芝加哥急救

Chicago Med S05E19

Part 4 June 22, 2020, 10:19 a.m.

就是你跟我们说的那些
Like you told us.
对那里有...
Yeah, there was--
那里有个家伙在大喊大叫
there was this guy who was yelling
像疯了似的
and acting crazy.
好
Right.
然后他开始推我
And, uh, he started shoving me,
我想躲开他
and I tried to get out of the way,
但他还是一直推我
but he--he wouldn't stop, and...
不知不觉我就失去了平衡
before I knew it, I--I lost my balance.
好
All right.
那
Well, um...
扎克今天挺不容易的
you know, Zach's been through a lot today.
有人问过他想吃东西吗
Has anybody asked him if he wants anything to eat?
-没有 -没有吗
- No. - No?
你饿吗伙计
Are you hungry, buddy?
来个三明治如何
How about a sandwich?
-火鸡三明治吧 -好
- Maybe--maybe turkey. - Okay.
我们何不去给他买♥♥个三明治
Um, why don't we get going on that?
等我们回来的时候
And then when we get back,
也许可以多聊一会好吗
maybe we can talk a little bit more, okay?
很高兴认识你扎克
Nice to meet you, Zach.
谢谢
Thank you.
你知道是他父母引导他那样说的
You know his parents coached him to say that.
他们是担心他被抓吗
Are they worried he's gonna get arrested?
也许吧
Probably.
听着就算扎克不承认他是自己跳下去的
Look, even if Zach won't admit he jumped,
我们为了他好还是可以让他
we gotta put him on a psych hold
留院精神观察
for his own good.
强制留院吗
Forced hold?
让未成年人离开他的父母是
Taking a minor away from his parents
很不容易的你明白吗
is a very high bar to clear, you know?
更重要的是除非你得到全家人的支持
More importantly, it doesn't really tend to work
否则很可能没有什么好结果
unless you get buy-in from the whole family.
我们不能让一个有自杀倾向的孩子离开这里
We can't let a suicidal kid walk out of here.
我听到了
I hear you.
听着我们先看看火鸡三明治的效果好吗
Look, let's see what a turkey sandwich gets us, okay?
妈妈喜欢看到自己的孩子吃饱
Moms love to see their kids get fed.
她的宫颈无法承受不断长大的胚胎的重量
Her cervix isn't handling the weight of the growing fetus
已经开始扩张了
and is starting to open up.
她的宫颈已经扩张了一厘米
She's already dilated one centimeter.
那她会失去这个胎儿
Then she's going to lose the pregnancy.
不一定
Maybe not.
我想试着给她用黄体酮
I'd like to try her on progesterone,
看看我们是否能阻止她的宫颈继续扩张
see if we can stop her from dilating any farther.
等等这样安全吗
Wait, is that safe?
毕竟她感染和出血的风险相比常人要高
I mean, giving her increased chance of infection and bleeding?
这是特殊情况
This is a unique situation,
因为她时间有限
due to her limited time frame.
这个胎儿对她来说非常重要
This pregnancy is very important to her.
我想尽力保住它
I'd like to try and save it.
那好吧谢谢
Okay, then. Thanks.
霍斯特德医生我读过关于
Dr. Halstead, I've read the literature
宫颈机能不全伴随出血的
on cervical insufficiency with bleeding
高危病人的论文
in high-risk patients,
试图干预并不是标准疗法
and trying to intervene is not the standard of care.
艾什医生是专家
Dr. Asher is the specialist.
我信任她
I trust her.
但她以前嗑药
She's had a drug problem.
这是两码事
That is irrelevant.
你管得太多了库里女士
You're way out of line, Ms. Curry.
他感冒了
He's cold.
还有点喘不过气
And he's getting a little short of breath.
介入科为什么这么久还不带他下去
What's taking IR so long to
做经颈静脉肝内门体分流术
get him down for his TIPS?
他们总是很忙我给他们打电♥话♥
They're always backed up. I'll give them a call.
等等手术安排上根本没有他
Wait, he's not even on the schedule.
什么
What?
我一小时之前就预约了
I put the order in an hour ago.
上面说他被儿家部拒绝了
Uh-uh, it says he's been denied by DCFS.
