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    六六的《心術》

    作者: 阮一峰

    日期: 2010年9月1日

    1、

    一位醫生朋友推薦我讀這本小說,六六的《心術》。

    我發現它是一個蠻好看的故事,12萬字,我一口氣就讀完了。主人公的命運打動人心,它會讓你站在醫生的角度,觀察和思考人生和社會。

    《心術》講述了三個醫學博士的故事。他們都是上海一家著名三甲醫院”神經外科“的醫生。(不知道“神經外科”的朋友,可以把它簡單理解成,開刀切除腦瘤。)三個博士的年齡和資歷都不同,唯一的共同點就是,內心深處,他們都希望成為一位好醫生。但是,在殘酷的現實面前,他們發現這是一個艱難的、幾乎不可能完成的目標。

    主任醫生劉曦,熱愛工作,關心病人,但是六歲的女兒腎衰竭,急需換腎。他無法找到腎源,只能眼睜睜看著女兒病情一天天惡化。醫生做得再好,卻救不了自己的女兒,這是不是命運的嘲諷?

    副主任醫生霍思邈,出生于醫生世家,學醫更多是因為家庭傳統,而不是本人愿望。雖然技術高超,但總覺得,這個職業不符合自己的選擇。用他的話說,就是”十年醫生當下來,覺得自己像個木頭一樣,已經跟社會完全脫節了。“

    主治醫生鄭艾平,一個沒錢沒房沒地位的小醫生。經過四年本科、五年碩博,兩年住院醫生、兩年主治醫生之后,他依然沒有機會看門診,只能在手術室和急診間里當無名英雄。因為病人不信任年輕醫生,沒人選擇讓他開刀。

    小說講的就是這三個人的經歷。他們懷著熱忱,離開學校,來到這所全國著名的醫院,可是等待他們的是什么呢?

    2、

    根據小說的描述,醫生這個職業有三大現實。(下面的引文都是出自小說原文。)

    第一,長時間、高負荷的勞動。

    每天都有手術,有時一個人一天好幾臺。長的手術會持續4、5個小時,甚至更久。”本周,我最長睡覺時間是周三,五個小時;最短睡覺時間是周一,就沒睡,大夜班過后直接是手術,然后就地躺了半個鐘頭。“”這個醫院的繁榮下面,墊的都是醫生的骨灰。“

    第二,收入不高,尤其是年輕醫生。

    剛畢業的住院醫生,一年收入四、五萬元。即使工作10年之后,明的收入也不過”基本工資2千多,獎金3千到4千“。在上海這個地方,這只是溫飽水平,根本不要提買房買車了。

    相比工資,醫生的勞動價格更低。”普通掛號費2元5角,醫生個人可以拿到2毛。“如果一天門診看60個病人,也不過才12元。”一臺手術,從護工的搬運到護士的準備,到麻醉師的檢測,到輔助醫生的開顱縫合,到主刀大夫的取瘤,全程耗時最短三個鐘頭,長就說不好了。全部人工費多少?一千塊以下,其中大頭還要被醫院拿走。“當然,”手術最后的結算價格,從三萬到八萬不等。其中,器材費遠高于人工費。開刀是不值錢的。“開刀醫生的收入,要靠器材費提成彌補。

    第三,醫患關系緊張,沒有尊嚴。

    醫生被打被罵,是常有的事。“新醫生值夜班,第一件要知道的事,就是如果被家屬追打,如何逃脫。”

    醫生與病人不再是治病救人的關系,更像是互相提防的對手。寫病史的時候,一個疏忽,或者有一項檢查沒做,都可能成為醫生將來敗訴的證據。至于手術,則更是只能成功,不能失敗,否則病人家屬就會認定這是醫療事故。所以,到了后來,只要病人本人不提出來,醫生就不敢開刀,”因為病死是他的責任,開刀死了,就成了我的責任。“

    3、

    讓我們站在主人公的角度,設想一下。

    你終于讀完9年或10年的醫學課程,拿到了博士學位。來到醫院后,卻發現自己的收入,低得只夠維持溫飽,但是工作卻非常辛苦,而且還可能被病人家屬打罵、起訴,萬一敗訴還有被吊銷執業許可的風險。你會怎么想?你還會一腔熱情地對待醫生這個工作嗎?你還會拒收紅包和回購嗎?你還會把”救死扶傷“當作醫生的天職嗎?

    這就是小說中三個主人公的困境。他們有熱忱,想做好醫生,可是在現實面前卻處處碰壁。個人的理想和操守,生存的壓力,家人的期待,職業的艱難,一切都是如此堅硬,到底應該何去何從?

    4、

    繼續堅持理想?

    在現實中很可能會窮死累死。

    放棄理想,追求個人利益?

    那么當初何必選擇當醫生呢,選擇更輕松更賺錢的職業,不是更好嗎。

    小說中,神經外科主任有一段話,可以看作鼓勵,也可以看作自我安慰。

    ”有些人當了幾年學生就不愿意做了,我恭喜他們,在年輕的時候他們就發現這樣一條艱苦的道路不適合他們,他們還來得及轉行。有一些人當了幾年醫生不愿意干了,我祝福他們,不干醫生,干醫藥代表也很好,收入比醫生高得多,得償所望。但我更珍惜我們留下的這個團隊,珍惜你們。有些人天資可能比你們好,可他們沒成為一名合格的醫生。因為他們差的那點點東西,你們有----信念。一個有著堅定信念的人,才會在我們這里經歷各種打擊磨難而無怨無悔。“

    5、

    看到這里,有的朋友可能會說:這篇小說完全站在醫生角度,不夠客觀全面,沒有考慮到病患的觀點,而且里面的人物太過理想化,顯得不真實。

    在我看來,這些都不重要。真正重要的是,我們要追問:想當好醫生的人,卻當不成。這樣的困境是誰造成的?

    一方面,普通人看不起病,覺得醫療費昂貴;另一方面,醫療資源十分緊張,醫生感到收入偏低。這到底是怎么回事?到底是哪里出了問題?

    醫患之間緊張的關系,并不是因為醫生沒有醫德,也不是因為病人刁鉆,而是因為這兩個群體被逼成這樣。說到底,是我們的制度出了問題。在這個制度里,你只能按照它的規則行事,不服從就要被淘汰。醫生和病人都是這個制度的受害者,他們被逼得對立起來。

    6、

    這就是,我寫這篇書評的根本目的,我就是想問:在制度的壓迫下,個人應該怎么辦?

    你有一個很美好的事業,你也熱愛它,可是你偏偏遇上了一個非常差的制度,它不讓你堂堂正正做人、光明正大地追求理想,你該怎么辦?

    其實,答案大家都知道,只是承認起來有點傷感。你一個人不可能改變制度,最多就是心里掙扎一下,然后不得不接受它為你定下的規則。我忘了是誰說的:擺脫一個制度的有效方法,就是成為這個制度里的成功者。真是糟到不能再糟的一句實話。

    小說中,主任說:”人活著要有兩個主義。理想主義和樂觀主義。如果沒了這兩個主義,人生會變得暗無天日,活得行尸走肉。“可是,理想主義和樂觀主義,明明都是精神勝利法啊。

    這就是小說《心術》。怎么當一個好醫生?它也不知道答案,或者知道但是不愿意承認,那么就精神勝利一下吧,讓三個主人公最后都在個人生活中如償所愿。

    最后生成于 2018-7-9 07:42:00

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