“我仍然活着，直到真正死去那一刻”
本文首发于2017年5月，是 When Breath Becomes Air的读书笔记。在昨天推送的Tuesdays with Morrie中有人提到了它，于是稍作编辑重新和你分享。
加缪在《局外人》开头写到：
今天，妈妈死了。也许是昨天，我不知道。我收到养老院的一封电报，说：“母死。明日葬。专此通知。” 这说明不了什么。可能是昨天死的。
这几个短句把至亲去世写得如此平淡，像足了局外人。Paul Kalanithi在When Breath Becomes Air的开头也有这样一段：
I flipped through the CT scan images, the diagnosis obvious: the lungs were matted with innumerable tumors, the spine deformed, a full lobe of the liver obliterated. Cancer, widely disseminated. I was a neurosurgical resident entering my final year of training. Over the last six years, I'd examined scores of such scans, on the off chance that some procedure might benefit the patient. But this scan was different: it was my own.
Paul是位神经外科住院医生，他正在看一张CT片子，专业知识告诉他这是肺癌晚期。和以往不同的是，这是他自己的片子。
"It was my own." 这一刻开始，他从医生变成了患者，不再是局外人。学了这么多医学知识，做了无数次手术，这一次他要直面死亡。
When Breath Becomes Air是Paul的故事。文字朴实真诚，没有慷慨激昂的鸡汤和口号，没有哗众取宠的煽情。讲他的童年，第一次和尸体接触，第一次在同一天经历了新生和死亡。讲他在文学和医学中探索生命的意义，和死神同行。
如果没有选择神经外科医生的话，他应该是位作家。10岁那年妈妈让他读1984，从此爱上读书，从The Count of Monte Cristo（《基督山伯爵》），Edgar Allan Poe（爱伦坡），到The Prince（《君主论》）和梭罗，《哈姆雷特》和浪漫主义诗歌伴他度过了青春期。当妈妈担心他是否吸食毒品的时候，他说：
...the most intoxicating thing I'd experienced, by far, was the volume of romantic poetry she'd handed me the previous week. Books became my closest confidants, finely ground lenses providing new view of the world.
于我而言，毒品没有吸引力，最最令人上瘾的，是上周她递给我的那套浪漫诗歌选集。书籍成为我最形影不离的密友，就像精心制作的镜头，为我展开新世界的大好风景。
他认为文学是对生命意义最好的诠释。这本书中也出现了一些诗歌，例如标题When Breath Becomes Air来自17世纪诗人Fulke Greville的十四行诗Caelica 83，章节标题“In Perfect Health I Begin" "Cease Not Till Death"都来自惠特曼的Song of Myself。
Literature not only illuminated another's experience, it provided, I believed, the richest material for moral reflection.
大二暑假他申请了两份工作，一份是像科学家一样做研究，一份是野营活动中做厨师。他说“我要么去研究生命的意义，要么就去亲自体验生命的意义。” (I could either study meaning or I could experience it.)
大学里他一边学文哲探究生活的意义，一边学神经科学来了解大脑运行的机制。当文学已经无法给他答案的时候，他决定弃文从医：
I wanted that direct experience. It was only in practicing medicine that I could pursue a serious biological philosophy. Moral speculation was puny compared to moral action. I finished my degree and headed back to the States. I was going to Yale for medical school.
在医学院读了4年后，他决定做一名神经外科医生，很重要的一个原因是神经手术有着“哲学和生物学上的双重意义。因为每做一次神经手术就意味着患者可能会丧失某些能力，例如命是保住了，但是失去了视力和语言能力，那个充满活力的人就再也回不来了。这就意味着医生、家属和患者要要共同面对现实，知道手术意味着什么，共同思考一个问题：What makes life meaningful enough to go on living？
毕业后他和妻子开始做residency，成为住院医生。在这里他和死神一次次狭路相逢。他说选择做医生是因为想追寻死神：抓住它，掀开他的神秘斗篷，与他坚定地四目相对。
I had started in this career, in part, to pursue death: to grasp it, uncloak it, and see it eye-to-eye, unblinking.
他在生与死之间找到一个舞台，在面对生死和与病人的沟通中反思和探索。他说：...my highest ideal was not saving lives -- everyone dies eventually -- but guiding a patient or family to an understanding of death or illness. 他说: When there's no place for the scalpel（手术刀）, words are the surgeon's only tool.
培训的第七年，苦尽甘来之际，他发现自己得了癌症 -- 要知道，36岁就得肺癌的概率只有0.0012%。他一下子从渡人的牧人变成了一只茫然的羔羊。
“多年来我治疗过无数病人，如今自己站在这个十字路口，我本应该看到和跟随他们密集的脚印，然而眼前却是一片白色沙漠，空空荡荡，艰险残酷，荒无人烟，闪着刺眼的光，仿佛一场暴风雨过境，抹去了所有熟悉的痕迹。”
My carefully planned and hard-won future no longer existed. Death, so familiar to me in my work, was now paying a personal visit. Here we are, finally face-to-face, and yet nothing about it seemed recognizable. 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 f familiarity.
他想知道自己还能活多久 -- 尽管他知道医生是不该不负责任地给患者一个数字。他说If had two years, I'd write. If I had ten, I'd get back to surgery and science.
医生告诉他: you have to figure out what's most important to you. 他迷失在死亡的荒原中，为了找寻生命的意义他又开始求助于文字的力量，如饥似渴地阅读与死亡有关的作品。在疼痛沮丧的时候，除了药丸之外还有塞缪尔贝尔特的那句萦绕耳旁："I can't go on. I'll go on."
The privilege of direct experience had led me away from literary and academic work, yet now I felt that to understand my own direct experiences, I would have to translate them back into language.
他最后决定自己要回到手术室中，Why? Because I could. Because that's who I was. Because I would have to learn to live in a different way, seeing death as an imposing itinerant visitor but knowing that even if I'm dying, until I actually die, I am still living.
“我会把死神看作一个威风凛凛、不时造访的贵客，但心里要清楚，即使我是个将死之人，我仍然还活着，直到真正死去的那一刻。”
又开始工作七个月之后，肺部出现了新的肿瘤，开始化疗，病情逐渐恶化。2015年3月9日，癌症被确诊的22个月后，吗啡注入静脉，他完成了最后一次呼吸。
蒙田说: "If I were a writer of books, I would compile a register, with a comment, of the various deaths of men: he who should teach men to die would at the same time teach them to live." Paul在他的弥留之际谈论死亡，他感到恐惧、迷茫和脆弱，也勇敢地面对死亡。当那一刻来临的时候，他对妻子用轻柔而坚定声音说：我准备好了。
我总是觉得死亡离我还很远，可是我也知道它离我很近。我怕死，可我到底怕的是什么？对我来说最重要的事情是什么？活着就好好活吧，有意识的活，给它一个意义。