当麻醉失效，病人被切开时

来自《纽约时报》，我是蕾切尔·阿布拉姆斯，这里是《每日新闻》。

From The New York Times, I'm Rachel Abrams, and this is The Daily.

剖宫产是美国最常见的外科手术。

C sections are the most common surgery in The United States.

但事实证明，在大量案例中，麻醉都失效了。

But it turns out, in a shocking number of them, the anesthesia is failing.

这导致女性在手术进行时仍能清晰感受到整个过程。

And that's leaving women to feel a major surgery as it is being performed.

记者苏珊·伯顿为我们同事在《Serial Productions》制作了一系列关于这一现象的报道。

Writer Susan Burton made a series about this phenomenon for our colleagues at Serial Productions.

今天，她向我们讲述了她采访的一些女性，以及关于她们经历普遍性的最新研究。

And today, she tells us about some of the women she spoke to and the new research on how common their experiences are.

今天是2月6日，星期五。

It's Friday, February 6.

苏珊，非常感谢你来到这里。

Susan, thank you so much for being here.

当然。

Of course.

谢谢。

Thank you

感谢您邀请我。

for having me.

您对如此可怕的事情进行了大量出色的报道——这些女性在剖腹产过程中竟然能清楚地感受到手术，这听起来简直像噩梦或恐怖电影里的情节。

You have done so much tremendous reporting on something really horrific, which is all of these women who have gotten c sections and could actually feel them, which sounds like something literally out of a nightmare, out of a horror movie.

最近，有一项研究证实了您之前收集的这些亲身经历。

And recently, there was a study that came out that actually backed up some of these anecdotes that you had been collecting.

所以

So

您是怎么

how did you

一开始就开始接触这些女性的呢？

even get started talking to these women in the first place?

所以在2023年，我做了一个故事，以播客系列的形式发布，表面上看有点像真实的犯罪剧情。

So in the 2023, I did a story published as a podcast series that on the surface had kind of this true crime y plot.

一名护士从耶鲁大学运营的生育诊所偷走了芬太尼，并用生理盐水替换了它。

A nurse had stolen fentanyl from a fertility clinic run by Yale University and replace that fentanyl with saline.

这意味着，这家诊所的许多接受手术的患者经历了剧烈的疼痛。

And, essentially, what this meant was that a lot of patients at this clinic who had surgical procedures experienced excruciating pain

嗯。

Mhmm.

在这些手术过程中。

During those procedures.

因此，这个播客的核心主题是医疗领域对女性疼痛的普遍忽视，这引起了大量听众的共鸣。

So that was the underlying theme of the podcast, you know, the kind of routine dismissal of women's pain in medicine that resonated with a lot of listeners.

嗯。

Mhmm.

成百上千的人，主要是女性，开始给我发送她们自己遭遇疼痛被忽视或治疗不足的故事。

And hundreds of them, mostly women, began to send me stories about their own experiences of inadequately treated or ignored pain.

所以有很多关于宫内节育器植入或子宫内膜异位症经历的故事。

So lots of stories about things like IUD insertions or experiences with endometriosis.

这些邮件令人动容。

And these emails were you know, they were moving.

它们令人难过。

They were upsetting.

它们充满真情实感。

They were raw.

然后有一天下午，我打开了一封与我之前收到的任何邮件都不同的邮件。

And then one afternoon, I opened an email that was unlike any of the others I'd received so far.

写信人说，她在剖腹产过程中全程都有知觉。

The writer said that she had felt everything during her c section.

她感受到了医生切开她的身体。

She had felt the doctor cutting into her.

她说，她感受到了自己的内脏被挪动。

She had felt, she said, her organs being moved around.

天啊。

Oh my god.

因为我们应该提醒人们，这是一次重大腹部手术。

Because we should remind people this is a major abdominal surgery.

是的。

Yes.

我很高兴你提到了这一点，因为很多人以为，哦，剖腹产算不上真正的手术。

I'm really glad you pointed that out because a lot of times people think, like, oh, a C section, that's not a real surgery.

这确实是一场真正的手术，而且是一次重大腹部手术。

It is a very real surgery, and it's a major abdominal surgery.

在美国，有三分之一的产妇会接受剖腹产，所以这其实是一种相当普遍的手术。

A third of women who give birth in The United States will have a C section, so it's also a surgery that a lot of people have.

