芝加哥急救

Chicago Med S08E11

Part 6 April 5, 2023, 10:19 a.m.

You're out of luck. He declined the procedure.
根据法律，州政♥府♥不能强迫他动手术
And by law, the state can't force him to have it.
没错，但阿伦是未成年人
True, but Aaron's a minor.
他用来找工作跟租公♥寓♥的身份证
ID he's been using to get a job, rent an apartment,
都是假的
it's fake.
没想到他在几个月前
Turns out, a few months ago,
从最近一次的寄养家庭逃跑
he ran away from his latest foster family.
一直假装自己成年来掩盖他的行踪
Been pretending to be of age to cover his trail.
这是阿伦的儿童与家庭服务部的文件
Aaron's DCFS paperwork.
他才17岁，所以没错州政♥府♥可以强制他进行手术
He's only 17, so yes, the state can compel surgery,
我们希望拿到手术过程中取出的子弹
and we'd like that bullet in the process.
我一直在问自己欧玛怎么会没意识到
Been asking myself how Omar didn't realize
他只能移♥动♥整颗头，而不能只动眼睛
he was moving his whole head instead of just his eyes.
后来我想到了一名雪崩受害者
And then I remembered this avalanche victim.
我们到那里的时候，他已经脱困了
By the time we got there, he had dug himself free.
他两只手都被冻得乌黑
His hands were jet black with frostbite,
但等到我们跟他说，他才发现
but he didn't realize it until we pointed it out.
很扯吧，大脑是如何
It's crazy, right, how the brain
比我们更早发现问题
recognizes problems long before we do
并且自发性做出反应的？
and instinctively compensates?
有画面了
Image up.
好，你看这里
Oh, okay. Look. Right here.
等一下，基恩，你能… 放大这个部分吗？
Wait, Gene, can you... Can you blow that section up?
嗯
Mm-hmm.
这是压♥迫♥脑下垂体的微腺瘤
So we got microadenoma pressing against the pituitary gland.
不算太大，可能是这样
Not that big either, which is probably
早上的电脑断层扫描才看不出来
why CT didn't pick it up this morning.
脑损伤可以解释欧玛的头痛
Well, the brain lesion explains Omar's headaches,
但是眼睛不会动？
but the eye lock?
你有看到这边的扩散吗？
Well, you see this sort of diffusion right around here?
我很肯定这是出血
I'm pretty sure that's a bleed,
这肯定会
which would definitely, you know,
对脑神经造成压力
put pressure on the cranial nerves
可能导致眼睛无法移♥动♥
and could cause a lock.
欧玛的头痛大约从三年前开始
Omar's headaches started almost three years ago.
眼睛不会动是30分钟前才开始的
Eye lock only set in 30 minutes ago,
也就是说出血是在那之前开始的
which means the bleed had to have started just before then.
我想可能是今天早上
I think it might've happened this morning
我第一次跟他说话的时候
when I was first talking to him.
-血压飙升？-对
-The BP spike? -Yeah.
像那样的高血压绝对会引发出血
A jolt of hypertension like that, it'd absolutely trigger a bleed.
所以脑损伤是欧玛所有问题的根源
So the lesion is the root of all of Omar's issues.
我们该怎么解决这个问题？
How do we fix it?
这个嘛，我们没办法解决神经外科可以
Well, we don't. Neurosurgery does.
所以茱迪的
So there's a slowness
思考过程很缓慢，这很明显
to Jodie's thought process that's evident,
但她明白自己病了
but she grasped that she's ill,
有一颗肿瘤
that there's a tumor present,
我们建议切除
that we recommend it be resected,
还有如果她不动手术的后果
and the consequences if she doesn't have surgery.
好，四比四
Okay, four for four.
听起来她有能力表示同意
Sounds like she's capable of giving consent.
那由我接手，然后送她去动手术
So I'll get it, and then I'll get her up to the OR.
好
Okay.
医院的新人工智能认为茱迪是个瘾君子
The hospital's new AI pegged Jodie as a drug-seeker.
就因为算法，我们差点让她出院
We almost let her walk because of an algorithm.
滥用鸦♥片♥类药物是个问题
Opiates are a problem.
我明白要利用工具来帮助解决这个问题
I get building tools to help solve it.
是啊，只是有病人因此受害
Yeah, except patients are falling through the cracks.
还好不是今天
Well, luckily, not today.
对…
No...
但我担心明天
but I'm worried about tomorrow.
这可是搜查令
I mean, it's a warrant.
-我们有得选吗？-也许吧
-Do we even have a move? -Well, perhaps.
从法律上来说只有在阿伦的生命危在旦夕时
Legally, Med only has to operate
医院才会动手术，对吧？
if Aaron's life is at stake, so is it?
血压很糟，他还在出血
