良医

The Good Doctor S04E03

Part 4 March 10, 2021, 11:58 a.m.

我来安排
I'll schedule it.
莫菲医生在把开乳♥房♥♥实质
Dr. Murphy is dividing the breast parenchyma
分成三蒂单瓣
into three pedicles.
有人知道这个技术是从哪里来的吗
Anyone know where this technique is derived from?
缩胸手术
Breast reduction surgery.
正确
That's right.
那我为什么要用缩胸术
And why would I use a breast reduction technique
来让病人的乳♥房♥♥变大
to make the patient's breasts larger?
这项技术释放了组织
The technique frees up the tissue.
你可以把单瓣聚合在一起
You can bring the pedicles together
让乳♥房♥♥变小
to make the breasts smaller
或者在植入时让它们展开使之变大
or spread them out over an implant to make them larger.
非常好
Very good.
现在我要把麦克关掉
And now I'm going to turn the sound off.
别担心没什么问题
Don't worry. Nothing's wrong.
我只是想说点你们的悄悄话
I just wanna talk about you behind your backs for a little bit.
说说第一印象
So, first impressions.
莫菲
Murphy?
我喜欢约翰·伦德伯格医生
I like Dr. John Lundberg.
他都没听过他说话呢
I haven't even heard him speak yet.
他的执医考试分数最高
He has the highest U.S.M.L.E. Scores.
那对你来说很重要吗
And that's important to you?
是的
Yes.
这说明他的医学知识很渊博
It shows he has a broad knowledge of medicine.
你认为什么重要
What is important to you?
我更关心
Well, I'm more interested
他们能用学到的知识
in what they can do
做些什么
with their knowledge,
所以目前我对乔丹·艾伦印象深刻
which is why, so far, I'm most impressed with Jordan Allen.
不不你说她冒犯了你
No. No, you said she undermined you.
那需要勇气
Which takes courage
以及自信果断日后都将对她大有裨益
and an assertiveness that will serve her well.
那你为什么叫她别再教训你了
Then why did you tell her to stop lecturing you?
教一个急性子学会保持克制
It's easier to teach an aggressive resident restraint
比教一个慢性子学会据理力争更容易
than a passive one to assert themselves.
朴医生你觉得重要的是什么
What about you, Park? What's important to you?
我想知道我每周能和谁待上80个小时
I wanna know who I can stand to be around for 80 hours a week.
当警♥察♥的时候我学会一件事
One thing I learned as a cop,
直到把酒言欢之后
you don't really know a person
你才能真正了解一个人
until you've had a few drinks with them.
左前降和回旋状动脉看起来很干净
LAD and circumflex look clean.
右冠状动脉怎么了
What's with the right coronary?
它在初端看起来很窄
It looks narrowed at the origin.
是有点窄但看起来像正常的变化
It's a bit narrow, but looks like a normal variant.
是但看起来很模糊
Yeah, but it seems hazy,
好像有肿瘤入侵
like there could be some tumor infiltration.
你们觉得呢
What do you guys think?
-我们吗 -是的
- Us? - Yeah.
过来看下
Come take a look.
我觉得
I guess...
-是左边的血管再生 -停
- It's angiogenesis of the left... - Stop.
插女同事的话
Interrupting a female coworker
几乎和男人说教一样烦人
is almost as annoying as mansplaining.
这又不是一场赛艇比赛
This isn't a rowing race.
你不必总是先开口
You don't always have to speak first.
我不喜欢插话
I... do not love the interruption.
但是
But...
我喜欢这种热情
I like the enthusiasm.
你刚准备说什么
What were you gonna say?
首先我没有性别歧视
First, um, I'm not sexist.
当然了
Of course not.
他从右冠脉循环转为左冠脉循环
He's shifting from right to left dominant circulation
来为肿瘤供血
to feed blood to the tumor.
-血管增生 -我表示怀疑
- Angiogenesis. - I doubt it.
手术中已经看出来
Surgery already showed
他的肿瘤也延伸到了右侧
his tumor extending to the right side, as well.
你刚才准备说什么
What were you gonna say?
肺动脉就在血管后面
