芝加哥急救

Chicago Med S05E18

Part 3 June 22, 2020, 10:19 a.m.

All right. Thanks.
伊森听着我...
Hey Ethan, listen, man, I...
怎么样
How'd it go?
伊芙琳绝对没有决策能力
Evelyn definitely does not have decisional capacity.
她不能理解提出的治疗方案
I mean, she didn't understand the treatment being offered
甚至根本都不明白她的肾脏
or even that she had an issue with her kidneys
出了问题
in the first place.
她看着抑郁吗有自杀倾向吗
Did she seem depressed? Suicidal?
不我看没有
No, I wouldn't say that.
那她仍然有活下去的意愿
So, she still possesses the will to live.
她只是无法清楚地表达而已
She just can't articulate it clearly.
不过她头脑清楚的时候
Well, except that when she was of sound mind,
她以书面形式向她丈夫明确表示...
she made it very clear in writing and to her husband--
可反过来她好像对他很有戒心
Who she seems highly suspicious of, by the way.
这不罕见
That's not uncommon.
主要的照顾人
I mean, it's often the primary caregivers
在这种情况下往往会成为妄想症的主要目标
that get the brunt of the paranoia in situations like this.
我... 我也不知道
Well, I--I don't know.
那也许需要召集道德委员会的人开个会吧
Maybe it's worth convening an ethics committee then?
道德委员会
An ethics committee?
多方听取意见啊
Yeah, just get some other perspectives.
威尔我觉得没必要
Will, I don't think that's necessary.
我给她做了很全面的评估
I gave her a very thorough evaluation.
对我的判断我很有把握
I'm confident in my assessment.
可到头来这还是主观的
Yeah, but ultimately, it is subjective.
-你的意见... -说得对
- Your opinion-- - That's right.
我的专业意见基于...
My professional opinion, which is based on--
数十年经验的意见我知道
Decades of experience. I know.
没错数十年的经验
That's right. Decades of experience.
回见
I'll see ya.
为什么是这个样子的
Why does it look like that?
腹水肿
Ascites.
腹腔里有积液
Fluid accumulates in the peritoneal cavity.
肝硬化的病人是有可能这样的
Can happen in patients with cirrhosis.
今早你告诉露丝你的肚子疼了吗
Did you tell Ruth that your belly was hurting this morning?
校车来之前她就去上班了
She goes to work before the school bus comes.
奥吉我要做一个叫穿刺术的处理
Auggie, I'm going to need to do a procedure called paracentesis.
我要插一根针到...
What I'll do is I'll insert a needle--
一根针到我的肚子里把坏东西都排出来
A needle into my tummy to get all the bad stuff out.
没那么可怕坎普尔先生就是听着吓人
It's not so bad, Mr. Campbell. Just sounds scary.
我会用机器人来对腹部的部分
So I'll be performing the abdominal portion
进行手术
of the surgery robotically,
卡斯塔涅达医生则从下面会用内窥镜做
while Dr. Castaneda works endoscopically from below.
曼宁医生来得正好
Dr. Manning. Perfect timing.
早上好马塞尔医生机器人和内窥镜
Good morning, Dr. Marcel. Robots and endoscopes?
不像是做结肠造口术啊
Doesn't sound like a colostomy.
尼克艾莉丝和我刚在讨论这个
Yeah, Nick and Alice and I were discussing it
我们要换一种不同的方式
and we're gonna take a different approach.
经肛♥门♥全直肠系膜切除术
Transanal Total Mesorectal Excision.
TaTME
TaTME.
抱歉请见谅我对这手术方式不熟
I'm sorry, forgive me. I'm not familiar with it.
我知道结肠全系膜切除这可是大手术
I am aware of TME, which is a major surgery.
对我介绍的是一种新的手术方式
Right, well, this is a new approach
可以在切除直肠下段肿瘤时
that allows for better visualization
提供更好的视野和切除效果
and removal of tumors in the lower rectum.
我相信你已经把手术风险
Well, I'm sure you've explained the risks
向尼克和艾莉丝解释过了
to Nick and Alice.
我当然解释了有事吗
I sure have. Yeah?
我们准备好把埃姆斯先生送去楼上手术了
We're ready to move Mr. Elms upstairs.
很好
Great. All right.
那我们几个小时后再见
So I'll see you in a couple hours.
-谢谢你马塞尔医生 -没事
- Thanks. Dr. Marcel. - All right.
