美国时代周刊 新一期 ( June 13th, 2011) (Time) 发表以肿瘤为题的健康专栏, 并冠以副标题:

The Next Wave of Cancer Treatment [肿瘤治疗的新潮]

是有关一位年过50的医生 .... 由 "后门镜" 引发的一些过程... 思考. 

原文后附有翻译的正文翻译者（nanmuzhou、静水走远）

What I Learned from My Cancer Scare
By Dr. Mehmet Oz

      At some level, I knew I was standing in the middle of New York City traffic, but my mind was in another dimension entirely. Reminders of your mortality will do that.

The day hadn't started off so strangely and scarily, but it hadn't started off to be much fun either. I was going to my doctor's office for a colonoscopy, my second in nine months. Colonoscopies aren't supposed to happen nine months apart, of course, unless the first one turns up something worrisome — and mine had. Back in August, my doctor discovered a suspicious polyp that needed to be removed. It turned out to be precancerous, and while a large majority of such growths do not eventually become cancer, colon cancer usually starts with just that sort of polyp. So did I have the 40-some years left to me that I had been more or less counting on — or just a year or two? You ask a lot of existential questions like that when you get the kind of news I had gotten. And you do a lot of hoping that when you return for a follow-up exam, all will be well — and the problem will simply go away.

Now I was going in for that follow-up. Surely I would get the all clear, and life would go back to being what it had been. I didn't, and it didn't. My doctor found another polyp, higher up in the colon — a more dangerous location.I left the doctor's office and stood out on the street wrestling with the news. Pedestrians bustled by — all of them, I felt, untroubled by the kinds of things I was feeling. But of course, I wasn't alone. Indeed, I had something in common with millions of people across the U.S. I was a medical statistic, one of many, many patients who receive the kind of diagnosis I did every day of every year. The very fact that I was joining so large a population meant that this was by definition a routine story. But that's the case only if the story isn't about you.

When it is about you, your mind races. Am I at fault? Could I have done something differently? What do I tell my children and wife? What if I actually get cancer? Have I done everything I set out to do in life? I am a physician who gives advice for a living. I have spent much of my professional life extolling the value of healthy eating and regular exercise, and I practice both. So how in the world did this happen to me?

Part of the answer to that last question is luck of the draw. A healthy lifestyle can dramatically lower your risk of cancer, but it's no guarantee of anything. But there was more at work too — at least in terms of how and when I learned of my condition. I take pride in being a good doctor and a good family man, but the fact is, I had been a pretty bad patient. Living my life on television, dispensing medical advice every day leaves me with a solemn obligation and moral imperative to be honest and to own up to mistakes — and I made some. They may not have been big, but they were more than enough to threaten my health, my future and the well-being of my family. The experience transformed me from Dr. Oz to just plain Mr. Oz, and it taught me a lot, both about myself and about my patients.

50 and Fabulous?

The story started about a year ago, when I celebrated my 50th birthday with a big bash attended by family and friends, many of them doctors. I bragged that I would commemorate my half-century mark by scheduling a colonoscopy, something I routinely counsel my patients and viewers to do — and something that I didn't look forward to with any more enthusiasm than anyone else does. Making light of it by making an announcement of it helped ease the reality that I had crossed midlife's threshold and somewhere out there a colonoscope was waiting for me.

Some guests suggested that the procedure be shown on my program, pointing out that viewers would be well served to see how easy this simple screening could be. I agreed, figuring that if I had to go through the prep and hassle, why not put it to good use? The gravity of the test was the last thing on my mind. Indeed, if I wanted to be truly honest with myself, I might not have scheduled it had I not been such a show-off at my birthday party.

But even though I did manage to make the appointment despite my belief that I had nothing at all to fear, I found a different way to act against my own interest beforehand. I knew full well that I wasn't supposed to eat for at least 36 hours leading up to the test, but I nonetheless sneaked a few mouthfuls of lunch just 18 hours before. How could it hurt, especially for someone as healthy as me? I said nothing to my doctor about this and reported for my test the next day.

