良医

The Good Doctor S04E14

Part 5 April 21, 2021, 9:05 a.m.

It was late and she fell asleep watching TV.
她起身上厕所突然头晕
She got up to use the bathroom and got light-headed
然后差点昏倒
and then almost fainted.
我觉得我只是累了
I think I was just exhausted.
后来又发生过吗
Did it happen again?
几乎没有
Uh, hardly ever.
在过去几年只有几次
A couple times, over the last few years.
在你的病历里没有提到这个
There is no mention of this in your medical record.
我告诉过我的内科医生
I told my internist.
他说一些更年期女性会有这个症状
He said it happens to some women during menopause.
你还有其他由更年期
Have you experienced other symptoms
引起的症状吗
that were attributed to menopause?
当然
Of course.
告诉我有哪些什么时候开始的
Tell me what they are and when they started.
我有些便秘和睡眠问题
Um, I think I had some constipation and sleep issues.
-什么时候持续多久了 -我不知道
- When? How long? - I-I-I don't know.
我不记得了
I don't remember.
我告诉医生他跟我说不用担心
I-I told my doctor, and he told me not to worry about it.
他跟我说别在意我照做了
He told me to forget about it, so I did.
威廉姆斯夫人
Mrs. Williams.
我有个十分紧急的问题一定要跟你谈谈
I have an urgent problem I have to talk to you about.
得等轮到你再说你是
You'll need to wait your turn, Mr., uh --
我是肖恩·莫菲医生
I am Dr. Shaun Murphy.
我需要一些关于琴·斯塔扎克的答案
I need answers about Jean Starzak.
她曾经是你的病人现在是我的
She was your patient. Now she is my patient.
莫菲医生如果你能等等我们可以私下聊聊
Dr. Murphy, if you can wait, we can talk in private.
好行
Okay. Yes.
你漏记了很多琴的症状
You failed to chart many of Jean's symptoms --
便秘睡眠障碍
constipation, sleep disturbances,
潮热性♥欲♥减退
hot flashes, reduced libido.
她不确定是否记得所有的症状
She's not sure she remembers all of her symptoms
或者它们开始于何时所以我们没法弄明白
or when they began, so we cannot figure out
她到底怎么了
what is wrong with her.
听起来像是更年期
Sounds to me like she's in menopause.
你是个很棒的诊断专家威廉姆斯夫人
You're a talented diagnostician, Mrs. Williams.
不她不是
No. She's not.
更年期没法解释她最近的血压问题
Menopause doesn't explain her recent blood pressure issues.
斯塔扎克夫人的病历谢谢
Mrs. Starzak's chart, please.
上面没写
It's not in there.
她提到了几次夜间眩晕的经历
And she mentioned several episodes of nighttime dizziness,
我认为是癫痫
which I believe were seizures.
这里记录的足以让我想起
What is in here is enough to remind me that
眩晕是由于更年期
the dizziness was menopause --
排尿晕厥而不是癫痫
Micturition syncope, not seizures.
血压问题也早就有了
And the blood pressure issue isn't new.
但也只能说明
But also isn't a symptom of anything
她对于强迫性退休很焦虑
besides her anxiety about forced retirement.
不是
It wasn't...
她在手术时发作了
I know it happened during surgery.
她不紧张而是无意识的
She wasn't anxious. She was unconscious.
我的女儿是永远不会来找你看病的
My daughter is never coming to see you.
症状血压降低髋/关节疼痛可能原因
根据《临床内分泌学》的这篇文章
According to this piece in "Clinical Endocrinology",
琴的症状很像是阿狄森氏病
Jean's symptoms match pretty well with Addison's disease.
她没有色素沉着过度
She doesn't have hyperpigmentation,
或者体重下降的症状
or weight loss.
-不是所有的病例都 -皮质醇水平正常
Not all cases presented with -- Cortisol levels are normal.
最近有几个病例研究
There have been several recent case studies
把甲状腺功能减退和术后的低血压症状联♥系♥起来
correlating hypothyroidism with low post-op BP.
琴的促甲状腺激素很高
Jean's TSH is borderline high.
但是她的甲状腺荷尔蒙在正常范围内
But her thyroid hormone is in the normal range.
那是睡眠呼吸暂停症吗
What about sleep apnea?
我读到有个病例有血压骤降的症状
I read about a case involving BP crashes.
有趣
That's interesting.
琴不是典型的暂停症身体类型
Mm, Jean's body type isn't typical with apnea,
