. stoljeća,

all of a sudden,

iznenada

the barber surgeon had given way

brijač-kirurg bio zamijenjen

to the physician who was trying to make a diagnosis.

liječnikom, koji je pokušavao postaviti dijagnozu.

If you'll recall, prior to that time,

Ako se sjećate, prije toga

no matter what ailed you, you went to see the barber surgeon

bez obzira na vaše tegobe, išli ste brijaču-kirurgu,

who wound up cupping you,

koji vam je na kraju puštao krv pomoću roga,

bleeding you, purging you.

pustio vam krv, pročistio vas.

And, oh yes, if you wanted,

I da, ako ste htjeli,

he would give you a haircut -- short on the sides, long in the back --

podšišao vas je, kratko sa strane, dugo odostraga,

and pull your tooth while he was at it.

i izvadio vam zub, kad ste već tamo.

He made no attempt at diagnosis.

Nije ni pokušavao postaviti dijagnozu.

In fact, some of you might well know

Štoviše, neki od vas možda i znaju

that the barber pole, the red and white stripes,

da brijački stup, sa crvenim i bijelim prugama,

represents the blood bandages of the barber surgeon,

predstavlja krvave zavoje brijača-kirurga,

and the receptacles on either end

a posude na oba kraja

represent the pots in which the blood was collected.

predstavljaju vrčeve u kojima se skupljala krv.

But the arrival of auscultation and percussion

Ali dolazak perkusije i auskultacije

represented a sea change,

je predstavljao postupnu promjenu,

a moment when physicians were beginning to look inside the body.

trenutak kada su liječnici počeli gledati u tijelo.

And this particular painting, I think,

A posebice ova slika, po mom mišljenju,

represents the pinnacle, the peak, of that clinical era.

predstavlja vrh, vrhunac tog kritičnog razdoblja.

This is a very famous painting:

Ovo je vrlo poznata slika:

"The Doctor" by Luke Fildes.

„Liječnik” Luka Fildesa.

Luke Fildes was commissioned to paint this by Tate,

Tate je naručio sliku od Luka Fildesa,

who then established the Tate Gallery.

i potom je osnovao Tate galeriju.

And Tate asked Fildes to paint a painting

Tate je zamolio Fildesa da naslika sliku

of social importance.

od društvenog značaja.

And it's interesting that Fildes picked this topic.

Zanimljivo je da je Fildes izabrao ovu temu.

Fildes' oldest son, Philip,

Fildesov najstariji sin Philip

died at the age of nine on Christmas Eve

je umro u dobi od devet godina na Badnjak

after a brief illness.

nakon kratke bolesti.

And Fildes was so taken by the physician

Fildes je bio toliko zadivljen liječnikom

who held vigil at the bedside for two, three nights,

koji je probdio dvije-tri noći uz krevet djeteta,

that he decided that he would try and depict

da je odlučio pokušati prikazati

the physician in our time --

liječnika našeg vremena,

almost a tribute to this physician.

skoro poput odavanja počasti tom liječniku.

And hence the painting "The Doctor," a very famous painting.

I tako je nastala slika „Liječnik”, vrlo poznata slika.

It's been on calendars, postage stamps in many different countries.

Bila je na kalendarima, poštanskim markama mnogih zemalja.

I've often wondered, what would Fildes have done

Često sam se zapitao, što bi Fildes napravio

had he been asked to paint this painting

da su ga zatražili da naslika ovu sliku

in the modern era,

u modernom dobu,

in the year 2011?

u 2011. godini.

Would he have substituted a computer screen

Bi li računalni zaslon stavio

for where he had the patient?

umjesto pacijenta?

I've gotten into some trouble in Silicon Valley

Malo sam upao u nevolje u Silikonskoj dolini

for saying that the patient in the bed

zato što sam rekao da je pacijent u krevetu

has almost become an icon

praktički postao ikona

for the real patient who's in the computer.

pravog pacijenta, koji je u računalu.

I've actually coined a term for that entity in the computer.

Čak sam osmislio i naziv za to stvorenje u računalu.

I call it the iPatient.

Zovem ga iPacijent.

The iPatient is getting wonderful care all across America.

iPacijent dobiva predivnu skrb diljem Amerike.

The real patient often wonders,

Pravi pacijent se često pita

where is everyone?

gdje su svi.

When are they going to come by and explain things to me?

Kada će netko doći i objasniti mi stvari?

Who's in charge?

Tko je glavni?

