我给课程主管打了电话，说我准备好了，要回去了。他非常激动。维多利亚也和我促膝长谈，讨论如何让我重新融入团队，迅速适应工作。我要求随时给我配一个后备的住院医生，以防万一。另外，我一天只能处理一个病例。等病人出了手术室，我就不管了，也不会值班。我们需要保守前进，一步一步来。手术安排出来了，我被派去做一个颞叶切除术，这是我最喜欢的手术之一。一般来说，癫痫是海马体异常放电引起的，而海马体就在颞叶的深处。切除海马体，癫痫就治愈了。但这项手术还是很复杂的，需要手法轻柔地将海马体从脑膜上切除。覆盖着大脑的透明脑膜非常脆弱，就在脑干附近。
I called up the program director to tell him I was ready to return. He was thrilled. Victoria and I talked about how best to reintroduce me and get me back up to speed. I requested that a fellow resident be available to back me up at all times in case something went awry. Furthermore, I would do only one case per day. I wouldn’t manage the patients outside the OR or be on call. We’d proceed conservatively. The OR schedule came out, and I was assigned to a temporal lobectomy, one of my favorite operations. Commonly, epilepsy is caused by a misfiring hippocampus, which is located deep in the temporal lobe. Removing the hippocampus can cure the epilepsy, but the operation is complex, requiring gentle dissection of the hippocampus off the pia, the delicate transparent covering of the brain, right near the brain stem.
手术前一晚，我熟读各种手术教科书，复习解剖图和手术步骤。我睡得很不安稳，脑子里一直浮现着头颅的角度，锯子锯开颅骨的情景，切除颞叶之后反射在骨膜上的灯光。我起了床，穿上衬衫，打好领带。（几个月前我把所有的刷手衣都还了，以为这辈子都用不上了。）我来到医院，十八个星期以来头一次换上那身熟悉的蓝色衣服。我和病人聊了聊，确定没什么最后的问题了，就开始手术的准备。病人插了管，主治医生和我也消好毒，准备开始了。我拿起手术刀，划开病人耳朵上方的皮肤，慢慢地进行每一步，努力确保毫无遗漏，不犯任何错误。我一边进行电凝止血，一边继续切到骨头的部位，然后钩起皮瓣。一切都感觉很熟悉，肌肉记忆并未消退。我拿起钻子，在颅骨上钻了三个洞。主治医生在旁边喷水，给钻子降温。我又换了开颅器，也就是从侧面切割的钻头，把几个洞连了起来，钻开一大片头骨。“咔嗒”一声，我把头骨撬开，银闪闪的硬脑膜就出现在眼前。值得高兴的是，我没有犯很多初学者常犯的错误，钻子没有伤到这片区域。我拿了一把锋利的手术刀，割开硬脑膜，也没有伤到大脑。接连的成功让我放松下来，我略微在硬脑膜上缝了几针，把它勒起来，免得进行主要步骤的时候碍事。大脑在轻轻地跳动，发着微光。巨大的脑静脉纵贯颞叶顶部，这情景原始而质朴。我熟悉的大脑啊，一个沟壑纵横的桃子，正在召唤着我。
I spent the night prior poring through surgical text-books, reviewing the anatomy and steps of the operation. I slept restlessly, seeing the angle of the head, the saw against the skull, the way the light reflects off the pia once the temporal lobe is removed. I got out of bed and put on a shirt and tie. (I had returned all my scrubs months ago, assuming I’d never need them again.) I arrived at the hospital and changed into the familiar blue garb for the first time in eighteen weeks. I chatted with the patient to make sure there were no lastminute questions, then began the process of setting up the OR. The patient was intubated, the attending and I were scrubbed and ready to begin. I picked up the scalpel and incised the skin just above the ear, proceeding slowly, trying to make sure I forgot nothing and made no mistakes. With the electrocautery, I deepened the incision to the bone, then elevated the skin flap with hooks. Everything felt familiar, muscle memory kicking in. I took the drill and made three holes in the skull. The attending squirted water to keep the drill cool as I worked. Switching to the craniotome, a sideways-cutting drill bit, I connected the holes, freeing up a large piece of bone. With a crack, I pried it off. There lay the silvery dura. Happily, I hadn’t damaged it with the drill, a common beginner’s mistake. I used a sharp knife to open the dura without injuring the brain. Success again. I began to relax. I tacked back the dura with small stitches to keep it out of the way of the main surgery. The brain gently pulsed and glistened. The huge Sylvian veins ran across the top of the temporal lobe, pristine. The familiar peach convolutions of the brain beckoned.
突然，我视力的余光有些模糊，只好放下工具，从手术台旁后退。眼前的黑暗逐渐扩大，蚕食着我的视力，一种轻飘飘的感觉占据了全身。
Suddenly, the edges of my vision dimmed. I put down my instruments and stepped back from the table. The blackness encroached farther as a feeling of lightness overcame me.
“抱歉，先生，”我对主治医生说，“我有点晕，可能需要躺下。我的助理住院医生杰克会完成这台手术。”
“Sorry, sir,” I told the attending, “I’m feeling a little faint. I think I need to lie down. Jack, my junior resident, will finish the case.”
杰克很快就赶来了，我离开了手术室，到休息室喝了点橙汁，躺在沙发上。二十分钟后，感觉好些了。“神经心源性晕厥。”我低声自言自语。自主神经系统突然引发短暂的心律不齐。说得通俗点，就是神经出了毛病。这是菜鸟才会出的问题，和我想象中重返手术室的情景可不一样。我走到更衣室，把脏了的刷手衣扔进脏衣篮，穿上便服。离开的时候，我抓了一摞干净的刷手衣，告诉自己，明天会更好。
Jack arrived quickly, and I excused myself. I sipped some orange juice in the lounge, lying on the couch. After twenty minutes, I began to feel better. “Neurocar-diogenic syncope,” I whispered to myself. The auto-nomic nervous system briefly shutting down the heart. Or, as it’s more commonly known, a case of the nerves. A rookie problem. This was not how I’d envisioned my return to the OR. I went to the locker room, threw my dirty scrubs in the laundry, and put on my civilian clothes. On the way out, I grabbed a stack of clean scrubs. Tomorrow, I told myself, would be a better day.
的确是这样。所有病例感觉都很熟悉，随着日子一天天过去，似乎越来越平稳顺畅了。第三天，我给一个病人的脊椎做退变椎间盘移除手术。盯着那凸出的椎间盘，我记不起之前到底是怎么做的了。负责监督我的同事建议用咬骨钳一点一点地来处理。
It was. Every day, each case felt familiar but moved a little more slowly. On day three, I was removing a degenerated disc from a patient’s spine. I stared at the bulging disc, not remembering my exact move. The fellow supervising me suggested taking small bites with a rongeur.
“嗯，我知道一般的方法，”我含糊地说，“但还有别的办法……”
“Yeah, I know that’s how it’s usually done,” I mumbled, “but there’s another way. . . ”
我一边用咬骨钳一点点弄了二十分钟，一边在脑子里寻找之前学过的更为优雅从容的方法。进行到下一节脊椎时，我在电光石火间想起来了。
I nibbled away for twenty minutes, my brain searching for the more elegant way I had learned to do this. At the next spinal level, it came back to me in a flash.
“剥离器！”我大声说，“骨锤、超薄咬骨钳。”
“Cobb instrument!” I called out. “Mallet. Kerrison.”
三十秒内，整个退变椎间盘就被移除了。
I had the whole disc removed in thirty seconds.
“这就是我的办法。”我说。
“That’s how I do this,” I said.
