生命的循环

Facing death, Jeff Cross and Lily Cheng had run out of options. But a rare "domino" liver transplant, involving a living donor, gave both a future.

   面对死亡，杰夫·克罗斯和程莉莉已经没有其他选择了。但是一个罕见的"多米诺"式肝脏移植(涉及到一位活人器官捐献者)，却给两人带来了新的生机。

 Circle of Life

Since last spring, Jeff Cross, 29, had been tormented by night sweats, a side effect of the rare genetic illness that threatened to kill him unless he got a new liver.

    生命的循环

   从去年春天起，29岁的杰夫·克罗斯天天被盗汗所困扰，这源于一种罕见的基因遗传病变，除非他获得一个新的肝脏，否则疾病将威胁他的生命。

Cross's disease, familial amyloidosis, prevents the liver from breaking down a protein called transthyretin. It takes about three decades for the substance to accumulate to dangerous levels, at which point it can destroy the victim's nerves and organs. Because of his background he had no idea that he carried a deadly gene. Born is South Korea, he was adopted as a 4-year-old orphan by Peter Cross, and his wife, Margaret. After receiving a degree in economics from the University of California in 1995, Cross went to work in customer service for a investment firm in San Mateo. There he met JoAnna Poblete, now 27. In March 1998 the couple moved in together, and in August '99 they relocated to Los Angeles. But Cross soon developed a cough so violent it made him vomit. His left foot hurt so badly that he could barely walk. Then he lost 25 lbs. and most of the sight in his right eye.

 Then in April Dr. Marc O.Yoshizumi, professor of ophthalmology at UCLA's Jules Stein Eye Institute, suggested Cross get tested for amyloidosis. Initially Cross was diagnosed with a different, incurable form of the disease, which would likely have killed him by age 40. In search of a second opinion, Poblete tracked down amyloidosis experts on the Internet. Dr. Morie Gertz, chairman of the hematology division at the Mayo Clinic responded, and after Cross flew out for an exam,Gertz delivered a new conclusion:familial amyloidosis, which affects about 1 in 4 million people and can be cured with a new liver." We were elated," Cross says.

    4月，加利福尼亚大学洛杉矶分校朱尔斯·斯坦视力协会眼科教授马克·欧·喜纯医生建议克罗斯就淀粉样变性做测试。最初克罗斯被诊断为患有另一种不可治愈的疾病，最多只能活到40岁。为寻求其他专家的不同意见，波夫莱特在网上查询淀粉样变性方面的专家。梅奥诊所血液部主任莫里埃·格茨医生回答了她的问题。当克罗斯做了一次抽血检测后，格茨提出了一个新的结论：家族淀粉样变性，其发病几率大约是400万分之1，可采用肝脏移植来治愈。克罗斯说："我们听后非常高兴。"

That joy proved short-lived. Cross's protein-damaged heart was in such bad shape, doctors said, that it could give out within six months. Yet because his liver was functioning well, aside from its one defect, he would be a lower priority than many candidates for a cadaverliver transplant. A desperate Poblete e-mailed 100 friends and family members, asking if anyone with the same blood type as Cross, O positive, would be willing to help.

   但那份欢乐是短暂的。医生们说，因蛋白质坏损，克罗斯的心脏状况极差，将会在6个月内衰竭。由于他的肝脏除了自身遗传缺陷外，运转功能仍然良好，因此在众多等待肝脏移植的候选人中并不具有任何优先权。绝望的波夫莱特向100名朋友和家人发出电子邮件，询问是否有像克罗斯一样是O型血的人愿意伸出援助之手。

No one in Cross's adopted family proved a match, so Doug Andrews stepped forward. Andrews is youth pastor of the First Baptist Church of San Mateo. Though he wasn't close to the ailing man, his wife, Krissie, 28, a product manager for a medical-device company, had been pals with Cross since kindergarten.