There's a real disjunction between the patient's perception

Postoji pravi nesrazmjer između pacijentove predodžbe

and our own perceptions as physicians of the best medical care.

i naše vlastite, kao liječnika, u tome što znači najbolja medicinska skrb.

I want to show you a picture

Želim vam pokazati sliku

of what rounds looked like

kako su vizite izgledale

when I was in training.

dok sam se ja školovao.

The focus was around the patient.

Težište je bilo oko pacijenta.

We went from bed to bed. The attending physician was in charge.

Išli smo od kreveta do kreveta. Vodeći liječnik je bio glavni.

Too often these days,

Danas prečesto

rounds look very much like this,

vizite izgledaju ovako,

where the discussion is taking place

raspravlja se

in a room far away from the patient.

u sobi daleko od pacijenta.

The discussion is all about images on the computer, data.

Rasprava se svede na slike na računalu, na podatke.

And the one critical piece missing

I nedostaje jedan ključan dio,

is that of the patient.

a to je pacijent.

Now I've been influenced in this thinking

Na ovo moje razmišljanje su utjecale

by two anecdotes that I want to share with you.

dvije anegdote, koje želim podijeliti s vama.

One had to do with a friend of mine who had a breast cancer,

Jedna je o mojoj prijateljici, koja je imala tumor dojke,

had a small breast cancer detected --

otkrili su joj mali tumor dojke.

had her lumpectomy in the town in which I lived.

Obavljena je lumpektomija u gradu u kojem sam živio.

This is when I was in Texas.

To je bilo dok sam živio u Teksasu.

And she then spent a lot of time researching

Nakon toga je provela puno vremena u traženju

to find the best cancer center in the world

najboljeg centra za tumore u svijetu

to get her subsequent care.

za nastavak njege.

And she found the place and decided to go there, went there.

Našla je mjesto i odlučila je otići tamo. Otišla je tamo.

Which is why I was surprised a few months later

I zato sam bio iznenađen nekoliko mjeseci nakon toga

to see her back in our own town,

kada sam je vidio u našem gradu,

getting her subsequent care with her private oncologist.

kako prima daljnju njegu kod svog privatnog onkologa.

And I pressed her, and I asked her,

I inzistirao sam, i pitao sam je.

"Why did you come back and get your care here?"

„Zašto si se vratila i dobivaš medicinsku njegu ovdje?“

And she was reluctant to tell me.

Nećkala se.

She said, "The cancer center was wonderful.

Rekla je, „Znaš, centar za tumore je bio predivan.

It had a beautiful facility,

Imali su predivne prostore,

giant atrium, valet parking,

golemo predvorje, privatno parkiranje,

a piano that played itself,

klavir koji je sam svirao,

a concierge that took you around from here to there.

djelatnik centra koji vas je vodio uokolo.

But," she said,

Ali, “ rekla je,

"but they did not touch my breasts."

„ali, nitko nije dodirnuo moje grudi.”

Now you and I could argue

Vi i ja bismo mogli braniti stajalište

that they probably did not need to touch her breasts.

da vjerojatno nisu ni trebali dodirnuti njene grudi.

They had her scanned inside out.

Pregledali su je iznutra i izvana.

They understood her breast cancer at the molecular level;

Shvaćali su njezin tumor na molekularnoj razini.

they had no need to touch her breasts.

Nije bilo potrebe dirati njezine grudi.

But to her, it mattered deeply.

Ali njoj je to bilo od izrazite važnosti.

It was enough for her to make the decision

To joj je bilo dovoljno da donese odluku

to get her subsequent care with her private oncologist

da daljnju njegu prima kod svog privatnog onkologa,

who, every time she went,

koji je svaki put kada je došla

examined both breasts including the axillary tail,

pregledao obje dojke, uključujući i aksilarni rep,

examined her axilla carefully,

pažljivo pregledao obje aksile,

examined her cervical region, her inguinal region,

pregledao vrat, preponsku regiju,

did a thorough exam.

napravio je opsežni pregled.

And to her, that spoke of a kind of attentiveness that she needed.

Njoj je to govorilo u prilog pažnji, koju je trebala.

I was very influenced by that anecdote.

Ova anegdota je imala veliki utjecaj na mene.

I was also influenced by another experience that I had,

Na mene je utjecalo i jedno iskustvo koje sam imao,

again, when I was in Texas, before I moved to Stanford.

opet, kada sam bio u Teksasu, prije no što sam se preselio na Stanford.

I had a reputation

Pratio me glas

as being interested in patients

da me zanimaju pacijenti

with chronic fatigue.

koji boluju od kroničnog umora.

