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更新時間:2019/5/12 8:19:29 來源:紐約時報中文網 作者:佚名

Cape Town's inspiring medical marvel
世界首例心髒移植手術的故事

Dawn was breaking on 3 December 1967, an otherwise unremarkable day in apartheid South Africa. But in operating theatre 2A, deep in the bowels of Cape Town’s Groote Schuur Hospital, history was being made.

1967年12月3日,是當時仍在種族隔離下的南非的一個普通日子。但在開普敦格羅特舒爾醫院(Groote Schuur Hospital)深處的2A手術室里,醫務人員正在創造醫學史上的奇跡。

Around 06:00, with Professor Christiaan Neethling Barnard watching anxiously from behind his surgical mask, the heart of Denise Darvall lurched unsteadily back to life, slowly finding its rhythm. But one thing had changed. Now, it was beating inside the chest of Louis Washkansky. The world’s first human heart transplant was a success.

6點左右,戴著外科手術口罩的巴納德(Christiaan Neethling Barnard)教授焦慮地看著達沃爾(Denise Darvall)的心髒不穩定地恢復了生命,慢慢地找到了節奏。但發生改變的是,這顆心髒現在在沃斯坎斯基(Louis Washkansky)的胸腔內跳動。世界首例人體心髒移植手術成功了。

It was a pivotal moment in medical history, an event that made headlines around the world and transformed Barnard into an overnight celebrity. And the journey up to, and beyond, the moment of the world’s first human heart transplant is expertly told in the very corridors where the operation took place.

這是醫學史上的一個重要時刻,這件事成為世界各地新聞的頭條,巴納德也一夜間成名。之後,專家們在手術的走廊里,生動講述了第一例人類心髒移植手術當時以及後來發生的事情。

“This is not just a museum, this is a heritage site,” said Hennie Joubert, founder and curator of The Heart of Cape Town Museum. “This is where it all happened.”

開普敦心髒博物館(The Heart of Cape Town Museum)的創始人兼館長的朱伯特(Hennie Joubert)說︰“這不僅僅是一個博物館,還是一個歷史遺跡。這里也是事件發生的地方。”

The Heart of Cape Town Museum is housed within the walls of Groote Schuur Hospital, one of the largest public hospitals in Cape Town, South Africa. Visiting the museum today, you’ll wander past orderlies in scrubs and family members visiting with care parcels. For as much as this is a heritage site, it remains a frenetic working hospital and the primary teaching hospital for the University of Cape Town’s medical faculty.

開普敦心髒博物館建在南非開普敦最大的公立醫院,格羅特舒爾醫院的圍牆內。今天參觀博物館時,你會看到穿著工作服的醫護人員以及帶著慰問品的病人家屬。這里既是一個歷史遺跡,也是一個正常運轉的繁忙的醫院,還是開普敦大學醫學院的主要教學醫院。

Barnard and the heart transplant have long fascinated Joubert. His father and Barnard became friends while studying together at the University of Cape Town, and before Barnard delved into the world of surgery the pair shared a general practice in the small farming town of Ceres.

巴納德做的心髒移植手術一直讓朱伯特感慨稱贊。他的父親和巴納德在開普敦大學學習期間成為好友,在巴納德全神投入外科領域之前,兩人還一起在南非的農業小鎮錫里斯(Ceres)當過全科醫生。

Joubert sold his oncology business in 2006 and opened the museum in 2007 to mark the 40th anniversary of the operation. “I told my wife that I was going to build a museum by any means possible,” he chuckled. Over the years, Joubert has poured more than R8 million (nearly £440,000) of his own money into the project, renovating and restoring the original operating theatres, creating exhibits and collecting memorabilia from the event.

朱伯特在2006年賣掉了自己的腫瘤學生意,並在2007年開設了該博物館,以紀念手術成功40周年。他笑著說道︰“我告訴我的妻子,我會用一切可能的方法來建一個博物館。”多年來,朱伯特已經自行出資800多萬南非蘭特(近44萬英鎊)投入該項目,翻新、修復了原來的手術室,策劃了多次展覽,並收集了這場手術的有關紀念品。

The museum traces Barnard’s path to medical history across seven exhibition spaces, along with the worldwide research and rivalry that paved the way for the first human heart transplant.

