良医

The Good Doctor S04E03

Part 6 March 10, 2021, 11:58 a.m.

她没生我的气
She's not mad at me.
她肯定在生你的气
She's definitely mad at you.
她一般不会隐瞒自己的想法
She doesn't usually hide what she thinks.
她不是在生他的气
She's not mad at him.
她知道他什么样他怎样讲话
She knows how he is, how he talks.
她是在生自己的气还有点害怕
She's mad at herself. And scared.
总有事情会让我们患得患失
We all have stuff that we're insecure about.
所以爱上别人才那么危险
That's why it's so risky falling in love.
我们都希望当自己完全放下戒备的时候
We all hope that when we let our guard down,
对面的人认为我们完美无瑕
it's for the one person that doesn't see our flaws.
那我该怎么办
So, what do I do?
你当时说的是实话就不能用这个理由道歉
You were being honest. You can't apologize that away.
你得弄清楚怎么才能让她
You gotta figure out what she needs
重新在这段恋情中找到安全感
to feel secure in the relationship again.
别问我我单身
Don't look at me. I'm single.
我不该对你的私生活说三道四
It's not my place to comment on your personal life.
你有自己的想法让我们听听
You have an opinion. Let's hear it.
好吧
Fine.
把她的颅骨底部放大一下好吗
Can you zoom in on her skull base?
好怎么了
I can, but why?
我们在担心她的心脏和代谢异常
We're worried about her heart and metabolic abnormalities.
我们不该担心这个不该还担心这个
We shouldn't be. Not anymore.
你和莫菲医生都错了
You and Dr. Murphy were both wrong.
她没有心脏或者代谢的问题
She doesn't have a cardiac or metabolic issue.
她向控制意识的脑部供血的
She has poor blood flow in the artery supplying blood
那条颈动脉血流不足
to the area of her brain that controls consciousness.
在她的基底动脉里有一个小血栓
A small clot in her artery of percheron.
如果我们不能尽快取出它她就永远都不会醒来
If we don't remove it fast, she's never going to wake up.
他们做得真棒
That's amazing.
不没有
No, it's not.
心脏完全离体却依然在跳动
The heart's totally outside of the body and still beating.
就像有自己的意识似的
It's like it has a mind of its own.
她现在本该开始再植入了
She should've started the reimplantation by now.
还顺利吗利姆医生
Is everything okay, Dr. Lim?
肿瘤的卷须侵入了右房♥壁
The tumor had tendrils invading the right atrial wall.
我们为了得到清晰的边缘切除了太多组织
We took so much tissue to get a clear margin,
剩下的组织不够重建他心脏的流入腔
there's not enough left to reconstruct his heart's inflow chambers.
能不能用膨体聚四氟乙烯人造血管
How about expanded PTFE graft?
剩下的心房♥不够接血管的
There's not enough atrial remnant to attach the graft.
你们可以用间隔壁
You could use the septal wall.
他在那里有稠密的传导纤维
He's got dense conduction fibers there.
-会导致心律不齐 -除非你们用...
- It could cause heart arrhythmias. - Not if you use...
他的动脉压很低
He's got low arterial pressure.
他在导管处失血
He's springing leaks at the cannulation sites.
这是过长的搭桥术导致的出血异常
It's a bleeding disorder caused by prolonged bypass.
你们应该尽快把他的心脏放回去
You need to get his heart back in ASAP.
摩根心脏还缺两个房♥室我们不能放回去
Morgan, we can't put the heart back in with two missing chambers.
这是一种罕见的并发症
It's a rare complication,
但不管做什么手术血栓都会带来风险
but a blood clot is a risk in any surgery.
它位于大脑深处不能开颅
It's too deep in the brain for open surgery.
如果我们在那里面做根管治疗
If we go rooting around in there,
肯定会破坏PCA 她就会死
we'd definitely damage the PCA and kill her.
我们可以向血栓注射溶解剂
We could inject a dissolving agent into the clot.
血栓有50%的可能无法完全溶解
There's a 50% probability it won't fully dissolve,
这可能导致她永久的虚弱
which could leave her with permanent weakness
以及认知障碍
and cognitive difficulties.
还是她能醒过来的话
Assuming she wakes up at all.
我们需要用支架取栓器取出血栓
We need to remove the clot with a stent retriever.
如果我们刺穿了后大脑动脉
If we rupture the posterior cerebral artery,