During a colonoscopy, many people are completely unconscious. Another option is twilight sleep, which eliminates pain while leaving the patient partly conscious. I chose that, and I also opted to watch on the monitor as Dr. Jon LaPook, my gastroenterologist and friend, conducted the test. It didn't take long before he began grumbling about the inadequacy of my prep. My colon was littered with the lentils I had heedlessly eaten the day before. I had been a mediocre patient, the kind I lecture about — and to — in my practice and public life. As I lay on the gurney, a snapshot of thousands of conversations I had had in my office with patients on whom I was about to operate formed vividly in my mind. My emphasis in those situations is always pointed: I look them in the eye and tell them I need their help, that this is a combined effort and that we will get through this together but that we both have responsibilities. I always feel frustrated when my patients seem to think that precise medical instructions based on years of experience don't apply to them. I was now that person.

LaPook scolded me for having disobeyed instructions, but he did so playfully; I was in a vulnerable enough position at that moment as it was. The banter ended fast, however, when he looked up from the monitor and announced that he had found a suspicious polyp that needed to be removed. I shifted my gaze to the screen, and there it was: a little teardrop of tissue attached to the colon wall. For a brief period, emotion superseded reason. The growth coming into focus indeed looked precancerous, but that was impossible! I have lived a pious life! I was feeling fear, yes, but also — irrationally — anger. LaPook coolly carved out the polyp and forwarded the specimen to pathology for rapid diagnosis. But it was a Friday — a Friday the 13th, as it happened — and there would be no results until Monday.

The Long Wait

The weekend was what you would imagine the weekend to have been — which is to say, lousy. All these years I have been telling people bad news, sad news, scary news. Now I was experiencing what they so often experienced. The very lonely terrain of awaiting diagnosis is bad enough. But as every parent or professional or employee knows, your responsibilities at home or at work don't stop just because your mind is whirling with worry. The same is true when you're a healer — when your pager continues to go off and the messages continue to come in and your patients expect, and deserve, your full attention. In the free moments I had that weekend, I went through my litany of medical options. Best-case scenario would be a hyperplastic polyp, which behaves like a skin tag and would never have hurt me. Worst case, I had cancer that had spread through the protective lining of the colon, and I would need surgery to remove my colon.

Monday morning at last arrived, and LaPook called and asked if I could come to his office. I immediately knew I could eliminate the best-case scenario. Doctors are taught to share good diagnoses over the phone but to deliver bad news in person, so as to offer better counsel. I sat attentively across from him as he told me that yes, my polyp was premalignant, the kind from which cancer arises to afflict 5% of Americans. The odds are higher if you have a relative with this cancer, if you are obese or if you smoke. I had none of these risk factors, nor do the majority of men and women diagnosed with an adenomatous polyp. This bears repeating, in case any of you believe you are even healthier than I thought I was. Most people with precancerous polyps have no risk factors. If I had not been showing off at my birthday party, I could have easily caught my problem too late and been facing major surgery and perhaps a colostomy, chemotherapy and even death.

I called my wife Lisa from LaPook's office. She was very calm when I told her the news, but by the time I got home that evening, she already had a shopping cart's worth of herbs and polyp-shrinking potions ready for me. We all cope in different ways. The tougher part was telling my children — not so much that I was sick, because I wasn't, at least not yet — but that they were now at high risk for polyps and would need to start getting screened when they are at least 10 years younger than I was. I was advised by friends to do this while driving in the car, which is a brilliant insight since the activity allows everyone to process information without being forced to look at one another.

I have four children, ranging in age from 12 to 25, and we spoke when we were driving to the airport in Maine after the wedding of Daphne, our oldest. The kids asked the right questions and took their emotional cues from me. If I wasn't panicking, they wouldn't either.

I also felt a moral imperative to share this news with my viewers. My unlucky outcome offered a teachable moment to help our audience get screened themselves and potentially save some lives. So we got the word out and heard back about hundreds of early diagnoses that resulted from timely screening. I learned the most not from the people who got screened but from those who didn't — or at least who put it off longer than was good for them.

