芝加哥急救

Chicago Med S08E12

Part 4 April 5, 2023, 10:19 a.m.

It's just like Axel.
查理斯医生，你能帮我一个忙吗？
Doctor Charles, could I get your help?
怎么了？
What's up?
七号♥治疗室的病人，李察怀亚特
Patient in Treatment Seven, Richard Wyatt.
那个…要竞选市议员的人
Oh, the guy that's, uh...that's running for City Council?
是的
Yeah.
他今天早上本来应该接受采访
He was supposed to do some interview this morning
但他的竞选经理发现他神志不清
but his campaign manager found him disoriented
讲话含糊不清，头上有一处小擦伤
and slurring his speech with a small bruise on his head.
就带他来医院了
Brought him in.
他的病历上有什么特别之处吗？
Anything interesting in his charts?
体♥检♥结果是阴性
Yeah, workup was negative.
他没事，除了体内有酒精和苯二氮䓬类
He's fine except for the combo of alcohol and benzos.
不知道这是意外，还是蓄意的
Don't know if it was an accident or intentional.
好…我去跟他聊聊
Oh, I will, um... I'll go chat with him.
好，谢谢
Yeah, thank you.
你好吗？我是查理斯医生
How you doing? I'm Doctor Charles.
希望你有带出院资料来
I hope you come bearing discharge papers.
我不确定资料是否准备好了
Uh, not sure that those are quite ready yet.
有办法快一点吗？
Any chance we could expedite them?
我们越快离开
The sooner we leave,
我就能尽快重新安排马修斯的采访
the sooner I can reschedule the interview with Mathews.
他不知道我们为什么要改期吧？
He doesn't know why we're rescheduling, right?
你处理好了吧？
You handled it?
当然
Of course.
你介意我跟怀亚特先生说几句话吗？
Do you mind if I just get a quick moment with Mister Wyatt?
好吧
Fine, okay.
我去候诊室等
Be in the waiting room.
谢谢
Thank you.
就好像在校长办公室一样
Feels like I'm in the principal's office.
出了什么事吗？
Is something wrong?
没有，完全没有
No, Not at all.
我只是想和你聊几句
I just wanted to have a quick chat.
我真的该走了，好吗？有很多事要忙
You know, I really need to get going, all right? Uh, lots to do.
我完全明白
Completely understand.
不过你体内有酒精
You did have a mixture of alcohol
和苯二氮䓬类药物的混合物
and benzodiazepines in your system, though.
好，我知道你在想什么
All right, I know what you're thinking,
也知道这看起来像什么但这只是个愚蠢的意外
what this might look like, but it was just a stupid accident.
很高兴听你这么说
Well, look, that's good to hear.
我只是想确认一下给你开药的医生
Um, just want to make sure your prescribing doctor
有没有说清楚这两种一起服用可能会致命？
did make it clear that it's a potentially lethal combination?
我知道我不该把药物和酒精一起服用
I mean, I know you shouldn't mix medication and alcohol
但你知道，我不相信有人可以不喝威士忌
but you know, I defy anyone to get through a fundraiser
就撑过募款活动
without at least one scotch.
我是说，要是我知道这么危险
I mean, if I'd known it was that dangerous.
天啊
Wow.
募款活动听起来压力很大
I mean, fundraisers sound pretty stressful to me.
你认为这就是你服药的原因吗？
You think that might be why you took medication?
什么？不是
What? No.
当然不是，我只是想在马修斯的采访前
No, look, I just needed to take the edge off
放松一下，好吗？
for the Mathews interview, all right?
他这个人很难搞
He's tough.
你…介意我问一下
Do you just...do you mind me asking,
为什么医生会开给你苯二氮䓬类药物吗？
why you were prescribed benzodiazepines in the first place?
听着，这只是个意外，如果你能帮我
Look, this was a one-off mistake and I'd appreciate it
确认一下出院资料，我会很感激的
if you'd just check on my discharge papers.
知道了
Got it.
我去找田中里德医生
I will get with Doctor Tanaka-Reed
看能不能让你出院
and see if we can move that along.
很高兴认识你
Nice to meet you.
所以他到底怎么了？
So, what's his deal?
我觉得以前没有发生过这种情况
I don't think this has ever happened before,
但他肯定是在自我治疗
but you know, he's definitely self-medicating.
心悒？
Depression?
我觉得是某种焦虑症
I think it's some kind of anxiety disorder,
但不管怎样，他只想离开这里
but anyway, he just wants to get out of here.
我没有理由把他留下来
I don't have a reason to keep him,
但如果他有什么状况…
