良医

The Good Doctor S01E05

Part 4 Jan. 5, 2020, 7:40 p.m.

被肿瘤科医师标为偏低
neutrophil count of 634 as low.
那确实挺低的
That is low.
是正常范围内的低
Low normal.
这句话里不还是有个「低」字吗
I can still hear the word "Low" In there.
他只是个孩子
He's just a kid.
我理解想到他死掉有多难受
I know how hard it is to think of him dying.
他自己能接受
He's okay with that.
真令人难以置信
I find that hard to believe.
我们都会死
We all die --
如果大家能接受这一点会更开心
if we accepted that, we'd be happier.
也许吧但是人都是不知足的
Maybe. But we're not good with contentment.
与死亡斗争是我们生存的意义
Fighting death is what keeps us alive.
我发现了是棘球绦虫
We got a hit -- Echinococcus.
「棘球绦虫」
Echinococcus?
囊肿里全都是绦虫吗
The cysts are filled with tapeworms?
还有其他囊肿吗
Cysts? There are more?
还有三个
Three more?
还有四个他大脑里还有
Four more. You missed the one in his brain.
-格拉斯曼医生 -什么事
- Dr. Glassman? - Yeah?
你曾是一名神经外科医生对吧
You used to be a neurosurgeon, right?
没错
So they say.
帮我拿一下
Take this, will you?
我需要一位你有人可以推荐吗
I need one. Who would you recommend?
什么情况
What you got?
真厉害
That's cool.
我的脑子里怎么会有绦虫
How the hell did I get tapeworms in my head?
不知道但确实有
No idea, but you do.
你可能是通过土狼或者狼接触到的虫卵
You can pick up the eggs from coyotes or wolves.
你接触过狼或者土狼吗
You been hanging around coyotes or wolves?
我住在郊区
I live in the suburbs --
连儿童动物园都没有
we don't even have a petting zoo.
你的囊肿已经存在一段时间了
You might've had these cysts for quite some time.
其中一个破裂
When one of them burst,
导致了你的第一次过敏反应
that's what caused the first allergic reaction.
为什么会破裂
Well, why did it burst?
为什么会破裂
Why did it burst?
任何突然的动作扭曲转动或压♥迫♥
Any sudden movements, twists, turns, squeeze.
拥抱呢
A hug?
有可能
Could be.
但第二次发作时你不在场
But you weren't there for the second one.
我做活体组织切片检查时刺破了你的囊肿
I punctured the cyst on your pancreas during the biopsy.
你也看到了过敏反应会逐次严重
As you've seen, allergic reactions get worse each time they happen.
要是再发生就糟了
So a third one, that would be bad.
那会...
That would be...
会非常糟糕
That would be very bad.
因此我们计划通过手术来完整除去所有囊肿
So we're gonna have to surgically remove all the cysts intact.
格拉斯曼医生是全国声誉最高的
Dr. Glassman's one of the most highly acclaimed
神经外科医生之一
neurosurgeons in the state.
他做手术你可以放心了
You are very lucky to have him.
卡卢医生拍马屁也越来越厉害了
And Dr. Kalu is fast becoming a very accomplished flatterer.
颅内的囊肿很重要
The cranial cyst, that is a big deal.
我们得打开颅骨顶部
We're gonna have to take off the top of your skull.
你们要进到我脑袋里面去
You'd be digging in to my brain?
差不多是这样
Well, yeah, pretty much.
用生理盐水
With saline.
轻轻地用它移置囊肿
We use it to gently displace the cyst,
然后它就奇迹般地出来了
and then, poof, it magically pops out.
有点像生孩子的过程
Kind of like delivering a baby.
如果分娩没有痛感的话
You know, if childbirth were painless.
之后再继续处理其他囊肿
And then we move on to the other cysts.
我们会治好你的
Hey, we're gonna take good care of you.
37度轻度皮疹
轻度皮疹
轻度皮疹
BGM: Run The Jewels by Run The Jewels
埃文没得癌症
Evan doesn't have cancer.
可能不是癌症
It might not be cancer!
可能不是癌症
It might not be cancer!
看看你连续两次准时到了
Look at you on time -- two for two.
可能不是癌症
It might not be cancer.
-胳膊骨折患者 -是的
- Fractured arm? - Yes.
你说他被确诊为患有晚期骨肉瘤
You said he'd been diagnosed with stage four osteosarcoma.
埃文八个月前被确诊的
Evan was diagnosed with the flu eight months ago,
但他更符合感染埃-巴二氏病毒的症状
