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更新時間:2019/5/2 11:20:52 來源:紐約時報中文網 作者:佚名

Antarctica's most extreme rescue mission
救援任務︰有如好萊塢電影的“南極救援行動”

In late April 2015, Tim Nutbeam was smuggled onto a plane carrying a big bag of blood to attempt a rescue mission in Antarctica. It was the beginning of winter when the continent is draped in almost total darkness and extreme cold, not to mention frequent high winds. Due to the dangerous conditions, there are normally no scheduled flights during the six months of winter.

2015年4月下旬,努特皮姆(Tim Nutbeam)帶著一大袋血漿,登上了前往南極的救援飛機。此時正值南半球初冬,整個南極大陸被黑暗和嚴寒籠罩,強風頻頻來襲。由于氣候條件惡劣,在為期半年的冬季里,一般不會安排任何航班在南極起降。

But Nutbeam, a consultant in emergency medicine based in the UK, went ahead with the journey, joined by a pilot and engineer.

即便如此,英國急診醫學顧問努特皮姆還是同飛行員和工程師一起,飛赴南極。

Their mission was to save the life of a critically ill worker on an Antarctic base. Malcolm Roberts, an engineer for British Antarctic Survey, had suffered a massive gastrointestinal bleed at the Halley Research Station days before. He was thousands of miles away from the nearest hospital.

他們是為了救助基地里一位生命垂危的患者。幾天前,在哈雷研究站(Halley Research Station)工作的英國南極調查局工程師羅伯茨(Malcolm Roberts)腸胃嚴重出血,而最近的醫院卻在數千英里以外。

Roberts had lost a lot of blood but had survived the first 24 hours. If they got to him in time, there was a chance that he would live but there were many challenges that could prevent them from saving their patient.

羅伯茨失血很多,但所幸挺過了前24小時。如果救援隊伍能夠及時趕到,那麼他還有一線生機——但是前往南極的路道阻且長,很難說羅伯茨能不能逃過一劫。

The flight to Halley would take about 24 hours with one stop to refuel in Rothera, another base on the Antarctic peninsula, before making the same journey back, meaning they would be flying for about 48 hours straight. And on the way back, they would have to deal with a medical emergency at the same time, having had little sleep or rest.

飛往哈雷研究站大約需要24小時,中途經停南極半島的羅瑟拉基地(Rothera)加油。再加上回程,總共需要連續飛行48小時之久。返程途中還要應對患者的緊急狀況,幾乎沒有時間休息睡覺。

Saving the patient’s life was challenge enough. But on top of that, how would Nutbeam be able to handle the mission psychologically?

單是拯救患者生命就已經不簡單了,而與此同時,努特皮姆能否做好這次任務的心理準備?

Initially, he wasn’t even meant to go on the trip. Nutbeam was supposed to be the back-up doctor on the mission. When the emergency occurred he had flown into Punta Arenas, a town near the southernmost tip of Chile. The plan was that he would be stationed there to help after the plane landed.

最初並不是要派努特皮姆去,他只是後備醫生,緊急救助開始後他飛到了智利最南端的蓬塔阿雷納斯鎮,按照計劃是等救援飛機在那里著陸後提供協助。

But when a volcano erupted north of where he was, everything changed. The lead doctor was waiting for a connecting flight in Santiago but all flights were cancelled. At the same time, there was a rare break in weather across the Drake Passage, the body of water between southern Chile and Antarctica, where visibility is often poor. “I suddenly realised that I would be going,” says Nutbeam. “It was too good an opportunity to wait.”

但是,小鎮以北的火山爆發,一切計劃都被打亂。主治醫生當時正在聖地亞哥等候轉機,但所有航班都取消了。而智利南部與南極洲之間的德雷克海峽卻出現了難得的好天氣,海上能見度很理想。努特皮姆說︰“我突然意識到該我去了,這是個千載難逢的好機會。”

Nutbeam admits that everything happened so quickly that he didn’t think much about the potential dangers at the time. Instead, he remembers feeling excited about getting to go to Antarctica and do the rescue.

