Abraham Verghese: A doctor's touch

エイブラハム・バルギーズ：医師の手が持つ力

翻訳: SHIGERU MASUKAWA 校正: Natsuhiko Mizutani

A few months ago,

ほんの数ヶ月前

a 40 year-old woman came to an emergency room

私の近所のとある病院に

in a hospital close to where I live,

40代の女性が意識不明で

and she was brought in confused.

担ぎ込まれました

Her blood pressure was an alarming

血圧は

230 over 170.

危険領域に達し

Within a few minutes, she went into cardiac collapse.

数分後 心肺停止状態となりました

She was resuscitated, stabilized,

すぐさま 蘇生処置がほどこされ

whisked over to a CAT scan suite

救命室の隣のCATスキャンへ

right next to the emergency room,

運ばれました

because they were concerned about blood clots in the lung.

肺に血栓の疑いがあったのです

And the CAT scan revealed

スキャンの結果

no blood clots in the lung,

血栓こそありませんでしたが

but it showed bilateral, visible, palpable breast masses,

なんと両方の乳房に明らかな

breast tumors,

癌の腫瘍が見られ

that had metastasized widely

体中に

all over the body.

転移していました

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

ひどい話ですが カルテによると

she had been seen

過去数年間に

in four or five other health care institutions

数箇所の医療機関で

in the preceding two years.

受診歴があるのです

Four or five opportunities

ということは こうなる前に

to see the breast masses, touch the breast mass,

乳房のしこりが発見され

intervene at a much earlier stage

早期に対処が

than when we saw her.

できたかもしれないということです

Ladies and gentlemen,

みなさん

that is not an unusual story.

珍しい例ではありません

Unfortunately, it happens all the time.

残念ながらどこででもありえます

I joke, but I only half joke,

半分はジョークですが

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

脚を失った状態で 病院に来ても

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

CATスキャン MRIといった検査を受けるまで

or orthopedic consult.

誰も気づかないでしょう

I am not a Luddite.

先端技術が嫌いなわけじゃありません

I teach at Stanford.

スタンフォードで教えてますし

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

こうした技術も利用しています

But I'd like to make the case to you

しかし この17分間でご紹介したいのは

in the next 17 minutes

患者と話をし

that when we shortcut the physical exam,

触れて診察を行う代りに

when we lean towards ordering tests

検査に偏重し 患者との

instead of talking to and examining the patient,

ふれあいを省略すると

we not only overlook simple diagnoses

まだ初期段階の 治癒可能な

that can be diagnosed at a treatable, early stage,

症状を見過ごしてしまうだけではなく

but we're losing much more than that.

もっと大切な「儀式」が

We're losing a ritual.

失われてしまうのです

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

これには 医師と患者の関係に

and is at the heart

変化をおこし 強力にする

of the patient-physician relationship.

力があるのです

This may actually be heresy to say this at TED,

TEDでご紹介するのは

but I'd like to introduce you

場違いかもしれませんが

to the most important innovation,

今後10年間における

I think, in medicine

もっとも重要な

to come in the next 10 years,

イノベーションは

and that is the power of the human hand --

人の手の持つ力でしょう

to touch, to comfort, to diagnose

触れて 癒し 診察する

and to bring about treatment.

そして治療を行う

I'd like to introduce you first to this person

まずはこの人物をご紹介します

whose image you may or may not recognize.

お気づきの方もいるでしょう

This is Sir Arthur Conan Doyle.

アーサー・コナン・ドイルです

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

私はコナン・ドイルの大ファンです

You might not know that Conan Doyle went to medical school

ここエジンバラで　彼は医学を

here in Edinburgh,

学んだ経験もあります

and his character, Sherlock Holmes,

シャーロック・ホームズは

was inspired by Sir Joseph Bell.

ジョセフ・ベルにインスパイアされました

Joseph Bell was an extraordinary teacher by all accounts.

あらゆる点で ジョセフ・ベルは優れた教師で

And Conan Doyle, writing about Bell,

コナン・ドイルは

described the following exchange

ベルと生徒とのやりとりについて

between Bell and his students.

こんな逸話を残しています

So picture Bell sitting in the outpatient department,

想像してください ベルは外来で

students all around him,

生徒は彼を取り巻き

patients signing up in the emergency room

受付を済ませた患者が

and being registered and being brought in.

処置室にやって来ます

And a woman comes in with a child,

彼女は子供を連れていました

and Conan Doyle describes the following exchange.

