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1颗子弹,10年创痛

更新时间:2016-4-28 10:33:42 来源:纽约时报中文网 作者:佚名

A Lone Bullet’s Long Toll
1颗子弹,10年创痛

The surgeons were almost three hours into their work on their extravagantly tattooed patient, Dustin E. Kirby, when they started the first cut through his jaw. Guided by a plastic jig, Dr. Stephanie Teng, a resident at Lenox Hill Hospital in Manhattan, pushed the reciprocating blade of a small electric hand saw through the bone. The blade protested as it moved, its pitch rising to a slight grinding whine, until the bone parted.

当他们开始动手切下颌的第一个切口时,外科医生们在满身纹身的达斯汀·E·柯比(Dustin E. Kirby)身上已经工作了将近三个小时。由一个塑料夹具引导,曼哈顿莱诺克斯希尔医院(Lenox Hill Hospital)的住院医师斯蒂芬妮·腾格(Dr. Stephanie Teng)用一只电动手锯的刃在骨头上来回推拉。锋刃移动的时候有阻力,声音愈来愈高,发出尖锐的碾磨声,最后骨头锯开了。

The first cut was done.

第一个切口完成了。

Almost 10 years after he was shot through the mouth, Kirby, a veteran of the Iraq War, was having his face overhauled again, the latest stop on what will be a lifelong tour of the damage a single bullet can do.

柯比是伊拉克战争中的老兵,一颗子弹从他的嘴射入已经有将近10年了,这一次他的脸又要彻底大修,而这只是一场终生旅行中的最新一站,这一切都是一颗子弹的伤害所带来的。

In the hours leading up to this moment, the surgical team, led by Dr. David L. Hirsch, the reconstruction director of maxillofacial surgery at the New York Head and Neck Institute, had removed the metal hardware that for years held Kirby’s previously shattered bones in place. This was a tedious undertaking of backing out rows of titanium screws that fastened the old plates to his bullet-wrecked jaw. It was a job accomplished with metal mallets, screwdrivers and a power drill — a process that resembled, in living tissue and in miniature, removing a sagging and overgrown front deck from an otherwise well-loved house.

在这一刻之前的几个小时里,由纽约头颈研究所(New York Head and Neck Institute)的上颌面外科整形主任大卫·L·赫希医生(Dr. David L. Hirsch)领导的手术小组去掉了几年来支撑着柯比破碎骨头的金属支架。一排排钛螺钉固定着他因子弹受损的下巴上的旧托板,这项繁琐的工作就是要把这些螺钉拆掉,需要使用金属锤、螺丝刀和电钻。整个工序有点像从一栋本来很讨人喜欢的房子上拆除塌陷冗余的前廊,只不过是在活体组织上进行,而且精微细致得多。

The nurses dropped the outgoing metal into a plastic cup, screw by bloody screw. Now came an afternoon of controlled trauma, as the surgeons continued breaking the jaw with precision cuts and then realigned Kirby’s profile and bite by pulling the mandible forward, up and to his right. This they fixed in place with fresh screws and a long, curved, custom-fitted titanium plate, which Hirsch had prefashioned through a computer-assisted design process called virtual surgical planning. With the follow-up procedures and rows of dental implants to come, the final results were intended to change how Kirby eats, talks, smiles, laughs, kisses and looks — in short, to change how a disfigured man experiences life.

一个接一个沾血的螺钉,护士们把拆下来的金属放在塑料杯子里。接着就开始了一个下午的外科手术。外科医生们继续用精确的切口打开下颌,重整柯比的侧脸型与咬合面,把他的下颌向前、向上、向右推。之后他们把新螺钉,以及一个特殊定制的、长而弯曲的钛板钉到合适的位置上去,这块钛板是赫希用一个名为“虚拟外科计划”的电脑辅助设计工序预先制作的。接下来还会有后续手术和牙齿种植,最后的结果将改变柯比吃饭、说话、微笑、大笑、亲吻的方式以及他看上去的样子。换言之,改变一个毁容者对生活的体验。