For many of us, health is binary, sort of like being pregnant: we are as healthy as a bull or are about to be hospitalized. In medical school we are taught much about lifesaving interventions during crises but little about the broad societal screening that profoundly affects the likelihood of needing to face end-of-life decisions prematurely. After all, prevention is pretty boring to learn and does not pay well, especially when compared with specialties like mine (cardiac surgery). This colors the discussions we have with our patients. Every week in my clinical practice, I dutifully admonish people to get screened but often leave the details to them. Between selective hearing, human error and confusion, many mismanage the seemingly simple request, and the tests slip away in the sands of time. Accordingly, we devoted a lot of airtime to the idea that both doctors and patients need to change the way they do things.

Of course, throughout all of this, I still had one serious bit of unfinished business to handle. The lentils in my intestines at my initial colonoscopy had partly obstructed LaPook's view, so he insisted on repeating the colonoscopy to look for potentially missed polyps. He gave me a three-month window, which is about standard in a case like this. Remarkably, I stalled. He called to remind me. I scheduled and then canceled. He sent periodic e-mails. I procrastinated. Once again, I was engaging in behaviors that had left me dumbfounded when my patients exhibited them. How could they be so casual with their health when there was real reason to worry about it?

Finally, after a full nine months, I came around. Once again, I found myself at home, reading the instructions for mixing the huge chemical cocktail that would wash out my intestines. This time around, I was taking this business seriously. As directed, I drank a big glass every 10 minutes without fail. I also took laxative pills and magnesium citrate and fasted for two days. I did not want a third look in my colon in one year. You could have eaten tapas off my colon lining. LaPook was thrilled. He had a great time looking around until he got to the most distant part of the colon, the most difficult section of the intestines to see and operate on.

Then, through the same anesthetic fog as before, I heard the same concerned voice I'd heard from him during the previous test. He had found another polyp, in a more hard-to-visualize location than the first one. He needed to excise the lesion deftly. Under the influence of the narcotics, I mumbled, "Good luck." Once the polyp was in the bucket, we repeated the same pathology exercise as the first time around and awaited the diagnosis. What kind of a reward was this for showing up dutifully for my test?

The best thing about a colonoscopy is that the test itself can be curative if the polyp is successfully removed before cancer pushes into the colon tissue. But if the tumor has spread into the wall of the intestine, my 10-year survival odds are about 72%. If any lymph node is involved, I am in the 50-50 club, and if the tumor has spread to another organ, I have less than a 5% chance of being alive in 10 years.

This second polyp, which worried me more than the first, turned out to be hyperplastic and not precancerous. This was good news, of course, but the fact that I had had a polyp at all did mean I would have to be vigilant for the rest of my life. I will probably be at little risk of dying from colon cancer — but only as long as I faithfully show up for periodic testing and continue to use a capable gastroenterologist who can meticulously do the procedure.

Getting Smart

Those colon-cancer numbers are likely to keep me on the straight and narrow from now on. But it was an awfully close call. Why did I almost blow it?

It was while I was sitting in my office's waiting room before the second test, watching a half-dozen patients pacing back and forth thinking many of the same anxious thoughts I was thinking, that I finally had the epiphany. The reason so many otherwise rational people don't screen themselves for disease is not that they don't understand the risks — they do. And it's not even that they believe they're somehow immune from disease or death. We all grasp that in a primal way from the time we're very small. But even as we age, death still seems somehow remote — something that will happen at some vaguely later time and that we'll deal with it in some hard-to-fathom way. It's that distance that helps us cope with the idea of our mortality.

What we can grasp much more clearly — and what we dread much more immediately — is the world-jolting way a bad medical diagnosis will affect us today. Our lives get complicated fast, and we are very uncomfortable being uncomfortable. We detest the passage into the unknown — that feeling of being out of control, victimized. Numbers like 75% or 6% or 50-50 are abstract and conceptual. The sickly, swoony feeling you get when your doctor says, "Come see me in my office," is something we can all imagine today. And so we avoid the test to avoid that experience — and that was precisely the choice I had made.

