第二季 第一集：案件

但到了晚餐时间，我觉得这是我第一次遇到硬膜外麻醉的问题，我当时根本不清楚发生了什么，因为疼痛只出现在我的阴道部位。

But then around dinner time, I think, was the first time that things that trouble started with my epidural where I didn't really even understand what was happening because it was just in my vagina that I felt pain.

所以我其实没有意识到宫缩的发生。

So I wasn't really I wasn't aware of contractions.

突然之间，我感觉自己的阴道像是被撕裂了一样。

It was just all of a sudden, it felt like my vagina was just being shredded.

我不清楚。

I don't know.

真的感觉就像有人穿着钢头靴子在里面乱踢一样。

It literally felt like like somebody had like a steel toe boot and was just kicking around in there.

天哪。

Oh, jeez.

克拉拉的硬膜外麻醉被追加了更多药物，这下有效了。

Clara's epidural is topped up with more drugs, and that does the trick.

她立刻感觉舒服多了。

She's more comfortable right away.

几个小时后，晚上11点，希瑟向值夜班的麻醉师交接，并向他介绍了克拉拉的情况。

A couple hours later, at 11:00, Heather signs out to the anesthesiologist on the overnight shift and fills him in on Clara.

交接时，我就说：嘿，情况是这样的。

When I was signing out, I was like, hey, You know, this is the deal.

效果不错，诸如此类的。

It's working, blah blah blah.

所以我离开时没预料到会出什么问题。

And so I didn't anticipate any problems when I left.

否则，我可能会留下来。

Otherwise, I would have probably stayed.

现在回头想想，我总是对我的患者说：我会尽量留在医院，因为我不想让别人去应对突发状况，我就想亲自在场，万一出事能第一时间处理。

Like, in hindsight now, I'm like, you know, one of the things I'm always like for my providers that I'm taking care of, like, I I kinda stay just stay in the hospital because I I just don't even wanna you know, I I just wanna be the one who's there if anything happens.

我们看到希瑟上了车，开车离开了医院。

We see Heather get in her car, drive away from the hospital.

她离开后发生了什么？

What happens after she leaves?

这将在广告后播出。

That's coming up after the break.

这里是《Serial》播客的主持人莎拉·科尼格。

This is Sarah Koenig, host of the Serial Podcast.

如果你已经爱上这个节目，那我可能就不需要多说了，如果你想听下去，请订阅《纽约时报》。

If you're already hooked on this show, then maybe I don't need to say anything else here except if you wanna hear the rest of it, subscribe to the New York Times.

结束。

The end.

但对于那些有疑问的人，尤其是为什么？

But for those of you who have questions, chiefly, why?

为什么我要为此付费？

Why do I have to pay for this?

很高兴你问了这个问题。

I'm glad you asked.

如果你听过《Serial》的节目，就知道我们的故事富有创意且报道精良。

If you've listened to serial shows, you know our stories are inventive and expertly reported.

没人像我们这样制作它们。

Nobody makes them like we make them.

但要像我们这样制作，成本相当高。

But to make them like we do, it's pretty expensive.

你需要制作人、记者、编辑、音频工程师、事实核查员，更别提软件、电脑、差旅费用以及各种开销了。

You need producers, reporters, editors, sound engineers, fact checkers, not to mention the software, the computers, the travel costs, the everything.

我们过去支付这些费用的方式是靠广告，这很好。

The way we used to pay for all that was with ads, which great.

但不幸的是，广告收入并不总是稳定，我们已经无法单靠广告覆盖全部成本了。

But, unfortunately, ad sales aren't always reliable, and we just can't cover the full cost with ads anymore.

因此，我们请求您通过订阅直接支持我们。

So that's why we're asking you to directly support us with a subscription.

通过订阅，您将获得很多权益。

With a subscription, you get a lot.

您可以收听整个系列档案，所有往期节目，以及提前获取我们的新节目，还有纽约时报音频制作的其他节目和附加内容。

You can listen to the entire serial archive, all our previous shows, plus early access to our new shows, and all the other shows and bonus content produced by New York Times Audio.

有一种仅音频的订阅方式。

There's an audio only subscription.

或者如果你想升级，我推荐你订阅整个《纽约时报》，这样就能获得所有优质的新闻报道，还有游戏、烹饪、Wirecutter等全部内容。

Or if you wanna go big, which I recommend, you can subscribe to all of the New York Times and get access to all the great journalism, plus the games, cooking, wire cutter, the whole thing.

所以，请订阅《纽约时报》。

So please subscribe to the New York Times.

你可以通过Apple Podcasts、Spotify，或者你收听播客的任何平台进行订阅。

You can do it through Apple Podcasts, Spotify, or wherever you get your podcasts.

希瑟离开时，克拉拉还很安稳。

Clara had been comfortable when Heather left.

但几个小时后，她又开始感到同样的疼痛，而且其他问题也出现了。

But several hours later, she's having the same pain again, and other things are going wrong too.

她的产程停滞了。

Her labor is stalling.

她的血糖正在升高。

Her blood sugar is climbing.

宝宝的心率也是。

So are the baby's heart rates.

克拉拉知道她即将剖宫产，但她请求再给她半小时，让她跪趴着分娩，看看是否能有所帮助。

Clara knows she's headed for a C section, but she requests one last half hour laboring on her hands and knees just to see if that will help.

现在我们看到房间，除了监护仪的灯光外一片漆黑。

Now we see the room, dark except for the lights of the monitors.

克拉拉跪趴在病床上。

Clara on all fours in the hospital bed.

靠近她的前臂，我们短暂地瞥见了纹身。

Close of her forearms, we briefly glimpse the tattoos.