所以，我收到了这封邮件，它让我非常不安。

So, you know, I get this email, and it was so disturbing.

我当时想，这会不会是个例外？

I thought, was this maybe a one off?

嗯嗯。

Mhmm.

我回复了那位听众，随后在二十四小时或最多四十八小时内，我又收到了两封邮件，描述的内容非常相似。

I wrote back to the listener, and then within twenty four or maybe forty eight hours, I had opened two more emails describing something really similar.

那时我才意识到，好吧。

And that was the point where I was like, okay.

这是普遍现象吗？

Is this a thing?

于是我开始和人们谈论这件事，逐渐发现这些经历中存在一些共同模式。

So I started talking to people about it, and I came to recognize that there were patterns in these experiences.

我被紧急推进去剖腹产。

I was rushed into the c section.

我丈夫在场，我能感觉到他们开始做手术。

My husband was there, and I could feel them starting the operation.

我能感觉到切口。

I could feel the incision.

比如，那种对手术的感知方式完全令人震惊。

So, for example, feeling the surgery in a way that was just totally shocking.

那种感觉像在灼烧。

It was burning.

就像有人拿了一块烧红的金属贴在我的肚子上。

It was like someone took a hot piece of metal and put it against my stomach.

右边有一位护士。

There was this nurse on my right side.

我只记得握着她的手，一遍又一遍地告诉她我能感觉到一切，我依然能感觉到。

I just remember holding her hand and telling her over and over again that I can feel everything, that I still feel it.

我依然能感觉到。

I still feel it.

你发声之后，却被告诉说你感受到的只是压力。

Speaking up and after you've spoken up, being told that what you're feeling is just pressure.

所以你的疼痛被错误地归因为其他东西。

So having your pain mischaracterized as something else.

他说，这不可能。

And he said, well, that's not possible.

你知道，如果你真的感到疼痛，早就疼晕过去了。

You know, if you were feeling it, you would pass out from the pain.

我当时就想，我真希望我能疼到晕过去。

And I was like, I wish I could pass out from the pain.

他们把我的儿子抱出来的时候，我浑身发抖，疼痛太剧烈了，根本抱不住他。

When they took my son out, I was shaking and I was I was I was so much in pain that I I could not hold him.

我一说到这个就忍不住发抖。

It was I'm shaking just talking about it.

这是一次没有完全麻醉的重大腹部手术。

It it was major abdominal surgery without full anesthesia.

手术后发生的一些令人不安的事情，比如经历从未被承认。

And some of the really unsettling things were happening in the aftermath of the surgery, like experiences never being acknowledged.

没有人道歉，也没有人解释发生了什么。

Nobody apologizing, nobody explaining what had happened.

所以你在这些不同的故事中听到了同样令人恐惧的主线。

So you're hearing the same horrifying through line in a lot of these different stories.

给我们讲讲一位特别让你印象深刻的人吧。

Tell us about one person who maybe stood out to you.

当然。

Sure.

我采访过的一位女性，她的名字叫瓦妮莎·伦纳。

So one of the women I spoke to, her name is Vanessa Lenner.

她怀孕时已经三十多岁了。

She was in her late thirties when she got pregnant.

她住在佛罗里达州。

She lives in Florida.

她是一名医师助理，她的丈夫是一名从事航空航天工程的工程师。

She works as a physician's assistant, and her husband is an engineer who works in aerospace.

就是这样。

Just like that.

她去医院分娩。

She showed up at the hospital to give birth.

我是在39周时被催产的。

So I was induced at thirty nine weeks.

我觉得那大概是39周的某一天。

I think it was, like, thirty nine weeks in one day.

第一胎真是让人兴奋。

Super exciting first baby.

我们到医院时，我觉得我才开了1厘米。

We got to the hospital, and I think I was only, like, one centimeter dilated.

她安排了催产，就是用药物启动宫缩。

She had a scheduled induction, which is when you get drugs to start your labor.

她用了药物。

She gets the drugs.

一切都很顺利。

Everything's going fine.

我们吃了晚饭。

We had dinner.

那时候快到万圣节了，所以电视上正播放《Hocus Pocus》。

It was, like, close to Halloween, so, like, Hocus Pocus was playing on the TV.

