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

譯者: William Choi 審譯者: Adrienne Lin

Ten years ago,

十年前，

I got a phone call that changed my life.

我接到了一通電話，改變了一生，

At the time, I was cardiologist at UCLA,

那時我是加州大學 洛杉磯分校的心臟病學家，

specializing in cardiac imaging techniques.

專門從事於心臟影像技術，

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

這通電話由洛杉磯動物園 的一位獸醫師打過來，

An elderly female chimpanzee

有一隻年老的母猩猩

had woken up with a facial droop

睡醒時面部下垂，

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

獸醫師擔心牠中風。

They asked if I'd come to the zoo

他們問我可否去一趟動物園，

and image the animal's heart

給母猩猩的心臟拍一張照片，

to look for a possible cardiac cause.

看看心臟有沒有問題。

Now, to be clear, North American zoos are staffed

先說明一下，

北美洲的動物園都會雇用 高水準兼持有執照的獸醫師，

by highly qualified, board-certified veterinarians

who take outstanding care of their animal patients.

為生病的動物提供良好照顧，

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

但是他們偶爾也會向 照顧人類的醫師尋求協助，

particularly for some speciality consultation,

特別是一些專業的諮詢，

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

而我是有幸受邀前去 幫助他們的其中一位醫師，

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

因此我有機會為這隻猩猩 排除中風的疑慮，

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

確保這隻大猩猩的主動脈未曾破裂，

evaluate this macaw for a heart murmur,

替這隻金剛鸚鵡測量心跳聲，

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

確保這隻加州海獅沒有患上心包炎，

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

在這張照片裡， 我正在給一隻獅子聽診，

after a lifesaving, collaborative procedure

這是在獸醫師和內科醫師合作

with veterinarians and physicians

進行了一次救生之後，

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

我們從這隻獅子心臟的心包

in which this lion's heart was contained.

排掉700毫升的液體，

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

這個步驟跟我曾在很多病人身上 實施過的完全相同，

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

除了那隻爪子和尾巴。

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

現在我經常會跟加州大學洛杉磯分校 醫學中心的內科醫師共事，

discussing symptoms and diagnoses and treatments

討論我們病「人」的

for my human patients,

症狀、診斷和療法，

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

但是有時候我會到洛杉磯動物園工作，

with veterinarians, discussing symptoms and diagnoses and treatments

為了他們的動物患者， 和那裡的獸醫師一起

for their animal patients.

討論症狀、診斷和療法，

And occasionally, on the very same day,

偶爾在同一天，

I went on rounds at UCLA Medical Center

我會在加州大學洛杉磯分校的醫學中心

and at the Los Angeles Zoo.

和洛杉磯動物園之間來回跑，

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

而在這裡開始變得非常明確清晰，

Physicians and veterinarians were essentially taking care

就是醫師和獸醫師 根本在處理同樣的疾病，

of the same disorders in their animal and human patients:

不管在人類還是動物身上：

congestive heart failure, brain tumors,

充血性心臟衰竭、腦部腫瘤、

leukemia, diabetes, arthritis, ALS, breast cancer,

白血病、糖尿病、關節炎、 漸凍症、乳癌，

even psychiatric syndromes like depression, anxiety,

甚至精神病症狀如憂鬱症、焦慮症、

compulsions, eating disorders and self-injury.

強迫症、飲食障礙症或自我傷害。

Now, I've got a confession to make.

現在我必須承認，

Even though I studied comparative physiology and evolutionary biology

雖然我在大學主修 對比生理學和演化生物學—

as an undergrad --

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

甚至畢業論文寫的是 關於達爾文理論—

learning about the significant overlap

當理解到動物和人類疾病之間

between the disorders of animals and humans,

存在著明顯的重疊部份時，

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

我突然靈光乍現，

So I started wondering, with all of these overlaps,

於是我開始想，既然有這麼多的重疊，

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

為甚麼從來沒想過請求獸醫師的意見，

or consult the veterinary literature,

或者查找獸醫方面的文獻，

for insights into one of my human patients?

以更好地瞭解我的病人呢？

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

為甚麼我或是我詢問過的 醫師朋友和同事

whom I asked, ever attended a veterinary conference?

都沒參加獸醫學的會議呢？

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

既然人類和動物的疾病是重疊的， 那麼又有甚麼奇怪的呢？

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

我的意思是每位醫師都知道

動物和人類之間有著生物學上的聯繫。

between animals and humans.

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

我們所處方的每份藥物， 或者我們自己的用藥，

or we've given to our families

或者給我們家人的用藥，

has first been tested on an animal.

都曾經先在動物身上進行試驗。

But there's something very different

但是情況也有很大的不同，

about giving an animal a medication or a human disease

給動物用一種藥或是患上人類疾病時，

and the animal developing congestive heart failure

及動物得了充血性心臟衰竭、

or diabetes or breast cancer on their own.

或糖尿病、乳癌。

Now, maybe some of the surprise

但現在讓我們感到驚訝的是，

comes from the increasing separation in our world

也許在我們這個世界裡

between the urban and the nonurban.

