良医

The Good Doctor S04E20

Part 3 July 17, 2021, 10:02 p.m.

Wait, why did you ask me that?
说真的我们为什么要聊这个
Seriously. Why are we having this conversation?
你觉得我不诚实
You think I'm being dishonest.
那你觉得我在隐瞒什么
What do you think I'm hiding?
我不知道
I don't know.
但除了你对运动的过度需求之外
But between your excessive need to exercise,
你跟我在一起时电♥话♥响了
the alarms going off that you never answer
你从来不接
when you're around me,
还有你每晚都做噩梦
and the nightmares that you have every night,
你在隐瞒一些事
you're hiding something.
我们起床做准备吧
Let's get ready for the day.
你准备好开始了吗
You ready to start?
差不多了
Almost.
来这里的外国医生有三种
There's three kinds of foreign doctors who come down here.
第一种他们太过在乎
The first, they care too much.
所有他们救不了的人这会把他们压垮
All the people they can't save, it, uh, overwhelms them.
第二种又太不在乎这类人本身也有问题
The second care too little, and that has problems of its own.
而第三种
And the third group,
他们会想办法让自己保持距离
they find a way to distance themselves
这样他们才能做好自己的工作
so they can do their job.
我最好属于这一组
I better be in that group.
你自成一组
You're in your own group.
你那么在意
You care so deeply.
但那只会让你更强大
But that only gives you more strength.
谢谢
Thank you.
我们走吧
Well, let's go.
进入腹膜腔
Entering the peritoneal cavity.
手术
第三天
给我一个腹腔拉钩
I need a long retractor.
腹腔拉钩
Long retractor.
这不只是胆结石
That's not just gallstones.
有一个不可滑动的不规则形肿块
There is an immobile, irregularly shaped mass.
她得的是胆囊癌
She's got gallbladder cancer,
而且已经转移到肝脏表面了
and it's spread to the surface of the liver.
-手术时长会翻倍 -3倍
- It will double the duration of the surgery. - Triple.
至少要十二个小时
You're looking at 12 hours at least.
我得跟你们俩其中一个换
I'll need to swap with one of you.
不行我们都没有准备过
That's not possible. Neither of us are prepped.
换的话会让两个病患都有危险
It would be endangering two patients instead of one.
我们不能就这样缝合腹腔
We can't just close her up.
很不幸可以这么做
Unfortunately, we can.
抱歉但你从来没有主刀过这样的手术
I'm sorry, but you've never led anything like this.
我觉得应该让她继续手术
I think we should let her keep going.
最坏的结果能是什么
What's the worst that can happen?
-比死更坏吗 -这个病患本来就要死了
- Beyond death? - This patient was gonna die anyway.
克莱尔至少给了她一线生机
Claire at least gives her a fighting chance.
好
Okay.
呼吸机怎么不见了
What happened to the ventilator?
他们拿走了手术室需要
They took it away. They needed it for the surgery.
那些医生要用
The doctors needed it.
那些医生要用
The doctors needed it?
那护士呢
And where's the nurse?
护士
The nurse?
她在忙事情很多
Busy. Lots of work.
好吧
Okay.
我留在这里
I'll stay.
无论多久都在这里陪你
Stay here no matter how long it takes.
出什么事了吗
Is there a problem?
对那个病患回来了
Yeah. The patient returned.
里昂得腹疝的那个
León, the guy with the ventral hernia,
他昨晚自己办了出院上班去了
checked himself out last night and went to work.
他是建筑工人
In construction.
他疝气复发了情况有多糟
He reherniated? How bad?
约一英寸的肠道发生嵌顿可能缺血坏死
About an inch of bowel is incarcerated, probably ischemic.
不动手术的话没几天就会死的
He'll be dead in days unless we operate on him.
能让他插队到你的颅骨重建手术后做吗
Can you fit him in after your skull reconstruction?
这样两台手术风险都会很大
Not without big risks to both of them.
其他外科医生呢
What about the other surgeons?
别人要是有空我还会来找你吗
You think I'd be here if anyone else was free?
给他点吗♥啡♥
Give him some morphine.
要让他等到什么时候
Until when?
这很糟糕但是他活该
It sucks but it's his own fault.
我们跟他说了要静养
We told him he needed to rest.
他不是那种溜出去开派对的旧金山程序员
This isn't some tech bro in San Francisco waltzing out to party.
他需要保住这份工作不让家人饿死
He needed to keep his job and not watch his family starve.
如果我们给他手术就没法给别人手术
If we operate on him, we don't operate on someone else.
我给里昂手术
I'll operate on León.
我去年做了物理治疗效果很好
I've been doing P.T. the last year. It's been going great.
你真的觉得你搞得定手术
You really think you can handle the surgery?
我知道我可以
I know I can.
我觉得我可以毫无痛苦地搞定
I think I can do it without any pain.
我们要得做肝门阻断法做切除
We need to do a crush clamp resection.
-你之前有做过吗 -我见过一例
- Have you ever done one? - I've seen one.
在我实习的时候
When I was an intern.
放开血管
Freeing up the vein.
把肝蒂分成几瓣
Dividing the pedicles.
分离每瓣肝蒂
Separating the pedicles.
将它们横切下来
Transecting the segments.
好第二步
Okay. Step two.
看起来不是很理想
That doesn't look ideal.
是中线腹侧缺损
It's a midline ventral defect.
而且组织平面都很脆弱
Also, the tissue planes are friable.
我们要分离组织
We're gonna need component separation.
我切除后腹直肌鞘
I'm gonna cut the posterior rectus sheath,
分离腹外肌上的软组织
mobilizing soft tissue off of the external oblique fascia
然后把它切除
and then incise it.
股总动脉几乎完全阻塞
Common femoral artery's almost completely occluded.
我来准备动脉吻合口
I'll prep the inflow anastomosis site.
我有创伤后应激障碍
I have PTSD.
所以会做噩梦
I have nightmares because of it.
我通过健身来控制这些症状
I exercise to help me manage my symptoms.
手♥机♥上设的闹钟
And the alarm on my phone
是为了提醒我每天吃药
is to remind me to take my daily cocktail
氟西汀哌唑嗪和喹硫平
of Fluoxetine, Prazosin, and Quetiapine.
你能把移植的旁路放到皮下吗
Can you tunnel the bypass graft in the subcutaneous plane?
我用止血钳穿过去
I'll get a clamp through.
我有一个好朋友去年去世了
I lost a good friend a year ago
好几个朋友死于新冠
and then lost more to covid
然后很长时间里我都在否认自己的心病
and then spent a lot of time denying I had an issue.
逃避痛苦
Running from pain.
以后我希望能
In the future, I'm hoping to do
更多地奔向而不是逃避各种事情
more running toward things than away from them.
我准备好移植了
I'm ready for the graft.
轮到我了
Oh, it's my turn.
你太累了躺下休息吧
You're exhausted. You should lie down.
不不
No. No.
十分钟
10 minutes.
十分钟
Ten minutes.
我没事我下一轮休息
I'm good. I'll rest next.
我下一轮
Me next.
十分钟
10 minutes.
谢谢你
Thank you.
如果你要休息一下
If you need a break --
我没事有点抽筋而已
I'm fine. Just cramped a little.
我好了
I'm done.
我可以接手
I can take over.
这个腹侧壁缺损好大
This ventral wall defect is huge.
对
Yeah.
给我两个有齿直钳
Two Kocher clamps.
心率飙升
Heart rate is spiking.
血压下降她要不行了