良医

The Good Doctor S04E04

Part 3 March 10, 2021, 11:58 a.m.

你是说要分清情况
So you're saying context matters.
当然
Of course.
就像两个室友住在一起
Same way that two roommates living together
和一对情侣同居不一样
is different from a couple living together.
都是两个人都是一间房♥ 但是情况不同
Same people, same place, different context.
一旦我们之间感觉变了一切都变了
Once our feelings change, everything changes.
和你在一起时我的感觉还是一样
I still feel the same way when I'm with you.
幸福
Happy.
肯齐的血压稳定了水肿在消退
Kenzie's BP and edema have improved.
B超显示胚胎的心功能有好转
The fetus's echo shows improved heart function.
导管起作用了
Catheter's working.
你感觉怎么样
How do you feel?
还好
Okay.
说真的你感觉怎么样
How do you really feel?
真的还好
Really okay?
你想知道我为什么总是很紧张
You want to know why I'm so nervous all the time?
我也不知道
I don't know.
我一直很怕各种第一次
I've always been very terrified of firsts.
第一次去学校去露营去教堂
First day of school, camp, church,
所有的陌生人都盯着我
all the new faces watching me,
等着我搞砸
just waiting for me to screw up.
五年级第一天
First day of fifth grade,
德罗得老师问我「六乘以九等于几」
when Mrs. Deloitte asked me what 6 times 9 was,
我当着全班的面说「等于45」
I told the whole class it was 45.
我现在还能想起他们的嘲笑
Yeah, I can still hear them laughing at me.
两晚前我梦到
And two nights ago, I dreamt I was standing
自己又一次站在德罗得老师的班里
in front of Mrs. Deloitte's class again.
我迫不及待地想醒来
Couldn't wait to wake up.
但当我真的醒来
But when I did,
我意识到如果今天我做错了什么
I realized that if I got the answer wrong today,
没人会笑我但有人可能因此丧命
no one will laugh, but someone may die.
小时候别人也嘲笑我
The kids laughed at me, too.
即使我知道六九五十四
Even though I knew 6 times 9 was 54.
双胞胎中那个强壮点的
One of the amniotic sacs ruptured.
羊水破了
The strong twin's.
癌症转移到肝脏了
It's metastasized to his liver.
那我们怎么办
So, what do we do?
腹腔镜射频消融术
Laparoscopic radiofrequency ablation.
恢复时间短但癌症复发的几率很大
Short recovery time, but a significant chance his cancer returns.
有人反驳吗
Care to rebut?
我觉得我们应该考虑肝叶切除术和
I think we should consider a hepatic lobectomy
淋巴结清除术
and lymph node dissection.
切除肝脏受感染的区域
Remove the affected area of the liver,
周围的组织和我们找到的所有肿胀的淋巴结
all the surrounding tissue, and every swollen node we find.
这是一种很激进的做法
And that's the aggressive approach.
恢复时间更长出现并发症的风险很高
Longer recovery time, high risk of complications,
而且
and, uh,
不可否认是战胜癌症最好的方法
admittedly, the best shot at beating the cancer.
你说的并发症是指几乎没有肝脏功能
By "complications," you mean a barely functioning liver,
持续的致命出血和慢性疼痛的威胁
a persistent threat of fatal bleeds, and chronic pain.
外科医生可以说切除他的内脏
As surgeons, you can gut him,
但作为他的主要负责医生我必须在
but as his primary doctor, I have to find the balance
寿命和生活质量之间找到平衡
between longevity and quality of life.
上周你还想在观摩室里做手术
Last week, you were trying to perform surgery from the gallery,
现在你就讨厌外科医生了
and now you hate surgeons.
站好队吧
Pick a side.
逐步解决的方式对比利没有用
A piecemeal approach is not going to work with Billy.
每当我们想解决一个问题时
Every time we try to solve a problem,
都会发现其他的问题
we discover another one.
你可能把宗教信仰丢在了布鲁克林
You may have left your religion in Brooklyn,
但你总是在随机事件中寻找意义
but you keep looking for meaning in random events.
骰子没有记忆
The dice have no memory.
我没有寻找意义我在寻找模式
I'm not looking for meaning. I'm looking for patterns.
