芝加哥急救
Chicago Med S04E04
Part 5
Jan. 21, 2020, 1:47 p.m.
该死 伤口太近 无法避开左冠状动脉前降支
Damn it, the tear is too close to the takeoff of the LAD.
这样搭血管支架肯定会伤到左主动脉
I can't deploy the stent without occluding the left main.
我们只能给他做血管重建术
We're gonna have to crack him open and revascularize.
我给楼上打电♥话♥要一个搭桥机器和灌注师
I'll call upstairs and get us a bypass machine and perfusionist.
还有巴多♥维♥医生
And Dr. Bardovi, too.
我需要多个人手协助手术
I'm going to need an extra set of hands to assist.
好 做好准备 挂上消毒帏
Okay, let's prep and drape.
了解
On it.
杰
我们得谈谈
杰 给我回电
请给我打电♥话♥
杰 你在哪里
给我打电♥话♥
我们现在必须谈谈
塔拉的核磁共振结果
Tara's MRI results.
无异常 没有肿瘤 病变或凝块
Clean--no tumors, lesions, or clots.
经阴♥道♥超声检查
And the transvaginal ultrasound.
扫面显示是单纯卵巢囊肿
Scan only shows simple ovarian cysts.
没有异常
Nothing abnormal.
你打算告诉我
Are you going to fill me in on
为什么你要复查这些囊肿吗
why you doubled back to look at the cysts?
我原以为有一个是畸胎瘤
I thought one might have been a teratoma.
一团本不该在那的细胞
A clump of cells that shouldn't be there.
但那能解释她腹部的刺痛感
Well, it would explain the sharpness she feels in her abdomen,
如果畸胎瘤包含原始脑细胞
and if the teratoma contains primitive brain cells...
可能会欺骗她的免疫系统
could have tricked her immune system
去攻击她真实的脑细胞
into attacking her actual brain cells.
引起那些神经症状
Causing the neurologic symptoms.
好 我明白了
Okay, yeah, I see the connections,
但你说的这种畸胎瘤非常罕见
but the kind of teratoma that you're describing is super rare.
是的
Yes.
畸胎瘤是唯一可以解释所有症状的病因
But a teratoma is the only thing that connects all her symptoms.
那为什么在超声波里没有显示
Then why didn't it show up on the ultrasound?
我不知道
I don't know.
但仅因为一个放射科医生没看见
But just because a radiologist couldn't see it
不意味着不存在
does not mean it's not there.
霍斯特德医生 每个卵巢里都有囊肿
Dr. Halstead, there are cysts in each ovary.
即使有个畸胎瘤藏匿其中
Even if there is a teratoma hiding,
你也不知道是哪个
you don't know which one it's in.
是啊
Yeah.
只有试着说服病人做手术
Our only move would be to push for surgery.
把两个都取出来
Take them both out.
卵巢切除术
An oophorectomy.
你想让我给妇科打电♥话♥吗
You want me to call gyne?
她才三十岁
She's only 30.
如果我这么做 她就不能有孩子了
I do this, she won't be able to have kids.
所以 我要给妇科打电♥话♥吗
So, do I call gyne?
不 重新开始 拿本新病历
No. Start over. Take a new history.
重做所有测试 检查罕见的病因
Draw all new labs and test for zebras.
从抗核抗体 抗SSA 抗SSB
Start with an ANA, SSA, SSB,
以及抗甲状腺球蛋白抗体
and antithyroglobulin antibodies.
好
Okay.
康纳
Connor.
我要个心胸科学徒 却来了个主治医生啊
I asked for the CT fellow and I get the Attending.
我的新职位可有不小的影响力呢
My new title really carries some weight.
别得意忘形 小子
Easy there, tiger.
我来是因为我的冠状动脉搭桥术手术
You only got me because the elective CABG
被暂停了
I was starting is now on hold
因为你的病人需要搭桥机器
because your trauma needs a bypass machine.
也可能是因为你怀念和我一起做手术
Also maybe because you miss operating with me.
洗手吧
Scrub in.
搭桥机器马上就会送来了
Bypass machine should be down here any minute.
事实上 我没让他们移♥动♥机器
Actually, I put a hold on that order.
机器已经消毒准备好投入使用
Machine's already prepped and ready for use up in the O.R.
把你的病人转移到楼上更简单
Simpler to bring your patient up than the equipment down.
