芝加哥急救

Chicago Med S03E15

Part 3 Jan. 23, 2020, 11:12 a.m.

and we can get out of here.
憩室炎一般不会引发呼吸困难
Well, shortness of breath isn't usually a symptom of diverticulitis,
所以我需要调查一下是什么原因
so I need to see what's going on with that.
做几个检查
I want to run a few tests.
这又要花多少钱
Whoa. What's that gonna cost?
-爸 -你别这么烦人
- Dad. - Stop being a pain.
你有保险的
You have insurance.
我只是想确保
I just want to make sure
你身上没有出现其他情况
we're not dealing with something else.
好
Okay.
做得越少越好
But just the bear minimum.
超声波显示左右心室
This echo shows significant dilatation
都出现了大幅度扩张
of both the right and left ventricles.
看这里双胞胎A
If we look here, at Twin A...
我解释一下双胞胎A是莉莉
For the record, Twin A is Lily.
主动脉瓣狭窄已经严重削弱了
The aortic stenosis has significantly diminished
正向血流
forward flow,
也使得射血系数为19%
and has compromised ejection fraction to 19%.
你的意思是她的心脏在衰竭
You're saying, essentially, that she's in heart failure.
是的如果我们几小时内不采取措施
She will die within the next few hours
她会死
without intervention, yes.
如果她死了那么点点也会死
And if she does, she takes Dot with her.
我们需要提前进行分离手术
We need to consider moving up the separation surgery.
我们还没准备好
We're not prepared.
没有演练过手术流程
We haven't rehearsed the procedure.
就算演练过也不能选这个方法
And even if we had, it's not an option.
手术定在原来的日期
The surgery is scheduled for when it is
是为了让双胞胎发育
so the twins can grow.
我不想听你们这些学徒的意见
Well, I'm not taking the word of a couple fellows.
叫莱瑟医生来
Page Dr. Latham.
他只会跟你说同样的情况
He's gonna tell you the same thing.
双胞胎还没有成长到经得住手术的程度
The twins aren't robust enough yet to survive the surgery.
快去
Go.
手术涉及到分开双胞胎的胸壁
The surgery involves separating the twins'
并重建她们共用的心房♥
chest wall and reconstructing their shared atrium.
但是我们还看不清她们身体内
However, we still don't have a clear enough image
肝脏静脉系统的分部
of their liver's venous system to determine
不确定能否进行分离
if it can be split.
此外现在莉莉的免疫系统有缺陷
In addition, Lily is now immunocompromised.
那么成功的可能性...
If you had to estimate the odds of success...
这种情况下两个人都活下来的几率吗
At this point? That both survive?
零莉莉不够强大
Zero. Lily is not strong enough.
但如果我们把所有精力都放在点点身上
But if we concentrated all of our efforts on Dot,
能救得了她吗
would we be able to save her?
可以
Yes, I believe so.
等等
Hold on a second.
我们真的要讨论终结莉莉的生命吗
Are we actually discussing terminating Lily's life?
我们在讨论目前情况下的最好选择
We are discussing the best course of action.
如克雷斯宁医生所说
Well, if as Dr. Krasny said,
问题在于莉莉的潜在病症
the problem is Lily's underlying condition,
我们应该查清楚
we should be addressing that.
你是说带她们去导管室吗
You mean take them to the cath lab?
没错
Exactly.
加宽莉莉的主动脉瓣
We widen Lily's aortic valve,
增强她的血流
increase her blood flow.
太危险了
Too risky.
我们现在还不清楚
We still don't have a real grasp
双胞胎的血管分部情况
of the twins' vascular anatomy--
包括血管路线流量有多大
the routing, how open the lumen is.
除非开刀否则都是猜想
We're just guessing until we open them up.
我完全同意我们需要更好的路线图
I completely agree we need a better roadmap.
所以我们应该先做一个超声心动图
That's why we should first perform a transesophageal echo.
你要对双胞胎进行麻醉
You want to put the twins under general anesthesia--
浪费我们所剩无几的时间
waste one of the few hours we might have left--
做出一份更好的路线图
so you can get a better roadmap
