呼吸是什么时候发明的_呼吸是什么时候发明的搞笑视频

这周读了一本书 When Breath Becomes Air。作者叫 Paul Kalanithi，看他的教育经历，就是一个彻彻底底的学霸。在

 

这周读了一本书 When Breath Becomes Air作者叫 Paul Kalanithi，看他的教育经历，就是一个彻彻底底的学霸在斯坦福大学读了文学、生理学学位后，又去剑桥读了科学史与哲学研究硕士。

但他还是觉得这不是自己真正想要的，于是考了耶鲁医学院，努力成为一名优秀外科医生他确实做到了，获得了美国神经外科医生协会最高奖，也即将成为斯坦福医学院外科教授，开设自己的研究室可就在前途一片光明之际，36岁的 Paul Kalanithi 被诊断患有肺癌四期。

《当呼吸化作空气》这本书写于 Paul Kalanithi 生命弥留之际向大家推荐这本书，不仅仅是被作者对医学的执着追求所感动，这本书也让我看到了医者对生命的思考，在矛盾和接纳中坦然走完生命最后的旅程分享几个印象深刻的片段。

关于职业选择Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But thats the point. Putting lifestyle first is how you find a job—not a calling.

大部分人选择工作，都是看工资高不高、环境好不好、工作累不累但对于 Paul Kalanithi 来说，学医是一种使命感他甚至开玩笑说，如果只是是把医生当做一份工作，那么这恐怕是天底下最糟糕的职业People often ask if it is a calling, and my answer is always yes.

You can’t see it as a job, because if it’s a job, it’s one of the worst jobs there is.Paul Kalanithi 说，虽然对文学、哲学很感兴趣，但它们都没有给他想要的人生答案，是医学让他对生命有了更深的理解和体验。

But I couldnt quite let go of the question: Where did biology, morality, literature, and philosophy intersect?

I realized that the questions intersecting life, death, and meaning, questions that all people face at some point, usually arise in a

medical context.I had spent so much time studying literature at Stanford and the history of medicine at Cambridge, in an attempt to better understand the particularities of death, only to come away feeling like they were still unknowable to me.

关于对医生职业的理解在书的前半部分，Paul Kalanithi 分享了自己任住院医师期间遇到的一些经历他接诊过各式各样的患者：双胞胎妈妈、82岁入院的高龄老妇、患脑瘤的母亲、摩托车事故脑伤严重年轻小伙……。

有时候虽竭尽全力，却依旧无法挽留病人的生命在家属的眼泪面前，他也感受到无助、自责和疲惫At moments, the weight of it all became palpable. It was in the air, the stress and misery. Normally, you breathed it in, without noticing it. But some days, like a humid muggy day, it had a suffocating weight of its own.。

Some days, this is how it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of tears of the families of the dying pouring down.

但作为医者，付出超出常人的努力和精力，承受超出常人的压力和痛苦，这些，他都不在乎The schedule took a toll. As residents, we were working as much as one hundred hours a week; though regulations officially capped our hours at eighty-eight, there was always more work to be done.。

My eyes watered, my head throbbed, I downed energy drinks at two A.M. At work, I could keep it together, but as soon as I walked out of the hospital, the exhaustion would hit me.

I staggered through the parking lot, often napping in my car before driving the fifteen minutes home to bed.

但同时，他也明白，拥有精湛的医术远远不够死亡是每个人都要面临的人生课题再优秀的医生，手中的手术刀，也会有使不上劲的时候Technical excellence was not enough.As a resident, my highest ideal was not saving lives—everyone dies eventually—but guiding a patient or family to an understanding of death or illness.。

当手术刀不再管用，语言就是剩下的唯一工具帮助患者或者家属正确的看待和理解疾病和死亡，也是医生职责中不可或缺的一部分关于对生命的思考生命太过短暂，短暂到你几乎没有时间来思考即便如此，Paul 问地最多的问题就是。

「what kind of life is worth living」，到底什么样的人生才是有价值，有意义的？对于生命，Paul Kalanithi 始终保持着敬畏之心他说，能力越大，责任也就越大As my skills increased, so too did my responsibility.

I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking.

Neurosurgery attracted me as much for its intertwining of brain and consciousness as for its intertwining of life and death.