我们突然想起，克拉拉为我们褪去了一层保护。

We remember for a moment that Clara has stripped a layer off for us.

她允许我们看到的这一切充满了脆弱。

There's a lot of vulnerability in what she's allowing us to see.

房间里唯一的另一个人是克莱。

The only other person in the room was Clay.

这又是克拉拉提出的要求。

That was another thing Clara had requested.

求你们了，都出去吧，再给我一次机会。

Just please, everyone clear out and give me one more try.

但这次尝试失败了，时间已经不容再浪费。

But the try doesn't work and there's no more time to waste.

护士们拔掉克拉拉身上的监测设备，推着她沉重的病床穿过走廊前往手术室。

The nurses unplug Clara from her monitors and push her cumbersome bed down the hall to the OR.

但我当时就想，好吧。

But I was like, okay.

会没事的。

It's gonna be fine.

会没事的。

It's gonna be fine.

我的宝宝就要出生了。

My baby's gonna be born.

所以

So

但她还是在凌晨三点或四点给我打了电话，说他们决定剖腹产。

And yet she called me around three or four in the morning that they had decided to do a c section.

敏迪当时在家睡觉，但她立刻起床，拿起了她的摄像包。

Mindy was at home, asleep, but she got right out of bed and grabbed her camera bag.

我们看到她将包背在肩上，匆匆走下平房的前门台阶，上了她的小型货车。

We see her strap over her shoulder, hurrying down the bungalow's front steps and into her minivan.

于是我赶了过去，情况有点紧急，但还不是我们所说的‘紧急抢救’——那种我们直接把线从墙上拔下来就跑的情况。

So I raced over there, and it was a little bit of an urgent case, meaning it's not what we call a crash, like where we literally just rip cords out of the wall and run.

就是说，好吧，我们现在就做。

It was like, alright, we're doing this now.

我们行动吧。

Let's move.

也就是说，如果没有交通堵塞，我离医院只有十分钟的路程。

So, I mean, I'm only ten minutes away from the hospital when there's no traffic.

所以我赶紧赶过去，因为是紧急情况，就把车停在了街上。

So I raced over there, and I parked on the street because I'm like, it's an urgent case.

我得赶紧去，因为他们可能在我到之前就开始了。

Like, I need to go because they might start before I get there.

那天我还收到了一张停车罚单，因为晚上不用付停车费，但我停得太久，早上他们还是给我开了罚单。

I even got a parking ticket that day because at night, you don't pay for the meters, but I was there so long that in the morning, they gave me a ticket.

但不管怎样。

But anyways

在四楼，Mindy从衣橱里拿出一件塑料包装的手术服，套在自己的衣服外面。

Up on the 4th Floor, Mindy takes a plastic wrapped surgical suit from a closet and pulls the coverall on over her clothes.

然后她转向Clara的手术室。

Then she turns toward Clara's OR.

我进去的时候，她正躺在手术台上，我其实拍了一张她非常漂亮的照片。

And I walked in when she was on the Operating Room table, and I actually have a beautiful photo of her.

她还没看过这些照片。

She has not seen these photos.

或者我给了她，但我觉得她从未能看过这些照片。

Or I gave them to her, but I don't think she's ever been able to look at them.

但手术室的门半开着，她躺在那里，手臂垂着。

But it's the door of the Operating Room halfway open, and she's laying there with, like, her arms down.

她正微笑着看着我。

She's looking at me smiling.

是的。

And yeah.

所以，当我到那里并拍下那张照片时，她的喜悦让我几乎感受到了一种解脱。

So then, I mean, when I got there and I took that picture, just her joy, and I almost sensed relief.

她知道我来了。

She knew I was there.

我们所有人要么是夜班护士，要么是白班护士。

And we we are all either night shift nurses or day shift nurses.

尽管我们是一个团队，但彼此之间更有友谊和纽带。

And even though we're all one team, there's, like, more of a friendship and, like, bond.

比如，白班护士，我们都清楚自己是怎么工作的。

Like, day shift nurses, we all know how we work.

而夜班护士，我们从来不会和他们一起工作。

And, like, night shift, we don't work with them ever.

所以我们根本不知道他们是怎么做事的，你知道吧？

So like, we don't know how they roll, you know?

所以我觉得那个微笑是说：我正在生孩子。

So I think that smile was like, I'm having my babies.

你来了，给我拍了照片。

You made it to take my pictures.

你在这里。

You're here.

你是我们中的一员，我们团队的一员。

You're one of me, one of our team.

所以，是的。

So, yeah.

我也一样，我当时就想，是的，我在这里支持你。

And I I too was like, yes, I'm here for you.

这就是为什么这个病例如此艰难，因为我感觉自己完全辜负了她。

And this is why this case is so hard because I feel like I failed her a 100%.

当敏迪到达时，克拉拉仍在为手术做准备。

When Mindy arrives, Clara is still being prepped for surgery.

她平躺在手术室里，这显然不是她希望待的地方。

She's flat on her back, in the OR, which is obviously not where she wanted to be.

伊利诺伊大学芝加哥分校的产科手术室相对较小，属于旧时代的风格。

The L and D operating rooms at UIC are relatively small, out of another era.

墙上是薄荷绿的瓷砖，仿佛走进了YWCA的淋浴间，灯光刺眼。

Mint green tiles on the walls, like you're stepping into the showers at a YWCA, harsh light.

但克拉拉很平静。

But Clara is calm.

我们现在通过敏迪的取景器看到她，她闭着眼睛，脸上带着神情。

We see her now through Mindy's viewfinder, her eyes closed, the expression on her face.

我的天。

My god.

这正是一个很少被真正配得上的词的化身。

It's the embodiment of a word whose use is rarely earned.

安详的。

Beatific.