城市與鄉郊之間日漸擴大的隔閡，

You know, we hear about these city kids

我們聽說過那些城市裡的孩子，

who think that wool grows on trees

他們認為羊毛是在樹上生長的，

or that cheese comes from a plant.

或者乳酪從植物長出來的。

Well, today's human hospitals,

今天人類的醫院

increasingly, are turning into these gleaming cathedrals of technology.

正逐漸變成一些閃耀的科技教堂，

And this creates a psychological distance between the human patients

使在醫院治療的病人

who are being treated there

跟生活在海洋、農田和森林間

and animal patients who are living in oceans

的動物患者

and farms and jungles.

產生一種心理上的距離感。

But I think there's an even deeper reason.

但我認為還有一個更深層次的原因，

Physicians and scientists, we accept intellectually that our species,

我們作為醫師和科學家， 理智上明白到

人類作為一個物種， 也只不過是一個物種，

Homo sapiens, is merely one species,

no more unique or special than any other.

並不比其他物種更為獨特。

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

但其實在我們內心， 我們並不完全認同。

I feel it myself when I'm listening to Mozart

當我聽莫扎特的音樂時，

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

或在蘋果電腦上看火星探測器的照片， 我自己是這麼感覺的。

I feel that tug of human exceptionalism,

我感受到人類特殊論的勝利，

even as I recognize the scientifically isolating cost

即使我意識到人類以科學方式 孤立自身所付出的代價，

of seeing ourselves as a superior species, apart.

把自己隔開看做一種上等的物種。

Well, I'm trying these days.

現時我正在嘗試，

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

當我替病人看病時，我總會問，

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

獸醫對這個問題會否知道 那些我不知道的事嗎？

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

還有如果我把病人看做人類動物患者，

if I saw them as a human animal patient?

能否給他們更好的治療？

Here are a few examples of the kind of exciting connections

下面是幾個讓人興奮的聯繫的例子，

that this kind of thinking has led me to.

就是這種想法讓我聯想到那些點子。

Fear-induced heart failure.

恐懼誘發心臟衰竭—

Around the year 2000,

2000年左右，

human cardiologists "discovered" emotionally induced heart failure.

人類心臟學家「發現」 情緒會誘發心臟衰竭，

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

文獻曾經記述過一個嗜賭成性的父親，

他一次擲骰子就輸光畢生積蓄，

with a roll of the dice,

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

一個在聖壇前面被離棄的新娘，

But it turns out, this "new" human diagnosis

但最後我們發現 這種「全新」的人類疾病，

was neither new, nor was it uniquely human.

既不新奇又不為人類所獨有，

Veterinarians had been diagnosing, treating and even preventing

獸醫早就已經在診斷、治療甚至防止

emotionally induced symptoms in animals

動物身上的情緒誘發症狀，

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

從猴子到火烈鳥、從鹿到兔子，

since the 1970s.

乃自 19 世紀 70 年代起開始。

How many human lives might have been saved

如果急診室和心臟專科醫師能運用

if this veterinary knowledge had been put into the hands

這一點獸醫學的知識，

of E.R. docs and cardiologists?

那麼有多少人類生命可被拯救？

Self-injury.

自殘—

Some human patients harm themselves.

有些病人會傷害自己，

Some pluck out patches of hair,

有些會拔出整把頭髮，

others actually cut themselves.

有些會實際地切割自己。

Some animal patients also harm themselves.

有些動物患者也傷害自己，

There are birds that pluck out feathers.

有些鳥類會拔掉自己的羽毛，

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

有些成年公馬反覆地咬 自己的側腹直到流血。

But veterinarians have very specific and very effective ways

但是獸醫師使用 一些特定且有效的方式

of treating and even preventing self-injury

去治療甚至防止自我傷害的動物

in their self-injuring animals.

在身上自殘。

Shouldn't this veterinary knowledge be put into the hands

難道這些有關獸醫學的知識

of psychotherapists and parents and patients

不該被努力對抗自殘的精神治療師、

struggling with self-injury?

父母和病人所運用嗎？

Postpartum depression and postpartum psychosis.

產後抑鬱症和產後精神錯亂—

Sometimes, soon after giving birth,

有時就在生產之後不久，

some women become depressed,

有些婦女會變得憂鬱，

and sometimes they become seriously depressed and even psychotic.

有時她們患上嚴重憂鬱症 甚至精神錯亂，

They may neglect their newborn,

她們或者會忽視剛出生的寶寶，

and in some extreme cases,

在些極端的案例中，

even harm the child.

甚至會傷害她們的孩子。

Equine veterinarians also know that occasionally,

馬專科獸醫師也知道

偶爾一頭母馬剛剛生產後，

a mare, soon after giving birth,

will neglect the foal, refusing to nurse,

也會忽視小馬，拒絕餵奶，

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

有些時候會踢牠，甚至把牠們踢死。

But veterinarians have devised

但是獸醫師設計出

an intervention to deal with this foal rejection syndrome

一種介入方法以處理 這類馬駒抗拒症狀，

that involves increasing oxytocin in the mare.

