Barbara Natterson-Horowitz: What veterinarians know that doctors don't

翻译人员: Yixiong Zhu 校对人员: dahong zhang

Ten years ago,

十年前，

I got a phone call that changed my life.

一个电话改变了我的一生。

At the time, I was cardiologist at UCLA,

那时，我是加州大学洛杉矶分校（UCLA）的心脏病学家，

specializing in cardiac imaging techniques.

专攻心脏成像技术。

The call came from a veterinarian at the Los Angeles Zoo.

电话来自洛杉矶动物园的兽医。

An elderly female chimpanzee

一只高龄雌性黑猩猩

had woken up with a facial droop

睡醒后面部下垂，

and the veterinarians were worried that she'd had a stroke.

兽医担心她得了中风。

They asked if I'd come to the zoo

他们问我能不能来动物园

and image the animal's heart

给黑猩猩的心脏成像，

to look for a possible cardiac cause.

寻找可能的心脏病因。

Now, to be clear, North American zoos are staffed

要明确的是，北美的动物园都有

by highly qualified, board-certified veterinarians

高水平的经过认证的兽医，

who take outstanding care of their animal patients.

他们极为出色地照料着他们的动物患者。

But occasionally, they do reach into the human medical community,

但偶尔，他们会求助人类医疗社区，

particularly for some speciality consultation,

尤其是涉及专科问诊时，

and I was one of the lucky physicians who was invited in to help.

而我就是被邀请帮忙的幸运者之一。

I had a chance to rule out a stroke in this chimpanzee

我曾经有机会为这个黑猩猩排除中风可能，

and make sure that this gorilla didn't have a torn aorta,

为这个大猩猩排除主动脉撕裂的可能，

evaluate this macaw for a heart murmur,

给这个金刚鹦鹉听心脏杂音，

make sure that this California sea lion's paricardium wasn't inflamed,

确认这只加州海狮的心包没有发炎，

and in this picture, I'm listening to the heart of a lion

还有，在这张照片中，我在给一头狮子做心脏听音，

after a lifesaving, collaborative procedure

这是在兽医和医生的一起

with veterinarians and physicians

关乎性命的合作行动之后，

where we drained 700 cc's of fluid from the sac

我们从包裹这只狮子心脏的囊袋中

in which this lion's heart was contained.

引流出700cc的液体。

And this procedure, which I have done on many human patients,

还有这个操作，我在很多人类病患上进行过，

was identical, with the exception of that paw and that tail.

步骤是一样的，区别只是这里的爪子和尾巴。

Now most of the time, I was working at UCLA Medical Center with physicians,

大多数时候，我都是在UCLA医学中心与医生们工作，

discussing symptoms and diagnoses and treatments

探讨症状，诊断，和治疗方案，

for my human patients,

对象是我的人类患者们，

but some of the time, I was working at the Los Angeles Zoo

但偶尔，我也在洛杉矶动物园

with veterinarians, discussing symptoms and diagnoses and treatments

和兽医们合作，探讨症状，诊断，和治疗方案，

for their animal patients.

对象是他们的动物病患。

And occasionally, on the very same day,

少数情况下，在同一天里，

I went on rounds at UCLA Medical Center

我又要在UCLA医学中心工作，

and at the Los Angeles Zoo.

还要去洛杉矶动物园工作。

And here's what started coming into very clear focus for me.

我开始逐渐清醒地认识到这一点。

Physicians and veterinarians were essentially taking care

医生和兽医其实是在处理

of the same disorders in their animal and human patients:

人类病患和动物病患中的同样问题：

congestive heart failure, brain tumors,

充血性心力衰竭，脑瘤，

leukemia, diabetes, arthritis, ALS, breast cancer,

白血病，糖尿病，关节炎，“渐冻人症”医学名为肌萎缩侧索硬化症(ALS)，乳腺癌，

even psychiatric syndromes like depression, anxiety,

甚至还包括精神疾病，例如抑郁症，焦虑症，

compulsions, eating disorders and self-injury.

强迫症，进食障碍，自虐等。

Now, I've got a confession to make.

