WEBVTT

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（掌聲）

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最壞嘅情況會變成點？

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大概喺十年前

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我坐喺一個非常凍嘅診症室

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等我嘅腫瘤醫生

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我好驚

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即使我嘅另一半當時就坐喺我嘅右手邊

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我仲係覺得好孤獨

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我啱啱被確診有乳腺瘤

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似乎同時

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掃描圖上我右肺上有一個白點

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意味著我嘅癌症已經開始擴散

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我患咗擴散咗嘅乳腺癌

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當時我仲未開始我嘅醫學培訓

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但我知如果呢個結果係真嘅

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會係無藥可治嘅乳腺瘤

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係末期嘅乳腺瘤

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我當時只有 27 歲

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啱啱有醫學院錄取咗我

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但我要思考我嘅人生係咪走向咗盡頭

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我嘅腫瘤醫生唔係一個好熱情嘅人

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佢比較注重客觀事實

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就好似其他專業嘅醫生一樣

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佢啱開口講「我哋嘅身體
係由好多細胞組成嘅……」

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我就打斷佢，我話

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「我就快開始讀醫學院，

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所以我知。」

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佢無繼續講

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而係直接進入正題

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佢話我要開始進行化療

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去控制住癌症

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佢開始講藥物嘅細節同副作用

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仲有成個療程

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我提佢佢仲未幫我肺部嘅白點做活檢

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真係可以確認我有癌症？

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我記得佢當時對我嘅問題表現震驚

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或者佢當時認為我唔係好信佢

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甚至認為我否認佢講嘅嘢

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但我只係想令佢明白，作為佢嘅病人

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活檢唔係單純一個形式
用嚟證明已成定局嘅結論

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佢仲係一條鋼針
穿過皮膚、肌肉同骨

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會令我更加深刻噉意識到呢個問題

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一個我希望無遇到嘅問題

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活檢之前，我係一個 27 歲嘅女人

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或者我嘅乳腺癌會擴散

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或者我嘅乳腺癌已經擴散咗

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呢兩樣嘢係有關鍵性嘅分別

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但係最精英嘅腫瘤學培訓裡面
無人會強調呢一點

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所以佢無視我嘅問題
而係決定直接開始治療

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僅僅幾個禮拜之後

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自從第一次確診後
好多事情都隨之而來

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諷刺嘅係，活檢不單止係一種形式

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我之前嘅腫瘤醫生係啱嘅

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（笑聲）

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確實係癌症

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不過係完全唔同嘅肺癌

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聽起身好瘋狂係咪？

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一個好消息係

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我無擴散性乳腺癌

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我係有兩種唔同嘅癌症

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但呢兩種癌症都係局部性嘅

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而肺癌嘅局部範圍細到

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可以被移除

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所以治療從肺部手術開始

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跟著就係化療

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我 28 歲生日後做咗胸部手術

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兩個禮拜後

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我開始去醫學院返學

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我有一個新嘅腫瘤醫生……

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（笑聲）

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佢同我嘅溝通比較愉快
佢講咗啲客觀事實，同對我影響

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佢建議埋我

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應該延遲一年入學

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將時間用喺休息、康復度

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我接納咗佢嘅意見

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喺高強度嘅化療過程中，我覺得好痛苦

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我寫信畀醫學院嘅院長

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解釋咗我嘅情況

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我嘅延期申請好快就批咗

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我稍微好少少嘅時候

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我開始思考
呢一年嘅時間裡我應該做咩呢

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我應該去海灘嗎

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（笑聲）

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但其實我唔係一個鍾意去海灘嘅人

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（笑聲）

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我仲有幾多年命呢

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我真係好想去醫學院讀書

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呢件事就好似我人生裡面
唔見咗嘅一塊拼圖

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與其猶豫不決

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我開始問自己，最壞嘅情況會係點

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或者我可能會太虛弱或者
病得太嚴重而無法學習

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或者我會情緒崩潰

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或者我會考試唔過

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但我諗，呢啲一定唔會係
發生喺我身上最壞嘅事

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更加唔會係嗰一年裡發生最壞嘅事

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咁點解唔返學校呢

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咁點解唔按照我想要嘅方式去生活呢

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所以我決定好

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當時我無頭髮又瘦骨嶙峋

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我戴我最好嘅耳環，著我最鍾意嘅裙

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開始返去讀書

