The use of force

The Use of Force  
By William Carlos Williams
取材：《醫生的故事》
  http://www.medtoday.com.tw/39218.htm
作者威廉斯醫師（Dr. William Carlos Williams）可能是全職的開業醫師裡最多產的文學家，而這本書的編者是受他影響至深、著作等身、獲獎無數，影響美國教育至深的哈佛大學兒童精神科教授，柯爾斯醫師（Dr.Robert Coles）。柯爾斯醫師寫了一篇導讀，敘述他如何認識威廉斯醫師以及他如何受到他的影響，而書的最後則由威廉斯醫師的醫生兒子Dr. William Eric Williams寫了一篇以＜我的父親醫生＞為題的回憶，道出一些鮮為人知的威廉斯醫師寫作的經過。

　　這本書收集了威廉斯醫師描寫醫師生涯的14篇散文與六篇詩，其中最為人所樂道的＜行醫＞（The Practice），是來自於他膾炙人口的《自傳》（the Autobiography by William Carlos Williams）裡摘錄出來的一篇非常精采的文章，描述他如何一方面看病，一方面禁不住文思泉湧，隨時寫下note，然後有時間就寫成文章的樂趣。在這篇文章裡，他強調看病從來沒有阻礙他的寫作，他說，事實上醫療的經驗反而是他寫作的靈感來源，使他更能寫出真實的故事。曾經有人問他，「你開業這麼忙，怎麼還能找出時間來寫作」，他回答說，「行醫與寫作事實上並不是兩個職業，行醫生涯使我人生經驗增加，擴展我對生命的感受深度，而使我有豐富的寫作靈感。」

{全文梗概}
（The Use of Force）傳神地描述他如何與一個不合作的小孩子奮鬥，最後在強力的壓制下張開他的嘴巴而看到扁桃腺長滿了白喉黏膜，而及時給予抗生素，才救回了一條小生命。但是他一心想要幫忙這孩子，換回來的卻是被小孩子踢打、抗拒。他在文中毫不掩飾的寫出行醫者得不到病人和家屬的合作所遭受到的沮喪。

本文作者為詩人 有醫學背景 本文為其小鎮行醫經驗
這一家人全家擠在廚房裡 一則窮 一則取暖
line65 for heaven's sake...醫生終於敲開小孩的嘴巴 對話沒有引號 與敘述無分別
第一段僅三行 有兩人對話 醫生與媽媽在對話
come down 從都市過來 或從北邊下來
生動到來不及用引號 直接把聲音表現出來
look things over - 把東西檢查一遍
病人不主動告知病情 以為僅付了三塊錢 所有事情都要由醫生來負責
又出現 look over - 徹底檢查
不合文法的英文 - 顯示這個家庭的貧窮事實
Nothing doing.一動也不動
ground my teeth in disgust - 咬牙切齒

{Summary }
A physician is summoned to make a housecall on a family with whom he has had no prior contact. He quickly sizes up the situation: the household is poor but clean; the patient is a female child whose parents are nervously concerned, dependent on, yet distrustful of the doctor. The child's beauty and penetrating stare make an immediate impression on him.

Concerned that diphtheria may be the cause of illness, he uses his customary professional manner to determine whether or not the child has a sore throat. But the child will have none of it and "clawed instinctively for my eyes." The attempt at an examination rapidly escalates into a physical "battle" as the physician, convinced that it is crucial to see the child's throat "and feeling that I must get a diagnosis now or never," becomes ever more enraged and forceful while the girl continues to resist with all her strength, and the parents are in an agony of fear for her health and embarrassment over her behavior.

This is no longer a professional encounter. The doctor admits at the beginning of the struggle to having "fallen in love with the savage brat" and recognizes that he is behaving irrationally. The closing sequence could as easily be depicting a rape as a forced throat examination.

Commentary The story evokes with great immediacy a number of important issues about doctoring: the predicament of having quickly to assess a medical/social situation in an unfamiliar, even hostile environment; the doctor's impressive powers of observation; his concern to do the right thing medically; the anxiety of the sick child's parents; the power that the doctor wields; the dark side of human nature which may allow such power to surface in unsavory ways and which the professional, like any rational person, has under most circumstances learned to control.

{study}
http://www.enotes.com/short-story-criticism/williams-william-carlos
{text}
http://beemp3.com/download.php?file=102886&song=The+Use+of+Force

They were new patients to me, all I had was the name, Olson. Please come down as soon as you can, my daughter is very sick.
When I arrived I was met by the mother, a big startled looking woman, very clean and apologetic who merely said, Is this the doctor? and let me in. In the back, she added. You must excuse us, doctor, we have her in the kitchen where it is warm. It is very damp here sometimes.

