良医

The Good Doctor S03E20

Part 2 April 2, 2020, 9:29 a.m.

一个胸痛的35岁健康病患
Otherwise healthy 35-year-old with chest pain.
-高敏度肌钙蛋白查过吗 -第一次是阴性
- High sensitivity troponins back? - First was negative.
一小时后再查
Repeat the tropes in an hour.
还是阴性的话让他出院
If there's still no change, discharge him.
二区十六岁
Bay 2 -- 16-year-old.
梳妆台倒在她的腿上
Dresser fell on her leg.
-脉搏和感觉测试正常吗 -对
- Normal pulse and sensory exam? - Yes.
这是非移位性骨折
It's a non-displaced fracture.
给她准备后板安排后续检查
Prep her for a posterior slab and book a follow-up.
利姆医生
Dr. Lim.
-这是谁 -梅伦德斯医生
- Who is this? - Dr. Melendez.
朴医生
Dr. Park.
怎么样了
So, how'd it go?
不太好凯西
Not good, Casey.
我们治不好了
We couldn't fix things.
当我们抬起这个时你就会流血
When we take this off you, you'll start bleeding,
而我们无法止血
and we won't be able to stop it.
你会死的
You're gonna die.
不
No.
不不不你错了
No, no, no. You're wrong.
你一定你一定搞错了
You gotta -- you gotta be wrong.
天呐我我爸爸在哪里
Man, where's... where's my dad?
他在路上了
He's on his way.
我们会让你舒服些
We're gonna keep you comfortable.
我不疼好吗
I'm not in pain, okay?
你肯定错了
You gotta be wrong.
我很抱歉凯西
I'm sorry, Casey.
我爸爸在哪儿啊
Where's my dad?
「向前看」不就是放弃和失败的
Isn't "moving on" just a euphemism
委婉说法吗
for giving up, for failure?
你真的相信吗
Do you really believe that?
你认为你失败了吗
Do you think you failed?
接受失败
Accepting...loss
会让我们更强大
makes us stronger.
拒绝接受失败我们就没失败
Refusing to accept failure makes us not fail.
只要我们不成功就一直奋斗的话那...
If we keep fighting till we succeed, then --
那那不是真的
Th-- that's not true!
它束缚我们
It traps us,
阻止我们取得其他的胜利
prevents us from moving on to other victories.
你的红细胞压积表明你还在流血
Your hematocrits suggest you're still bleeding.
似乎是腹膜后腔出血
Appears to be in the retroperitoneum.
可能是胰腺出血
Probably from the pancreas.
如果我们给你开腹
If we open you up,
意味着要大范围地切除和重建
it means major resections and reconstructions,
最终可能会用造瘘袋或得糖尿病
and you could end up with ostomy or diabetes.
我很清楚腹部手术的风险
I'm well aware of the risks of abdominal surgery.
比较保守的方法是
The more conservative approach
血管栓塞止血
is an angio for embolization to stop the bleed.
低创...
Less invasive --
同样很清楚
Again, aware.
做栓塞术
Do the embolization.
在这种情况下
In this case,
我觉得那不会更安全
I don't think it's actually safer.
如果不是胰腺出血
If the bleed isn't from the pancreas,
我们就只能在里面不停寻找
we'll have to keep poking around till we find it,
那样可能就太迟了
and it might be too late.
你想做手术吗
You want to do the surgery instead?
不想
Not really.
但克莱尔是对的
But Claire's right.
我们已经与你♥爸♥爸接通了卫星电♥话♥
We've been able to get a satellite hook-up to your dad.
你想先跟他通话吗
Do you want me to talk to him first?
不我必须要跟他话说
No, I need to talk to him.
儿子
Son?
爸爸对不起
Dad, I'm sorry.
爸爸我很抱歉
Dad, I'm so sorry.
我听不见你再说一次
I can't hear you. Say that again.
你受伤了吗
Are you hurt?
爸爸是我的错我...