我拍下了所有东西。

And I took pictures of everything.

比如，我拍了Clay和她牵手的照片。

Like, I took pictures of, like, Clay and her holding hands.

我拍了两支团队在等待两个不同婴儿的照片，拍了麻醉师工作的照片。

I took pictures of, like, the teams waiting two different teams for two different babies, pictures of, like, anesthesia working.

我只是喜欢拍下那里的人，因为我们通常因为隐私法规而不能这么做。

Just I like to take pictures of people there because we never get to do that because of privacy laws.

所以让他们知道我站在他们这边，就像在说：这是你们真正参与手术时的照片。

So for them to know that I'm on their team, like, it's almost like here's a picture of you actually in a case.

手术马上就要开始了。

Surgery's getting closer now.

克拉拉床的两侧各有一根杆子，很快，一大块医用纸张将被拉伸在两根杆子之间，挡住克拉拉看到自己腹部的视线。

There are poles on either side of Clara's bed, and soon a giant piece of medical paper will be stretched between the poles, blocking Clara's view of her abdomen.

这种纸被称为手术单，它既能防止手术区域被污染，也能让患者看不到自己敞开的身体。

This paper is called the drape, and it both protects the surgical field from contamination and protects the patient from the sight of her open body.

麻醉师已经向克拉拉的硬膜外腔添加了更多药物，使其药效足够强，足以支撑她完成手术。

The anesthesiologist has added more drugs to Clara's epidural, making it strong enough to get her through the surgery.

现在，医生们需要测试麻醉是否生效。

Now the doctors need to test to see if the anesthesia is working.

皮肤紧绷测试，这种测试方式奇怪地简单——麻醉师用一根折断的压舌板戳克拉拉。

Tight on the skin test, it's so weirdly basic, the anesthesiologist poking Clara with a broken tongue depressor.

另一位医生做了更严重的测试，用手术器械紧紧夹住克拉拉的腹部。

Another doctor does something more severe, clamping Clara's belly hard with a surgical instrument.

克拉拉一点感觉都没有，这意味着他们可以开始了。

Clara feels none of it, and that means they're ready to go.

关于剖腹产手术，我们需要决定展示多少内容。

There's a decision to make about the c section, how much of this procedure to show.

就像敏迪说的，我们要做到多详细？

Like Mindy said, how graphic are we doing?

我们这部剧并不追求血腥场面，不会为了刺激而展示开膛破肚的画面，但我们希望呈现‘ visceral ’这个词的所有含义。

We're not going for gore on this series, for showing open bodies for the kick of it, but we do want visceral, all the meanings of that word.

内脏，字面意思，就是患者腹腔内的器官。

Viscera, literally, that's what's inside a patient's abdomen.

但这个词在艺术中的用法也是如此。

But also how that word is applied to art.

具有 visceral 感的艺术。

Art that's visceral.

它关乎身体。

It's of the body.

它关注身体。

It attends to the body.

希望让你在身体里产生某种感受。

Hopefully, makes you feel something in your body.

一种 visceral 的美学，肌肉感强，贴近骨骼，原始却不煽情，毫不回避。

A visceral aesthetic, muscular, close to the bone, raw but not sensational, not shying away.

好了，别再自我陶醉了，别再谈理论了。

Okay, enough self regard, enough theory.

这在实践中意味着什么？

What does this mean in practice?

现在，外科医生喊道：切口，然后在克拉拉的耻骨上方切开腹部。

Now the surgeon calls out, Incision, and then cuts into Clara's abdomen, just above the pubic bone.

我们看不到手术刀切入她的皮肤，但要知道，这种切口被称为比基尼切口。

We're not seeing the scalpel in her flesh, okay, but just know that this kind of cut is called a bikini incision.

比基尼听起来很小，但这个切口其实很大。

Bikini sounds tiny, but this cut is big.

一旦克拉拉的腹部被切开，外科医生就需要触及子宫。

Once Clara's abdomen is open, the surgeon needs to reach the uterus.

子宫位于一对肌肉的后方。

The uterus is behind a pair of muscles.

现在我们真正看到，外科医生和产科住院医生分别站在克拉拉的两侧，用力拉扯。

Now we see, actually see, the surgeon and the OB resident position themselves on either side of Clara and pull.

这两位穿着手术服的女性用力拉扯肌肉，身体向后倾斜，就像拔河一样。

These two women in scrubs pull so hard to separate this muscle that their bodies lean back like in tug of war.

这是一场非常耗费体力的手术。

This is a very physical surgery.

当克拉拉作为护士参与剖宫产时，她会在这部分闭上眼睛或转过头去。

When Clara is a nurse in a C section, she either covers her eyes or looks away for this part.

但当然，今天克拉拉是患者。

But of course, today Clara is the patient.

我们现在掀开手术帘，特写她的脸，但有些地方不一样了，截然不同。

We go behind the drape now, tight on her face, but something's different, radically different.

就在刚才，她还神情安详，但现在她的嘴唇紧绷。

It was just moments ago that she was beatific, but now her mouth is tight.

我突然之间就只想说，天哪。

I just remember all of a sudden just being like, oh my god.

我感觉不太好。

I don't feel good.

你知道吗？

You know?

是的。

Yeah.

我不确定。

And I I don't know.

我本来以为我只是在恐慌。

I I assumed I was just panicking.

你知道吗？

You know?

我以为我只是需要稍微放松一下。

I assumed that I just needed to relax a little bit.

几年前，克莱尔在伊利诺伊大学芝加哥分校的另一次手术中经历过恐慌发作。

A few years earlier, Claire had a panic attack during another surgery at UIC.

是眼科手术，白内障，这么年轻就得这种病真奇怪。

An eye surgery, cataracts, weird to have them at such a young age.