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我扮我係屬於嗰度嘅

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然後就開始啦

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我唔知點形容有幾困難

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有啲日子我甚至覺得
無辦法繼續支撐落去

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我感覺我喺度做啲對未來無意義嘅事

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每一日，我都會問自己
你仲享受呢啲嗎？

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呢啲仲係你想做嘅事情嗎？

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每一日我嘅答案都係，係嘅

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有時候係一個有條件嘅肯定

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但佢仍然係一個肯定

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然後我嘅身體舒服咗少少

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然後我覺得
或者我都唔一定唔可以畢業

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然後，我收到更差嘅消息

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我嘅 TP53 或簡稱 P53 基因發生咗突變

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呢個基因係一種守護基因嘅……

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一種突變

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P53 負責監督我們基因嘅修復

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基因突變意味著錯誤已經唔可以被修正

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因此正常嘅細胞變成
癌細胞嘅可能性會高好多

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得知呢件事情嘅時候好突然

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我嘅醫學常識帶畀我一種好差嘅感覺

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細個嘅時候、喺我七歲嘅時候
患過一種癌︰橫紋肌肉瘤

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喺我青少年時期又複發咗一次

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呢啲都係喺 P53 被實驗室發現之前

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跟住，我患咗年輕成年人嘅
乳腺癌同肺癌

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得知基因突變呢件事之後

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喺我可以預見嘅未來裡面

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我睇唔到呢一切嘅盡頭

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然後

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我決定成為一個放射腫瘤學家

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（笑聲）

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我希望幾個月後當我從住院部實習結束

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可以去一個新城市

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開始我嘅第一份醫生同研究者嘅工作

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因為毅力

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因為大家對我嘅優待

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因為治療

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因為我嘅醫療團隊
我嘅家庭同我嘅教授

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因為基因診斷畀我哋嘅知識

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我需要繼續向前

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即使喺 2020 年

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仲係無奇蹟療法同醫學突破

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而嗰次基因診斷報告嘅壞消息

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意味著我要學識同不確定性共存

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意味著了解你同你嘅病情
唔算最壞嘅事

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學識同不確定性共存

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意味著向著生活向前行

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充滿美好但都充滿挑戰

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亦都意味著你要認識到
癌症只不過係你故事裡嘅一個部分

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或者唔係發生喺你身上最壞嘅事

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假如係，都無乜大不了

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你會承認你嘅命運，然後掌握佢

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令佢成為你可以同人講嘅故事

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除咗你無人可以規定你係成為一個乜嘢人

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即使你手裡有學業延期書
都要按照自己嘅意願去用

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我就快要完成我腫瘤科課業嘅時候

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我腦一次又一次浮現咗以下場景：

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有個病人有咗癌症

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有好幾種選擇

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所有嘅選擇都提供咗一種
治愈同生活質素之間嘅平衡

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係減輕痛苦

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同加劇痛苦之間嘅平衡

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一個腫瘤學家列出咗啲選擇

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但係，事情有時候會有改變

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事情最終可能會變成

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「你揀咗做一啲事，

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或者你選擇乜都唔做，

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我哋可能好積極噉醫好你嘅癌症，

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或者我哋可以只係睇住癌症發展落去。」

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而超過 99% 嘅病人會話

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我會做所有嘢

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當然啦

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邊個唔想做所有嘢呢

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但係所有嘢又係咩？

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係指坐喺自己屋企嘅窗口外面

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一邊同家人團聚，一邊灑太陽？

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係指喺手腳仲未因為化療變僵硬之前

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仲感受到自己手同腳？

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作為腫瘤學家
我哋所做嘅一切都係癌症治療

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係電療、手術、化療同新療法

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而對於我哋，最壞嘅事情可能會發生

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我聽過唔止一位腫瘤學家講

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最壞嘅事情可能係

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患者嘅癌細胞擴散

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或者係，五年之後

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癌症會變嚴重，我必須做更多嘅化療

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作為一個患者同一個腫瘤學家

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我從來唔會去否定呢啲係傷心嘅打擊

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但係咪最壞？

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控制癌症

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應該一直係我們腦海最重要嘅嘢嗎？

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好多難以形容，難以理解嘅殘酷嘅事情
曾經發生喺我身上

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因為我嘅癌症，我嘅基因突變

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但依家，我認為我自己十分幸運

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因為最壞嘅事情無發生

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因為我已經面對到個衝擊同不確定性

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而且將佢哋擺埋一邊

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當我被確診為擴散性乳腺癌嘅時侯

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我想尋求第二種意見而去咗波士頓
因為，我仲有咩可以失去？

