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死亡的温柔前兆

更新时间:2017-7-13 12:05:14 来源:纽约时报中文网 作者:佚名

The Gentler Symptoms of Dying
死亡的温柔前兆

The patient’s hair was styled with curls so stiff, they held her head a few inches up from her hospital pillow. She had painted her lips a shade of bright pink that exuded the confidence of age.

病人做了很硬的卷发,以至于她的头离着医院的枕头有几英寸。她的嘴唇上涂着玫粉色口红,透露着年龄所带来的自信。

Just after her colon burst, she was still awake. She looked around, at me, at the monitors. She asked for pain medication. “Am I dying?” she asked.

结肠破裂之后,她仍然清醒着。她四处张望,看着我,看着监测仪。她要求吃止痛药。“我要死了吗?”她问。

“We think so,” I said, touching her manicured fingernails. “I am here with you.”

“我们是这么认为的,”我抚摸着她做过美甲的指尖说。“我在这儿陪你。”

Later, she kept her eyes closed but opened them when we talked. It was a state that the author and hospice nurse Barbara Karnes described as “one foot in each world.”

后来,她闭上眼睛,但当我们开始交谈时又睁开了眼。作家、临终关怀护士芭芭拉·卡尼斯(Barbara Karnes)形容这种状态是“置身阴阳两界”。

“Can I do anything?” I asked.

“需要我做点什么吗?”我问。

“No, honey. I’m just tired.” She closed her eyes again.

“没有,亲爱的。我只是累了。”她再次闭上眼睛。

Still later, she lapsed into a stupor. It was as if I wasn’t in the room at all, as if she’d gotten so close to death that she could no longer see the living world. With each hour, her lipstick appeared brighter as if in defiance as her blood pressure dropped and her skin whitened. Midmorning, she died.

后来,她陷入恍惚状态。就好像我根本没有在房间里,好像她同死亡已经如此接近,再也看不到活生生的世界了。每过一个小时,她的口红就会变得更明亮,好像在反抗她下降的血压与变得苍白的皮肤。上午十点左右,她死了。

While some of the symptoms of dying, like the death rattle, air hunger and terminal agitation, can cause alarm in witnesses, other symptoms are more gentle.

有些死亡的症状——比如濒死喉音、空气饥渴和临终烦躁——会令旁观者感到惊恐,但还有一些则比较温和。

The human body’s most compassionate gift is the interdependence of its parts. As organs in the torso fail, the brain likewise shuts down. With the exception of the minority of people who suffer sudden death, the vast majority of us experience a slumberous slippage from life. We may be able to sense people at the bedside on a spiritual level, but we are not fully awake in the moments, and often hours, before we die.

人体最仁慈的一项能力就是各部分之间的相互依存。当躯干中的器官衰竭时,大脑也会关闭。除了少数遭遇猝死的人之外,我们绝大多数人都会在沉眠中离开人世。我们可能能够在精神层面感觉到床边的人,但是在死亡之前的时刻(通常是几个小时),我们并不完全清醒。

Every major organ in the body — heart, lungs, liver, kidneys — has the capacity to shut off the brain. It’s a biological veto system.

身体中的每个主要器官——心、肺、肝、肾——都有能力关闭大脑。这是一种生理上的一票否决制。

When the heart stops pumping, blood pressure drops throughout the body. Like electricity on a city block, service goes out everywhere, including the brain.

当心脏停止输送血液时,全身的血压都会下降。就像一个城市的电力,所有地方都会停止提供服务,包括大脑。

When the liver or kidneys fail, toxic electrolytes and metabolites build up in the body and cloud awareness.

当肝脏或肾脏衰竭时,有毒的电解质和代谢物在身体中积累,让意识变得模糊。

Failing lungs decrease oxygen and increase carbon dioxide in the blood, both of which slow cognitive function.

肺部衰竭会降低血液中的氧气含量,并增加二氧化碳含量,二者都会减缓认知功能。

The mysterious exception is “terminal lucidity,” a term coined by the biologist Michael Nahm in 2009 to describe the brief state of clarity and energy that sometimes precedes death. Alexander Batthyány, another contemporary expert on dying, calls it “the light before the end of the tunnel.”