在这里，我要坦白。

Even though I studied comparative physiology and evolutionary biology

尽管我学过比较生理学和进化生物学，

as an undergrad --

那是我读大学的时候 —

I had even written my senior thesis on Darwinian theory --

我的毕业论文甚至都是关于达尔文理论的 —

learning about the significant overlap

动物疾病和人类疾病

between the disorders of animals and humans,

存在明显重叠的这一认知，

it came as a much needed wake-up call for me.

为我及时敲响了警钟。

So I started wondering, with all of these overlaps,

我开始想，有这么多重叠，

how was it that I had never thought to ask a veterinarian,

我为什么从来没有想过请教兽医，

or consult the veterinary literature,

或者是参考兽医学文献，

for insights into one of my human patients?

来为我的人类病患提供见解？

Why had I never, nor had any of my physician friends and colleagues

为什么我从未，而我问过的医生同事们也从未，

whom I asked, ever attended a veterinary conference?

参加过兽医学会议？

For that matter, why was any of this a surprise?

就这点而言，有什么可让人奇怪的？

I mean, look, every single physician accepts some biological connection

你看，每一名医生都同意动物和人类间

between animals and humans.

存在某种生物学上的联系。

Every medication that we prescribe or that we've taken ourselves

我们开过的每一种药，以及我们自己服过的药，

or we've given to our families

以及我们给我们家人的药，

has first been tested on an animal.

都是先在动物身上进行试验的。

But there's something very different

但的确动物被动人为病变，与动物自身病变之间存在有很大的差异

about giving an animal a medication or a human disease

给动物用一种药物，或使其患上一种人类疾病 是一回事，

and the animal developing congestive heart failure

而动物们患自己特有的充血性心力衰竭，

or diabetes or breast cancer on their own.

糖尿病，乳腺癌病是另一回事。

Now, maybe some of the surprise

对此感到奇怪的部分原因，

comes from the increasing separation in our world

可能是我们社会中城镇与非城镇之间

between the urban and the nonurban.

逐渐扩大的隔阂。

You know, we hear about these city kids

我们常听说城里长大的孩子

who think that wool grows on trees

以为羊毛长在树上，

or that cheese comes from a plant.

或者奶酪来自植物。

Well, today's human hospitals,

是的，今天人类的医院，

increasingly, are turning into these gleaming cathedrals of technology.

正在变为某种闪耀金光的科学殿堂。

And this creates a psychological distance between the human patients

这就使得在医院里治疗的

who are being treated there

人类病患

and animal patients who are living in oceans

和生活在海洋，农场，和丛林中的

and farms and jungles.

动物病患之间在认知上出现了距离。

But I think there's an even deeper reason.

但我觉得还有更深的原因。

Physicians and scientists, we accept intellectually that our species,

对于医生和科学家而言，我们理智上承认我们这个物种，

Homo sapiens, is merely one species,

智人(人类)，仅仅是物种之一，

no more unique or special than any other.

并不比其他物种更独特。

But in our hearts, we don't completely believe that.

但在情感上，我们不完全这么想。

I feel it myself when I'm listening to Mozart

当我听莫扎特，或是当我在MacBook上

or looking at pictures of the Mars Rover on my MacBook.

看火星探测车传回的照片时，

I feel that tug of human exceptionalism,

我就能感觉到一股人类特殊论，

even as I recognize the scientifically isolating cost

尽管我明白把人类看做与众不同的高等物种，

of seeing ourselves as a superior species, apart.

在科学上会有多么大的代价。

Well, I'm trying these days.

如今，我正在努力。

When I see a human patient now, I always ask,

如今，当我看到人类病患时，我总是自问，

what do the animal doctors know about this problem that I don't know?

对这一情况，兽医会不会掌握我不了解的知识。

And, might I be taking better care of my human patient

以及，如果我把他们(病人)视为“人类动物”病患，

if I saw them as a human animal patient?

我是不是能更好地医治他们？

Here are a few examples of the kind of exciting connections

以下几个例子，是这类思考给我带来的

that this kind of thinking has led me to.