コナン・ドイルはこんな会話を残しています

The woman says, "Good Morning."

「おはようございます」患者は言いました

Bell says, "What sort of crossing did you have

「バーンティスランドからのフェリーは

on the ferry from Burntisland?"

いかがだったかな？」ベルは言います

She says, "It was good."

「よかったですよ」患者は答えます

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

「もう一人のお子さんはどうしたのかな？」ベルは言います

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

「リースの姉に預けて来ました」

And he says,

彼は続けます

"And did you take the shortcut down Inverleith Row

「ここに来る時に 植物園を通って

to get here to the infirmary?"

近道をしたんじゃないかね？」

She says, "I did."

「そうです」患者は答えます

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

「今も リノリウム工場で働いているのかね？」

And she says, "I am."

「そうです」患者は答えます

And Bell then goes on to explain to the students.

ベルは生徒達に説明し始めました

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

「彼女が挨拶した時

I picked up her Fife accent.

ファイフ訛りと気づいてね

And the nearest ferry crossing from Fife is from Burntisland.

ファイフから最寄のフェリーはバーンティスランドだ

And so she must have taken the ferry over.

だからフェリーを使ったに違いないと

You notice that the coat she's carrying

そして 彼女が持っているコートを見ると

is too small for the child who is with her,

連れている子供のものにしては小さすぎると

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

なので 最初は２人連れて出発し

but dropped one off along the way.

途中で一人を預けたのだろうと

You notice the clay on the soles of her feet.

靴底の土に気づいてね

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

エジンバラの周辺には こんな赤土は存在しない

except in the botanical gardens.

植物園を除いてはね

And therefore, she took a short cut down Inverleith Row

だから 彼女は植物園を通って

to arrive here.

近道したんだなと

And finally, she has a dermatitis

最後に 彼女の右手の指には

on the fingers of her right hand,

皮膚炎が見られる

a dermatitis that is unique

この皮膚炎はバーンティスランドの

to the linoleum factory workers in Burntisland."

リノリウム工場の工員に独特のものなんだ」

And when Bell actually strips the patient,

ベルは実際に服を脱がせ

begins to examine the patient,

診察を始める前に

you can only imagine how much more he would discern.

なんと多くの情報を得ていたことか

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

医学の教師であり また生徒でもある私は

I was so inspired by that story.

この話に大変感銘を受けました

But you might not realize

しかしながら

that our ability to look into the body

医師の知覚という単純な手段で

in this simple way, using our senses,

体の中が調べられるようになったのは

is quite recent.

ごく近年のことです

The picture I'm showing you is of Leopold Auenbrugger

こちらは レオポルト・アウエンブルッカー

who, in the late 1700s,

1,700年代 彼により

discovered percussion.

打診法が開発されました

And the story is that Leopold Auenbrugger

きっかけは 彼の父親が

was the son of an innkeeper.

居酒屋の主人であったことです

And his father used to go down into the basement

父親はワイン樽をコツコツ叩いて

to tap on the sides of casks of wine

ワインの残量を測っていました

to determine how much wine was left

ワインの追加注文のタイミングを

and whether to reorder.

決めるためです

And so when Auenbrugger became a physician,

アウエンブルッカーは医師となり

he began to do the same thing.

同じことをはじめました

He began to tap on the chests of his patients,

患者の胸部や腹部を叩く診察法を

on their abdomens.

はじめました

And basically everything we know about percussion,

打診はいわば当時の超音波診断ですが

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

今日知られている全て －臓器肥大も

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

心嚢水も肺水腫も

abdominal changes --

腹部の異変なども全て

all of this he described in this wonderful manuscript

この優れた著書に記されています

"Inventum Novum," "New Invention,"

「新発見」

which would have disappeared into obscurity,

この手法は忘れさられるところでした

except for the fact that this physician, Corvisart,

著名なフランスの医師 コルヴィザール－

a famous French physician --

彼はこちらの紳士の

famous only because he was physician to this gentleman --

主治医であったことのみで有名でしたが－

Corvisart repopularized and reintroduced the work.

彼は打診法を復活させました

And it was followed a year or two later

1〜2 年後にラエンエックにより

by Laennec discovering the stethoscope.

聴診器が発明されるに至ります

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

彼がある日 パリを歩いていた時のこと

and saw two children playing with a stick.

棒で遊んでいる二人の子供を見かけました

One was scratching at the end of the stick,

一人が端っこを引っかいて

another child listened at the other end.