BP's in the toilet. He's still bleeding.
不动手术，情况只会更糟
Without surgery, it only gets worse.
好，要是不取出子弹
Okay, there's no projectile to hand over
就不需要交出子弹，马素医生
if it never comes out, so, Dr. Marcel,
有没有办法在不取出子弹的情况下
is there a way to operate and stop Aaron's bleeding
替阿伦止血？
without removing the bullet?
这就是我一直在想的问题
That's what I've been debating.
子弹的位置很糟糕
The bullet is in a terrible position,
正好在胰腺的颈部
right on the neck of the pancreas.
所有的损伤都在…子弹的正下方
All the damage is... It's directly below it.
那子弹就非得取出来不可了
So it's gotta come out, then.
我可没这么说
I didn't say that.
我搞混了
Well, I'm confused.
如果子弹挡住了，你要怎么
How do you get to the damaged area of the pancreas
接近胰腺受损的区域？
if the bullet's in the way?
我只能从周围溜进去
I'm just gonna have to slip in around it.
我完全支持遏制鸦♥片♥类药物滥用
I am all for helping to curb opiate abuse,
但鸦♥片♥医疗的人工智能是有缺陷的
but this OpioHealth AI is flawed.
这个系统有问题，我们医院不该使用
The program has bugs, and Med shouldn't use it.
听着，分♥析♥有助于确定
Look, analytics that help identify
患者滥用鸦♥片♥类药物的风险进而保护我们的责任
a patient's risk for misusing opioids protect our liability.
这是我们医院绝对该用的系统
This is a program Med should absolutely be using.
是为了保护我们的责任？
Liability is the driving force?
那病患照顾呢？
What about patient care?
你知道我不是这个意思再说，鸦♥片♥医疗并不是
You know that's not what I'm saying. Plus, OpioHealth, it's not meant
为了取代医生的诊断
to supplant a doctor's diagnosis.
但它确实取代了它给了我不信任的种子
But it does! It sows seeds of distrust.
我今天的病人，档案里的那些描述
My patient today, the scrips in her file,
那些让她变成黑名单的描述
the ones that got her red-flagged,
是她家年迈的老猫
they were for her aging cat.
兽医登记成她的名字
Veterinarian put it in her name.
我很遗憾，但如果你仔细研究
And I'm sorry about that, but if you look hard enough
任何人工智能系统你都会发现异常情况
into any AI program, you are gonna find outlier cases.
几周前夜班有个病人
The night shift had a patient a few weeks ago
因为在多个州填写处方而被列入黑名单
who got flagged for filling scrips in multiple states.
没想到他是个飞行员
Turns out he was a pilot.
他去哪间药局取决于他的飞行路线
His pharmacies depend on what route he's flying.
没错，发展时期是会有困难
Yes, there are some growing pains,
但算法不是敌人
but algorithms are not the enemy.
算法可以帮助预测哪个病人
They can help predict which patient
最有可能从特定的治疗中受益
is most likely to benefit from a particular treatment,
估计重症监护室的概率
estimate ICU probabilities,
病人出院后是否会
whether a patient's gonna deteriorate or die
-恶化或死亡 -彼得，我们知道了
-after being discharged. -Peter, we get it.
你很信这一套
You're a believer.
但艾莎医生的问题不在于人工智能
But Dr. Asher's problem is less with AI
而是在于这个特定的系统
and more with this specific program.
坦白说，我也有同感
And frankly, I share her concerns.
董事会一批准测试鸦♥片♥医疗这个系统
As soon as the board approved testing OpioHealth,
我就联♥系♥了这家母公♥司♥
I reached out to the parent company
了解他们是如何搜集和解释数据的
for clarity on how they amass and interpret their data.
他们到目前尚未分享任何信息
They have yet to share any information,
并声称这将侵犯
and they claim that it would infringe
他们专有的算法
upon their proprietary algorithm.
听我说
Look.
如果鸦♥片♥医疗不愿意分享他们的系统是如何运作的
If OpioHealth isn't comfortable sharing how their program works,
那我也不愿意使用
I'm just not comfortable using it.
鉴于越来越多的错误案例
And given the growing number of errant cases,
我要向董事会请♥愿♥ 在全医院范围内取消这个系统
I'm going to petition the board to remove the program hospital-wide.
你这是在自找麻烦
You're gonna be picking a fight,
你不仅会跟董事会杠上也会惹毛积戴顿
and not just with the board but with Jack Dayton.
-那也只能这样了 -好
-Eh, so be it. -Okay.
好，找到乳突了，进行插管
Okay. There's the papilla. Gonna cannulate.
进入胰管
Moving into the pancreatic duct.
2.0，显示胰腺颈部