Kirby is known as Doc, a reference to his former duties as a Navy corpsman assigned to a Marine Corps infantry battalion in Karma, Iraq, a small but especially violent town in Anbar Province. I first met him in the fall of 2006 with Joao Silva, a New York Times photographer; one day on a raid we were present as he saved the life of a Marine, Colin Smith, who had been shot through the skull. Kirby’s own turn as a battlefield patient came on Christmas Day that year, when he was 22. He was standing on a rooftop when a single shot found him. The bullet entered through his left cheek and exited his right. Along the way it ripped out part of his tongue and seven teeth, and shattered the right side of his jaw. It also cracked part of his lower skull, near the roof of his mouth, and damaged his sinuses.

柯比绰号“医生”(Doc),这个绰号来自他担任海军医护兵的经历,他被分配到海军陆战队步兵团,驻扎在伊拉克的卡玛,那是安巴尔省一个很小但特别动荡的县城。我第一次见到他是在2006年的秋天,与《纽约时报》的摄影师若昂·席尔瓦(Joao Silva)一起;那天我们在一场突袭中看到他救了头骨被子弹击穿的海军陆战队士兵科林·史密斯(Colin Smith)的命。同年圣诞节,22岁的柯比自己成了战场上的伤兵。他站在屋顶上时,一颗子弹打中了他。子弹进入了他的左脸,又从右脸飞了出去,撕开了他的舌头与七颗牙齿,击碎了他的右下颌。还打裂了他颅骨靠近上颌骨的下半部分,损伤了鼻窦。

Doc knew none of this at the time. What he knew was that he had been hit, that his mouth was so full of blood and loose tissue that he could not talk and that if he did not act quickly and decisively he would die. Using his own knife, he pushed a blade into the base of his neck — opening a makeshift airway that bypassed the sputtering mess behind his chin.

“医生”当时什么也不知道。他只知道自己被打中了,嘴里都是血和脱落的组织,不能说话,如果他不快速、坚决地做出反应就会死。他用自己的小刀插入脖颈基部,避开下巴后面被打烂了的血肉,为自己打开一条暂时的空气通道。

The tracheotomy ensured his breathing would be maintained, at least for a short while. His wounds carried another set of immediate risks: Because of their location, there was no way for a tourniquet to stop his bleeding. By the time a helicopter had carried him to a military hospital, he was struggling for consciousness. As the doctors leaned over and the anesthetic fog carried him away, he assumed that he was dead.

这个气管切开术让他可以至少暂时继续呼吸。但他的伤势还带来其他迫在眉睫的危险:由于伤口的位置,止血带不能止血。一架直升机载着他来到军队医院,那时他已经几乎要失去知觉。医生们凑近他身边,给他使用了麻醉剂,失去意识的时候,他觉得自己死了。

The first medical team saved his life. In the years that followed, other teams undertook the tasks of rebuilding his face. Surgeons removed his right fibula and grafted a portion of it to the right side of his jaw. They installed titanium plates to reinforce his hybrid mandible and give it shape. He began speech therapy so he could relearn to talk, and psychological counseling so he might unpack his experience of being wounded and its particular effects on him, and adjust to a life different from what he had ever imagined.

第一个医疗队挽救了他的生命。在接下来的几年里,其他若干医疗队承担了为他重建面部的工作。外科医生取出了他的右腓骨,把它的一部分移植到他的下颌右侧。他们在他脸上安装钛板,固定他接受了移植的下颌骨,为之塑形。他还接受了重新学习说话的语言治疗,并且接受心理咨询,倾吐受伤的经历和它对自己的特殊影响,调整自己,过一种自己以前从未想过的、完全不同的生活。

From a distance, at a glance, Doc’s case could seem a success. In most any other war, most any other context, the bullet that blew out the right side of his face would have taken with it his life. Instead, Doc took his place in the long, scarred line of living exhibits showing how the American military was rushing gravely wounded troops from the battlefield and treating them with skills and confidence no American fighting force had known before. In 2007, he was back in the States, still in uniform, helping to train new corpsmen for the combat lifesaving skills they would need in Afghanistan and Iraq. All the while doctors kept working on his face.