事發突然,他承認當時甚至無暇思考可能發生的危險,只記得對前往南極救援激動無比。

Extreme personalities

極限探險者的品質

There have been few medical evacuations during the Antarctic winter. In 2016, an ill worker was airlifted from the South Pole mid-winter when there are 24 hours of darkness while another patient rescue took place from the main US research base in 2010.

在南極冬天進行的醫療撤離屈指可數。2016年曾在24小時不見太陽的極夜里用飛機接走過一名病人,另一次是2010年從美國的研究主基地接走的。

According to Nathan Smith, a psychology researcher at the UK’s University of Manchester, people who take part in extreme expeditions often are motivated by the chance to do something that not many people do. “They are often highly trained so it’s an opportunity to test their skills out and do a task they haven’t done before,” he says.

英國曼徹斯特大學的心理學研究員史密斯(Nathan Smith)表示,參加極限探險的人通常是想要嘗試大多數人所做不到的事情。他說︰“這些人往往訓練有素,因而將這當成是一次檢驗技能並嘗試新任務的機會。”

Certain personality types are better able to deal with the stress of extreme expeditions. Research has shown that people who are less neurotic perform better. “What we see is that people in high-risk jobs are not easily anxious and when they are, they are able to control it quite well,” says Smith.

面對極限探險的壓力時,某些性格類型的人會更加自如。有研究顯示,神經沒那麼敏感的人表現得更好。史密斯說︰“我們發現,從事高危工作的人更不容易焦慮,即使焦慮也能控制好。”

Conscientiousness also play a role. A study looking at the personality traits of people willing to take a parabolic flight, for example, found that conscientiousness allowed them to cope better with extreme demands. This goes against the common notion that people who take part in extreme activities are adrenaline junkies. “What we found is that people typically spend a lot of time de-risking,” says Smith. “They do a lot to avoid having an adrenaline rush because to them that signals a threat.”

這也與負責心有關。例如,一項研究調查了願意嘗試飛機拋物線飛行的人有哪些性格特質,結果發現責任心能讓他們更好地應對極端的要求。人們普遍認為敢于嘗試極限活動的人玩的就是心跳,但這項研究的結論恰好相反。史密斯說︰“我們發現,這些人常常會花很多時間來降低風險,會盡力避免腎上腺素飆升,因為他們覺得這是一個危險信號。”

Nutbeam and his team had to be diligent to deal with the challenges they faced during the long journey. Throughout the trip, for example, Nutbeam had to monitor the temperature of the bagged blood, ensuring that it remained within a narrow optimum range. The front of the plane, where the team was huddled, was kept warm, but it was about -10C at the back. “I had to try and find a sweet spot to put the blood and had to check on it every hour,” he says.

此次漫長的旅程中,努特皮姆和團隊必須積極應對各種困難。譬如,努特皮姆需要全程監控血袋的溫度,確保它處于有限的最佳溫度範圍之內。大家都擠在較為溫暖的機頭,機尾的溫度則低至零下10攝氏度。他說︰“我得找個合適的地方放置血袋,而且每小時都要檢查一次。”

The team landed in Halley just as dawn broke and had about an hour and a half to retrieve Roberts before it would be too dark to take off again. It was -30C without the windchill factor. Nutbeam took a snowmobile to the station where he successfully performed what is thought to be the first Antarctic blood transfusion on Roberts and transferred him to the plane. Meanwhile, the engineer kept the plane’s engines functional, since if they got too cold they wouldn’t be able to start up again.

破曉時分,援救團隊成功抵達哈雷基地,有一個半小時的時間將羅伯茨運上飛機,再晚天就黑得無法起飛了。氣溫已經到了零下30攝氏度,寒風將體感溫度降得更低。努特皮姆坐著雪地摩托抵達基地,並在羅伯茨身上成功進行了南極第一例輸血,隨後把他轉移到了飛機上。與此同時,飛行員保持發動機運轉,因為引擎一旦過冷就再也發動不起來了。

Nutbeam says that nothing was meticulously planned due to the unpredictable circumstances. His strategy was to “wing it in an informed way”.

