芝加哥急救

Chicago Med S05E18

Part 5 June 22, 2020, 10:19 a.m.

Here we go, Nick.
乔伊你的癫痫是由
Joy, your seizure was caused
血液中氨含量过高引起的
by high levels of ammonia in your blood.
她血液里怎么会有氨
How'd she get ammonia in her blood?
测试显示乔伊有尿素循环障碍
Testing revealed Joy has a urea cycle disorder.
这是一种遗传疾病
It's a genetic condition
会导致血液中缺失
that causes a deficiency in one of the six enzymes
清除氨的六种酶中的一种
responsible for removing ammonia from the bloodstream.
但如果是遗传的为什么我小时候诊断不出
But if it's genetic, why was I never diagnosed as a child?
症状较轻的患者
With milder forms of the disorder,
通常在被诱因触发时才会被诊断出来
often undiagnosed until a trigger unmasks it.
比如分娩
Such as childbirth--
另一个可能的诱因是
Another possible trigger can be
蛋白质摄入量急剧增加
a dramatic increase in protein intake.
可能是你在新的饮食计划中摄入太多蛋白质吗
Could you be taking in more protein with your new diet?
没有
Not really.
实际上我还去掉了红肉和大部分奶制品
I actually cut out red meat and most dairy.
那蛋白质棒或奶昔呢
What about protein bars or shakes?
没有我喝绿色奶昔
No. I drink green smoothies.
别管诱因你们要怎么治疗
Triggers aside, how do you treat it?
你的后半辈子都得
Well, you're going to have to be on an enzyme supplement
服用酶补充剂
for the rest of your life,
而且饮食中只能摄入非常低的蛋白质
and maintain a very low protein diet.
我们可以做到对吗宝贝
We can manage that. Right, babe?
是的
Yeah.
乔伊你得明白
Joy, just so you understand,
如果你不控制蛋白质摄入
if you don't regulate your protein intake,
会有很严重的后果
there can be serious consequences.
-明白 -即使是一点点高蛋白的食物
- Understood. - Now, even a few high protein meals--
我说我明白崔医生
I said I understand, Dr. Choi.
怎么你看我胖所以觉得我没有自♥制♥力吗
What, do you think because I'm fat I have no self-control?
没有完全没有
No. Not at all.
-我只是说如果蛋白质是诱因 -是的
- I'm just suggesting if protein is the trigger-- - Yeah,
我刚才跟你说了不是
and I just told you that it wasn't.
崔医生可以出来说几句话吗
Dr. Choi, may I speak with you outside, please?
不好意思
Excuse us.
-怎么了 -你对乔伊过于疑心了
- What? - You're so suspicious of Joy.
我不禁怀疑你是不是在借题发挥
I can't help but wonder if you're projecting.
我没有借题发挥
I'm not projecting anything.
唯一说得通的诱因就是蛋白质
The only trigger that makes sense is protein.
所以她要么在吃的东西上撒谎了
So she's either lying about what she's eating,
要么就是拒绝接受现实
or she's in denial.
非常对不起我没有接到你的电♥话♥
I am so sorry I missed your calls.
我们经理不允许我们
My manager doesn't allow us
工作时查看信息
to check our messageswhile we're working.
不应该发生这种事
This should never have happened.
我们知道奥吉已经错过了
We know that Auggie has missed
最近两次的就医预约
his last two doctor's appointments.
我真的很抱歉
And I'm really sorry about that.
我我尽最大的努力送他去诊所
I--I do my best to get him there,
但诊所离我家六十多公里远
but the clinic's 40 miles from my house.
我我没有车而且我不能经常早退
I--I don't have a car, and I can't always get off of work.
还有其他人可以帮忙吗
Is there someone else that could help out?
或许找个保姆带他去
Maybe a babysitter that could take him?
谁来付钱呢
Who's gonna pay for that?
琼森女士我们本该报告这起疏忽事件
Ms. Johnson, we're supposed to report this as neglect.
但这样的话他们可能会把奥吉从你家带走
But if we do that, they might remove Auggie from your home.
-也许你们应该报告 -什么
- Maybe you should. - What?
也许你们应该报告上去
Maybe you should report it.
我爱那个小男孩
I love that little boy.
我爱他但是...
I love him, but...
但是负担太重了
But it's too much.
负担太重了
It's too much.
我撑不下去了
