良医

The Good Doctor S04E09

Part 2 March 10, 2021, noon

pituitary mass went from manageable with meds
现在可能需要手术
to likely surgery.
所以跟新来的放射科住院医师聊天呢
So, talking to the new radiology resident, huh?
我拿难解的扫描图询问德苏莎医生
I wanted Dr. D'Souza's opinion on an intriguing set of scans.
她很有才华
She is very talented.
你迷上她了
You're crushing on her.
没有
N... no.
我没有我爱莉亚
I am not. I love Lea.
这两件事并不矛盾
Well, those two things aren't mutually exclusive.
古铁雷斯先生的血液中催乳素含量很高
Mr. Gutierrez's blood has high levels of prolactin.
催乳素在垂体中产生
Prolactin is produced in the pituitary gland.
可能是肿瘤分泌的
The tumor could be secreting it.
也可能是身体其他部位产生了高水平荷尔蒙
Or the tumor could be reacting to the high levels of hormones
肿瘤对其做出反应
being produced elsewhere in the body.
病人是个跨性别者
The patient is a transgender man.
做超声检查
Do an ultrasound.
探针向内推进直到你能看见心腔
Advance the probe until you see the cardiac chamber.
扎拉可能因为肾血管疾病
Maybe Zara has secondary hypertension
患有继发性高血压
due to renal vascular disease.
她没有她的肌酸酐是1.2
She doesn't. Her creatinine is 1.2.
肾小球滤过率正常
Her GFR is in normal range.
只是理论上不会并不是不可能
Well, that would make it unlikely, but not impossible.
这也能解释
It'd also explain
为什么给她开的高血压药不起作用
why her prescribed hypertension meds weren't working
而你给她开了ACE抑制剂之后有所好转
and why she got better when you gave her that ACE inhibitor.
更简单的解释是她其实没吃药
Mmm. Simpler explanation, she's not taking her meds.
瓣膜看起来正常
Valve looks normal.
我要继续下一步做二腔观吗
Should I move on to the two-chamber view?
是的
Yeah.
我们没理由怀疑她撒谎
We have no reason to think that she's lying.
她对自己吸大♥麻♥的情况好像说的是真话
She seems to be telling the truth about her pot usage.
血液和尿液中都不含有四氢大♥麻♥酚
No THC in her blood or urine.
她绝对有其他事撒谎了
She couldn't possibly be lying about something else.
左心室厚度增加
The left ventricle is thickened,
证明没有治疗过高血压
which is consistent with untreated hypertension.
心率攀升
Heart rate's climbing.
心脏排血量在减少
Cardiac output is dropping.
每搏输出量也是
Stroke volume as well.
她出现了心源性休克
She's in cardiogenic shock.
你介意我给你做一个腹腔超声检查吗
Would you mind if I did an ultrasound on your abdomen?
因为脑肿瘤吗
For a brain tumor?
这是我的未婚夫伊莱·辛普森
This is my fiance, Eli Simpson.
当我听到新的扫描结果时
When I heard about the new scans,
我几乎快疯了
I kind of stormed the castle.
我的英雄
My hero.
你的催乳素水平很高
Your prolactin levels are very high,
可能是肿瘤引起的
which might be caused by the tumor,
除非有别的情况提高了你的催乳素水平
unless another condition raised your prolactin,
造成了肿瘤增生
encouraging more growth.
什么情况会促进催乳素分泌
What condition boosts prolactin?
你认为我怀孕了吗
Do you think I'm pregnant?
他不可能他在服用睾丸激素
He can't be. He's on testosterone.
除了上个月的几个星期
Except for a few weeks last month.
在我们旅行前我忘了注射激素
I forgot to take my shot before our trip.
但那也不可能
But there's no way that...
你怀孕了
You're pregnant.
你得了心源性休克
You went into cardiogenic shock
因为你的心脏没法有力地跳动
because your heart wasn't pumping adequately.
我们做了个小手术来安装一个分流泵
We did a minor procedure and installed an Impella pump,
但这只是缓兵之计
but it's a short-term solution.
我确实感到有点喘不上气
I do feel a little out of breath.
但我可能是因为看到你才这样的安德鲁斯医生
But that might be just 'cause of you, Dr. Andrews.
诺顿女士我已经结婚了而且我只是你的医生
Ms. Norton, I'm a married man and your doctor.
