良医

The Good Doctor S05E17

Part 3 June 30, 2022, 10:49 a.m.

是的它是一个运作中的葡萄园和奶牛场
Yeah. It's a working vineyard and dairy farm,
所以莉亚饮酒尚恩饮 Jolly Sandy
so Lea drinks wine, Shaun drinks one percent.
你呢？
You?
呃一个面包机
Uh, a bread maker.
摩根拣的
Morgan chose it.
嗯我不知道他们对面包有兴趣
Mm. I didn't know they were into bread.
我相信他们会喜欢它
I'm sure they'll love it.
肾脏团队怎么样了？
How's Team Kidney?
只是有太多曲折的血管
There's just too many tortuous vessels.
如果不过度出血我们永远也做不到这一点
We're never gonna do this without excessive bleeding.
对那么我们还有甚么？
Right. So, what else do we have?
切除肾脏是最安全的选择
Removing the kidney is the safest option.
让他在余生中进行透析？
Putting him on dialysis for the rest of his life?
这可能是我们唯一的选择
It may be our only option.
危地马拉的透析...
Dialysis in Guatemala...
陆祖会被送进机构
Lucho would be institutionalized.
你需要想出一个更好的计划
You need to come up with a better plan.
我建议穿过后墙
I like going through the posterior wall.
它使我们能够最好地接触到肿瘤
It gives us the best access to the tumor.
我们会切开大量的组织
We'd be cutting through a massive amount of tissue.
那不是会严重削弱他的心肌吗？
Wouldn't that seriously weaken his heart muscle?
不像肿瘤那么多
Not as much as the tumor will.
嘿有甚么进展吗？
Hey. Making any progress?
呃你告诉我
Uh, you tell me.
嗯这将减少他的心输出量
Hmm. It'll decrease his cardiac output.
不像肿瘤会那么多
Not as much as the tumor will.
这也是我想出的手术方案
It's the same surgical plan that I came up with.
这就是为甚么我研究了一个非手术计划
Which is why I've looked into a non-surgical plan.
MTOR 抑制剂
M.T.O.R. inhibitors.
经证实对缩小小肿瘤有效
Proven effective at shrinking small tumors
就像陆祖心中的那个
like the one in Lucho's heart.
这些药物需要几个月才能发挥作用
Those meds take months to work.
几个月陆祖有的
Months that Lucho will have
因为心脏手术不会杀死他
because the heart surgery won't have killed him.
在其他手术中他的心脏仍然会受到压力
His heart will still be stressed during the other surgeries.
他可能会在手术台上发生心脏骤停
He could have a cardiac arrest on the table.
这就是为甚么我们会有非手术团队
Which is why we'll have a non-surgical team,
摩根和阿什在手术室观察是否有心律失常
Morgan and Asher, in the O.R. watching for any arrhythmias.
林医生呢？
What about Dr. Lim?
她被提拔到大脑团队
She's been promoted to Team Brain.
好吧我希望它能伴随着加薪
Well, I hope it comes with a raise.
我可以告诉你昨天晚上和我的男朋友在一起
I could tell you everything that was happening
所发生的一切
with my boyfriend last night,
但我知道你不想听借口
but I know you don't want to hear excuses.
我很同情家里的情况不好
I'm sympathetic that things are bad at home,
但病人有权因此死亡
but a patient could have died.
如果你需要解雇我我理解
I understand if you need to fire me.
剥夺你的收入并不会有任何帮助
Depriving you of income isn't gonna help anything.
但我要让你担任行政职务
But I am gonna put you on administrative duties.
谢谢你林医生我...
Thank you, Dr. Lim. I...
坐
Dalisay.
你需要帮助
You need help.
这位是贝沙尔妇女庇护所的主任
This is the director of Bayshore Women's Shelter.
我说了你会打过去
She's expecting your call.
这真是个好地方
It's a really great place.
这很复杂
It's complicated.
为我简化一下吧
Simplify it for me.
两年前当我母亲
Two years ago, when my mother
被诊断出患有肝癌
was diagnosed with liver cancer,
这真的很艰难
it was really tough.
她是一个单身母亲我是她唯一的孩子
She was a single mom. I was her only child.
而当她过世后
And when she passed,
我得返自己一个
I was alone.
就在这时我遇到了澳文
And that's when I met Owen.
我迫切地需要一个人而他就在我身边
I desperately needed someone, and he was there for me.