The child was fully dressed and sitting on her father's lap near the kitchen table. He tried to get up, but I motioned for him not to bother, took off my overcoat and started to look things over. I could see that they were all very nervous, eyeing me up and down distrustfully. As often, in such cases, they weren't telling me more than they had to, it was up to me to tell them; that's why they were spending three dollars on me.

The child was fairly eating me up with her cold, steady eyes, and no expression to her face whatever. She did not move and seemed, inwardly, quiet; an unusually attractive little thing, and as strong as a heifer(小母牛) in appearance. But her face was flushed, she was breathing rapidly, and I realized that she had a high fever. She had magnificent blonde hair, in profusion. One of those picture children often reproduced in advertising leaflets傳單and the photogravure凹版印刷/插圖套色sections of the Sunday papers.

She's had a fever for three days, began the father and we don't know what it comes from. My wife has given her things, you know, like people do, but it don't do no good. And there's been a lot of sickness around. So we tho't you'd better look her over and tell us what is the matter.

As doctors often do I took a trial shot at it as a point of departure. Has she had a sore throat?

Both parents answered me together, No . . . No, she says her throat don't hurt her.

Does your throat hurt you? added the mother to the child. But the little girl's expression didn't change nor did she move her eyes from my face.

Have you looked?

I tried to, said the mother, but I couldn't see.

As it happens we had been having a number of cases of diphtheria白喉in the school to which this child went during that month and we were all, quite apparently, thinking of that, though no one had as yet spoken of the thing.

Well, I said, suppose we take a look at the throat first. I smiled in my best professional manner and asking for the child's first name I said, come on, Mathilda, open your mouth and let's take a look at your throat.

Nothing doing.一動也不動

Aw, come on, I coaxed用好話勸, just open your mouth wide and let me take a look. Look, I said opening both hands wide, I haven't anything in my hands. Just open up and let me see.

Such a nice man, put in the mother. Look how kind he is to you. Come on, do what he tells you to. He won't hurt you.

At that I ground my teeth in disgust. If only they wouldn't use the word "hurt" I might be able to get somewhere. But I did not allow myself to be hurried or disturbed but speaking quietly and slowly I approached the child again.

As I moved my chair a little nearer suddenly with one catlike movement both her hands clawed instinctively for my eyes and she almost reached them too. In fact she knocked my glasses flying and they fell, though unbroken, several feet away from me on the kitchen floor.

Both the mother and father almost turned themselves inside out in embarrassment and apology. You bad girl, said the mother, taking her and shaking her by one arm. Look what you've done. The nice man . . .

For heaven's sake, I broke in. Don't call me a nice man to her. I'm here to look at her throat on the chance that she might have diphtheria and possibly die of it. But that's nothing to her. Look here, I said to the child, we're going to look at your throat. You're old enough to understand what I'm saying. Will you open it now by yourself or shall we have to open it for you)

Not a move. Even her expression hadn't changed. Her breaths however were coming faster and faster. Then the battle began. I had to do it. I had to have a throat culture for her own protection. But first I told the parents that it was entirely up to them. I explained the danger but said that I would not insist on a throat examination so long as they would take the responsibility.

If you don't do what the doctor says you'll have to go to the hospital, the mother admonished告誡 her severely.

Oh yeah? I had to smile to myself. After all, I had already fallen in love with the savage brat頑童, the parents were contemptible可鄙的to me. In the ensuing struggle they grew more and more abject糟透的, crushed, exhausted while she surely rose to magnificent heights of insane fury of effort bred of her terror of me.

The father tried his best, and he was a big man but the fact that she was his daughter, his shame at her behavior and his dread of hurting her made him release her just at the critical times when I had almost achieved success, till I wanted to kill him. But his dread also that she might have diphtheria made him tell me to go on, go on though he himself was almost fainting, while the mother moved back and forth behind us raising and lowering her hands in an agony of apprehension.

Put her in front of you on your lap, I ordered, and hold both her wrists.

But as soon as he did the child let out a scream. Don't, you're hurting me. Let go of my hands. Let them go I tell you. Then she shrieked terrifyingly, hysterically. Stop it! Stop it! You're killing me!

Do you think she can stand it, doctor! said the mother.

You get out, said the husband to his wife. Do you want her to die of diphtheria?

Come on now, hold her, I said.

Then I grasped the child's head with my left hand and tried to get the wooden tongue depressor between her teeth. She fought, with clenched teeth, desperately! But now I also had grown furious--at a child. I tried to hold myself down but I couldn't. I know how to expose a throat for inspection. And I did my best. When finally I got the wooden spatula壓舌板behind the last teeth and just the point of it into the mouth cavity, she opened up for an instant but before I could see anything she came down again and gripping the wooden blade between her molars臼齒 she reduced it to splinters before I could get it out again.