努特皮姆表示,由于情況難以預料,他們的計劃也很粗略。他的策略是“隨機應變,恰當處理”。

After interviewing expeditioners, Smith and his colleagues found that excessive planning was less important than having confidence in one’s skills. “Then it comes down to being flexible and adaptable and being able to adjust to the situation as it unfolds,” he says. “There are lots of things you can’t control so being able to accept that is really important.”

史密斯和同事們在采訪過探險隊員後發現,自信要比太詳盡的計劃重要得多。他說︰“然後就是要靈活處理隨機應變,要根據事態發展相機行事。有許多事情是你無法控制的,能接受這一點也很重要。”

Sleep deprivation

睡眠嚴重不足

Even a combination of expertise, conscientiousness and confidence could not make up for perhaps the biggest challenge: the extreme sleep deprivation of the 48-hour flights. Nutbeam says that he slept for about four hours over the course of the mission. “I just wasn’t functioning as a human,” he adds.

訓練有素、盡職盡責、滿懷信心,即使具備了這三點,也無法忽略可能是救援任務中最大的挑戰︰飛行48小時所造成的睡眠嚴重不足。努特皮姆說任務中他一共就睡了四個小時,還說“他已經不是自己了”。

Microsleeps quick bouts of shut-eye that can last between a fraction of a second and 30 seconds can help the body recuperate. “The brain finds ways to catch up on sleep in short bouts if it can’t otherwise obtain the sleep it needs,” says Hans Van Dongen, the director of the Sleep and Performance Research Center at Washington State University in the US.

閉目養神不到半分鐘的微睡眠有助于恢復體力。美國華盛頓州立大學睡眠與表現研究中心的主任凡•東恩(Hans Van Dongen)說︰“不能好好睡覺的時候,大腦會通過短暫休息來補充睡眠。”

However, microsleeps cause lapses in attention that affect performance if they occur while driving often resulting in car accidents for example.

但是微睡眠也會分散注意力,影響各種表現——一個人如果剛好在開車就很可能發生車禍。

During the long flight back to Chile, Nutbeam was so tired that he had trouble recalling medical knowledge and making choices. And that posed some serious dangers, given that Roberts’ condition required constant monitoring and there were important medical decisions to be made. Around Rothera, for example, they needed to be flying high to pass the tall mountains below. Roberts, however, had a low circulatory blood volume due to his bleed, which affects how long he could tolerate high altitude without the need for more blood.

在返回智利的長途飛行中,努特皮姆異常疲憊,甚至都忘了醫學知識,也無法下醫療決斷。這很危險,因為羅伯茨的情況需要時時監控,需要重要的醫療決定。例如在羅瑟拉基地附近時,飛機需要高海拔飛行以越過高大的山體,但是羅伯茨由于失血體內的血液循環量很低,要考慮如果不輸血,他的血量能夠承受多長時間的高海拔飛行。

“I needed to make a decision about Malcolm’s care and just could not decide,” says Nutbeam an unfamiliar sensation for him. “I am normally pretty pragmatic in my approach and don’t struggle with decisions.”

“我需要根據羅伯茨的狀況做出決斷,但我沒法下定決心,我通常都很講求實效,從來都很果決。”努特皮姆說,他從未有過這樣的情況。

Sleep also plays a role in regulating emotions and can affect mood: the emotional centers in the brain are less connected when a person hasn’t had enough rest so it’s harder to control one’s feelings. As a result, sleep-deprived people can be overly grumpy or giddy, says Von Dongen.

