芝加哥急救
Chicago Med S03E12
Part 3
Jan. 23, 2020, 11:11 a.m.
Okay, keep breathing, keep breathing.
好吗 继续呼吸
Okay? Keep breathing.
-努力放松下来 -没事的
- Just try to relax. - It's okay.
罗德斯医生
Dr. Rhodes?
怎么了
What's wrong?
卢克的肝功能指标在升高
Luke's LFTs are rising.
那是什么意思
What--what does that mean?
那表明他可能出现了早期肝功能衰竭
It indicates that he might be in early liver failure.
不幸的是 如果情况继续
Unfortunately, if it progresses,
就可能让他无法接受肺移植
it could prevent him from getting the lungs.
不能移植吗
Prevent him?
所幸 在我们试着阻止他的肝功衰竭时
Fortunately, we can still get him off the ECMO,
依然可以停止体外膜肺氧合
while we try to reverse this trend.
但是 如果现在停止
However, if we take him off of ECMO now,
那会减小他撑到肺源来的生存几率
it decreases the odds that he survives until the lungs get here.
我不明白 你们拿不出统一的意见吗
I don't understand. Can't you agree on what to do?
这不是非黑即白的情况
It's not a black and white situation.
一直治疗他的是你 罗德斯医生
Uh, you've been treating him, Dr. Rhodes.
你说我们该怎么办
What should we do?
继续给他上膜肺机
We should keep him on the ECMO.
那还是我们把握最大的方式
It's still our best chance that he gets those lungs.
好的
Okay.
好 那就这么办
Yes. That's what we'll do.
好的
All right.
你这完全是不负责任
You're being completely irresponsible.
等不到新肺 那孩子就会死
That kid is going to die if he doesn't get new lungs.
除非他先死在你的膜肺机上
Only if your ECMO doesn't kill him first.
他的情况只会越来越严重
He's a snowball rolling down a hill,
这是我们阻止的最后机会了
and this is our last chance to stop it.
我们要把托马斯先生怎么办
So what are we doing about Mr. Thomas?
精神科医生正在过来
Psych's in there right now.
等他们一宣布他无行为能力
As soon as they declare him incompetent,
我就喊肿瘤科派人来开始手术
I'm gonna call oncology down here to get started.
无行为能力吗
Incompetent?
谁关心啊 这家伙是个恋童癖
Who cares? The man is a pedophile, okay?
他要是想死 就让他死好了
If he wants to die, why don't we just let him?
艾普尔 我们要挽救他的生命
April, we're going to stop him from dying,
因为他是我们的病人 也因为我们能
because he's our patient and because we can.
你让他留院精神观察了吗
Did you put him on a psych hold?
我还没准备好做这个结论
Uh, I'm not ready to make that decision.
为什么 他想自杀了
Why? He's suicidal.
他可能想死 但他很清醒
He may want to die, but he is lucid
也能理解他的选择的后果
and understands the consequences of his choices.
他的病情是可治愈的
He--he has a treatable condition.
他都不让我们治 能有多清醒
How lucid can he be if he's not letting us treat it?
如果他抑郁 你会让他留院精神观察
If he was depressed, you'd put him on a psych hold
然后想办法治疗他的抑郁
and try and treat his depression.
恋童癖你就不打算这么做了吗
You're not gonna do the same for pedophilia?
我只是对恋童癖不是那么了解
I just don't know that much about pedophilia.
那你最好尽快了解 因为他快死了
Well, you better find out fast, because he's dying.
部门指控护士麦基·洛克伍德
Department charge nurse Maggie Lockwood,
尤其因为她提供了诱因
especially providing incentive.
-真是不敢相信 -先别激动
- I don't believe this. - All right, take it easy.
你知道这个病人的事吗
What do you know about this patient?
不知道啊
I don't.
而我绝对没有让任何一位救护车司机
And I definitely never told any ambulance driver
根据保险购买♥♥情况来挑选病人
to make decisions based on insurance coverage.
那好 这个叫约翰·盖茨的司机
All right. This driver, John Gates,
-你认识他吗 -认识 他是个混♥蛋♥
- do you know him? - Yeah, he's a jerk.
那帮我个忙 他来了之后就叫我
Well, do me a favor: page me when he comes in.
我想和他谈谈
I wanna talk to him.
好 如果他不被我先弄死的话
Sure... if I don't kill him first.
-这里需要医生 -救命
- I need a doctor in here. - Help him!