手术中，一种不同的纸质遮盖物被展开，盖住了克莱拉的整个身体，像裹尸布一样，使她全身都被蓝色纸张覆盖，只留下一个覆盖一只眼睛的洞。

In the surgery, a different kind of paper drape had been unfolded over Clara's whole body, like a death shroud, so that she was entirely covered in blue paper except for a hole over one eye.

然后她听到医生说：‘你得给她点别的药。’

And then she'd heard the doctor say, You need to give her something else.

她正在过度换气。

She's hyperventilating.

整个怀孕期间，她都担心如果需要剖腹产，自己会再次出现恐慌发作。

All through her pregnancy, she'd been worried that if she needed a c section, she would have a panic attack again.

所以我跟尼克松医生讨论了如果我恐慌时该如何应对的策略。

And so I had spoken with doctor Nixon about strategies for how to deal with that if I panic.

是的。

Yeah.

我们讨论了他们可以使用的不同药物，有时候在这种情况下，一氧化二氮非常好，你知道的，只要吸一会儿气体就行，因为它们的作用时间不长。

And we talked about the different medicines they can give and that sometimes in that case, nitrous oxide is a really nice, you know, just breathe the gas for a little bit because they don't last that long.

所以也许你只需要吸一会儿气体，一分钟左右，症状就会过去，然后你就没事了，你知道吗？

So like maybe you can just breathe the gas for a minute or so It'll pass and then you'll be fine, you know?

是的。

Yeah.

于是我问，我可以只用点气体之类的吗？

So I asked, can I just have some gas or something?

他给我戴上了面罩，但情况却越来越糟。

And he put the mask on and it just it just was getting worse.

我记得当时感到非常恶心，只是说我不舒服。

And I remember feeling very nauseous and just saying that I wasn't okay.

然后一切都变得模糊不清，我想，幸运的是，我无法像最初那样清晰地回忆起细节。

And and then everything was really fuzzy and hazy and I am not, I guess, thankfully able to necessarily recall it in as much detail as I could at first.

但那种痛苦是难以想象的，我记得我恳求他们停下来。

But I it was an unfathomable amount of pain, and I remember begging them to stop.

直到她不停地恳求，求求你，求求你，求求你。

And it wasn't until she just kept begging, like, please, please, please.

其中一位主治医生看着我，让我告诉她这是正常的。

And one of the attendings, she looked at me and told me to tell her that it was okay.

她让我告诉她的伴侣，请告诉他没关系。

She told me to tell her partner, please tell him it's okay.

在那一刻，我不再是朋友或倡导者。

So at that moment, I was no longer a friend or like an advocate.

我更像是一个被医生告知‘这没问题’的工作人员。

I was more like a staff member being told by the doctor, like, it's fine.

所以我记得对克莱说：克莱，你知道的，这很正常。

So I remember telling Clay, like, Clay, you know, this is normal.

这种情况有时会发生。

This sometimes happens.

克莱，我记得他的肢体语言很明确地表示：是的。

And Clay, I remember his body language was very like, yeah.

好的。

Okay.

我是听到了，但别跟我说话。

Like, I I hear you, but don't talk to me.

我记得我当时想，天哪。

And I remember being like, oh my gosh.

因为他太紧张了。

Because he was so stressed out.

这是我最后悔的一件事，那位医护人员看着我说，告诉他们没关系。

That's one thing I regret the most, that that provider looked at me and said, Tell them it's okay.

而我照她的话做了，明明知道那并不 okay。

And that I did what she told me to, knowing that it wasn't okay.

我觉得这是我反复回想的最大的遗憾之一，我没有说：这不对。

I think that's one of my biggest things that I replay over and over again, that I didn't say like, it's not okay.

我们能停下来吗？

Like, can we stop?

克拉拉的麻醉失效了。

Clara's anesthesia is not working.

她现在正在进行重大腹部手术，却能感受到手术的疼痛。

She is now in the middle of major abdominal surgery, and she can feel that surgery.

克拉拉知道这种情况可能发生。

Clara Clara's knew this could happen.

她曾亲眼见过这种情况发生。

She had seen this happen.

剖宫产术中疼痛，医护人员对此是了解的。

Intraoperative pain during cesarean, healthcare providers know about it.

但患者并不知道。

Patients don't.

当克拉拉刚开始在产科工作时，有产妇告诉她：‘我上次生孩子时做了剖宫产，但什么都感觉得到。’

When Clara herself first started working on L and D and patients in labor would tell her, For my last baby, I had a C section and I felt everything.

克拉拉心里想：这不可能是真的。

Clara would think to herself, That can't be true.

这不可能。

There's no way.

谁会这么做？

Who would do that?

然后她亲眼目睹了这种情况，而现在这种事发生在了她自己身上。

And then she saw it happen, and now it is happening to her.

内脏感，这个关键词。

Visceral, that keyword.

克拉拉所感受到的是内脏痛，也就是说疼痛源自她的腹部内部。

What Clara is feeling is visceral pain, meaning pain that originates inside her abdomen.

医生做皮肤测试的时候，克拉拉没感觉到，对吧？

When the doctors did the skin test, Clara didn't feel it, right?

她没有知觉。

She was numb.

有时剖腹产患者在测试皮肤时感觉不到疼痛，但一旦切开，却发现她其实仍有知觉。

Sometimes a cesarean patient is numb when you test her skin, and when you open her up, you find she's not.

造成这种情况的原因有很多，但在当下，疼痛的原因并不那么重要。

There are a lot of reasons for this, but in the moment the reason for the pain doesn't totally matter.

重要的是你要治疗它。

What matters is that you treat it.

孩子们。

The babies.

