What Happens As We Die? | Kathryn Mannix | TED

翻译人员: Lydia Guan 校对人员: Yip Yan Yeung

Human beings are the only animals capable of contemplating

人类，是唯一一种动物，

their own mortality,

能够思考自己的死亡，

and they've been doing that for thousands of years.

并且已经这么做了上千年了。

And yet somehow, in the very recent past,

然而，不知道什么原因，在近现代，

we have lost the practical wisdom of what happens as people die.

我们失去了真实死亡过程的实践智慧。

I think that that's a problem.

我认为这是个问题。

And if you agree with me that it is a problem,

而且，如果你跟我一样认为这是个问题，

then we have to work out what we're going to do about it.

我们就必须一起思考可以采取什么行动。

When she was in her mid-20s, in the 1920s,

在 1920 年代， 我的祖母 20 多岁的时候，

my grandmother was already deeply familiar with the sequence of events

她就已经非常熟悉，

that happened to a human person

人们的生命即将抵达终点时，

as they were coming to the end of their life.

发生在那人身上的一系列事情。

And that’s because, as a woman --

这是因为，作为一名女性——

and it was usually women’s work --

这也通常是女性的工作——

she was doing what women had done for centuries,

她当时做着女性做了好几个世纪的工作，

looking after people at the very end of their lives,

在人们临终的日子里，照顾他们，

in their own beds, in their own homes,

在他们自己的床上，在自己的家里，

supported by their own people,

被自己的亲朋好友照拂着，

because hospital had nothing to offer,

因为医院没什么可以提供的，

once a person was so sick that their death was imminent.

人病到那个程度，他们的死亡近在咫尺。

And yet, when I reached my mid-twenties,

但是，当我二十多岁时，

in the 1980s,

1980 年代那会儿，

I had none of her wisdom and understanding and knowledge of dying,

我完全没有她那种 对于死亡的智慧、见解和知识，

and that was even though I'd just finished five years of medical school.

即使我刚读完 5 年的医学院。

As a newly qualified doctor,

作为一名新入职的医生，

I'd spent five years being trained to stop people from dying.

我花了五年时间接受拯救生命的培训。

And actually, if a death happened,

实际上，一旦救不活了，

it was a thing that was seen as a medical disaster.

这就会被视为医疗灾难。

It was a thing that was embarrassing,

这很丢人，

it was a thing of which we do not speak.

我们避而不谈。

Why the difference,

为什么会有这样的变化，

and why within just a couple of generations?

还有，为什么隔了两代人就变成这样了？

Think about what happened to medicine over the course of the 20th century.

想想 20 世纪医学界发生了什么。

It was not worth going to hospital when you were dying

如果你濒死了，就没必要去医院了，

in the 1920s.

在 1920 年代就是这样。

But by the 1960s, '70s, '80s and onwards,

但到了 1960 年代、 70 年代、80 年代和之后，

think of the fantastic progress that had been made

想想医学界取得的巨大进步，

so that people who were so sick that they might die,

那些病入膏肓的人

of course we took them to hospital, because there were antibiotics,

我们肯定会带他们去医院， 因为我们有抗生素，

there were really clever anesthetics

有高明的麻醉

that allowed surgeons to spend a long time unpicking things

可以让外科医生有足够长的手术时间

during operations.

解决病灶。

There were new and very sophisticated treatments for cancers,

崭新的、精巧的治疗方案层出不穷， 用于对付癌症、

for heart failure, for kidney failure.

心脏衰竭、肾衰竭。

There were intensive care units,

我们有重症监护室，

there was transplantation of organs,

有器官移植，

some of that pioneered in this very city.

其中一些技术还是这座城市率先领头的。

Medical progress was astonishing,

医学进步令人惊讶，

taking dying people to hospital very often saved their lives,

将垂死病人送往医院 往往能挽救他们的生命，

and that is fantastic.

这太棒了。

And yet ...

但是……

By taking dying people out of home and putting them in hospital,

通过将垂死病人带出家门并送往医院，

we changed our understanding of the process.

