良医

The Good Doctor S04E11

Part 4 March 10, 2021, 12:01 p.m.

表示你也不是完全没天赋
which means you're not entirely without talent.
但是看看那些你不应该修复的骨头
But look at the bones you're not supposed to fix.
有什么是你的直觉告诉你
What are your instincts telling you
而操作手册却没有提到的吗
that this procedure manual isn't?
恭喜
Congratulations.
你现在跟新手一样好了
You're now as good as a Firsty.
我差点就为吃了你的冰淇凌愧疚了
I almost feel bad about eating your ice cream.
高压82 低压50 是脊髓休克吗
B.P.'s 82/50. Spinal shock?
体感诱发电位和运动诱发电位水平正常
S.S.E.P. and M.E.P. Waves are normal.
检查是否有变形
Check for buckling.
脊髓没有受压
No cord compression.
血压还在下降
Pressure's still dropping.
我们是在椎管里戳了个洞吗
Did we poke a hole in the canal?
把这些螺丝拿下来
Let's back out these screws.
不是脊柱的问题是他的心脏
Spine's not the problem. It's his heart.
心力衰竭上救生车
It's in failure. Crash cart!
纱布
Sponges
我知道丹妮为什么会醒过来了
I know why Dannie woke up.
副神经节瘤里充满了多巴胺
The paraganglioma was filled with dopamine.
有微量的泄露我们就是这么发现它的
And leaking it in trace amounts. That's how we found it.
但是当囊膜破裂
But when the capsule ruptured,
肿瘤泄露了大量多巴胺
the tumor released the dopamine in very large amounts.
他的脊椎穿刺显示每升有超过1200纳克
Her spinal tap showed over 1,200 nanograms per liter.
把她的整个大脑都泡在了多巴胺里
Which bathed her brain in dopamine,
因此激活了大脑让她醒了过来
which energized it and woke her up.
这就是个意外事件
It was just a freak event.
但只是暂时的
A temporary freak event.
多巴胺会耗尽
The dopamine's gonna wear off,
她的大脑会重新停止工作
and her brain will shut down again.
对而且让她保持清醒的剂量将会让她中毒
Yes. And the dose she'd need to stay awake would be toxic.
如果不能复♥制♥那个手术她就会重新陷入昏迷
If we don't replicate the surge, she'll relapse into a coma.
如果我们复♥制♥ 她就会死
And if we do, she'll die.
你的多巴胺水平正在快速下降
Your dopamine levels are dropping quickly,
当它们回归正常水平
and when they return to normal,
你会重新陷入昏迷
you'll return to your comatose state.
-什么 -不要
- What? - No.
看看她她很清醒啊
Sh-- Look at her. She's lucid.
她能说能笑她很好
She's talking and laughing. She's fine.
我很抱歉
I'm sorry.
就这样吗
Th-That's it?
没有治疗没有手术没有药吗
There's no treatment, no surgery, no medication?
-伊莱斯我们希望 -不要
- Elias, I wish we -- - No!
我还有多长时间
H-How long do I have?
不到24个小时
Less than 24 hours.
但是她可以再次醒过来是吗
But she could wake up again, right?
你们这次也没想到她能醒过来
I mean, you didn't think she would this time.
你们说她不应该醒过来的
You said she shouldn't have.
那一系列让她醒过来的巧合
The series of events that coincided to make this happen
不太可能再发生了
was so unlikely,
基本上可以说这是不会再发生的了
it is safe to say it will never happen again.
我想看别的医生
I want to see another doctor.
- 伊莱斯 -肯定有办法
- Elias. - There -- There must be some way --
我们总得面对
We have to face this.
为什么因为他们这么说了吗
Why? Because they say so?
听我说
Listen to me.
你就在这里
You're right here,
看着我握着我
looking into my eyes and holding my hand.
你哪都不会去丹妮
You're not going anywhere, Dannie.
我保证
I promise.
肌钙蛋白正常不是心力衰竭
Troponin's normal. It's not a heart attack.
没有心包积液的症状
Yeah, no signs of P.E.
心脏也没有凝块
No clots in the heart either.
心瓣正常心壁运动正常
Normal valves, no wall motion abnormalities.
但在他右室流入道S波和D波混合了
But he has S/D wave fusion on RV inflow.
他的心脏泵血不正常
His heart's not filling properly.
双腿肿胀
His legs are swollen.
