与不确定性共存的勇气｜TED演讲
字幕摘录
| 时间 | 英文 | 中文 |
|---|---|---|
| 0:00 | Almost exactly 10 years ago, I was sitting in an exam room | 差不多10年前 我坐在考试室里 |
| 0:04 | that was way too cold, waiting to meet my new oncologist. | 太冷了 等着见我的新肿瘤学家 |
| 0:08 | I was terrified. | 我吓坏了。 |
| 0:10 | Even though my partner at the time | 虽然当时我的搭档 |
| 0:12 | was sitting right by my side, I felt completely alone. | 坐在我身边,我感觉很孤独 |
| 0:17 | I had just been diagnosed with breast cancer. | 我刚刚被诊断为乳腺癌 |
| 0:20 | And it seemed at the time that a single bright spot | 当时似乎只有一块亮点 |
| 0:24 | on a scan of my right lung meant that the cancer had already | 我右肺的扫描表明 癌症已经 |
| 0:28 | spread. | 展开。 |
| 0:29 | I had metastatic breast cancer. | 我患了发育性乳腺癌 |
展开字幕全文（244 条）
| 序号 | 英文 | 中文 |
|---|---|---|
| 1 | Almost exactly 10 years ago, I was sitting in an exam room | 差不多10年前 我坐在考试室里 |
| 2 | that was way too cold, waiting to meet my new oncologist. | 太冷了 等着见我的新肿瘤学家 |
| 3 | I was terrified. | 我吓坏了。 |
| 4 | Even though my partner at the time | 虽然当时我的搭档 |
| 5 | was sitting right by my side, I felt completely alone. | 坐在我身边,我感觉很孤独 |
| 6 | I had just been diagnosed with breast cancer. | 我刚刚被诊断为乳腺癌 |
| 7 | And it seemed at the time that a single bright spot | 当时似乎只有一块亮点 |
| 8 | on a scan of my right lung meant that the cancer had already | 我右肺的扫描表明 癌症已经 |
| 9 | spread. | 展开。 |
| 10 | I had metastatic breast cancer. | 我患了发育性乳腺癌 |
| 11 | I had no medical training at this point, | 这时候我没有受过医学训练 |
| 12 | but I knew what it meant if it were true. | 但我知道,如果它是真实的。 |
| 13 | Incurable breast cancer. | 无法治愈的乳腺癌。 |
| 14 | Terminal breast cancer. | 终极乳腺癌。 |
| 15 | I was 27 years old, had just been accepted to medical school, | 我27岁 刚被医学院录取 |
| 16 | and I wondered if I was already at the end of my life. | 我在想我是否已经到了生命的尽头 |
| 17 | My new oncologist was not a warm person. | 我的新肿瘤学家 不是一个温暖的人。 |
| 18 | She dealt in simple facts, as many brilliant physicians do. | 她只处理简单的事实,就像许多杰出的医生一样。 |
| 19 | Our body is made up of cells, she started. | 我们的身体是由细胞组成的, 她开始。 |
| 20 | I stopped her. | 我拦住了她。 |
| 21 | I'm starting medical school soon. | 我马上就要上医学院了 |
| 22 | I know. | 我知道,我记得 |
| 23 | Instead of taking this as a signal | 而不是把它当作信号 |
| 24 | to go backward, to start again, she went forward. | 向后走 重新开始 她向前走 |
| 25 | She said that I would need to start on chemotherapy | 她说我要开始化疗 |
| 26 | to control the cancer. | 来控制癌症 |
| 27 | She launched into the details of the drug, and the side effects, | 她把药物和副作用 都写进了细节 |
| 28 | and the schedule. | 还有日程安排 |
| 29 | I reminded her that we hadn't even yet biopsied | 我提醒她我们还没被活化 |
| 30 | the bright spot on my lung, and I asked if she | 肺部的亮点 我问她是否 |
| 31 | was sure that it was cancer. | 确定这是癌症。 |
| 32 | I remember viscerally how she seemed almost frustrated | 我记得她看起来很沮丧 |
| 33 | with my question. | 我的问题。 |
| 34 | Perhaps she thought I wasn't following along | 也许她以为我没有跟着 |
| 35 | with her explanations, or worse still, I was in denial. | 更糟糕的是 我否认了 |
| 36 | I simply wanted her to understand that as her patient, | 我只是想让她明白 作为她的病人 |