博物館通過7個展覽空間追溯巴納德的從醫之路,同時還講述了,為首例人類心髒移植打下基礎的世界各地的研究以及競爭對手的故事。

For Barnard certainly wasn’t the only heart surgeon hoping to suture their name into the history books. In the United States, Dr Richard Lower and Dr Norman Shumway spent the late-1950s and 1960s perfecting transplant procedures on dogs, and Barnard drew heavily on their research and methods in his own trials with canine ‘patients’ in South Africa.

巴納德當然不是唯一一個希望將自己的名字載入史冊的心髒外科醫生。美國醫生洛爾(Richard Lower)以及沙姆威(Norman Shumway)在20世紀50年代後期以及60年代,一直在狗的身上試驗移植手術,而巴納德在對南非犬類“患者”進行的試驗中,也大量借鑒了他們的研究和方法。

In exploring these early trials, which took place at the height of South Africa’s apartheid period of racial segregation, the museum also touches briefly on the crucial role black and mixed-race assistants played in the historic transplant. Hamilton Naki, in particular, became famous for his rise from hospital groundskeeper to a skilled member of the team assisting with transplant research in Groote Schuur’s animal laboratory.

開普敦心髒博物館,在介紹南非種族隔離時期的早期實驗的同時,也簡要介紹了黑人及混血助理在這一歷史性的手術移植中扮演的重要角色。在這些人中,納基(Hamilton Naki)尤為出名,他從醫院場地管理員,一路晉升為格羅特舒爾動物實驗室協助移植研究技術團隊成員。

And in many ways, South Africa was an unusual place for this medical breakthrough to have taken place. In 1967, the country was in the grips of apartheid, increasingly isolated from the world for its policies of racial segregation.

從很多方面來看,南非是取得這一醫學突破不尋常的地方。1967年,該國處于種族隔離狀態,也因為種族隔離政策而日益與世界隔絕。

But part of Barnard’s success came down to the legal interpretation of death. While South African doctors could pronounce a patient brain dead and make preparations for organ donation, in the US only the absence of a heartbeat qualified a patient as legally dead. Shumway ridiculed this as an antiquated “boy-scout definition of death”, and it nearly saw Lower prosecuted for murder after performing his first heart transplant, the world’s 16th, in May 1968.

巴納德的成攻部分歸結于對死亡的法律解釋。南非的醫生可以宣布患者腦死亡,並為器官捐獻做準備,但在美國,只有患者停止了心跳才會被法律上認定為死亡。沙姆威嘲笑這是一個過時的“童子軍式對死亡的定義”,而這一定義也險些讓洛爾在1968年5月進行的自己做的第一例,世界第16例心髒移植手術,被控謀殺罪。

Without locating the family of the donor, Bruce Tucker, Lower proceeded with the operation and removed the man’s heart for transplant. When Tucker’s family learned what had happened, they filed a lawsuit for wrongful death. Lower was eventually cleared of any wrongdoing in 1972, and the precedent ultimately changed US legislation on the determination of death.

洛爾在沒有聯系到器官捐獻者塔克(Bruce Tucker)家人的情況下,就開始手術摘除了這名男子的心髒進行移植。當塔克的家人知道發生的事情後,就以非法死亡提起訴訟。洛爾最終在1972年,被證明沒有不當行為,而這一先例也最終改變了美國關于死亡裁定的立法。

Death, as much as life, is a thread that runs through the museum, and its most moving corner comes not from the researchers and surgeons battling for fame, but in the bedroom of Denise Darvall, the 25-year-old bank clerk who unwittingly found herself written into the history books.

和生命一樣,死亡也是貫穿博物館的一條線索,而其中最動人的角落不是來自研究人員和外科醫生的榮譽,而是達沃爾(Denise Darvall)的房間。這名25歲的銀行職員無意中被寫入了歷史。

Running errands with her family on 2 December 1967, she and her mother were knocked down by a car on Main Road, which runs below Groote Schuur. While her mother, Myrtle, was killed instantly, Denise sustained brain injuries that would, hours later, prove fatal. In the museum, the walls of her recreated bedroom are filled with personal effects donated by the Darvall family, including sketches from her diaries and a small bible. Scattered across the bed are a handful of her vinyl records, mostly waltzes and opera of the day.