睡眠也能調節情緒,影響心情︰如果睡眠不足,大腦里情緒中心的聯系就不那麼緊密,自我情緒控制能力就會下降。凡•東恩說,睡眠不足的人可能會特別暴躁,或是昏昏沉沉。

And this would be an additional challenge to Nutbeam’s decision making when, at a later point in the flight, Roberts suffered a stroke. Nutbeam had to give him more blood as well as fluid and medication to stabilise him. “I remember feeling quite emotionally overwhelmed,” says Nutbeam. “He must have been feeling terrible but was incredibly stoical.”

在航程後段,羅伯茨中風了,這也給努特皮姆增加了挑戰。為了穩定病人的身體狀況,努特皮姆要給他加大輸血,也增加了輸液和用藥。他回憶說︰“當時我情緒上有些承受不住了。羅伯茨一定很難受,但他很堅強。”

Understanding the effects of sleep loss can help people cope, says Smith. “People can prepare for it and think about how it might shape their decision-making,” he says. Nutbeam says that he knows that he is much less tolerant when he’s tired, which might have helped.

史密斯說,知道缺乏睡眠的後果就能更好地應對。他說︰“可以對此有所準備,想想這些後果會如何影響自己做決定。”努特皮姆說他疲憊時很沒有耐心,如果知道這一點可能會有所幫助。

Teamwork

團隊合作

Nutbeam was also fortunate to have a dedicated team that helped to keep his sleep-deprived mind in check. In addition to the team aboard the plane, there was a remote support network keeping a close eye on their journey from afar.

所幸有一個專門的團隊幫助努特皮姆控制睡眠不足時的情緒。除了同行的團隊外,還有一個遠程支援網絡密切關注他們的情況。

During stopovers, when they were able to communicate, colleagues abroad informed the team of weather conditions to help ease the logistical decision making.

中轉停留期間能夠進行通訊,遠程團隊會向飛機救援小組通報天氣情況,幫助他們進行後勤安排。

Nutbeam also had regular debriefs with his boss in the UK about treatment and what to do in various circumstances.

努特皮姆還會定期向英國的上司匯報治療情況,以及在不同境況下要如何應對。

When the plane landed in Rothera, for example, Roberts had another gastrointestinal bleed. There was a doctor there to help. But Nutbeam didn’t want to leave Roberts, even though he was exhausted.

飛機在羅瑟拉基地降落時,羅伯茨再次腸胃出血。基地有位醫生可以幫忙,雖然努特皮姆已經精疲力竭,但還是寸步不離羅伯茨。

A call from his boss in the UK put things in order. She told Nutbeam to let the local doctor take over so he could get some sleep: he was the only one that could look after Roberts during the remaining flight. “It was the best advice in the world,” says Nutbeam. “Otherwise I think I would have stayed with him and been even more tired and psychologically broken for the final leg of the journey.”

努特皮姆的上司從英國打來電話,將一切布置得井井有條。她讓努特皮姆交給基地醫生暫時接管,自己休息一下,畢竟在接下來的航程中,能照看羅伯茨的就只有他一個人了。努特皮姆說︰“沒有比這更好的建議了。不然我會一直陪著他,最後一段航程身心都會更加疲憊。”

Tense situations can be easier to handle when there are others around. “Being in a dangerous environment surrounded by competent people who are supportive is a good way of mitigating stress,” says Smith.

周圍有其他人時緊張情況會比較容易處理。史密斯說︰“人在危險中如果能得到有能力人的支持,可以有效緩解壓力。”

It all depends on the team dynamics, though: if people aren’t able to work well together it can have a negative impact on the functioning of the group. Personality traits in particular agreeableness - can often predict who will be a good team player. “People that have to work in small groups in risky settings tend to be good at getting on with people,” says Smith. “They are good at communicating effectively and maintaining group function.”

這與團隊的狀態密切相關︰如果一個團隊無法和諧相處,那麼整個團隊的運作勢必受到負面影響。不難從性格品質(尤其是令人愉快的品質)的角度推斷誰能成為一位好隊員。史密斯表示︰“一般來說,在高風險下從事小組合作的人處理起人際關系更勝一籌。他們知道如何有效溝通,如何保持團隊運作。”

Aftermath

後續影響

After the final flight from Rothera, the plane landed in Punta Arenas, Chile. Roberts was transferred to a hospital where he was successfully treated. But Nutbeam didn’t feel like the mission was over yet. “I really didn’t want to let Malcolm go,” he says. “I wanted to go with him to the hospital even though I could hardly string a sentence together.”

