前线的悲伤：看见医护人员的职业创伤（节选）

人文类翻译，不是我翻译的。括号里是笔者改的

从急诊抢救室到重症监护室再到安宁疗养院，一线医护人员都承受着频繁且沉重的情感负担：做出改变病人生活的决策，直面他人痛苦甚至死亡的冲击，可以预见结局却无能为力……医护人员的精神创伤是深远的。然而这些创伤往往被忽视，无人问津。

《前线的悲伤》带领读者走过一段令人警醒的旅程，作者直白地剖陈了医护人员每天经受的压力、暴力和创伤，对他们在工作中产生的悲伤、倦怠、抑郁心理进行了及时且重要的发声；还分享了医护人员“治愈自己”的很多方法，以及美国医疗界人士为解决医护人员的人性需求而试行的新项目，以期为正在职业创伤中挣扎前行的医护人员带来希望。

Patients Who Get into Your Heart

Most medical professionals have experienced patient deaths that are, for whatever reason, exceptionally heart-wrenching. Sometimes it’s because the patient was young; sometimes because the death was unexpected; sometimes because the patient reminded them of someone they love.These situations can profoundly impact healthcare workers, forcing them to develop more effective coping strategies, affecting their relationships, and bleeding into other aspects of their personal lives. For both patients and providers, finding closure often helps to mitigate the stress, and diverse approaches can include attending funerals; avoiding funerals; saying goodbye; journaling; sharing case notes; and helping patients and their families make hard decisions.

那些刻骨铭心的病人

在医疗行业，每位医护人员都有难以释怀的患者离世经历。或许因为生命逝去得太早，或许因为死亡来得太过突然，又或许因为患者的遭遇让他们想到了自己的至亲。这些经历在医护人员心中留下深深的烙印，推动他们建立起更成熟的心理调适机制，也悄然影响着他们的人际关系和生活的方方面面。对医患双方来说，找到释怀的方式都极其重要，这可能是参加追思会、选择不出席悼念活动、作最后的道别、写日记、分享病例心得，或是帮助患者及家属做出艰难的抉择。

For Don Dizon, the director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, the deaths that most affect him are “the ones that should never have happened”—such as the 16-year-old with ovarian cancer who only lived to see her eighteenth birthday, or the mother diagnosed with ovarian cancer three months after she gave birth. “They absolutely change you,” Dizon said. “Each time someone gets into your heart you find out: How can I construct a better wall so that I’m still standing five years from now?” Oncologists build relationships with patients—and often, their extended families—over time, making a balance between healthy empathy and clinical distance especially challenging. “You get invited to special moments in their lives that have nothing to do with their cancer,” said Dizon, who has watched patients outlive their children, suffer through divorces, attend children’s weddings, or witness the birth of their grandchildren. “It’s such a profound thing when you hope for the best and it doesn’t happen.”

对生命科学医疗系统（Lifespan）癌症研究所女性癌症主任兼罗德岛医院医学肿瘤科主任唐·迪森（Don Dizon）而言，最令他痛心的是那些本可避免的离世——比如一位年仅16岁就确诊卵巢癌、两年后便离世（只活到了18岁生日）的女孩，又或是一位产后三个月就确诊卵巢癌的年轻妈妈。“这些经历确实会改变一个人，”迪森说道。“每当有病人走进你的内心，你就会思考：我该如何筑起更坚实的心理防线，才能确保自己五年后仍能坚守这个岗位？”肿瘤科医生常常会随着时间的推移与患者及其整个家庭建立起深厚的情谊，这使得在保持专业同理心与恰当医患距离之间寻找平衡变得格外困难。“你会被邀请参与他们生命中许多与癌症无关的重要时刻，”迪森说，他曾陪伴患者经历丧子之痛、承受婚姻破裂之苦、见证子女步入婚姻殿堂，或迎接新生孙辈的到来。“当你满怀希望却最终事与愿违时，那种失落感格外沉重。”

While Dizon attended the funerals of both the previously mentioned women, the new mother’s stayed with him for months, and he determined shortly after the eighteen-year-old’s that he wouldn’t participate in any more patient memorials. “It’s something I’ve discovered that I need to do to persevere and to sort of go beyond the grief so I can see the next person,” he said. Instead, Dizon now brings his stylish, soft-spoken presence to the bedside as he bids farewell to those who are moving into home hospice or approaching death in the hospital.“I’ll let them know that it was a tremendous honor to be in their lives and to get to know them and their family,” he said. Clinicians typically take comfort from having some form of farewell: some may do so by attending patient funerals; others, like Dizon, prefer to find closure at the bedside.

