抉择（小旺）

Ｂｏｂ　Ｄｅｔｒａｎｏ　ＭＤ　ＰｈＤ

My young son had just died of hunger.

I could not suppress a wail of my own

When the whole land was sobbing.

What troubles me is in being a father

My not getting food caused this infants death.

I could not have known that before the harvest

Such calamity would come to our poverty.

……幼子饿已卒!

吾宁舍一哀,里巷亦呜咽。

所愧为人父,无食致夭折。

岂知秋禾登,贫窭有仓卒。

¬¬——节选自杜甫《自京赴奉先县咏怀五百字》

Poet Du Fu (about 755 AD) after learning that his son was a victim of the famine in his village in western China.

诗人杜甫(约公元755年)获知儿子在位于西部的家乡死于饥荒后写下的。

Pediatrician Richard Lu called me from the Bless China Christian Clinic in Western Kunming on Monday afternoon. I nervously guessed that it was another case of pediatric congenital heart disease. Trained as an adult cardiologist and having spent 90% of my 30 year medical career researching coronary heart disease, I felt under-qualified to evaluate and recommend treatment for children. When I had established my twice a month home clinic in Kunming, I had expected to see angina, congestive heart failure, rheumatic heart disease and maybe a rare adult congenital case.Instead, most of my patients were little kids; some blue, some short of breath, some passing out, and some with fingers deformed by chronic hypoxemia.

周一下午,儿科医生理查德•陆从昆明西部的一家名为Bless China Christian的诊所给我打来电话。我不安地猜测可能又是一例儿童先天性心脏病。作为一名训练有素的成人心脏病专家,30年医学生涯中我90%的时间都用来研究冠心病,但每当遇到要给小孩做体检和治疗建议的时候我总觉得自己不能胜任。当我确定每月两次回昆明坐诊时,更希望碰上的是患咽峡炎、充血性心力衰竭、风湿性心脏病或者罕见的成人先天性疾病的患者,但是,我大部分的病人都是小孩子。他们有的(由于先天心损害)皮肤发紫,有的呼吸困难,有的已经失去知觉,还有些则因为长期血氧不足造成了手指畸形。

Richard Lu had been providing free care for impoverished rural children from the Yunnan hills for five years. He resorted to me because I was the only cardiologist in Kunming who performed free consultations. There was another reason he sought me. I had contacts in Los Angeles who were congenital heart experts. Richard knew that, unless I was sure, I would always check with them before making a recommendation.

五年以来,理查德•陆都在无偿照料云南山区贫困的农村孩子们。他求助于我是因为我是昆明唯一一个提供免费咨询的心脏病专家。另一个原因则是:我认识一些洛杉矶的先天性心脏病专家。理查德知道,除非我已经胸有成竹,我通常会在给出医疗建议之前跟那些专家们商量。

'I have a three year old boy who has frequent colds and loses his breath when he runs with other kids in his village. He has had a loud murmur since birth and I can't figure out what it is. His name is Xiao Wang. Can you take a look at him?'

“我这儿有一个三岁的小男孩,他经常感冒,和村里的小伙伴们赛跑的时候就喘不过气来。打从出生开始他的体内就有种明显的连续低沉的声音,我不知道是怎么回事。他叫做小旺,你能给他看一下吗?”

After agreeing to see the child on Thursday and asking that Richard first send him for an echo - cardiogram at Yan An hospital, I hung up and hoped that this would be another ventricular septal defect; a hole between the right and left pumping chambers that usually closes spontaneously during childhood. There would be no hard decisions about surgical procedures for that.

我答应周四去看这个孩子,并让理查德先把他送到延安医院做回声心电图。挂掉电话之后,我希望这又是一例室间隔缺损的病例:在儿童时期,心房左右两瓣之间的一个小孔常常会自动关闭。在这种情况下确定手术实施步骤并不是什么难事。

Thursday at 2 PM, my cell phone rang. The caller spoke a Miao (the local minority people) dialect I could not understand. I passed the phone to my assistant, Xin Hua. Xin Hua learned that Xiao Wang's Ye Ye (grandfather) had arrived at the building and could not find the staircase to climb to my apartment on the 11th floor. Impatiently, she told him to use the elevator. Ten minutes later, Ye Ye arrived at the apartment, panting and puffing with the toddler on his back. Ye Ye had never used an elevator and would rather climb eleven flights than admit ignorance and ask for instructions.

周四下午两点钟,我的手机响了。来电者说着一口我听不懂的苗语。我把电话递给了我的助手新华。新华得知小旺的爷爷已经到楼下了,可就是找不着可以通往我居住的第11层公寓的楼梯。她不耐烦地让他搭电梯上来。10分钟以后,爷爷背着小孩上气不接下气地来到了我的公寓。爷爷从来没有搭过电梯,他宁愿爬11层的楼梯也不愿意承认自己的无知,向别人请教。

While Ye Ye was catching his breath, I examined the child. Xiao Wang's heart rate was fast, over 150 beats per minute and he, like his grand father was short of breath though he had traveled the 11 flights on Ye Ye's back. Xiao Wang's was not the murmur of ventricular septal defect but rather a long, loud, rough murmur that penetrated from his breast bone through to his spine. Patent ductus arteriosus is the abnormal retention of a short arterial connection between the main artery of the body, the aorta, and the main artery of the lungs. Usually this short artery closes spontaneously at birth, but when it does not, it can cause breathing difficulties and eventually death in childhood. The Yan An hospital echo cardiogram confirmed that this was a rather large patent ductus arteriosus and that the pressure inside the pulmonary artery was only mildly elevated. The ductus needed to be closed pretty soon to give this child a decent chance to live a normal life. Of course, before sending the child for a procedure, I would consult a congenital expert, but first I had to get a good history from Ye Ye.

