芝加哥急救

Chicago Med S01E16

Part 4 Jan. 25, 2020, 11:24 a.m.

可能不仅仅是过敏反应
could be more than an allergic reaction.
有人会马上来帮你做检查
Someone will be with you shortly.
保罗这屋子里还有别人吗
Paul, is there anyone else in the house?
不不只有我
No, no, it's just me.
你们快点
You've got to hurry!
伊森怎么了
Ethan, what happened?
你没事吧
Are you okay?
-这是什么 -显然想在芝加哥医院
- What's all this? - Well, it's pretty clear
谋得职位是不可能的事了
an attending job at Med isn't gonna happen.
你怎么知道
You don't know that.
事实而已
Just being realistic.
佩灵顿是招聘委员会的
Perrington's on the hiring committee.
她讨厌我
She hates me.
更别提古德温了
Not to mention Goodwin.
但你真的打算去迈阿密吗威尔
But really, Miami, Will?
你连从急诊室走到车里都会被晒伤
I've seen you sunburn walking from the ED to your car.
哪里有工作我就去哪里
Hey, got to go where the jobs are.
不能带咖啡出去健康护理措施鉴定日
No coffee. JCAHO day.
对
Right.
我不明白
I don't understand.
脑白质中应该出现萎缩
There should be atrophy, heavy degeneration,
严重变形细胞纠缠
tangled cells in the white matter.
这是什么时候做的
When was this taken?
一小时之前
About an hour ago.
抱歉这是我的直觉
I'm sorry. I had a hunch.
就擅自做了我真的...
I rushed it. I really should have--
那是一个健康的大脑
That is a healthy brain.
没有疾病这说明...
There's no disease. This means that--
内森没患上路易体痴呆症
Nathan doesn't have Lewy Body Dementia.
他表现出这种症状了
He has the symptoms.
病情越来越严重简直就是典型病例
Keeps getting worse. Practically a textbook case.
怎么会
How?
看一下之前核磁共振时拍的剖面图
Take a look at this cross section we took during the MRI.
注意那个腺瘤
Notice the adenoma,
甲状旁腺上的良性瘤
benign tumor, in the parathyroid gland.
你觉得这是激素失调吗
So you think this is all hormonal irregularity?
甲状旁腺激素升高
Elevated parathyroid hormone
会出现钙水平增加
is consistent with increased calcium
以及认知障碍的症状内森都具备了
and cognitive impairment. Nathan has both.
是但他还出现幻觉
Yes, but he also has hallucinations,
攻击行为甲状旁腺功能亢进患者
physical aggression. You don't see that
不会出现这样症状
in patients with hyperparathyroidism.
这是他最近做的心脏搭桥手术引起的
That's where his recent bypass surgery makes him unique, okay?
他术后一直服用的乙型阻滞药
The beta blocker he's been taking ever since
导致了不少此类患者
causes increased levels of violent behavior
出现暴♥力♥行为
in a select amount of patients.
天呐
Oh, my God.
激素失衡
A hormonal imbalance
加上药物副作用
with a medication side effect.
我怎么就没看出来
Why didn't I see that?
这些迹象就发生在我眼前
The clues were right in front of me.
因为这些症状
Because they mimic the symptoms
跟路易体痴呆症十分相似
of Lewy Body Dementia to a T,
而且四年前腺瘤肯定很小
and four years ago that adenoma would have been so small
扫描检测不出来
no scan could have caught it.
听着我就想说
Look, I'm just telling you
鉴于这些症状
that presented with the same evidence,
我也会像你那么做
I would have done exactly the same thing,
做出一样的诊断
reached exactly the same diagnosis.
大家都会的
Anybody would have.
你没有
You didn't.
我做了
I did.
如果我四年前诊断出是甲状旁腺功能亢进
And if I had caught the PTH four years ago,
内森就不会冲上大马路
Nathan doesn't run into traffic,
不会被车撞
doesn't get hit by a car.
就不会发生今天的事了
Today never happens.
他快死了
He's dying
这都是我的错
and it's entirely my fault.
救命啊快来救我了
Help. Please, please anybody!
救命啊
I need help!
伊森
Ethan.
伊森说话
Ethan, talk to me.
伊森你听到了吗
Ethan, do you copy?
我们走
Let's go.
客厅安全
Living room's clear.
-谢天谢地 -保罗
- Thank God. - Paul?
-快救我 -保罗我是崔医生
- Help me, please. - Paul, I'm Dr. Choi.
你心跳剧烈
Okay, your heart's racing.
你上次喝水是什么时候
When's the last time you had any fluids?
我腿烫伤了
My leg, burned it.
-看到了 -不要碰那个
- I see that. - Don't touch that.
-怎么烫伤的 -我当时在做饭
- How did this happen? - I was cooking.
我脚一滑锅里的油洒下来了
I tripped and spilled a frying pan, grease.
这不是刚烫的
This didn't just happen.
伤口已经发硬结疤了
This burn is thick, leathery.
有一天了吧
24 hours old?
你怎么不早点找人帮忙
Why didn't you seek help sooner?
我不想让大家知道我的生活方式
I didn't want anybody to see how I live.
好吧我来了
Okay, I'm here now.
我会医治的
Gonna take care of you.
近距离放射治疗源
Brachytherapy seed.
是的不常发生
Yep, doesn't happen often,
但能通过尿液排出
but it can get expelled in the urine.
辐射强度多少
So, um, how radioactive is it?
对人类无害
To us, harmless.
但还是不要用手去碰
Still, don't touch it with your bare hands.
你不打算处理掉吗
So you're not gonna dispose of it?
坚定日我肯定不干啊
Not on JCAHO day.
抱歉
Sorry.
联♥系♥辐射安全管♥理♥员♥吧
Call the Radiation Safety Officer.
天呐
Oh, man.
好吧
Here we go.
我懂
I get it.
内森的搭桥手术不是你做的
You didn't do Nathan's bypass surgery.
你不知道要处理什么情况
You don't know what you're walking into.
我可以把他拍过的血管成像都拿给你
I can get you every angio he had.
你会了解那个医生缝线的具体♥位♥置
You will know exactly where the surgeon placed every suture.
这里更重要的问题是
The bigger issues are the adhesions
已经成型五年的黏连和疤痕组织
and scar tissue that have formed over the last five years.
一颗健康的心脏 10到15分钟就能开胸
We can expose a healthy heart in 10 or 15 minutes.
对于心脏四处搭桥的患者
After a quadruple bypass surgery,
会耗费数小时
it could take hours.
还可能引起无数并发症
An infinite number of complications can arise.
我决定让内森免遭罪时
When I decided to make Nathan comfortable,
我以为他神经系统有问题没救了
I believed he had a neurological death sentence.
现在情况完全改变了
Now it's a whole new world.
痴呆症可以消除
The dementia can be reversed.
我明白但他没患上路易体痴呆症
I understand, but the fact that he doesn't have LBD
不代表手术就会变容易
doesn't make the surgery any easier.
内森死在手术台上的几率
Nathan's odds of dying in that operating room
还是跟以前一样高
are just as high as they ever were.
我还是不建议手术
It's still my recommendation to not operate.
很遗憾
I'm sorry.
我来手术
I'll do the surgery.
谢谢你
Thank you.
谢谢给我们一个重来的机会
Thank you for giving us a second chance.
困难而已并非不可能
Difficult is not impossible.
布莱特你还有多远
Brett, how close are you?
伊森终于联♥系♥上了你没事吧
Ugh, Ethan, finally. You okay?
我没事但保罗的皮肤呈三度烫伤
I'm fine, but Paul's got a serious third degree burn