In hindsight, I recognize that the universe had to drill through three distinct layers of arrogance (or denial) as it changed my perspective on cancer and cancer screening. First, I was cavalier going into my initial screening. I was healthy, and I knew the statistics, and I figured the risks didn't apply to me. Second, I felt that decades of research and experience that led to the prep-and-testing guidelines as we know them also didn't apply to me. And last, I felt that the follow-up was somehow a formality and the risk still didn't apply to me. The transformation from Dr. Oz to a modest, wiser Mr. Oz did not become complete until I was staring directly at a pathology report.

So am I satisfied with the results of my birthday-boy bravado? Well, I have learned to embrace the uncertainty and terror that we all experience as we confront threats to our health. I will perhaps fear bad news a little less and will thus show up for screenings more willingly in the future. I am surely pleased that what I learned will help me manage a disease risk that might otherwise have killed me. So, if a newly modest me can still be immodest enough to offer advice: Learn from my mistakes.

The goal, I now know better than I did before, is not to be the perfect patient but simply to be as good a patient as you can be. Many of you have not had any kind of cancer screening in a decade or more. Please know that it's often not too late for a clean medical slate and that even if something is detected, it's better to find it sooner rather than later. The fact that you have never had a screening or have failed to keep up with the appropriate schedule has no bearing on the karma of cancer, but it has an enormous bearing on the outcome.

Most important, my colonoscopy wasn't entirely about me. It was about my wife and our children. It's about our someday grandchildren. It's about my childhood friends whose lives remain closely intertwined with mine. It's about my colleagues and patients at the hospital who teach me as I learn from them. I need to be there for all these people I know and care about. I need to show up in my own life. And you need to show up in yours. Sometimes that requires courage — the courage to undergo a colonoscopy or Pap smear or mammogram or chest X-ray. It's not easy, but it could save your life. And if it helps even a little, remember that I will be rooting for you.

 50 and fabulous

  故事发生在大约一年以前，当时我和我的家人，朋友举行了一个盛大的舞会庆祝我的五十岁生日，并且他们之中很多人是医生。

我吹嘘道我会以进行一次结肠镜检查来纪念我已经走过的的半世纪，结肠镜检查—这是一件我经常例行公事般的建议我的病人和咨询者经常去做的一件事，当然这也是我最讨厌做的一件事。发出这个声明意味着事实变得更清楚了：我已经度过了一半的生命并且我即将进行一次结肠镜检查！

      一些客人向我建议我的手术计划中的步骤应该向大众展示，以此让咨询者知道在手术中他们将会得到很好的服务并且会发现这个简单的身体检查会很便捷。我接受了他们的建议，试想既然我一定要经过手术前的准备和何种各样的麻烦，那为什么自己不好好利用这次手术呢？体重测定是我仅存的念头，事实上，如果我真的认真面对自己真实的想法，如果我从不是这样一个爱在聚会上炫耀自己的人，我可能不会有这样的计划。

       尽管我坚信我无所畏惧但即使我成功的做出了许诺，我还是发现了一种会影响我的健康的潜在危险！

我非常清楚的知道手术前三十六小时之内我是不可以吃任何东西的，然而就在手术前的十八小时我偷偷的吃了一点午餐，可这又能怎么样呢，尤其是像我一样健康的人！医生对这件事一无所知，不过第二天做手术的时候还是被他发现了。

