良医

The Good Doctor S05E06

Part 3 Nov. 20, 2021, 8:50 p.m.

并帮助他的大脑恢复
to try to help his brain recover.
他要多久才能恢复
And how long will that take for it to recover?
很难说
It's... It's hard to say.
根据他的伤势很可能
What's more likely, given the extent of his injuries
恢复不了
is that it won't.
而且会发展为脑死亡
And he will progress to brain death.
我这周还想给他打电♥话♥的
I thought about calling him this week.
好解决些问题
So we could work through some stuff.
嗯这样的电♥话♥
Yeah, those are...
确实不容易打
...tough calls to make.
我们已经两年没说过话了
We haven't talked in about two years.
自从他从安那波利斯军校退学后
Since he dropped out of Annapolis.
他放弃学业想做个
Instead, he was gonna be a
鼓手
drummer.
你♥爸♥爸一定很为你骄傲
Your dad must be very proud of you.
他希望我成为拉比
He wanted a rabbi.
而且是直男拉比
A st-straight rabbi.
这两方面我都让他失望了
I failed at both,
所以他跟我断绝关系了
so he disowned me.
我真的需要跟我儿子再谈一次
I really need to talk to my son again.
我们会尽一切努力实现你的愿望
We're trying everything we can to make that happen.
打扰一下
Knock, knock.
你看到我发给你的妮拉的治疗方案了吗
Did you see the proposal I sent you about Nira's treatment?
看到了
Yes.
非常有野心
Very ambitious.
而且也很贵
And also quite expensive.
如果质子束放疗能成功
If the proton beam radiotherapy is successful,
我们就能保留妮拉全部的视力
we'd save 100% of Nira's vision.
我们绝对能拿到她们公♥司♥的合同
We'd definitely win the company's contract.
这是合理的医疗决定
Reasonable medical decision.
但是糟糕的商业决定
Bad business decision.
设备和治疗的成本比
The cost of the equipment and treatment
那份合同的价值
is several hundred thousand dollars more
还要高几十万美元
than the value of that contract.
你已经有了一种完全可接受的治疗方案
You have a perfectly acceptable treatment
食品药品管理局许可她的医保又能报销
that's FDA approved, covered by her insurance,
也可以拯救她的生命
and saves her life
还能保留她60%的视力
while preserving 60% of her vision.
我很确定这已经足够让你拿到那份合同了
I'm fairly certain that's all you need to secure the contract.
我们的客户有权知道她的所有选择
Our client deserves to know all of her options.
你是她的医生
You're her doctor.
做你觉得对的事
Do what you think is right.
但我们得协议只有在
But our deal only stands
你让门诊盈利的情况下才能生效
if you make the clinic profitable.
就像心形手套一样合适
It's gonna fit like a heart-shaped glove.
我们看看你带着多少积液奥利
Let's see how much excess fluid you're lugging around, Ollie.
好吧整周都不吃盐和喝汽水
Well? No salt and no soda all week.
你知道雷龙的心脏有
And did you know the brontosaurus had
136千克重吗
a 300-pound heart?
想象一下它的心跳是什么样的
Imagine what that sounds like.
可能是「轰隆轰隆」
Probably like "ka-boom, ka-boom!"
看看这个
Check this out.
这是我的新护身符
It's my new lucky charm.
是三角龙的脚趾
It's a triceratops toe.
它有六千五百万...
It's, uh, 65 million...
岁了
...years old.
你胸口疼吗奥利
Is your chest hurting, Ollie?
我需要护士和体外膜肺氧合团队马上
I need a nurse and the ECMO team, stat!
波士顿的这位医生使用
Oh, this doctor in Boston used
外部引流来降低颅内压
an external drain to lower pressure in the brain.
算了病人去世了
Never mind. The patient died.
也许我们可以尝试用偏侧颅骨切除术开
Well, maybe we can try to relax brain pressure
释放颅内压
with a hemicraniectomy.
他也挺不过这个手术
He wouldn't survive that surgery either.
你们的病人有什么进展吗