你说得对 就这么办
You're right. Let's do it.
我猜自己还真是怀念和你一起手术了
Guess I do miss operating with you.
听你说我是对的时太爽了
Love hearing you say I'm right.
崔医生
Dr. Choi?
刚得到东慈爱医院的回复
Just heard back from East Mercy.
诺雅并不是那里的病人
Nora's not on file as a frequent flier.
从没去那里看过病
Never been a patient there.
但她肯定做过手术
Well, she definitely had a surgery.
背上的伤疤可不会说谎
Scar on her back is clear proof.
我再问问别的医院
Well, I'll start calling other hospitals,
看看她在其他地方是否有档案
see if she's on file somewhere else.
如果诺雅在骗我们 很有可能
If Nora is playing us, it stands to reason
她对自己在哪做的手术也撒了谎
she'd also lie about where she had her operation.
也许没那么复杂
Maybe it's simpler than that.
如果我想骗过医疗系统
If I were trying to game the system,
我会用假名
I certainly wouldn't use my real name.
如果她不是诺雅·布莱克 那她是谁
So, if she's not Nora Blake, who is she?
问得好
Good question.
查尔斯医生 我能问点事吗
Dr. Charles, can I ask you something?
我有预感我的病人用假名
I've got a strong feeling my patient gave a fake name
来骗取处方药
to get a prescription.
你认为来了个瘾君子
You think we're dealing with addiction?
很可能 但如果分不清
Likely, but I can't help her with it
事实真♥相♥ 我帮不了她
if I can't separate fact from fiction.
很多时候人们撒谎
You know, often when people lie,
会只描述事情的大概
they tend to describe things in generalities.
但他们说细节时
But when they use specifics,
往往说的是实话
it's more likely they're telling the truth.
你的病人说了什么细节吗
Your patient give you any details?
她想要的药物名称
The type of meds she wanted.
还有她的工作
Oh, and her job.
她是一家律所的合伙人
That she's a partner at a law firm.
阿斯特-卡德威尔-戴维斯律所
Astor, Caldwell, and Davis.
从那着手
Start there.
谢谢
Thanks.
阿斯特-卡德威尔-戴维斯律所
布伦娜·麦克道格拉斯
合伙人
看这里
There.
诺雅·布莱克其实是布伦娜·麦克道格拉斯
Nora Blake is actually Brenna McDouglas.
找到你了
Gotcha.
我匹配吗
Am I a match?
不 很抱歉
No, I'm sorry.
你跟琳达的白细胞抗原重合度不够高
You don't have enough HLA markers in common with Linda.
那埃文呢
What about Evan?
他是她唯一的血亲
He's the only other blood relation.
有可能 但捐赠者需要注射药物
It's possible, but the injections needed
来增长体内的干细胞数量
to boost stem cells increase the chance that the donors
这会增加其自身在将来患上白血病的风险
themselves develop leukemia in the future.
鉴于埃文的家族病史和他的年纪
Evan's family history and his young age...
他冒的风险会特别高
His risk would be significantly higher.
还有别的办法吗
Is there any other way?
造血干细胞也可以
Stem cells can also be extracted
直接从埃文的骨髓中抽取
directly from Evan's bone marrow,
但这个过程也会对他造成损伤
but it's an invasive process,
再考虑到他的体重 可能要重复多次
and given Evan's weight, it would take multiple procedures
才能抽取到足够的干细胞
to harvest the amount of cells needed.
这对他来说会很痛苦
It would be painful for him,
我也不能保证这个方法♥会♥对你有用
and I can't guarantee it would be successful for you.
所以救我妻子的唯一办法
So the only way to save my wife is to give my son
就是让我儿子把命也搭进这个病里
the disease that's killing her
或者让他痛不欲生然后祈祷万事如意吗
or put him through hell and hope for the best?
我会捐赠我的干细胞
I'll donate my stem cells.
我来美国是为了一段更好的生活
I came to the United States for a better life.
琳达跟詹姆斯和埃文已经拥有了这样的生活
Linda has one with James and Evan.
我不能把它从她身边夺走
I can't take that from her.
好吧 被你发现了
Fine, you got me.
我叫布伦娜·麦克道格拉斯 不是诺雅·布莱克
My name's Brenna McDouglas, not Nora Blake.
现在我能拿到我的处方药了吗
Can I have my prescription now?
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