实习医生格蕾

Grey's Anatomy S08E22

Part 3 Feb. 29, 2020, 7:35 p.m.

你怎么无处不在啊
How are you everywhere?
你答得怎么样
How'd it go for you in there?
亲爱的我知道你很吃惊
Look, baby, I know you were shocked.
只是吃惊吗
Shocked?
看到我妈妈半裸着和一个我医院里的
Shocked at the sight of my mother half naked
高年资主治医生在一块而吃惊吗
with a senior attending at my hospital?
不差远了知道吗
No, far from it. Okay?
对你来说这是家常便饭了吧
I mean, it's kind of par for the course for you,
对吧妈妈
right, Mom?
但是我每开一扇门
But every door that I open,
每次转过几个街角
every--every corner that I turn,
都能看见你
there you are.
我知道我是你妈妈但我也是个女人
I know I'm your mother, but I'm also a woman.
我有需求的
I have needs.
如果你不能像个成年人一样说这事
If you don't want to talk about this like an adult,
就别再提了
don't bring it up.
等等是我提起的吗是我提起的吗
Wait a second. Did I bring it up? Did I bring it up?
别闹了小声说
Don't play games. Just talk to me.
别烦我了
Just leave me alone!
我正在整那让人焦头烂额的答辩呢
I'm in the middle of my freakin' boards.
你跟着我♥干♥吗妈妈
Are you following me, Mom?
我负责的答辩室就在你旁边
I'm the examiner in the room right next to yours.
当然你在了
Of course you are.
第二环节
之后我会移♥动♥小肠
After that, I might mobilize the small intestine
来形成一个肠吻合
to create a roux-en-y,
然后从尾部到颈部
and open up the pancreatic duct
纵向切开胰管
longitudinally from the tail to the neck?
病人已经死了
The patient has died.
进行下一个场景
Moving on to the next scenario.
我们能不能再说说刚才那个...
Um, can we--can we go back
就再讨论一下
just--just for a second?
我们得继续了凯普娜医生
We're moving on, Dr. Kepner.
三十八岁的女性有病史...
A 38-year-old male with a history...
但我们就再回顾一下
But--but if we could just go back,
就一下我就能说清楚了
just for one second so that I can clarify.
你手上有一个病人四十岁男子
You have a 40-year-old man
时常抱怨直肠疼有感染而且在发烧
who complains of rectal pain and burning with defecation
大便有时会带血
and occasionally some blood in the bowel movement.
我会给他做一个硬式乙状结肠镜检查
I would do a rigid sigmoidoscopy
来检查他的直肠是否有病变
to make sure there were no lesions in the rectum.
有点紧张是吧格蕾医生
Squeamish, Dr. Grey?
不一点也不
No, not at all.
好吧那咱们对检查结果分♥析♥一下行吧
Good, then let's pick up the answers, shall we?
当然
Of course.
如果直肠有病变
If there were lesions in the rectum,
我会对病灶部位进行切片活检
I would do an incisional biopsy...
然后做肠镜下电刀活检
and begin to fulgurate...
我会用网膜覆盖肠管
I would cover the bowel with omentum
之后先把筋膜缝合
and close the fascia primarily.
缝线时把筋膜穿破了
The sutures tear right through the fascia.
这样的话我会用一点零的尼龙可吸收线
In that case, I would use 1-0 nylon retention sutures
穿过肠壁较厚的地方进行缝合
through the full thickness of the abdominal wall.
继续
Moving on.
因为我要确保那片区域的血
Because I would make sure the area
-被吸干了而且缝合完好 -凯普娜医生
- was adequately drained and closed-- - Dr. Kepner--
因为如果有泄露而且如果泄露很早
Because if it leaked, and if the leak was early,
我可以再检查一遍病人修复泄露点
I would re-explore the patient and repair the leak,
确保如果...
making sure that if-- that if--
一个问题回答完了就结束了
Once a question is finished, it's finished.
结束了是我知道很抱歉
Finished. Yes, I know. I'm sorry.
我只想要你们明白