もう一人が別の端っこで音を聞いていました

And Laennec thought this would be a wonderful way

ラエンネックは思いつきました

to listen to the chest or listen to the abdomen

これは 体内の音を聴くのに 良い方法だと

using what he called "the cylinder."

これをシリンダーと彼は名付け

Later he renamed it the stethoscope.

のちに 聴診器と改名し

And that is how stethoscope and auscultation was born.

こうして聴診器と聴診が生まれたのです

So within a few years,

18世紀の終わりから

in the late 1800s, early 1900s,

19世紀初頭の数年間で

all of a sudden,

急激に

the barber surgeon had given way

手術を行う理髪店は

to the physician who was trying to make a diagnosis.

診察を行う医師に取って代わられました

If you'll recall, prior to that time,

当時の人々は

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

どんな症状であっても こうした理髪店に行っていました

who wound up cupping you,

そこでは吸引療法

bleeding you, purging you.

血抜き療法 洗浄療法

And, oh yes, if you wanted,

そして お望みなら

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

もちろん髪も切ってくれました

and pull your tooth while he was at it.

おまけに歯だって抜いてくれます

He made no attempt at diagnosis.

ただ 診察は全くありません

In fact, some of you might well know

事実 ご存知の方もいるでしょうか

that the barber pole, the red and white stripes,

理髪店の赤と白の縞模様のポールは

represents the blood bandages of the barber surgeon,

血に染まった包帯からきたものなんです

and the receptacles on either end

両端の物体は

represent the pots in which the blood was collected.

血液を集める容器を表しています

But the arrival of auscultation and percussion

聴診と打診の登場は

represented a sea change,

転換期を象徴するものでした

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

医師が患者の体内に注目しはじめたのです

And this particular painting, I think,

個人的には こちらの絵は

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

そうした決定的な時代の頂点を表しています

This is a very famous painting:

とても有名な絵で

"The Doctor" by Luke Fildes.

ルーク・フィルデス作 「医師」

Luke Fildes was commissioned to paint this by Tate,

彼はテート美術館の創立者である

who then established the Tate Gallery.

テート氏の依頼により描きました

And Tate asked Fildes to paint a painting

社会的に影響力のある絵画を頼む と

of social importance.

依頼されたのです

And it's interesting that Fildes picked this topic.

医師がテーマに選ばれた興味深い話があります

Fildes' oldest son, Philip,

フィルデスの長男のフィリップは

died at the age of nine on Christmas Eve

9つのとき 短期間の病を経て

after a brief illness.

クリスマス・イヴに亡くなりました

And Fildes was so taken by the physician

息子の横で数日に及び

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

寝ずの看病を続けた医師に感動したフィルデスは

that he decided that he would try and depict

医師の姿を描こうと

the physician in our time --

決めたのです

almost a tribute to this physician.

この医師に捧げるためでした

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

「医師」はとても有名で

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

各国でカレンダーや切手のデザインになってます

I've often wondered, what would Fildes have done

よく思うんです もしフィルデスが

had he been asked to paint this painting

2011年にこの絵画を依頼されたなら

in the modern era,

一体何を

in the year 2011?

描くのだろうと

Would he have substituted a computer screen

患者のかわりにパソコン画面を

for where he had the patient?

もってくるのでは？

I've gotten into some trouble in Silicon Valley

シリコンバレーで批判を受けました

for saying that the patient in the bed

「患者はもはや

has almost become an icon

パソコン上のデータに

for the real patient who's in the computer.

過ぎなくなった」と言ったのです

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

そうしたデータに名前まで付けました

I call it the iPatient.

アイ・ペイシャントです

The iPatient is getting wonderful care all across America.

全米でデータは手厚いケアを受ける一方

The real patient often wonders,

本物の患者は思います

where is everyone?

「みんなどこ？」

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

「いつになったら僕のところに説明にくるの？」

Who's in charge?

「担当者は誰？」

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

一流の治療の定義は患者と

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

我々医師の間ではかけ離れたものになっています

I want to show you a picture

こちらをご覧いただきましょう

of what rounds looked like

私が研修医の頃の

when I was in training.

回診の様子です

The focus was around the patient.

中心には患者がいました

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

ベッドからベッドへ 主治医が回ります

Too often these days,

最近では

rounds look very much like this,

回診の様子はこうです

where the discussion is taking place

議論は患者から遠く離れた

in a room far away from the patient.

