芝加哥急救

Chicago Med S06E01

Part 4 Nov. 13, 2020, 11 a.m.

好的我去问克罗特
All right. I'll ask Crockett.
等一下
You know what? Wait.
别叫克罗特问问其他还有谁在吧
Don't page Crockett. Just page whoever's on call.
记得交给他
Make sure he gets that.
为什么不叫克罗特
Why not Crockett?
没什么
Oh, it's nothing.
我需要一次会诊
I just--I need a consult.
我打算呼叫值班人员
And so I was gonna page the call person.
何必麻烦呢我现在有空
Why do that? I'm free.
好吧
Okay.
好的
Okay.
病人名叫凯丽·刘
Uh, the patient is Kellie Lieu.
十二岁患有白血病
She's 12. She's been battling leukemia.
她今天出现了由化疗引发的心力衰竭
She presented today with chemo-induced heart failure.
所以你不想叫我过来
Is that why you didn't wanna bring me in?
白血病儿童
Kid with leukemia.
因为我因为白血病失去了女儿
'Cause I lost my little girl?
我只是觉得这可能让你想起伤心事
I just thought maybe it was a little too close to home.
谢谢你
Thank you.
跟我说说病人的情况
Tell me about the patient.
脑钠肽2500 射血分数15%
BNPs 2500, ejection fraction 15%.
数据不太好
Bad numbers.
而且情况越来越糟
And it just gets worse.
她最近的一次血液涂片显示
Her latest blood smear shows an increase
她骨髓中的癌变细胞增加了
in elevated cells in her bone marrow.
-也就是说癌症复发了 -是的
- So the cancer's coming back? - Yeah.
把病理报告给我
Okay. Well, send me the chart.
就因为你刚才的举动
And what you just did,
所以我才不把我的过去告诉别人
that's why I don't tell people about my past.
白血病又复发了
The leukemia's gonna come back?
看起来是的
Yes. It seems like it is.
很抱歉刘先生
I'm so sorry, Mr. Lieu.
所以
So...
我们要重新开始化疗
we have to start chemo again.
还是要的
Eventually, yes.
但是现在凯丽的心脏承受不了
But right now, Kellie's heart's too damaged
化疗带来的损伤
for more chemo.
治疗心脏衰竭是目前的第一任务
Getting her heart in shape has to be her first priority.
好的
Yes. Okay.
我们该怎么做
How do we do that?
我们现在有两个选择
Well, there are two options.
首先我们可以
The first we talked about--
用毒性较低的药物
replace Kellie's current regimen
替换凯丽目前服用的药物
with one that's less toxic,
但我们需要额外增加米利酮
but in addition, we add Milrinone
来缓解她心脏的压力
to ease the strain on her heart.
但是我们不确定服用多久的药物才能见效
But we don't know how long that would take to work.
如果白血病在她的心脏
And if the cancer comes back
可以支撑化疗之前复发的话
before her heart is healthy for chemo,
我们就没有办法继续治疗了
we'd have no way to fight it.
你说还有第二种选择
You said there's a second option.
手术
Surgery.
安装左心室辅助装置
Implant an LVAD--
这是一种可以缓解凯丽心脏压力的辅助装置
an assist device that will take the pressure off Kellie's heart
可以让心脏更快恢复
so it can recover faster.
手术
Surgery.
我推荐这种方法
That would be my recommendation.
但是你必须知道手术是有风险的
But you have to know, it comes with risks.
凯丽目前处于免疫受损状态
Okay, Kellie is immunocompromised.
这可能会增加术后感染的风险
That increases the chance of post-op infection.
再加上疫情危险程度就更高了
And with COVID, the danger is even greater.
所以你不推荐手术
So you don't advise surgery?
我们也知道如何降低风险
Well, we've learned how to mitigate those risks.
但是左心室辅助装置很少用于儿童病例
Still, LVADs are rarely used in pediatric cases
因为这种装置只有成年人的尺寸
because they are tailored to fit adults.
那是因为很少有小孩子
