好好照顾玛雅：虐儿案罗生门（2023）

I hear your story
‎我知道她经历了很多痛苦
I understand she's been going through a heck of a lot of stuff
‎但我跟你说实话
but I'm still not certain of what we're dealing with
‎我仍然不确定这是什么病
to be honest with you
‎孩子能告诉你 ‎“我无法呼吸 我无法呼吸”
A kid can tell you, "I can't breathe…" -Mm-hmm
‎我不知道她是否是焦虑症发作
How do I know she's not having an anxiety attack?
‎这…
Well-- -There's a lot of question marks
‎所以有很多事情是不确定的
‎给我一点时间
Just give me one second
‎妈妈 这不是焦虑
Mom, it's not anxiety
‎我知道 宝贝 我知道
I know, baby. I know
‎他只是试图搞清楚 ‎你尽量保持冷静
He's just trying to figure it out. You just stay as calm as you can
‎作为父母 我们知道有些不对
We knew, as parents, something was wrong
知道他们做得不够
and they are not doing enough
‎所以当贝亚特到家的时候 ‎她没有去睡觉
So when Beata got home, she didn't go to bed
‎她进行了研究
She researched
‎就是这时候 ‎她最终找到了柯帕里克医生
And that's when she ended up finding Dr. Kirkpatrick
‎玛雅 我们可以用这段视频 ‎教育其他孩子吗？
Maya, is it okay if we can use this video to educate other children?
‎-可以 ‎-好 很好
Yeah. -Okay, good
‎我们来温习一下你的历史
Let's go over your history a little bit
‎大约三个月前
Approximately three months ago
‎你的脚这里开始痛了 是吗？
you started having some pain down in your feet here, okay?
‎你看到她的腿向内弯折了吗？
You see how her legs are turning in?
‎我们称之为肌张力障碍 好吗？ ‎肌张力障碍
We call that dystonia, okay? Dystonia
‎事实上 现在情况很糟 ‎她甚至不能安全地承受重量 好吗？
In fact, it's so bad right now she can't even bear weight safely, okay?
‎-准备好做点检测了吗？ ‎-对
Ready for testing? -Yeah
‎好 尽你所能举起右手
Take that right hand, as best you can
‎在达到你的上限 必须停止之前 ‎看看你能举起多高 好吗？
and see how far you can get it before you have to stop, okay?
‎已经… 就这样 就到那儿了？ ‎非常棒 玛雅
Is that… That's it, right there? Very good, Maya
‎现在我们要请你妈妈帮助你
Now we're gonna ask your mom to help you
‎她要到这里来 举起你的脚
She's gonna get over here, and she's gonna hold your foot up
‎尽力扭动你的脚趾 尽你所能 好吗？
and try to wiggle your toes as best you can, okay?
‎你可以试试吗？
Can you try that?
‎你尽全力了吗？
You giving it everything you got there?
‎-妈妈 你没看到任何动作 是吧？ ‎-没有
Mom, you don't see any movement, do you? -No
‎好的 妈妈 很好 做得好
Okay, Mom. Good job
‎玛雅 你想要一个毯子…
Maya, would you like to have a blanket…
‎我2015年9月第一次见到考尔斯基
When I first saw the Kowalskis in September 2015
‎玛雅是什么问题很明显
it was obvious what the problem was with Maya
‎非常简单清楚 区域疼痛
It was clear and simple CRPS
‎复杂性区域疼痛综合征
complex regional pain syndrome
‎本录像的准备
This videotape has been prepared
‎经过咨♥询♥安东尼·柯帕里克医生
in consultation with Dr. Anthony Kirkpatrick
‎什么是复杂性区域疼痛综合征？
What is complex regional pain syndrome?
‎最好的理解方式是它怎样发展
The best way to think about it is the way it evolves
‎假设你受伤了
Let's say you have an injury
‎你知道可能在一、两周后 ‎疼痛就会减轻
You know that probably in a week or two, the pain's gonna go down
‎肿胀会消退 ‎红肿和其他症状都会消失
the swelling's gonna go down, the redness and all that's gonna go down
‎但在复杂性区域疼痛综合征 ‎患者身上发生的情况是
But what happens in these patients with CRPS
‎实际上整个期间症状会强化
is that it actually intensifies over that period of time
‎公开♥发♥表的案例研究显示
Published case studies indicate
‎复杂性区域疼痛综合征的发生
that the incident of CRPS increases dramatically
‎在九到11岁之间急剧上升
between nine and 11 years old
‎而且主要发现于年轻女孩身上
and it is found predominantly in young girls
‎病患描述的主要症状是烧灼感
The patients describe it primarily as a burning sensation
‎他们的皮肤对轻触变得非常敏感
That their skin becomes exquisitely sensitive to light touch
‎想象一根漂浮的羽毛 ‎我们碰触感觉很轻柔
Picture a floating feather, soft to our touch
‎患者说这感觉更像
Patients say this feels more like
‎一把刀刺进他们的身体
a knife stabbing their body
‎这个病征第一次被描述 ‎是在100多年前
The syndrome was first described over 100 years ago
‎在1990年才被现代医学所认识到
but it was only recognized in modern medicine in the 1990s
‎直到现在 ‎很多人依然不知道这个问题的存在
Still, many don't know the problem exists
‎很多患者被告知
and many of those suffering were told
‎症状是心理想象出来的
the problem was psychological and imagined
