芝加哥急救

Chicago Med S07E04

Part 3 Oct. 25, 2021, 3:53 p.m.

我是说，那些导管很贵，对吧？
I mean, those catheters are pretty pricey, right?
哦，对不起，我不是故意要说出来的
Oh, I'm sorry, I didn't mean to say that out loud.
不，我的意思是，这是个很公平的观点
No, I mean, it's a fair point.
你怎么看，霍斯特德医生？
What do you think, Dr. Halstead?
嗯，是或不是
Well, yes and no.
我是说，瓦西监视仪比别的
I mean, the 瓦西监视仪 is more expensive
设备更贵，但是考虑到它的
than other devices, but it's certainly
众多功能，它当然不是定价过高
not overpriced considering the multitude of functions
它有这个能力
it's capable of.
哦，好吧，我想说，它
Oh, yeah, I mean, it is
就是个瑞士军刀，这一点毫无疑问
a Swiss army knife, there's no doubt about that.
阿彻医生，那不是个坏东西
Dr. Archer, that's not a bad thing.
当然不是，但是它也不是必要的
Uh, no, but it's not necessary, either.
最后，瓦西监视仪看起来
At the end of the day, the 瓦西监视仪 just seems
就像是对现在的所有血液动力设备进行的
like a high-tech repackaging of all the hemodynamic devices
高科技的再包装
already out there.
我是说，为什么要把事情搞这么复杂
I mean, why complicate things
尤其是近些年中心静脉压设备
when info from central venous pressure's been working
一直运转良好？
perfectly well for decades?
至少，我是这么看的。
At least, that's, you know, that's how I see it, so.
嗯，我不敢苟同
Well, I disagree.
我会把你描述的中心静脉压监测器比作翻盖手♥机♥
I'd liken the CVP you're describing to a flip phone.
瓦西监视仪，是智能手♥机♥
The 瓦西监视仪 though, is the smart phone
我们都想拥有它
we all want in our pockets.
嗯，好吧，不是我们所有人
Yeah, well, not all of us.
我们中的一些人只想打个电♥话♥就行了，对吧
Some of us just want to make a phone call, right?
所以这个对我来说一直
And this has been working excellent
工作良好，仍然良好地运转
for me, still does.
不管怎么说，我是个老派的人
Anyway, I'm old school.
好吧，我找到水杯了，你们继续。
All right, I got my water, and I'll leave you to it.
阿什莉手臂的X光片。显示桡骨远端骨折
X-rays on Ashley's arm. Distal radius fracture.
我叫了矫形科
I paged Ortho--
他们会下来打石膏的
they're gonna come down and cast it.
这是她的CT吗？看看
Is that her CT? Take a look.
噢，天啊。病变
Oh, man. Lesions.
有四个。是的
Four. Yeah.
这个区域是一个切除腔
And this area here is a resection cavity.
周围组织显示放射性坏死
Surrounding tissue shows evidence of radiation necrosis.
所以这有一个肿瘤被切除了
So there was a tumor that was removed.
考虑到坏死的组织它一定是癌变的。
It must have been cancerous given the dead tissue.
间变性星形细胞瘤
Anaplastic astrocytoma.
我调出了阿什莉
I was able to pull up Ashley's medical records
2000年的医疗记录
dating back to 2000.
那时候一切才开始电子化
That's when everything started going digital.
诊断是在那之前的某个时间做出的
Diagnosis was made sometime before that.
是的，自2000年以来
Yes, since 2000,
已经复发了三次
there have been three recurrences.
这些病变的活检结果都是阴性的。
Appears biopsies on those lesions, though, were all negative.
都是良性的，但只有三次复发？
So all benign, but only three recurrences?
我在CT上数到了四个病变
I'm counting four here on her CT.
是的，有一处新的病变。癌症可能复发了
Yeah, there's a new lesion. The cancer may be back.
所以我认为他的药物的不良反应
So I'm thinking an adverse reaction to his meds
肯定和他今天早上的发病有很大关系
definitely had a lot to do with his episode this morning.
是，我也倾向于这个结论
Yeah, I was leaning that way too.
我带他进来的时候发现他的肌肉有些痉挛
I noticed some spastic muscle contractions when I brought him in.
是啊，他还很难
Yeah, he's also having a hard time
在嘴里控制他的舌头
controlling his tongue inside his mouth.
这两种都是过度用药的症状
Both of those things, you know, symptoms of overmedication.
我只是觉得他的药剂量太高了
I just think his dose is too high.
他现在要下来。是啊
He's coming down now, though. Oh, yeah.
给他一些安定和苯海拉明让他休息
Gave him some Ativan and some Benadryl so he can rest.
我还需要在评估一下
