芝加哥急救

Chicago Med S03E08

Part 5 Jan. 23, 2020, 11:10 a.m.

Well, legally, they don't have a move.
法♥院♥早已有了先例
Precedent's already been set in the courts.
每桩案子最后都是尊重病人的意愿
In each case, the patient's wishes were upheld.
那就找她的父母他们没决定权吗
So we go to the parents. Don't they have a say?
艾莉森是成年人了伊森
Allison's an adult, Ethan.
最终要死要活还是看她自己
I mean, ultimately, she decides her own fate.
所以我们什么也做不了吗
So, there's nothing we can do?
七年的厌食症
Look, after seven years,
就是一种持久性的严重病症
anorexia is considered severe and enduring.
这个可怜的姑娘患厌食症已经15年了
This poor lady has been struggling for more than 15.
她整个人都执着于获得控制
Her entire being is fixated on gaining control,
还有坚持
and holding onto it.
哪怕那会要她的命
Even if it kills her.
所以不听医生劝告
So regardless of the injunction,
或是她父母的爱
or her parents love...
她的康复几率是...
The odds of her recovery are...
你好啊
Hey, there.
感觉怎么样
How you feeling?
总的说来感觉很棒
All things considered, fantastic.
我是说...
I mean...
我少了一个肾但至少我没搭上
I'm down a kidney, but at least it didn't cost me
一条胳膊或腿
an arm and a leg.
看你的幽默感回来了
See, you got your sense of humor back.
算是吧
Kind of.
那还挺糟糕的对吧
Yeah, that was pretty awful, huh?
不开玩笑了谢谢你们
Look, jokes aside, thank you.
不客气
Sure.
我过几个小时会再回来看你
So, I'm gonna be back to check on you in a couple hours,
但我们走之前你还有什么问题吗
but before we head out, any questions?
就一个我的右腿有点疼
Just one. My right leg is achy.
小腿骨周围
Around the shin.
之前从没感觉到
Never felt it before.
可能是麻醉的副作用吗
Maybe a side effect from the anesthesia?
有可能
Could be.
让我去找麻醉师问问
Let me speak with the anesthesiologist
看他怎么看
and see what he thinks.
现在你安心休息就好
Right now, you just get some rest.
腿疼吗那可不是麻醉的问题
Leg pain? That's not from the anesthesia.
是但做透视前我们先别妄下论断
No, but let's not say it out loud without an X-ray.
我去安排
I'll get it going.
汉娜
Hannah.
汉娜
Hannah?
天啊汤米
Oh, my God. Tommy?
来人呐来人
Help. Help!
怎么回事
What's happening?
体温升高到40度浑身发抖
Temp's up to 104. He's tacky.
血压94/62 感染性休克
BP's 94/62. Septic shock.
第一剂万古霉素未起效
First dose of Vanc didn't work.
静注一升生理盐水加推泰诺
Bolus a liter of normal saline, and push IV Tylenol.
汤米可以把嘴张开吗
Tommy, can you open your mouth for me?
你在找什么
What are you looking for?
新出现的脓肿溃疡
Abscesses that weren't there earlier.
牙齿或口腔无异常
Nothing dental or oral.
帮我检查皮肤
Help me search his skin.
这侧没东西
Nothing on this side.
这侧也是
Here either.
拿条降温毯来
Get a cooling blanket.
他应该慢慢好转但却越来越糟
He should be getting better, but he's only getting worse.
会没事的没事的
It's gonna be okay. It's okay.
我在看汤米最新的检查结果
Tommy's latest labs.
他不是葡萄球菌感染
He doesn't have a staph infection.
是抗万古霉素肠球菌
Vancomycin-Resistant Enterococcus.
-超级病菌吗 -对
- The super bug? - Yeah.
而且不是容易感染的那种
And one that is not easy to get.
抗万肠球菌是种医院里的感染病菌
VRE's a nosocomial infection. It lives in hospitals.
我好像根本没见过其他地方的传染源
I don't think I've ever seen it contracted anywhere else.
汉娜
Hannah.
她十年前得过肺炎
She had pneumonia a decade ago.
住院了两周
