Abraham Verghese: A doctor's touch

翻译人员: Chunxiang Qian 校对人员: Jing Gao

A few months ago,

几个月前

a 40 year-old woman came to an emergency room

一个40岁的女士来到急诊室

in a hospital close to where I live,

这个医院离我住的地方不远

and she was brought in confused.

她被带来时神智不清

Her blood pressure was an alarming

血压处于警戒值

230 over 170.

收缩压230, 舒张压170

Within a few minutes, she went into cardiac collapse.

几分钟内她就心血管虚脱了

She was resuscitated, stabilized,

然后她被救醒，稳定下来

whisked over to a CAT scan suite

带到靠着急诊室旁边的

right next to the emergency room,

CAT扫描室

because they were concerned about blood clots in the lung.

因为医生担心她的肺部有血块

And the CAT scan revealed

CAT扫描仪显示

no blood clots in the lung,

肺部并没有血块

but it showed bilateral, visible, palpable breast masses,

但是两侧胸部有清晰可见的肿块

breast tumors,

是乳腺肿瘤

that had metastasized widely

并且已经转移到

all over the body.

全身各部位

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

但真正的悲剧是，如果你查看她的纪录

she had been seen

会发现她已经

in four or five other health care institutions

在过去几年里

in the preceding two years.

辗转去过四五家医疗机构

Four or five opportunities

有四五次机会

to see the breast masses, touch the breast mass,

发现这些乳腺肿瘤，触碰到它们

intervene at a much earlier stage

在早期就介入治疗

than when we saw her.

而不是我们发现的时候

Ladies and gentlemen,

诸位

that is not an unusual story.

这不是个不寻常的故事

Unfortunately, it happens all the time.

不幸的是，这样的事一直在发生

I joke, but I only half joke,

我开个玩笑，不过只是半开玩笑

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

如果你缺胳膊少腿去了医院

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

没人会相信你丢了个肢体，除非你做了CAT扫描，磁共振成像

or orthopedic consult.

还有骨科诊断

I am not a Luddite.

我不是勒德分子

I teach at Stanford.

我在斯坦福大学教书

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

我是个掌握尖端技术的内科医生

But I'd like to make the case to you

但我将在接下来的

in the next 17 minutes

17分钟里想向你们讲述的是

that when we shortcut the physical exam,

当我们缩短检查

when we lean towards ordering tests

给病人开一堆检查单

instead of talking to and examining the patient,

而不是与病人交流并检查时

we not only overlook simple diagnoses

我们不仅忽视了

that can be diagnosed at a treatable, early stage,

处在早期可治疗阶段的简单诊断

but we're losing much more than that.

也失去了更重要的东西

We're losing a ritual.

我们失去了一种仪式感

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

一种我认为是具有影响力并且至高无上的仪式感

and is at the heart

这正是

of the patient-physician relationship.

医患关系的核心

This may actually be heresy to say this at TED,

在TED讲这个内容可能有点逆势而行

but I'd like to introduce you

但我想向各位介绍

to the most important innovation,

在未来十年的

I think, in medicine

医学界

to come in the next 10 years,

最重要的发明

and that is the power of the human hand --

这就是人类之手的力量－

to touch, to comfort, to diagnose

关怀，抚慰，诊断

and to bring about treatment.

和治疗

I'd like to introduce you first to this person

首先我想介绍一个人

whose image you may or may not recognize.

你们不一定认得出他

This is Sir Arthur Conan Doyle.

他是亚瑟·柯南·道尔爵士

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

既然这是爱丁堡，我本人是柯南·道尔的粉丝

You might not know that Conan Doyle went to medical school

也许有人听说过柯南·道尔是在爱丁堡

here in Edinburgh,

上的医学院

and his character, Sherlock Holmes,

他创造的人物形象，福尔摩斯

was inspired by Sir Joseph Bell.

是受到约瑟夫･贝尔的启发

Joseph Bell was an extraordinary teacher by all accounts.

约瑟夫･贝尔是个无可挑剔的杰出老师

And Conan Doyle, writing about Bell,

而柯南·道尔关于贝尔的著述

described the following exchange

描绘了贝尔和他的学生

between Bell and his students.

