人生沒有用不到的經歷

下面的文章修改自某位住院醫師的病歷，原文已找不到了。

This 64-year-old male found that his voice became hoarse in August last year. Three weeks after his voice changed, he started a non-productive cough that was so severe as to disturb his sleep. He felt like to cough soon after lying on the bed. There were no other symptoms associated with the cough.

This 64-year-old male found that his voice became hoarse in August last year. Three weeks after his voice changed, he started a non-productive cough (我建議加 a, 意味著某種未詳細說明, 或難以說明的 cough, 而你將再說明) that was so severe as to disturb his sleep (說明 non-productive cough). He felt like to cough soon after lying on the bed (必須加 the, lying on the bed 與 lying on bed 有不同的意義，差別很微妙，下面有說明). There were no other symptoms associated with the cough (the, 指定前述的 non-productive cough).

「Lying on bed」or 「Lying on the bed」？

The past week was awesome and finally ended up with a party on Friday afteroon. Lying on bed, he escaped from bombard exams. (他躺著，總算脫離考試的轟炸)。那張床在此句中是一個虛擬抽象的名詞，寫文章時「Lying, 躺」總要寫出一個躺的地方吧！但躺 (Lying) 在哪裡並不重要，“escaped” 才是句子的重點。

He felt like to cough soon after lying on the bed.

這張床 (bed) 與咳嗽 (cough) 關係十分密切，「一躺下去就想咳」，感覺  Lying one the bed 就是比較貼切。

During the past half a year, he became anorexic and lost 7 kilograms. He was able to eat two bowls of rice food in a meal six months ago but only half a bowl recently. His bowel habit and urine passage were the same as before. Leg edema appeared gradually after the cough developed. Due to the above symptoms, he visited our OPD and was admitted for a further survey on Oct. 15, 2000.

During the (必須加 the --指定 past half a year) past half a year, he became anorexic and lost 7 kilograms. He was able to eat two bowls of rice food in a meal (一餐之中) six months ago but only half a bowl recently. His bowel habit and urine passage were the same as before. Leg edema (不必加 the, 文章中第一次出現; 加 a 有點奇怪；但若 edema 很特殊, 你會在後面說明, 則可用 An unusual leg edema appeared gradually------) appeared gradually after the cough (指定上述之cough) developed. Due to the above symptoms (必須加 the--指定 above symptoms), he visited our OPD and was admitted for a further survey (加 a，把 survey 當成可數的名詞，代表你心裡有一個初步但不很具體的檢查與診斷的構想；不加任何冠詞，就是把 survey 當成一個抽象名詞，survey 甚麼，你還不太清楚) on Oct 15, 2000.

The result of a lung biopsy revealed non-small cell lung cancer. Bone scan was negative. No other metastasis was found. The disease was staged as IIIb. Then, he was discharged on Oct. 26, 2000 and arranged for OPD chemotherapy. However, the non-productive cough and leg edema persisted when he was discharged.

The result of a lung biopsy (biopsy 是一普通可數名詞, 應加a, 代表未指定的某一次；但若你只是想傳達 biopsy 的結果, 管它幾次，管它那一次，不加 a，把 biopsy 抽象化也沒人怪你；但你的文章若請專人修改，他可能會替你加 a。 biopsy 不是 apple，很少人會注意它是可數名詞或抽象名詞) revealed non-small cell lung cancer. Bone scan (加 a 有點奇怪；若你將bone scan視為類似 liver、lung 的醫學名詞，加 the 似乎也還通順) was negative. No other metastasis was found. The disease (指 lung cancer) was staged as IIIb. Then, he was discharged on Oct. 26, 2000 and arranged for OPD chemotherapy. However, the non-productive cough and leg edema (只須加一個 the，指是上述的 cough 及 edema) persisted when he was discharged.

The OPD chemotherapy was arranged, twice on Dec. 15 and Dec. 22. After the first chemotherapy, the leg edema was improved, and his general condition became better. His body weight was maintained at 43kg without progressive loss due to improved appetite. There were no hemoptysis, sputum, URI symptoms, and fever before this admission. He previously had epigastralgia and was much bothered by nausea, heartburn, and epigastric pain after a meal. Pre-pyloric and pyloric ulcers were found by endoscopy. With regular medication, the disease was well treated, and the GI symptoms were alleviated.

The OPD chemotherapy (加 the 以指定前述之OPD chemotherapy; 不加 the, 也沒什麼不對，因為你對 OPD chemotherapy的內容藥物，現在並沒有寫清楚) was arranged, twice on Dec. 15 and Dec. 22. After the first chemotherapy (必須加 the), the leg edema (加 the, 指前述 leg edema) was improved, and his general condition became better. His body weight was maintained at 43 kg without progressive loss due to improved appetite (沒有特別指定，不必加 the；若加 the， 也不錯，前面已對病患的飯量有很好的描述，此處若用 the improved appetite，有強調之意). There were no hemoptysis, sputum, URI symptoms, and fever before this admission. He previously had epigastralgia and was much bothered by nausea, heartburn, and epigastric pain after a meal. Pre-pyloric and pyloric ulcers (沒有特別指定, 不必加 the) were found by endoscopy. With regular medication (不可數, 不加 a; 沒有特別指定, 不必加 the)，the disease (指定上述的 lung cancer) was well treated, and the GI symptoms (the, 指定前述 nausea, heartburn, and epigastric pain) were alleviated.

後記: 定冠詞 "the" 及不定冠詞 "a" 的用法是英文寫作中最令人困擾的部分。日常生活中，很少人會去研究那個醫學名詞是可數，那個不可數或抽象。你隨便拿一個句子去問一位大學畢業的美國人，這地方是否該加 the or a，他可能回答：I am not sure; That depends on the context; I am not familiar with this noun; 甚至告訴你 I don’t know. 冠詞加得好，讀起來會讓人感覺很「讚」。