Was hospitalized for two weeks.
可能是从那时候携带上的
Could've picked it up then, had it ever since.
健康带菌者
Asymptomatic carrier.
他们俩是恋人
Intimate relationship,
她能传染给他的机会很多
lots of ways she could've passed it on.
好我们先为汤米静注利奈唑胺
Okay, let's start Tommy on IV Linezolid,
给汉娜的鼻腔和喉咙采样检测细菌
swab Hannah's nose and throat for the bacteria,
确认她是传染源
confirm she's the source.
-好 -谢谢
- Got it. - Thank you.
查尔斯医生我们的无名氏叫杰米·沃克
Oh, Dr. Charles, our Jane Doe is Jamie Walker,
是在就读烹饪学校的一名厨师
an aspiring chef in culinary school.
一个月前她开始彻夜不眠
A month ago, she started staying up all night,
读《圣经》写告示
reading the Bible, and writing a manifesto.
上周她退了学
Last week, she dropped out of school
而且已经四天没回家了
and hasn't been seen home in four days.
现在以我最初的发现
Now, my original findings,
结合她突然间的行为异常
combined with her sudden onset drop,
机能缺乏睡眠减少
lack in functioning, her decreased need for sleep,
广泛思维和宗教狂热
her grandiose thinking combined with hyper-religiosity,
符合我原先双相躁狂症的猜想
it is what I thought: bipolar mania.
检查和实验室检测也都能佐证吗
So, exams, lab results didn't poke any holes?
不我没看那些
No, I never go to them.
我是靠额外病史确定的
I filled in the blanks with the added history.
等等这么多内容
Wait, so, you got all that,
这么详细有序的病史
a detailed, chronological history,
都是你从她嘴里问出来的吗
from a patient in a manic state?
不
I--well, no,
是靠间接来源
it came from collateral.
我找到了她姐姐梅丽莎跟她聊的
I found and spoke with her sister, Melissa.
里斯医生我们不是说要考虑所有情况
Dr. Reese, I thought we were checking all the boxes.
照程序诊断
You know, doing it by the book?
我确定了我的诊断
I-I confirmed my diagnosis.
怎么确定的重要吗
Does it matter how I got there?
当然如果是在试用期的话
Yes, when you're on probation, it does.
你怎么确定的很重要
It does matter how you got there.
你说得对
Um, you're--you're right.
好吧
Okay.
所以对你的病人来说下一步是什么
So, um--so what's the next move, for your patient?
我想让她住进精神病区
I want to admit her to the psych ward.
她对她的用药没有一丁点反应
She hasn't responded to any of her meds.
她的用药有哪些
And what meds would those be?
我加倍了利培酮的剂量又加了双丙戊酸钠
I doubled the Risperdal and added Depakote.
这些我之前也没跟你说过
Also without filling you in.
好吧
Okay,
你知道的如果病人患有躁郁症
Well, um, you know, with bipolar,
那些药物
all those meds,
应该会有效果
should've made some kind of dent,
所以我想看一下
so I'd like to take a look.
癌症转移到她的胫骨了
The cancer metastasized to her tibia.
很有可能是几个月前的事
Likely months ago.
入院的时候她没有不舒服吗
No discomfort upon admission?
被她肾造成的背痛给掩盖了
It was drowned out by the back pain from her kidney.
稍有好转后...
Once that was alleviated--
她的身体就暴露出了新的问题
Her body registered the new problem.
那我们及时诊断出来了吗
So, did we catch it in time?
给艾斯特德服用一颗高剂量的白介素-2
Let's start Asterid on a high dose bolus of Interleukin-2,
看看她有没有反应
see if she responds.
如果没有反应她可以参加
If she doesn't, she may be a candidate
帕唑帕尼的第三阶段试验
for our phase three trial of Pazopanib,
那是一种化疗药物
a chemotherapy agent.
我去把骨科也拉过来
I'm gonna pull Ortho in, as well.
打扰一下罗德斯医生
Excuse me, Dr. Rhodes,
霍尔斯德特我能跟你们谈一谈吗