| 37 | that biopsy was not just a mere formality | 活体检查不仅仅是一种形式 |
| 38 | to prove an already foregone conclusion. | 证明一个已经没有的结论。 |
| 39 | It was a steel needle through skin, muscle, and bone | 钢针穿过皮肤、肌肉和骨头 |
| 40 | that would deliver a deep piece of me to the surface | 那会把我深处的一块带到水面 |
| 41 | and answer a question I wish didn't have to be asked. | 并回答一个问题 我希望不用问。 |
| 42 | Before the biopsy, I could be a 27-year-old woman | 在做活检之前,我可能是个27岁的女人 |
| 43 | who might have metastatic breast cancer, who probably | 可能已经发育不良的乳腺癌 |
| 44 | had metastatic breast cancer. | 曾患上发育不良的乳腺癌。 |
| 45 | This is a critical distinction, but it's not | 这是一个关键区别,但它不是 |
| 46 | one that's emphasized in the most elite oncology training. | 在最精英的肿瘤学训练中强调的 |
| 47 | Instead, I was dismissed with an appointment | 相反,我被辞退了 |
| 48 | to start treatment in just a few weeks. | 几周后开始治疗 |
| 49 | So much has happened since that first visit. | 自从第一次访问以来,发生了许多事情。 |
| 50 | Ironically, the biopsy was not just a mere formality. | 具有讽刺意味的是,活体检查不仅仅是一种形式。 |
| 51 | My former oncologist was right. | 我之前的肿瘤医生是对的 |
| 52 | It did show cancer, but it was a totally separate | 它确实显示出癌症,但它是一个完全独立的 |
| 53 | lung cancer, and as crazy as it sounds, | 肺癌,和疯狂的 听起来, |
| 54 | this was great news. | 这是好消息。 |
| 55 | I did not have metastatic breast cancer. | 我没患过乳癌 |
| 56 | I had two different cancers, but both of them were localized. | 我患了两种不同的癌症, 但它们都是局部的。 |
| 57 | And so the lung cancer was localized enough | 所以肺癌已经足够本地化了 |
| 58 | that it could be removed. | 可以被删除。 |
| 59 | And so the onslaught of treatments began | 所以治疗的冲击开始 |
| 60 | with a lung surgery, continued with chemotherapy, | 肺部手术 继续化疗 |
| 61 | and ended with a breast surgery just after my 28th birthday. | 最后在我28岁生日后做了乳房手术 |
| 62 | And then two weeks later, I started medical school. | 两周后,我开始了医学院。 |
| 63 | My new oncologist, who deals much more fluidly | 我的新肿瘤学家,他更灵活 |
| 64 | both with facts and their implications, | 有事实和意义, |
| 65 | very reasonably suggested that I should defer my acceptance | 非常合理地建议我推迟接受 |
| 66 | to medical school for a year, take some time to rest, | 上医学院一年 休息一段时间 |
| 67 | to recover, and I trusted her advice. | 我信任她的建议 |
| 68 | I felt terrible during the intensive chemotherapy sessions. | 在强化化疗期间我感觉很糟 |
| 69 | And so I wrote to the dean. | 所以我写信给院长 |
| 70 | I explained my circumstances, and a deferral | 我解释过我的情况,还有推迟 |
| 71 | was speedily granted. | 迅速获准。 |
| 72 | But as the chemo fog lifted, I wondered what I was gonna do | 但随着化疗雾的解除,我想知道我该怎么办 |
| 73 | with a year. | 一年时间。 |
| 74 | Should I go to the beach? | 我应该去海滩吗? |
| 75 | I wasn't really a beach person. | 我不是一个真正的海滩人。 |
| 76 | And how many years did I have left anyway? | 我到底还剩多少年? |
| 77 | I really wanted to go to medical school. | 我真的很想上医学院 |
| 78 | It seemed like a missing piece of my puzzle. | 这似乎是我拼图中缺失的一块 |
| 79 | So instead of going around and around within decision, | 因此,与其在决定中左右, |
| 80 | I asked myself, what's the worst that could happen? | 我问自己,最糟糕的是什么? |
| 81 | Well, I could be too weak or too sick to do the work. | 好吧,我可能太虚弱或太病 做工作。 |