That's because there aren't many kids
患上凯丽那么严重的心脏病
with Kellie's level of heart disease.
如果你们俩都意见不一
If you two don't agree,
我还怎么做决定
how can I make this decision?
刘先生我知道
Mr. Lieu, I know h--
我们知道这有多难但我
We know how difficult this is but I--
我觉得你们不知道
I don't think you do.
两年前我妻子去世
I lost my wife two years ago.
我没有她在身边帮我
She's not here to help me.
世界混乱不堪
The world is upside down.
昨天停车场有个女人
Yesterday, a woman in the parking lot
指着我们大骂
pointed at us and screamed,
"你们把新冠带到这里的是你们的错
"You brought COVID here. It's your fault.
哪来的回哪去"
Go back where you're from!"
我要担心我女儿的白血病
I have to worry about my daughter's leukemia,
和传染病
the pandemic.
现在还要担心受到袭击
And now that we could get attacked...
我该信任谁
Who do I trust?
对你的遭遇我表示很遗憾
I'm sorry this is happening to you.
我只在乎怎样做对凯丽最好
All I wanna do is what's best for Kellie.
最安全
The safest thing.
手术似乎不是最佳选择
And that doesn't sound like surgery.
-我们试试药物治疗 -好的
- We'll try the medication? - All right.
我打电♥话♥给你的肿瘤医生然后开始治疗
I'll call your oncologist, and we'll get started.
谢谢你
Thank you.
-什么 -你怎么了
- Yeah? - What's going on with you?
你什么时候变得这么保守了
When did you get so hyper-conservative?
我觉得他应该了解所有实情
I thought he should have all the facts.
我告诉你
Let me tell you something.
他女儿需要手术
You talked that man out of an operation
而你说服他放弃了
his little girl needs.
谢谢你
Thank you.
你在干什么
What are you doing?
拉尼克医生取消了麦克尼尔的体外膜肺氧合
Dr. Lanik cancelled Mr. MacNeal's ECMO.
你为什么取消
Why did you cancel it?
他一开始就不应该预订
Look--he shouldn't have ordered it in the first place.
不好意思他是我的病人
Excuse me. He's my patient.
我是急诊科主任
And I'm chief of the E.D.
我要调配资源
I have to allocate resources.
我们整个医院只有四台体外膜肺氧合机四台
We only have four ECMOs for the entire ward--four.
三台已经在使用
Three are already in use.
那就还剩一台给麦克尼尔先生
Which leaves one for Mr. MacNeal.
艾普尔我不能把最后一台耗在他身上
April, I can't tie up my last circuit on him.
特别是我们知道布克先生将会需要
Especially when we know Mr. Booker,
他还有一线生机
who still has a chance, is gonna need it.
你都不知道他是否一定需要
You don't know he's gonna need it for sure.
体外膜肺氧合是唯一
And ECMO's the only thing
能救麦克尼尔命的东西
that could possibly save Mr. MacNeal's life.
这个人将面临多器官功能衰竭
The man is gonna go into multi-organ failure.
过去六个月
Over the last six months,
我们多少次目睹这一幕
how many times have we seen this?
体外膜肺氧合不会改变结果
ECMO is not gonna change the outcome.
你不能说得这么绝对
You can't say that for sure.
你打算就这么放弃
You're just gonna give up?
我们已经竭尽全力了
We've done everything we could.
你想让我充当恶人吗
Look, you wanna make me the bad guy?
回去工作
Get in line.
-克罗特 -什么
- Hey, Crockett. - Yeah?
对她没事
Oh, yeah. She's doing fine.
她通过了自主呼吸试验
Aced her spontaneous breathing trial.
我刚给她拔管
I just extubated her.
-你可以进去 -好
- You can head in. - All right.
-我很抱歉 -没事的汉娜
- I'm so sorry. - It's all right, Hannah.
-没事的 -不是的
- It's all right. - No.
你信任我我让你失望了
No, you trusted me, and I let you down.