会議室で行われます

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

議論の中心はパソコン上のイメージとデータのみ

And the one critical piece missing

不可欠な要素である

is that of the patient.

患者本人が抜け落ちています

Now I've been influenced in this thinking

では 私が影響を受けた

by two anecdotes that I want to share with you.

２つのエピソードをご紹介したいと思います

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

一つ目は乳がんを患った友人の話です

had a small breast cancer detected --

小さな乳がんが発見され

had her lumpectomy in the town in which I lived.

私の住む地元で摘出手術を受けました

This is when I was in Texas.

私がテキサスにいた頃です

And she then spent a lot of time researching

その後 術後のケアのため

to find the best cancer center in the world

彼女は世界で一番のがんセンターを

to get her subsequent care.

探しはじめました

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

お目当ての場所が見つかり 彼女はそこに行ったんです

Which is why I was surprised a few months later

なので数ヵ月後 町に戻った彼女を見かけて

to see her back in our own town,

私は驚きました

getting her subsequent care with her private oncologist.

ここで 地元の癌専門医に通っていたのです

And I pressed her, and I asked her,

彼女に聞きました

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

「なぜここでケアを受けることにしたの？」

And she was reluctant to tell me.

彼女はためらいながらも言いました

She said, "The cancer center was wonderful.

「がんセンターはステキだったわ

It had a beautiful facility,

施設も立派だし 巨大な

giant atrium, valet parking,

吹き抜けに バレー・パーキング

a piano that played itself,

自動のピアノだってあるの

a concierge that took you around from here to there.

あちこち連れてってくれる世話人もいるしね」

But," she said,

「でもね

"but they did not touch my breasts."

そこでは 胸に一度も触わらなかったの」

Now you and I could argue

胸に触る必要さえなかったと

that they probably did not need to touch her breasts.

言えなくもありません

They had her scanned inside out.

彼女のデータはスキャンされ

They understood her breast cancer at the molecular level;

彼女の乳がんは分子レベルで把握され

they had no need to touch her breasts.

触る必要さえなかったわけです

But to her, it mattered deeply.

でも 彼女にとっては

It was enough for her to make the decision

病院を変えさせるくらい

to get her subsequent care with her private oncologist

重要な要素だったのです

who, every time she went,

今の医者は毎回

examined both breasts including the axillary tail,

両方の乳房をわきの下も含め

examined her axilla carefully,

じっくり診察し

examined her cervical region, her inguinal region,

首まわり 股のあたりもじっくりと

did a thorough exam.

診察します

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

彼女は こうした手厚いケアを求めていたのです

I was very influenced by that anecdote.

この話に私は大いに影響を受けました

I was also influenced by another experience that I had,

もう一つ影響を受けた経験をお話しましょう

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

スタンフォードに移る前 テキサス時代の話です

I had a reputation

当時 私には

as being interested in patients

慢性疲労患者の専門医

with chronic fatigue.

という評判がありました

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

好ましい評判ではありません

I say that because these are difficult patients.

というのも なにせ手強い相手です

They have often been rejected by their families,

こうした患者は家族から見放され

have had bad experiences with medical care

医療機関では苦い経験をし

and they come to you fully prepared

私の所に来る頃には

for you to join the long list of people

もう期待などない状態

who's about to disappoint them.

なんですから

And I learned very early on with my first patient

まさに最初のこうした患者を診察した時

that I could not do justice

彼らが持ってくる

to this very complicated patient

これまでの診察記録は

with all the records they were bringing

初診の45分間で

in a new patient visit of 45 minutes.

症状を把握するには

There was just no way.

全く役に立たないことが分かりました

And if I tried, I'd disappoint them.

また同じ事の繰り返しです

And so I hit on this method

そこで ある方法を思いつきました

where I invited the patient

初診では 全ての時間を使って

to tell me the story for their entire first visit,

患者に自分の状態を語ってもらうのです

and I tried not to interrupt them.

中断せずじっと聞くことにしました

We know the average American physician

アメリカでは平均的な医師は

interrupts their patient in 14 seconds.

患者の話に14秒で割って入ります

And if I ever get to heaven,

もし私が天国にいけるなら

it will be because I held my piece for 45 minutes

患者の話を中断することなく

and did not interrupt my patient.

45分聞き続けたからでしょう

I then scheduled the physical exam for two weeks hence,

２週間後に仕切りなおして 診察をします

and when the patient came for the physical,

その時には

I was able to do a thorough physical,

じっくりと診断ができます

because I had nothing else to do.