但我们可以问问她是否打呼噜
but we could ask about snoring.
我想看看那个病例的资料
I would like to see that case literature.
这不是一个常规的病例记录
It's not a conventional case write-up.
是我在红迪网[投票网]上看到的帖子
I saw a post on Reddit.
哪个小组
What subgroup?
妇女健康社区
The women's health community.
这是不科学的
It's not scientific.
完全不科学这没用
At all. It's not helpful.
但这些也不是
But neither is this.
这里什么都没有
There is nothing here.
医疗机构没有研究这些事
The medical establishment isn't looking into this stuff.
是像琴这样被忽视的女人
It's ignored women like Jean,
她自己的医生都没有记录她的症状
as demonstrated by her own doctor not charting her symptoms.
确实如此但依靠帖子收集证据
That is true, but is still a bad idea
仍然是个坏主意
to rely on anecdotal evidence.
我同意你的看法
I agree with you.
如果你有更好的主意我很乐意接受
If you have a better idea, I am happy to go with it.
继续检索红迪网
Keep checking Reddit.
克莱尔你能看看社交媒体的帖子吗
Claire, can you look at social media postings?
我去看看博客
I'll check out the blogs.
你更改了个人资料的照片
You changed your profile picture.
-太难看了 -它看起来像我
- It sucks. - It looks like me.
我又没有把你的头安到别人身上
It's not like I photoshopped your head on someone else's body.
如果我要贩卖♥♥自己
If I'm gonna sell myself,
我至少想贩卖♥♥真实的我
I at least want to sell who I actually am.
回复你帖子的女人才不在乎真实的你
The women who answer your posts don't care who you actually are.
根据这张照片我觉得是你不知道自己是谁
And based on this photo, I don't think you know who you are.
你在读普鲁斯特吗
You're reading Proust?
一旦昂丹司琼生效你应该会开始感觉好些
Once the ondansetron sets in, you should start feeling better.
正好赶上你的下一轮化疗
Just in time for your next chemo session.
我会坚持过去的
I'll get through it.
我相信你会的
I know you will.
但并不意味着你应该坚持
Doesn't mean you should.
太蠢了
It's dumb.
你表现得像个白♥痴♥是因为
You're acting like an idiot because you're less afraid
比起数月的疼痛和恶心你更担心被曝光
of months of pain and nausea than being exposed.
你营造了一个完美的门面
You've constructed a perfect facade,
而为了保持这个门面你会害死你自己的
and you're gonna kill yourself trying to preserve it.
但是坚强与保持「健康躯体」无关
But being strong has nothing to do with being "The Body."
跟我的粉丝们
Tell that to my fans.
和我的赞助商说去
My sponsors.
我想你应该告诉他们
I think you should.
告诉他们这些都不能让你成为男人
Tell them none of this makes you a man.
现在的你和当初那个
You were just as brave and strong
胖胖的受到霸凌但是决心改变的小孩
back when you were a fat, bullied little kid
一样的勇敢
that decided to make a change.
那孩子不需要别人告诉他
That kid didn't let other people tell him
他会是什么人或者他能做到什么
who he could be or what he was capable of.
现在的你不要让他失望
Don't let him down now.
安排手术
Schedule the surgery.
这个女人说她有慢性低血压
This woman says she had chronic low blood pressure
而她的医生把这归咎于她的「减肥癖」
and her doctors blamed it on her "weight loss obsession".
结果她得的是充血性心力衰竭
Turned out she had congestive heart failure.
这个女人的癫痫是由于怀孕引起的
This woman's seizures were attributed to her pregnancy.
她看了四个医生
She was on her fourth doctor
才被正确诊断出癫痫
before they correctly diagnosed her epilepsy.
我有发现
I got something.
这个女人和琴有着同样的症状
This woman spent years with the same symptoms as Jean,
多年后才被诊断为
before she was diagnosed.
帕金森病
Parkinson's Disease.
你恢复得很好病理结果显示边缘干净
You're healing well. Pathology results show clean margins.
你应该完全恢复体力
You should regain full strength
然后几个月内就能回到八角笼
and be back in the octagon in a few months.
非常感谢
Thank you.
我想给你们看一些东西
There's something I wanna show you.
「我的下一场战斗是乳腺癌」
"My Next Fight is Breast Cancer."