她在手术台上就会死
she'll die on the table.
她也可能完全康复
Or total recovery.
她这么进的这家医院
That's how she came into this hospital.
也会这么走出去
That's how she's leaving.
给她准备支架取栓器
Prep her for stent retriever.
我在给他输血小板和新鲜冷冻血浆
I'm hanging platelets and fresh frozen plasma.
他的血压还是很糟糕
His pressure is still in the toilet,
但流血减缓了
but the bleeding is slowing down.
持续不了太久
Not for long.
小肠粘膜下层能满足
Small intestine submucosa has the right compliance
重塑室壁的条件可是...
to shape the chamber walls, but...
材料有限覆盖不了那么大的区域
There isn't enough to cover that much area.
如果用得太少他会在一个月之内死于心脏衰竭
Use too little and he'll have heart failure in a month.
我知道这就是我想说的「可是」
I know. That's the "but."
他的深筋膜有多厚
How thick is his deep fascia?
如果厚度超过2毫米...
If it's over 2 millimeters...
摩根
Morgan.
出去
Get out.
对不起我会... 我会保持安静
I'm sorry. I'll... I'll be quiet.
不你不会你做不到
No, you won't. You can't.
所以离开观摩室
So leave the OR gallery.
马上离开
Now.
我们需要能完全满足动脉灌流与收缩压的
We need 2.6-millimeter-thick tissue with perfect compliance
2.6毫米厚的组织
for arterial filling and contractile pressures.
如果只是心瓣我们就可以用牛心包移植
If it was just the valve, we'd use a bovine pericardial graft.
但牛心脏组织的持久力
But cow heart tissue
不足以做完整个心腔
is not durable enough to do an entire chamber.
但猪膀胱组织刚好合适
But pig bladder tissue is just right.
我以前用过它重建过膀胱
I've used it for bladder reconstructive surgeries,
但从没在心脏上用过
but never hearts.
我们来用它重建整个心房♥壁
Let's rebuild the entire atrial walls with it.
去组织采购实验室
Get down to the tissue procurement lab
拿200厘米的猪膀胱组织
and get 200 centimeters of porcine bladder tissue.
她的脑电图的δ波正在放缓
Her EEG delta waves are slowing further.
仅有一根血管支撑着她的丘脑
She only has one vessel feeding her thalamus.
这也是为什么血栓会在出现在那里
That's why the clot landed where it did.
我正在接近丘脑旁正中动脉
I'm approaching the artery of Percheron.
我离血栓只有一毫米了
I'm one millimeter from the clot.
停在这里
Stop right there.
如果我们破环了这个血栓
If we disrupt this clot,
可能会导致大量血栓进入脑部
we could cause a shower of emboli into her brain.
用取栓器
Deploying the retriever.
脑电图刚刚停止了
EEG just went flatline.
冷静我快
Calm down. I'm almost...
好了
Got it.
血液流过动脉了
Blood's flowing through the artery.
她的脑电图看起来好多了
Her brain tracing's looking better.
当新的心室缝合上时
This should fill the gap
上下腔静脉之间的缝隙
between the inferior and superior vena cava
应该能补上
when the new chambers get sewn in.
移植血管去哪里了
Where's that graft?
我需要更多的纱布出血情况更加糟糕了
I need more sponges. The bleeding is getting worse.
他的状况恶化了推点肾上腺素
Oh, he's tanking. Can you push epi?
我已经推过了用了最大剂量了
I already did. He's maxing out.
我没办法提高他的血压了
I'm running out of ways to keep his pressure up.
我拿到了
I got it.
他们有205厘米的猪膀胱组织
They had 205 centimeters of it.
谢谢
Thank you.
如果你想穿上手术服你可以在旁边观摩
If you want to gown up, you can watch from down here.
当然谢谢
Definitely. Thanks.
我以为在别人面前
I thought telling her how much I love her
告诉她我有多爱她能让她开心
in front of other people would make her feel good.
但盖林医生说我让她缺乏安全感和害怕
But Dr. Guerin said I made her feel insecure, and scared.
女人很敏感
Women are sensitive.
评价她们的缺点时
When commenting on their flaws,
完全诚实会有很高的风险
total honesty is a high-risk procedure.
听起来是性别歧视男人也会这样吧
That sounds sexist. Aren't men also insecure about their flaws?
男性更加糟糕
Men are much, much worse.
并且我们真的很蠢
And also, we're really stupid.
好吧
Okay.
我现在该怎么做
What can I do now?