你知道的，一切刚开始的时候其实挺顺利的。

Like, you know, everything was really it started really good.

几个小时过去了。

And hours pass.

情况变得越来越紧张。

Things get more intense.

她很痛苦。

She's in pain.

她打了无痛分娩针。

She gets an epidural.

你知道，分娩时打无痛分娩针是为了减轻不适。

And, you know, when you get an epidural during labor, right, that's to reduce your discomfort.

但对于范妮莎来说，硬膜外麻醉似乎并没有起到应有的效果。

But for Vanessa, the epidural, like, isn't really working right.

是的。

Mhmm.

她当晚住在医院里。

She's in the hospital overnight.

她感到很不舒服，一直在床上辗转反侧。

She's a lot of discomfort, kind of, you know, moving around in the bed.

到了第二天。

It's the next day.

从这一切开始已经过去了二十四小时。

It's been twenty four hours since this all started.

范妮莎的心率略微上升了。

Vanessa's heart rate is rising a little bit.

婴儿的心率也略微上升了。

The baby's heart rate is rising a little bit.

宝宝没有往下移动，医生们说：‘我觉得是时候进行剖腹产了。’

The baby's not moving down, and the doctors are like, well, you know, I think it's time to do a c section.

我对这个决定基本是接受的。

And I was pretty much okay with that.

你知道，我只想要一个健康的宝宝，而且那时我已经非常累了。

You know, I just wanted a healthy baby, and I was very tired at that point.

范妮莎对这次手术并不紧张。

Vanessa isn't that nervous about the surgery.

她告诉我，她是一名医疗工作者。

She told me, you know, she's a healthcare provider.

她在医院工作。

She works in a hospital.

她信任自己的医疗团队。

She trusted her medical team.

她担心的是她的硬膜外麻醉。

The thing she is concerned about is her epidural.

在她分娩过程中，这个方法效果一直不太好。

It just hadn't been working that well during her labor.

我本人很担心，因为我在硬膜外麻醉后还能动腿。

I personally was concerned because I could move my legs with the epidural.

而且，在我们进手术室之前，我就告诉麻醉师，我说，我能动腿。

And, you know, even before we went into the C section, I was I told the anesthesia, I said, you know, I can move my legs.

我觉得这不正常。

I don't think this is normal.

他说，不是的。

And he's like, no.

不是的。

No.

不是的。

No.

这跟疼痛管理没关系。

It has nothing to do with the pain management.

我想我们大多数人通常都知道硬膜外麻醉是什么。

And I think a lot of us know in general what an epidural is.

对吧？

Right?

它是用来缓解疼痛的。

It's the thing that controls pain.

但硬膜外麻醉实际上是一根小小的塑料管，也就是导管，插入你的背部，医生通过这根管子注入药物。

But what an epidural actually is, it's a little plastic tube, a catheter, that goes into your back, and doctors push medicine through that tube.

嗯。

Mhmm.

所以在分娩过程中，药物剂量较轻，以便你能自由活动。

So during labor, the medicine is lighter to allow you to move around.

在手术期间，药物剂量更强。

During surgery, the medicine is more potent.

目的是让你下半身失去知觉，但保持清醒，以便见证孩子的出生。

The idea is to, like, numb your mid section, but to allow you to remain awake for the birth of your child.

据她所说，她曾向两位不同的麻醉师咨询过这个硬膜外麻醉的问题。

And so as she tells it, she'd asked two different anesthesia providers about this epidural.

其中一位说：‘我该换掉它吗？’

One of them had been like, should I change it?

也许我该换掉它。

Maybe I should change it.

我不确定该不该换掉它。

I'm not if I should change it.

然后他们需要换班。

And then they had to change shift.

等他回来时，他说：‘不用换了。’

And then by the time he came back, he's like, no.

我们没时间换掉了。

We don't have time to change it.

最终，大家决定没有足够时间更换，范妮莎被送进了手术室。

Ultimately, it's decided there's not enough time to change it, and Vanessa goes into the operating room.

所以范妮莎进了手术室，麻醉师需要测试她是否已经失去知觉。

So Vanessa's in the OR, and the anesthesiologist needs to test that she's numb.

通常，这个测试是用一个折断的压舌板放在患者身上，看患者是否能感觉到。

Often, this test is something like putting a broken tongue depressor on a patient's body and seeing whether the patient can feel it.