我们错过了接生，但现在能看到他们在房间边缘的新生儿保温箱里。

We miss the delivery, but we see them now at the edge of the room in newborn warmers.

我们知道他们很健康，他们没事。

And we understand they are healthy, that they are okay.

但克拉拉不是。

But Clara is not.

我们看到克拉拉在击打手术单，仿佛想打到产科医生。

We see Clara punching the drape as if trying to hit the OBs.

产科医生在手术单的另一边做什么？

What are the OBs doing on the other side of the drape?

她们在理解什么？

What are they understanding?

她们在感受什么？

What are they feeling?

为什么她们要命令明迪告诉克拉拉的丈夫一切都没事？

Why are they ordering Mindy to tell Clara's husband everything is all right?

我们还不知道这些问题的答案。

We don't know the answers to these questions yet.

我们和克拉拉以及麻醉师在一起，麻醉师正在给她补充药物，芬太尼和氯胺酮。

We're on the side of the drape with Clara and the anesthesiologist, who's giving her supplemental drugs, fentanyl, ketamine.

他给她用这些药物，做对了吗？

Is he doing the right thing, giving her those drugs?

我们目前也不知道这一点，但我们传达的感觉是，出了问题，非常严重的问题。

We don't know this yet either, but the feeling we convey now is that something is wrong, very wrong.

克拉拉内心正在经历的是，所有这些药物让她产生了幻觉。

What's going on inside for Clara is that all these drugs have her hallucinating.

这会不会是那种采用魔幻现实主义手法，进入她意识层面的剧集？

Is this the kind of show where we do a magical realism thing of inhabiting her consciousness?

我的意思是，确实可以这样处理。

I mean, it could be, yes.

为什么不用这种方式呢？

Why not use it this way?

为什么不用它来展现克拉拉所看到的画面？

Why not use it to show what Clara is seeing?

我听过一个故事，我快速说一下：一位母亲在剖腹产时被注射了氯胺酮。

A story I heard, I'll say this fast, a mother is given ketamine during her C section.

孩子出生后，护士把婴儿抱给她，患者却说：这孩子很漂亮，但这不是我的孩子。

Her baby is born, and the nurse brings her the baby, and the patient says, This is a lovely baby, but this is not my baby.

我的孩子不会有两个头。

My baby does not have two heads.

这个故事是我从一位医生那里听来的。

I heard this story from a doctor.

这件事发生时她还是住院医生，她告诉我，自从那件事之后，她再也没给剖宫产患者使用过氯胺酮。

It happened while she was still a resident, and she told me that after that woman, she never used ketamine for a cesarean patient again.

我们现在看到的就是克拉拉所看到的。

What Clara is seeing, we see now.

颜色和形状。

Colors and shapes.

如果你是某种类型的人，你可能对敞开的腹部无动于衷，却会对幻觉感到恐惧。

If you're a certain kind of person, you might be fine looking at an open abdomen, but freaked out looking at hallucinations.

克拉拉感到无法沟通。

Clara feels unable to communicate.

她只是语无伦次，一直说：求求你，求求你，停下来。

She was just so slurry, like, please, please, like, stop.

不。

No.

不。

No.

不。

No.

听起来那时候她已经像灵魂出窍了一样。

Like, sounded like she was out of her body at that point.

我几乎开始想，我知道她之前有过类似创伤后应激障碍的问题。

And I almost started thinking, like, I know she's had issues with, like post traumatic stress type issues.

所以我觉得，这可能不是疼痛的问题。

So I'm like, maybe this is not pain thing.

可能是个心理问题。

Maybe it's a psychological thing.

你知道，很多时候患者抱怨疼痛，我们却轻易地归因于她焦虑。

And you know, I mean, this happens a lot where patients complain of pain and we brush it off as she's anxious.

只是压力而已。

It's just pressure.

但其实不是，因为每当他们触碰她或使用电灼时，她都会说有灼烧感，她真的能感觉到那种灼烧。

But it wasn't because she would feel anytime they touched or, like, did the cautery, like she would say the burning, she could feel the burning.

电灼器械叫做Bovie，用于止血。

The cautery instrument is called the bovie, with stanches bleeding.

电灼带来的灼痛感，克拉拉记得清清楚楚，多年后仍会在半夜将她惊醒。

And the red hot pain of it is something Clara remembers precisely, something that years later would wake her up in the middle of the night.

电灼的灼烧感让克拉拉喊出‘哎哟’，而医生则说：‘我们换到另一边。’

The sear of that instrument, Clara exclaiming, Ow, and a doctor saying, We'll move to the other side.

什么？

What?

分娩后还有很多手术要做。

There's still a lot of surgery left after the delivery.

现在我们要看一部分，我知道有些人可能不想看。

And now we're going to see a part I know some people might not want to see.

做好心理准备，我提前警告你们。

Brace for it, I'm giving you the warning.

医生把克拉拉的子宫从体内托出，放在她的腹部上。

The doctor is lifting Clara's uterus out of her body and resting it on her abdomen.

它就像一个巨大的闪亮的复活节彩蛋。

It's like a giant shiny Easter egg.

子宫已经被移出体外，这就是所谓的外部化，我们之所以能看到这一幕，是因为请记住，克拉拉能感受到这一切，能感觉到自己的器官被从体内抬出来。

The uterus has been exteriorized, that's what this is called, and the reason we're seeing this is, please remember that Clara can feel this, can feel her organ being lifted out of her her body.

哦，在整个过程中，克拉拉开始呕吐了。

Oh, and at some point during all of this Clara starts throwing up.

现在，外科医生将前臂的大部分伸入克拉拉的体内。

Now the surgeon sticks a good portion of her forearm into Clara's body.

镜头中我们看到的只是手臂消失在腹部。

What we see in the shot is just the arm disappearing into the abdomen.