This is not a reputation you would wish on your worst enemy.

To ne biste poželjeli svojem najgorem neprijatelju.

I say that because these are difficult patients.

To kažem zato što su to zahtjevni pacijenti.

They have often been rejected by their families,

Često su ih se njihove obitelji odrekle,

have had bad experiences with medical care

imali su loša iskustva s medicinskom njegom

and they come to you fully prepared

i dolaze vam potpuno spremni

for you to join the long list of people

da ćete se i vi pridružiti dugom popisu ljudi

who's about to disappoint them.

koji će ih razočarati.

And I learned very early on with my first patient

Vrlo sam rano naučio sa svojim prvim pacijentom

that I could not do justice

da ne mogu dati dovoljno pažnje

to this very complicated patient

ovom kompliciranom pacijentu

with all the records they were bringing

sa svom dokumentacijom koju donosi

in a new patient visit of 45 minutes.

i s trajanjem posjeta od 45 minuta.

There was just no way.

Jednostavno nije bilo šanse.

And if I tried, I'd disappoint them.

A da sam pokušao, razočarao bi ih.

And so I hit on this method

I tako sam počeo s metodom

where I invited the patient

kojom bih zatražio od pacijenta

to tell me the story for their entire first visit,

da mi priča tijekom cijelog prvog posjeta,

and I tried not to interrupt them.

i pokušao sam ih ne prekidati.

We know the average American physician

Znamo da prosječni američki liječnik

interrupts their patient in 14 seconds.

prekine svojeg pacijenta za 14 sekundi.

And if I ever get to heaven,

I ako ikad odem u raj

it will be because I held my piece for 45 minutes

to će biti zato što sam 45 minuta mirno slušao

and did not interrupt my patient.

svojeg pacijenta bez prekidanja.

I then scheduled the physical exam for two weeks hence,

Potom sam naručio pacijenta za fizikalni pregled za dva tjedna,

and when the patient came for the physical,

i kada je pacijent došao na pregled

I was able to do a thorough physical,

mogao sam napraviti detaljni fizikalni pregled,

because I had nothing else to do.

zato što nisam imao ništa drugo za raditi.

I like to think that I do a thorough physical exam,

Smatram da radim detaljan fizikalni pregled,

but because the whole visit was now about the physical,

ali zbog toga što je cijeli dolazak sada bio zbog pregleda,

I could do an extraordinarily thorough exam.

mogao sam obaviti iznimno detaljan fizikalan pregled.

And I remember my very first patient in that series

I sjećam se da mi je prvi pacijent iz te grupe

continued to tell me more history

nastavio pričati svoju anamnezu

during what was meant to be the physical exam visit.

tijekom posjete koja je trebala biti samo fizikalni pregled.

And I began my ritual.

I počeo sam svoj ritual.

I always begin with the pulse,

Uvijek počinjem s pulsom,

then I examine the hands, then I look at the nail beds,

potom pregledam ruke, pogledam ležište nokta,

then I slide my hand up to the epitrochlear node,

onda prođem rukom do epitrohlearnog limfnog čvora,

and I was into my ritual.

i bio sam u svom ritualu.

And when my ritual began,

A kada je moj ritual počeo,

this very voluble patient

ovaj vrlo govorljiv pacijent

began to quiet down.

je postajao sve tiši.

And I remember having a very eerie sense

I sjećam se da sam imao jezovit osjećaj

that the patient and I

da smo pacijent i ja

had slipped back into a primitive ritual

ušli u primitivni ritual

in which I had a role

u kojem sam ja imao ulogu

and the patient had a role.

i pacijent je imao ulogu.

And when I was done,

I kada sam bio gotov,

the patient said to me with some awe,

pacijent mi je rekao s blagim strahopoštovanjem,

"I have never been examined like this before."

„Nikad me nitko nije ovako pregledao.“

Now if that were true,

Ako je to istina,

it's a true condemnation of our health care system,

to bi bila prava osuda našeg zdravstvenog sustava,

because they had been seen in other places.

zato što su bili pregledani na drugim mjestima.

I then proceeded to tell the patient,

Onda sam nastavio govoriti pacijentu,

once the patient was dressed,

kada je bio obučen,

the standard things that the person must have heard in other institutions,

standardne stvari koje je sigurno čuo u ostalim institucijama,

which is, "This is not in your head.

a to su, „Ovo nije u vašoj glavi.

This is real.

Ovo je stvarno.

