Art of Alleviating Pain in Final Days of Cancer缓和癌症晚期疼痛的艺术

王昊灵　周晟杰/文　王一宇/译

“To cure sometimes， to relieve often， to comfort always” is a famous inscription on the gravestone of American doctor Edward Livingston Trudeau.

美国医生爱德华·利文斯顿·特鲁多的墓碑上刻着一句名言：“偶尔治愈，常常缓解，总去安慰。”

That mantra has been adopted by many doctors around the world， including Shanghainese doctor Cheng Wenwu， director of the Department of Integrated Therapy at Fudan University Shanghai Cancer Center， who in 2006 established the first palliative treatment and care department in a Chinese grade III， class A hospital—the countrys best.

世界各地的许多医生都信奉这句口号，其中就包括上海的成文武医生。他是复旦大学附属肿瘤医院綜合治疗科主任，于2006年在一家三甲医院（中国的一流医院）成立了中国第一个姑息治疗与护理专科。

In 2008， a couple walked into Chengs office. The husband， a surgeon， suffered from advanced intestinal cancer with metastasizing tumors. He came to Cheng not to be cured but to deal with the pain of dying， as his days seemed to be numbered. Cheng promised to do his best， using painkillers to relieve the surgeons pain. When he died two months later， his wife found a letter of thanks left for Cheng， which said “Thank you Dr Cheng for letting me live my final days almost pain-free， and helping me walk to the end of my life peacefully and with dignity.”

2008年，一对夫妇走进成医生的诊室，其中的丈夫是一名外科医生，患有晚期肠癌伴肿瘤转移。他来找成医生并非为了治愈，而是为了应对垂死之痛，因为他似乎已经时日无多。成医生承诺会尽最大努力，他用止痛药来缓解这位外科医生的疼痛。两个月后，患者去世，他的妻子发现了他留给成医生的感谢信。信中写道：“谢谢成医生让我几乎没有痛苦地度过了最后时日，也谢谢成医生帮助我安宁地、有尊严地走到生命尽头。”

“One distinguishing feature of palliative care is a greater focus on mental health and pain management than on curing patients illnesses，” said Cheng. “Actually， most cancers cant be cured， but what I can do is try to alleviate their symptoms and improve their quality of life.”

“姑息关怀的一个显著特点是，比起治好患者的病，更注重患者的心理健康和疼痛管理。”成医生说，“事实上，大多数癌症都无法治愈，但我能做的就是尽力缓和他们的症状，提高他们的生活质量。”

According to official statistics in 2008–2009， 28，000 cancer patients die every year in Shanghai， but there are only 60 palliative care beds in the entire city， including 12 in Chengs department. In 2004， after 14 years spent treating advanced liver cancer， Cheng enrolled at The University of Texas MD Anderson Cancer Center in the United States—one of the largest cancer centers in the world. A graduate of the Shanghai University of Traditional Chinese Medicine， Cheng witnessed how much his patients suffered during the final stages of their lives. He decided to study palliative care and rehabilitation in the US to learn how to alleviate some of that suffering.

根据2008年至2009年的官方统计，上海每年有28000名癌症患者死亡，但整个城市只有60个姑息关怀床位，其中包括成医生所在科室的12个床位。2004年，在治疗了14年晚期肝癌后，成医生进入全球最大的癌症中心之一——美国得克萨斯大学MD安德森癌症中心学习。毕业于上海中医药大学的成医生，曾目睹自己的患者在生命最后阶段所遭受的痛苦。因此，他决定到美国进修姑息关怀和康复医学，学习如何缓和这种痛苦。

“I had a really eye-opening experience at MD Anderson， which introduced me to a brand-new concept of providing support systems to advanced cancer patients， such as setting different levels of care for different patients and providing tailor-made treatment plans，” Cheng said.

“在MD安德森癌症中心学习的经历让我大开眼界，我了解到了为晚期癌症患者提供支持体系的新理念，比如为不同的患者安排不同级别的护理，提供量身定制的治疗计划。”成医生说。

Following his studies in the US， Cheng returned to Shanghai to practice and promote what he learned， including a proposal to the centers director to create a palliative care department. Two years later， that proposal became a reality. The integrated therapy department accepts all patients suffering from malignant tumors， including those have been turned away by other doctors.

在美国完成进修后，成医生回到上海，实践并推广他所学的知识，包括向医院领导提议成立姑息关怀科。两年后，这一提议成为现实。综合治疗科接收患有各类恶性肿瘤的患者，包括被其他医生拒之门外的患者。

Incorporating new concepts and basic guidelines from overseas， Cheng also localized the department by applying Chinese traditional medicine to patients care. “We didnt simply copy the Western model，” he said. “We enhanced it with traditional Chinese medicine， which can alleviate many symptoms Western medicine cant. My process is to take the first step and then reassess a patients condition before proceeding further. Some are cured， which I think is the essence of palliative care. Miracles happen here sometimes.”

除了吸收国外的新理念和基本方针，成医生还将中医应用于患者护理，从而实现了科室的本地化。“我们不是简单地照搬西方模式。”他说，“我们用中医来强化西方模式，这样就能够缓和西医无法缓和的许多症状。我的做法是先迈出第一步，然后重新评估患者的病情，再采取下一步行动。有些患者已经治愈了，我认为这是姑息关怀的精髓。奇迹有时会在这里发生。”

Xu Haiquan from Suzhou， Jiangsu Province， is one of those miracles. Two years ago， Cheng treated Xu who suffered from malignant mesothelioma. When the patient arrived， one of his symptoms was pleural effusion， or water on the lungs. To make Xu more comfortable， Cheng began by draining the fluid from his lungs. After draining more than 10，000 milliliters of fluid， he applied traditional Chinese medicine to strengthen his vital qi （energy flow） and body resistance. Amazingly， his condition greatly improved. “Even I did not expect that amazing outcome， because Xu had previously tried many Western treatments，” Cheng said. “It seems traditional Chinese medicine helped his immune system destroy cancerous cells.”