尤其是在担任住院医师期间，他意识到，和患者相处，自己不仅仅是一个见证者，更是亲历者、参与者是医师、护士、患者，在同一时空的连结I was not yet with patients in their pivotal moments, I was merely at those pivotal moments. I observed a lot of suffering; worse, I became inured to it.。

Drowning, even in blood, one adapts, learns to float, to swim, even to enjoy life, bonding with the nurses, doctors, and others

who are clinging to the same raft, caught in the same tide.书中两个同事的离去，给了 Paul Kalanithi 很大的触动一个是 Laurie，原来他在医学院的朋友。

因车祸送进医院抢救，但隔日还是抢救无效去世这让 Paul 反省，自己原来对于患者，并没有做到足够的感同身受，直到身边亲近的朋友离去In that moment, all my occasions of failed empathy came rushing back to me: the times I had pushed discharge over patient worries, ignored patients pain when other demands pressed.。

The people whose suffering I saw, noted, and neatly packaged into various diagnoses, the significance of which I failed to recognize—they all returned, vengeful, angry, and inexorable.

另一个是 Jeff，两人是同事但因工作繁忙，疏于联系，再次听到他的名字，已是 Jeff 跳楼身亡的死讯对此，Paul 非常自责他后悔出事那天晚上没有在他身边开导他，后悔没有像往常一样彼此分担压力痛苦，后悔自己没有及时告诉他对于生命的感悟。

I wished, desperately, that I couldve been walking with him out the door of the hospital that evening. I wished we

couldve commiserated as we used to. I wished I could have told Jeff what I had come to understand about life, and our chosen way of life, if only to hear his wise, clever counsel.

Death comes for all of us. For us, for our patients: it is our fate as living, breathing, metabolizing organisms. Most lives are lived with passivity toward death—its something that happens to you and those around you.

虽然医生的双手可以救死扶伤，但是在死亡面前，显得过于苍白无力Our patients lives and identities may be in our hands, yet death always wins.。

但同时 Paul 也说，虽然无法尽善尽美，但生命不停歇，对医学的探索就不止步You cant ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.。

从医者到患者的角色转化书中用了这样一段话来描述自己确诊之后的心理感受：Standing at the crossroads where I should have been able to see and follow the footprints of the countless patients I had treated over the years, I saw instead only a blank, a harsh, vacant, gleaming white desert, as if a sandstorm had erased all trace of familiarity.

Paul 以为，自己之前接诊过这么多患者，如今自己成为患者，至少也能从熟悉的道路上获取与病魔的经验之谈、相处之道然而，横亘在他面前的是一片的白色的沙漠，风沙已经抹去了前人留下的所有印记毫无经验可循，毫无前路可鉴。

他必须自己摸索前进此外，多数患者知道自己患病后，心理状态大概是：“否认事实、感到愤怒、权衡较劲、郁郁寡欢、选择接受”，但 Paul，是完全反着来的It struck me that I had traversed the five stages of grief—the “Denial → Anger → Bargaining → Depression → Acceptance” cliché—but I had done it all backward.。

知道自己患病后，他最开始是坦然接受的，但随之而来的是郁闷、拧巴、愤怒和不甘虽说，在命运面前休伦公道但是，为什么偏偏是我?从医者到患者身份的转变，也是 Paul 全书中最纠结，最矛盾的地方说两个阅读细节：。

（一）患者在医生眼里，到底是什么样的存在？书中讲到这样一个故事Paul 接诊过一名女性患者，她对手术非常恐惧，说什么怎么也不愿意做手术虽然 Paul 认为手术是最佳的治疗方式，但想到说服这样一个人是件很难的事情，觉得还是按照本人的意思，就不做手术了。

但在那一刻，Paul 意识到，他把患者当成了一个“问题”“麻烦”而存在，而不是把作为一个“生命体”I had met her in a space where she was a person, instead of a problem to be solved. She chose surgery. The operation went smoothly. She went home two days later, and never seized again.。

最后，Paul 决定和患者家属沟通，尝试说服进行手术最后这名患者同意了，手术进行很顺利，她也没有再复发对比之下，Paul 却有段令他难过的经历Paul 确诊后住院，有次病情加重，值班医生认为是药物导致，决定晚上停药。

Paul 认为不是药物的问题，觉得不应该停药，遂与值班医生 Brad 产生意见分歧，并建议他询问主治医生而 Brad 因不愿意在大晚上打扰上司，而且明天交班给别人这事就不归自己管了，于是对 Paul 诉求选择回避。

I could see that in Brads eyes I was not a patient, I was a problem: a box to be checked off.在那一刻，Paul 感受到的是失望和不被尊重，因为 Brad 并没有把他当做是一个“病人”，而只是把他当成一个“麻烦”。

（二）为什么你不告诉我，我还能活多久？确诊肺癌后，Paul 对主治医生 Emma 问地最多的问题就是：我还能活多久?Emma 对其他问题悉数解答，唯独对这个问题闭口不谈只是说，恢复得好的话，甚至可以回到热爱的工作岗位继续当外科医生。

Go back to work? What is she talking about? Is she delusional? Or am I dead wrong about my prognosis? And how can we talk about any of this without a realistic estimate of survival?

