良医

The Good Doctor S03E12

Part 3 Feb. 18, 2020, 10:43 a.m.

如果你不能给他找到有效的药
If you don't find a medication he responds to,
他会体内窒息而死的
he'll drown from the inside.
詹姆斯的序列基因发生突变
The mutation is on James' ARAF gene.
产生一种叫做激酶的酶
It makes an enzyme called kinase,
会导致细胞过度增殖
which can cause cells to overproliferate.
这是种遗传病
It's a genetic condition.
什么引起的
What set it off now?
可能是应力骨折
Probably the stress fracture.
导致他的免疫系统过劳运作
Sent his immune system into overdrive,
刺♥激♥了他的淋巴系统
which fired up his lymphatic system.
针对这种突变的治疗方案是什么
What treatment protocol targets this mutation?
用甲基乙基酮抑制剂
An MEK inhibitor.
问题是用哪一种
The problem is, which one?
有41种
There are 41 possibilities,
每种都有不同的副作用
each with different side effects.
祝你们好运
Good luck.
我希望你能留下来
Well, I was hoping you could stay.
好可以
Okay. Sure.
我们需要你保持不动
We need you to stay completely still.
没问题
Not a problem.
你还好吧
You okay?
瑞恩彻底抛弃我了
Ryan totally bailed.
他没有回来看我
He hasn't come back to see me.
如果你告诉她是她妈不让他来探视
If you tell her that her mom said he couldn't visit,
她会生她妈妈的气
she'll be pissed at her mom.
这样做有什么好处
How's that gonna help?
他可能在学校忙
He's probably busy catching up in school.
我们有约定
We had a pact.
只要我们在一起癌症就打不垮我们
As long as we were together, cancer wasn't gonna beat us.
他失言了
He broke it.
癌症赢了
Cancer wins.
你可以自己完成吧
Do you mind finishing?
造影结束了吗
Imaging finished?
还没有
Not quite.
瓦伦斯太太安吉很想见瑞恩
Mrs. Valens, Angie would really like to see Ryan.
我知道你担心感染
I know you're concerned about infection,
但风险很小
but there is minimal risk.
实际上如果他们只是视频聊天完全没风险
Actually... actually, none, if they do a video chat.
好主意
Interesting idea.
我会考虑的
I'll think about it.
安吉很沮丧
Angie's depressed.
研究表明
And studies have shown that
沮丧会对她的手术结果
that can have a negative impact
产生负面影响
on her surgical outcome.
瑞恩并不会一直让安吉开心
Ryan doesn't always improve Angie's mood.
几周前他们吵了一架
A couple of weeks ago, they had some silly fight,
她哭了好几天
and she cried for days.
谢谢你跟我说这些
Thank you for letting me know.
我会尽力让她高兴起来
I'm gonna do my best to cheer her up.
她才十六岁
She's a 16-year-old.
她需要她的男朋友
She wants her boyfriend.
是啊
Yeah.
你十六岁的时候有多聪明呢
And how smart were you when you were 16?
塞卢美替尼怎么样
Well, what about Selumetinib?
它治疗相关症状的效果很好
It's shown promising results on related conditions.
也很有可能造成肝脏疾病
And a high occurrence of liver disease.
比尼梅替尼也差不多但并发症少一些
Binimetinib is similar, but has fewer complications.
有人反对吗
Any objections?
那就先给詹姆斯试试
Let's start James on that.
一起工作感觉太棒了
This is exciting, working together.
是啊
It is.
但我习惯了
Although, I'm used to
面对样品和切片而不是病人
samples and slides instead of patients.
病人有时候很难搞定
Patients can be difficult.
但你会习惯的
But you will be fine.
你需要什么吗
Do you need something?
我只是好奇比尼梅替尼
I was curious how James was responding
对詹姆斯效果如何
to the Binimetinib.
他的尿量增多了
His urine output is up,
这表示他的淋巴液
which suggests the lymphatic fluid...
以及钾的含量偏低
and his potassium is a little low.
你能把这个给他吗
Can you...give him this?
我不是要...
I wasn't really...
你好我是莱瓦医生
Hi. I'm Dr. Lever.
肿瘤紧挨着甚至可能渗入了
The tumor's abutting and possibly infiltrating
她脑穹庐的白质束
the white matter tracts of her fornix.
所以我们很可能得切除一部分
We'll likely have to remove a section.
这会影响到她的记忆能力
That'll affect her ability to form memories.
通过神经心理学康复
With a lot of neuropsych rehab,
她也许能用其他的途径来弥补
she may be able to compensate with other pathways.
研究表明
Studies have shown that
积极的态度更利于得到积极的结果
positive attitudes lead to positive outcomes.
你在担心她的态度
You're worried about her attitude?
她在担心年轻人的爱情
She's worried about young love.
我在担心安吉手术后要面对的事
I'm worried about what Angie is facing after surgery.
理疗认知治疗
Physical therapy, cognitive therapy,
一个接一个的挑战
one challenge after another.
而她想要的其实很简单
And what she wants is so simple.
你想让一个难过的孩子开心
You want to make a sad kid happy?
我想是的
I guess I do.
这不是我的工作
Which isn't my job, and I need to stop
我也确实不能再卷入别人的私事了
getting sucked into people's personal issues.
能在不让她妈妈
Is there a way to do that without
反感的情况下做到吗
antagonizing the mother?
可能吧
Maybe.
那就让她开心点
Then make her happy.
我们从来没做到过这一步
We've never gotten this far before.
没有
No.
我们没有
We haven't.
你还好吗
And you're okay?
我非常好
I am very okay.
卡莉
Carly.
等等
Okay.
我做错什么了吗
Did...I do something wrong?
不对不起是因为我
No, I'm sorry. It's me.
你说过我们没事
You said we were okay.
我以为没事
I thought we were.
我想让我们没事
I-I want us to be.
你没有理由继续生气了啊
You have no reason to still be mad.
我没有生气
I'm not mad.
我只是
I'm... I'm just...
是摩根
It's Morgan.
药物导致詹姆斯上消化道出血
The medication caused James an upper GI bleed.
你找到出血点了吗
Have you localized the source of the bleeding?
正在找
Working on it.
看起来是在胃窦
Seems to be coming from the antrum of the stomach.
我们停了比尼梅替尼
We stopped the Binimetinib.
除了导致出血
On top of causing this,
药物并没能消肿
it hadn't done much to curtail the swelling.
莱瓦医生在哪
Where's Dr. Lever?
这里有一处溃疡性病损电灼器
There's the ulcerative lesion. Cautery.
斑马鱼
Zebrafish.
它们因为成熟得很快
They're used in medical research
而被用于医疗研究中
because of their quick maturation,
而且84%和人类疾病有关的基因
and 84% of genes associated with human disease
在斑马鱼中都有对应
have a zebrafish equivalent.
你觉得我们应该在斑马鱼的基因组中
You think we should do a transgenic expression
对詹姆斯的突变基因进行转基因表达
of James' ARAF mutation into the zebrafish genome.
给不清楚遗传学的我们翻译一下吧
Translation for those of us without a genetics textbook handy?
把有相同基因突变的斑马鱼当作小詹姆斯样本
We make mini-Jameses, as zebrafish, all with the same disorder.