良医

The Good Doctor S04E12

Part 2 April 21, 2021, 9:04 a.m.

也许会导致他手部的问题
maybe could cause the hand problems.
生孩子
利弊
如果有那么严重我们早就看到中风的征兆了
If it got that bad, we'd have already seen signs of a stroke.
还有人因为我们浪费这么多资源去确认
Anyone else annoyed that we're wasting
明显是腕管综合征的诊断而烦恼吗
all these resources to confirm what's clearly carpal tunnel?
他可能是个混♥蛋♥ 但他是个伟大的医生
He may be a jerk, but he's a great doctor.
如果塞拉斯·钱伯斯有医疗意见
If Silas Chambers has a medical opinion,
我们最好查清楚
we better check it out.
我觉得他不是混♥蛋♥
I didn't think he was a jerk.
安德鲁斯医生和利姆医生也会批评我们
Dr. Andrews and Dr. Lim also criticize us
也会有特殊的要求
and have particular demands.
对他们想让我们进步
Yeah. They want us to improve.
你怎么知道钱伯斯医生不想让我们进步
How do you know Dr. Chambers doesn't?
他确实让恩里克进步了
He did improve Enrique.
没开玩笑
Not kidding.
你看着时髦了
You look snazzy.
我知道钱伯斯医生有什么病了
I know what Dr. Chambers has.
我们都很难找到你丈夫疼痛的
We're having trouble finding a physical basis
身体原因
for your husband's pain.
而且我之前问他止痛药的事时
And you defended me when I asked him
你帮我辩解过
about painkillers earlier.
几年前奥斯卡在工地
A few years ago, Oscar was on a job site.
疯狂加班
Working crazy hours.
累得不行
He was exhausted.
他用钉枪射到了自己
He shot himself with a -- with a nail gun.
射穿了他的手掌
Right through his palm.
我们当时没有医保
We didn't have insurance,
所以我们去了个诊所然后...
so we went to this clinic, and, um...
开了类鸦♥片♥药物
Opioids?
真的很糟
Really bad.
他花了一年时间才戒掉
Took a year for him to kick.
现在他吃的药比以前更多了
Now, um...he's taking more pills than ever.
我只要劝他寻求帮助
Whenever I talk to him about getting help,
他就会生气
he just gets mad.
我
I, uh...
我上周不得不搬出去了
I had to move out last week.
我来这里只是因为他要我来
I'm only here because he asked me to.
我觉得他是装的
I think he's faking.
你做手术的最后一天缝了113针
You threw 113 sutures in your last day of surgery.
其中有一半以上的针数
In at least half,
你的手都在非常细微的震颤
I detected a very subtle tremor.
恭喜你发现了我告诉过你的症状
Congratulations on discovering a symptom I told you about.
你伸直手腕缝针时会出现
It occurs during the part of your stitch
这种症状而你手腕弯曲时则不会
when the wrist is straight, not when it's bent.
这不是腕管综合征
That is not carpal tunnel.
这是音乐家的肌张力障碍
It is musician's dystonia.
我每次缝合时手腕都会弯曲
My wrist flexes on every suture.
你说的是几毫秒的差异
You're talking about a difference of milliseconds.
没错
Yes, he is.
你的病症可能是因为
Your condition was probably caused
你的重复动作引起的
by your repetitive technique.
就连安德鲁斯医生也会用不同的方法缝合
Even Dr. Andrews throws sutures in varied ways.
而你从来不会这种强迫行为
You never do. This kind of obsessive behavior
在自闭中患者中很常见
is common for those with autism.
所以我可以...
So, I can refer --
你说什么
What did you just say?
我没有自闭症
I'm not autistic.
莫菲医生没有冒犯的意思
Dr. Murphy didn't mean any offense.
他自己就患有自闭症
He himself is on the spectrum.
是吗
Oh, is he?
我还以为他攥紧双手像个机器人一样说话
I thought his robotic voice and hand clasping
是在装模做样呢
were just charming affectations.
你真觉得我跟他有一点相似的地方吗
Do you really think I am anything like him?
我没有说
I'm not saying that --
是的
I am.
你极其有条理
You're extremely organized.
几乎不做眼神接触
You hardly make eye contact.