之间的交流

So picture Bell sitting in the outpatient department,

想像贝尔坐在门诊部

students all around him,

他的学生围坐着

patients signing up in the emergency room

病人在急诊室登记

and being registered and being brought in.

然后挂号，被带进来

And a woman comes in with a child,

一个带小孩的女士进来了

and Conan Doyle describes the following exchange.

柯南･道尔这样写道

The woman says, "Good Morning."

女人说：早上好

Bell says, "What sort of crossing did you have

贝尔说：你从Burntisland坐渡船过来

on the ferry from Burntisland?"

一路如何？

She says, "It was good."

她说：挺好

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

贝尔说：你的另一个孩子怎么办了？

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

她说，我拜托住在利斯的姐姐照顾了

And he says,

他说

"And did you take the shortcut down Inverleith Row

那你来诊所有没有

to get here to the infirmary?"

从 Inverleith Row抄近路？

She says, "I did."

她说没错

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

贝尔道，那你还打算在油毡厂干活吗？

And she says, "I am."

她说是的

And Bell then goes on to explain to the students.

然后贝尔向他的学生解释说

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

当她说你好的时候

I picked up her Fife accent.

我听出她的法夫口音

And the nearest ferry crossing from Fife is from Burntisland.

而离法夫最近的渡船是在Burntisland

And so she must have taken the ferry over.

所以我推测出她是从那里过来

You notice that the coat she's carrying

你也注意到她拿着的外套

is too small for the child who is with her,

对跟她一起小孩子来说太小了

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

所以她开始肯定带了两个孩子来了

but dropped one off along the way.

路上放下一个

You notice the clay on the soles of her feet.

还有她鞋底上泥

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

爱丁堡方圆百里内没有这种红泥

except in the botanical gardens.

除了植物园

And therefore, she took a short cut down Inverleith Row

所以她肯定是从 Inverleith Row抄近路

to arrive here.

来这儿的

And finally, she has a dermatitis

最后，她右手手指

on the fingers of her right hand,

有皮炎

a dermatitis that is unique

这种皮炎是只见于

to the linoleum factory workers in Burntisland."

Burntisland的油毡厂工人

And when Bell actually strips the patient,

然后贝尔就让她脱了衣服

begins to examine the patient,

开始检查

you can only imagine how much more he would discern.

你无法想像他是多么仔细地察看

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

作为一个医学老师，一个学生

I was so inspired by that story.

我深受这个故事启发

But you might not realize

也许你们还没有意识到

that our ability to look into the body

我们的这种利用各种感官

in this simple way, using our senses,

以一种简单的方式检查身体的能力

is quite recent.

并没有太久历史

The picture I'm showing you is of Leopold Auenbrugger

这张照片是利奥波德·奥恩布鲁格

who, in the late 1700s,

他在18世纪末

discovered percussion.

发明了叩诊法

And the story is that Leopold Auenbrugger

故事是这样的

was the son of an innkeeper.

利奥波德·奥恩布鲁格的父亲是个旅馆老板

And his father used to go down into the basement

他父亲常常去地下室的酒窖

to tap on the sides of casks of wine

敲敲酒桶

to determine how much wine was left

就能知道还有多少酒

and whether to reorder.

要不要追加订单

And so when Auenbrugger became a physician,

所以当奥恩布鲁格成了内科医生

he began to do the same thing.

他也开始这么干

He began to tap on the chests of his patients,

他开始敲病人的胸腔

on their abdomens.

还有腹部

And basically everything we know about percussion,

基本上我们对叩诊的认识

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

那是当时的超声波技术－

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

器官扩大，心肺积水

abdominal changes --

异常变化－

all of this he described in this wonderful manuscript

他在手稿中纪录的一切

"Inventum Novum," "New Invention,"

“新发明”

which would have disappeared into obscurity,

很有可能因为它的晦涩而消失在历史中

except for the fact that this physician, Corvisart,

多亏一位叫科维扎卡的内科医生

a famous French physician --

一位著名的法国内科医生

famous only because he was physician to this gentleman --

他著名是因为他是奥恩布鲁格的内科医生

Corvisart repopularized and reintroduced the work.

重新介绍和普及了这部著作

And it was followed a year or two later

一两年后

by Laennec discovering the stethoscope.