我们改变了对这一过程的认知。

We lost our ownership of the process and we gave it to healthcare ...

我们失去了对死亡流程的所有权 并将其交给了医疗机构……

And we forgot what dying looked like.

而且我们忘记了迈向死亡的样子。

So, having been qualified for just over four years,

因此，在获得医疗资格仅仅四年之后，

I find myself in a new job.

我给自己找到了一份新工作。

Having originally intended a career in cancer medicine,

我原本打算从事抗癌药物行业，

I’d spent the last four years choosing to train

但在过去的四年中，我选择

in the places where the most sick people were.

在绝症区接受培训。

And then I realized that actually, what was really interesting to me

然后我意识到，实际上，

was the detective journey of symptom management

我真正感兴趣的是症状管理的侦查之旅

and the emotional integration of feeling well enough

和在生命的尽头感觉良好、

to live a little bit during the very end of life,

能够享受一点生活的情感整合，

and I went to work in a hospice.

所以我去了临终关怀医院工作。

But I'd been working in a big teaching hospital,

但我曾在一家大型教学医院工作，

I'd learned a lot of medicine,

我学过很多药物，

I'd seen a lot of dying.

我见过很多死亡。

We had a patient in the hospice.

我们在临终关怀医院有个病人。

She was a memorable woman for many reasons.

从各方面来说，她是一个令人难忘的女人。

She had been a member of the French Resistance

她曾是法国抵抗运动的一名成员，

during the Second World War.

那时是第二次世界大战期间。

She'd married a British airman,

她嫁给了一名英国飞行员，

she'd come to live in England.

搬到了英格兰生活。

She'd never lost her French accent.

她从未失去过法国口音。

She had a cloud of glorious white hair,

她有一团光彩照人的白发，

like a halo.

闪耀着光泽似的。

She had piercing brown eyes,

她有一双深邃的棕色眼眸，

the kind of gaze that you feel a person can see your soul.

那种目光让你感觉到 一个人能看穿你的灵魂。

She was self-contained, she was a little bit aloof.

她自给自足，有点冷漠。

In fact, she was a little bit scary.

事实上，她有点吓人。

(Laughter)

（笑声）

One day, she told the nurse who was looking after her

有一天，她告诉照顾她的护士 ，

that she was terrified of dying in agony,

她害怕在痛苦中死去，

because if she were to die in agony, she might despair in God.

因为如果她痛苦地死去， 她可能会对上帝感到绝望。

And if she were to despair in God,

而如果她对上帝感到绝望，

as a French Roman Catholic,

作为一名法国罗马天主教徒，

her belief was that that would be a mortal sin,

她的信仰将其视为一种致命的罪过，

so she would not be able to go to heaven,

那她就无法上天堂了，

and heaven was the place she knew her husband was waiting for her.

而天堂是她知道丈夫在等着她的地方。

This was a profound existential distress.

这是一种深刻的生存困境。

And my boss said, "We need to go and talk to her, and you should come,

而我的老板说：“我们需要去 和她谈谈，你应该来，

you'll find this interesting."

你会觉得这挺有趣的。”

I was 26.

我当时 26 岁。

Do you remember 26?

你还记得你的 26 岁吗？

It's the last age when you know that you know everything.

这是你以为自己无所不晓的最后一年了。

(Laughter)

（笑声）

So I went along, wondering what I might learn,

于是我跟着去了，疑惑我能学到什么，

because I thought I was quite good at pain control.

因为我觉得我的疼痛管理学得挺好。

That conversation ...

那次谈话……

changed my life.

改变了我的生活。

It changed my career.

它改变了我的职业生涯。

And it's brought me here.

并且它把我带到了这里。

Sitting on her bed, with me on a little footstool

老板坐在她的床上， 我坐在一张小脚凳上

so I can see him and her, and the nurse sitting on the chair,

这样我能看见他和她， 护士坐在椅子上，

he said to her,

他对她说，

"I'm concerned that you've got worries about what might happen as you're dying."

“你为你死亡时发生的一切忧虑， 这让我很担心。”

And she said yes. She knew him well, she trusted him.