考虑到你在食物毯子
And given your problems with food, blankets,
以及灯光的问题另外你在手术期间都要带耳机
and lighting, plus the fact you wear headphones even in surgery,
你很明显有感官上的问题
you clearly have sensory issues.
我有条理
I'm organized.
难道我应该随随便便出现在手术室吗
Would you rather I show up in the O.R. and just wing it?
我对于食物和音乐有品位
I have good taste in food and music.
这也算是精神疾病吗
Now that's a mental disorder?
至于眼神接触
And as for eye contact...
好
Okay.
我不是来这里做心理咨♥询♥的
I didn't come here for a psych consult.
他只是在观察
It was just an observation about a possible reason
导致你手部症状的可能原因
for the behavior that led to your hand symptoms,
这也是我们应该讨论的
which is what we should be talking about.
物理治疗是肌张力障碍患者的推荐方案
Physical therapy is the recommended course for dystonia.
我不会在没用的治疗上投入几个月的时间
I'm not wasting months on a treatment that won't work.
我要做丘脑前腹侧核的
I want an MRI-guided ultrasound ablation
磁共振引导超声消融术
of the VO nucleus of the thalamus.
你要跳过脑部手术吗
You want to jump to brain surgery?
我会直接快进到切断脚趾
I would jump right to amputating a toe
如果这能让我重返工作
if it got me my career back.
你在想什么
What were you thinking?
你刚刚还支持了我
You just supported me.
对因为工作不允许我在病人面前
Yes, because part of my job is not yelling at residents
冲住院医生大喊
in front of patients.
你像是看了一张模糊的核磁共振
What you did is equivalent to looking at a fuzzy MRI
就立马说病人有癌症
and blurting out a patient has cancer.
癌症是致命的
Cancer can kill you.
没有病人愿意听到这两句诊断
Neither diagnosis is one a patient is excited to hear.
准备送他去做消融术
Prep him for the ablation.
别再跟他说自闭症的事了
And do not talk to him again about autism.
他上个月已经看了六个医生了
He's seen six doctors in the last month,
拿到了三次类鸦♥片♥处方药
gotten three opioid prescriptions,
曾经有过类鸦♥片♥药物使用障碍
and he had a previous opioid problem.
典型的觅药行为
It's textbook drug-seeking.
这也是经典的傻瓜
It's also textbook "a bunch of dingbats
误诊三叉神经痛行为
missing a trigeminal neuralgia diagnosis."
他妻子同意我说的她了解他
Mm, his wife agrees with me. She knows him.
明白你的妻子为什么会离开你了
Would explain why yours left you.
说得好但是我妻子没有离开我
Snap. Except my wife didn't leave me,
没什么说服力也不算聪明
so neither a good point, nor even a clever one.
安排稳态采集快速成像得要好几个小时
FIESTA imaging would take hours to set up,
还会花病人很多钱
cost the patient serious money,
结果却还是正常
and still come out negative.
因为这是标准的觅药行为
Because...it's textbook drug-seeking.
还有其他病人需要我们
We have other patients who need us.
我要送他出院了
I'm sending the discharge order.
我讨厌粑粑
I hate poop.
如果我换尿布的时候犯恶心怎么办
Like, what if I suck at changing diapers?
也许我们得从更大的问题聊起
Maybe we should start with the bigger issues
再一个一个向下解决
and work our way down.
我不是特别担心这个
This isn't at the top of my list,
但因为你是个医生
but since you are a doctor...
肖恩的自闭症是不是
Shaun's ASD -- is it...?
遗传吗
Inheritable?
有可能
Probably.
但不清楚有多大的概率
But it's unclear how much.
如果那样的话
So, even that.
我该怎么办
W-What am I supposed to do with that?
好好想想
Think it through.
假如你有个小宝宝肖恩
Let's say you have a little baby Shaun.
小小的很真诚
Like...tiny, honest,
喜欢我的聪明小家伙
brilliant guy who adores me...
小小的衬衫
Mini button-down,