The good news, it's not cancer, it's not tuberculosis,

Dobra je vijest da se ne radi o tumoru ili o tuberkulozi,

it's not coccidioidomycosis or some obscure fungal infection.

niti o kokcidioidomikozi ili nekoj drugoj bizarnoj gljivičnoj infekciji.

The bad news is we don't know exactly what's causing this,

Loša vijest je da ne znamo točno uzrok vašim tegobama,

but here's what you should do, here's what we should do."

ali trebali biste napraviti sljedeće, trebali bismo napraviti sljedeće.“

And I would lay out all the standard treatment options

I iznio bih sve standardne mogučnosti liječenja,

that the patient had heard elsewhere.

koje je pacijent čuo i prije.

And I always felt

I uvijek sam mislio

that if my patient gave up the quest

da ako moj pacijent odustane od potrage za

for the magic doctor, the magic treatment

čarobnim liječnikom, čarobnim liječenjem,

and began with me on a course towards wellness,

i krene sa mnom na put prema dobrostanju,

it was because I had earned the right

to znači da sam zavrijedio pravo

to tell them these things

da im kažem takve stvari

by virtue of the examination.

na temelju pregleda.

Something of importance had transpired in the exchange.

Nešto važno se odvilo tijekom te razmjene.

I took this to my colleagues

Iznio sam to svojim kolegama

at Stanford in anthropology

na Stanfordu na antropologiji

and told them the same story.

i ispričao sam im istu priču.

And they immediately said to me,

I odmah su mi rekli,

"Well you are describing a classic ritual."

„Opisuješ klasični ritual.“

And they helped me understand

Pomogli su mi da shvatim

that rituals are all about transformation.

da je bit rituala u preobrazbi.

We marry, for example,

Primjerice, vjenčamo se

with great pomp and ceremony and expense

u velikoj raskoši, ceremoniji i o velikom trošku

to signal our departure

da označimo naš odlazak

from a life of solitude and misery and loneliness

iz života samoće, jada i usamljenosti

to one of eternal bliss.

u život vječnog blagostanja.

I'm not sure why you're laughing.

Ne znam zašto se smijete.

That was the original intent, was it not?

To je bila izvorna zamisao, zar ne?

We signal transitions of power

Označavamo prijelaze moći

with rituals.

ritualima.

We signal the passage of a life with rituals.

Označavamo prolaznost života ritualima.

Rituals are terribly important.

Rituali su iznimno važni.

They're all about transformation.

Njihova bit je u preobrazbi.

Well I would submit to you

Pa, predložio bih vam

that the ritual

da je ritual

of one individual coming to another

dolaska jednog pojedinca drugome

and telling them things

i pričanje o stvarima,

that they would not tell their preacher or rabbi,

koje ne bi rekli svojem svećeniku ili rabinu,

and then, incredibly on top of that,

i onda, začuđujuće, povrh toga

disrobing and allowing touch --

skidanje odjeće i dopuštanje dodira.

I would submit to you that that is a ritual of exceeding importance.

Predložio bih da je taj ritual od iznimne važnosti.

And if you shortchange that ritual

I ako loše obavite ovaj ritual

by not undressing the patient,

tako da ne skinete pacijenta,

by listening with your stethoscope on top of the nightgown,

ili slušate stetoskopom preko ogrtača,

by not doing a complete exam,

ili ne obavite cjeloviti pregled,

you have bypassed on the opportunity

propustili ste priliku

to seal the patient-physician relationship.

učvrstiti odnos između pacijenta i liječnika.

I am a writer,

Ja sam spisatelj,

and I want to close by reading you a short passage that I wrote

i želio bih završiti izlaganje s čitanjem kratkog odlomka kojeg sam napisao,

that has to do very much with this scene.

koji ima veze s ovom situacijom.

I'm an infectious disease physician,

Ja sam infektolog,

and in the early days of HIV, before we had our medications,

i u počecima HIV-a, prije nego smo imali naše lijekove,

I presided over so many scenes like this.

prisustvovao sam mnogim situacijama poput ove.

I remember, every time I went to a patient's deathbed,

Sjećam se da svaki put kada bih išao do pacijenta na smrtnoj postelji,

whether in the hospital or at home,

bilo u bolnici ili kod kuće,

I remember my sense of failure --

sjećam se svog osjećaja poraza,

the feeling of I don't know what I have to say;

osjećaja da ne znam što moram reći;

I don't know what I can say;

ne znam što mogu reći,

I don't know what I'm supposed to do.

ne znam što bih trebao napraviti.

