良医

The Good Doctor S06E18

Part 3 April 10, 2023, 8:40 p.m.

序列
The sequence.
现在我的大脑连刷牙顺序都搞不清
Now my brain can't handle the sequence of brushing my teeth.
我的注意力我的工作记忆所有的...
My focus, my working memory, all of the...
天啊...
Oh, my...
还有管控功能
The executive function.
时灵时不灵的
It's not always happening.
请呼叫沃尔克医生来观察她你留下来等他来了再走
Please page Dr. Wolke to monitor her and stay until he comes.
把你的手推到我的手上
Push your hand against mine.
管控功能的错误形成了模式
The pattern is errors in executive function.
我正在处理事情 -你的脑癌可能已经复发了
I'm in the middle of something. - Your brain cancer may have returned.
所有错误都跟管控功能有关 -肖恩
All errors tied to executive function. - Shaun.
储存程序记忆的背外侧前额叶皮层
Specifically procedural memory in the dorsolateral prefrontal cortex,
是复发性神经胶质瘤的常见部位
a common site for a recurrent glioma,
这都证明你的癌症已经复发
which strongly suggests your cancer has returned.
我上次的扫描结果完全清晰
My last scan came back completely clear.
我很好 -上次扫描是六个月前
I'm fine. - Last scan was six months ago.
这些错误来自过去四个月你需要再次扫描
These errors are from last four months. You need another scan.
证据非常有说服力 -事实并非如此
The evidence is very compelling. - It's not.
我进行的复杂的手术
I perform complex surgeries,
比这医院中的任何其他医生都要多
more so than any other doctor on this staff, by the way.
所以百分比会导致
So the percentages would dictate
我可能会犯更多无关紧要的小错误
that I might make more minor and irrelevant missteps,
如果你非要说那些算错误的话
if that's what you wanna call 'em.
错误率增加了
The rate of errors has increased.
是的因为我处理的病例更棘手
Yeah, 'cause I take on tougher cases.
都是别人处理不了的
The ones no one else will.
不行你需要再做一次核磁共振 -肖恩
No. You need another MRI, now. - Shaun,
我要做的是回到病人身边而你需要记住下次先敲门
what I need is to get back to my patient, and you need to knock first, next time.
“树木变绿了”
"It's the greening of the trees."
轮到我了
My turn.
试图做我的认知练习
Trying to get my cognitive exercises in.
你在背什么?
What're you memorizing?
是阿达利蒙的《承受》里的一首诗
It's a poem from The Carrying, Ada Limón.
这个诗集主要讲的是
The collection is mostly about.
本该拥有却未能拥有的生活
not having the life you thought you'd have, I guess.
我刚读的那首是关于春天的
The one I was just reading. it's about spring coming.
“关于不放弃的建议”
"Instructions on Not Giving Up."
听起来很有用 -可惜我不能一下子读完
Sounds useful. - Too bad I can't read it all at once.
我刚读完俳句
I've just graduated from haikus.
在我生病之前我甚至从没想过要看一首诗
Never even thought to look at a poem before I got sick.
没有耐心也没有时间
Didn't have the patience for it, or the time.
但现在我只能读诗了
That's basically all I read now.
也开始写作了就当是...
Started writing, too, as kind of a...
创造性疗法
creative therapy.
白三叶草的遗传变异
There was a kind of poetry
其实也像一首诗
to the genetic variations in white clover, too.
我愿意付出任何代价...
I'd give anything to...
你的血压在下降心率在上升
Your blood pressure's dropping, heart rate's climbing.
我头晕 -我来检查你的血糖
I'm dizzy. - Checking your glucose.
她癫痫发作了抢救车快点
She's having a seizure. Crash cart now.
我们以为是你的心脏问题但其实是肾脏问题
We thought it was your heart, but it's a kidney issue.
你的肾动脉变窄了
Narrowing of your renal arteries, which was exacerbated
肺动脉高压引起的肾功能衰竭加剧了你的肾动脉变窄
by the pulmonary hypertension, causing kidney failure.
这是睡眠呼吸暂停导致的吗? -我们认为是的
This is 'cause of my sleep apnea? - We believe so. Yeah.
她能做移植手术吗? 我可以做个测试看看我是否匹配
Can she get a transplant? I can do a test, see if I'm a match.
不幸的是你的其他健康问题导致做不了移植
Unfortunately, your other health concerns rule out a transplant.
但是肾动脉旁路术可以让你的肾脏自行愈合