‎在我对玛雅进行初步评估之后
After my initial evaluation for Maya
‎我很清楚 ‎因为她的症状严重
it was clear to me that, because of the magnitude of her symptoms
‎皮肤损伤 腿上的灼烧感
the lesions, this burning sensation in her legs
‎贯穿全身的疼痛
and the pain throughout her entire body
‎玛雅患有晚期复杂性区域疼痛综合征
that Maya had advanced CRPS
‎我们必须立即进行积极治疗 ‎控制病情
that we had to right away get aggressive with and get under control
‎我们已经治疗了超过三千名 ‎复杂性区域疼痛综合征病患
We've treated over 3,000 patients with complex regional pain syndrome
‎我们知道最佳疗法是什么
And we know what the best therapy is for it
‎叫做氯♥胺♥酮♥
It's called ketamine
‎一种通常被人熟知 ‎用在俱乐部中的药
A drug typically known for its recreational use in clubs
‎现在在疼痛治疗专家之间 ‎有另一个名声
is now making another name for itself among pain-management specialists
‎叫做氯♥胺♥酮♥ 药物专家用它
It's called ketamine, and medical experts are using it
‎治疗患有慢性疼痛的病人
to treat patients suffering from chronic pain
‎氯♥胺♥酮♥对于晚期 ‎复杂性区域疼痛综合征
Ketamine is a safe, effective treatment
‎是安全有效的疗法
for advanced complex regional pain syndrome
‎因为当氯♥胺♥酮♥进入你的身体
Because when the ketamine gets into your body
‎它其实激发了大脑 ‎并且某种程度上重启了一切
it actually stimulates the brain and kind of resets everything
‎它通常会增加你的血压 ‎增进你的血液循环
It tends to increase your blood pressure, increase your circulation
‎增强你的呼吸
and increase your breathing
‎对玛雅 我们先用相对较低的剂量
With Maya, we first tried the outpatient procedure
‎尝试门诊治疗…
at a relatively low dose…
‎有造成任何疼痛吗？
Any pain? -Um…
‎…但没有见效
…but it was not working
‎就在这儿…
Just here…
‎于是我跟妈妈和玛雅讨论了一下
So I discussed with the mother and with Maya
‎氯♥胺♥酮♥昏迷治疗的想法
the idea of the ketamine coma procedure
‎有些病人会凭借进入昏迷状态 ‎来控制疼痛
Some patients are taking control of their pain by going into a coma
‎在这里 医生通过使用 ‎通常剂量的最高50倍量
Here, doctors use up to 50 times the typical dose
‎引发一次五天的昏迷
to induce a five-day coma
‎你看到足够多的病人 ‎你知道他们如何恶化
You see enough patients, you know how they deteriorate
‎什么都不起作用
Nothing is working
‎手术不起作用 药物不起作用 ‎神经阻滞不起作用
Surgery doesn't work, drugs don't work, nerve blocks don't work
‎然后你做了这一件事 它就起作用了
and you do this one thing, and it works
‎柯帕里克医生说
Dr. Kirkpatrick says
‎这种实验性的治疗只能在墨西哥接受
the experimental treatment is only available in Mexico
‎当他们告诉我 我们必须去墨西哥时
When this was told to me, that we would have to go to Mexico
‎我不敢相信
I… I was in disbelief
‎…背朝下平躺…
…flat on your back…
‎然后他告诉我们 ‎她可能有死亡的危险
And then he told us that there's a chance that she could potentially die
‎我有感觉她会做得很好 非常好
I have a feeling she'll do very well
‎非常可怕
It was very scary
‎但当时没有其他选择
but there was no other options
‎选择治疗 不然就每天看着玛雅恶化
It was that, or see Maya deteriorate every day
‎于是我们决定带她去墨西哥蒙特雷
So we decided to take her to Monterrey, Mexico
‎（墨西哥 蒙特雷 2015年11月）
‎我会醒来吗？
I will wake up? -Yes, you will
‎是的 你会从昏迷中醒来的
‎我会正常吗？
Will I be normal? -Yes. You are normal
‎会 你很正常
‎对 等你醒来 会非常正常
Yes, and you'll be very normal when you wake up
‎-我感觉很奇怪 ‎-不 你不奇怪
I feel weird. -You're not weird
‎我感觉很奇怪
I feel very weird
‎我感觉很奇怪
Has the… -I feel very weird
‎你做得很好
You're doing great. -She's doing well. Responsive
‎我想聊聊在墨西哥的氯♥胺♥酮♥昏迷治疗
I'd like to go back to the ketamine coma in Mexico
‎你记得那次住院治疗的任何事吗？
Do you remember anything about that hospitalization?
‎对 我记得在房♥间里
Uh, yeah. I remember being in the room
‎很高的剂量
It was a higher dosage, and therefore
‎因此 我经历了更多副作用 例如幻觉
I experienced more of the side effects, like the hallucinations
‎但我知道妈妈和我一起在那里 ‎这对我很有帮助
But I know that my mom was there with me, and that helped
‎这是昏迷第一天
Here is coma day one
‎11月18日 星期三
Wednesday, November 18th
‎玛雅状态很好
Maya is doing well
‎今天是11月20日 星期五
Today is Friday, November 20th
‎这是昏迷第三天
This is day three coma
‎玛雅状态很棒
Maya is doing great
‎昏迷第五天
It's coma day five
‎今天早上她呕吐得很严重
She, uh, had a bad episode this morning of vomiting
‎所以他们不得不给她额外的氯♥胺♥酮♥