良医

The Good Doctor S05E16

Part 2 June 30, 2022, 10:49 a.m.

嗯对不起但你不是尚恩
Um, sorry, but you're no Shaun.
除了他之外没有人能够做尚恩的视觉
Nobody can do Shaun's vision thingies but him.
这是他的超能力
It's his superpower,
好像他有一个 X 射线、MRI 和 CT
like he has an X-Ray, MRI, and CT
同时在他的脑子里都有齐
all in his head all at the same time.
我永远无法做到这一点
I'm never gonna be able to do that.
但我从观察尚恩中学到的是
But what I've learned from watching Shaun is,
找出你擅长的东西并专心致志
figure out what you're good at and lean into that.
你的超能力是什么
What's your superpower?
你有多少时间
How much time do you have?
手术很成功
The surgery was a success.
我们能够消除所有不能生存的组织
We were able to eliminate all non-viable tissue
并使用自体移植覆盖整个
and use autograft over the entire
烧伤的表面
burn surface area.
他们在这里做什么
What are they doing here?
他们正在给我录像他们会模糊掉你的脸
They are taping me. They will blur out your face.
我什么时候能看到我的家人
When can I see my family?
护士正在带他们来他们应该很快就到了
The nurse is bringing them. They should be here shortly.
很痛
That hurts!
你正在服用强效静脉麻醉剂
You are on strong IV narcotics,
而且移植物应该仍然是麻木
and the grafts should still be numb.
请停止
Please stop.
停止
Stop!
痛啊
It hurts!
我没有碰你
I am not touching you.
有明显的肿胀和水肿
There is significant swelling and edema.
它正在拉动移植锚点
It is pulling on the graft anchor sites.
这完全讲不通
That doesn't make sense.
妈咪
Mommy?
是的
Yes.
宝贝
Baby.
我在这里
I'm here.
我想回家
I want to go home.
我不能这样做好吧好吧好吧
I can't do this. Okay, okay, okay.
你好丹娜的自体脂肪采购
Hello. Dana's autografts were procured,
摆放的位置、固定都是完美
placed, and secured perfectly.
我们在术前开始静脉注射 Ancef 抗细菌药并在术后继续
We started IV Ancef before surgery, continued post-op,
并确认所切除的组织中没有阳性培养
and confirmed none of the tissues removed had positive cultures.
移植物不应该失败
The grafts should not be failing.
你有没有保持她的伤口敷料的湿润
Did you keep her wound dressings moistened?
是的而且她的水肿情况越来越严重
Yes, and her edema is getting worse,
即使在更换了敷料之后
even after replacing dressings.
你需要去仔细检查她的实验室结果
You need to go double-check her labs.
我知道我做了什么
I know what I did.
我记住了病人病历上的所有数据
I memorize all data in my patient charts.
你是否使用在所有自体移植部位了正确的
Did you use proper sterile technique and prep
无菌技术和准备工作
on all autograft sites?
是的
Yes.
充分的液体复苏和补充损失
Adequate fluid resuscitation and replacement for losses?
我每隔一段时间就检查尿量和中心静脉压
I checked urine output and central venous pressure every...
每...小时但她真的很不舒服
Hour, but she was really uncomfortable,
所以我跳过了一次但我不认为...
so I skipped one, but I don't think...
不你不能跳过步骤
No, you cannot skip steps.
去复检每一个生命体征检查
Go review every vitals check,
所有尿量的进出以及每一个 CVP
all urine output ins and outs, and every CVP.
嘿我的手下告诉我说你以前是蓝帽子
Hey. My boys tell me you're a former brother in blue.
当了 15 年的更
Walked the beat for 15 years.
我们能不能私下谈谈
Can we talk privately?
哦我们这里都是手足
Oh, we're all squad here.
格林德你的 CT 显示你有一个不稳定的腰椎骨折
Grant, your CT showed you have an unstable lumbar fracture.
你将需要广泛的后续融合手术来稳定它
You'll need extensive posterior fusion surgery to stabilize it.
我还要多久才能恢复工作
How long before I'm back on the job?
几日后你就可以站起来走路了
You'll be up and walking in a few days.
但在这种融合之后你的脊柱...
But after this kind of fusion, your spine...
你将不能再成为一名消防员