莱尼克发明了听诊器

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

据说莱尼克走在巴黎的街上

and saw two children playing with a stick.

看见两个小孩在玩一根棍子

One was scratching at the end of the stick,

一个在挠棍子的一端

another child listened at the other end.

另一个听着另一端

And Laennec thought this would be a wonderful way

莱尼克认为用他所谓的“圆筒”

to listen to the chest or listen to the abdomen

听胸腔和腹腔

using what he called "the cylinder."

是个很不错的主意

Later he renamed it the stethoscope.

后来他重新命名为听诊器

And that is how stethoscope and auscultation was born.

这就是听诊器和听诊法的由来

So within a few years,

几年后

in the late 1800s, early 1900s,

19世纪末，20世纪初

all of a sudden,

突然

the barber surgeon had given way

理发医师被

to the physician who was trying to make a diagnosis.

进行诊断的内科医生取代

If you'll recall, prior to that time,

在那之前

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

不管你病得多么厉害，去了理发医师那儿

who wound up cupping you,

他们给你拔火罐

bleeding you, purging you.

给你放血，给你冲洗

And, oh yes, if you wanted,

当然如果你愿意的话

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

他也给你理个发－两边短后边长

and pull your tooth while he was at it.

还顺便给你拔个牙

He made no attempt at diagnosis.

完全没有诊断环节

In fact, some of you might well know

也许有些人还记得

that the barber pole, the red and white stripes,

理发店的标志，红白条纹

represents the blood bandages of the barber surgeon,

象征理发医师的绷带

and the receptacles on either end

两侧的容器

represent the pots in which the blood was collected.

象征收集血液的壶

But the arrival of auscultation and percussion

但听诊法和叩诊法的出现

represented a sea change,

意味着一个大变化

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

内科医生开始能探视人体内部

And this particular painting, I think,

这幅画，我认为

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

代表这那个医疗时代的顶峰

This is a very famous painting:

这是个非常著名的油画

"The Doctor" by Luke Fildes.

卢克･菲尔德斯的《医生》

Luke Fildes was commissioned to paint this by Tate,

此画是卢克･菲尔德斯受泰特之托

who then established the Tate Gallery.

泰特建立了泰特美术馆

And Tate asked Fildes to paint a painting

他请卢克.菲尔德斯画一幅

of social importance.

表现社会重要现状的画

And it's interesting that Fildes picked this topic.

有趣的是菲尔德斯选择了这个主题

Fildes' oldest son, Philip,

菲尔德斯的大儿子，菲利普

died at the age of nine on Christmas Eve

9岁的时候因为一点小病痛

after a brief illness.

死在了平安夜

And Fildes was so taken by the physician

菲尔德斯被这位守夜守了两三夜的

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

医生深深感动

that he decided that he would try and depict

于是他决定试着描绘

the physician in our time --

这个时代的医生－

almost a tribute to this physician.

几乎是对这位医生的赞颂

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

因此《医生》这幅著名的画

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

出现在很多国家的挂历上和邮票上

I've often wondered, what would Fildes have done

我常想，菲尔德斯会怎么办

had he been asked to paint this painting

如果他被要求在这个时代

in the modern era,

画那幅画

in the year 2011?

在2011年？

Would he have substituted a computer screen

他是不是得把患者

for where he had the patient?

换成电脑屏幕？

I've gotten into some trouble in Silicon Valley

我因为说病床上的病人

for saying that the patient in the bed

基本上只是

has almost become an icon

电脑里真正病人的图标

for the real patient who's in the computer.

而和硅谷惹上麻烦

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

事实上我为计算机里的那个实体（病人）创造了个新词

I call it the iPatient.

iPatient

The iPatient is getting wonderful care all across America.

全美国的iPatient都得到很好的治疗

The real patient often wonders,

真的病人倒在奇怪

where is everyone?

人都哪里去了？

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

他们什么时候来给我解释这些玩意儿？

Who's in charge?

谁负责啊？

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

病人和医生对最佳医疗的认识

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

有着很大的距离

I want to show you a picture

我想给你们展示

of what rounds looked like

我当时的临床实习

when I was in training.