所以是那种有点尖锐的感觉，但他们并没有真正切进去

So it's, like, kind of sharp, but they're not cutting into

你。

you.

没错。

Correct.

切开了，我记得当时感觉到了什么，但那是一种难以忍受的疼痛。

Open, and I remember, like, feeling something, but, like, it was an excruciating pain.

而且

And

范妮莎说她只感觉到一点点刺痛，然后医生就切了进去。

Vanessa says she kind of feels a little prick, and then the doctor cuts into her.

她确实能感觉到。

And she definitely feels that.

大家都一直告诉我，你知道的，你只是感觉到了很多压力。

And everybody kept telling me, oh, you know, you're just feeling a lot of pressure.

我说，不是这样的。

And I was like, no.

这非常痛苦。

It's extremely painful.

现在，在继续讲范妮莎的故事之前，我想我应该先描述一下剖宫产过程中究竟发生了什么？

And now I feel like before I keep going with Vanessa's story, like, maybe I should just describe what actually goes on during a C section?

请说。

Please.

好的。

Okay.

我不想太血腥，但我觉得能够想象出当时的情景也很重要。

And I don't wanna be too graphic, but I think it's also important to be able to visualize what's going on.

在剖腹产手术中，会做一个切口。

So in a C section, there is an incision.

这被称为比基尼切口，听起来像是很小的切口，但实际上相当大。

It's called a bikini incision, which sounds like something really tiny, but it's actually a fairly sizable incision.

是的。

Mhmm.

然后医生会打开腹部。

And then the doctors, you know, open the abdomen.

需要分离一对肌肉才能接触到子宫，而这些肌肉很难分开。

There's a pair of muscles they need to separate to access the uterus, and these muscles are hard to separate.

医生告诉我，这是一场非常费力的手术。

Doctors told me this is really physical surgery.

有时候你会看到医生像拔河一样向后倾身，来分离这些肌肉。

You know, sometimes you see the doctors kind of leaning back like in tug of war, right, to separate the muscles.

这就是手术开始时发生的情况。

That's what happens at the beginning of the surgery.

对吧？

Right?

然后，随着手术进行，婴儿最终会被从患者身体上的这个开口挤压出来。

And, you know, then as the surgery goes on, the baby is eventually pressed, right, out of sort of this hole in the patient's body.

之后，手术还远未结束。

After that, there's still a lot of the surgery left.

需要缝合七层肌肉和皮肤。

Seven layers of muscle and skin need to be sewn back up.

正如瓦妮莎所说，她什么都感觉得到。

And as Vanessa says, she feels everything.

她感觉太多了。

She feels way too much.

我记得那种强烈的、剧烈的疼痛，大喊大叫，让他们停下来。

I remember, like, this intense, like, severe pain and screaming and telling them to stop.

麻醉师说，没事的。

And the anesthesia guy was like, it's okay.

这只是压力。

It's just pressure.

我记得医生问：出什么事了？

And I remember the doctor saying, what's going on?

他说：我只是在加更多药物，但都没效果。

And he's like, I'm just pushing more meds and they're not working.

麻醉医生告诉我，你再坚持一下，我不能再给你别的药了。

And the anesthesia doctor was telling me, you know, just hold on, and I can't give you anything else.

我们需要等把孩子取出来，之后才能给你任何你需要的药物。

We need to wait to get the baby out, and then I'll give you anything that you can.

再坚持一下。

Just hold on.

坚持住。

Hold on.

不知为什么，她的丈夫在手术室外。

For some reason, her husband is outside the OR.

他从手术一开始就不在手术室里。

He's not in the surgery from the very beginning.

等他进来时，看到范妮莎被绑在手术台上，正在大喊大叫。

And once he comes in, what he sees, he sees Vanessa strapped to the table, and she's screaming and crying.

所以范妮莎的丈夫走到她身边，她说：跟我聊聊。

So Vanessa's husband, he comes to her side, and she says, talk to me.

他问：跟你聊什么？

And he's like, talk to you about what?

我说：我不知道。

I'm like, I don't know.

跟我聊聊你的工作。

Talk to me about your work.

随便聊点什么都行。

Like, just talk to me about anything.