她用一块纱布垫检查内部出血情况。

She's using a pad of gauze to check for internal bleeding.

再次强调，重点是克拉拉正在感受这一切。

Again, the point is Clara is feeling this.

现在我们听到她尖叫：你们为什么要这么做？

Now we hear her scream, Why are you doing this?

让它停下。

Make it stop.

现在我们照做了，仿佛听从了她的命令。

And now we do, as if on her command.

我们离开了手术现场。

We leave the surgery.

我们需要离开这个手术室，这里正在发生糟糕的事情而我们却不明白原因。

We need to get out of this OR where bad things are happening and we don't understand why.

手术室外，一位名叫科里的产科麻醉师正赶来上他早上7点的

Outside of the Operating Room, an obstetric anesthesiologist named Corey is arriving for his seven a.

班

M.

。

Shift.

科里，我们不会把科里作为主要角色来介绍。

Corey, we're not going to meet Corey as a main character.

也许他会在另一集的后续剧情中被进一步展开。

Maybe he's someone who will be developed later in another episode.

他身材匀称，有着少年般的英俊外表。

He's trim and boyishly handsome.

我们看着几位护士催促他走向手术室。

We watch as several nurses urge him toward the OR.

科里，你现在得进去。

Corey, you need to get in there now.

科里推开大门，正好赶在外科医生为克拉拉缝上最后一针时进入房间。

Corey pushes open the door and enters the room just as the surgeons are putting the final stitches in Clara's skin.

然后，突然间，在某个时刻，一切结束了。

And then all of a sudden, at some point, it was over.

我记忆中第一件事就是环顾四周，然后就看到科里在那里。

And I just the first thing I remember is just sort of looking around and then Corey was there.

他是那些麻醉师之一，就像……他是麻醉师之一。

He's one of the, like, he's one of the anesthesiologists.

是的

Yeah.

我记得看到科里，他直接俯身到我脸上，因为我还躺在手术台上，但所有的帘子和覆盖物都已经被移除了，科里就在我身边。

And I remember seeing Corey and he came right by down my face because I was still on the table, but all the drapes or everything was gone and done and Corey was right there.

我记得我当时就想，哦，科里，你知道的，我只是想，哦，你会帮我的。

And I I I remember I was just like, oh, Corey, you'll you know, I was just like, oh, you'll help me.

科里。

Corey.

克拉拉认识他，信任他。

Clara knows him, trusts him.

与其他那位麻醉师不同，她根本不知道那个人是谁。

Unlike the other anesthesiologist, she had no idea who that guy was.

我们看到克拉拉脸上流露出一丝放松，也看到科里强忍着泪水。

We see some relief in Clara's face, and we see Corey holding back tears.

尽管没有明确的解决或完整解释，但至少我们知道克拉拉正在得到照顾。

And even though there's no resolution or total explanation, at least we know that Clara is being cared for.

科里推着克拉拉去恢复室，也就是PACU，她一安顿下来，科里就沿着走廊去给他的上司希瑟打电话。

Corey wheels Clara to the recovery room, the PACU, and as soon as she's settled, Corey goes down the hall and calls his boss, Heather.

他给我打电话，说：‘希瑟，出事了。’

He calls me and he's like, Heather, something happened.

我当时说：‘哦，好的。’

And I was like, okay.

我问：‘怎么了？’

Like, what's going on?

希瑟当时在家。

Heather was at home.

她前一天在医院待了太久，所以那天休息。

She'd been at the hospital so long the night before that she got the day off.

科里把克拉拉的事告诉了她。

Corey told her about Clara.

天哪。

Oh my god.

不。

No.

不。

No.

不。

No.

不。

No.

不。

No.

不。

No.

不。

No.

这不可能，这真的不可能。

Like, that can't that just can't be.

我当时就说，科里，发生什么事了？

And I was like, Corey, what happened?

他回答说，我也不清楚。

He's like, I don't even know.

而且我当时就觉得，特别难受。

And and I and I just felt I felt horrible.

我觉得我不该离开医院。

Like I felt like I shouldn't have left the hospital.

对吧？

Right?

我觉得我本该一直待到她得到妥善照顾为止。

Like that I should have just stayed until she was safely taken care of.

对吧？

Right?

她已经生了。

That she had delivered.

我让她在那件事上失望了。

That I had let her down in that.

然后我生气了。

And then I got mad.

然后我变得非常生气。

And then I got really mad.

希瑟很生气，因为她在这里负责，而且她是一名麻醉师。

Heather is mad because she's in charge here and she's an anesthesiologist.

麻醉师在场的职责是管理疼痛。

The thing the anesthesiologist is in the room to do is manage pain.

切开一个人的身体，然后在他们能感受到疼痛的情况下进行手术，这种情况本不应该发生。

Cutting someone's body open and then operating when they can feel it, that is not supposed to happen.

这属于过去或战争时期的做法。

That's something from history or from war.

但在美国，这种情况每年会发生十万次。

But in The United States it happens a hundred thousand times a year.

这是对剖宫产期间经历显著疼痛的患者数量的最佳估算。

That's the best estimate of how many patients have significant pain during cesarean.

并非所有这些患者感受到的疼痛强度、部位或持续时间都完全相同。

Not all of these patients feel the exact same intensity of pain, or at the same parts of the surgery, or for the same length of time.

但他们所经历的疼痛是显著的。

But the pain they feel is significant.

大多数人对此并不了解。

Most people don't know about this.

直到最近，我也不知道。

Until recently, I didn't.

我是通过收听这个播客第一季的听众了解到这一点的。

I learned of it from listeners to season one of this podcast.

即使你没听过第一季也没关系。

It doesn't matter if you haven't heard season one.