| 82 | It could be too hard for me emotionally. | 这对我来说可能太难了 |
| 83 | I could fail out of medical school. | 我可能从医学院退学了 |
| 84 | But then I remembered that wouldn't be the worst thing | 但后来我想起了 这不会是最糟糕的事情 |
| 85 | that happened to me even that year. | 连那年我也是这样 |
| 86 | So why not get started? | 那为什么不开始呢? |
| 87 | Why not continue living the way that I wanted to live? | 为什么不继续像我想的那样生活? |
| 88 | 所以我就这么做了 And so I did. | |
| 89 | Bald and real thin, I put on my best earrings | 秃头又瘦 我戴上最好的耳环 |
| 90 | and my favorite dress, and I started. | 和我最喜欢的裙子, 我开始。 |
| 91 | I pretended to belong, and I began to. | 我假装属于我, 我开始。 |
| 92 | There is no way to describe how hard it was. | 无法描述这有多难。 |
| 93 | Some days it felt impossible. | 有时候感觉不可能 |
| 94 | It felt as if I was doing things | 感觉好像我在做事 |
| 95 | that would never matter in the future. | 这在未来永远不会重要。 |
| 96 | But every day I asked myself, are you still enjoying this? | 但我每天都问自己 你还喜欢这个吗? |
| 97 | Is this still what you want to be doing? | 这还是你想做的吗? |
| 98 | And every day the answer was yes. | 每天都有答案是肯定的。 |
| 99 | Sometimes a very qualified yes, but a yes. | 有时候,一个非常合格的是,但是一个是。 |
| 100 | And then just as I was getting comfortable | 礛碞и何谋 |
| 101 | and feeling like I might not necessarily fail out of medical school, | 感觉我可能不会从医学院毕业 |
| 102 | I received even more devastating news. | 我收到了更毁灭性的消息。 |
| 103 | I learned that I had a mutation in a gene called TP53, | 我得知我有一个突变 一个基因叫TP53, |
| 104 | or P53 for short. | 简称P53。 |
| 105 | Known as the guardian of the genome, a mutation, | 被称为基因组的守护者,一种突变, |
| 106 | P53 is responsible for supervising the repair of our DNA. | P53负责监督我们的DNA修复工作. |
| 107 | A mutation in this gene means errors go uncorrected. | 这个基因的突变意味着错误得不到纠正. |
| 108 | It means that normal cells become cancerous at a much higher rate. | 这意味着正常细胞以更高的速度成为癌细胞. |
| 109 | All of a sudden, with this knowledge, | 突然间,有了这种知识, |
| 110 | my medical history made a terrible kind of sense. | 我的病史很有意义 |
| 111 | 我7岁时得了儿童癌症, rhabdomyosarcoma。 | |
| 112 | It recurred when I was a teenager, | 在我十几岁的时候, |
| 113 | and this was all before P53 had been discovered in the lab. | 这都是在P53在实验室被发现之前发生的 |
| 114 | Then I'd had young adult breast and lung cancers. | 然后,我患上了年轻的成人乳腺癌和肺癌。 |
| 115 | With the knowledge of this mutation, | 以知此变异. |
| 116 | it seemed that there was likely no end to the number of cancers | 似乎癌症数量没有结束 |
| 117 | that I could expect in my future. | 我将来会想到的 |
| 118 | And yet, I decided to become a radiation oncologist. | 然而,我决定成为一名放射肿瘤学家。 |
| 119 | I hope to graduate from residency in just a few months, | 我希望几个月后从居住区毕业 |
| 120 | move to a new city and start my first real job | 搬去新城市 开始我第一份真正的工作 |
| 121 | as a doctor and researcher. | 作为医生和研究员. |
| 122 | Because of grit, because of privilege, | 因为Grit 因为特权 |
| 123 | because of therapy, because of my medical teams | 因为治疗,因为我的医疗队 |
| 124 | and my family and my teachers, | 还有我的家人和我的老师, |
| 125 | because genetic diagnoses should give us the knowledge to move forward. | 因为基因诊断应该给我们 前进的知识。 |
