实习医生格蕾
Grey's Anatomy S18E02
Part 4
Oct. 11, 2021, 11:46 a.m.
that completely removes the undifferentiated cells.
太棒了 他们太棒了
That's amazing. They're amazing.
抱歉 我有一个视频会
Excuse me, I have a conference call.
我们回头再聊吧
But we'll talk more later?
- 很高兴见到你 - 谢谢 Bartley医生
- Great to meet you. - Thank you, Dr. Bartley.
谢谢 David
Thank you, David.
所以呢
So?
你们怎么样想
What do you...
同意 完全同意
Yes. All the yeses.
这是治愈帕金森 改变世界的机会
An opportunity to impact Parkinson's, change the world
能拥有这样的设备和团队
with this equipment and this team?
我加入
I am... I'm in.
Grey医生呢
Dr. Grey?
快答应呀
Just say yes.
咱们把艾莎的裙子收起来吧
Should we shelve the Elsa costume?
- 什么 - 让Leo穿T恤牛仔裤吧
What? You know, put Leo in more T-shirts and jeans?
这才是家长应该做的吧
Just, is that the right parenting move?
- 发生什么事了吗 - 没有 就是...
Did something happen? No, I just...
你知道的 在日托的其他孩子
You know, none of the other kids at daycare
他们都没穿装扮 所以我...
are wearing costumes, so I just...
- 病人是什么情况 - 车祸 无明显外伤
- What do we got? - MVC with no visible trauma.
年轻退伍兵 去过几次伊♥拉♥克♥
A young vet who did several tours in Iraq.
杵状指 发绀 呼吸困难
He has finger clubbing, cyanosis, dyspnea.
在楼下时 他还咯血了
He coughed up blood when he was downstairs.
X光的结果不乐观
His chest X-ray does not look good.
考虑是某种呼吸系统疾病
And I'm thinking it's some kind of respiratory illness.
你确定没事吗
Are you sure nothing happened?
天啊 Owen
Oh, my God. Owen...
他的肺千疮百孔了
His lungs look like a war zone.
Pierce要跳槽到波士顿吗
Is Pierce taking a job in Boston?
你叫我来 是因为这事吗
Is that why you paged me?
如果再失去一位医生...
Because if I lose one more surgeon...
不是的 她爸要做髋关节手术
No, her dad is having hip surgery.
是我的错
Well, now I feel badly.
主任 我有一位病人 34岁
Chief, I have a patient, 34
黑人女性 糖尿病并发慢性肾病
Black woman with chronic kidney disease from diabetes.
因为凝血异常 没办法透析
She hasn't been able to get on dialysis due to a clotting disorder.
在等待移植吗
A candidate for transplant?
她的肾病医生说 她的肾小球滤过率太高
Well, her eGFR is too high according to her nephrologist.
但是你看
But look.
这是另一位移植候选人
Here's another patient on the transplant list.
年龄 体重 健康情况基本相同
Almost the same age, weight, and health profile to my patient.
唯一的区别就是他们是白人
The only real differentiating factor is that they're white.
他们的肾小球滤过率计算结果更低
So their eGFR measures lower
也就更符合移植条件
making them better transplant candidates.
在设计肾小球滤过率估值时
When the estimated GFR was developed
人们认为黑人肌肉量更大
it was assumed that Black people have higher muscle mass.
所以在计算时 增加了一个乘数
It added a multiplier to account for that assumption
导致黑人患者的肾小球滤过率估值增高
which then increases a Black patient's GFR
误以为黑人的病情更轻
and registers them as having less severe disease than other people.
所以就无法申请器♥官♥移♥植♥了
Making them ineligible for transplants.
怎么会这样设计呢
How does this even happen?
源于对黑人的一系列"假定"
Stems from a long line of "assumptions" about Black people
甚至影响医疗领域了
that have snaked their way into medicine...
比如 我们的疼痛忍♥耐度更高
you know, that we have a higher tolerance for pain
骨密度不同 肺容量更低
different bone density, lower lung capacity.
但这些假定信息依旧用在临床公式里
And yet these assumptions still exist in clinical formulas.
我之前都没仔细想过肾小球滤过率估值
I never even stopped to think about the eGFR.
主任 有没有其他办法呢
Is there any way around it, Chief?
我能不能给移植委员会写信申请呢
Uh, can I write an appeal to the transplant board?
倒是可以
That only works
但是病人需要处于紧急医疗状态
if the patient qualifies for medically urgent status.