來自江苏省苏州市的徐海全（音译）就是其中一个奇迹。两年前，成医生接诊了这位患有恶性间皮瘤的患者。初诊时，他的症状之一是胸腔积液，也称肺积水。为了让他舒服，成医生先从他的肺部引流积液。排出超过10000毫升积液后，成医生又用中医来增强他的正气（能量流）和身体抵抗力。令人惊讶的是，患者的病情大大好转。“我也没想到会有如此惊人的效果，因为患者之前曾尝试过许多西医疗法。” 成医生说，“看来中医帮助他的免疫系统消灭了癌细胞。”

Wu Yuese is another miracle. Wu lived with lung cancer for nine years， and in 2011 came to Cheng who applied traditional Chinese medicine during his chemotherapy treatments. “Its import-ant to escape from cancers darkness and have a good attitude，” said Wu. “Finding a good doctor isnt easy.” Wu conceded he initially feared palliative care and didnt want Cheng to treat him. “I then told myself I had to try， and if I didnt feel comfortable， I would leave，” he said. “Fortunately， I stuck it out， and thanks to Dr Cheng Im still alive.”

吳越瑟（音译）是另一个奇迹。2011年，已患肺癌九年的他找到成医生。在他化疗期间，成医生采用了中医疗法。“逃离癌症阴霾，保持良好心态是很重要的。”吴先生说，“找到一个好医生不容易。”他也承认最初害怕接受姑息关怀，不想让成医生为他治疗。“然后我告诉自己必须尝试一下，如果觉得不舒服就停下。”他说，“幸运的是，我坚持了下来，多亏了成医生，我还活着。”

Like many Chinese， Wu misunderstood the nature of palliative medicine. “Palliative care isnt about foregoing treatment，” Cheng said. “Initially， we deal with patients symptoms and relieve them of pain， then we determine the best course of action.” According to the World Health Organization， palliative care is a method that improves the quality of life of those with life-threatening illnesses—as well as their families—via early identification， assessments and addressing physical， psychosocial and spiritual issues.

和许多中国人一样，吴先生之前误解了姑息医学的本质。“姑息关怀不等于放弃治疗。”成医生说，“我们先是缓解患者的症状，减轻他们的痛苦。然后，我们确定最佳治疗方案。”世界卫生组织表示，姑息关怀可通过早期识别、评估和解决身体、心理及精神问题，改善绝症患者及其家属的生活质量。

Cheng said Xu and Wu are exceptions to the reality that most patients he treats dont survive. “In my career， I have witnessed the death of about 1，500 patients.” Cheng said. “If half my patients are still alive after one year， thats good news. If 10 percent of them are still alive after five years， thats even better. What I do is offer a supportive system to help patients and their families cope.”

成医生说，现实是他接诊的大多数患者最终还是走向了死亡，徐先生和吴先生是例外。“在我的职业生涯中，我亲眼目睹了大约1500名患者的死亡。”他说，“如果我的患者半数能活到一年后，那便是个好消息。如果他们中的10%在五年后还活着，那就更好了。我所做的就是提供一个支持体系，帮助患者及其家属应对病情。”

Cheng may be the only doctor in China who provides supportive services for bereaved families of his deceased patients. “The longest bereavement case Ive had lasted three and a half months，” said Cheng. “He was an old man who lost his wife and was devastated.” Every week or two， the old man came to Chengs outpatient clinic and chatted with him about the treatment his wife received and how she was able to die peacefully. These chats were clearly therapeutic. “One year later， he remarried and sent me candies from his wedding，” Cheng said.

成医生可能是中国唯一为去世患者的家属提供支持服务的医生。“我参与最久的丧亲支持个案持续了三个半月。”成医生说，“一位失去妻子的老人精神崩溃。”每隔一两周，这位老人就会来看成医生的门诊，与成医生聊聊妻子接受的治疗，以及她是如何安宁离世的。这一次次聊天显然很有疗效。“一年后，他再婚了，还给我送来了喜糖。”成医生说。

Every day at 7：30 am， Cheng checks on patients with his colleagues， and visits them a second time before the end of the day. “All my patients endure critical illnesses that can quickly change，” he said. “Each days second round enables me to quickly respond to any changes. Moreover， the second visit is a more casual opportunity for me to address humanistic concerns.” During those second visits， Cheng chats with his patients about personal matters such as feelings and wishes.

每天早上七点半，成医生会和同事一起查房，下班前还会查看一次。“我所有的病人都患有危重症，病情可能迅速变化。”他说，“每天的第二轮查房能使我快速应对一切变化。而且，第二轮查房是个放松的时机，便于我提供人性关怀。”在第二轮查房期间，成医生会与患者聊聊个人话题，比如感受和愿望。

Every night before going to sleep， Cheng enjoys reading auction records and antique picture books. “Ancient artworks always make me feel peaceful，” he said， “I think its best for doctors to combine science and art， like telling patients the truth in an artistic way. Every patient is like an excellent textbook. If we learn something new from every patient we treat， we will be more successful treating future patients.”

每天晚上睡覺前，成医生喜欢阅读拍卖笔录和古董绘本。“古代艺术品总能让我静下心来。”他说，“我认为医生最好将科学和艺术结合起来，比如用具有艺术性的方式告知患者病情真相。每位患者都像一本优秀的教科书。如果我们能从自己治疗的每一位患者身上学到新东西，那么我们未来就能更成功地治疗患者。”

（译者为“《英语世界》杯”翻译大赛获奖者；单位：北京大学国际法学院）