I'm gonna reassess in a bit.
你知道，在我还是个菜鸟警♥察♥的时候我就认识这家人了
You know, I've known the family since I was a rookie cop.
罗兰总是一个阳光的孩子
Roland's always been a bright kid
但是他害羞又敏感
but shy, sensitive.
更何况他的社区是一片战区，这更糟
Doesn't help that his neighborhood's a war zone.
是啊
Yeah.
我很抱歉你不得不一个人出去
I'm sorry that you had to go it alone out there,
但是，谢天谢地你在那
but, look, thank God you were there, right?
干得漂亮
So a good job.
我一会再回来查看
I'll check back.
你好，库玛尔先生。我是马塞尔医生
Hey, Mr. Kumar. I'm Dr. Marcel.
我是今天的急诊室值班外科医生
I'm the E.D. surgeon on call today.
哦，天啊，我升级了？
Oh, man, I've been upgraded?
这—这可不是什么好兆头
That's--that's not a good sign.
鉴于你的胸部x光检查结果
Well, the resident you saw when you came in
你进来时看到的住院医生让我来会诊
asked me to consult because of your chest X-ray results.
这是规矩，不一定是预兆
It's protocol, not necessarily an omen.
好吧，X光片，让我看看
All right, the X-ray. Lay it on me.
所以X光片显示了在你的肺之间的隔膜有一个扩大的纵膈。
So it showed a widened mediastinum, partition between your lungs.
所以考虑到你的症状，疲劳，背痛，
So given your symptoms, fatigue, back pain,
吞咽困难，高血压
trouble swallowing, hypertension.
纵隔增宽可能是由很多症状引起的，
The widened mediastinum could by symptomatic
也可能是什么都没有
of a lot of things, or it could be nothing.
什么都没有。让我们，让我们就这样吧
Nothing. Let's-- Yeah, let's go with that.
对
Right.
我要去送你做个胸部和腹部的CT
Well, you know, I'm gonna send you for a CT of your chest and abdomen.
好好看看什么情况
Get a better look at what's doing,
然后我们再继续，好吗？
and then we'll go from there, okay?
我这会应该在骑自行车
I'd be on my bike by now.
你说什么？
I'm sorry?
我不得不退出半铁人三项
I had to pull out of a Half-Ironman triathlon.
哦
Oh.
2公里的咸水游泳
1.2 mile saltwater swim,
90公里的自行车赛
56 mile bike ride.
现在只是在网上看个比赛就把我累坏了
Now it tires me out just watching the race online.
哦，对此我很遗憾，兄弟
Well, I'm sorry to hear that, man.
好吧，听着，在这待着。
Yeah, well, listen, hang in there.
技术人员马上就来，带你去做扫描
Tech'll be by soon, get you that scan, okay?
好
Okay. All right.
我11年级的时候偏头痛发作，
It started with migraines when I was in the 11th grade,
一年后他们发现了肿瘤
and they found the tumor a year later.
我高中毕业的第二天
The day after I graduated from high school,
他们切除了它，我感觉好多了
they took it out, and I felt much better.
没有说话问题，没有平衡问题
No speech issues, no more balance problems.
我痊愈了，至少我是这么认为的
I was healed, or so I thought.
结果发现肿瘤是癌变
Turns out the tumor was cancerous.
自1991年起，间变性星形细胞瘤就成了我的生命。
Anaplastic astrocytoma has been my life since 1991.
以前的复发是良性的
The previous recurrences were benign.
这次没准也是
It's possible that this one is too.
但如果不做活检，我们没法确定
But we can't be sure without-- A biopsy.
再挖出一点我的大脑
Digging out a little more of my brain.
不了，谢谢
No, thank you.
你不想知道这是什么吗？
Do you not want to know what it is?
最初的化疗和放疗，它们是残忍♥的
The original chemo and radiation, they were brutal.
那活检呢？
And the biopsies?
这每件事都让我疲惫不堪
Each one has left me a little worse for wear.
我的视力不好，听力也不好
My eyesight's bad, my hearing's going,
我的荷尔蒙不正常
my hormones are out of whack,
我的骨头很脆。
my bones are brittle.
我只是不想再冒任何受伤害的风险
I just don't want to risk anymore damage.
所以，你可以治疗我的胳膊
So, okay, you can treat my arm.
但治好以后，我就要回家了
But after that, I want to go home.
好
Okay.
矫形科马上就来
Ortho will be by soon.
我为她感到难过
I feel so bad for her.
毫无疑问，她经历了地狱
She's been through hell, there's no question.
但她的诊断，间变性星形细胞瘤，
But her diagnosis, Anaplastic astrocytoma,
这说不通。
it doesn't add up.
你什么意思？
What do you mean?