芝加哥急救
Chicago Med S05E05
Part 4
Nov. 18, 2019, 10:06 a.m.
a manic episode, Eunice, systematic of bipolar disorder.
不
No...
不不不 我不能有躁郁症
no, no, no. I can't have bipolar.
我还有三十万助学贷款要还
I have $300,000 in student loans
我的工资根本就不够
and my salary doesn't even make a dent.
我要成为合伙人
I need to make partner.
大多数律师要花五年的时间才行
Takes most lawyers five years.
我在努力挤进三年
I'm on track to do it in three.
你能给我多开点那种药吗
Can't you just give me more of that medication?
或别的药
Or something else?
问题是
The thing is,
这样并不能治疗躁郁症
bipolar disorder doesn't really work that way.
如果你不进行全面治疗
Unless you address it comprehensively,
很可能还会狂躁发作
the manic episodes will likely return.
会发作得更厉害 还会伴有
They'll increase in intensity and can even be followed
周期性抑郁
by cycles of depression.
但我现在知道发病的征兆了
But I know the signs now.
只要感觉不对 我就可以事先采取措施
I can get out in front of it if I start to feel off.
控制住
Control it.
我觉得没人能控制住
I don't think anybody can control this,
像你这样意志坚定的人也不行
you know, not even somebody as determined as you.
尤妮斯 但你绝对可以学习如何管控它
But, Eunice, you can absolutely learn how to manage it.
让我收你入院
Why don't you let me admit you
开始寻找稳定的治疗方法
and let's start looking for a stable medication?
不 我想出院
No, I'd like to be discharged.
今天还没结束
Today's not a wash, yet.
我还可以跟律所视频连线一下
I can still put in some face time at the firm.
听着 我知道非自愿监管的标准
Look, I know the criteria for involuntary commitment.
从法律上来说 你不能把我留在这里
Legally, you can't keep me here.
你眉头紧皱是不是表示
Does the furrow of your brow
马上需要外科咨♥询♥
suggest a surgical consult is now needed?
核磁共振显示远端胰腺中
MRI revealed a focal solitary mass
有个孤立的肿块 可能是个囊肿
in the distal pancreas. May be a cyst.
我同意
I concur.
如果是它导致卡尔严重腹痛
Gotta assume it's what's riling Carl's belly up so fiercely.
那他需要进行远端胰腺切除手术
He needs a distal pancreatectomy.
你把包裹肿块的这部分胰腺切除
You take out the section of pancreas housing the mass,
下游器官就不会再有问题了
no more chaos downstream.
这是个大手术
Whoa, that is a huge procedure.
更不用说 如果问题不是这个肿块造成的
Not to mention, it won't do a thing for Carl
这个手术就没有任何作用
if the mass isn't the issue.
如果问题不是这个肿块造成的
If the mass isn't the problem,
那我们究竟要找什么
then what are we looking at?
卡尔的症状已经持续多年
Carl's been suffering for years.
这个肿块可能一直都在 从未改变
The mass could have been there the whole time, unchanged,
这意味着它可能不是腹痛的因素
which means it's likely not a factor.
也有可能这个肿块一直在慢慢长大
Or the mass has been growing over time.
我们不管的话 如果炎症恶化
We leave it in, the inflammation worsens,
直肠就会完全阻塞
the bowel completely obstructs,
然后穿孔 卡尔就会得败血症
then perforates, and Carl becomes septic.
这种潜在致命威胁的初始症状就是
The first step of that potentially fatal catastrophe
发烧 这个症状
is a fever, which,
看他的样子 已经出现了
by the looks of him, has set in.
38度多了 但体温没再升高
100.6, but holding.
没错 这只是暂时的
Yeah, for now.
如果你给他的胰腺做了手术 然后发现错了
You operate on his pancreas and you're wrong,
造成的坏处远远大于好处
it does way more harm than good.
但如果我对了 他会活下去
But if I'm correct, he lives.
我不喜欢如果
And I don't like ifs.
在卡尔以前的扫描结果
Carl will be treated medicinally until
送到今天的核磁共振结果进行对比之前
his previous scans arrive and I can compare them
他只能接受药物治疗
against today's MRI.
问题就出在这
Uh, that's gonna be a problem.
他在韦斯特伍德地区医院的医疗记录
His medical records from Westwood Regional
被劫持了
are being held hostage.
真是一团糟
This is a mess.
你知道 韦斯特伍德地区医院破产了
You know, Westwood Regional's bankruptcy
跟他们打官司就相当于多方混战
has created the legal equivalent of a battle royale.