然后她说是的。 她很了解他，她信任他。

And he said, "I'm sorry to hear that,

然后他说：“听到这个消息我很抱歉，

and I wondered whether it might help you

要是我向你描述一下 一个人死亡时通常发生的事情，

if I described to you what usually happens as a person is dying."

我想这或许能帮到你。”

And I'm sitting on the stool of all knowledge, thinking,

而我坐在自以为是的小脚凳上，心想，

"You can't tell her that."

“你可不能这么告诉她。”

(Laughter)

（笑声）

Because I’ve seen lots of dying, and I know they’re all different.

因为我见过很多死亡， 而我知道每种死法都不一样。

And she said, "Yes, please."

然后她说：“好的，拜托你了。”

And he said, "I'll describe what we usually see,

他就说：“我会描述我们平时的所见所闻，

and if it gets too much, you tell me.

如果对你来说太过了，你就告诉我。

Promise, I'll stop.

我保证，我会打住。

The thing that's really interesting, Sabine,

萨宾，真正有趣的是

is that as people are dying,

当人们死亡时，

it doesn't really matter what the illness is they're dying from.

他们死于哪种疾病并不重要。

The pattern of events is very similar.

症状的顺序都是非常相似的。

We see people becoming more and more tired.

我们看到人们变得越来越疲倦。

It's harder and harder for them to find the energy to do things.

他们越来越难找到做事的能量。

In fact, they recharge their energy not so much by eating and drinking,

实际上，他们不是通过吃喝来补充能量，

but by sleeping.

而是通过睡觉来补充能量。

And as time goes by,

随着时间的推移，

what we see is that people sleep more and they're awake less.

我们看到人们睡得更多，醒得更少。

And if they want to do something important,

而且，如果他们想做一些重要的事情，

they should take a snooze before it."

他们需要在此之前小睡一会儿。”

She nodded, and she got hold of his hand.

她点了点头，并抓住了他的手。

"As time goes by," he said, "we see people are asleep for longer,

他说：“随着时间的流逝， 我们看到人们的睡眠时间更长，

they're awake for shorter,

醒着的时间更短，

and something interesting we notice that they don’t is,

我们注意到而他们却忽略的有趣事实是，

maybe it's medicine time, or there's a visitor,

可能是该吃药了，或者有人来探访，

we need to waken them ...

我们需要叫醒他们……

For a period, we can't waken them.

有那么一段时间，我们无法叫醒他们。

They're not just asleep,

他们不只是睡着了，

they're actually unconscious.

他们实际上失去了知觉。

And when they waken, they tell us they've had a lovely sleep.

当他们醒来时， 他们告诉我们他们睡得很好。

It turns out that human beings don't recognize

事实证明，当我们失去知觉时，

when we become unconscious.

人们是意识不到的。

And so at the very end of somebody's life, they're not just asleep,

因此，在生命的最终尽头， 他们不只是睡着了，

they're actually deeply unconscious.

他们实际上已经陷入深度昏迷。

And when the brain is unconscious,

而当大脑失去知觉时，

the only part of it that's still working

唯一仍在起作用的部分

is the part that's working their breathing."

是呼吸的部分。”

By now, she is sitting right up in bed.

此刻，她从床上坐了起来，

She's got hold of one of his hands, and she's stroking it.

抓住了他的一只手，她抚摸着它。

She's nodding at everything he says.

她点头附议他说的每句话。

And in the meanwhile, I’m sitting on my stool,

与此同时，我坐在凳子上吓坏了，

horrified that he seems to be describing dying to a dying person.

他在对一个垂死之人描述怎么死。

And that feels, to me, to be really not very OK.

对我来说，那感觉不太合适。

But she is mesmerized.

但是她听得入神。

"By the time the brain is deeply unconscious,"

“当大脑陷入深度昏迷时，”

he's saying to her now,

他现在对她说，

"the only bit that's still working is the bit that drives the breathing.

“唯一能起作用的部分 是推动呼吸的部分。

And so breathing cycles we don't normally see start to happen.