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當我嘅醫生畀咗我非常好、非常安全

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非常標準嘅建議嘅時候

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我仲係不顧一切咁開始咗
我嘅醫學院生涯

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即使我同時承受緊癌症治療嘅痛苦

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我無選擇避開癌症患者

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我成為咗一個放射性腫瘤醫生

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我嘅工作需要我
同我好相似嘅癌症患者相處

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每一日都要

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與其想像有一日，我帶畀我伴侶嘅傷痛

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因為我可能會死於癌症

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我嫁咗畀一個很好嘅丈夫

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最壞情況

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永遠都係一系列嘅負面情緒

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又或者咁講，空白鍵

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係需要被生活填滿

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所以我喺呢種超級不確定
學到最有用嘅係乜呢？

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呢個係威廉

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佢係我認識嘅人裡面，最快樂嘅人

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僅僅一年嘅時間內
佢令呢個世界變得更好

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作為腫瘤學家，我哋同病人交流時

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講到最壞嘅事都離唔開

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佢哋可能癌症復發

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或者可能癌症擴散
或者佢哋因為癌症而死

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作為一個病人，我知道噉係最壞嘅結果

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但我想改變我哋思考呢個問題嘅方式

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我想轉變我哋同病人
講起呢件事時嘅方式

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作為一名病人

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最壞嘅事係癌症掠奪咗你嘅機會

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去活出你自己

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去做你嘅嘢

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去愛你嘅人

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癌症確實可以掠奪

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至少暫時會

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但為咗將生活嘅損失最小化

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雖然咁樣好難，但我想講
腫瘤學家真正嘅工作

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係將我哋手中有嘅資源同工具

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用喺病人嘅生命裏邊

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教佢哋點樣面對痛苦

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對佢哋所承受嘅痛苦有同理心

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但唔好畀恐懼奪去未來嘅人生旅程

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我嘅一個導師成日話
同病人講醫治嗰部分係好簡單嘅

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雖然年輕醫生唔係噉睇

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但佢又講得幾啱

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我哋喺醫院駐院嗰陣會有
好勁嘅學術指引帶著我哋

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但更難嘅部分係點樣幫助病人
度過各種各樣嘅難關

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包括佢哋嘅病痛

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所以我發現回憶非常有趣

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我嘅人生睇起嚟就好似一個好好嘅計劃

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睇上去我將每一步都計劃得好好

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呢啲可能就係癌症帶畀我生活好嘅嘢

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第一步：申請醫學院

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第二步：確診，治療癌症

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第三步：擁有事業同一個家庭

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但我仲想話畀你知

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每一個階段都係信心嘅提升

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就算就快俾不確定嘅事麻痺

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就係呢種勇氣

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我都努力將勇氣帶畀我每一個病人

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我努力忽略癌症嘅技術性治療細節

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仲有嗰啲基因突變

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無視嗰啲預測可以帶畀我哋嘅後果

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我嘗試去了解患者想要嘅

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同需要嘅嘢

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患者渴望嘅同擔心嘅事

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仲有患者夢想追求嘅嘢

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有咩令佢哋以前好開心

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以及有乜可以支撐佢哋
捱過可怕嘅癌症治療

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呢啲嘢都唔需要花太多時間

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只需要花少少注意力同幾個安靜嘅片刻

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同時都需要有意識嘅培養

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而最重要嘅係醫生同病人嘅合作關係嚟

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呢樣嘢最重要

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因為最壞嘅事

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係有腫瘤醫生做咗所有嘢去醫你嘅癌症

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而你又乜都唔做去改善你嘅生活

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多謝