-凝血障碍 -什么意思
- He's coagulopathic. - What does that mean?
他的肝脏功能不良 再加上
The combination of his poor liver function
我们给他输的抗凝血剂
and the anticoagulants that we gave him
干扰了他的凝血能力
has disrupted his ability to clot.
给他上一袋肝素
Hang a bag of heparin.
为了给他做体外膜氧合不得不稀释他的血液
We thinned his blood for the ECMO, we had to,
但他的肝脏衰竭速度超出我们的预计
but his liver is failing more quickly than we expected.
是你决定的 那你把那机器停了
You did this, so take him off that machine!
恐怕已经来不及了
I am afraid that it is too late for that.
来不及
Too late?
肝素好了
Heparin's running.
我们会尽力阻止出血
We're gonna try and reverse the bleeding now.
开始血浆置换
Run the plasma now.
先等等
Hold on that.
输血会继续提高他的抗体数
A transfusion is going to increase his antibody count.
他的血浆肾素活性已经到50了
His PRA's already at 50.
等到了80 就不能移植肺了
If it hits 80, we can't use those lungs.
你以为我不知道吗 我们没得选择
You think I don't know that? We don't have a choice.
要不是你非要做体外膜肺氧合
We wouldn't be in this situation
我们也不会到这步两难境地
if you hadn't insisted on ECMO in the first place.
你把问题重复再多遍有什么用
You keep pointing out problems.
我需要办法 你要是没有办法
What I need are solutions, so if you don't have any,
你别碍我的事 好吗
just--just get out of my way, okay?
开始注射吧
Hang the bags.
霍斯特德医生说的有道理
Dr. Halstead has a point.
这个恋童癖真的是理性的吗
Is this man, this pedophile, really being rational?
说来有趣 我觉得他挺理性的
Funny enough, it sounds to me like he is.
那我们难道就袖手旁观
Uh, so we just have to, uh, stand by
-让他自杀吗 -不治疗癌症
- and watch him kill himself? - Not treating your cancer
和自杀是两回事
is not the same thing as committing suicide.
这是他的决定 他有权做这种决定
I mean, it's his decision. He's allowed to make it.
更重要的是 我觉得他的真正目的
More to the point, I think what he may be trying to do
是想找个办法 逃脱他的冲动
is looking for a way to... escape his urges.
办法就是死
By dying.
里斯医生 你看过恋童癖的PET扫描吗
Dr. Reese, have you ever seen a pedophile's P.E.T. Scan?
前额皮质和豆状核
The prefrontal cortex and the putamen,
都会显示高亮
they--they light up.
所以恋童癖的大脑
There's a very good chance that pedophilia
很有可能天生就是这么长的
could be genetically hardwired into the brain.
那他就没办法了吗
There--there--there's nothing he can do about it?
也有也没有
Well, yes and no.
办法就是既然不能改变天生的脑回路
I mean, the thinking is, you can't change the hardware,
但是后天思维运作就是另一回事了
but the software is another question,
在我听来似乎这就是托马斯先生
and it sounds to me like-like that's what Mr. Thomas
想的办法
has been trying to do.
如果你从他的角度来看
If you look at it from his perspective,
整件事似乎非常理性
the whole thing seems quite rational.
你不是休息吗 怎么又来了
Hey, what are you doing here on your day off?
-别问了 -别问
- Don't ask. - Don't ask?
我没疯 知道我在做什么
I'm not crazy about what I'm doing,
而且我之后会完完整整地跟你说
and I will tell you the whole thing later,
但现在 我只是来取点东西就走
but right now, I just need to get something and go.
-回头再聊 -好吧
- I'll talk to you later. - Okay.
大家请先出去一下
Everyone out, please.
你留下
You stay.
约翰·盖茨 这位是莎伦·古德温
John Gates, this is Sharon Goodwin,
是病患服务部的主管
the Executive Director of Patient Services.
你最好站起来
You might stand up.
你最近有没有因为一场诉讼
Did you speak to anyone recently
跟谁说过话
regarding a lawsuit?
有 律师来问了我几个问题
Yeah, lawyers asked me some questions.
你怎么说的
And what did you say?
我说你们只想收保险齐全的病患
I said you guys only wanted patients with good insurance,
所以我就按你们的意来
so I brought you what you wanted.
那你是从哪里得到这样的印象的
And where exactly did you get that idea?
你看看这里
Look around.
什么
Excuse me?
这大电视 还有披萨
芝加哥急救
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