她让他说话的部分原因是为了分散她对疼痛的注意力，但也是因为这是家教学医院，她能听到产科医生在指导住院医生。

And part of the reason she's asked him to talk to her, it's to distract her from the pain, but it's also because this is a teaching hospital, and she can overhear obstetrician teaching the resident.

你知道吗，我一直听着，这里切一下，那里动一下，做这个，做那个，把这个挪开。

You know, I could hear the whole time, you know, cut here, move here, do this, do that, move this over.

让我展示

Let me show

你怎么做这个。

you how to do this.

她听到他说：我正在切开筋膜。

She hears him say, I'm cutting through fascia.

对吧？

Right?

所以你想象一下。

So just imagine this.

对吧？

Right?

你躺在手术台上，全身敞开，能感受到正在发生的一切，还能听到有人描述他们正在对你体内做什么。

You're lying open on an operating table, and you feel what's going on, and you hear somebody describing what they're doing to your insides.

这太吓人了。

Like, it's frightening.

很可怕。

It's scary.

当你面对一个因疼痛而尖叫的病人时，你知道，有时候该教学，有时候就得赶紧做，特别快地做。

When you have, like, a patient screaming and yelling in pain, you know, there's a time to teach and there's a time to do this like really, really fast.

这也让我觉得，这位医生根本觉得我歇斯底里。

And so that also told me, you know, like this doctor, like he just thinks I'm hysterical.

他根本不承认我正在尖叫，而他自己的动作却不够快。

He doesn't acknowledge that like I'm screaming and yelling and he's not really moving fast enough.

终于，孩子出生了。

Finally, the baby is born.

范妮莎松了一口气。

Vanessa is relieved.

范妮莎松了一口气。

Vanessa is relieved.

宝宝很健康。

The baby is healthy.

她松了一口气，觉得终于结束了，然后接受了大量药物。

She's relieved it's over, and then she does get a lot of drugs.

但接着，你知道，她就昏昏沉沉的了。

But then, you know, what happens is she's out of it.

她飘飘然了。

She's high.

她没有感受到你希望在孩子出生时拥有的那种兴奋或喜悦，而是处于震惊状态。

She doesn't have that moment of elation or joy that you wanna have when your baby is born, and she's in shock.

你在电影里看到过这样的场景，人们在孩子出生时欢呼雀跃，我觉得这才是应有的样子。

You see this stuff in movies where, like, you know, people rejoice when their baby is born, and I think that's how it's supposed to be.

但她出来的时候，我只是感到松了一口气。

But, like, she came out, and I was just relieved.

哦，终于结束了。

Like, oh, this is over.

你知道，痛苦已经结束了。

You know, the pain's over.

我真的没有那种‘天啊’的喜悦感。

Like, I really didn't feel that joy of, oh my gosh.

我期盼了九个月的宝宝终于来了。

My baby that I've been waiting for nine months is here.

你知道，你几乎会觉得自己的体验被剥夺了，而且完全失去了控制。

And, you know, so you almost feel too that you've been robbed of an experience and completely out of your control.

她是怎么理解自己所经历的一切的？

And how did she make sense of what had happened to her?

我的意思是，有一段时间她真的无法理解。

I mean, for a while, she really couldn't.

她不得不问她丈夫，那真的是真的吗？

She had to ask her husband, like, was that real?

那真的发生了吗？

Did that really happen?

她无法相信这种事情真的会发生？

She couldn't believe that it could have happened?

是的。

Yeah.

她无法相信这种事情真的会发生，你知道的，而他会说，是的。

She couldn't believe that it could have happened, you know, and he would say, like, yes.

那是真的。

That was real.

它真的发生了。

It happened.

你当时很痛苦。

You were in pain.

你当时在尖叫。

You were screaming.

情况很糟糕。

It was bad.

你知道吗，她正在经历创伤后应激障碍的症状。

You know, she's having PTSD symptoms.

她出现了闪回。

She's having flashbacks.

她告诉我，有一段时间，她做了一个梦，梦见自己怀孕了。

She told me that at one point, she had this dream that she was pregnant.

我记得很清楚，这个梦里的恐惧在于，他们该怎么把孩子从我体内取出来？

I remember, like, clearly, like, the fear in this dream was, like, how are they gonna get this baby out of me?

怎么？

How?

就是，怎么？

Like, how?