but his symptoms were actually a better fit with Epstein-Barr virus,
与朗格汉斯细胞组织细胞增生症有关
which is linked to Langerhans cell histiocytosis,
这会导致上肢长骨部位产生溶骨性病变
which causes osteolytic lesions in the long bones of the upper limbs.
而病变可能被误诊为了骨肉瘤的症状
And those lesions could be misdiagnosed as signs of osteosarcoma.
-的确 -那他的脑肿瘤呢
- Yes. - What about his brain tumor?
朗格汉斯症也会在头骨中出现
Langerhans can also manifest in the skull.
那么其实代替死亡诊断
Instead of a death sentence,
他患的可能是可以轻易用强的松治好的病吗
he could have something that could easily be treated with prednisone?
接下来需要做骨髓穿刺进行确认
Next, we need to do a bone-marrow aspiration to confirm.
你应该看过他的病例了
I assume you've looked at his file.
看了很久
For a very long time.
上面肯定有活体组织检查
Well, there must've been a biopsy.
病理报告上怎么说
What did the pathology report say?
没错做过两次活体组织检查
Yes. There were two biopsies.
两次都显示有骨肉瘤
Both were positive for osteosarcoma.
-莫菲 -他们可能误诊了
- Murphy... - They could be false positives.
你知道两次都误诊的可能性有多低吗
Do you have any idea how unlikely it is to have two false positives?
0.3%.
因此我们倾向于认为这「不可能」
Which we can comfortably round off to "not likely."
但也有可能...
It is possible --
没错但这意味着让濒死孩童的父母
Yes, but it means telling the parents of a dying child
去盼望一件根本没有可能的事
that there's hope, when really there isn't.
洗个澡准备巡房♥吧
Grab a shower and get ready for rounds.
-想象力与创造力 -没错
- Imaginative and creative. - Yes.
你正确的几率有多少
What are the chances you're right?
0.3%.
330例中出现1例
330 to 1.
应该是333例
333 to 1.
你真的认为值得让埃文父母经历这一切吗
You really think that it's worth putting Evan's parents through all this?
当然
Of course.
如果我们做了这333次诊断
If we did this 333 times,
那我们可能花了四个小时
we'd be giving false hope to 332 people
给了332个人虚假的希望
for approximately four hours,
但我们能拯救一个生命
and we'd save one life.
难道不值得吗
Isn't that worth it?
但梅伦德斯医生不允许我申请检测许可
Anyway, Dr. Melendez won't let me ask for consent to test.
如果我不告诉他们我在做什么呢
What if I don't tell them what I'm doing?
公然违反医德这就是你的办法吗
A blatant ethics violation -- that's your solution?
没错
Yes.
我该怎么做
How do I do that?
就直接检测别告诉别人谁也别说
You do it and then don't tell anyone. No one.
如果有人问起
If anyone asks...
就说主治医生注意到红血球数低要找原因
your attending noticed a low RBC count and needed to find the cause...
就这样没什么大不了的
that's it -- no biggie.
你知道圣克拉17街的威尔克斯杂货铺吗
You know Wilks' Grocery on Santa Clara 17th?
它已经建立近60年了
It's been an institution for nearly 60 years.
我祖父母于1958年开了这家店
My grandparents started it in 1958,
我和妻子在1982年接手
and my wife and I took it over in '82.
我妻子生病后
But when my wife got sick
我开始跟凯文说接手的事
and I started talking to Kevin about taking it over,
而他就那么离开了
he just... took off.
对他来说那就是个卖♥♥生菜和厕纸的地方
To him, it was just a place to sell lettuce and toilet paper.
我父亲在英国开了一家房♥地♥产♥开♥发♥公♥司♥
My father chairs a real-estate development company in the U.K.
认为我是设立美国分公♥司♥的最佳人选
Thought I'd be the perfect person to set up the U.S. office.
但你想加入「救人行业」是吗
You wanted to be in the "helping profession" ?
我想做我的专业
I wanted to be in my profession.
不在于风险的高低
It's not about how small or how big the venture is,
而在于做属于自己的事
it's about doing something that's yours.
我猜是吧
I guess.
他小时候我们很亲密
When he was little, we were inseparable.