实习医生格蕾

Grey's Anatomy S18E19

Part 4 Oct. 14, 2022, 8:46 p.m.

and he narrates his life out loud.
比如说 "我现在要煮咖啡了
Like, "And now, I'm making the coffee.
我在把豆子放进过滤器里
I'm putting the beans in the filter.
现在我要加水进水壶了"
Now, I'm putting the water in the pot."
这实在是
That is --
令人生气没错
Enraging. Yeah, it is.
这件事
That...
再加上高♥潮♥的时候唱歌♥
plus the singing orgasm --
-很难忍♥受 -没错
- It's a lot. - Yeah.
但他人真的很好
But he's -- Oh, he's so nice.
*费加罗*
*Figaro*
*费加罗*
*Figaro*
-*费加罗费加罗* -别唱了
- *Figaro, Figaro* - No!
糟糕
Oh, damn it.
这样做如何
Okay, how about this?
假设我们切除她的全部胰腺
What if we resect her entire pancreas,
提取胰岛细胞
extract the islet cells,
注射进肝脏里
and insert them into her liver
这样她就依然能制♥造♥胰岛素了
so she can still make insulin?
我们说了要大胆的想法这很大胆
Well, we said bold swings. That's a bold swing.
我以前做过胰岛细胞移植
I have done an islet cell transplant before.
当然了你当然做过
Of course you have. Of course.
-你佩服吗 -当然佩服了
- Are you impressed? - I mean, impressed.
我一边被撩拨得很兴奋一边又很佩服
I'm turned on. I'm impressed, I'm turned on...
我只是希望有办法
I just wish there were a way to just get in there
可以进到肿瘤周围分次切除
and cut around the tumor a little bit at a time,
一点一点切除
piece by piece.
但我们要怎么在血液短缺的情况下做到呢
But how do we do that during a critical blood shortage?
等等如果我们不在她体内做手术的话
Wait, she would lose a lot less blood
她就不会失那么多血了
if we didn't do the surgery inside the body.
你想做离体手术吗
You want to do an ex-vivo surgery?
你也做过这类手术对吧
You've done one of those, too, haven't you?
-没错 -如果我们要这么做的话
- Right. - Well, if we were going to go that route,
最好能再找一个人帮忙
it would be helpful to have an extra set of hands.
所以你想做个惠普尔手术
So, basically, you want to do a Whipple,
但在病人体外做吗
but outside the body on the back O.R. Table?
没错取出所有相关的器官
Exactly. Remove everything involved --
肝脏
the liver,
带有肿瘤的胰腺头部
the pancreatic head with the tumor,
肠道
the intestines.
全部移出体外
Remove it all en bloc,
切除肿瘤
excise the tumor,
然后再全部移植回科拉体内
and then transplant everything back into Cora's body.
这是谁的主意
And whose idea was this?
这重要吗
Does it matter?
不重要因为这是个坏主意
No, it doesn't, because it's a bad idea.
风险太大了
I mean, it's too risky,
坦白讲今天做这个手术太不负责任了
and, frankly, today, it's irresponsible.
这样的手术要做超过二十小时
I mean, a surgery like this would take over 20 hours.
难道我们就应该让她回家等死吗
So we should, what, send her home to die?
杰马拉·布莱克正在决定
Jamarah Blake is on her way to decide
这间医院是否能继续它的培训项目
whether or not this hospital can continue its training program,
因为我过于自信以至于做了无用功
because I was too confident and tried to reinvent the wheel.
不该在今天莽撞行事
Today is not the day to go rogue.
这可能不是莽撞这或许是走在前沿
Maybe it isn't rogue, maybe it's cutting edge.
也许走在科技前沿
And maybe cutting edge is exactly
正是我们拯救项目的办法
what we need to do to save the program.
不行我很抱歉
No, I'm sorry.
我不会做这个手术的
I'm not gonna do it.
好我们让她一直住院
Okay, um...well, we can keep her admitted.
我们可以几天后再做
I mean, we could do it in a few days.
他搞砸了不代表科拉就得死
Just because he screwed up doesn't mean Cora has to die.
我去预订手术室
I'm booking the O.R.
行吧
Okay.
西蒙不仅现有的肺病灶更严重了
Not only did the existing lung mets grow,
病灶数量还增加了
Simon now has more.
我们能割除病灶吗
So can we resect them?
不幸的是不行
Unfortunately, no.
他的肿瘤程度已经很严重了