因此，我们不常见的呼吸周期开始出现。

Reflex automatic breathing

反射式自动呼吸

cycles from very deep breaths becoming shallower and shallower,

从非常深的呼吸变得越来越浅，

and then going back to the beginning again,

然后又回到起点，

cycles of fast breathing that gradually become slower,

快速呼吸周期逐渐变慢，

maybe with pauses,

可能会有暂停，

and then back to the beginning again.

然后又回到起点。

The person can't feel their throat.

这个人感觉不到自己的喉咙。

They don't notice if they breathe out through their voice box,

他们没有注意到如果他们通过喉头呼吸，

making a noise families might think that they're sighing

发出的声音可能会让家人以为他们在叹气

or groaning, or uncomfortable.

或者呻吟，或者不舒服。

We'll always check,

我们会经常检查，

but it's part of this reflex breathing.

但这是反射性呼吸的一部分。

Saliva or mouth-cleaning fluid won't irritate their throat,

唾液或漱口液不会刺激他们的喉咙，

it won't make them cough or swallow.

也不会让他们咳嗽或吞咽。

They just lie there with a little pool of fluids,

他们只是躺在那里带着一点液体，

sometimes in the back of their throat.

有时在喉咙后面。

It's not in the way.

不会堵住喉头。

Air is moving in and out of their lungs,

空气正在流入和流出肺部，

and it bubbles through that little film of fluid,

并通过那小片液体膜冒泡，

but families can mistake that for drowning or choking.

但家人们可能会误认为是呛到喘不上气。

So one of the things that we'll do, Sabine,

因此，我们要做的一件事，萨宾，

if your nieces and nephews are here,

就是如果你的侄女和侄子在这里，

is we will make sure we explain to them what is happening to you."

我们保证，我们会向他们解释 你身上正在发生的一切。”

She's stroking his hands, she's nodding.

她抚摸着他的手，点点头。

She is absolutely taking in everything that he says.

她绝对会接受他所说的一切。

And then he says -- and I think,

然后他说——然后我想，

"Oh my goodness, he's going to the last breath."

“天啊，他要准备解释‘最后一口气’了。”

"And then, during, usually, one of those phases of slow breathing,

“接下来，通常在某一次的缓慢呼吸阶段，

there'll be a breath out ...

会有呼气……

that just isn't followed by another breath in.

但没有下一次吸气了。

There is nothing special about the last breath.

最后一口气没什么特别之处。

It's so not like on the television or in cinema.

太不像在电视或电影院里演的那样。

There's no rush of pain at the end. There's no sudden panic.

没有骤然降临的痛苦。 没有突如其来的恐慌。

There's no feeling of fading away.

没有思绪消散的感觉。

Sometimes, we who work in palliative care,"

有时候，我们从事姑息治疗工作，”

and I've subsequently discovered this to be true,

后来我发现这是真的，

"sometimes, we will walk into a room where a family has been around a person

“有时候，我们会走进一个房间， 一家人围着那人，

who is in the act of dying,

那人濒临死亡，

and we'll realize the person has stopped breathing,

我们会意识到这个人已经停止了呼吸，

and the family hasn't noticed yet,

但全家人都没有注意到，

because the Hollywood finale that they're waiting for hasn't happened."

因为他们等待的 好莱坞式大结局并没有出现。”

She got hold of both of his hands.

她抓住了他的双手。

She shook them in hers,

她用手摇了摇它们，

and then she pulled his hands to her face and she kissed them.

然后她把他的手放在脸上并亲吻了他们。

And then, she closed her eyes,

然后，她闭上她的双眼，

she lay back on her pillows.

她躺回她的枕头上。

I just watched her relax,

我就看着她放松下来，

and in her own inimitable and aloof way,

用自己独特又超然的方式，

she told us that we were no longer required.

告诉我们，可以走了。

(Laughter)

（笑声）

And my boss said to me, “Are you OK?” And I said, “Yes.” (Voice breaking)

然后我的老板对我说：“你还好吗？” 然后我说：“是的。”（哽咽）

And I went to the kitchen to blow my nose and dry my eyes,

然后我去厨房擤鼻涕、擦眼泪，

and think about what just happened.