是什么样的

The focus was around the patient.

重点都是病人

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

我们一张病床一张病床走过去 当值的医生负责

Too often these days,

现如今

rounds look very much like this,

临床实习更像这样

where the discussion is taking place

讨论是在一个

in a room far away from the patient.

远离病人的房间进行的

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

讨论的场面都是电脑，数据

And the one critical piece missing

最重要的部分－病人

is that of the patient.

却缺失了

Now I've been influenced in this thinking

我想跟你们分享两个故事

by two anecdotes that I want to share with you.

我本人深受影响

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

一个是跟我一个患有乳腺癌的朋友有关

had a small breast cancer detected --

在发现一个小的乳腺肿瘤后

had her lumpectomy in the town in which I lived.

她在我住的那个城市做了手术切除

This is when I was in Texas.

这是我在德克萨斯的时候

And she then spent a lot of time researching

然后她花了很多时间

to find the best cancer center in the world

寻找世界上最好的癌症中心

to get her subsequent care.

接受后续治疗

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

她找到了然后去了

Which is why I was surprised a few months later

几个月后我很惊讶地

to see her back in our own town,

看见她回来了

getting her subsequent care with her private oncologist.

在她的私人医生那里接受术后康复

And I pressed her, and I asked her,

我问她

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

你问什么回来接受康复？

And she was reluctant to tell me.

她不是很愿意吐露

She said, "The cancer center was wonderful.

她说，”那个癌症中心非常棒

It had a beautiful facility,

设施一流

giant atrium, valet parking,

大堂超级大，服务生停车

a piano that played itself,

自动弹奏的钢琴

a concierge that took you around from here to there.

有人待你到处溜达“

But," she said,

但是

"but they did not touch my breasts."

“他们根本没碰我的胸部”

Now you and I could argue

现在我们可以说

that they probably did not need to touch her breasts.

他们也许没有必要碰她的胸部

They had her scanned inside out.

可以扫描嘛

They understood her breast cancer at the molecular level;

他们可以从分子层面了解她的乳腺癌

they had no need to touch her breasts.

没有必要碰

But to her, it mattered deeply.

但对她来说，这很重要

It was enough for her to make the decision

这足够让她决定

to get her subsequent care with her private oncologist

从她私人医生那里接受康复

who, every time she went,

她去私人医生那里

examined both breasts including the axillary tail,

医生会检查两侧乳房包括腋窝端

examined her axilla carefully,

很仔细地检查腋窝

examined her cervical region, her inguinal region,

检查她的子宫颈和腹股沟

did a thorough exam.

一个全面的检查

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

对她来说，这表达了她所需要的关注

I was very influenced by that anecdote.

这件事深深影响了我

I was also influenced by another experience that I had,

另外还有一个我的经历同样对我有影响

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

也是我在德克萨斯的时候，还没搬到斯坦福

I had a reputation

我有个名声在外

as being interested in patients

就是非常关注患有

with chronic fatigue.

慢性疲劳的病人

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

这不是个坏名声

I say that because these are difficult patients.

我这么说是因为他们都不容易

They have often been rejected by their families,

他们多被家人拒绝

have had bad experiences with medical care

有很不如意的医疗经历

and they come to you fully prepared

他们早准备好了

for you to join the long list of people

你是许多人之后

who's about to disappoint them.

下一个另他们失望的人

And I learned very early on with my first patient

我从第一个病人身上就早早认识到

that I could not do justice

我无法公平地

to this very complicated patient

去查看这位复杂病人的

with all the records they were bringing

所有纪录

in a new patient visit of 45 minutes.

一个新病人只有45分钟

There was just no way.

无可奈何

And if I tried, I'd disappoint them.

如果我尝试了，我会令他们失望

And so I hit on this method

所以我的做法是

where I invited the patient

第一次会诊的时候

to tell me the story for their entire first visit,

我让病人们给我讲述他们的情况

and I tried not to interrupt them.

我尝试不去打断

We know the average American physician

我们知道美国医生平均

interrupts their patient in 14 seconds.

14秒后就打断病人说话

And if I ever get to heaven,

如果我能进天堂

it will be because I held my piece for 45 minutes

肯定是因为我能倾听上45分钟

and did not interrupt my patient.