奇妙的认识。

Fear-induced heart failure.

恐惧引起的心力衰竭。

Around the year 2000,

在2000年左右，

human cardiologists "discovered" emotionally induced heart failure.

人类心脏病专家“发现”了情绪诱导的心力衰竭。

It was described in a gambling father who had lost his life's savings

该情况出现于一位好赌的父亲因为掷骰子赌博

with a roll of the dice,

失去了一生的积蓄之后，

in a bride who'd been left at the alter.

以及一位新娘被遗弃在教堂门口之后。

But it turns out, this "new" human diagnosis

但后来发现，这一“新”的人类疾病

was neither new, nor was it uniquely human.

既不新，也不是人类的特权。

Veterinarians had been diagnosing, treating and even preventing

兽医们诊断，治疗，甚至预防

emotionally induced symptoms in animals

动物中情绪引发的症状，

ranging from monkeys to flamingos, from to deer to rabbits,

对象包括猴子，火烈鸟，鹿，兔子在内，

since the 1970s.

从20世纪70年代就已经开始了。

How many human lives might have been saved

会有多少人的生命获得拯救，

if this veterinary knowledge had been put into the hands

如果这一兽医知识能传授给

of E.R. docs and cardiologists?

急救室大夫和心脏病学家？

Self-injury.

还有自虐。

Some human patients harm themselves.

一些人类病人会伤害自己。

Some pluck out patches of hair,

有的拔下一把把的毛发，

others actually cut themselves.

有的甚至会割伤自己。

Some animal patients also harm themselves.

一些动物患者也会自我伤害。

There are birds that pluck out feathers.

有的鸟会拔掉自己的羽毛，

There are stallions that repetitively bite their flanks until they bleed.

有的马会不停地咬自己的侧腹，直到流血。

But veterinarians have very specific and very effective ways

但兽医有很具体和有效的方法

of treating and even preventing self-injury

来治疗甚至预防自我伤害，

in their self-injuring animals.

针对的是自我伤害的动物们。

Shouldn't this veterinary knowledge be put into the hands

这些兽医的知识难道不应该传授给

of psychotherapists and parents and patients

心理医生，家长，

struggling with self-injury?

和受自我伤害困扰的患者们？

Postpartum depression and postpartum psychosis.

还有产后抑郁症和产后精神病。

Sometimes, soon after giving birth,

有时候，在生产后不久，

some women become depressed,

一些女性会变得抑郁，

and sometimes they become seriously depressed and even psychotic.

有时甚至严重抑郁，甚至患精神病。

They may neglect their newborn,

她们会忽视自己的婴儿，

and in some extreme cases,

在某些极端的病例中，

even harm the child.

甚至会伤害孩子。

Equine veterinarians also know that occasionally,

马科兽医也知道偶尔地，

a mare, soon after giving birth,

母马在生产之后，

will neglect the foal, refusing to nurse,

会忽视马驹，拒绝抚养，

and in some instances, kick the foal, even to death.

而在某些情况下，甚至会去踢马驹，致其死亡。

But veterinarians have devised

但是兽医们发明了一种干预疗法

an intervention to deal with this foal rejection syndrome

来处理这种拒绝抚养马驹的症状，

that involves increasing oxytocin in the mare.

那就是提高母马的催产素水平。

Oxytocin is the bonding hormone,

催产素是一种促进结合的荷尔蒙，

and this leads to renewed interest,

这能使母马对马驹重新

on the part of the mare, in her foal.

产生兴趣。

Shouldn't this information

难道这一信息

be put into the hands of ob/gyn's

不应传授给产科和妇科医生，传授给

and family doctors and patients

正受产后抑郁症和精神病困扰的

who are struggling with postpartum depression and psychosis?

患者们和家庭医生？

Well, despite all of this promise,

可是，即便有这么多好处，

unfortunately the gulf between our fields remains large.

我们两个学科之间的鸿沟依旧不幸存在。

To explain it, I'm afraid I'm going to have to air some dirty laundry.

要解释这个现象，我可能要揭示一些黑暗面。

Some physicians can be real snobs

一些医生真的是瞧不起

about doctors who are not M.D.'s.