回想刚才发生的事情。

Two huge ideas exploding in my brain at the same time.

两个重要的想法同时在我的脑海中爆发。

One is "How have I never noticed that?"

一是“我怎么从没注意到呢？”

That pattern that he has just explained,

他刚才解释的那个顺序，

I have seen hundreds of times.

我已经看过数百次了。

But I was the most junior doctor.

但我是最初级的医生。

It was my job to stop the person dying, remember?

我的工作是阻止那个人死亡，还记得吗？

So I was so busy worrying about this person's oxygen levels

所以我忙着担心这个人的氧气水平、

and that person's pulse, and this person's kidney function

脉搏、肾脏功能

that I didn't stand back and see that there's a pattern going on here.

以至于我没有退后一步， 看到这里有一种顺序。

We can describe the process of ordinary human dying,

我们可以形容普通人的死亡过程，

and it's as much a process as the process of giving birth is.

这个过程就跟分娩过程差不多。

It has stages.

它是阶段性的。

We can recognize them, we can pace ourselves.

我们可以辨别那些阶段， 可以调整自己的节奏。

We can work out where we are in it.

我们可以认出我们处于其中的位置。

But even more fascinating

但更令人着迷的是

was that realization from watching Sabine's reaction,

通过观察萨宾的反应，我意识到，

that we can describe ordinary dying to a dying person ...

我们可以向一个垂死的人描述普通死亡……

and it shines the light of understanding and information

它焕发出理解和知识的光芒，

into that dark place

照亮了漆黑一片的地方，

where all their fears and imagination were at play.

那个他们的各种恐惧 和幻想在作怪的地方。

I've gone on in my career in palliative care

在我从事姑息治疗的职业生涯中，

to have that conversation thousands of times, countless times.

我有过成千上万次、无数次这样的对话。

I always offer to stop.

我总是主动提出要不要停下来。

I've never been stopped.

我从来没有被喊停过。

But what happens at the end is that relaxation,

而最终的结果是那种释然，

that moment of, "Well, that isn't what I was expecting,"

如释重负的那一刻， “嗯，不是我以为的那样”，

followed almost immediately by "Can you tell my family that?"

然后几乎立刻就是 “你能告诉我的家人吗？”

“Can you tell my wife, my husband, my kids, my parents?

“你能告诉我的妻子、我的丈夫、 我的孩子、我的父母吗？

That’s not what we’re expecting.”

这不是我们以为的那样。”

And I think we can do that.

而我认为我们当然可以那么做。

So losing the wisdom really matters.

因此，失去智慧确实很要紧。

And we can't leave it to palliative care people,

而我们不能只让姑息治疗人员，

or even medical people,

甚至是医务人员，

to reclaim that lost wisdom, one family at a time.

逐个家庭去教导，重拾失去的智慧。

This is a massive social public health issue.

这是一个广泛的社会公共卫生问题。

And I invite everybody who's listening to step up.

我邀请所有听众挺身而出。

The reason my grandmother understood about dying

我的祖母之所以理解死亡，

was that she'd seen it alongside people who knew it,

是因为她和明白死亡的人一起看到死亡，

who described to her, as the process was happening,

他们向她描述了死亡的过程，

what she was seeing,

她所见证的，

so that she would understand and not be afraid.

让她理解死亡并不再害怕。

And it requires all of us who are mortals,

这需要所有血肉之躯，

all of us who love other mortals,

所有热爱其他血肉之躯的人，

to step up, to say, “Enough,

挺身而出，说：“够了，

death is not a medical event, it's a social event.

死亡不是医疗事件， 而是一场社会活动。

It's a deeply personal event.

这是一场非常私人的活动。

And we can understand it,

我们可以理解它，

we can describe it,

我们可以描述它，

we can console each other.

我们可以互相安慰。

We can accompany each other.

我们可以互相陪伴。

We can reclaim dying."

我们可以重拾死亡的慧思。”

Thank you.

谢谢。

(Applause)

（掌声）