实习医生格蕾

Grey's Anatomy S13E15

Part 3 Jan. 26, 2020, 10:58 a.m.

"deep fryers are dumb," and listen to me!
你能告诉我我父亲怎么样吗
Can you tell me how my father is?
小帕我很抱歉
Pam, I'm sorry.
或者先别说话了
Maybe just stop talking.
有人会来处理这些烧伤的
Someone will come dress those burns,
我去问问你父亲的情况
And I'll go get an update.
他脖子多处肿胀
All right, he's got a lot of neck swelling.
你能给我一个光导纤维探镜吗
Can you get me a fiber-optic scope just in case?
这些伤口太深了膀胱都不行了
This wound extends deep. The bladder is destroyed.
我得带他去手术室修补
I need to get him in an O.R. for a repair.
不你可以随后再做膀胱修补
Uh, no, you can do the bladder repair later.
我得先开腹探查清洗腹腔
I need to do an ex-lap with an abdominal washout first.
是啊我甚至连声带都看不到
Yeah, I can't even see his vocal cords.
-这儿让我来试试 -不我找到了
- Here. let me try. - No, I got it. I got it.
沃伦预定手术室
Warren, call up to the o.r.
告诉他们准备截石位手术
Tell them to place the patient in a lithotomy position
以便进行会阴♥部♥评估
For a perineal evaluation.
沃伦告诉他们进行肾造口术的准备
Warren, let them know we need a perc nephrostomy setup
还可能会进行回肠膀胱重建术
And a possible ileal conduit for reconstruction.
他的小肠已经露出来了
His small bowel is sticking out of his abdomen.
你在说什么回肠膀胱术
What ileal conduit are you talking about?
杰克森他的肌腱已经露出来了需要皮瓣移植
Jackson, the tendon is exposed. he's gonna need a skin flap.
-不那还可以等 -我只是说
- No, no, no, that can wait. - I'm just saying...
我知道什么时候需要皮瓣什么时候不用
I know when flap coverage is warranted and when it isn't.
另一个争吵的家庭真棒啊
And another bickering family. Fantastic.
沃伦你在说什么吗
Warren, did you say something?
我说我来预定手术室
Uh, I said i'm gonna go book an o.r.
-好的 -那得抓紧了
- Okay, well, hop to it, then. - Well, hurry up, then.
-去吧孩子 -加油接着干
- Get going, child. - Come on. let's get this.
艾格尼丝没事了
Sister Agnes is good to go.
很顺利
It went great.
进去出来没问题
In, out, no problem.
回来的感觉不错对吧
Feels good to be back, huh?
是啊
Yeah.
回来工作
Back at work.
但我还是没准备好见欧文
I'm still not ready to see Owen.
我只是不知道该对他说什么
I just, uh, don't know what I would say to him.
好吧我只是说说而已
Okay, well, i'm just riffing here,
你可以从“嗨欧文”说起
But you could start with "hi, owen."
抱歉
Sorry.
你准备好了再说吧没关系
When you're ready. No judgment.
你可以帮我检查下走廊好让我走吗
Uh, could you just check the hall so I can get out of here?
当然好的
Yes, of course. Okay.
-没问题 -好的
- All clear. - Okay.
走吧
Go. Go. Go.
这种病叫左心发育不全综合征
It's called hypoplastic left heart syndrome.
格斯的左边心脏发育不全
The left side of Gus' heart is underdeveloped,
所以无法给身体其余部分
So it can't deliver oxygenated blood
提供氧和血
to the rest of his body.
好吧那我们现在要怎么做
Okay, so, what do we do now?
他需要手术吗
He'll need surgery?
有两种选择心脏移植
There are two options... a heart transplant
或者做开胸手术重建格斯的心脏
Or an open-heart surgery to reconstruct Gus' heart,
这叫Norwood手术我认为我们应该做这个手术
Called a Norwood. I think we go with that.
我认为我们应该考虑
And I think that we should consider
等待心脏移植
waiting for the heart transplant.
我担心你们的小家伙
I'm concerned that your little guy
承受不了分期手术
doesn't have the strength to withstand a staged procedure.
分期手术
A staged procedure?
是的 Norwood手术是三次分期手术中的第一次
Yeah, the Norwood is the first of three separate surgeries
这三♥期♥手术在他生命的前三年完成
That are performed over the first three years of his life,
而不是移植手术的一次手术
As opposed to just one for the transplant.
但像格斯这种情况
But with a heart like Gus',
他可能等不到供移植的心脏
the wait could be more time than he has.
并且你们永远都需要寻找
Also, you're looking at a lifetime
抗免疫药物
of anti-rejection drugs.
