实习医生格蕾

Grey's Anatomy S18E10

Part 1 March 7, 2022, 12:28 p.m.

从20世纪初
Since the early 1900s
发病和死亡病例讨论会就已开始应用
morbidity and mortality conferences, or "M&M"s
分♥析♥有严重并发症或死亡的病例
have helped surgeons learn from cases
帮助医生吸取教训
where there was a serious complication or a fatal outcome.
在讨论中会分♥析♥制度缺陷和人为错误
During M&Ms, we assess both systematic and personal errors.
回顾所有步骤所有决定
We review every step, every decision.
还原事实真♥相♥ 寻找根本原因
We get to the bottom of what happened and how it happened.
谁啊
Yeah?
客房♥服务
Room service.
嗨谢谢
Hi. Thank you.
送孩子上学了吗
You... get your kids to school?
- 是啊 - 好哦
- I did. - Good.
还提前了五分钟呢
They were five minutes early.
从来都没早到过
They're never five minutes early.
今天怎么样
What's your day look like?
很烦人
Tedious.
先要给Hamilton复查
I have a follow-up with Hamilton
然后参加病例讨论会我最喜欢的住院医要被质问
and then I have to watch someone I really like get interrogated in an M&M.
- 没有好事吗 - 没有他做回肠造口还纳术时
- Anything good? - No, he avulsed the IMA
将肠系膜下动脉从主动脉上撕裂了
right off the aorta during an ileostomy takedown.
病人♥大♥出血死亡
Patient bled to death.
而且当时没有主治医生在场
And there was no attending in the room.
你的飞机是几点的
What time's your flight?
20分钟以后就要出发去机场了
I have to leave for the airport in about 20 minutes.
我希望你能留下
I wish you were staying.
我还有20分钟哦
I have 20 minutes.
思考更好的方案探索不同的操作
We consider what we could have done better or differently...
我知道
I know.
你说得对
Oh, you were right.
真好玩
This is fun.
希望再也不会犯同样的错误
and hope we never make the same mistake ever again.
Yeyni先生的冠脉搭桥手术怎么样
How was Mr. Yeyni's CABG?
很顺利是啊
Oh, smooth. Yeah.
有机会找Richard聊了吗
Were you able to talk to Richard?
没有
No.
我问他的时候他只回答
All he said when I asked him about it was
讨论会上再聊吧
"Save it for the M&M."
他没做错
Well, I mean, he's not wrong.
我们是教学医院
We are a teaching hospital.
我知道讨论会非常必要但我不喜欢
I know M&M's are essential, but I hate them.
真是没办法
Both things are true.
Grey 给你
Grey! Here, take this.
腹疝修补术
A ventral hernia repair.
病人叫Franks 1443床
Patient's name is Franks. 1443.
等等
Wait.
- 现在吗 - 是啊
- Right now? - Yeah.
病例讨论会怎么办我不参加吗
What about the M&M? Aren't I supposed to weigh in?
其他人都没空我要主持讨论会
No one else is available, and I need to run the M&M
除非你要上飞机
so unless you're needed on a plane
不然就去三号♥手术室
I really need you in O.R. 3.
- 好吧我去 - 好的
- Okay. I'm on it. - Okay.
对了不要为难Schmitt
But, you know, go easy on Schmitt.
他已经够痛苦了能走到现在不容易
I'm sure he's suffering enough, and he's come a long way.
他还没来他人呢
He's still not here yet. Where is he?
- 我不知道 - 你们不是合租吗
- I don't know. - Doesn't he live with you?
我又没在他身上装GPS
I don't put GPS locators on my roommates, do you?
用不着这么凶吧
No need to be rude.
你当时在场会不会让你发言
Do you think you'll have to go up there? Since you were in the room?
嘿 Schmitt呢
Hey, where's Schmitt?
- 我不知道 - 好吧
- I don't know! - Okay.
好吧大家都有手术和门诊
Okay, we all have surgeries and clinic
所以我就开始了
so I'm gonna go ahead and get started.
有问题随时提问
Ask questions as they arise.
问有意义的问题我们是教学医院
Keep them constructive. We are a teaching hospital.