You won't be able to be a firefighter anymore.
那么你需要想出一个不同的计划
Then you need to figure out a different plan.
这是最安全的手术
This is the safest surgery.
你的腹部损伤带来了太多的风险我们无法...
Your abdominal injury poses too many risks for us to...
我们为了救人而跑进燃烧的建筑物
We run into burning buildings for a living.
我不惧怕风险
I'm not afraid of a risk.
我相信你能让我回到我的团队中
I trust you to get me back to my team.
你还好吗
You okay?
我只是在仔细检查我们病人的实验室工作
I'm just double-checking our patient's lab work.
那对于实验室工作有点情绪化
That's some emotional lab work.
尚恩认为我造成了我们病人的移植问题
Shaun thinks I caused our patient's graft issues,
而且他在镜头前这样说
and he said so on camera.
而我...
And I'm...
我对自己跳过一个步骤感到非常生气
I'm so angry at myself for skipping a step.
但我不认为是我造成的水肿
But I don't think I caused the edema.
对今日早上的事情感到抱歉
Sorry about this morning.
艰难的一日是的
Rough day. It happens.
我需要得到批准
I need approvals.
我们上周实施了一个新系统
We implemented a new system last week.
你是在用旧的
You're working off the old one.
我很抱歉我不知道
I'm sorry. I didn't know.
你在训练日迟到了重做吧
You were late on training day. Redo it.
也许也不要在地面接听个人来电
And maybe cool it with the personal calls on the floor.
请让这成为一个实际的医学问题
Please let this be an actual medical issue.
我的病人拒绝接受后路融合手术
My patient's refusing posterior fusion surgery.
我们需要一个能让他重新站起来的替代方案
We need an alternative that will get him back on his feet.
后路融合会让他站起来
Posterior fusion would get him on his feet.
他坚持想把人背在身上
He just wants to carry someone on his back.
我们可以尝试通过他的腹部进行腹腔手术
We could try ventral surgery through his abdomen.
L3 很难到达腹腔——
L3 is hard to get to ventrally,
即使一切都很完美
even if everything was perfect.
但是如果我们尝试采用经颅的方法
But if we try a transpedicular approach,
我们可以做一个后置的椎体支架
we could do a posterior cage placement
和短节段手术
and short segment surgery.
有灾难性神经损伤的风险
There's a risk of catastrophic nerve injury
或因放置太大的椎体支架而
or an uncontrollable bleed
无法控制的出血
from placing too large a cage.
你会尝试吗
Would you try it?
你的病人你的决定
Your patient, your call.
我最喜欢尚恩的什么
What do I love most about Shaun?
我无法选择
I can't choose.
他很聪明而且很有趣
He's brilliant, and he's so funny.
他让我感到安全
He makes me feel safe.
我知道无论发生什么他都在我身边
I know no matter what happens, he's there for me.
而且他超级可爱
And he's super cute.
尚恩你最喜欢莉亚的什么
Shaun, what do you love the most about Lea?
尚恩
Shaun.
我爱...
I love...
她高兴时眼睛会皱起来
That her eyes crinkle when she is happy
或悲伤或愤怒或担心
or sad or angry or worried.
而且我知道哪个是什么意思
And I know which one means what.
你知道我的眼睛会皱吗
You know my eye crinkles?
这意味着她很高兴
That one means she is happy.
是的
Yes.
我仔细检查了每一个记录的生命体征
I double-checked every recorded vital sign
和每小时的尿量
and hourly urine output.
所有这些都表明有足够的血压维持移植物的厚度
All suggest adequate blood pressure to maintain graft profusion
并且没有液体超载的迹象
and no signs of fluid overload.
我不知道是什么原因造成的
I don't know what caused it,
但丹娜的水肿和移植问题不是我的错
but Dana's edema and graft issues are not my fault.
我需要检视你的录像
I need to see your footage.
停止
Stop.
从那里开始播放
Play it from there.
移植物不应该失败
The grafts should not be failing.
一定是出了什么问题
Something must have gone wrong.
我需要答案来解决这个问题请倒回去
I need the answers to fix it. Please rewind.