And out of that sense of failure,

I iz tog osjećaja neuspjeha,

I remember, I would always examine the patient.

sjećam se, uvijek bih pregledao pacijenta.

I would pull down the eyelids.

Pogledao bih njihove kapke.

I would look at the tongue.

Pogledao bih im jezik.

I would percuss the chest. I would listen to the heart.

Perkutirao bih prsa. Poslušao bih srce.

I would feel the abdomen.

Opipao bih trbuh.

I remember so many patients,

Sjećam se mnogih pacijenata,

their names still vivid on my tongue,

njihova imena još uvijek prisutna na mojim usnama,

their faces still so clear.

njihova lica još uvijek jasna.

I remember so many huge, hollowed out, haunted eyes

Sjećam se toliko velikih, upalih, ukletih očiju

staring up at me as I performed this ritual.

kako me gledaju, dok obavljam ovaj ritual.

And then the next day,

I onda bih došao sljedeći dan

I would come, and I would do it again.

i ponovio ga.

And I wanted to read you this one closing passage

Htio sam vam pročitati i ovaj završni odlomak

about one patient.

o jednom pacijentu.

"I recall one patient

„Sjećam se jednog pacijenta

who was at that point

koji u tom stadiju

no more than a skeleton

nije bio ništa više od kostura

encased in shrinking skin,

u oklopu skupljajuće kože,

unable to speak,

nije mogao govoriti

his mouth crusted with candida

njegova usta obložena kandidom

that was resistant to the usual medications.

koja je bila otporna na uobičajene lijekove.

When he saw me

Kada me vidio

on what turned out to be his last hours on this earth,

u svojim zadnjim satima na Zemlji,

his hands moved as if in slow motion.

njegove ruke su se pomakle kao u usporenom filmu.

And as I wondered what he was up to,

I dok sam se pitao što to radi,

his stick fingers made their way

njegovi su se štapićasti prsti pomakli

up to his pajama shirt,

do košulje njegove piđame

fumbling with his buttons.

petljajući s gumbima.

I realized that he was wanting

Shvatio sam da je htio

to expose his wicker-basket chest to me.

otkriti svoja prsa, koja su izgledala poput pletene košare.

It was an offering, an invitation.

Bila je to ponuda, poziv.

I did not decline.

Nisam odbio.

I percussed. I palpated. I listened to the chest.

Perkutirao sam. Palpirao sam. Poslušao sam pluća.

I think he surely must have known by then

Mislim da je do tada morao znati kako je

that it was vital for me

ovo bilo toliko vitalno za mene

just as it was necessary for him.

koliko je bilo nužno za njega.

Neither of us could skip this ritual,

Nijedan od nas dvojice nije mogao preskočiti ovaj ritual,

which had nothing to do with detecting rales in the lung,

koji nije imao nikakve veze s otkrivanjem hropaca na plućima,

or finding the gallop rhythm of heart failure.

ili traženjem galopnog ritma srčanog zastoja.

No, this ritual was about the one message

Ne, ovaj ritual je bio o poruci

that physicians have needed to convey to their patients.

koju su liječnici trebali prenijeti svojim pacijentima.

Although, God knows, of late, in our hubris,

Iako sam Bog zna da se čini da smo u zadnje vrijeme,

we seem to have drifted away.

odlutali u našoj oholosti.

We seem to have forgotten --

Kao da smo zaboravili,

as though, with the explosion of knowledge,

kao da s eksplozijom znanja,

the whole human genome mapped out at our feet,

cijeli ljudski genom stoji mapiran pred nama,

we are lulled into inattention,

uljuljkani smo u nepažnju,

forgetting that the ritual is cathartic to the physician,

zaboravljajući da ritual pruža katarzu liječniku,

necessary for the patient --

da je nužan za pacijenta,

forgetting that the ritual has meaning

zaboravljajući da ritual ima značenje

and a singular message to convey to the patient.

i jednu jedinu poruku koju treba prenijeti pacijentu.

And the message, which I didn't fully understand then,

A poruka, koju nisam u potpunosti tada shvatio,

even as I delivered it,

čak i kad sam je prenosio,

and which I understand better now is this:

a koju shvaćam sada bolje je ova:

I will always, always, always be there.

Uvijek, uvijek, uvijek ću biti uz tebe.

I will see you through this.

Pratit ću te kroz ovo.

I will never abandon you.

Nikad te neću napustiti.

I will be with you through the end."

Bit ću s tobom do kraja.“

Thank you very much.

Puno vam hvala.

(Applause)

(Pljesak)