-他们可以这么做吗 -我不知道
- Can they do that? - I don't know.
走
Come on.
玛德琳
Madeline--
如果是关于奥吉的事很抱歉
If this is about Auggie, I'm sorry.
在克莱默夫妇得到最终许可之前
But until the Kramers get final approval,
奥吉的法定监护人还是州政♥府♥
the state is still Auggie's legal guardian.
他的病情恶化了他需要手术
He's getting worse. He needs this.
根据伊利诺伊的医疗服务规定
According to the Illinois health service protocols,
只有在前两种治疗方法都失败的情况下
TIPS is only indicated
才能使用经颈静脉肝内门体分流术
if two other previous treatments fail.
这只是个指南
That's just a guideline.
病人情况各异
Every patient is different.
所以我已经把这个病例升级为
Which is why I've already escalated this
交给州政♥府♥指定的医生调解员来决定
to a physician mediator appointed by the state.
那得等好几天
That's gonna take days.
他现在就需要做
He needs this now!
听着他有脑病和腹膜炎的风险
Look, he's at risk for encephalopathy, peritonitis--
我知道
I understand--
玛德琳他需要有人替他说话
Madeline, he needs someone to advocate for him.
我已经尽力了
And I'm trying my best.
我也无能为力
There's nothing else I can do.
拉尼克医生你记得奥吉·罗伯茨吗
Dr. Lanik, do you remember Auggie Roberts?
收养的孩子当然
Foster kid. Sure.
他的情况更糟糕了
He's getting worse.
我在想你能不能写张字条
I was wondering, could you write a note
说他可以接受经颈静脉肝内门静脉分流术
saying that he'd do well to receive a TIPS procedure?
他在楼上让他的儿科医生写
Well, he's upstairs now. Get his pediatrician to do it.
她写了但有一些繁琐的程序要走
She did, but there's some red tape.
我在想如果我们有两个医生
I thought if we had a double doc,
我们就可以召集道德委员会我们可以
we could convene an ethics committee and we could--
所以我写的这张条是要跟委员会
Oh, so my quick note is turning into an afternoon
-打招呼是吗 -拉尼克医生
- in front of a committee? - Dr. Lanik--
麦基我有病人要去问诊
Maggie, I have patients to see.
候诊室里也满是病人等你去操作
And you have a waiting room full of them to process.
三厘米还在扩张
Three centimeters, you're still progressing.
我们现在该怎么办
So what do we do now?
我们可以试着增加孕酮
Well, we can try increasing the progesterone,
再给你点时间看看能不能扭转局面
give you a little more time to see if we can turn this around.
-我同意 -你确定吗
- I agree. - Are you sure?
我们等的时间越久
The longer we wait,
出现严重并发症的几率就越高
the greater the chance of a serious complication.
我觉得还没到那一步
I don't believe we're there yet.
你觉得我们应该怎么做
What do you think we should do?
终止妊娠
Terminate the pregnancy.
这个时候这是最安全的选择
At this point, it's the safest option.
什么不
What? No.
库里女士是一位医学生不是医生
Ms. Curry is a medical student, not a doctor.
我要生下这个孩子
I need to have this baby!
这样我丈夫就能有一个像我一样爱他的人
So my husband can have someone to love him as much as I do...
他也能一样爱这个孩子
and someone he can love.
如果这样的话
If I can have that...
我不介意为此而死
then I'm okay to die.
我们会给你加大药量等下再回来看你
We'll increase your meds and check back in a little bit.
你能别再盯着笔记本吗
You gonna get your nose out of that laptop?
对不起妈妈我有很多准备工作要做
I'm sorry, Mom. I just got so much prep to do.
问你一下莱瑟医生心胸科医生
Let me ask you, Dr. Latham, CT surgeon--
你知道他喜欢什么吗有没有爱好
you know if he's into anything, any hobbies?
不不知道我们之间不社交
No, not really. We don't socialize.
很多心胸科医生喜欢车
A lot of CT surgeons are into cars.
古董车赛车
You know, vintage, racing?
这个不太像莱瑟医生
Yeah, that doesn't sound like Dr. Latham.