细节不如它所描述的共同体验重要。

The details are less important than the common experience it described.

医生没有倾听的疼痛，医生没有充分治疗的疼痛。

Pain a doctor didn't listen to, pain a doctor didn't adequately treat.

这种经历引起了众多听众的共鸣，其中数百人——大多是女性——开始写信给我，分享她们自己的故事。

That experience resonated with many listeners, and hundreds of them, mostly women, began writing to me with their own stories.

有一天下午，我打开了一封与我之前收到的任何信件都不同的留言。

One afternoon, I opened a note that was unlike any I'd received so far.

我做了剖宫产，这封邮件开头写道，麻醉没有被正确实施。

I had a C section, the email began, where anesthesia was not properly administered.

我记得我告诉他们，我能感觉到切割、器官的移动、灼烧、刺痛、残酷的疼痛，但他们却告诉我这不可能，我只能硬撑过去。

I remember telling them I could feel the cutting, the moving of my organs, the burning, shocking, brutal pain, and being told that wasn't possible and that I would just have to tough it out.

对我来说，这位听众的经历如此超乎寻常，似乎独一无二。

To me, this listener's experience seemed so out of range that it might be singular.

接着，我又打开了另外两封类似的留言。

Then I opened two more of these notes.

很快我就意识到，这将是一个反复出现的话题。

Soon I understood this was a subject that would come up again and again.

剖宫产是全球最常进行的手术。

C sections are the most frequently performed surgery in the world.

在美国，每年有120万例剖宫产。

In The US, there are one point two million of them a year.

因此，每年有十万名患者在剖宫产过程中感到疼痛，占比百分之八。

So a hundred thousand patients a year feeling pain during cesarean, that's eight percent.

有些人说这个比例甚至更高。

Some people say the rate is even higher.

没有其他手术会出现这种情况。

There's no other surgery where this happens.

没有其他重大手术会让人接受百分之八的患者在手术中感到疼痛。

No other major surgery where it would be acceptable for eight percent of patients to feel that surgery.

百分之八是一个来自最近完成研究的新数据。

Eight percent is a brand new number from a recently completed study.

它并不是取代了旧的数据。

It didn't replace an old number.

这是同类中的第一个数据。

It's the first number of its kind.

直到现在，还没有人做过这样的研究，去询问美国和加拿大的数千名产妇在剖宫产过程中是否感到疼痛。

Until now, nobody had ever done a study like this, asking thousands of patients in The US and Canada whether they felt pain during their C sections.

但现在这项研究已经完成，由那些认识到这是一个问题、并将数字量化视为解决之道的医生们开展。

But now the study has been done, by doctors who recognize that this is a problem and that putting a number to it is a step towards solving it.

而这正是这个故事所要讲述的内容。

And this is what this story is about.

不仅仅是存在严重疼痛的问题，更是关于人们正在努力解决医学中忽视女性疼痛这一问题的方案。

Not just that there's a problem with severe pain, but that people are trying to solve solutions to fixing this problem in medicine of dismissing women's pain?

我第一次被问到解决方案时感到很惊讶。

I was surprised the first time I got this question about solutions.

显然，我不该感到惊讶。

Obviously, I should not have been surprised.

但我并没有一个明确的要点清单。

But I didn't have a bullet point list.

如何改变整个文化。

How to shift an entire culture.

如何倾听女性患者。

How to listen to women patients.

这些都是非常复杂的问题。

These are really complicated issues.

而解决方案并不是我报道的重点。

And solutions had not been the focus of my reporting.

我关注的是哪里出了问题。

I'd looked at what went wrong.

探索哪里出了问题，并不自动带来如何纠正问题的解决方案。

Exploring what went wrong doesn't automatically translate to solutions on how to make it right.

但这个问题引起了我的好奇。

But this question made me curious.

那么，有哪些解决方案呢？

Well, what are the solutions?

结果发现，许多关注剖宫产期间疼痛问题的人，都在思考同样的事情。

It turned out that a bunch of people interested in pain during cesarean were thinking about the same thing.

那么，我们来看一下。

So here we go.

这是一个解决医学界最持久问题之一的案例：倾听女性患者并充分治疗她们的疼痛。

A case study in solving one of medicine's most persistent problems, listening to women patients and adequately treating their pain.

故事通过四位女性——克拉拉、希瑟、明迪和苏珊娜的经历展开，她们遭遇了这一问题，并采取了既影响个体患者又波及整个国家的行动。

Told through the experiences of four women, Clara, Heather, Mindy, and Susannah, who run up against this problem and take it on with efforts that touch both individual patients and entire countries.

她们是如何做到的？

How do they do this?

她们能改变什么？

What can they change?

这为她们带来了怎样的代价？

And what does it cost them?

回到医院，克拉拉已被从恢复室转移到了一张病床上。

Back at the hospital, Clara has been moved from the PACU to a bed.

没过多久，她就收到了海瑟的消息。

It isn't long before she hears from Heather.

就是那天。

It was that day.

她也很伤心。

She was really upset too.

她对发生这件事感到非常抱歉。

She was really sorry that it happened.

是的。

Yeah.

因为科里显然……

Because Corey obviously yeah.

科里告诉了她。

Corey told her.

总之。

Anyway.

她真的非常抱歉。

And she was really sorry.

第一次，呃，我第一次见到她的时候，她看着我说：‘海瑟，’

The first well, the first time I saw her, she looked at me and she goes, Heather,

什么

what the

操？

fuck?

海瑟，你搞什么？

What the fuck, Heather?

我只是说：‘对不起，真的很抱歉。’

And I just went, I'm so sorry.

你知道的，她当时真的很难过。

And, you know, she was really it was hard.