没有医学博士文凭的医生。

I'm talking about dentists and optometrists and psychologists,

我是指牙医，眼科验光师，和心理学家，

but maybe especially animal doctors.

但特别也指动物医生。

Of course, most physicians don't realize that it is harder

当然，绝大多医生不知道如今

to get into vet school these days than medical school,

上兽医学校比上医学院还难。

and that when we go to medical school,

我们读医学院的话，

we learn everything there is to know

我们要学习所有能学的知识，

about one species, Homo sapiens,

只针对一种生物，智人，

but veterinarians need to learn about health and disease

但兽医需要学习的卫生和疾病，

in mammals, amphibians, reptiles, fish and birds.

对象是哺乳动物，两栖动物，鱼类，和鸟类。

So I don't blame the vets for feeling annoyed

所以我不责怪兽医厌恶

by my profession's condescension and ignorance.

我这一职业的高傲和无知。

But here's one from the vets:

这有一句兽医的话：

What do you call a veterinarian

只可以治疗一种物种

who can only take care of one species?

的兽医是什么？

A physician. (Laughter)

医生。（笑声）

Closing the gap has become a passion for me,

缩小鸿沟是我的愿望，

and I'm doing this through programs

我正在通过例如UCLA的Darwin on Rounds(达尔文医疗查房)项目

like Darwin on Rounds at UCLA,

来做到这点。

where we're bringing animal experts and evolutionary biologists

该项目中，我们将动物专家和进化生物学家

and embedding them on our medical teams

安排到我们的医疗团队中，

with our interns and our residents.

连同我们的实习生和住院医生一起工作。

And through Zoobiquity conferences,

还有，通过跨物种共病(Zoobiquity)会议，

where we bring medical schools together with veterinary schools

我们让医学院和兽医学校

for collabortive discussions

一起参加合作性讨论，

of the shared diseases and disorders

讨论动物病患和人类病患

of animal and human patients.

共通的疾病和失调。

At Zoobiquity conferences,

在跨物种共病(Zoobiquity)会议上，

participants learn how treating breast cancer in a tiger

参会者们了解了为老虎治疗乳腺癌

can help us better treat breast cancer

能如何帮助我们更好地治疗

in a kindergarten teacher;

幼儿园教师的乳腺癌；

how understanding polycystic overies in a Holstein cow

了解了明白荷斯坦牛的多囊卵巢综合征

can help us better take care

能如何让我们更好的照顾

of a dance instructor with painful periods;

痛经的舞蹈老师；

and how better understanding the treatment of separation anxiety

以及了解了治疗敏感不安的喜乐蒂牧羊犬

in a high-strung Sheltie

的分离焦虑

can help an anxious young child struggling with his first days of school.

能如何让我们更好地帮助第一天上学感到焦虑的儿童。

In the United States and now internationally, at Zoobiquity conferences

在美国以及现在在全世界，在跨物种共病(Zoobiquity)会议上

physicians and veterinarians check their attitudes and their preconceptions

医生和兽医将彼此之间的态度和成见

at the door and come together as colleagues,

抛在门外，团结成为同事，

as peers, as doctors.

同行，医疗工作者。

After all, we humans are animals, too,

毕竟，我们人类也是动物，

and it's time for us physicians to embrace

是时候让我们医生坦承

our patients' and our own animal natures

我们患者和我们自己的动物本性，

and join veterinarians

加入兽医们一起

in a species-spanning approach to health.

用跨物种的视角来看待医疗。

Because it turns out,

因为事实是，

some of the best and most humanistic medicine

一些最好的最人性化的医药

is being practiced by doctors whose patients aren't human.

是被医生用于不是人类的患者身上。

And one of the best ways we can take care

而我们照料人类病患的最好方式之一

of the human patient is by paying close attention

就是要仔细关注

to how all the other patients on the planet

地球上所有其他病患如何

live, grow, get sick and heal.

生活，生长，生病，以及痊愈。

Thank you.

谢谢。

(Applause).

（掌声）