And Finally: Matters of Life and Death

Author
Henry Marsh
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Publish Date
Completed
Sep 1, 2023
Status
Done
Type
Introduction
We are such stuff as dreams are made on, and our little life is rounded with a sleep. 出自莎士比亚悲喜剧作品《暴风雨》(The Tempest) 第4幕第1場 我々は夢と同じ物で作られており、我々の儚い命は眠りと共に終わる 大意指人生虚无缥缈、如梦似幻 (知乎)
Part 1: Denial
King Canute and the tide Only at the very end does hope finally flicker out. 作者书房里的壁画:Saint Jerome in His Study (Dürer,丢勒) St Jerome: 耶柔米 Optimists assure us that one day we will have such equations, just as powerful as the equations of quantum mechanics, but I have my doubts. You can’t cut butter with a knife made of butter, as a neuroscientist friend of mine once told me. 我认为我们最终能完全发现大脑的物理规律,实现人脑的“自举”。 In its first eighteen months a baby has many more synapses in its brain than an adult. The development from then on is as much about removing synapses – ‘synaptic pruning’ – as it is about creating new ones. The brain is sculpted by experience, cutting away connections that are not being used. Until the age of two, for instance, children in all cultures can discriminate between all the basic sounds of all languages, but from then on, they can only recognise the phonemes of their mother tongue. Chinese children, for instance, lose the ability to distinguish between the consonants l and r.
Part 2
Any set of symptoms can be caused by different pathologies. There is an acronym for these – MIDNIT – metabolic, inflammation, degenerative, neoplastic (新生物の,肿瘤细胞性质), infection, trauma. And the neoplastic can be benign, or it can be malignant; cancer, in short. Inflammation of the prostate cannot be distinguished from cancer in its early stages. // 医院就是另一种形式的监狱。 Much of what goes on in hospitals – the regimentation, the uniforms, the notices everywhere – is about emphasising the gap between staff and patients, and helping the staff overcome their natural empathy. It is not about helping patients. Hospitals always remind me of prisons. These are places where your clothes are taken away, you are given a number and you are put in a small, confined space. You must obey orders. And then you are subjected to a rectal examination – well, perhaps not always. As my anthropologist wife Kate – who has been in hospital more frequently than she would like – tells me, patients often ask each other exactly the same question as prisoners: ‘What are you in for?’ There is some neuroscience to this. Self-control, social sensitivity, planning for the future, all come from the frontal lobes of the brain. At least, people with frontal brain damage typically lose these abilities. But the frontal lobes are also the last part of the human brain to become myelinated (髓鞘化) – for the axons to become insulated. The process is not complete until the late twenties. Teenagers and young adults do not choose to be unreasonable: they cannot help it. 前额叶皮层在25岁之前还没有完成髓鞘化,这意味着人在20多岁时,许多由前额叶皮层提供支持的技巧才刚刚培养起来,这些技巧包括注意力和做出复杂决策的能力。所以年轻人容易行为冲动、失去理性。 The endocannabinoid system (ECS) 内源性大麻素系统 Theodosius Dobzhansky 费奥多西·多布然斯基 Boltzmann brain / 玻尔兹曼大脑 Dietary restriction has been shown to increase significantly the lifespan and healthspan in mice, other small rodents and non-mammalian creatures. 限制能量摄入是(唯一)被(小鼠等动物)实验证明能够确实延迟寿命的方式。这已经是一个常识了。 You can never know what the researchers will find, but if they are eventually successful(找到大幅延长人类寿命的方法) I doubt if living longer will make the billionaires’ lives any more meaningful, or their dying any better. Many of the listed side effects – such as headaches, dizziness and chronic fatigue, constipation, diarrhoea – are very non-specific. The problem with these non-specific symptoms is that we are all deeply suggestible. It is called the nocebo effect. This is the opposite of the benign placebo effect, where people will feel better because they have been told to expect to, and not because of a direct effect of the particular treatment they have been given. With the nocebo effect you feel worse, because you expect to. Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles. The only certainties in life, as is often pointed out, are death and taxation.
Part III HAPPILY EVER AFTER
作者区分 assisted dying (succicide) 和 euthanasia, 定义后者是未经病人明确同意(e.g. 插管维持生命的植物人无法表达意志)的医生自发行为。虽然在一般语境中两者可以近似互换使用。 反对协助自杀合法化的观点:the right to die will become the duty to die // 真他妈能说会道 Rhodes Must Fall But when I think of all the descendants of Britain’s slaves and of other subjugated races who live in Britain, and who are as British as myself, I see things very differently. Why should they have to look at statues glorifying their ancestors’ oppressors, without there being any kind of admission of guilt? If we take pride in our nation’s history – as the current government demands that we do – should we not be ashamed as well? 所有的民族主义者都应该问自己这个问题。 Parents are an inconvenience in most children’s stories and need to be got out of the way as soon as possible. 作者长年给孙女创作并朗读故事经历的结论。 Fairy stories are about what doesn’t really happen, which is why typically they end: and they all lived happily ever after. 童话: Once Upon a Time / むかしむかし happily ever after / めでたしめでたし
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左起:作者母亲、her sister、their young brother, 1929, 德国马克德堡。 Why is it that only in old age, and closer to death, I have come to understand so much more about myself and my past? We are like little boats that our parents launch onto the ocean, and we sail round the world, full circle, to return finally to the harbour from which we started, but by then our parents are long gone. Physicists talk of ‘block time’ – that the past, present and future are all equally real. In Einstein’s equations for relativity and space-time, time can run forwards or backwards. There is nothing inevitable about time always moving irredeemably forwards. The arrow of time that dominates our lives, ages our bodies and ultimately kills us, has no place, apparently, in theoretical physics. The present is a place, and past and future are simply other places, just as the place I am in at the moment is one place among many others on the surface of the planet. Looking into my mother’s young eyes, my own life now possibly nearing its end, I felt as close as I could ever possibly be to living in block time – past, present and future all combined in one whole. Block time: 永恆論是一種對於時間的本體論性質的觀點。在這個理論下,現在、過去以及未來的實在性都是等價的。// 这更多是一种哲学观点。
Postscript
At the time of writing, in spring 2022, it is impossible to know what will happen in Ukraine, other than that the country will be devastated, with many thousands of people killed and millions displaced. But the Ukrainians will fight to the death. I always knew they would. They see no alternative. Glory to Ukraine!!!