就是增加母馬體內的催產素。

Oxytocin is the bonding hormone,

催產素是一種跟聯繫有關的荷爾蒙，

and this leads to renewed interest,

它會給母馬重新

on the part of the mare, in her foal.

感到對小馬的興趣。

Shouldn't this information

難道這種知識不應該

be put into the hands of ob/gyn's

被正在與產後憂鬱症和精神錯亂抗爭的

and family doctors and patients

婦產管理者、醫師

who are struggling with postpartum depression and psychosis?

和病人所運用嗎？

Well, despite all of this promise,

好吧，即使這些都已實現，

unfortunately the gulf between our fields remains large.

不幸地在我們領域間的鴻溝還很大，

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

為了解釋這一點， 我恐怕要揭露一些陰暗面，

Some physicians can be real snobs

有些醫師是完完全全的勢利眼，

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

他們看不起不是醫學博士的醫師，

I'm talking about dentists and optometrists and psychologists,

我指的是牙醫、配鏡師和心理醫師，

but maybe especially animal doctors.

也尤其指獸醫師。

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

當然大多數醫師意識不到

現在進入獸醫學院較進入醫學院更難，

to get into vet school these days than medical school,

and that when we go to medical school,

而且當我們上醫學院時，

we learn everything there is to know

我們在那裡所學的全部東西

about one species, Homo sapiens,

都只為瞭解一個物種—人類，

but veterinarians need to learn about health and disease

但是獸醫師需要學習哺乳動物、

in mammals, amphibians, reptiles, fish and birds.

兩棲動物、爬行動物、魚類和 鳥類的健康和疾病，

So I don't blame the vets for feeling annoyed

因此我不會責怪獸醫師，

by my profession's condescension and ignorance.

因著我的專業所帶來的 優越感與無知而感到厭煩，

But here's one from the vets:

但是獸醫有個說法:

What do you call a veterinarian

你會把一個只能照顧

who can only take care of one species?

某一物種的獸醫師叫做甚麼？

A physician. (Laughter)

一位醫師（笑聲）

Closing the gap has become a passion for me,

將兩者的差距縮小變成我的熱情，

and I'm doing this through programs

而我正在通過一些專案來做這件事，

like Darwin on Rounds at UCLA,

比如加州大學洛杉磯分校的 「達爾文巡邏員」專案，

where we're bringing animal experts and evolutionary biologists

我們把動物專家和演化生物學家找來，

and embedding them on our medical teams

安插在我們的醫療隊伍中，

with our interns and our residents.

跟我們的實習生和住院醫師一起工作。

And through Zoobiquity conferences,

而且通過「人獸同源學」會議，

where we bring medical schools together with veterinary schools

我們讓醫學院和獸醫學院聚在一起，

for collabortive discussions

討論動物患者

of the shared diseases and disorders

和人類病者之間

of animal and human patients.

的共同疾病和失調，

At Zoobiquity conferences,

在「人獸同源學」會議上，

participants learn how treating breast cancer in a tiger

參與者學習到替老虎治療乳腺癌

can help us better treat breast cancer

將會如何幫助我們更好地治療

in a kindergarten teacher;

一位幼兒園老師的乳腺癌；

how understanding polycystic overies in a Holstein cow

好好瞭解荷斯坦牛的多囊卵巢

can help us better take care

將會如何幫助我們

of a dance instructor with painful periods;

更好地照顧一位受經痛困擾的舞蹈老師；

and how better understanding the treatment of separation anxiety

深入瞭解一隻患上分離焦慮症

in a high-strung Sheltie

且高度緊張的喜樂蒂牧羊犬的治療，

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

將會如何幫助一個首天上學 就感費力的焦慮幼孩。

In the United States and now internationally, at Zoobiquity conferences

在美國，而且現時在全球， 於「人獸同源學」會議上，

physicians and veterinarians check their attitudes and their preconceptions

醫師和獸醫師會將態度 以及成見留在會議室外，

at the door and come together as colleagues,

然後以同行的身份、

as peers, as doctors.

同輩的身份、 以及醫師的身份聚在一起。

After all, we humans are animals, too,

畢竟我們人類也是動物，

and it's time for us physicians to embrace

是時候讓我們醫師去接受

our patients' and our own animal natures

我們同時是病人和動物的本質，

and join veterinarians

和獸醫師合作

in a species-spanning approach to health.

以跨越物種的方式處理健康問題。

Because it turns out,

因為最後證明是

some of the best and most humanistic medicine

一些最好且最合乎人道主義 的藥物治療，

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

正被患者並不是人類的醫師所使用，

And one of the best ways we can take care

而我們照顧人類患者的最好方法之一

of the human patient is by paying close attention

就是密切注意

to how all the other patients on the planet

在這星球上其他病患者

live, grow, get sick and heal.

是如何生活、成長、患病以及康復。

Thank you.

謝謝！

(Applause).

（掌聲）