也许他有什么潜在疾病
Maybe he's got some underlying condition.
我同意亚舍
I agree with Asher.
骰子没有记忆但可以给它们加载记忆
The dice have no memory, but they can be loaded.
那是选择安全但让身体严重受损的方法
So... safe and seriously compromised
还是激进但有可能会死的方法
or aggressive and possibly dead?
布朗医生你的病例
Your case, Dr. Browne.
你决定
Your call.
你感觉如何
How you feeling?
你牺牲了很多
You sacrificed a lot.
你的手你的职业生涯
Your hands, your career.
而且你在拿我和克莱尔
And you're taking it out on me and Claire
还有整个外科职业出气
and the whole surgical profession.
我明白这很痛苦
I get it. It hurts.
你真可悲
You're pathetic.
你担心我是因为我做不了外科医生了吗
You're worried about me because I'll never be a surgeon?
呜呜
Boo-hoo.
你担心我是因为我喜欢跟
You're worried about me because I took pleasure
你和克莱尔捣乱吗
in screwing with you and Claire?
我就是这样的人
That's who I am.
问题是你是什么样的人
The question is, who are you?
你不会为迟到找些愚蠢的借口
You don't show up late with lame-ass excuses,
如果有人看不起你你会也看不起他所以
and when you get dissed, you diss back, so...
你感觉如何
How are you feeling?
当我没问
Forget I asked.
他失去了大部分羊水
He's lost most of his amniotic fluid.
在子♥宫♥里活不久了
Won't last very long in utero.
我们为帮助弱小的胎儿而伤害强壮的胎儿
In helping the weak, we hurt the strong.
剖腹产呢
C-section?
如果我们做剖腹产来挽救强壮的胎儿
If we do a C-section to save the strong baby,
弱小的胎儿有90%的可能性会死
there's a 90% chance the weak baby will die.
但如果我们做羊膜腔灌注术来挽救弱小的胎儿
But if we do an amnioinfusion to save the weak baby,
强壮的胎儿有85%的可能性会死
there's an 85% chance that strong baby will die.
这是更好的选择
It's the better option.
5%的几率来决定哪个婴儿能活吗
5% to decide which baby lives?
肯齐的身体已经做出选择了
Kenzie's body has already made that choice.
如果两个婴儿一强一弱
If there's a strong baby and a weak baby,
那么咱们该救哪一个就显而易见了
it's pretty clear which one we save.
这就是优胜劣汰吧
Survival of the fittest.
不好意思只是
Sorry. It's just...
那并不是我们作为文明人的意义
That's not really what we're about, is it,
不是吗
as a civilization?
道德上来讲强者没有义务帮助弱者吗
Aren't the strong morally obligated to help the weak?
如果没有那不是所有人都会每况愈下吗
And if they don't, isn't everybody ultimately worse off?
两个婴儿都不用死
Neither baby has to die.
延迟性间隔分娩
Delayed interval delivery.
我们进行引产先接生更强壮的婴儿
We induce labor, deliver the strong twin,
然后停止分娩让较弱的婴儿继续留在子♥宫♥里
then stop the labor to keep the weak twin in utero
让他的肺部发育成熟
until his lungs mature.
停止分娩的几率太低了
The chances of stopping labor are very slim.
没错有70%的可能
That's true. There's about a 70% chance
两个婴儿都会死亡
that both babies would die.
所以这个是最差的一个选择
Which makes it the worst possible choice.
我们得问问肯齐
We need to ask Kenzie.
不不行
No, we don't.
一旦她知道了还有一点点机会
Once she hears there's the slightest chance
能够把两个婴儿都救活
of saving both babies,
她就不会再听任何备选方案了
she won't listen to any alternatives.
数据上看这个选择很糟糕
Statistically, it's a terrible option.
但也是个选择
But it is an option.
不不你不是真的在问我这个吧
No. No, you can't seriously be asking me this.
我知道没有母亲该做这样的决定
I know that this is something no mother should ever have to decide.
现在没有好的选择
There are no good options here,
但还是有个选择有很大的可能性让你成为
but there is one that'll most likely make you the mother
一个健康男婴的母亲
of a healthy baby boy.
好吧
Okay.
准备进行羊膜腔灌注术
Prep for an amnioinfusion...
你给他们起名字了吗
Have you named them?