| 126 | And even in the year 2020, | 而即使在2020年, |
| 127 | that generally doesn't mean miracle cures or medical breakthroughs. | 这一般并不意味着奇迹治疗 或医疗突破。 |
| 128 | Having a devastating genetic diagnosis means learning to live with uncertainty. | 具有毁灭性的遗传诊断,意味着学会生活在不确定之中. |
| 129 | It means learning that you and your diagnosis | 意思是学习你的诊断 |
| 130 | are not the worst thing that could happen. | 这不是可能发生的最糟糕的事情。 |
| 131 | Learning to live with uncertainty means walking forward into a life | 学会过着不确定的生活 意味着走向人生 |
| 132 | that is as full of beauty as it is of challenges. | 充满了挑战的美丽 |
| 133 | It means learning for yourself that cancer is just part of your story. | 它意味着为自己学习 癌症只是你的故事的一部分。 |
| 134 | It may not be the worst thing that happens to you. | 这也许不是发生在你身上的最坏的事情 |
| 135 | If it is, that's OK. | 如果是这样,没关系。 |
| 136 | You can claim that and you can own that, | 你可以声称,你可以拥有, |
| 137 | but let that be a narrative that you author and you authorize, | 但让这成为你写作和授权的叙述, |
| 138 | not one that's prescribed to you by someone else. | 不是别人给你开的药 |
| 139 | Have your deferral letter in hand, but use it on your terms. | 把你的延期信拿来 但用你的条件 |
| 140 | As I come to the end of my oncology training, | 当我的肿瘤训练结束 |
| 141 | I have deja vu again and again with the following scenario. | 我一遍又一遍地经历了以下情况。 |
| 142 | A patient has cancer. | 一个病人得了癌症。 |
| 143 | There are several options, | 有几个选择 |
| 144 | all of which offer a different balance between cure and quality of life, | 所有这些在治疗和生活质量之间提供了不同的平衡, |
| 145 | between the possibility of alleviating suffering | 减轻痛苦的可能性 |
| 146 | and the possibility of causing suffering. | 以及造成痛苦的可能性。 |
| 147 | An oncologist lays out the options, | 肿瘤学家提出了选择 |
| 148 | but somewhere in the discussion, things get skewed. | 但是在讨论的某个地方,事情变得扭曲。 |
| 149 | The choice becomes something more like, | 选择变得更像是 |
| 150 | well, you could choose to do something, | 你可以做点什么 |
| 151 | or you could choose to do nothing. | 或者你可以选择什么都不做。 |
| 152 | We could be aggressive and treat your cancer, | 我们可以积极治疗你的癌症 |
| 153 | or we could watch it. | 或者我们可以看它。 |
| 154 | And 9.9 times out of 10, the patient says, | 病人说: |
| 155 | I want to do everything I can do. | 欲尽一切法. |
| 156 | Of course, who wouldn't want everything? | 当然,谁不会想要一切? |
| 157 | But what is everything? | 但什么是一切吗? |
| 158 | Is everything the ability to sit in your own home, | 一切都能坐在家里吗? |
| 159 | in front of your window, bathed in sunshine and surrounded by family? | 在你的窗户前, 沐浴在阳光下 和包围着家人? |
| 160 | Is everything still being able to feel your fingers and your toes | 一切还是能感觉到你的手指和脚趾 |
| 161 | because they haven't gone numb from chemotherapy? | 因为他们没有麻木 从化疗? |
| 162 | As oncologists, our everything is cancer treatment. | 作为肿瘤学家 我们的一切都是癌症治疗 |
| 163 | It's radiation and surgery and chemotherapy and novel treatments. | 它的辐射和手术 化疗和新颖的治疗。 |
| 164 | And for us, the worst thing that could happen, | 对我们来说,最糟糕的事情可能发生 |
| 165 | and I have heard more than one oncologist say this, | 我听到不止一个肿瘤学家这么说 |
| 166 | the worst thing that could happen | 最糟糕的事情会发生 |
| 167 | is that the patient will develop metastatic disease. | 即患者将出现元病。 |