这是我们学习的方式
This is how we learn.
Schmitt医生将会报告...
Dr. Schmitt will be presenting...
第一例肛肠外科病人
Okay, so, our first case is colorectal surgery service.
26岁男性
26 year-old male...
Schmitt医生
Dr. Schmitt.
病人26岁男性
The case is a 26-year-old male
溃疡性结肠炎史
with history of ulcerative colitis.
医人当自强第18季
第10集心意离散
这时我们准备进行下一步
at which point, we were about ready to proceed
用吻合器进行吻合
with stapling the anastomosis
但我觉得需要小肠术野更清晰一些
but I felt that I needed better exposure of the small bowel
所以我伸进腹腔了
so I reached into the cavity.
必须要提出问题这是要求
Questions are not encouraged. They're required.
Wright医生你来提问
Dr. Wright, ask a question.
当时发现有出血了吗
Had you observed any bleeding at that point?
没有
No.
牵引的部位是否术野良好呢
Did you have good visualization on what you were putting traction on?
是的
I believed I did.
好吧
Okay.
在那时没有任何出血
At that point, everything was dry
准备进行吻合
and ready for anastomosis.
我之前说过病人...
As stated, the patient...
Schmitt医生
Dr. Schmitt?
继续
Continue.
当时没有出血
Everything was dry and...
术野内无异常所以我要了吻合器
the field was clean, so I asked for the GIA stapler.
但是...
But there was...
当时没有任何指征
There was no indication
提示解剖结构异常或组织脆弱对吧
of any abnormal anatomy or friable structures, right?
至少你没看到对吧
That you could see, I mean.
什么
What?
也就是说你当时并不知道
Meaning you couldn't have predicted
主动脉将会破裂
that the aorta was gonna rupture...
这里太棒了
This is just the best.
是啊我要在这里待一会
Yeah. I'm gonna stay here awhile, you guys.
那是无法预测的并发症
It was an unanticipated complication.
Helm 你是在提问吗
Is there a question in there somewhere, Helm?
我并不这样认为
I didn't think so.
Schmitt 继续
Schmitt, go.
也就是在那时
That was the...
术野内全都是血了
the field, it filled with blood, and...
对不起
I'm sorry.
- 你是Devon Gomez - 我居然还有粉丝啊
- You're Devon Gomez. - Never knew I had a groupie.
Schmitt医生很高兴认识你
It's nice to meet you, Dr. Schmitt.
Schmitt 宣布死亡吧
Schmitt, call it.
我杀死了Devon 我...
I killed Devon. I...
我害死了他他死了
I just ... I killed him. He's dead.
Schmitt医生我们只是要...
Dr. Schmitt, look, we are here...
Schmitt医生别走
Dr. Schmitt, no, no.
我们只是要弄清楚事实以及如何...
We are here to determine what ha... and how to ...
等等会议还没结束
Hey, no! The M&M isn't finished.
在Schmitt医生回来前
Until Dr. Schmitt returns
Webber医生负责回答问题
Dr. Webber will take the questions.
如果Schmitt医生是负责医生
If Dr. Schmitt was the primary surgeon
而您是主治医生那谁说了算呢
and you're the attending, who's in charge?
根据Webber教学法
The Webber Method dictates that
住院医不应擅自进行下一步操作
a resident cannot go on to the next step in the procedure
必须有主治医生在场
without an attending being present.
是的我明白教学法的规则
Yeah, I understand what the method is, sir.
我只是不清楚谁有权作决定
I'm just not sure I understand the chain of command.
什么意思
I beg your pardon?
在Webber教学法中
Well, I mean, the Webber Method
手术期间的决定权是轮换的
seems to rotate authority during surgery
步骤不同决策者也不同
depending on which step you're on
说实话这有点混乱
which, with all due respect, sir, seems confusing.
可能在这里再多待几天
Perhaps a little more time in our program