而没打断他们

I then scheduled the physical exam for two weeks hence,

然后我会在两周后安排体检

and when the patient came for the physical,

当病人来的时候

I was able to do a thorough physical,

我就能做一个彻底的体检

because I had nothing else to do.

因为这就是我能做的

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

我想我做彻底的检查

but because the whole visit was now about the physical,

是因为这个会诊就是为了体检

I could do an extraordinarily thorough exam.

我可以做一个格外细致的检查

And I remember my very first patient in that series

我记得我第一个慢性疲劳病人

continued to tell me more history

在他的体检会诊过程中

during what was meant to be the physical exam visit.

给我讲述更多她的历史

And I began my ritual.

我开始了我的仪式

I always begin with the pulse,

我总是从测脉搏开始

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

然后检查手，接下来是甲床

then I slide my hand up to the epitrochlear node,

然后是滑车上淋巴结

and I was into my ritual.

由此进入我的仪式

And when my ritual began,

当仪式开始

this very voluble patient

这个健谈的病人

began to quiet down.

开始安静下来

And I remember having a very eerie sense

我记得感受到一种神秘的畏惧感

that the patient and I

当我和病人

had slipped back into a primitive ritual

都进入到这种原始性的仪式

in which I had a role

其中我有我的角色

and the patient had a role.

而病人有病人的角色

And when I was done,

当我完成的时候

the patient said to me with some awe,

病人怀着敬畏对我说

"I have never been examined like this before."

“我从来没有被这样检查过”

Now if that were true,

如果这是真的话

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

是对医疗保健系统的一个真实的谴责

because they had been seen in other places.

因为他们从来没在别的地方经历过

I then proceeded to tell the patient,

等病人穿戴完毕

once the patient was dressed,

我接着告诉他

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

他肯定在其他医疗机构都听过的内容：

which is, "This is not in your head.

“这不是你想像的

This is real.

这是真的

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

好消息是，得的不是癌症，不是肺结核

it's not coccidioidomycosis or some obscure fungal infection.

不是球孢子菌病或者什么真菌感染

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

坏消息是我们不清楚是什么导致的

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

你应该做这些，我应该做这些”

And I would lay out all the standard treatment options

我会列出病人在其他地方也听过的

that the patient had heard elsewhere.

所有标准治疗的选项

And I always felt

我总觉得

that if my patient gave up the quest

如果我的病人放弃追着

for the magic doctor, the magic treatment

某个神奇医生，神奇疗法

and began with me on a course towards wellness,

而转投我开始走向健康

it was because I had earned the right

那是因为我一丝不苟的检查

to tell them these things

为我赢得了

by virtue of the examination.

告诉他们这些的权利

Something of importance had transpired in the exchange.

通过交流一些重要的信息已经透露

I took this to my colleagues

我将此讲给

at Stanford in anthropology

在斯坦福大学人类学的同事们

and told them the same story.

告诉他们这个故事

And they immediately said to me,

他们立刻对我说

"Well you are describing a classic ritual."

“你描述了一个经典仪式”

And they helped me understand

他们帮助我理解了

that rituals are all about transformation.

仪式意味着转变

We marry, for example,

举例说，我们结婚

with great pomp and ceremony and expense

用舞会，仪式和花费

to signal our departure

来宣告

from a life of solitude and misery and loneliness

孤独寂寞的悲惨生活

to one of eternal bliss.

变成永恒的幸福

I'm not sure why you're laughing.

我不知道你们为什么笑

That was the original intent, was it not?

我们结婚原本是这么希望的，是吧？

We signal transitions of power

我们通过仪式表达

with rituals.

力量的转变

We signal the passage of a life with rituals.

我们用仪式表达生命

Rituals are terribly important.

仪式非常重要

They're all about transformation.

全部都与转变有关

Well I would submit to you

我想告诉你这种仪式

that the ritual

一个人

of one individual coming to another

来到另一个人面前

and telling them things

告诉他一些

that they would not tell their preacher or rabbi,

连神父都不告诉的的事

and then, incredibly on top of that,

除此之外

disrobing and allowing touch --

还换衣解带并让他触碰

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

我想告诉你们这是个极度重要的仪式

And if you shortchange that ritual

如果你在仪式上玩花样

by not undressing the patient,

比如不解衣服

by listening with your stethoscope on top of the nightgown,

隔着睡裙听诊

by not doing a complete exam,

或者检查不完整

you have bypassed on the opportunity

你已经错过了

to seal the patient-physician relationship.