血液没有从下半身回流
His fluid's not returning from his lower body.
他的身体结构适应了躯体的扭曲
His anatomy adapted to his contortions.
和正常的身体结构完全不一样
Nothing is where it started.
而现在移♥动♥到这个新姿势
And now, moving to this new position
可能会束缚住他的腔静脉
could be trapping his vena cava.
他的脊椎和胸骨
His spine and breastbone
正在挤压流向心脏的血液
are squeezing off blood flow to his heart.
静脉受到了压♥迫♥
The vein's compressed.
我们能用支架撑开它吗
Can we prop it open with a stent?
有太多的胸腔限制
There's too much chest-cavity restriction.
杰弗的身体不允许我们让他直起身
Jeff's body is not letting us straighten him out.
我们需要复原手术
We need to reverse the surgery.
已经没办法复原了
All the king's horses.
伊莱斯是时候去上厕所了
About time Elias took a bathroom break.
他每时每刻都在谈论你
He never shuts up about you.
我知道你喜欢滑雪不管是滑水还是滑雪
I know you love skiing, both water and downhill,
还知道你居然一天内在塔霍湖都玩了
and how you actually did both the same day in Tahoe
尽管水温只有9度
despite a water temperature of 48 degrees.
我知道你最喜欢的电影是《地球战场》
I know your favorite movie is "Battlefield Earth."
因为太烂反而挺好看我懂
So bad it's good. I get it.
还有你最爱的糖果这是我自己摸索出来的
And your favorite candy, well, that I got all on my own.
我也听说了小狗的事
I also heard about the puppies,
他在三只小狗中无法抉择所以他
how he couldn't decide between three of them, and so he --
把它们都带回家了
Brought them all home.
是啊
Yeah.
你是想说我是个幸运的女孩吗
Are you trying to tell me that I'm a lucky girl?
没事的
It's okay.
我知道我是
I know that I am.
我找到了我的灵魂伴侣
I found my soul mate.
人们还在用这个蹩脚的词吗
Do people still use that lame word?
他是个很好的人
He's a wonderful man...
他很难做出艰难的抉择
who has trouble making tough decisions,
而他的余生
and he's gonna spend the rest of his life
都要坐在你床边
sitting at your bedside,
听着呼吸机维持你生命的声音
listening to a ventilator keeping you alive.
这一切都取决于你
Which puts it all on you.
螺钉卡住了
Screw's stuck.
我试试腰板摊开器
I'll try a lamina spreader.
如果我们在这里做骨移植
If we do a bone graft here,
我们可以像以前一样重新融合第三椎骨
we can re-fuse the T3 vertebrae the way it was before.
再也不会跟以前一样了
It'll never be the way it was before.
我们在十五个不同的部位弄断了他的脊椎
We cracked his spine at 15 different levels.
他会变得更加扭曲更痛苦
He will be more contorted. He'll be more in pain.
T型手柄
T-handle.
漏斗胸
Pectus excavatum.
漏斗胸
Pectus excavatum.
如果你从没听说过
If you never heard of it,
不要担心这是非常罕见的
don't feel bad -- it's very rare.
漏斗胸的人出生时胸部中间就有一个凹陷
The person is born with a big dent in the middle of his chest.
有时候情况很糟糕
Sometimes it's so bad that the breastbone
因为胸骨会压♥迫♥心脏
presses against the heart,
你得打断胸骨
and you got to break away the sternum,
敲开肋骨用金属棒撑开
you got to crack open the ribs, prop it open with metal bars.
如果我们能帮杰弗做到这一点
If we can do that for Jeff,
我们就能在他的胸部创造足够的空间
then we can create enough space in his chest.
准备缝合我们把他转过来
Close him up. Let's turn him around.
这是不抢救预嘱
It's, uh, a DNR.
我不想再靠机器维持生命
I don't want to be put back on life support.
这样活着没有意义
That's not life.
你给了她这个
You gave her this?
但我签字了
But I signed it.
你还记得我们一起过的第一个情人节吗
You remember our first Valentine's Day together?
你给我的那个有两颗心的银吊坠
You gave me that -- that silver pendant with the two little hearts.
我告诉你我在考虑那份在波士顿的工作
I told you I was considering that job in Boston.