| 168 | Or the worst thing that could happen is that five years from now, | 或者最糟糕的事情是 五年之后, |
| 169 | the cancer will grow and I'll have to give more radiation. | 癌症会增加,我不得不给更多的辐射。 |
| 170 | As a patient and as an oncologist, | 作为一个病人和肿瘤学家, |
| 171 | I would never argue that these are not devastating outcomes. | 我绝不认为这些不是破坏性的结果。 |
| 172 | But are they the worst? | 但他们是最坏的吗? |
| 173 | Should cancer control be at the center of our thinking always? | 癌症控制应该永远成为我们思想的中心吗? |
| 174 | Many unspeakably, unfathomably painful and brutal things | 很多难以言喻的 痛苦和残酷的东西 |
| 175 | have happened to me because of my cancers and my genetic mutation. | 是因为我的癌症和基因突变 |
| 176 | And yet, I consider myself very lucky indeed, | 但我觉得自己非常幸运 |
| 177 | because the worst thing that could happen never came to pass, | 因为最糟糕的事永远不会发生 |
| 178 | because I have let devastation and uncertainty sit at the table, | 因为我让毁灭和不确定性坐到桌上 |
| 179 | but somewhere off to the side. | 但某处离侧。 |
| 180 | When I was diagnosed with metastatic breast cancer, | 当我被诊断为 运动性乳腺癌, |
| 181 | I went to Boston for a second opinion, because what could I lose? | 我去波士顿谈了第二个意见 因为我会失去什么? |
| 182 | When my oncologist gave me very good and very safe | 当我的肿瘤学家给了我非常好,非常安全 |
| 183 | and very standard advice, I started medical school anyway, | 和非常标准的建议, 我开始医学院反正, |
| 184 | even though I was undergoing active cancer treatment. | 虽然我正在接受癌症治疗 |
| 185 | Instead of shying away from patients with cancer, | 而不是回避癌症患者, |
| 186 | I became a radiation oncologist | 我成了放射肿瘤学家 |
| 187 | and I work with patients who are very much like me every single day. | 我每天和像我一样的病人一起工作 |
| 188 | Instead of imagining the suffering that I might cause to a future partner | 而不是想象我给未来的伴侣带来的痛苦 |
| 189 | when I died of cancer, I married my wonderful husband, | 当我死于癌症, 我娶了我的好丈夫, |
| 190 | because the worst thing that can happen is always a series of negatives. | 因为最坏的事情是 总是一系列的负面。 |
| 191 | It's blank spaces that should be filled with life. | 空白的空间应该充满生命 |
| 192 | So what is the most that I have leaned into this kind of radical uncertainty? | 那么,什么是我最倾向于 这种激进的不确定性? |
| 193 | Well, this is William. | 这是威廉 |
| 194 | He is the most joyful person that I have ever met. | 他是我见过最快乐的人 |
| 195 | And in just over a year, he has already made the world a better place. | 在短短一年多的时间里,他已经使世界变得更美好。 |
| 196 | As oncologists, we talk to our patients as if the worst thing that could happen | 作为肿瘤学家,我们和病人交谈 就像最糟糕的事情会发生一样 |
| 197 | is that their cancer could come back | 他们的癌症可能会复发 |
| 198 | or that it could spread or that they could die from it. | 或让它蔓延,或使他们死亡。 |
| 199 | As a patient, I know that these are paramount, | 作为一个病人,我知道 这是最重要的, |
| 200 | but I want to change the way that we think about this. | 但我想改变我们的想法 |
| 201 | And I want to change the way that we talk about this with our patients. | 我想改变我们和病人谈论这个问题的方式。 |
| 202 | As a patient, the worst thing that can happen is that cancer robs you | 作为病人,最糟糕的事情是癌症会抢劫你 |
| 203 | of opportunity, of the ability to be and to do and to love. | 机会,能力 做和爱。 |