而现在
And now,
他......经历了很多
he's... going through a lot.
不是说他应该把气撒在我身上
Not that he should take it out on me.
我知道这一定很困难
I know it must be hard.
但我也知道这很有必要
But I also know it's necessary.
我给她打电♥话♥
I'll call her.
多谢你
Thank you.
看看那个心室
Look at that ventricle.
它有林肯隧♥道♥那么大
It's the size of the Lincoln Tunnel.
这就是我们要进去的地方
That's where we're gonna go in.
它仍然可能无法让我们完全接触到肿瘤
It still may not give us full access to the tumor.
为了获得完整存取我们必须弹出头骨
To get full access, we'd have to pop off the skull
然后钻进他的大脑
and then burrow through his brain.
如果我们不切除所有的肿瘤
If we don't excise all of the tumor,
你的手术将是浪费时间
your surgery will be a waste of time.
你怎么说首领？
Whaddya say, chief?
我选择格拉斯曼医生
I'm going with Dr. Glassman.
这将是正确的答案
That would be the correct answer.
好了我们都在这里了
Okay, we're all done here.
让我们把他关上
Let's close him up.
莉亚选择了我们的婚礼主题
Lea chose our wedding theme.
她给我发了一张我应该穿甚么的照片
She texted me a picture of what I'm supposed to wear.
这个叫「高斯令」装
It is called The Gosling.
哦很有风度
Ooh, very debonair.
褡裢看起来很束缚
The cummerbund looks very restrictive.
哦
Oh.
而这种发型需要大量发泥
And that hairstyle requires a lot of gel.
我讨厌发泥它让我的头感觉很紧
I hate gel. It makes my head feel tight.
好吧那么你需要告诉莉亚
Well, then you need to tell Lea
所以你们两个人可以想办法解决其他问题
so the two of you can figure something else out.
你怎么看格拉斯曼医生？
What do you think, Dr. Glassman?
我想如果在 30 年前我的妻子让我穿这套衣服
I think if, 30 years ago, my wife had asked me to wear that suit,
我可能不娶她了
I probably wouldn't have married her.
而如果两年前黛比问我
And if Debbie had asked me two years ago,
我可能会把她直接从房♥间里笑出来
I probably would have laughed her right out of the room.
那我就不用穿这套衣服了？
So I don't have to wear the suit?
不你不一定要穿它
No, you don't have to wear it.
我只是说...
I'm just saying that...
我不知道也许我的婚姻会变得
I don't know, maybe my marriages would have turned out
稍有不同
a little bit differently
如果我有你知道穿上这套衣服
if I had, you know, worn the suit.
你认为莉亚不会想知道你对此事的感受吗？
You think Lea wouldn't want to know how you feel about this?
这是你的大日子尚恩
It's your big day, Shaun.
血压为 201 对 123
BP is 201 over 123.
他癫痫病发作了
He's having a seizure!
脑瘤阻碍了 CSF 流动导致癫痫发作
The brain tumor is obstructing CSF flow, causing seizures.
它需要尽快移除
It needs to be removed as soon as possible.
等我们切除肾脏肿瘤后
After we remove the kidney tumors.
如果我们在他的肾脏受损的情况下进入他的大脑
If we go into his brain while his kidneys are impaired,
我们有高血压、AML 破裂、脑水肿的风险
we risk hypertension, AML rupture, cerebral edema.
如果我们进入他的肾脏
If we go into his kidneys
而他的大脑正处于压力之下
while his brain is under pressure,
那么我们就有脑疝、中风和
then we risk brain herniation, stroke,
缺氧性脑损伤的风险
anoxic brain injury.
只有在严重失血的情况下
Only in the case of serious blood loss.
你看到他的肿瘤了吗？
Have you seen his tumors?
会有一些严重的失血
There's gonna be some serious blood loss.
嗯我们认为我们有一个更好的计划
Well, we think we have a better plan.
我们在肿瘤切除前结扎进食动脉
We ligate the feeding artery before tumor resection.
而且如果我们先做肾脏手术
And, if we do the kidney surgery first,
我们也将 SIADH 不适当分泌症的风险降到最低
we also minimize the risk of S.I.A.D.H.,
这可能非常容易导致长♥期♥的心脏损伤
which could very easily lead to long-term heart damage.
所以先做脑
So, brain first,
更安全但更有可能使他受到损害
safer, but more likely to leave him compromised.
肾脏先
Kidneys first,