医院革命

New Amsterdam S01E20

Part 2 Nov. 27, 2019, 1:19 p.m.

- Pass. Next? - Max--
过下一个
Pass. Next?
警♥察♥局长又打电♥话♥了
Police commissioner called again.
我猜应该跟迈克尼尔警官的事有关
I'm guessing it has to do with what happened to Officer McNeil.
直接拒绝
Yeah, hard pass.
-麦克斯 -别说了
- Max. - No.
整个名单上没有一个会议是必要的
There's not a single essential meeting on that entire list.
全是走个过场
They're all just arbitrary,
我不会再在走过场上浪费时间了
and I'm not wasting any more time on arbitrary.
好吧那么既然你已经取消了
Well, what-- well, now that you've cleared
所有的行程你打算做什么
your entire schedule, what do you intend to do--
我不知道什么重要的事情吧
I don't know, something that matters.
一些值得我花时间在上面的事情
You know, something worth my time.
一些关乎生死的事情
Maybe something life and death.
怎么回事
What was that all about?
他心情不好
He's in a mood.
没事亲爱的
It's okay, honey.
这里到底是怎么回事
What the hell happened in here?
你可能想问问他
You might want to ask him.
好吧我来吧
Okay, I got this.
-突然就这样了 -没关系
- It just came out of nowhere. - It's okay.
好了我们走吧
All right, let's go.
那是你的愿景板孩子
That was your vision board, bud.
-怎么了 -我哪儿也不去
- What's going on? - I'm not going nowhere!
阿维
Avi...
你今天不会有问题的
You're gonna do great today.
我参加过很多
I've been to plenty
发病率和死亡率会议
of morbidity and mortality conferences.
但我从来没有亲自主持过
Just never had to lead one.
好吧你现在是我的首席住院医师了
Well, you're my, uh, chief resident now.
也算是有头衔了
It comes with the job title.
我刚看了你那个的病例听起来很糟糕
Been going over your case and it sounded just awful.
迈克尼尔警官失血速度太快了
Officer McNeil just bled out so fast.
没错
Yes.
我很抱歉雷诺兹医生
I'm sorry, Dr. Reynolds.
我也是
So am I.
听着我只是想让你知道在会议中
Look, I just want you to know I'm not gonna throw you
我不会对你发起攻击或者怎么样
under the bus or anything during this discussion.
不听着双率会议不是用来责备医生的
No, no, no. Look, M&Ms aren't about blame, all right?
这是一种教学工具
They're a teaching tool.
我们聚在一起讨论是否我们的操作导致
We come together to see if our actions contributed
病人死亡然后我们不会再重复这些错误
to the patient's death so we never repeat those mistakes.
但这就是问题所在
But that's just the thing.
我已经准备了好几天了
I've been preparing this for days.
我没有发现任何错误
I haven't found any mistakes.
那也是有可能的好吗
Hey, that can happen too, all right?
但我们仍在研究这个病例
But we still study the case
我们发誓下次会做得更好
and we vow to do better the next time.
就是这样
That's it.
今天的病例是一名40岁的白人女性
Today's case is a white 4o-year-old female
创伤病人
trauma patient.
她最初被诊断为
She initially presented with--
继续
Go ahead.
病人被诊断为股骨骨折
The patient presented with a fractured femur,
颈部和胸部擦伤
cervical and thoracic abrasions--
迈克尼尔警官当时在服药吗
Was Officer McNeil on any medications?
她在
She was on...
低剂量避孕
low-dose birth control.
抵达医院25分钟后
25 minutes post arrival--
迈克尼尔警官有心脏病病史吗
Did Officer McNeil have a history of heart disease?
没有这个病人没有
No, the patient did not.
我们都知道你在讨论
We all know you're talking
迈克尼尔警官诺丁汉医生
about Officer McNeil, Dr. Nottingham.
不需要匿名
No need for anonymity.
好的
Okay.
抵达医院25分钟后迈克尼尔警官出现
25 minutes post arrival, Officer McNeil developed
纵隔气肿因此
a pneumomediastinum, necessitating--