   在收养克罗斯的家庭成员中无人与其血型相配，于是道格·安德鲁斯挺身相助。安德鲁斯是圣马蒂奥浸礼会的年轻牧师。他本人与病魔缠身的克里斯并不熟识，但他28岁的妻子--一位医疗器械公司的产品经理，从幼儿园时起就同克罗斯是好朋友。

 In so doing he gave 43-year-old Lily Cheng a new chance at life as well. Born in Beijing, Cheng was a professional dancer before getting married and having a son, Jack, now 15. In 1989 she got into the import business and three years later moved to the U.S.. After divorcing her husband in 1996, she settled with Jack in an apartment outside L.A. and went to work for an import-export business that requires her to make frequent trips to China.

   安德鲁斯的义举还给43岁的程莉莉带来了一个新生的机会。程莉莉出生在北京，在她结婚并生下今年已15岁的杰克之前，曾是一名专业舞蹈演员。1989年她开始做进口生意，3年后搬到美国。1996年她与其丈夫离婚后，同儿子杰克住在洛杉矶市郊的一座公寓中，为了进出口生意需要经常往来中国。

It was on one such excursion in July that Cheng, who still felt more comfortable with the medical system in her native land, decided to get a routine physical." The doctor saw something on my liver right away," says Cheng. Although she still had no symptoms, specialists back in the U.S. delivered a grim prognosis. Says Dr. Busuttil:" She would probably have been dead within a year." By the time she became eligible for a cadaver liver, the cancer would have spread throughout her body.

   这是7月里的一个短期旅程，程莉莉来到她的出生地北京，由于对当地的医疗体制更适应一些，于是决定做一次常规体检。程说："医生立即在我的肝脏上发现了问题。尽管她当时尚未有症状，但回到美国后专家对其病情的预测却令人担忧。比叙蒂医生说："她可能在一年内离开这个世界。"待到她得到一个适合的活体肝脏时，肝癌细胞早已扩散到全身。

 Even harder than hearing that news was breaking it to her only child. " She said she wanted to see me grow up and she loves me very much," Jack recalls. " I don't usually cry, but I cried when she told me." Cheng then returned to China to see her parents, for what she feared might be the last time. There she received the call from UCLA telling her she was a perfect candidate for Cross's liver, since it was similar in size to hers and their blood types matched. And because Cross's amyloidosis was so slow-acting, she would be in her 70s before symptoms set in.

　 比这个更痛苦的是把这个消息告诉她惟一的孩子。杰克回忆道："她说她想看着我长大，她非常地爱我。我平常不爱哭，但当时我哭得很伤心。"程接着回到中国去看望双亲，她恐怕这可能是最后一次了。但在北京她接到了来自加利福尼亚大学洛杉矶分校的电话，告诉她克罗斯的肝脏同她的肝脏大小相似，且他们的血型相配，她是接受克罗斯肝脏移植的完美候选人。由于克罗斯的淀粉样变性发展缓慢，疾病发作之前她将是70多岁的人了。

With Andrews, Cross and Cheng lined up, doctors scheduled the triple surgery. The surgeons would not be sure until they opened up Andrews that his liver was healthy enough to be transplanted. Even if it was, Cross had a 40 percent chance of dying on the operating table because his heart had grown so weak.

　安德鲁斯，克罗斯和程将以此为序接受医生们计划的3人一组的外科手术。在外科医师打开安德鲁斯的体腔确定其肝脏健康可进行移植前，大家对这次手术的成功性都难以把握。而且即便如此，由于克罗斯的心脏十分虚弱，他死在手术台上的概率达40％。

　 But it was Cheng who carried the most risk. Not only did doctors fear her cancer might have already spread beyond her liver -- thereby rendering a transplant futile -- but two nights before the surgery, she came down with a cold. Because transplants weaken the immune system, they cannot be performed on sick patients.

   然而程的风险最大，医生担心她的癌细胞已经扩散，会使移植徒劳无功，更糟糕的是在手术前两个晚上，她患了感冒。由于移植会使免疫系统变弱，病人在此情况下不能施行手术。

 Cheng immediately checked into the hospital, and doctors had her infection-free within 24 hours. She met Cross and Andrews for the first time when they arrived on Oct. 1, trading jokes and encouragement with the men in Cross's room.