1967年12月2日,達沃爾和家人一起外出辦事時。她和母親在格羅特舒爾醫院下方的主干道上被車撞倒。達沃爾的母親默特爾(Myrtle)當場死亡,而達沃爾的腦部受了致命傷,幾個小時後就會喪命。博物館重現了達沃爾的臥室,牆壁上掛滿了達沃爾家庭捐贈的各類私人物品,包括她日記里的素描和一本小的聖經。床上散落著她的許多黑膠唱片,主要是當時的華爾茲和歌劇。

But what is most striking here are the words, tucked away on a wall display, from her father. Just hours after losing his wife and daughter, doctors asked his permission for Denise’s heart to be transplanted into the chest of a desperately ill 54-year-old patient. His reply?

但最震懾人心的是牆壁上寫著的她父親說的話。在失去妻女幾小時後,醫生詢問他是否同意將達沃爾的心髒移植到一位垂危的54歲病人體內。他是怎麼回答的?

“Well, doctor, if you can’t save my daughter, try and save this man.”

“好吧,醫生,如果您救不了我的女兒,就試著救這個人吧。”

That man was Louis Washkansky, who we find in mannequin form in a ward bed in another room. He’d been admitted with little hope of a cure for his progressive heart failure. Look carefully at the copies of the medical charts above his bed and one scrawled doctor’s comment stands out.

這位接受心髒移植的人就是沃斯坎斯基,我們在另一個房間的病床上找到了他的人體模型。他當時因患進行性心力衰竭住院,已經沒有治愈的希望。仔細看看他床頭的醫療表格的復印件,是一位醫生用潦草的字跡寫下的很特別的診斷。

“No operation will help. Let nature take its course.”

“任何手術都幫不上忙。順其自然吧。”

Barnard disagreed, and the ambition of this young surgeon is well told in the recreation of his office. Wall panels trace his journey from humble beginnings as a pastor’s son in the semi-desert town of Beaufort West to his frustrations in general practice to his later surgical training in the US. In the adjoining auditorium, a 26-minute documentary unpacks the many facets of Barnard: a brilliant surgeon, but a man who generated controversy throughout his career.

巴納德並不同意這個結論,這位年輕外科醫生的雄心壯志也在這間重現的辦公室里得到了很好的體現。牆上的瓖板記錄了他的經歷,從一個半沙漠小鎮博福特西(Beaufort West)的牧師兒子的平凡出身,到備受挫折的全科醫生,再到後來在美國接受的外科專業培訓。在毗鄰的禮堂里,放映著一部26分鐘的紀錄片,揭示了巴納德的許多方面︰他是一位才華橫溢的外科醫生,也是一位在職業生涯中引起不少爭議的人。

All of which is a prelude to the pair of operating theatres where the historic transplant took place in the early hours of 3 December 1967. Theatre 2A, where Washkansky lay waiting on an operating table for a new heart, and 2B, where Darvall lay ready to donate hers.

所有這些都是這兩間手術室的前奏,這一具有歷史意義的移植手術是在1967年12月3日凌晨的幾個小時進行的。當時沃斯坎斯基躺在2A手術室的手術台上,等待新的心髒,而達沃爾則躺在2B手術室里,準備捐獻她的心髒。

“I wanted to make the museum back to exactly how it looked the night of the operation. I became obsessed with it,” Joubert reminisced.

朱伯特回憶說︰“我想讓博物館回到手術當晚的樣子。我對此非常著迷。”

Happily, the bureaucracy of South Africa’s public health system proved useful.

令人高興的是,南非公共衛生系統的繁文縟節還是有用的。

“The documentation of Groote Schuur Hospital was very accurate, so all the serial numbers of all the equipment that was in the theatre the night of the operation was available,” Joubert recalled.

朱伯特回想說︰“格羅特舒爾醫院的記錄非常準確,所以當晚所用手術設備的序列號都能查到。”

Returning the equipment to its original home didn’t always prove simple, though. The theatre bed on which Darvall lay in theatre 2B had been donated to the Roman Catholic Hospital in the Namibian capital, Windhoek.