有一个神秘的例外是“terminal lucidity”(直译“临终清醒”,本文按中文习惯作“回光返照”。——译注),这是生物学家迈克尔·纳姆(Michael Nahm)在2009年创造的一个术语,用于描述有时在死亡之前短暂出现的头脑清晰及活力状态。另一位当代濒死专家亚历山大·巴提亚尼(Alexander Batthyány)称之为“隧道尽头的光亮”。

A 5-year-old boy in a coma for three weeks suddenly regains consciousness. He thanks his family for letting him go and tells them he’ll be dying soon. The next day, he does.

一个昏迷了三周的五岁男孩突然恢复了意识。他感谢家人愿意放手,并告诉他们他很快就会死去。第二天,他真的走了。

A 26-year-old woman with severe mental disabilities hasn’t spoken a word for years. Suddenly, she sings, “Where does the soul find its home, its peace? Peace, peace, heavenly peace!” The year is 1922. She sings for half an hour and then she passes away. The episode is witnessed by two prominent physicians and later recounted by them separately, at least five times, with identical descriptions.

一名有严重精神障碍的26岁女子很多年都没说过一句话。突然间,她唱起歌来,“灵魂在哪里觅得家园,觅得安宁?安宁,安宁,天堂般的安宁!”那是1922年。她唱了半个小时,随后离开人世。两位知名医生目睹了这一切,后来他们分别陈述过至少五次,说法完全相同。

Early reports of terminal lucidity date back to Hippocrates, Plutarch and Galen. Dr. Nahm collected 83 accounts of terminal lucidity written over 250 years, most of which were witnessed by medical professionals. Nearly 90 percent of cases happened within a week of death and almost half occurred on the final day of life.

回光返照的早期报告可以追溯至希波克拉底、普鲁塔克和盖伦。纳姆搜集了在250余年间写就的83份关于回光返照的描述——述及的情形大多有医学专业人士在场见证。其中将近90%的回光返照现象发生在死者死前一周内,将近一半发生在死者生命的最后一天。

Terminal lucidity occurred irrespective of ailment, in patients with tumors, strokes, dementia and psychiatric disorders. Dr. Nahm suggested the mechanism of terminal lucidity may differ from one disease to another. For example, severe weight loss in patients with brain tumors could cause the brain to shrink, yielding fleeting relief of pressure on the brain that might allow for clearer thinking. Yet this theory doesn’t explain terminal lucidity in people dying from dementia, kidney failure or other diseases. Like death itself, terminal lucidity retains a screen of mystery.

回光返照不受疾病种类限制,肿瘤、中风、失智和精神疾病患者都可能出现回光返照。纳姆认为,回光返照的机制或许会因疾病的不同而不同。举个例子,脑瘤患者体重严重下降,可能引起脑萎缩,从而让脑部压力暂时得到缓解,由此或许可以令思维更清晰。不过这一理论并不能解释死于失智、肾衰竭以及其他疾病的那些人的回光返照。像死亡本身一样,回光返照笼罩着一层神秘的面纱。

My grandfather talked to us for 10 minutes the day before he died. He hadn’t spoken coherently in days. His hands had become baby-like, grasping our fingers or the bed railing reflexively. The weight of his eyelids had become too heavy to lift.

我的祖父去世前一天,和我们交谈了10分钟。那之前,他已经很多天都没连着说话了。他的手变得好像婴儿的手,本能地抓着我们的手指或床栏杆。他的眼皮太重,以至于无法抬起。

Suddenly, he was back. “What’s the good word?” he asked, as if that day was the same as all the days before. He marched down the line of grandchildren at his bedside, asking for the latest news in our lives. He asked if they ever finished building the Waldorf Astoria in Jerusalem. He made a joke, one I can’t remember except for the way he smiled out of the right side of his mouth, tilted his head from side to side, and held up his hands in jest.

突然间,他回来了。“都还好吧?”他问,就好像那一天与以往的每一天没有任何不同。他扫视着床前的一排孙辈,询问我们生活中的最新动态。他问耶路撒冷的华尔道夫酒店是否建成了。他开了一个我已经记不清内容的玩笑,我只记他让笑容从右侧嘴角绽开,把头从一边偏到另一边,诙谐地举起双手的样子。

And then, again, he was gone.

然后,他再次离去。

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