大概六个月前，我的体重开始下降，背上疼痛难忍。早上穿裤子的时候，皮带先是紧了一个扣，接着紧了两个。我去找我的初级保健医生，也是我在斯坦福的老同学。她的哥哥是在神经外科住院医生岗位上猝死的，就因为没在意一些病毒感染的征兆，所以她特别关注我的健康状况，像我妈似的。不过，等我到了她的诊室，却发现里面坐着另一个医生。我同学休产假去了，真的要做妈妈了。
About six months before, I had started losing weight and having ferocious back pain. When I dressed in the morning, my belt cinched one, then two notches tighter. I went to see my primary care doctor, an old classmate from Stanford. Her brother had died suddenly as a neurosurgical resident, after ignoring signs of a virulent infection, and so she’d taken a maternal watch on my health. When I arrived, however, I found a different doctor in her office—my classmate was on maternity leave.
我穿了一件薄薄的蓝色体检服，躺在冰冷的检查台上，向这位新医生描述我的症状。“当然，”我说，“如果这是医生资格考试中的问题，三十五岁，体重莫名其妙地下降，初发性背痛，那明显该选C——癌症。但也说不定只是我工作太拼命了。我也不知道。想做个核磁共振确定一下。”
Dressed in a thin blue gown on a cold examining table, I described the symptoms to her. “Of course,” I said, “if this were a boards exam question—thirty-five-year-old with unexplained weight loss and new-onset back pain—the obvious answer would be cancer. But maybe it’s just that I’m working too hard. I don’t know. I’d like to get an MRI to be sure.”
“我觉得还是先照X光吧。”她说。背痛要做的核磁共振价格不菲，而且最近全国上下都在不断强调，为了节省医疗成本，不要做这种不必要的检查。但医学扫描的价值，要看你找的是什么：X光基本上是查不出癌症的。不过，很多医生还是觉得，这么早就做核磁共振简直有愧医者之心。她说：“X光是没有那么敏感，但也是个合理的开始。”
“I think we should get X-rays first,” she said. MRIs for back pain are expensive, and unnecessary imaging had lately become a major national point of cost-saving emphasis. But the value of a scan also depends on what you are looking for: X-rays are largely useless for cancer. Still, for many docs, ordering an MRI at this early stage is apostasy. She continued: “X-rays aren’t perfectly sensitive, but it makes sense to start there.”
“那我们做个屈伸X光，看看更现实的诊断是不是峡部脊椎滑脱？”
“How about we get flexion-extension X-rays, then— maybe the more realistic diagnosis here is isthmic-spondylolisthesis?”
墙上有面镜子，我能看到她正在谷歌上搜索我说的术语。
From the reflection in the wall mirror, I could see her Googling it.
“一种椎弓骨折，发病率大概是5%，年轻人背痛经常是这个原因。”
“It’s a pars fracture affecting up to five percent of people and a frequent cause of back pain in the young.”
“好，那我就约你说的那个X光。”
“Okay, I’ll order them, then.”
“谢谢。”我说。
“Thanks,” I said.