对于 Emma 的闭口不谈，Paul 有点愤怒他想知道自己可以活多久，毕竟他还有太多事情没来得及做如果能活一年，他就做一年的规划，如果能活十年，他就做十年的规划重要的是，他希望医生给句痛快话，给个确切数。

但其实，当 Paul 还是一名医生的时候，对于要不要告诉患者还有多大存活概率这事，他的立场和 Emma 是一样的First, detailed statistics are for research halls, not hospital rooms。

Second, it is important to be accurate, but you must always leave some room for hope.他认为，所谓的存活率这样的数据或许适合在实验研究中讨论，但并不适合病房。

何况，数据的精准固然重要，但是一旦说出来，也就扼杀了希望毕竟，希望是身处绝境的患者所能抓住的最后一根稻草Rather than saying, “Median survival is eleven months” or “You have a ninety-five percent chance of being dead in two years,” Id say, “Most patients live many months to a couple of years.” This was, to me, a more honest description.。

如果被问到“还能活多久” 这样的问题时，当时还是一名医生的 Paul 说，自己不会给出 “平均来说能活11个月” “有95%的概率活不过两年” 这样的精准的数字表述，而是会用 “大部分人能活好几个月，甚至数年”这样的模糊化的说法。

The problem is that you cant tell an individual patient where she sits on the curve: Will she die in six months or sixty? I came to believe that it is irresponsible to be more precise than you can be accurate.

Paul 认为，回答这个问题的关键，在于不能告诉病人处在卡普兰-梅耶曲线的具体坐标位置，不论是生命还剩下6个月，还是60个月。

注释：卡普兰-梅耶生存曲线（Kaplan-Meier curve）上的点表示此时存活人数占全组人数的比值，即生存率生存率与风险率之和为图中在任意一个时间点上，两个组的风险率之比，就是风险比率所以，或许这也是 Emma 始终不正面回应 Paul 对于自己还能活多久这个问题的原因。

不论答案是什么，对当事人都很残忍想起了 Paul 在书中的这么一句话：How little do doctors understand the hells through which we put patients.。

这样的矛盾和纠结，让 Paul 在从一名医者到患者的身份转变过程中，体现得尤为深刻。

关于爱情、关于亲情在确诊肺癌后，Paul 对妻子 Lucy 说，“我希望在我离开人世后，你可以改嫁再婚”“What are you most afraid or sad about?” she asked me one night as we were lying in bed.。

“Leaving you,” I told her.对 Paul 来说，比起死亡，他更害怕的是留下 Lucy 一个人此时，两人还有一个遗憾就是，还没有自己的孩子I knew a child would bring joy to the whole family, and I couldnt bear to picture Lucy husbandless and childless after I died, but I was adamant that the decision ultimately be hers: she would likely have to raise the child on her own, after all, and to care for both of us as my illness progressed.。

虽然遗憾，但两个人有各自的顾虑Paul 担心 Lucy 一个人抚养孩子会很辛苦，Lucy 担心 Paul 会因为没有足够的时间见证孩子成长感到痛苦“Will having a newborn distract from the time we have together?” she asked. “Don’t you think saying goodbye to your child will make your death mor epainful?”。

“Wouldn’t it be great if it did?” I said.但在充分沟通和思考过之后，他们还是生下了女儿 Elizabeth Acadia。

Lucy and I both felt that life wasnt about avoiding suffering, its about finding meaning.后 记历经 22月的治疗，37岁的保罗最终还是在2015年3月离开人世。

My love goes on—lives on—in a way I’d never expected.Lucy 后来在一段视频演讲中说道，当 Paul 离去，他的呼吸化作了空气，但他们女儿的诞生，则像是把空气化为了呼吸，让生命有了延续，就像是 Paul 从未离开过。

Paul is gone, and I miss him acutely nearly every moment, but I somehow feel Im still taking part in the life we created together.

He spent much of his life wrestling with the question of how to live a meaningful life, and his book explores that essential territory.

Paul 一直在追寻生命的意义。他的故事，让我看到了他对医学纯粹的执着与热爱，对生命的浓烈的坦然与敬畏。如果有机会，也推荐你读一读。

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