来做一场风险极高的手术吗
for a procedure too risky to even try?
莱瑟医生你要不要劝劝你的同事
Dr. Latham, care to wrangle your fellow?
牺牲一个孩子的生命是悲剧
Having to surrender a child is tragic.
如果我们没有用尽全力去救她
I'd be remiss if we didn't exhaust every opportunity
就是我的失职
to try to save her.
我同意罗德斯医生的观点
I second Dr. Rhodes' recommendation.
好的那就做超声图吧
All right. Let's get the echo.
罗德斯医生贝克医生稍等
Dr. Rhodes, Dr. Bekker, a moment.
如果能够成功救下两个双胞胎
If we are successful in saving both the twins,
分离手术也按照计划进行的话
and the separation surgery can go as scheduled,
我已经决定任命罗德斯医生担任我的副手
I have decided to name Dr. Rhodes as my second.
贝克医生我希望你继续当候补
Dr. Bekker, I'd still like you to be prepared as backup.
好的
Of course.
恭喜你
Congratulations.
谢谢
Thank you.
我写了一些说明
So I've written down a few notes
来解释当时的情况
explaining the situation.
这可能用不上
It may not be necessary.
彼得
Peter?
如果我告诉你
So what if I told you
当你为吉尔·费舍尔插管的时候
that when you criked Jill Fisher,
不是以护士而是持证急救人员的身份呢
you weren't acting as a nurse but as a licensed paramedic.
我不明白
I don't get it.
作为护士你无权为病人进行插管
As a nurse you're not permitted to crike a patient.
因为你没有接受过相应培训
You haven't been trained to do so.
那作为急救人员呢
But as a medic?
你就接受过国家批准的
You received state-approved training
环甲软骨切开术操作培训
on how to perform a cricothyrotomy.
所以你不是超出职责范围行动
So you were not acting out of scope.
而是在尽身为持证急救人员的职责
You were acting as a licensed paramedic.
我希望你的执照还没过期
Your license is still valid, I hope.
是在我家放着呢
Yes, I have it at home.
很好拿来带到听证会上
Good. Go get it. Bring it to the hearing.
听着这也是一招险棋
Okay, now, there is a wild card.
因为如果费舍尔提起诉讼这些就都没用了
Because if Fishers were to file suit this would all be moot,
医院别无选择只能对你进行处罚
and the hospital would have no choice but to sanction you.
但目前还没有法律举动
But there's been no legal action taken,
所以继续祈祷吧
so keep your fingers crossed.
我会的太谢谢你们两位了
I will. Thank you. Thank you both so much.
这样的分♥裂♥状态
It's very often emotional distress
往往是由于精神痛苦触发的
that triggers this kind of dissociative state.
什么样的精神痛苦
What kind of emotional distress?
我们希望你能告诉我们
We were hoping you could tell us.
说实话我们才开始
To be honest, we had just begun
重建我们的感情
to reestablish a relationship.
我在22年前和她母亲分开后就没怎么
I hadn't seen Kat much after I split with her mother
见过凯特了
22 years ago.
为什么不见呢
Why not?
我们的婚离得挺难看
Well, it was a pretty ugly divorce.
你们也看到了我前妻有多不正常
I mean, you've seen how unstable my ex-wife is.
在我们离婚后她就一直破坏我和凯特的感情
After we split, she poisoned my relationship with Kat.
还有...
And...
我最后悔的
That's really my biggest regret,
就是任由萨曼莎把我赶出女儿的生活
is that I let Samantha push me out of my daughter's life.
当重新联♥系♥上凯特后
Once I reconnected with Kat,
我就发誓永远也不会让那种事再发生
I swore to her that I would never let that happen again.
你们俩是什么时候重新联♥系♥的
And when was that, you two reconnecting?
大概一年前我找到了她
About a year ago, I reached out to her.
是因为什么
And what prompted that?
我当时心脏病发作
I had a heart attack.
差点死掉
And it nearly killed me.
我发誓要弥补失去的时光
And I swore that I needed to make up for lost time,
所以我会偶尔飞过来
so I would fly in once in a while.
和她一起吃晚餐
We went to dinner.
然后她搬回了我前妻家里
And then she moves back in with my ex-wife
开始不回我电♥话♥ 然后...