在爷爷歇息的时候,我给小孩做了检查。小旺的心率非常快,每分钟心跳超过150下。虽然他是爷爷背上来的,却和爷爷一样喘不过气来。小旺体内的声音不是由于室间隔缺损而发出的,而是一种从胸骨一直渗透到脊椎的既长又响亮的刺耳的声音。躯干大动脉、主动脉和肺部主要动脉由一小节动脉连接,而动脉导管未闭是指这一小节动脉的不正常固位。通常情况下,这个短动脉会在人出生的时候自动闭合,如果没有闭合,则可能引起呼吸困难甚至导致夭折。延安医院的回声心电图将其确诊为严重的动脉导管未闭,肺动脉的压强只能轻度上升。要使这个孩子有机会能够过上正常的生活,必须马上闭合导管。当然,在送这个孩子去手术之前,我会向先天性疾病的专家咨询一下。不过首先我必须先从爷爷那了解一下过去的事情。

Ye Ye had recovered from his 11 floor climb. He told Xiao Wang's story. They lived in a Miao village in western Yunnan where incomes were less than $120 per year. Ye Ye was not really Xiao Wang's grandfather but had adopted the child at infancy when Xiao Wang's real parents had left him in a field because he would not be able to work the potato and corn fields. Farming families in that region can legally have a second child only if the first is a girl. Xiao Wang was worse than a girl. His body was deformed. Ye Ye had lost his wife and one of his own children and had a little money that his daughter was earning at her waitressing job in Kunming. Ye Ye cared for the boy and hoped. When Xiao Wang had starting coughing and having trouble running, Ye Ye discovered Richard Lu's clinic in Kunming.

爷爷已经从爬11层楼梯的疲劳中恢复过来了。他讲了小旺的故事。他们住在云南西部的一个苗族村落里,那里的年收入还不到120美元。爷爷其实并不是小旺的亲爷爷。小旺还是个婴儿时,被父母抛弃在田里,是爷爷收养了他。小旺之所以被遗弃,是因为他长大以后不能在马铃薯或者玉米地里干活。在那个地方,农村家庭只能在第一胎是女孩的情况下才能生第二胎。因为他有着残疾的身体,小旺甚至还不如一个女孩。爷爷的老伴和一个孩子已经过世,靠女儿在昆明当服务员赚回来的一点钱过活。爷爷照顾着这个小男孩并且对他充满希望。当小旺开始咳嗽并且跑步有困难的时候,爷爷找到了理查德在昆明的诊所。

Xiao Wang had fallen asleep on the examining couch. As I lifted him, he woke up, coughed twice and his little hand clutched my shirt. His eyes stared gratefully at his grandfather. The love that brought Xiao Wang and Ye Ye together, and then to Richard Lu and myself will soon bring Xiao Wang to others who would remove a tiny plug from into his inside and save his life. That love is the engine that transcends family and blood, nation and race and will soften and give courage to the hearts of those so desperate and lost that they abandon their children.

小旺在检查台上睡着了。当我抱起他的时候,他醒了,咳嗽了两下,小手紧紧地抓住我的衬衣。他充满感激地看着爷爷。爱把小旺和爷爷连在了一起,又把他带到了我和理查德身边,不久还会将小旺交给其他医生,他们能够把他体内的小塞子取出,从而挽救他的生命。爱正如一个引擎,能够超越家族和血缘,国家和种族,能够软化和鼓励那些弃子之人绝望茫然的心灵。

After checking out my recommendation with my overseas expert friends and negotiating ways to pay for the curative procedure, I sent Ye Ye and Xiao Wang to a local Kunming hospital for placement of an expensive closure device. That worked fine. Xiao Wang does not cough any more and he runs just fine. He will grow up not quite understanding why parents would leave a healthy baby in a field.

我和海外专家朋友们检查过我的医治方案,并商讨了医疗手续的付费方法,之后,我把爷爷和小旺送到昆明当地一家医院,给他安上了昂贵的闭合仪器。一切都很顺利,小旺停止了咳嗽,还能跑步了。长大之后,他可能会不明白,为什么父母要把这样一个健康的孩子遗弃在田地里。

Notes

1. pass out

意为“分发, 昏倒”。

例句:The boxer passed out during a game.

拳击手在一场比赛中昏倒过去了。

2. resort to

意为“求助于”。

例句:He resorts to me because I will never turn him down.

他求助于我是因为知道我永远不会拒绝他。

You must never resort to violence.

你们决不能诉诸武力

3. figure out

意为“解决, 断定, 领会到”。

例句:Sooner or later we can figure it out.

很快我们就会弄清楚了。

4. catch ones breath

意为“屏息;喘气,气喘;歇口气”。

例句:He runs all the way, without stopping to catch his breath.

他一直在跑,没有停下来喘口气。

The song is so beautiful that it make me catch my breath.

这首歌太好了,我禁不住屏息而听。