離開羅瑟拉基地後,飛機最終在智利蓬塔阿雷納斯鎮著陸,羅伯茨被轉移到醫院並成功接受了治療,但努特皮姆卻覺得任務尚未完成。他說︰“我真的不想離開羅伯茨,我想和他一起去醫院,雖然我當時已經連話都說不完整了。”

Expedition groups often have similar reaction when they return. After having lived through an intense experience together, there is a sense of empathy among those who were there, says Smith. It can also be hard to communicate what it was like to people who weren’t present so there is a tendency to be drawn to those who shared the experience.

探險隊員回來後常有類似的反應。史密斯解釋說,他們在高強度的環境中共同生活了一段時間,會對還留在那里的同僚產生同理心。他們也很難將這種情緒向沒有類似經歷的人傾訴,因此有相似經歷的人會走得更近。

Nutbeam was able to visit Roberts regularly at the hospital and there was a daily meeting about his recovery which gradually helped him readjust.

努特皮姆可以定期去醫院看望羅伯茨,每天都有例會討論康復情況,他也慢慢把狀態調整了回來。

According to Smith, people often reflect on what happened and what could have happened for about three weeks afterwards. After playing an important part in a mission, people may feel like they have no purpose when they return but finding something meaningful to do can ease the transition.

史密斯說,任務結束後,人們會去思考所發生的事情以及可能發生的事,這往往會持續三周時間。要是曾在任務中擔當重任,之後可能會覺得喪失了奮斗目標,做些有意義的事情能夠幫助心理過度。

“Writing a report or putting your experience into a story is really helpful psychologically,” says Smith.

史密斯說︰“從心理學的角度來說,寫工作報告,或者把自身經歷寫成故事都很有幫助。”

New types of training could help too. People working in extreme environments, such as astronauts or military workers, do a lot of simulations as preparation. But according to Smith, it’s rare to have training that focusses on the psychological aspects of a mission. “It seems a bit like missing a trick,” he says. “There is a lot that could be done to equip people with strategies to deal with these environments.”

新的訓練方式也有所裨益。像宇航員、軍人這樣需要在極端環境中工作的人,準備任務時一般要進行大量的模擬訓練,但史密斯表示很少有心理上的訓練。他說︰“這好像少了一環。指導人們適應極端工作環境有很多可以做的。”

In a sense, the rescue was just a more extreme version of what emergency room doctors encounter every day.

從某種意義上說,這場救援只是急診室日常工作的一個極端案例罷了。

As a coping strategy, Nutbeam recommends mentally rehearsing events beforehand when well-rested. “This can prepare your mind for the insult of sleep deprivation,” he says.

努特皮姆建議,趁還能充分休息的時候先在心里演練救援。他說︰“這樣能為睡眠不足做好心理準備。”

Upon reflection, Nutbeam isn’t convinced that he would take part in such a mission again. He had mentally prepared himself to be the back-up doctor so hadn’t analysed the risks involved beforehand. Now he realises that there was a significant chance that they could have been stranded or suffered harm. “It’s nice to reflect on a successful rescue but there is a need to consider all the opportunities for it to go wrong and was the risk justified,” he says. “I’ve still not quite got my mind around that.”

事後再去回顧時,努特皮姆認為自己當時並不覺得會去參加救援任務,對自己的定位只是個備選醫生,因此沒有預先考慮那麼多問題。現在他意識到,任務過程中飛機很有可能不能起飛,他們也可能受傷。他說︰“回憶一次成功的救援固然讓人開心。但也要去想一想有哪些地方可能會出現問題,能不能避免。我到現在還會去想這些問題。”

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