虽然迪森出席了这两位女性的追悼会，但那位年轻母亲的告别仪式却在他心头萦绕了数月之久。而参加那位18岁患者的追悼会后，他很快做出决定，不再出席任何患者的追悼活动。“我意识到，这是为了能继续前行、走出悲伤、照顾更多患者而不得不做出的选择，”他说。如今，当患者转入居家临终关怀或在医院弥留之际，迪森都会以他一贯温和优雅的方式，来到病床前作最后的道别。“能够走进他们的生命，结识他们和他们的家人，对我而言是无上的荣幸，”他说。临床医生通常会通过不同形式的告别仪式寻求心灵的慰藉：有些人选择参加患者的追悼会；而另一些人，就像迪森一样，更愿意在病床前寻求内心的释然。

Janine Overcash, a geriatric nurse practitioner and professor of clinical nursing at The Ohio State University who’s spent most of her career in oncology, said that she finds herself considering the welfare of patients she sees every couple of weeks for treatment long after their visits. “I often think, ‘I wonder if they got home okay, I know they were really tired,’” she said. “You know when their daughters are visiting and you wonder how things went.” Overcash takes comfort in minor improvements, such as when changing medications means someone’s not nauseous anymore and they’re able to achieve a small goal such as visiting someone. Despite forming attachments, Overcash, who has also worked as a nurse in ICUs, in a burn unit, in trauma, and in hospice, typically finds long-anticipated deaths easier to process than those that come suddenly—including young people with “terrible brain cancers” or who’ve suffered traumatic accidents. “It changed the way I parented,” said Overcash, who had two sons of her own and raised a third. She strongly discouraged all three from going on motorcycles, riding horseback, or sitting in the backs of moving pickups. “You look at risks as very real,” she said.

俄亥俄州立大学的执业护士兼临床护理教授珍妮·奥弗卡什（Janine Overcash）在肿瘤科度过了她的大半职业生涯。她说，即使在患者离开很久之后，她仍会时常牵挂那些每隔几周来接受治疗的病人。“我经常会想，他们是否平安到家了？我记得他们当时已经很疲惫了，”她说。“你知道他们的女儿要来探望，你也想知道探视的情况如何。”每当调整用药后患者不再感到恶心，或是能够实现探望亲友这样的小目标时，奥弗卡什都会感到欣慰。尽管难免会与患者建立情感联系，但奥弗卡什发现，相比那些突如其来的离世——比如年轻人患上恶性脑瘤或遭遇严重事故——那些在预期之中的离世反而更容易让人接受。她曾在重症监护室、烧伤科、创伤科和临终关怀机构工作过。“这些经历改变了我的育儿方式，”已经养育了两个亲生儿子和一个非亲生儿子的奥弗卡什说。她坚决反对三个孩子骑摩托车、骑马或坐在行驶的皮卡车后斗里。“你会对风险有更深刻的认识，”她说。

The fact that patient deaths affect clinicians differently depending on things such as age and parental status is something that Alexandra Jabr, a paramedic educator in the Los Angeles area of California with a master’s in mental health specializing in grief and bereavement, has often witnessed in the field. Jabr spent about fifteen years as an active paramedic and now teaches aspiring paramedics in community colleges and counsels fire departments on occupational resilience, behavioral health, and death communication. “The way I respond to a child dying is different from the way a parent is going to respond,” Jabr said. Instead, Jabr found herself reacting strongly to a young couple who’d suffered a car accident in which the husband died and his wife waited for hours on the side of the road. “It was heartbreaking because we were the same age,” Jabr said. “It was just the association that changed for me, and I never quite forgot that.”

作为洛杉矶地区的急救员教育工作者，亚历山德拉·贾布尔（Alexandra Jabr）拥有一个专攻悲伤与丧亲心理学的硕士学位。她在长期工作中观察到，医护人员对病患离世的情感反应往往因年龄差异和是否为人父母等因素而存在明显不同。在担任急救员近15年后，贾布尔现在正在社区大学培养新一代急救员，同时为消防部门提供职业压力管理、心理健康辅导和死亡沟通等专业咨询服务。“对于儿童死亡，我的感受确实与那些为人父母者大不相同，”贾布尔说道。但有一次年轻夫妇的车祸事件却让她格外揪心——丈夫在事故中不幸身亡，而妻子在路边苦等了数小时。“这个案例令我心碎，或许是因为我们年龄相仿，”贾布尔解释说，“正是这种共鸣让我久久无法释怀。”