如果只是远远一瞥,“医生”的例子似乎很成功。在大多数其他战争里类似的情况下,击穿右侧脸颊的子弹会要了他的命。但是,“医生”活下来了,成为众多负伤老兵的一员,他们伤痕累累,却成为活生生的案例,展示着美国军方是如何紧急抢救重伤员,并以之前任何美国作战部队都未曾体验过的技术与信心治疗他们。2007年,他回到美国,仍然身穿军装,帮助培训新医护兵,教他们在阿富汗和伊拉克可能用得上的战场救生技巧。同时,医生们也在治疗他的脸。

Those who knew Doc well understood that his recovery did not proceed as far as he hoped, and that the neat stories of maimed but rebounding veterans, a feel-good genre of the period, did not quite apply to him. Doc had dodged death to face a cascade of problems: chronic pain, migraines, PTSD, insomnia. His rebuilt jaw did not line up with his teeth. He retained enough of his tongue that he was able to compensate for speech, but the altered shape of his oral cavity and the damage to his tongue made eating difficult. Sometimes he had to chew food on one side of his mouth, then manipulate it toward his throat with his left index finger. By 2008 his brief marriage had ended. Within a few years he racked up 32 operations. He was jumpy, brooding and self-conscious. To manage pain and sleeplessness, and the loneliness, he took to drinking, sometimes to a restless stupor.

认识“医生”的人们了解,康复进展并不如他的期望,那些标准的受伤后又走出低谷的老兵故事,那种让人感觉良好的类型,并不完全适用于他。“医生”死里逃生,但还面临一系列问题:慢性疼痛、偏头疼、创伤后精神障碍、失眠。重修后的下巴让他的牙齿无法对齐。他的舌头保留了足够长度,让他还可以勉强说话,不过他口腔的形状变了,舌头遭到损伤,吃东西非常困难。有时候,他只能用口腔一侧咀嚼食物,然后用左手食指把它们推向喉咙。2008年,他短暂的婚姻也走到了尽头。这几年来,他接受了32次手术。他变得焦虑、忧郁、无所适从。为了解决疼痛、失眠与孤独,他开始喝酒,有时会不顾一切地酩酊大醉。

When he was medically discharged from the Navy in 2012, he was stripped of a sense of purpose and belonging. When I visited him that spring, he began drinking before we ate lunch. New physical problems presented themselves, in forms only a person who has suffered a devastating wound to the mouth can know – bits of teeth loosened and dropped out, later followed by a chunk of bone and a screw. Doc gained weight, added tattoos and grew a beard, which partly hid the fact that his jaw, his teeth and his mouth were getting worse.

2012年,他因为健康原因从海军退伍,被剥夺了目标与归属感。那年春天,我去看望他,他在我们吃午饭前就开始喝酒。新的身体问题开始出现了,只有口腔受了严重伤害的人才能了解——他的部分牙齿开始松动脱落,然后是一块骨头与一颗螺钉。“医生”开始发胖和纹身,他留起了大胡子,部分是为了遮盖他每况愈下的下巴、牙齿和嘴。

By last year he had dialed back his drinking, was in a new relationship and had become a father. But still he struggled to move forward, and his confidence in the Department of Veterans Affairs plummeted. As his dental pain became unbearable, he called for appointments. The V.A. offered him tooth extractions, he and his mother said, after a wait of several months. Tooth extractions were never going to be enough.

去年,他喝酒喝得少了、开始了新的恋情,并且当上了爸爸。但生活仍然充满挣扎,他对美国退伍军人事务部的信心已经跌到谷底。他的牙疼变得难以忍受,于是要求预约治疗。他和他的母亲说,等了好几个月,退伍军人事务部才向他提供拔牙手术。而拔牙治疗对他来说是远远不够的。

Doc sensed that his government-funded facial reconstruction had crested, and now was failing. He had no plan. Last year he was 31, tormented by pain and backsliding. “We were at a point where there was not much more they could do,” he said.