Aren't you ashamed, the mother yelled at her. Aren't you ashamed to act like that in front of the doctor?

Get me a smooth-handled spoon of some sort, I told the mother. We're going through with this. The child's mouth was already bleeding. Her tongue was cut and she was screaming in wild hysterical shrieks. Perhaps I should have desisted停止 and come back in an hour or more. No doubt it would have been better. But I have seen at least two children lying dead in bed of neglect in such cases, and feeling that I must get a diagnosis now or never I went at it again. But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it.

The damned little brat must be protected against her own idiocy, one says to one's self at such times. Others must be protected against her. It is a social necessity. And all these things are true. But a blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives. One goes on to the end.

In a final unreasoning assault I overpowered the child's neck and jaws. I forced the heavy silver spoon back of her teeth and down her throat till she gagged. And there it was--both tonsils covered with membrane. She had fought valiantly to keep me from knowing her secret. She had been hiding that sore throat for three days at least and lying to her parents in order to escape just such an outcome as this.

Now truly she was furious. She had been on the defensive before but now she attacked. Tried to get off her father's lap and fly at me while tears of defeat blinded her eyes.

{本文單字}

William Carlos Williams

頁1-段1
patient 病人

頁1-段2
startle 驚嚇
apologetic 懷有歉意的
merely 僅僅是
damp 潮濕的

頁1-段3
lap 腿上
motion 打手勢、搖或點頭示意
bother 煩惱、擔心
overcoat 大衣
nervous 緊張
distrustfully 不信任地

頁1-段4
fairly 完全地
steady 堅定的
expression 表情
inwardly 內心、精神的
heifer 小母牛
flush 臉泛紅
rapidly 急促的
fever 發燒
magnificent 極美的、動人的
blonde 金黃色的
profusion 大量
reproduce 複製、重現
advertising 廣告
leaflet 傳單
photogravure 照相印刷術
section 欄

頁1-段5
sickness 疾病
matter 問題

頁1-段6
trial shot 測試
departure 起程、出發
sore throat 喉嚨痛

頁2-段1
diphtheria 白喉
apparently 顯然
though 然而

頁2-段4
aw 噢（狀聲詞）
coax 哄

頁2-段5
put in 插話

頁2-段6
grind teeth 磨牙、咬牙
disgust 反感
hurry 急忙
disturb 不安

頁2-段7
claw 抓、撕、扯
instinctively 本能、直覺地
knock 重擊

頁2-段8
embarrassment 尷尬、窘迫

頁2-段9
For heaven's sake 看在老天爺份上
break in 打斷、插嘴
nothing to 對~來說無足輕重

頁2-段10
battle 戰鬥、鬥爭
culture 培養
protection 保障
entirely 全部地
insist 堅持要求
examination 檢查
so long as 只要
responsibility 責任

頁3-段1
admonish 告誡
severely 嚴厲地

頁3-段2
savage 野蠻的
brat 小壞蛋、淘氣鬼
contemptible 可輕視的
ensue 接著產生
struggle 掙扎、搏鬥
abject 難堪的
crush 壓垮、壓服

exhaust 筋疲力盡
insane 精神錯亂的、瘋狂的
fury 狂怒
effort 力氣
breed 釀成、招致
terror 驚恐、恐懼

頁3-段3
shame 羞愧
behavior 行為、舉止
dread 害怕、恐懼
critical 緊要關頭
faint 昏厥
back and forth 前後來回
agony 痛苦
apprehension 憂慮、擔心
wrist 手腕

頁3-段5
shriek 尖叫
terrify 驚恐
hysterically 歇斯底里地

頁3-段9
tongue depressor 壓舌板(檢查口腔
喉嚨用)
clench 咬緊
desperately 不顧一切地
furious 狂暴、難以控制的
expose 使曝露
inspection 檢查、檢驗
spatula 壓舌板
cavity 洞、窟窿
grip 握緊
blade 扁平物
molar 臼齒
reduced to 變成
splinter 碎片

頁3-段10
ashamed 難為情的、羞恥的

頁3-段11
sort 種、類、型
desist 停止、斷念
neglect 疏忽、忽略
diagnosis 診斷

頁4-段2
protect against 免受於
idiocy 愚蠢行動
necessity 必然
blind 輕率的、魯莽的
muscular 強健的
operative 工人

頁4-段3
assault 猛襲
overpower 壓服、制服
jaw 下頜
gag 噎住
tonsil 扁桃腺
membrane 薄膜
valiantly 英勇地、勇敢地
outcome 結果
furious 狂怒的
defensive 處於防禦姿態
defeat 挫折、失敗

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