And I can't.
艾莉丝
Alice.
他很好艾莉丝真的很好
He did well, Alice. Real well.
你很快就可以去康复室去看他
You can visit him in the recovery room shortly.
谢天谢地
Oh, thank God.
现在是什么情况
So, what happens now?
伊芙琳的家人要带她回家接受临终关怀
Evelyn's family is gonna take her home to receive hospice care
直到她去世
until she dies.
我今天不是想证明你错了
I wasn't trying to prove you wrong today,
如果你是这么想的话
if that's what you're thinking.
威尔我从来不觉得你是个心怀恶意的人
Will, I never thought of you as a spiteful person.
但当我们面对自己不想听到的事情时
But we all have a tendency to put blinders on
我们都会倾向于视而不见
when we're confronted with things that we don't wanna hear.
所以我们觉得你最好
That's why we thought it would be better
和另一个家庭一起生活
for you go live with another family.
因为她不能在你每次需要看医生时带你过去
Since she can't always take you to the doctor when you need it.
她不想让你再难受奥吉
She doesn't want you to get sick again, Auggie.
我知道去新的地方生活很可怕
I know it's scary going to live somewhere new.
我不害怕
I'm not scared.
我知道她为什么不想要我
I know why she doesn't want me.
亲爱的不是她不想要你
Oh, sweetie, it's not that she doesn't want you.
-她只是 -没人愿意要一个生病的孩子
- She just-- - No one wants a sick kid.
麦克斯我知道乔伊想出院
Max, I know Joy wants to be discharged,
但这个饮食计划她能坚持下去吗
but this meal plan she's on, is she adhering to it?
能
Yeah.
因为她的检查结果
Because her tests results
和她所说的并不相符
and what she's saying, they don't add up.
麦克斯
Max...
好吧
Okay, um...
我知道是什么情况
I have an idea of what's going on.
有时我半夜醒过来
Sometimes I wake up in the middle of the night,
听见乔伊在楼下厨房♥
and I hear Joy downstairs in the kitchen.
第二天早上冰箱和食物储藏室里的食物
And in the morning, there's food missing
就会少
from the fridge and the pantry.
你跟她谈过这件事吗
Have you ever talked to her about it?
没有我猜她是真的不好意思
No, I'm guessing she's real self-conscious.
所以才会在我睡着后这么做
That's why she does it after I'm asleep.
是的
Yeah.
她听上去像是得了暴食症
Sounds like she may have a binge-eating disorder.
我建议让精神科介入和她谈话
I like to bring in psychiatry to come speak with her.
不行
No.
我了解她揭穿她只会让她觉得难堪
I know her, and an ambush will just humiliate her.
这件事必须立刻解决
This has to be dealt with now.
如果她再过度摄入蛋白质可能就没命了
If she overloads on protein again, it could kill her.
上帝
God.
这样吧我可以让你和乔伊先谈谈
Tell you what. I'll let you speak with Joy first.
加油
Come on.
我做不到
I can't do this.
乔伊并没有在夜间暴食
Joy doesn't binge in the middle of the night.
是我一直在她的节食奶昔里掺蛋白粉
I've been slipping protein powder in her green smoothies.
为什么
Why?
我听说蛋白粉能让人增重
I read protein powder can make you gain weight
因为它能提高热量摄入
by increasing your overall caloric--
你为什么要试着让乔伊增重
Why were you trying to make Joy gain weight?
我没想让她增重
I wasn't trying to make her gain weight,
我只是想让她别再减肥了
I was trying to keep her from losing weight.
-我知道这听上去很疯狂 -这是犯罪
- I know it sounds insane. - And criminal.
我不会一直这样做的
I wasn't gonna do it forever.
只要等到她灰心丧气
Just long enough for--for her to get discouraged
放弃节食的那一刻
and stop dieting.
我从来没想过要伤害她
And I never meant to hurt her.
我害怕如果乔伊减肥成功
I was scared that if Joy lost weight,
就会离开我
she'd leave me.
你必须告诉乔伊真♥相♥ 否则我来说
You need to tell Joy the truth or I will.
艾莉丝和我在讨论医生
So Alice and I were talking, Doc,
虽然我们非常愿意
and while we really would like
以您的名义给我们的儿子取名
to name our son in your honor...
可还没想好要不要叫克罗特