我绝不会再经历一次那样的事了。

I just won't go through that again.

梦里最可怕的是，他们该怎么把孩子从我体内取出来？

And the scary thing in the dream was, how are they going to get the baby out of me?

我们不再要孩子了，因为你知道，我们都四十多岁了，现在很幸福，而且有一个健康的小女儿。

We're not having more children because, you know, we're in our forties, and we're happy, and we have a healthy little girl.

但另一方面，我也觉得，这并不是我不想要更多孩子的唯一原因，却是最重要的原因之一，因为再次经历这一切真的让我害怕。

But part of me also feels like, you know, that is not the only reason why I don't want more children, but is one of the biggest reasons because it really scares me to have to go through that again.

随着时间推移，她开始能够谈论这件事，并且从其他人那里得知，这种情况其实并不少见。

Over time, she was able to start talking about it, and she heard from other people that this is a thing that goes on.

比如，她的哺乳顾问说，其他客户也遇到过类似的情况。

Like, her lactation consultant said, oh, this has happened to other clients.

她的治疗师说，我也从其他患者那里听过这样的经历。

Her therapist said, I've heard this from other people.

这对薇薇安来说，一方面是一种安慰，因为她知道这种事确实会发生。

And it was, on the one hand, reassuring to Vanessa, right, that this is a thing that happens.

知道她不是一个人在经历。

To know she's not alone.

知道她不是一个人在经历。

To know she's not alone.

但另一方面，范妮莎说，这件事的发生频率远超大多数人所知，这让她非常愤怒。

But on the other hand, Vanessa says it was infuriating that this happens more than most people know.

范妮莎，记得她自己就是医疗从业者，现在她觉得医生们应该了解这种情况。

Vanessa, remember, she's a health care provider herself, and now she's like, doctors should know about this.

应该为此制定一套标准流程。

There should be a protocol for this.

本可以采取一些措施来缓解我的痛苦。

Something could have been done to address my pain.

为什么没有人为我做点什么？

Why wasn't anything done for me?

我们马上回来。

We'll be right back.

我是贾德森·琼斯。

I'm Judson Jones.

我是《纽约时报》的记者兼气象预报员。

I'm a reporter and meteorologist at The New York Times.

在过去大约二十年里，我一直在报道极端天气，而这些天气正因气候变化而变得更加严重，因此及时、准确的天气信息变得愈发重要。

For about two decades, I've been covering extreme weather, which is getting worse because of climate change, And it's becoming more important to get timely and accurate weather information.

这就是为什么我们会发送定制化的简报，提前最多三天告知您可能影响您或您关心的地方的极端天气。

That's why we send these customized newsletters letting you know up to three days in advance about extreme weather that could impact you or a place you care about.

在《纽约时报》，您可以确信我们发布的所有内容都基于我们所能获得的最准确、经过验证的科学信息，因为我们希望您能够根据这些信息实时做出关于如何安排生活的决定。

At The Times, you can be confident that everything we publish is based off the most accurate scientific and vetted information available to us because we want you to be able to make real time decisions about how to go about your life.

这种工作让订阅《纽约时报》变得如此有价值，也是您支持基于事实的独立新闻的方式。

This is the kind of work that makes subscribing to The New York Times so valuable, and it's how you can support fact based independent journalism.

如果您想订阅，请访问 nytimes.com/subscribe。

So if you'd like to subscribe, go to nytimes.com/subscribe.

所以，苏珊，在广告之前，你告诉我们，范妮莎得知自己并不孤单时，既感到沮丧又感到安慰，因为这引发了许多新问题：如果她不是唯一一个，那为什么没有人更多地为像她这样的人采取行动呢？

So, Susan, before the break, you told us both how upsetting and comforting it was for Vanessa to learn that she wasn't alone because it raised all these new questions like, if she's not alone, why isn't more done for people like her?

而且我猜你一定采访了很多医生，了解他们在手术室里经历了什么，对吧？

And presumably, you did talk to a lot of doctors, right, about what they were experiencing in these OR.

那么，请告诉我们，从他们的角度来看，他们是怎么说的？

So tell us what they told you this is like from their perspective.

是的。

Yes.

所以我采访了很多医生，试图理解为什么会发生这种情况，以及当这种情况发生时，他们的感受如何。

So I talked to a lot of doctors trying to understand why this happens and also what it feels like for them when it does.