Dad, it's -- it's my fault, okay? I --
你听得见吗坚强点好吗
Can you hear me? Just be strong, okay?
-爸爸 -凯西
- Dad! - Casey!
爸爸
Dad!
再打过去
Get him back.
飞机遇上风暴了
The plane's caught in a storm.
-我不知道会不会... -再打过去
- I don't know if it'll... - Get him back.
分开胃结肠韧带露出胰脏
Divide the gastro-colic ligament and expose the pancreas.
撕裂的是肠系膜主动脉的一个分支
It's a branch of the superior mesenteric artery that's torn,
不是他的胰脏
not his pancreas.
判断得不错
Good call.
我要切除坏死的组织
I need to resect the devitalized tissue
做一个健康的接口
to get a healthy anastomosis.
我们需要夹钳 6-0薇乔线和卡斯特罗持针器
We need clamps and 6-0 vicryls on Castros.
利姆医生
Dr. Lim?
在肠系膜上动脉上面小肠...
Above the SMA, the small bowel...
有三种方法可以止血
There are three ways to stop a bleeding vessel --
夹钳灼烧或修复
clamp, cauterize, or repair.
因为这个管是用钢制成的
Since this vessel is made of steel,
夹住它需要六十吨♥的压力
clamping requires a 60-ton press,
而灼烧需要氧炔焊炬
and cauterization requires an oxyacetylene torch.
我不用让水停下来
I don't need to stop the water.
减慢流速就行
Just slow it down.
你很擅长应对挑战
You're good at a-adapting to challenges.
没错
Yes, I am.
一味地锯钢筋也没用
Blindly keeping on sawing wasn't gonna work.
是的
No.
但这不是失败
But it wasn't a failure.
因为你的目标不是要切断钢筋
Because cutting the rebar wasn't your goal.
而是救我的命
Saving me was your goal.
而且你的目标也不是莉亚
And your goal isn't Lea.
而是爱
It's love.
我觉得这个疤会跟纹身很配
I think the scar will work with the tattoos.
出血的不是胰脏
The bleed wasn't from the pancreas.
而是肠系膜上动脉
It was from the SMA.
但我们发现肠系膜上动脉一直到
But we found additional injuries
腹腔动脉干有很多其他的损伤
all the way to the celiac trunk.
肠缺血吗
Ischemic bowel?
还是早期
Early stages.
我们已经恢复了全部的血流并进行了再灌注
We have restored full blood flow and reperfused.
我确定肠道会没事的
I'm sure the bowel is gonna be just fine.
有多确定
How sure?
我的乳酸是多少
What's my lactate?
四
Four.
说明肠壁已经出问题了
Means there's already been some failure of the bowel wall.
我们会再测一下你的乳酸
We're going to re-test your lactate.
而且我肯定会降下来的
And I'm sure it'll have gone down.
但如果上升了就是说肠缺血恶化了
But if it's gone up, it means ischemia is progressing,
而且细菌泄漏会更严重
and there'll be more bacterial leakage.
这意味着会出现感染性休克
Which in turn will mean septic shock...
已经错过了治疗时间
...past the point of treatment.
还没到那一步
We're not there yet.
告诉他还得等一会
Let him know it's still gonna be a while.
一会是多久
How long is a while?
抱歉我不知道
Sorry. I don't know.
他说他们十五分钟后就要被淹了
He says they're gonna drown in 15 minutes.
「一会」比十五分钟长还是短
Is "A while" more or less than 15 minutes?
刚刚那次余震让一切都太不稳定
That last tremor made things too unstable
没法派我的队员下去
to send my crew down.
你是来拯救生命的
You're supposed to be saving lives.
你是来当英雄的
You're supposed to be the heroes.
你没意见的话我现在要做的就是
If you let me, what I'm gonna do right now
帮我的队员带更多支架脚手架和
is help my crew get in more braces, scaffolding,