“医生”意识到,政府为他出资的面部修复术是有限度的,如今已经失败了。他完全没有办法。去年,31岁的他备受疼痛和情况恶化的折磨。“我们到了这样一种地步,他们也不能再为我作更多事情了,”他说。

One night he pulled out an offending tooth with the pliers on his Leatherman tool. Two nights later he removed another. When his mother, Gail Kirby, understood what he had done, she pleaded with him, asking what he wanted, what someone might do to help. “He said, ‘Mama, I want my face,’ ” she said.

一天晚上,他用自己的莱瑟曼工具包里的钳子拔掉了一颗有问题的牙齿。两天后又拔掉了一颗。他的母亲盖尔·柯比(Gail Kirby)知道了他做的事后,苦苦哀求他,问他到底想要什么,问他别人怎么才能帮助他。“他说,‘妈妈,我想要我的脸,’”她说。

He had been lean and handsome before.

过去的他曾是那样削瘦、英俊。

His mother had an idea. It was a long shot.

他的母亲有了个主意。那是一次希望渺茫的尝试。

In 2007, Doc attended a benefit dinner honoring veterans at the Waldorf Astoria. It was hosted by the Marine Corps-Law Enforcement Foundation, a private organization that provides college scholarships to the children of Marines and federal law-enforcement officers killed in the line of duty. He was the guest of Jack Doyle, an investment portfolio manager and foundation donor whose brother-in-law, Dennis M. Edwards, was killed in the terrorist attacks in 2001 on the World Trade Center. There Doc met a pair of brothers — a doctor and a dentist — who said that if he ever needed care, they would help. The dentist was a former Marine. Doc had mentioned the meeting to his mother, but in the ensuing years he thought little of their pledge. He forgot their names. “I just thought, That was nice of them to say,” he said.

2007年,“医生”在华道夫-阿斯多里亚饭店(Waldorf Astoria)参加一场为退伍军人举办的慈善晚宴。它是海军陆战队执法基金会(Marine Corps-Law Enforcement Foundation)举办的,这是一个私人组织,为在执行任务时遇害的海军陆战队队员和联邦执法警官的子女提供大学助学金。“医生”是应杰克·多伊尔(Jack Doyle)之邀而来的。多伊尔是一名投资组合经理,也是该基金会的捐款人。他的姐夫(或妹夫)丹尼斯·M·爱德华兹(Dennis M. Edwards)在2001年世贸中心(World Trade Center)的恐怖袭击中丧生。“医生”在慈善晚宴上遇到一对兄弟——一个是医生,一个是牙医——他们说如果“医生”需要帮忙,他们愿意效劳。那名牙医曾为海军陆战队工作。“医生”跟母亲提起过这次会面,但在随后几年里,他很少想起他们的承诺。他忘了他们的名字。“我当时觉得,他们那样说只是一种善意,”他说。

Last September, despondent, his mother emailed Doyle. She warned that she was venting. She apologized for rambling. She said that if he did not want to read her long email, she would understand. And she told him about her son’s ongoing pain and problems, and asked whether he might connect her to the people he had met in New York in 2007 and who had offered help.

去年9月,母亲在绝望之中给多伊尔写了封邮件。在信的开头,她先说明自己是在发泄怨气,并为自己的絮叨道歉。她说,如果他不想读她的长邮件,她可以理解。她向他讲述了儿子不断出现的疼痛和问题,问他是否可以帮忙联系儿子2007年在纽约遇到的那两位曾提出帮忙的医生。

Twelve minutes later, Doyle wrote back.

12分钟后,多伊尔就回邮件了——

I’m on it

我愿意帮忙

Give me a day or two to get in touch with my friends

给我一两天时间,我去联系一下我的朋友们

A Navy Corpsman banged up while Attending to his Marines needs HELP.