她真的，真的非常痛苦。

She was really, really raw.

她状态不好。

She was not okay.

我对她说，你知道的，我说，听好了。

And I said to her, you know, I said, listen.

等你准备好了，我真的很想从你这里了解一些信息。

When you're ready, I I'd love to just get some information from you.

我说，因为我打算把这件事推进到我们目前所处的层面之外。

I said, because I'm gonna I'm gonna take this beyond where we are right now.

我说，我会确保在制度层面，这样的事情不会再发生，我会确保人们听到这件事，并让它发挥积极的作用。

I said, I'm gonna make sure that institutionally, like, this doesn't happen again, and I'm gonna make sure that people hear about this and that this can be used for good.

她不会就此罢休，她会采取行动。

She wasn't gonna let it go, and she was gonna take action.

你知道的？

You know?

她会做点什么，防止这种事情再次发生。

She was gonna do something to prevent this from happening again.

现在我们看到克拉拉躺在病床上，镜头跟随她的目光望向窗外，越过医院，落在街道上，短暂停驻在敏迪的厢式货车上方，挡风玻璃上贴着一张橙色的停车罚单。

And now we see Clara in her bed, and we follow her gaze out of the window, out of the hospital, down to the street, where we pause for a second over Mindy's minivan, an orange parking ticket on the windshield.

接着，镜头穿越城市，再次掠过我们之前经过的高架轨道和宽阔的高速公路，只是此刻已是黄昏，而非黎明。

And then we continue across the city, arcing back over the same elevated tracks and wide highways we traversed earlier, only now it's dusk instead of dawn.

当我们抵达湖边时，镜头转向，让我们能看见夕阳映照在那些宏伟建筑上，窗户被白昼最后的余晖染成火红色，我们保持这个镜头，直到音乐渐强，字幕缓缓升起。

And when we get to the lake, we turn around so that we can see the sunset over those magnificent buildings, their windows fiery with the day's last light, and we hold that shot as the music swells and the credits roll.

本节目由Serial Productions和《纽约时报》联合出品，我是苏珊·伯顿，欢迎收听《 Retrieval》第二季：《剖宫产》。

From Serial Productions and The New York Times, I'm Susan Burton, and this is The Retrieval Season two, The C Sections.

接下来是海瑟。

Next up, Heather.

《 Retrieval》由我，苏珊·伯顿，撰写并报道，由我，朱莉·斯奈德，以及本·菲兰制作。

The Retrievals is written and reported by me, Susan Burton, and produced by me, Julie Snyder, and Ben Phelan.

朱莉负责本系列的编辑。

Julie edited the series.

本负责研究与事实核查。

Ben did research and fact checking.

请订阅我们的通讯，每周我们将分享更多来自节目的报道、听众故事和阅读清单。

Be sure to sign up for our newsletter, where each week we'll share more reporting from the show, listener stories, and reading lists.

前往 nytimes.com/serial-newsletter。

Go to nytimes.com slash serial newsletter.

音乐监制、音效设计与混音由王菲比负责。

Music supervision, sound design and mixing by Phoebe Wang.

原创音乐由丹·鲍威尔、弗里茨·迈尔斯和尼克·索伯恩创作。

Original music by Dan Powell, Fritz Myers, and Nick Thorburn.

卡拉·波隆创作了我们的主题曲，并由丹·鲍威尔进行混音。

Carla Polone composed our theme song, and it was remixed by Dan Powell.

额外制作由麦克·米勒负责。

Additional production by Mac Miller.

额外混音由凯瑟琳·安德森负责。

Additional mixing by Katherine Anderson.

本集的编辑协助来自杰西卡·韦斯伯格、劳拉·斯塔奇斯基和詹·盖拉。

Editing help on this episode from Jessica Weisberg, Laura Starcheski, and Jen Guerra.

我们的标准编辑是苏珊·韦斯林格。

Our standards editor is Susan Wesseling.

法律审核由达娜·格林提供。

Legal review from Dana Green.

本节目的视觉设计来自帕布罗·德尔孔和埃里克·坦纳。

The art for our show comes from Pablo Delcon and Eric Tanner.

《Serial》制作的监制是恩德·楚布。

The supervising producer for serial productions is Nde Chubu.

额外制作由马希玛·查布兰尼、杰弗里·米兰达和科里·比奇在《纽约时报》完成。

Additional producing comes from Mahima Chablani, Jeffrey Miranda, and Corey Beach at The New York Times.

萨姆·多尔尼克是《纽约时报》的副总编辑。

And Sam Dolnick is Deputy Managing Editor of The New York Times.

我提到的那项研究——在研究中，患者被问及剖宫产过程中是否感到疼痛——由詹姆斯·奥卡罗尔领导。

The study I mentioned, the one in which patients were asked if they felt pain during their C sections, was led by James O'Carroll.

特别感谢凯蒂·富克斯、伊丽莎白·利文斯顿、布莱尔·亚瑟、范妮莎·莱纳、蕾切尔·罗伯茨、林·荷兰、卡罗琳娜·门多萨、杰米·戴利、伊丽莎白·戴维斯·摩尔、尼娜·拉斯姆、乔丹·科恩、维多利亚·金、马迪·马西埃洛、凯莉·多和约翰·帕帕斯。

Special thanks to Katie Fuchs, Elizabeth Livingston, Blair Arthur, Vanessa Lehner, Rachel Roberts, Lynn Holland, Carolina Mendoza, Jamie Daly, Elizabeth Davis Moore, Nina Lassem, Jordan Cohen, Victoria Kim, Maddie Massiello, Kelly Doe, and John Pappas.

《The Retrievals》是由Serial Productions和《纽约时报》联合制作的节目。

The Retrievals is a production of serial productions and The New York Times.