你的情况很罕见
You have a rare condition.
你心肌的某些部位
Certain parts of your heart muscle
变得异常肥厚
have become abnormally thick.
心室之间的心壁就是隔膜
So, this wall in between the chambers, that's the septum.
这是正常的样子
That's a normal one.
这是你的样子
This is what yours looks like.
这需要手术
It's gonna require surgery.
我们还需要更多化验来决定最佳方案
We're gonna run a few more tests to determine the best approach.
等等你是我的主治医生吗安德鲁斯医生
Wait. You gonna be my surgeon, Dr. Andrews?
我当然是
I sure will.
你们俩会跟他一起吗
And y'all two gonna be with him?
对啊
Yeah.
真是我的幸运日
My lucky day.
三个有色人种医生治疗我
Three doctors of color taking care of me.
而不是那种高高在上的医生
Doctors who won't talk down to me.
和我以前遇到的医生不一样
Not exactly what I'm used to.
你们懂我是什么意思
You guys know what I mean.
之前每次我妈妈带我去看儿科医生
My mother made me wear a suit and tie
她都会让我穿西装打领带
whenever we went to the pediatrician.
穿上最好的衣服
Put on your Sunday best
就是为了在人前表现得礼貌
just to get on the scale and touch your toes.
是啊气死我了我最后还是成了医生
Yeah. Made me so mad, I wound up becoming a doctor.
化验结果证实了
The testing confirmed
你的肿瘤是产生激素的催乳素瘤
your tumor is a hormone-producing prolactinoma.
你怀孕六周了
And the pregnancy is about six weeks along.
你考虑过自己是男同性恋吗
Do you consider yourself gay?
-我觉得这个问题 -当然
- I don't think that's... - Yes.
因为我就是男同性恋
Because I am gay.
但你和你未婚夫有阴♥道♥性♥交♥
But you have vaginal intercourse with your fiance.
-这就是他怀孕的原因 -墨菲医生够了
- That is how he got pregnant... - Dr. Murphy, that's enough.
-我只是想 -我觉得你该离开
- I... I just want... - I think you should leave.
我很抱歉
I'm sorry.
他的话很不合适
That was completely inappropriate.
我们对肿瘤的治疗计划
Our treatment plan for your tumor
取决于你们对怀孕的打算
depends on your plan for your pregnancy.
所以
So...
我们讨论过孩子的事情
We've talked about kids,
但我一直以为那是很遥远的事情
but I always figured that was way down the road.
而且也不该是这样
And not this way.
我一直想领养
I always assumed we'd adopt.
我本来已经不当T了也不再当T
I'd have go off T, and stay off.
如果里奥要中止妊娠
If Rio doesn't continue the pregnancy,
然后会怎么样
then what happens?
你的激素水平会骤降
Your hormone levels would drop quickly,
这会导致肿瘤缩小
which would cause the tumor to shrink.
然后我们会用药可能会有个小手术
After that, we'd use medication, possibly a minor surgery.
我想终止妊娠
I'd like to terminate the pregnancy.
我检查了扎拉所有的化验结果
I looked over all of Zara's labs.
所有迹象都指向
All signs point to her
她定期服用高血压药
taking her hypertension medicine regularly.
核磁共振显示心室内隔明显增厚
Her MRIs show significant ventricular septal thickness,
心脏射流严重紊乱
bad turbulence jet flow.
还有心肌水肿
There's myocardial edema, too.
用ACE抑制剂治疗不是个好主意
The ACE inhibitors were a bad call.
最终导致我们的病人心源性休克
Which eventually sent our patient into cardiogenic shock.
你为什么忽视她告诉我们的话
Why'd you ignore what she was telling us?
我根据模式化处理方式
I made a medical diagnosis
做出临床诊断
based on pattern processing
这就是医学院教的
that we're taught in med school,
它要你考虑种族教育
which involves considering, you know, race, education,
职业体重指数
occupation, BMI.
对我来说都是病例侧写
Always sounded like profiling to me.
没错今天有雨
Yes, we have the rain,
但是风力更大
but more impressively, the wind.
由于风大将产生横向雨
That rain's going to be coming in sideways.
今天一天
Just take a look at how the wind increases
风力将持续加大
as we progress throughout the day.
所以预计到今天下午