对吧？

Right?

没有医生希望病人受苦。

No doctor wants a patient to be in pain.

大多数医生在手术室里并没有遇到像范妮莎那样的极端病例，但他们都在职业生涯早期经历过病人感到过度痛苦的情况。

Most of them were not seeing extreme cases like Vanessa's in their operating rooms, but they'd all been in situations where a patient was feeling too much, especially early in their careers.

每当我想到这件事，我脑海中就会浮现出这些女性的身影。

I just see all these women in my head when I think about it.

我当时是住院医师。

I was a resident.

那是凌晨两点。

It was 02:00 in the morning.

我们紧急为一位病人进行了剖宫产手术。

We took a patient back for a pretty urgent C section.

有一个案例让我印象深刻，是一位通过急诊室入院的病人。

There's a case that stands out to me of a patient who came in through the emergency room.

当你能察觉到某人不舒服时，通常最初只是轻微的皱眉。

In the moments when you can tell someone is uncomfortable, it usually starts with just a little grimace.

病人紧紧抓住我的手，用力 squeezing。

The patient was grasping my, squeezing my hand.

手术开始后，病人一直在尖叫，我也在喊，不是因为恐慌，而是因为必须让她睡过去。

We started the case and the patient is just screaming, I am also screaming, not panic, but like, You need to put her to sleep.

她需要入睡。

She needs to go to sleep.

她正在感受这一切。

She's feeling this.

我们还没提到的一点是，在剖宫产过程中，你所接受的麻醉类型，很可能仍会感受到一些感觉。

One thing we haven't talked about yet is that during a C section, the kind of anesthesia you have, most likely you will feel sensation.

我们被教导说，在这种情况下可能无法做到完美，比如患者感受到的一些压力感，我们其实无法完全消除，而这通常是预期之中或正常的。

We were kind of taught that like maybe we can't be perfect in this, like maybe some of the pressure sensations that they feel we really can't completely block, and that's kind of expected or normal.

大多数时候，这种感觉是可以忍受的，但因为医生们预期会感受到感觉，包括压力感，这就可能变成一种滑坡效应。

Most of the time that sensation is tolerable, but because doctors expect sensation, including the sensation of pressure, it can become this slippery slope.

我记得我培训时，有一位非常出色的教授，他总是告诉所有患者：压力感是正常的。

I remember when I trained, had a very impressive professor who used to tell all the patients, pressure's normal.

这是正常的压力感。

Precious normal.

我当时就想，他怎么知道那是压力而不是疼痛呢？

And I'm like, how does he know that it's pressure and not pain?

因此，当我更深入地与这些医生交谈时，他们帮助我理解了手术室里可能发生的各种情况。

And so as I got deeper into these conversations with these doctors, they helped me understand, like, the whole range of things that might be going on in the OR.

其中一些是医院系统层面的问题。

Some of the things are, like, systemic things in hospitals.

有一位麻醉医生在半夜值夜班。

There's an anesthesiologist who's on call in the middle of the night.

另一层楼出现了紧急情况。

There's an emergency on another floor.

他们人手不足。

They're stretched thin.

他们帮助我理解了手术室内的权力动态。

And they help me understand power dynamics within the OR.

比如，实际上很难开口说‘停下’。

Like, it can actually be hard to speak up and say, stop.

她感到不舒服。

She's uncomfortable.

我们需要采取行动。

We need to do something.

麻醉师和外科医生之间存在权力关系。

There are power dynamics between anesthesiologists and surgeons.

也许房间里有一位护士，却觉得自己没有发言的底气。

Maybe there's a nurse in the room who doesn't feel empowered to speak up.

还有，你知道的，患者和医护人员之间也存在权力动态。

And then there's actually, you know, power dynamics between patients and providers.

当你是一名剖宫产患者时，你正躺在手术台上，身体敞开。

When you are a cesarean patient, right, you are lying open on a table.

你如此脆弱。

You are so vulnerable.

你可能害怕宝宝会发生什么意外。

Maybe you're scared that something is going to happen to your baby.

在某些情况下，你被告知这是紧急情况，必须立即进行手术以保护宝宝的健康。

In some of these situations, you've been told it's an emergency that, like, this needs to happen now to protect your baby's health.