在纵隔气肿之前她的生命体征中有没有
Before the pneumomediastinum, were there any other signs
任何迹象可以预测她最终的死亡吗
in her vitals that could have predicted her eventual death?
-我不知道 -好吧
- Not that I'm aware of. - Hmm.
迈克尼尔警官进手术室之前
What did Officer McNeil look like
状态怎么样
as she went into surgery?
-我不知道 -你不知道
- I don't know. - You don't know?
我不在那里
I wasn't there.
你不在那里
You weren't there.
如果我们今天希望得到一些真正的答案
Well, if we have any hope of getting some real answers today
那么我们换个当时在那里的人
then we need someone presenting this case
来介绍这个病例
who was actually there.
雷诺兹博士
Dr. Reynolds?
她是你的病人对吗
She was your patient, right?
-是的没错 -那么
-Yes, she was. - Hmm.
在这种情况下你能告诉我们
So you would have the most salient information
最直观的信息
on this case.
我认为诺丁汉已经准确地
I think Nottingham is providing
回顾了病例
an accurate case review.
没错
Hmm. Indeed.
但是为了真正弄清她是怎么死的
But, uh, to really get to the bottom of how she died,
你不觉得你自己更适合
don't you think that you might be better qualified
领导这次讨论吗
to lead this discussion?
如果你不觉得太麻烦的话
If it's not too much trouble.
让我们切到胸片吧就是这里
Let's go to the chest x-ray, ok? Good.
好了
All right.
这里我们看到的是玛丽·迈克尼尔的胸片
So here we have Marie McNeil's chest x-ray.
你会注意到纵隔
You will notice the mediastinum.
它的长度刚刚超过9厘米
It measured just over 9 centimeters in length.
现在诺丁汉医生你能给我们提供
Now, Dr. Nottingham, can you give us the criteria
病理性变宽的标准吗
for pathological widening?
仰卧时长度超过8厘米
8 centimeters on a supine AP chest.
非常好我们已经达到了病理性变宽的标准
Very good. We have met the criteria for pathological widening.
如果我们再仔细看看这里看到了吗
If we take a closer look right about here-- see that?
气泡
Air bubbles.
这就是纵隔扩大的原因
That's the cause for the widened mediastinum.
实际上是食道撕裂造成的
Now, that's actually caused by tears in the esophagus
被称为自发性食管破裂
called Boerhaave's syndrome, all right?
另外请注意
And also of note:
肺实质正常
normal pulmonary parenchyma
心脏轮廓正常
and normal cardiac silhouette.
下一张
Next.
检验结果
等等回到胸片那页
Uh, wait, go back to the chest x-ray.
你说心脏轮廓正常吗
You said cardiac silhouette was normal?
是的
Yes.
但是用胸片检查像人类心脏这样
But the chest x-ray is a rather blunt instrument
脆弱的东西是不是有点太不细致了
for examining something as delicate as the human heart,
你不觉得吗
wouldn't you say?
你还用了其他的什么检测手段吗
So what other modalities did you use?
心电图和经胸超声心动图
An EKG and a transthoracic echocardiogram,
两者都很正常
both of which came back normal.
不错我们能看看吗
Good. Can we see those?
诺丁汉医生没有把它们放在
Uh, Dr. Nottingham didn't include them
幻灯片里因为它们是正常的
in today's presentation because they were normal.
但是如果我没有亲眼看见
- Well, I can't tell if they were normal
我不知道他们是否正常
if I can't see them for myself.
我现在没有
Well, I don't have them here.
没有吗
No?
双率会议的唯一目的是分♥析♥数据
The entire purpose of an M&M is to analyze the data
以确保如果医生犯了错误
to ensure that if mistakes were made
那么这些错误不会再犯
those mistakes will not be made again.
如果连数据都没有
It is particularly difficult to analyze that data
我们还怎么分♥析♥数据
when that data isn't here.
我们何不休息一下
So why don't we take a brief recess