Made any progress with your patient?
还没
Not yet.
你有跟家属谈过器官捐赠的事吗
H-Have you discussed organ donation with his family?
没有
No.
他的情况不稳定器官坚持不了太久
In his fragile state, his organs won't last long.
肖恩无论如何这都将是个悲剧
Shaun, this is a tragedy no matter how it ends.
你在违反规定
You are breaking the rules.
我病人的情况每况愈下
My patient is getting weaker by the minute.
停
Stop.
器官接受者的医生
An organ recipient's doctor
不该和可能的捐献者的医生沟通
is not allowed to communicate with a potential donor's doctor.
我是以朋友的身份跟你聊
I am talking to you as a friend.
你无法救所有人
You can't save everyone.
如果你的病人救不回来了让我救我的
If your patient is gone, let me save mine.
离开这不然我会向器官资源共享网络
Go away, or I will report you to UNOS,
举报你而你将失去移植资格
and you'll lose your transplant privileges.
现代神经生理学医疗方法
-肖恩 -你迟到了
- Hey, Shaun. - You're late.
航♥班♥晚点了座位特别挤
Yeah, the plane was late and cramped
空气也不流通我饿坏了
and devoid of refreshments, and I'm starving.
去吃点薄煎饼吗
You ready to get some pancakes?
我得处理我的神经生理学考试
I need to fix my neurophysiology test.
挺好
Okay, well, uh, great.
-能边吃边弄吗 -不行
- Can we do it while we eat? - No.
这道题我答对了
I answered this one correctly.
-看看我的回答 -我知道这分数
- Check my work. - I understand that it's not...
-不够好 -看看我的答案求你了
- not a perfect score, but... - Check my work, please. Check it.
-第五题 -好吧好吧
- Question 5. - Okay, okay.
是应该选A 不过也可以选C
Yeah. It should be A, but, uh, it could also be C.
但是颈内动脉分支
But the internal carotid arteries branch.
这词是有点奇怪
It is worded a little strangely.
我也会弄错的
I would have gotten it wrong, too.
对方丹教授错了
Yes, Professor Fontaine is wrong.
你得跟他说
You need to tell him that.
我不会让教授去改试♥卷♥问题的
I'm not gonna tell a professor to rewrite his test question.
但是关于血如何流入
But he is wrong about how blood flows
幕上脑他是错的
into the supratentorial brain!
那又怎样肖恩
So what, Shaun?
这只是个考试我快饿死了
It's just a test, and I'm starving!
你去吃饭
You go eat.
我要去找教授
I'm going to see my professor.
肖恩
Shaun.
颈内动脉
The internal carotid arteries.
那里好像没什么问题
I don't see any issues in that area.
藏在肿胀和其他损伤
You wouldn't, if there is a very small dissection
之后的小损伤是看不到的
hidden by all the swelling and other damage.
支架会增加幕上脑的血流
Stents could increase circulation to his supratentorial brain,
或许能把他唤醒
which might wake him up!
妮拉
Nira?
我找到了一种术式
I found a surgery.
不仅能从你的眼后
It's not only going to remove the tumor
去掉肿瘤还能挽救
from behind your eyes, it will also be able to save...
六成的视力
...60% of your vision.
谢谢
Oh, thank you.
就在这
There it is...
动脉上有个微小的撕裂
a tiny tear in the carotid.
好样的莫菲医生
Good catch, Dr. Murphy.
但是有个血栓
But there's a clot.
支架会使血栓膨胀
The stent could expand the clot,
会要了他的命
which could kill him.
要是用治疗剂量肝素
Not if we break up the clot
除掉血栓就没事了
with therapeutic heparin.
这样会有多器官大出血的风险
We'd be risking major bleeds in all his organs.
要是不给他用肝素他可能会脑死亡
If we don't give him heparin, he will end up brain dead.
我做住院医时
During my residency,
有个女子死在了手术台上
we had a woman die on the table.
器官健康没有联♥系♥信息