他にする事が無いのですから

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

徹底的に診察するのは

but because the whole visit was now about the physical,

その回が診察のための回だからという理由でなく

I could do an extraordinarily thorough exam.

とてつもなく詳細に診察するためです

And I remember my very first patient in that series

こうした診察回に最初に訪れた患者は

continued to tell me more history

最初 自身の症状をとうとうと

during what was meant to be the physical exam visit.

語り始めました この回は診察のための回というのに

And I began my ritual.

そこで私も手順に従って

I always begin with the pulse,

まず脈を図ります

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

そして患者の手を 爪床をチェックします

then I slide my hand up to the epitrochlear node,

手を滑らせながら肘のリンパ腺へ－

and I was into my ritual.

いつもの手順です

And when my ritual began,

私の手順が始まると

this very voluble patient

このおしゃべりな患者が

began to quiet down.

静かになり

And I remember having a very eerie sense

不思議な感覚を覚えました

that the patient and I

患者と私は なにか

had slipped back into a primitive ritual

原始的な儀式を行っているという感覚

in which I had a role

私には役割があり

and the patient had a role.

そして患者にも役割がある

And when I was done,

診察が終わった際

the patient said to me with some awe,

患者は畏敬の念とともに言いました

"I have never been examined like this before."

こんな風に診察されたのは始めてです

Now if that were true,

さて これが事実なら

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

現代の医療システムに

because they had been seen in other places.

問題があるということです

I then proceeded to tell the patient,

そして 私は患者が服を着た後

once the patient was dressed,

診察結果を説明します

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

他の医療機関でも聞いたであろう内容です

which is, "This is not in your head.

「あなたの思い込みではなく

This is real.

病気は存在します

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

良いニュースは 癌や結核 はたまた

it's not coccidioidomycosis or some obscure fungal infection.

なにか恐ろしい感染症ではありません

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

悪いニュースは一体何が原因かわからないことです

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

では まずあなたがすべき事と 私達がすべき事です…」

And I would lay out all the standard treatment options

こうして私は患者に通常の治療法を説明します

that the patient had heard elsewhere.

他でも聞いた内容なのです

And I always felt

よく思うのが

that if my patient gave up the quest

もし 私の患者が ありもしない

for the magic doctor, the magic treatment

名医や特効薬を探すのはやめて

and began with me on a course towards wellness,

私と治療へのプロセスを歩み始めてくれるなら

it was because I had earned the right

それは 徹底的な診察の結果として

to tell them these things

治療法を説明するに必要な

by virtue of the examination.

信頼を築いたからだと思います

Something of importance had transpired in the exchange.

診察を通して 何か重要なものが生まれたのだと思います

I took this to my colleagues

スタンフォードで

at Stanford in anthropology

人類学を教える同僚たちに

and told them the same story.

この話をしてみました

And they immediately said to me,

彼らはすぐに答えました

"Well you are describing a classic ritual."

「それは古典的な儀式のことだね」と

And they helped me understand

彼らによると 儀式とは

that rituals are all about transformation.

つまるところ 変化であると

We marry, for example,

例えば 私たちは

with great pomp and ceremony and expense

豪華な結婚式を行います

to signal our departure

寂しい独り身から

from a life of solitude and misery and loneliness

永遠の祝福への出発を

to one of eternal bliss.

お祝いしているわけです

I'm not sure why you're laughing.

なぜ みなさん笑っているのでしょうか？

That was the original intent, was it not?

もともとはそういう意味だったでしょ？

We signal transitions of power

儀式こそがこうした変化を知らせる

with rituals.

シグナルなのです

We signal the passage of a life with rituals.

人生の節々でこうしたシグナルを出します

Rituals are terribly important.

儀式はとても大事なものなのです

They're all about transformation.

儀式とは変化を表すものです

Well I would submit to you

ある人が

that the ritual

とある人を訪れ

of one individual coming to another

牧師やラビには

and telling them things

言いたくないことを伝え

that they would not tell their preacher or rabbi,

驚くべきことに

and then, incredibly on top of that,

服を脱ぎ

disrobing and allowing touch --

体を触らせるという儀式－

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

こうした儀式がとても重要なのです

And if you shortchange that ritual

服を着せたまま診察したり

by not undressing the patient,

ガウンの上から聴診したり

by listening with your stethoscope on top of the nightgown,

徹底的な診察をせず

by not doing a complete exam,

こうしたことで 儀式を省略すると

you have bypassed on the opportunity

患者と医師の関係をつなぐ機会を

to seal the patient-physician relationship.