在医患关系上留下鉴印的机会

I am a writer,

我是个作家

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

我想以我写的一段话结尾

that has to do very much with this scene.

它与这个场景契合

I'm an infectious disease physician,

我是个传染病医生

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

在HIV传染早期，还没有治疗方法的时候

I presided over so many scenes like this.

我经历过如此之多的这样的场景

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

我记得，每次去医院或者病人家里的

whether in the hospital or at home,

临死的卧床

I remember my sense of failure --

我总有种失败感－

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

一种无话可说的感觉

I don't know what I can say;

我不知道说什么好

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

我不知道做什么好

And out of that sense of failure,

带着那种失败感

I remember, I would always examine the patient.

我记得，我总会检查病人

I would pull down the eyelids.

看看眼皮

I would look at the tongue.

看看舌头

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

敲敲胸部 听听心跳

I would feel the abdomen.

按压腹腔

I remember so many patients,

我记得很多病人

their names still vivid on my tongue,

他们的名字仍犹如在耳

their faces still so clear.

他们的脸庞仍历历在目

I remember so many huge, hollowed out, haunted eyes

我记得很多大而空洞的眼睛

staring up at me as I performed this ritual.

在我进行仪式的时候盯着我

And then the next day,

次日

I would come, and I would do it again.

我会再来，再做

And I wanted to read you this one closing passage

我想给各位读的结束语

about one patient.

是关于一位病人的

"I recall one patient

“我记得一位病人

who was at that point

当时的他

no more than a skeleton

瘦骨嶙峋

encased in shrinking skin,

如同干柴

unable to speak,

无法言语

his mouth crusted with candida

嘴里长满念珠菌

that was resistant to the usual medications.

这种真菌对普通药物具有抗药性

When he saw me

当他看见我时

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

已是他活在人世的最后几个小时

his hands moved as if in slow motion.

他的手像慢镜头一样移动

And as I wondered what he was up to,

我想他要表达点什么

his stick fingers made their way

他的干柴一样的手指

up to his pajama shirt,

伸向他的睡衣

fumbling with his buttons.

要解开扣子

I realized that he was wanting

我意识到

to expose his wicker-basket chest to me.

他是想给我们看他骨瘦如柴的胸膛

It was an offering, an invitation.

那是个邀请

I did not decline.

我没有拒绝

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

我叩诊 触诊 听诊了胸腔

I think he surely must have known by then

我认为他一定知道

that it was vital for me

那对我的重要

just as it was necessary for him.

就想对他的必要一样

Neither of us could skip this ritual,

谁也不能省略这个仪式

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

不是为了听肺部的水泡

or finding the gallop rhythm of heart failure.

或是心脏衰弱的跳动

No, this ritual was about the one message

不，这个仪式

that physicians have needed to convey to their patients.

是医生向患者传达的一个信息

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

虽然后来因为我们的傲慢

we seem to have drifted away.

我们把它弄丢了

We seem to have forgotten --

我们好像忘了－

as though, with the explosion of knowledge,

虽然有了知识大爆炸

the whole human genome mapped out at our feet,

整个人类的基因组被绘制出来

we are lulled into inattention,

我们渐渐变得冷漠

forgetting that the ritual is cathartic to the physician,

忘记了仪式是医生的泻药

necessary for the patient --

病人很需要－

forgetting that the ritual has meaning

我们忘了仪式具有意义

and a singular message to convey to the patient.

并且将信息传达给病人

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

这个信息虽然我当时传递给了病人

even as I delivered it,

但我并没有完全理解

and which I understand better now is this:

现在我更好地理解了：

I will always, always, always be there.

我会永远，永远，永远在这里

I will see you through this.

我会陪你经历这一切

I will never abandon you.

我永远不会抛弃你

I will be with you through the end."

我会陪你到最后

Thank you very much.

谢谢

(Applause)

（掌声）