你真的想说些什么，可能会拖慢手术进程吗？

Like, do you really wanna say something that might slow down the surgery?

因此，患者通常不会说出疼痛的感受。

So patients often don't speak up about pain.

好的。

Okay.

所以，你所接触的医生似乎至少了解像范妮莎这样的案例，即使他们自己没有经历过。

So doctors that you talk to sound like they are aware of cases like Vanessa's, at least, even if they haven't experienced them themselves.

他们有没有想过为什么止痛药对这些女性无效？

Do they have any idea why the pain meds are failing these women?

是的，他们确实有一些关于麻醉为何失效的想法。

So, yes, they do have ideas about why anesthesia can fail.

比如，对于硬膜外麻醉，可能是针头插入时偏了中心，或者导管移位了。

So for instance, with an epidural, like, maybe the needle was inserted off center, maybe the catheter moved.

他们也对系统如何辜负患者有一些看法。

They also have ideas about how the system is failing patients.

但至于具体哪里出了问题，基本上并没有一个简单的‘顿悟’式答案。

But, like, as far as what exactly is going wrong, basically, there's not one kind of simple eureka.

这就是问题所在。

This is the problem.

这就是我们需要调整的唯一关键点。

This is the one thing we need to tweak.

所以目前，他们正处于一个阶段，正在审视各个不同领域以寻找解决方案。

So right now, they're at a stage where they're looking at all these different areas trying to find solutions.

他们具体在关注哪些方面呢？

And what are they looking at exactly?

比如，他们是如何研究这个问题的？

Like, how are they examining this?

嗯，他们现在开始做研究了，这其实也是我在报道中非常感兴趣的一件事，就是梳理出一个时间线，追踪这一问题在医学文献中的发展。

Well so they're starting to do studies, and that was actually one of the things I was really interested in doing in my reporting is kind of making a timeline of this, following it through the medical literature.

多年来，医学文献中几乎没有任何关于这个问题的记载。

For years, there wasn't much about this in the medical literature at all.

直到2016年，一位患者发表了她经历剖腹产时全程清醒、疼痛难忍的亲身经历，这项研究的故事才真正开始。

It seemed like the story of that research really began in 2016 when a patient actually published her account of a painful cesarean in which she felt everything.

从那时起，你可以看到相关研究的兴趣逐年增加。

And from there, you can kind of track increasing interest over time.

例如，2021年发表了一篇社论，其标题我认为非常能说明问题。

For example, there was an editorial published in 2021 that has this title that I think is really telling.

我们终于开始正视剖宫产过程中的疼痛问题了吗？

Are we finally tackling the problem of pain during cesarean section?

哇。

Wow.

你知道吗，这触及了这件事那种讳莫如深、无人言说的特质，而现在我们终于开始关注它了吗？

You know, so it sort of gets at this hush-hush quality of this thing kind of unspoken, and now are we finally paying attention to it?

但就在最近，上个月，发布了一项非常重要的研究。

But just recently, just last month, there was a really important study released.

它发表在《麻醉学》期刊上，试图衡量患者在剖宫产过程中感到疼痛的频率。

It was published in the journal anesthesiology, and it tries to measure how often patients are feeling pain during c sections.

对。

Right.

因为到现在，我们知道这种情况确实存在，但一直缺乏真正量化它的努力。

Because by now, we know this is happening, but there's been no real effort to quantify it.

之前确实有过一些努力，但规模都比较小。

So there have been efforts, but they've been smaller scale efforts.

这些努力通常局限于单个医疗机构内的测量。

They've been efforts to measure it within one institution, for example.

而且大多数都是依赖医生对患者疼痛的评估。

And they have most often been efforts that rely on doctors' assessments of patient pain.

这项研究之所以重要，是因为它是一项大规模研究。

So this study is important because it was a big study.

它涵盖了美国和加拿大的15家医院。

It was at 15 hospitals in The US and Canada.

它招募了近4000名患者，并直接询问患者在剖宫产过程中是否感到疼痛。

It enrolled almost 4,000 patients, and it asked patients whether they were in pain during c section.

这似乎对于理解女性是否感到疼痛至关重要，

Which seems pretty crucial to understanding if women are feeling pain,

直接询问

to ask

她们本人。

them directly.