在结肠镜检查的时候，许多人是完全昏迷的，而另一种称之为半麻醉的方法可以在保留病人部分意识的前提下消除疼痛，于是我选择了这一种方式！并且当我的朋友兼胃肠病专家在为我实施手术的时候我要求同时在显示器上观看整个手术过程。很快我的朋友就开始抱怨我的手术前准备，我的结肠里残留着我昨天毫不在乎吃下的扁豆。我本来只是一个平凡的病人，恰如我演讲中提到的，实践和生活中（此句实在想不透），当我躺在手术台上的时候，成千上万次我在办公室和那些由我主刀的病人对话的场景清晰的出现在我的脑海里快速掠过。在那种情况下我总会指明这次手术的关键，我会看着他们的眼睛并且告诉他们，我需要他们的帮助，我们需要一起努力，我们将一起度过这次难关，但是如有不幸得话，我们都对这件事都负有责任。

当我的病人看起来正在思考那些基于多年的工作经验而给出的适合于他们的精确的用药指导时，我经常会感觉到沮丧，而现在我就是这样的病人。

因为我违背了他的指导，LaPook 用开玩笑的方式指责了我！事实上那时的我正处于一个很敏感的状态，然而当他从显示器中抬起头告诉我说他找到了一个需要清除的可疑性息肉时，玩笑结束了！我把目光移向屏幕，它就在那，一个小小的附生在肠壁上泪滴状的组织，一瞬间我丧失了理性。提前发现潜在的肿瘤危险是不可能的。我一直过着虔诚的生活，是的，我承认我怕了，但同时我感到莫名的愤怒。LaPook冷静的切除了这个组织然后把样品送去做病理快速诊断。

但今天是星期五，十三号的星期五！像往常一样，作为患者必须到星期一才能知道诊断结果。

漫长的等待

         一刻不停的想象周末，周末也就变成了你想象中的样子。由此而论我的这个周末过得简直糟糕极了！这些年以来我一直在告诉着别人那些坏的，悲伤的，令人提心吊胆的，消息。而现在的我正经受着那些人经常经受的一切。孤独的等待诊断结果的日子真的是坏透了，但正如每位父母，专家，雇员知道的一样，只要你的大脑还在运转，你在家庭工作中的责任就不会终止，尽管你的每一分钟的思考都伴随着深深的忧虑。道理是一样的，当你作为一名医生，当你的呼机关机了的时候而信息还在不停的向他发送，值得你关注的病人还在期盼着你的到来，在那个周末我所度过的空闲时间里，我做了无数的病况抉择。最好的情况是这只是一块生长在皮肤上的增生息肉并且绝不会危害你的健康。最坏的情况是，我得了癌症并且癌细胞正在通过肠内保护层扩散。我将需要做一次手术切除掉我的结肠！

星期一的早晨终于到来了，LaPook打电话来问我是否方便去一下他的办公室，我立刻就知道，我可以不用幻想最好的那种情况了。医生早已经学会了要在电话中和病人分享好好运，却面对面的告知病人他们的的不幸,以便向病人提供更好的建议。我紧张万分的的坐在他的对面听他告诉我说：“是的，你得的是癌前息肉。”由它引起的癌症折磨着大约百分之五的美国人，如果我吸烟或者肥胖的话息肉恶化为患癌症的概率将会大大增加。我没有这些危险的患病因素，也没多大多数美国人患病的理由。

请务必铭记，以防你们其中有些人仍然坚信你们比我想象中的我更健康！大多数患癌前息肉的人其实都没有患病的危险因素，如果我没有在生日聚会上吹嘘的话，我会非常“顺利”的的直到很晚才知道我的病情然后面对一次大型手术或许是一次结肠造口术，当然也许会是化疗，甚至死亡。

       我在LaPoo的办公室给我妻子打电话，当我告诉她这个消息的时候，她表现得非常平静。然而当那天晚上我回到家的时候，她已经为我买来了治疗癌前息肉的各种药物，我们都在用不同的方式解决问题！当时比较艰难的一件事就是如何把这件事告诉我的孩子们，并非是告诉孩子们我生病了，因为一切还有希望，让我感到艰难的是他们很有可能会得息肉，他们将不得不在比我现在的年纪年轻10岁的时候去做身体检查，开车的时候朋友建议我让我的孩子这么做，这是个很好的建议