医疗记录服务部
MRS... Medical Record Services.
我觉得他们应该掌控着韦斯特伍德的病人病历
I'm assuming they control Westwood's patient charts?
没错 就是医疗记录服务部把文件封锁了
Correct, it's MRS that have the files on lockdown.
实际上他们还威胁要毁掉它们
They're actually threatening to destroy them.
我目前关注的焦点还是卡尔
My main concern right now is Carl
我的想法还是没变
and my opinion has not changed.
他的远端胰腺损坏严重 需要切除
His distal pancreas is wreaking havoc and it needs to come out.
没有卡尔以前的扫描结果 很明显我们
Without Carl's previous scans, which it's clear
拿不到了 你无法证明这种治疗方案是对的
we're not gonna get, you can't prove that's the fix.
-对 我证明不了 -那你就不该做手术
- No, I cannot. - Then you shouldn't operate.
胰脏是身体里最无情的器官
The pancreas is the most unforgiving organ in the body.
手术并发症的可能性
The potential for surgical complications
非常高
is through the roof.
没错 但上帝给了我这么多次心跳
True, but God only gave us so many heartbeats.
卡尔的心跳不可能这么快就跳完了
No sense in Carl running out of his early.
抱歉 这里还发生了什么
Uh, excuse me, is there something going on
应该让我知道的事吗
here that I should know about?
据我所知没有 崔医生
Nothing I'm aware of. Dr. Choi?
那说说你们的建议
Then give me recommendations.
让我现在就做手术
Let me operate now
趁他直肠还没穿孔 现在已经太晚了
before his bowel perforates and it's too late.
古德温女士 这个手术风险很大
Ms. Goodwin, it's a risky procedure
而且有可能是没必要的
that may be unnecessary.
让我对卡尔再做些检测
Let me admit Carl for more tests.
很抱歉 化验室用的时间比我预料的久
Hi, I'm sorry, the lab took longer than expected.
所以卢卡斯的尿素氮 肌酸酐
So Lucas's BUN, creatinine,
白细胞数量升高了
and white cell count are all elevated.
这意味着脱水
That suggests dehydration.
鉴于白细胞增长 持续性咳嗽
And between the white cell count, his persistent cough,
以及鼻后滴注
and the post-nasal drip,
大概率是细菌性鼻窦炎
it's likely a bacterial sinus infection.
好的 谢谢 曼宁医生
Okay. Thanks, Dr. Manning. Yeah.
所以你怎么想
So what do you think?
我们可以用椰汁水做些冰棒
We could make popsicles from coconut water.
那应该对治疗脱水有好处
That should help with the dehydration.
还可以在里边加点草药抗组胺剂
Yeah, maybe add an herbal antihistamine, too
我可以在农贸市场买♥♥些
I can pick up some powdered quercetin
槲皮素粉
at the farmer's market.
好的
Great.
抱歉 也许更直接的治疗
I'm sorry, perhaps a more immediate treatment...
你是说抗生素吗 不 不可能再有下一次
You mean antibiotics? No, not after last time.
去年卢卡斯耳部感染
Lucas had an ear infection last year.
医生开了阿莫西林
The doctor prescribed amoxicillin.
只服了一剂 他就全身起麻疹
One dose and he broke out in hives everywhere.
他从抗生素中恢复的情况
I mean, his recovery from the antibiotic was
可比耳部感染糟糕多了
worse than the ear infection.
从那以后 只要有无副作用的
And since then, if there are natural options
自然措施 我们都会先尝试
without side effects, we try those first.
和你们一样
Look, like you two,
我儿子的健康对我来说是最重要的
my son's health comes before anything else.
但是 有时候有些病
But, you know, sometimes there's just some things that
仅靠整体性疗法是无法治愈的
a holistic approach alone won't cure.
我们同意
We agree.
但是鼻窦炎不其中
A sinus infection isn't one of them, though.
你是对的 时间长了 自然疗法
You're right. Over time, natural remedies
可能会协助他的免疫系统解决感染
may help his immune system resolve the infection,
但是现在脱水...
but the dehydration...
卢卡斯需要的不只是冰棒
Lucas needs more than popsicles.
至少让我给他喝点电解质饮料
At least let me give him an electrolyte drink.
喝多少
How much?
一天24盎司
24 ounces to sip throughout the day.
用吸管杯喝24盎司
24 ounces through a sippy cup?
他才不会喝
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