一名为海军陆战队服务时严重受伤的海军医护兵需要帮助。

He’s gonna get it Momma

他一定会得到帮助,妈妈

Take a deep breath.

请放心。

He signed it, “JD.”

他最后署名JD。

Ten days after that, Gail Kirby received an email from Dr. Spero J. Theodorou, a plastic surgeon in Manhattan and the doctor Doc met at the gala at the Waldorf. He asked for Doc’s medical file and then found Dr. Hirsch, who had pioneered virtual surgical planning and the use of precise three-dimensional models of a patient’s current and reconstructed bone structure to design custom titanium plates — technology that was not available when Doc was shot. He and Lenox Hill Hospital offered Doc the operation and said they would follow up with dental implants, giving him an aligned bite and mouth full of teeth.

10天后,盖尔·柯比收到曼哈顿整形外科医生斯佩罗·J·塞奥左鲁(Dr. Spero J. Theodorou)以及“医生”在华道夫饭店晚宴上遇到的那位医生的邮件。他要来“医生”的医疗文件,然后找到赫希医生,后者开创了虚拟手术计划,制作出病人目前及重整后的骨骼结构的精确三维模型,以此设计合适的钛板——这种技术在“医生”遭枪击时还不存在。赫希和莱诺克斯希尔医院提议给“医生”做这种手术,还说随后会给他种牙,让他能够正常咬合,并拥有整口牙齿。

The price for all this work typically ran to about $300,000. In Doc’s case, Hirsch said, the procedures and implants would be free. More generosity followed: a GoFundMe.com campaign to crowd-source donations for the families’ travel expenses, and grants from the Semper Fi Fund, which covers family costs for veterans as they recover from their wounds. (Disclosure: I donated $100 to the GoFundMe campaign.)

所有这些的费用通常是约30万美元。赫希说,“医生”将免费接受手术和牙齿种植。之后“医生”又得到了更多慷慨的帮助:GoFundMe.com网站为他家人的旅行费举行了一个众筹捐款活动;永远忠诚基金会(Semper Fi Fund)也提供了资助——该基金会为正从伤病中恢复的退伍军人提供家庭生活费(透露一下:我给GoFundMe的那个活动捐了100美元)。

Early on the evening of the operation Teng and Dr. Todd Hanna, a fellow in oral and maxillofacial surgery, spent an hour suturing Doc’s face. The jaw reconstruction was over. The first four dental implants were in place. Dr. Hanna unpeeled the tape over Doc’s eyes, which had protected them from the operation’s debris, and the two surgeons rinsed the blood from Doc’s beard. They washed his face gently and prepared to slide him from the table to a rollaway bed, on which he would be moved to a recovery room for a reunion with his family.

手术当晚,腾格和口腔颌面外科医生托德·汉纳医生(Todd Hanna)花了一个小时缝合“医生”的脸。下颌重建完成了。第一批四颗牙齿也种好了。汉纳取掉“医生”眼上的绷带——它是为了保护眼睛不被手术中的碎片弄伤。然后两位外科医生擦掉“医生”胡子上的血,轻柔地洗净他的脸,准备把他从手术台平移到移动床上,然后他会被推到康复室与家人见面。

Hirsch leaned over and put his mouth near Doc’s ear. “Dusty, we’re all done,” he said. “Are you O.K.?”

赫希弯下腰,把嘴凑到“医生”耳边。“达斯蒂(达斯汀的昵称——译注),我们做完了,”他说,“你还好吗?”

Doc stirred. He was semiconscious. With his left elbow on the operating table, he lifted his big tattooed forearm, formed a fist and slowly made a thumbs-up sign. He held it for a few long seconds. Then he clutched the surgeon’s hand.

“医生”动了一下。他处于半清醒状态。他的左肘放在手术台上,举起刺有纹身的强壮前臂,握起拳头,慢慢竖起了大拇指。这个动作保持了好几秒钟。然后他紧紧握住了赫希的手。

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