At 5 a.m.on Oct.2,Cross and Andrews were wheeled into separate operating rooms,each staffed by a team of eight doctors and nurses.(Cheng would follow at 9 a.m.)First Dr.Ghobrial opened up Andrews. After seeing that his liver was in fine shape, Ghobrial sliced off a little more than half of the organ's right side. In the room down the hall, Dr. Busuttil began to remove Cross's liver.

程立即住进医院，医生们在24小时内将其感冒治好。克罗斯和安德鲁斯于10月1日到达，程与他们第一次见面，她轻松地开着玩笑并表示鼓励。

10月2日凌晨5点，克罗斯和安德鲁斯分别被送进手术室，每个手术小组配备8名医生和护士(程的手术将于上午9：00开始)。贾布里勒医生为安德鲁斯实施手术。在确认他的肝脏健康完好，贾布里勒医生切下了右边肝脏的多半部分。在大厅南侧的房间里，比叙蒂医生开始切除克罗斯的肝脏。

 At 11:30 a.m.Busuttil connected the partial liver from Andrews to Cross's now-empty liver cavity, stitching together veins, arteries and bile ducts. An hour later, after receiving word that Cheng's cancer was limited to her liver, Ghobrial moved to the third operating room to help implant Cross's liver into Cheng.

By 5:30 p.m. all three patients were in recovery. " There are often hitches in surgery," says Busuttil, " but with this particular one, it was like clockwork." Which is exactly what Cross's fiancé e told him as soon as he woke up. " Jeff, you made it, you're okay," said Poblete. Cross, on a respirator, responded the only way he could -- with tears.

   上午11：30，比叙蒂将安德鲁斯的部分肝脏植入克罗斯的肝腔，缝合静脉、动脉和胆管。1小时以后传来消息说，程的肿瘤没有从肝脏扩散。贾布里勒来到第三间手术室，帮忙将克罗斯的肝脏移植到程身上。

下午5：30，3名病人都处于康复状态。比叙蒂说："在外科手术中经常会有事故发生。但是这个特殊的手术却像时钟一样精确。"当克罗斯刚刚醒来，他的未婚妻波夫莱特告诉他说："杰夫，手术成功了，你很好。"克罗斯戴着一个呼吸器，只能用热泪作为回应。

A few complications cropped up post-surgery. Andrews spent an extra four days in the hospital until the nerves in his liver began functioning fully, while Cheng's bile duct had to be restitched after it developed a slight leak. Cheng, meanwhile, has a 60 to 70 percent chance of surviving five years cancer-free. And though she, like Cross, will take immunosuppressant drugs for the rest of her life to prevent rejection of the new liver, she's thrilled to have been given more time with her son. "Every time I see Jack," she says, " I feel grateful."

    手术后出现了一些并发症。安德鲁斯因此在医院又多住4天，直到其肝脏的神经开始完全正常工作。而程的胆管因出现泄漏而不得不再次缝合。程有60％至70％的可能在5年内不会出现癌症。尽管她像克罗斯一样，为了防止新肝脏的排异性，将终身服用抑制免疫力之药物。但对于能有更长的时间同她儿子在一起，她仍感到很兴奋。她说："每当看到杰克，我就心怀感激。"

 Cross, too, is counting his blessings. He was planning to return to work this month, and because doctors give him an 85 percent chance of surviving the next year, he and Poblete feel confident enough to plan a fall wedding. His eyesight has been restored, following a separate operation, and now Cross is undergoing physical therapy three times a week to rebuild the strength in his nerve-damaged feet. That should allow him to walk down the aisle and to fulfil another dream of Poblete's." All I've ever wanted,"she says," is for him to be able to dance all night.

    克罗斯也不断地作感恩祷告。他计划本月重返工作岗位。由于医生告诉他有85％的机会活过明年，他和波夫莱特充满信心，计划举行秋季婚礼。又经过一次手术后，他的视力恢复了。现在克罗斯一周3次接受理疗，以使他神经受损的双足逐渐恢复力量，能够沿走廊漫步，进而实现波夫莱特的另一个梦想。她说："我曾经梦想的，就是他能够整夜地跳舞。"马宁 摘译自People