| 204 | And it will, at least temporarily it will. | 它会,至少暂时会。 |
| 205 | But to minimize this loss of life in the living, that is the harder | 但是,为了尽量减少生命的损失, 这是困难的 |
| 206 | and, I would say, truer job of the oncologist, | 我想说 肿瘤学家更真实的工作 |
| 207 | to take all the tools that we have and situate them | 将我们拥有的所有工具 放在他们的位置上 |
| 208 | in the context of a patient's whole entire life, | 在病人的整个一生中 |
| 209 | to be guides for how to sit with suffering, acknowledge it deeply, | 成为如何忍受痛苦的指南, |
| 210 | but to not let fear of future suffering be the narrative for the journey forward. | 但不要让对未来痛苦的恐惧成为前进之路的叙述。 |
| 211 | One of my mentors always says the medicine part is easy, | 我的一位导师总是说 药物部分很简单 |
| 212 | and it never feels that way to a junior doctor, | 对初级医生来说 从来没有这种感觉 |
| 213 | but its contours are finite. | 但它的轮廓是有限的。 |
| 214 | We have big studies to guide us, and it's what we learn to do in residency. | 我们有大研究来指导我们, 这就是我们在居住中学会的。 |
| 215 | Much harder is learning how to help each patient | 学着如何帮助每个病人 |
| 216 | navigate the multitudes contained in their illness. | 驾驭着他们病中的人群 |
| 217 | So I find it really funny that, in retrospect, | 所以我觉得这很有趣, 回想起来, |
| 218 | my life looks like a neat package. | 我的生活看起来像一个整洁的包裹。 |
| 219 | It looks as if I planned each successive step, | 看来我计划了每一步 |
| 220 | and that perhaps cancer has led to the good things in my life. | 也许癌症导致我生命中的美好 |
| 221 | Step one, apply to medical school. | 第一步,申请进入医学院. |
| 222 | Step two, get diagnosed with and treated for cancer. | 步骤二,确诊并治疗癌症. |
| 223 | And step three, have it all, a career and a family. | 第三步 拥有一切 事业和家庭 |
| 224 | But I will tell you that each phase was a leap of faith, | 但我会告诉你每个阶段都是信仰的飞跃, |
| 225 | despite an almost paralyzing uncertainty. | 尽管不确定性几乎瘫痪。 |
| 226 | And so it's that courage that I try to give to each of my patients. | 所以我试着给每个病人以勇气。 |
| 227 | I try to do this regardless of the technical medical details | 我试图这样做 无论技术医疗细节 |
| 228 | of cancers and treatment decisions and mutations, | 癌症和治疗决定及变异, |
| 229 | regardless of the slippery fiction of prognosis. | 不论预后如何滑动 |
| 230 | I try to learn what they want and what they need, | 我试着学会他们想要什么和需要什么 |
| 231 | what they wish and what they worry, | 他们所希望的和他们所担心的, |
| 232 | what they dream about, | 他们所梦见的, |
| 233 | what animated them before | 以前是什么动画 |
| 234 | and what will sustain them during the beastly process of cancer treatment. | 在治疗癌症的猛烈过程中 是什么能支撑他们 |
| 235 | It doesn't actually take that much time. | 其实不需要那么长时间 |
| 236 | It does take a few focused, quiet moments | 这确实需要一些专注,安静的时刻 |
| 237 | that require intentional cultivation. | 需要故意种植。 |
| 238 | But this is partnership. | 但是,这是伙伴关系。 |
| 239 | And it matters. | 这很重要 |
| 240 | Because the worst thing that can happen | 因为最糟糕的事情会发生 |
| 241 | is to have an oncologist who does everything, everything, | 是让肿瘤学家做一切,一切, |
| 242 | to help cure your cancer. | 帮助治愈你的癌症。 |
| 243 | And who does nothing to help you live your life. | 而谁不做任何帮助 你生活。 |
| 244 | Thank you. | 谢谢 |
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