The pulmonary artery is right behind that vessel.
是它导致了这片区域的射线散射
It's causing radiographic scatter in this area.
阴霾只是假象
The haze is just an artifact.
他的动脉没有受到入侵
His arteries are clean.
我觉得她是对的
I think she's right.
你的想法也许能奏效
Your idea might just work.
如果你反过来缝
If you invert the sutures
把线埋在皮肤下面
and bury them under the skin,
就不会看到疤痕
the scar will be invisible.
没人会知道她做过手术
No one will ever know we were here.
做得很好你们俩
Nice work, both of you.
她的血压在下降
Her BP's dropping.
推注药液静脉注射升压药检查出血情况
Push fluids, start IV pressors. Check for bleeding.
她有室速把救生车推过来
She's in V-tach. Move in the crash cart.
没有出血没有血肿
No bleeding. No hematomas.
充电
Charging.
离手
Clear.
窦性心律血压稳定了
Sinus rhythm. Her BP is stabilizing.
把她送进重症监护室我需要做术后检查
Get her to the ICU. I want post-op labs,
胸部血管成像还有24小时心电遥测
CTA chest, and full 24-hour cardiac telemetry.
我们要弄清楚刚才是怎么回事
We need to figure out what just happened.
她很稳定
She's stable,
但是分散的δ波很缓慢
but diffuse delta wave slowing.
大脑活动极少
Minimal brain activity.
某种原因未明的新陈代谢紊乱可能导致
An undiagnosed metabolic disorder could've caused
对麻醉剂产生不良反应
an adverse reaction to the anesthesia.
对但她的术前检查都很正常
Yeah, but her pre-op labs were all normal.
一定是某种隐藏的心脏疾病
It's gotta be some sort of hidden heart condition.
你们主意比较多
You're big on opinions.
你们怎么看
How are you with ideas?
如果是你们接下来会怎么做
What would you do next?
我会进行肌松监测
I'd check train of fours
用新斯的明药消除麻痹
and reverse the paralytics with neostigmine.
如果莫菲医生没错她会醒过来
If Dr. Murphy's right, she should wake up.
很聪明但有风险
Smart. But risky.
药物会使她的心脏负荷加重
The meds will stress her heart.
如果朴没错她可能会再次心脏骤停
If Park's right, she could arrest again.
我去年见过类似的情况在婆罗洲
I saw a similar case last year. In Borneo.
你在婆罗洲的医院实习过
You interned at a hospital in Borneo?
不我是在一个猩猩救援基地当志愿者
Uh, no. I, uh, volunteered at an orangutan rescue foundation.
我们的向导是个当地村民从树上摔下来
Our guide, a local villager, fell out of a tree.
大约有24米高
It was, like, 80 feet up.
从树上摔下来和病人在乳♥房♥♥重塑手术中
How is falling out of a tree similar to a patient arresting
心脏骤停有什么相似之处
during breast reconstruction surgery?
他背部断裂
Well, he broke his back,
但是当我们把他送到医院时
but when we got him to the hospital,
我发现他还因风湿热而导致心脏受损
I found he also had heart damage from rheumatic fever
以及因缺碘而导致代谢异常
and metabolic abnormality from iodine deficiency.
这里很少见但在那里很常见
It's rare here, but it's common there.
我们是在给他做全身放射性核素显像时
We only realized it when we ran a nuclear profusion scan
才发现的
of his entire body.
不错
Good catch.
但是大面♥积♥扫描需要大量的放射性示踪剂
But a scan that extensive requires multiple radioactive tracers.
你认为她的心脏能承受吗
You think her heart could handle that?
今晚不做
Not tonight.
我要先征求「老妈」的同意
I'll get consent from the mom.
明天早上第一件事就是这个
We'll do it first thing in the morning.
我们一旦确定心房♥闭合就把心脏放回去
Once we confirm atrial closure, we'll put the heart back in.
利姆医生会重新接好主动脉
Dr. Lim will reconnect the aorta
和上腔静脉的接口
and the superior venous connections,
而我则连接下腔静脉
while I connect the inferior.
我在实习期间
During my sub-internship,
多次协助过心脏移植手术
I assisted on multiple heart transplants.