艾莉丝回见
Alice, I'll see you.
-克罗特 -怎么
- Crockett. - Yeah?
你为什么向一个终末期癌症患者
Why would you suggest a radical surgery
建议根治性的手术
for a terminal patient?
就算手术能成功
Even if it's successful,
这能挽救他生命的可能性也很小
it is highly unlikely it's gonna save his life.
但这能让他活久一点
But it could buy him more time
而且有更高质量的生活
and a better quality of life.
前提是他不死在手术台上
Yeah, if he doesn't die on the table,
考虑到他的心脏问题这风险可不小
which is a real risk, given his heart problems.
我也没想过要掩饰这种风险
And I didn't sugarcoat that risk.
他看过了很多外科医生
He has seen many surgeons,
没人给过他这样的选择
and none of them have put this option on the table.
对因为他们几乎都是胆小鬼
Yeah, 'cause most of them are gutless,
迷恋于自己的手术成功数据
obsessed with their stats.
你说他们胆小鬼我说这叫务实
Okay, you say gutless. I'd say pragmatic.
我看我们这是越吵越向着抠字眼去了
I see us edging towards a semantics debate.
我可知道这是我的短板
I know when I'm out of my depth.
你为什么不能和我一起住呢
Why don't you just stay with me?
不用公♥司♥安排我住在半岛酒店
No, the company's putting me up at the Peninsula.
真下本钱他们肯定是很想要你这个人
Ooh, fancy! They must really want you.
所以我得问问老爸那些胡说八道的话了
So I gotta ask about this nonsense Dad was talking.
他说的不是真的对吧
It's not for real, right?
等等你真的要考虑和他破镜重圆吗
Wait, you're not seriously considering taking Dad back?
迈克尔
Michael.
他他抛下了一段36年的婚姻
He -- he walked out after 35 years of marriage.
离婚协议几乎纸墨未干
Ink was barely dry on the divorce papers
他就已经另寻新欢了
when he started seeing someone else.
你♥爸♥爸和我小酌了一杯
Your father and I had a drink.
也许他对此过度解读了
Maybe he read more into it.
所以你们没在交往什么的吧
So you're not dating or anything?
没有
No.
我就知道他是满口瞎说
I figured he was full of it.
所以我们共进晚餐的计划照旧
So are we still on for dinner?
定了今晚七点斯威夫特和桑斯牛排店的座
I got us a reservation at Swift & Sons for seven.
不不不那家店太贵了
No, no, no! That's too expensive!
我的妈妈就得吃最好的店
Only the best for my mom!
再说这顿饭是公♥司♥买♥♥单
And the company's paying for it.
你今晚忙吗
Hey, are you busy tonight?
附近新开了一家泰餐店
This new Thai place opened up in the neighborhood.
-要去尝尝吗 -去尝尝吧
- Wanna give it a whirl? - Let's give it a whirl.
七点左右
Seven-ish?
我没问题
Works for me.
崔医生有情况
Dr. Choi, something's wrong!
打5毫克安定
5 of Ativan.
乔伊之前有过癫痫发作吗
Has Joy ever had a seizure before?
没有从来没有过
No. Never.
乔伊亲爱的
Joy? Babe?
我记得你说她检查结果都正常的
Well, I thought you said all her labs were normal.
-确实正常 -药打进去了
- They were. - Meds are in.
所以这像是她对你们给的药物
Well, so, is this like an allergic reaction
产生了过敏反应吗
to something you gave her?
我们只用过布洛芬她之前吃过也没事
We only gave her ibuprofen, and she's had that before.
"经肛直肠全系膜切除术
"TaTME,
直肠癌创新手术方式"
Innovative Surgery for Rectal Cancer,"
论文由马塞尔·克罗特博士合著
co-authored by Crockett Marcel, M.D.
你是在网上跟踪我吗曼宁
Oh, you internet stalking me, Manning?
别自作多情了
Don't flatter yourself.
我是在研究这个手术方式的时候查到的
I found it when I was researching the procedure.
你研究研究也挺好
Good for you.
你在医学院的科研年就是学习这种手术
You spent your lab-year studying the technique.
你的外科实习也是
You did your fellowship in the surgical center
在那家帮着推广手术的外科中心完成
that helped pioneer it.
这让我怎么说呢
Which makes me, what?
很有资格去做这类手术
Highly qualified to perform the procedure?
不这会让你为了职业发展
No, it makes you biased
而心存偏见另有动机
and motivated by professional advancement.
你只看到了你想看到的失陪了
You see what you want to see. Excuse me.
你这是冒着让尼克