醫學生日記2016年3月7日-選擇

醫學生日記2016年3月7日-選擇
阿山 （龐靜譯）二零一六年三月七日

今天我實踐婦科麻醉。我的朋友們都知道我對兒科非常有興趣，經過嬰兒時，我根本無法不硬扭著我那轉動有限的脖子去多看那個嬰兒幾眼。但是今天我的注意力必須集中在母親們身上。這一天過得很慢，沒有幾個新生兒。我隻見了幾個病人。有一個病人著實引起了我的注意，讓我絞著腦汁想了一陣子。

她隻有二十一歲，剛生完第三個孩子。我在此不想詳述那些關於醫療保障、教育、婦女生育權力、倫理標準、等々一係列矛盾的論辯。以前，很多人都很專業性地講過這些。這裏我隻想說々我怎麽看待她的想法。

我跟她接觸非常有限，僅々摸了一下她脊背上麻藥注射點的標記，她的輸卵管結紮手術完成之後，我又幫助她下了手術台。為什麽她讓我這麽著迷？她比我年輕三歲。就在這裏，她居然做了今後不再生育的決定。

如今有很多避孕方法可取，粗翻了一下她的醫療檔案，我推斷，直到她懷孕，她都幾乎沒有機會了解那些避孕方法。她為什麽要做這個決定？最直接了當的回答是：三個孩子已經足夠了，她不需要也不想再多要了。

在她做結紮手術時，我無法不多看々她的臉。一條藍色單子把她的臉和她的身體隔開了。她的眼睛看上去那麽遙遠，就如同她將來再也不能生育一般虛幻。如果她的決定並不單純，三個孩子並不意味著足夠，結果會怎麽樣呢？

她在懷孕期間經曆過什麽樣的痛苦？她為她自己和她的三個孩子展望著什麽樣的未來？她經曆這些時，她的家在哪？無論這些問題的答案是什麽，我覺得結紮輸卵管是一個挺好的決定。

我終於想明白了什麽對我震動最大。我可以自信地說，用特權來衡量，我們的背景十分不同。我總是有很多機會和很多途徑去做我想做的事情，而且從來不用顧及後果。最近，我開始懂得感恩這個事實：也就是我有很多機會，我可以非常自由地抓住這些機會，學習、成長、進步。而她，什麽樣的生活和經曆可以使她在這麽年輕的年紀就自願放棄自己的選擇呢？

我看著她抱著自己的嬰兒坐在輪椅上被推出了醫院，沒有鮮花，沒有氣球。我以前在密西根兒童醫院把這些都看習慣了。我突然明白過來我已經失去了和她說話的機會，無法再了解她的角度和立場了。老師教我們可以從接觸的病患那裏學習。就在今天，她挑戰了我考慮問題的方法。我指望我可以學更多。比起她所放棄的，無論一切顯得多麽微不足道，我還是失去了一次機會。

March 7, 2016 – No better option

Today, I had the chance to rotate with obstetric anesthesia. Those who know me know that I am very interested in pediatrics, and I can’t walk past a baby without testing my neck’s range of motion. But today, my focus was on the mothers. It was a slow day, not many babies were being born. I got to meet only a few patients, but there was one that has overwhelmingly entangled my imagination.

She was only 21 had just given birth to her third baby. I’m not here to expound upon the cases and arguments about contraception, health care access and education, women’s reproductive rights, moral standards, yada yada yada the topics that many with much more expertise have presented before me. I’m simply here to reflect on my thoughts about her thoughts.

Why did she fascinate me so much? I had extremely limited interaction with her: I only palpated her spinal landmarks for her spinal anesthesia injection and helped her off the operating table… after her elective bilateral tubal ligation. Here she was, 3 years younger than me, when I still feel very much like a child, yet she was already the mother of 3. And here she was, making the decision to end all possibility of another baby in the future.

Why was she making this decision? There are so many contraceptive methods available nowadays, and scouring through her medical record, I can reasonably make the deduction that she had very little exposure and education about those methods until her pregnancies. The simple answer would have been: 3 babies are enough, she doesn’t need or want more.

I couldn’t resist looking at her face and into here eyes during her tubal ligation. A blue drape separated her face from the rest of her body. The look in her eyes was just as distant and disconnected as she was physically with her reproductive future. I wondered, what if the answer wasn’t simply: 3 babies are enough?

What type of fear or emotional anguish did she experience during her pregnancies? What type of future did she envision for her 3 children and herself? Where was her family through all of this? No matter what the answer was to these questions, I realized the tubal ligation would have still felt like a good decision to pursue.

I figured out what had struck me most. I can confidently say we come from vastly different backgrounds in terms of privilege. I’ve always had abundant opportunity, had the means to pursue any choice I made, and felt confident I would be okay no matter the consequence. Mostly and recently, I’ve gained great appreciation for the fact that I have available options, and I’m mostly free to pursue them as I learn and grow and change. What type of life and experiences would somebody have had to gone through to willingly give up this option at such an early age?

I watched her get wheeled out of the hospital with her new baby, without the flowers and balloons that I had become so accustomed to seeing at Michigan. And I realized I lost the opportunity to talk to her, to maybe get to learn her perspective. We were told that we could learn something from every patient we encounter. Even in this brief day, she’s challenged me to think differently. I just wish I had learned more. And so I also lost an opportunity, despite being ridiculously miniscule compared to what she gave up.