失うことになるのです

I am a writer,

私が書いた

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

短い一節を読みまして 終わりにします

that has to do very much with this scene.

ご覧のようなシーンと関係します

I'm an infectious disease physician,

私は感染症の専門医で

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

エイズが認識されはじめ まだ治療法も無い頃

I presided over so many scenes like this.

こうした光景に立ち会うことが多々ありました

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

患者の臨終の床に立ち会う際

whether in the hospital or at home,

それが患者の自宅でも病院でも

I remember my sense of failure --

常に挫折を感じていました－

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

何を言わなければいけないのかー

I don't know what I can say;

何を言っていいのかー

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

何をすべきかも分かりません

And out of that sense of failure,

そうした挫折感から

I remember, I would always examine the patient.

いつも患者を診察するようにしていました

I would pull down the eyelids.

まぶたをめくり

I would look at the tongue.

舌を見て

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

胸部を打診し 心音を聴きます

I would feel the abdomen.

そして 腹部をさすります

I remember so many patients,

私は多くの患者の

their names still vivid on my tongue,

名前や顔は今でも

their faces still so clear.

はっきり覚えています

I remember so many huge, hollowed out, haunted eyes

大きく 窪み おびえたような目が

staring up at me as I performed this ritual.

儀式を行う私を見上げていました

And then the next day,

翌日も

I would come, and I would do it again.

また私は同じ事を行うのです

And I wanted to read you this one closing passage

では 最後となる一節を読みたいと思います

about one patient.

ある患者の話です

"I recall one patient

「ある患者を思い出す

who was at that point

彼はその時点で

no more than a skeleton

皮に包まれた

encased in shrinking skin,

骸骨と化していた

unable to speak,

話すことはできず

his mouth crusted with candida

普通の薬の効かない

that was resistant to the usual medications.

カンジダで 口もカサブタだらけ

When he saw me

亡くなる数時間前のことだった

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

彼は私を目にすると

his hands moved as if in slow motion.

スローモーションで手を動かし始めた

And as I wondered what he was up to,

何をしようとしているのか？

his stick fingers made their way

小枝のような指は

up to his pajama shirt,

パジャマのシャツを目指すが

fumbling with his buttons.

ボタンがつまめない

I realized that he was wanting

診察してもらうため

to expose his wicker-basket chest to me.

痩せた胸を出したいのだと私は気づいた

It was an offering, an invitation.

このような提案を—勧誘を

I did not decline.

断ることなどできない

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

打診し 触診し そして胸部の音を聴く

I think he surely must have known by then

彼はその時点で気づいていたに違いないだろう

that it was vital for me

これが自分にとって必要なだけではなく

just as it was necessary for him.

私にも不可欠なことだと

Neither of us could skip this ritual,

お互いに省略するわけに行かない儀式なのだ

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

肺の水泡を見つけるためではなく

or finding the gallop rhythm of heart failure.

心音の異常を探すこととは全く関係なく

No, this ritual was about the one message

医師が患者に伝えるべき

that physicians have needed to convey to their patients.

あのメッセージを伝えるための儀式なのだ

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

傲慢になった私たちは

we seem to have drifted away.

そこから押し流され

We seem to have forgotten --

忘れてしまったかのようだ

as though, with the explosion of knowledge,

知識を急速に増大させ

the whole human genome mapped out at our feet,

人間の遺伝子地図を踏破しつくし

we are lulled into inattention,

無関心に陥ったかのようだ

forgetting that the ritual is cathartic to the physician,

儀式が医師の癒しであり

necessary for the patient --

患者に欠かせないことが忘れられ

forgetting that the ritual has meaning

儀式の持つ意味と

and a singular message to convey to the patient.

患者に伝えるべき唯一のメッセージが忘れられている

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

当時の私が伝えつつも

even as I delivered it,

理解は十分ではなかったが

and which I understand better now is this:

今ではよく分かるようになったメッセージである

I will always, always, always be there.

私はいつもいつも ここにいて

I will see you through this.

最後まで見届けます

I will never abandon you.

決して見捨てません

I will be with you through the end."

最後まで一緒です」

Thank you very much.

どうもありがとうございました

(Applause)

（拍手）