与多次手术引起的紧张相不同
As opposed to the strain of multiple surgeries,
况且在长久情况下他总是需要心脏移植的
Often resulting in a transplant in the long run, anyway.
而且格斯的这种情况在他的症状变得更严重之前
And in Gus' case, we have a bit of time
我们拥有更充裕的时间
before his symptoms become intolerable.
我不会冒这个险的
I'm not willing to accept that risk.
好吧但是他
Okay, but he...
他说格斯活不过你说的这个手术
He says that Gus won't survive your thing, the...
Norwood 我认为他可以
Norwood. And I think he can.
但他是心脏科医生
Yeah, but he's a heart surgeon.
我是儿科医生
And I operate on babies all the time.
我见过的病例比他多
I've seen more of these cases than he has.
我知道他们会挺过来的
I know how well they do.
而且我觉得与捐献者不会及时出现相比
Also, I'd rather invest in a sure thing
我会做出更保险的选择
than wait for a donor that might not show up in time.
好吧所以你说有可能
Okay, so, you're just saying that there's a poss...
直接告诉我们到底要怎么做
Okay, well, then just tell us what to do.
我的孩子正生命垂危而我不知道该如何帮助他
My baby is dying, and I don't know how to help him.
你们说的只让我们更疑惑我们到底要怎么做
You're just confusing us. Just, what do we do?
我
I...
我我认为我们应该选择
I-I think that we should just go with
-移植 -Norwood
- the transplant. - Norwood.
你说我们还有一些时间对吗
You said that we have some time, right?
你♥他♥妈♥在做什么
What the hell, man?
他们要被压垮了他们刚刚才生了个孩子
They're overwhelmed. They just had a baby.
所以呢他们就不能听完全部内容
What, so they shouldn't hear the whole story?
他们不需要听到你与我争论
They don't need to hear you argue with me.
在你进去之前
Well, you should have heard me out
就应该先听我说完的
before you went running in there.
没有什么要听的他是我的病人
There's nothing to hear. He's my patient.
他非常适合做Norwood手术
He's a good candidate for a Norwood.
-我反对 -至少他现在是
- Well, I disagree. - Or at least he is now.
当他们花掉一大堆时间做决定之后他可能就不适合了
He might not be once they spend a bunch of time deciding.
德卢卡他们准备好了告诉我
Deluca, let me know when they're ready.
给器官共享组织打电♥话♥
Call UNOS.
把他登到心脏移植名单上去
Put that kid on the cardiac transplant list.
我认为克莱夫医生真的希望做Norwood手术
I-I think Dr. Karev's really into the Norwood idea.
不是由克莱夫医生做决定
Yeah, well, Dr. Karev's not making the decision.
是他的父母做决定
The parents are.
当他们决定了做移植手术
And when they decide on a transplant,
我不想是因为迟疑了而错过一个心脏
I don't want to have missed out on a heart because we waited.
把他登记到名单上去
Just put him on the list.
我不想听到你告诉克莱夫
And don't tell Karev. I don't want to hear about it.
并不是只有膀胱处于危险状态
The bladder isn't the only thing at stake.
-那正是我为什么说 -我是说我们可以
- That's why I'm saying... - I'm saying we can...
病人准备好了
The patient's prepped.
不我们延迟了软组织覆盖
No, we delay soft-tissue coverage.
他是Gustilo分型III型很明显要做皮瓣修复术
It's a gustilo type three. It's an obvious fix-and-flap.
那不是在像这样脏的伤口里
Not in a dirty wound like this.
我们需要做一个延迟重建
We need to do a delayed reconstruction,
而不是膀胱修复
Not a primary bladder repair.
-不 -重建应该现在就做
- No. - Reconstruction should happen now...
我们还有贯通伤需要解决
We have a penetrating wound to explore.
在组织发生水肿之前
...before the tissues become edematous.
这么做怎么样
Okay, what about this?
韦伯和凯普纳解决贯通伤
Webber and Kepner explore the wound
同时艾弗里评估烧伤
as Avery evaluates the burns
决定是否做皮瓣修复
to determine the need for more coverage.
另一个艾弗里可以完成会阴评估
The other Avery can do a perineal evaluation,
在经过所有评估之后
and after a full assessment,
一切就容易了
it'll become clear how to proceed.
我只明尼克说
I jus... you know, Minnick said that
我们应该与你们一起解决问题
We should work the problem with you.
其实沃伦这行得通
Actually, Warren, that should work.
谢谢
Thank you.
怎么了