Rashida等不及了
Rashida might not have that kind of time.
但是还有很多像Rashida的病人
There's a lot of Rashidas, though.
也要为他们争取
Fight for them, too.
介入室准备好了
The IR suite is ready for us.
Young中士 这是Teddy Altman医生
Sergeant Young, this is Dr. Teddy Altman.
Teddy Altman少校
Major Teddy Altman.
- Danny呢 - Hayes医生在照看他
- Where's Danny? - He's with Dr. Hayes.
他没事 但以防万一 还是要做头部CT
He's fine, but we need to do a head CT just to be sure.
扫描结果显示 你的双肺有严重瘢痕
Your scans reveal severe scarring in both your lungs.
我们想让你住院 然后...
We'd like to admit you and...
我患有肺纤维化
I have pulmonary fibrosis.
真♥相♥大白了
Mystery solved.
所以我不想做检查 不想治疗
That's why I didn't want any work-ups, no treatments.
我知道自己的病 我知道无法治愈
I know what I have, and I know there's no cure.
继续治疗 只会人财两空
Just a crap-ton of different ways to the poor house.
中士 你什么时候确诊的呢
When were you diagnosed, Sergeant?
大概一年前
About a year ago.
第二次去伊♥拉♥克♥回来后 我就开始咳嗽
I started coughing after the second Iraq tour.
一直咳嗽 停不下来
I couldn't shake it.
后来我听战友说 可能是因为焚烧坑
I started hearing from buddies about the burn pits
可能会导致癌症或其他怪病
how they were linked to all these cancers and mystery illnesses.
退伍军人事务部应该负责医疗费的
The VA's gotta cover these conditions.
基本不管
Barely.
只报销哮喘这些病
They just started covering stuff like asthma.
从没听说有哪位退伍兵
But I haven't heard of a single vet
有类似情况的 得到过报销
who's been covered for conditions like mine.
有各种方式阻挠我们
All kinds of ways to twist it
根本没办法判定是战伤
so you can't prove it was service-related.
更绝的是 我在海鲜工厂的工作也丢了
Cherry on top? I lost my job at the seafood plant
因为身体太差 没办法完成工作
'cause I was too weak to finish my shift.
所以我没保险 没工作 但有一堆医疗账单
So I got no insurance, no job, and a stack of medical bills.
- 中士 听着... - 叫我Noah就行
- Sergeant, look... - Please, just call me Noah.
Noah 能不能让我们的肺科专家看一下
Noah, would you sit down with one of our pulmonologists?
重新做检查 然后再做一些其他的
We'll redo your workup, and we will get you in for some tests
以便开始治疗
so that we can start some treatments.
不了 不检查 不治疗
Pass. No tests, no treatments.
我不是针对你们 但是余下的时间
Nothing against you guys, but whatever time I have left
我希望陪儿子一起度过
I'd like to spend it with my son.
- 快点 - 我知道
- Move. - I know!
小曾加油 把气球扎破
Pop these balloons, Tseng! Come on!
如果你输给第二年住院医
If you lose to a second-year
你就要扫半年厕所
you're cleaning the bathroom for six months!
别吵了
Get away from me!
内窥镜操作精准度与速度同等重要
Endoscopic proficiency is just as important as speed.
一时失手 就可能穿透结肠
One slip could mean you've perforated a colon.
还有20秒
20 seconds!
-加油 - 再来一个
- Yes! - One more.
这是什么项目
What category are they on?
内窥镜
Endoscopy.
简直惨不忍♥睹
It's a trash fire.
你是住院医了
You're a resident now.
能睡就睡 能吃就吃
Sleep when you can, eat when you can.
不了 今天打杂 吃不下了
Nah, I'm on the scut diet.
肛♥门♥检查吗
Rectal exams?
阴♥道♥检查
Vaginas.
对哦 粉色的
Right. Pink.
我是说工作服
The scrubs!
我在病人体内发现了一颗草莓
I found a strawberry in my patient.
读医学院的时候
Back in med school
我发现过山药 20块赌小曾赢
I found a yam. 20 bucks on Tseng.
好吧 我赌Helm
Okay, I'll take Helm.
加油 马上就赢了
Go, go! It's right there
马上成功
It's right there!
加油 加油
Go! Come on!
快点
Go.
- 完成了 - 完成了 是我
- Done! - Finished. Me.
小曾赢了
It's Tseng.
今天的第一名是...
Today's winner of the competition...
Schmitt 你今天可以主刀了
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