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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

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.


“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.


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.


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.


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.


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.


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.


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.


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?


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


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.


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


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.


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


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


“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.


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.


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.


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


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.


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.


But not everyone hailed the achievement.


“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.


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.


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.