I just really need you to understand
如果那泄露晚了我会做一次腹部CT
that if the leak was late, I would obtain an abdominal C.T.
来确定它不会...
just to make sure, and also, if it wasn't--
它不会流干天啊
if it wasn't drained-- God.
你们能不能稍等一下
Um, can you hang on just for a second?
这里真的很热
It's just so incredibly hot in here.
天啊
Ohh! Oh, God.
天啊
Oh, God.
我们能继续了吗凯普娜医生
Can we move on, Dr. Kepner?
你会允许我们吗
Would you allow us the courtesy?
会
Yes.
是的
Yes.
很好谢谢
Great. Thank you.
现在有一个三十八岁的男子有糖尿病的病史
Now a 38-year-old male with a history of diabetes--
我很抱歉很抱歉
I'm sorry. I'm sorry.
我很抱歉就...就...就...
I'm sorry. Just--just--just--
就最后一次回顾刚才那个病例
just--just one last thing going back to the beginning,
因为你们刚听到了我关于
'cause you-- you heard what I said
找到那段胰管的陈述了吧
about finding the pancreatic duct, right?
因为我只想让你们知道
Because I just--I really want to make sure you know
我会搞定这个吻合术的
that I would drain the anastomosis, r--
我...我那病人应该稳定下来了
Well, I-I--that patient should be stable!
他们...
They just...
你们为什么不告诉我求你们告诉我
Why won't you tell me? Just--just--just tell me!
我怎么能在没有获得所有信息的情况下
How am I supposed to answer this question
回答对这个问题呢
without the full information?
求你们...
Please t--
我... 我...
Look, I'm--I'm, um,
我真的是一个好医生真的
I'm--I'm a really good doctor. I am.
只是我要...
I just--I need--
我需要所有的信息
I need all the information.
我...
I'm...
我真的是个好医生
I'm a really good doctor.
没有多余的气体
Um, no free air.
脾脏...
The spleen...
脾脏看起来没问题
The spleen looks fine.
有一些肝周积液
There is some perihepatic fluid...
抱歉你们能听到隔壁的噪音吗
I'm sorry. Are you guys hearing this noise next door?
很让人分心
It's very distracting.
如果我们能让他们安静一点
If we could just ask them to... keep it down.
如果你这么容易就被分心
If you get distracted this easily,
那我就会质疑你在一个充满噪音的手术室里
I think it calls to question your ability to function
进行手术的能力
in a high-volume O.R.
绝对要质疑
Certainly calls it into question.
不是那回事
It is not that at all.
只是那边是我的...
Okay? It's just my--
算了吧
Never mind.
咱们等等外面的车也安静下来吧
Let's wait for traffic to die down.
我们不是想难为你艾弗里医生
We wouldn't want to throw you off your game, Dr. Avery.
我没事了咱们...
I'm fine. Let's just--
我会用门静脉分流术来阻止
I would stop the patient's continuous bleeding
病人的持续失血
with a portacaval shunt.
你的病人现在陷入了昏迷
Your patient is now in a coma.
这不太可能但是如果这样的话
That's highly unlikely, but, uh, in that case,
我会怀疑是不是肝性脑病
I would suspect a hepatic encephalopathy
检查病人的血氨水平来确诊
and check an ammonia level to confirm.
我给你省些麻烦吧
I'll save you the trouble.
已经确诊不是了
It's confirmed.
我会检查病人服用的药
I would check the patient's medication--
-也不是药物 -好吧
-Medication-- - Okay,
我会检查果糖和新霉素水平
then I'd start on lactulose and neomycin.
-病人... -仍未好转吗
- The patient-- - Still not getting better?
那我会用支架移植体做分流修复术
Then I would do a shunt revision with a stent graft.
支架移植体
Stent graft?
是的支架移植体
Yes, a stent graft.
那么...
Well...
冒险之选杨医生
Risky move, Dr. Yang.
那么...
Well...
继续
Moving on.
你还要什么要补充的吗杨医生