Um, he already has too much tumor burden.
肺部没有足够的肺储备了
There won't be enough pulmonary reserve.
那安装气管支架呢
What about a bronchial stent?
把空气输入他的肺部没有问题
Well, it's not a problem of getting air into his lungs.
问题是让他的肺部运作起来
It's a problem of getting them to work at all.
他妻子已经怀孕36周了
His wife is 36 weeks pregnant.
我们只需要让他坚持到
We just need him to hold on long enough
他妻子安全地完成剖腹产
that she can have a safe C-section.
我跟他说过会让他见到他孩子
I told him he'd meet his kid.
我知道这么做很愚蠢
Which, I know, I know, it was stupid.
用体外膜肺氧合机器呢
What about ECMO?
这种病不建议用体外膜肺氧合机器
ECMO's not medically indicated in this situation.
但有用吗
Would it work?
说啊是不是能争取点时间
Well, come on. Would it buy him some time?
我们可以遵循某条协议
There are protocols that we could follow
以减少用血量
in order to reduce the amount of blood products.
不行万一他失血过多死亡呢
No, because what if he bleeds out?
来见见克丽丝汀吧
Just come meet Kristen.
见见西蒙的妻子我们能一起商量方案
Meet his wife. We can go over these options together.
拜托了
Please.
布莱克女士作为住院医生项目的主任
Uh, Ms. Blake, as, uh, director of the residency program,
我想让你知道我们非常认真地
I want you to know that we have followed
遵循了你的建议
your recommendations very seriously.
我很高兴听到你这么说
Well, I'm glad to hear it.
在过去三个星期里
Just in the past three weeks,
我们雇佣了六位新的主治医生
we've hired six new attendings,
教学案例上升了40%
and teaching cases have risen 40%.
真是太了不起了
That's very impressive.
我也读了格蕾医生和谢博德医生的
I also read the Parkinson's research
关于帕金森的研究
of Doctors Grey and Shepherd.
听起来你们取得了突破性的成就
It sounds like you've done some groundbreaking work.
她们的确是的
Well, they have indeed.
这次随访应该不会持续太久
Well, this follow-up visit, it shouldn't take long.
最主要是要确认
I'll mostly be looking to confirm
我标出来的问题已经得到了解决
that the issues that I flagged have been addressed.
目前看来很多问题都解决了
Which it seems that many of them have.
-很快就好 -谢谢
- You're almost done. - Thank you.
这些是你的住院医生
Are these your residents?
布莱克女士你一定了解目前的情况
Ms. Blake, I am sure you are aware that the state --
就这一点而言全国
the entire country, for that matter --
都严重地短缺血液
has been experiencing a serious blood shortage.
所以我们决定亲自解决这个问题
So we d-decided to take matters into our own hands.
让你们的住院医生在值班期间捐血吗
By making your residents donate blood during a shift?
这他们完全是自愿的
It -- This is entirely voluntary.
你要为了这个全国性的问题让我们关门吗
Well, are you gonna shut us down for a nation-wide problem?
所以是让机器他的血抽出体外
So it moves the blood out of his body
然后给身体充氧让他不用肺部呼吸
and oxygenates it so he doesn't have to use his lungs?
没错这能绕过他的心和肺
That's right, it bypasses his heart and lungs.
好
Okay.
那就那么做吧
Um, let's do that, then.
克丽丝汀肺氧合机也会有问题
Kristen, ECMO comes with its own complications.
尤其是会有产生血栓的风险
Particularly, it comes with the risk of blood clots.
所以他可能...
So, he could...
会更快死亡
die more quickly.
克丽丝汀我们给病人使用肺氧合机
Kristen, we usually use ECMO on patients
通常是为了让他们的心脏和肺部能休息恢复
so that their heart and lungs can rest and recover.
但西蒙的肺没法恢复了
And Simon's lungs are not going to recover.
所以让我担心的是这个情况使用肺氧合机
So what worries me about using ECMO in this case
在特定情况下
is that at some point --
我们得放弃治疗他
We would have to unplug him.
在特定情况下是的
At some point, yes.
这可能会比你...
And that might be harder than you --
不会