我有四个孩子年纪从十二岁到二十五岁，参加完Daphne的婚礼后在我们开车去机场的路上曾经谈论过这件事，我的大儿子问了我一个很对的问题，我们之间有情感的纽带，只要我还冷静他们就不会恐慌。

我也感觉自己有道德上的义务向那些关注我的人宣布这件事，或许我的不幸的结局会警示我的观众去给自己做身体检查，或许会挽救一些人的生命。所以我发布了这条消息，收到了很多关于自于早期及时诊断的结果的回应。其实让我感触最深的并不是那些做身体检查的人，而是那些没有去做检查的人，至少他们会度过更多命运本没有赐予他们的快乐的时间。

对于我们中大多数人而言，健康是双面的的，有点像怀孕，或者我们健康的像一头公牛或者我们即将入院就医。在医学院的时候我们学会了在危机时刻救助生命的处置方式，却几乎从不涉及到广泛的社会大众检查而这项检查无疑将会将广泛的影响那些需要提前面对生命最终抉择的人。不可否认的是预防是一门学习起来极其枯燥的学科，而且报酬低的可怜，尤其是当与我们这些专家相比时。这影响了我与病人的交流，每星期在我的临床内科学时间时，我会尽心尽力的告诫人们去做检查但却从不告诉他们细节。在选择性倾听，人为误差和困惑中，许多对于简单诉求的处置失当导致身体检查这件事在时光的沙漏中被弃置脑后。因此，我们需要花费更多的电视剧前的广告时间去宣传这种想法：无论是医生还是病人都需要改变他们的现行的行为模式。

当然，除了以上所有，我还有一件非常棘手的事情需要着手解决。手术前胃肠镜检查时残留在肠子里的扁豆妨碍了医生的视线，所以他坚持让我再做一次检查寻找一下可能遗漏的息肉，他给我一个三个月的观察期，这是一个像我这样的病人应该遵循的标准。只是，我厌倦了。他打电话来通知我，我起先和他计划着然后我擅自取消了这次行程。他给我发来邮件，我却将他抛到九霄云外。再一次，我做出了让医生目瞪口呆的事情，当有一个确切的理由让病人去担心时，这些病人怎么能对自己的健康这么漠不关心呢？

       最终，在过了整整九个月之后，我又回到了当初的起点。我在家里读着那些混合化工鸡尾酒作为洗肠鸡的用药指导，我非常认真的对待这件事，按照指导，我一次不落的每隔十分钟我喝下一大杯洗肠剂，我还吃了泻药并且禁食两天，我真的不想一年之中第三次看见我的结肠。你本可以拿我的吃了（此处不明白求高人指点）LaPook显的非常兴奋，毕竟他将有足够的时间在我的结肠里四处搜寻直到结肠的最远端并且在内脏最困难的位置进行患病部位寻找和手术操作！

然后我经过了和以前相同的煎熬，我听到了和上次检查听到的一样的关怀的声音，他找到了另外一块息肉，在一个比第一个更难被发现的位置，他需要巧妙的切除这个病变部位，在麻醉剂的作用下，我模糊的说了一句“祝你好运”，Once the polyp was in the bucket我们像第一次一样重复着相同的病理学操作然后等待最后的诊断结果，我的检测究竟是怎样的结果呢？

结肠镜检查的最好情况是测试本身可以治愈，只是前提是在癌细胞侵入结肠部位之前运用手术的方法将其切除。但如果癌细胞已经进入了内脏壁，我将有72%的概率只能存活十年，如果有任何淋巴结被感染的话，概率减少到50%，如果肿瘤扩散进入了其他器官，我存活十年的概率将小于5%。

第二块息肉比第一块更让我担心，结果发现那只是增生并不是癌前息肉，当然了，这是个好消息。只是现实是，我已经得了癌前息肉，我将认真对待我残余的生命。其实，如果我找一个工作细致的医生坚持做定期检查的话，我可能不会死于结肠癌！

未完待续，翻译来源丁香园