不過,把這些設備運回來並沒有那麼簡單。達沃爾在2B手術室躺過的那張病床已經捐給了納米比亞首都溫得和克(Windhoek)的羅馬天主教會醫院(Roman Catholic Hospital)。

“I phoned the head of the hospital and explained that I needed the bed back in Cape Town because it’s part of history, South African history,” Joubert said. He replaced the bed with a new one and brought the original back to Cape Town.

朱伯特說道︰“我給醫院負責人打了電話,解釋說我得把那張病床要回來放在開普敦,因為它是南非歷史的一部分。”他重新給羅馬天主教會醫院買了一張病床,並把原來的那張床帶回了開普敦。

The theatre light from 2B had also been sold off, but Joubert tracked it down to a local veterinary hospital and convinced the owners to return the original to the museum.

2B手術室的手術燈也已出售,但朱伯特一路追蹤,在當地一家獸醫院找到了。他說服了獸醫院人員將原物送回了博物館。

The inclusion of original memorabilia lends a definite authenticity to the museum.

原始物件的陳列為博物館增添了現場的真實性。

In theatre 2A, the original heart-lung machine that kept Washkansky alive stands in place to one side. The scale used to measure blood loss was tracked down in a hospital storeroom, and today can be found at the nurse’s station in theatre 2A. In Barnard’s recreated office, his mannequin sits behind the original desk from his office at the University of Cape Town. The old leather doctor’s satchel on the mantelpiece is from his time as a general practitioner in Ceres.

在2A手術室里,維持沃斯坎斯基生命的那台心肺機器擺在一側。用來測量血液流失的量表也在醫院的儲藏室找到,現放在2A手術室的護士站立處。在重現的巴納德的辦公室里,他的人體模型坐在他在開普敦大學時用的那張辦公桌後面。而壁爐架上放著年限已久的皮質醫生背包,則是他在錫里斯當全科醫生時用過的。

In the corridor outside the operating theatres, display cases are filled with the original telegrams and letters that flew in from across the globe once news of the transplant broke. Shumway sent Barnard his congratulations and no doubt unwelcome advice on post-operative care.

在手術室外面的走廊,展示櫃里擺滿了當時移植手術成功的消息傳出後,來自世界各地的電報和信件原件。沙姆威向巴納德發來︰,也發來了有關術後護理的建議。毫無疑問,這些建議並不受歡迎。

But not everyone hailed the achievement.

但並不是所有人都稱贊這次成就。

“To the butcher of Groote Schuur Hospital,” reads a note from Mary Power Slattery in Chicago. “A bunch of ghouls, all of you,” wrote S Peschel from Arlington, Virginia.

來自芝加哥的斯拉特雷(Mary Power Slattery)就寫道︰“至格羅特舒爾醫院的屠夫們。”而來自佛吉尼亞阿靈頓(Arlington)的裴斯切爾(S Peschel)則寫道︰“你們這群食尸鬼,每一個人都是。”

But of all the artefacts in the Heart of Cape Town Museum, the most important are surprisingly easy to miss.

但讓人意外的是,在開普敦心髒博物館所有的藏品里,最重要的往往最容易被人遺漏。

Inside a glass case set into the walls of theatre 2B, you’ll find two glass cubes filled with formaldehyde preserving two important artefacts. On the left: the diseased heart that had failed Louis Washkansky. On the right: the heart of Denise Darvall that turned Barnard into a household name.

在2B手術室的牆內嵌著的兩個玻璃櫃里,有兩個裝滿了甲醛、保存著兩樣重要東西的玻璃立方體。左邊是沃斯坎斯基心衰的心髒。右邊則是達沃爾的心髒,正是它讓巴納德成為家喻戶曉的名人。

Washkansky lived for only 18 days after the transplant, eventually succumbing to double pneumonia. But as he breathed his last, Darvall’s heart was still beating strongly inside the chest of another human being.

沃斯坎斯基在心髒移植手術後只活了18天,最終因雙側肺炎去世。但直到他最後一次呼吸時,達沃爾的心髒仍然在他的胸腔內有力地跳動著。

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