but if he's got an issue...
也不足把他留下来
Not enough to hold him.
我只能…你知道…
I'll just, you know...
在他离开前推荐他适合的医生人选
make sure he has the proper referrals before he leaves.
这就是我喜欢手术的原因病人不用说话
This is why I like surgery. Patients don't talk.
嗯
Hm.
看到你帮病人积臣劳斯做了DNA测序
Saw you ordered "D.N.A." sequencing on your patient Jason Rouse.
你看了我病人的病历？
You're reading my charts?
不常在急症室看到医生做这种检查
It's a pretty unusual test to order in the "E.D."
引起了我的注意
Caught my eye.
看来这里没有人想优化什么情况
Apparently, no one has anything they want to optimize around here
所以我闲闲没事
so I'm just twiddling my thumbs.
积臣的哥哥阿克塞尔 12年前死于无法控制的癫痫
Jason's brother Axel died twelve years ago from uncontrolled seizures.
查不出原因
No diagnosis.
现在积臣癫痫发作了
And now that Jason's had a seizure...
你认为两者之间有关联所以你安排了测序
You think they're connected, so you ordered the sequence.
还有这个
And these.
癫痫脑病变
Epileptic encephalopathy.
我已经排除了感染
I've ruled out infection,
环境因素和大多数自身免疫性疾病
environmental factors and most autoimmune diseases.
基因突变是唯一说得通的解释
Genetic mutation's the only thing that makes sense.
问题是癫痫脑病变
Trouble is epileptic encephalopathy
与数百种不同的突变有关
has linked to hundreds of different mutations.
应该是一千五百种
More like fifteen hundred.
每种疾病都有不同的治疗方法
And every disease path has a different course of treatment.
所以要缩小范围需要花很多时间
So it's gonna take forever to narrow down this differential.
我也许能帮上忙
I think I might be able to do that for you.
我可以利用现有的DNA数据库构建一个神经网络
I could construct a neural network using existing "D.N.A." databases.
基本上就是把资料捆绑在一起输入积臣的DNA
Basically, bundle them all together, input Jason's "D.N.A."
和成千上万已知的突变进行比较
and compare it against tens of thousands of known mutations.
这个神经网络需要几个小时来编码
This neural network would take a few hours to code,
但可以给你一个极有可能的诊断
but it could give you a highly probable diagnosis.
假设突变基因已经在其中一个数据库中了
Well, assuming the mutation's already in one of these databases.
我们可以利用现有的资源
We work with what we have.
谢谢你的好意，宋医生
Uh, I appreciate the offer, Doctor Song.
但他的父母很害怕他们需要一个可以求助的人
But these parents are terrified and need a human they can turn to.
所以，我必须用我知道的最好的方法来解决这个问题
So, I have to figure this out the best way I know how.
需要帮忙就跟我说
You know where to find me.
好
Yeah.
我妈说内森到处看来看去
My mom said Nathan's looking all around.
真可爱
Sweet boy.
罗奥，残留的胎盘已经取出
So, Laurel, the piece of retained placenta has been removed,
应该能止血了
which should resolve the bleeding.
谢天谢地
Thank God.
我还是可以怀孕吧？
Um, I'll still be able to get pregnant, right?
有个大家庭一直是我的梦想
A big family has always been the dream.
不孕是一种极其罕见的
Infertility is an extremely rare complication
子♥宫♥扩刮术并发症，所以是的
from a "D-and-C," so yes.
那我很快就能回家了？
Then I can go home soon?
我想继续观察一段时间
I'd like to continue monitoring you for a while.
因为你大出血了九天
You did have heavy bleeding for nine days.
你知道，我们打给医生
You know, we called the doctor's office
想早点安排检查，然后…
to try to get checked out earlier and...
他们说这没有关系
and they said it was fine.
对，我…觉得有点怪怪的
Yeah, I...I felt like something was off,
没有胃口，出血量好像很大
had no appetite and the bleeding seemed heavy,
但我不知道对我来说出血量大对医生来说是不是正常，你知道吗？
but I didn't know if heavy to me was normal to the doctors, you know?
是的，出血量很难衡量，而且很主观
Yeah. Bleeding can be difficult to gauge and is subjective.
透过电♥话♥评估就更难了
And even harder to evaluate over the phone.
我…
Uh, oh, uh...
我还会持续流血吗？
should I still be bleeding?
朵莉丝，给她注射1克传明酸
Doris, give her a gram of "T.X.A.",
0.2毫克的美脱琴