But a renal artery bypass would allow your kidneys to heal on their own.
但有并发症的风险有些相当严重
There's risk of complications. Some quite serious.
但如果成功了你就可以过上充实、独♥立♥的生活
But in success, you could live a full, independent life.
有多严重我可能会死?
But serious, as in I could die?
有些并发症可能是致命的
Some complications can be fatal.
但风险相对较低
But the risk is relatively low.
还有其他选择吗?
Are there other options?
可以透析
Well, there's dialysis,
但在你的余生中你每周需要进行多次透析
but you'd need multiple sessions a week for the rest of your life.
那样风险较小但我觉得我一个人不行
That's less risky, but I don't think I could handle all that on my own.
妈如果你选透析我就留在圣何塞
Mom, if you want to choose the dialysis, I'll stay in San Jose.
对不起
I'm sorry.
我不想留下你 -用不着说抱歉
I don't want to keep you. - You have nothing to be sorry for.
原来这段时间你一直在生病、挣扎我却总说你
You know, all this time you've been sick and struggling, and I judged you.
可是你的新工作怎么办
But your new job.
那只是一份工作
It's just a job.
所以你用来让我的手术更安全的药
So the medication you gave me to make my surgery safer
实际上会增加我的风险吗?
will actually make it more risky?
没错
That's right.
但如果没有这种药物我很有可能会再次四联症发作
But without that medication, I'm much more likely to have another Tet spell.
是的而且可能比上次更严重
Yes, and possibly more severe than the last time.
脑雾我所有的症状都会更糟吗?
Brain fog, all my deficits. could get worse?
可能永远好不了?
For possibly forever?
是的
Yes.
但如果我们不做四联症修复你的心脏可能会突然停跳
But if we don't do the Tet repair, your heart will stop at some point.
我已经失去了我的头脑
I've already been through losing my thoughts,
我的整个自我
my whole self.
我不能再那样了
I can't do that again.
找个别的办法来做我的心脏手术
Find another way to fix my heart.
有了按照我们原来的想法直接做手术
New idea. We go back to the old idea and just do the surgery.
这是不可能的我们必须找个办法即解决四联症
It's a nonstarter. We need to present a way to help her Tet
又不引发四联症的症状
without triggering her Tet.
要想促进血液流动可以做经皮瓣膜和心室中膈缺损闭合
A percutaneous valve and VSD closure could help with blood flow.
这涉及心脏导管会导致肌肉痉挛
That involves catheters in the heart, which would cause the muscle to spasm.
好的是时候使用施展肖恩大♥法♥了
All right. It's time for some WWSMD.
无论你和杰罗姆在私下做什么...
Whatever you and Jerome do on your own time is--
“肖恩墨菲会怎么做?”
"What would Shaun Murphy do?"
(肺动脉瓣主动脉瓣)
(右侧三尖瓣房♥室瓣)
分流器怎么样?能改善血液流动
What about a shunt? It would improve blood flow.
可以给她几个月时间让她继续她的认知恢复
Buy a few months to continue her cognitive recovery.
当她感觉心脏好点的时候也许她会让我们修复她的心脏
When she feels better about her heart, maybe she lets us fix her heart.
在那之前四联症可能会要了她的命
Her Tet would likely kill her before that.
但是分流器不会引发症状她应该能接受
But placing a shunt won't trigger a spell, making it something she'd actually accept.
我跟她说
I'll take it to her.
我只能待45分钟然后我就要继续看格拉斯曼医生的手术视频了
I can stay only 45 minutes. Have to review Dr. Glassman's OR videos.
你不是看过了吗? -之前没找神经胶质瘤复发的线索
Didn't you do that? - Not for glioma recurrence symptoms.
我要找新证据让他去做核磁共振
New evidence will convince him to get a scan.
你今天看了几个月的数据了放松下明早你脑子会更清醒
You binged months of data in one day. You'll have a clearer head in the morning.
所以现在我们唱唱卡拉OK
Until then, here we are. Karaoke rager.
真棒 -确实棒我们有个歌♥单
Yay. - It is "yay". We have a song list.
而且贾里德是我们的朋友他刚回医院还邀请我们一起庆祝
Plus Jared's our friend. He just moved back. Celebration is in order.
那我明早再看视频
I will review the videos in the morning.
听起来很疯狂
Sounds pretty wild in there.
因为也许
Because maybe
你会成为拯救我的人
You're gonna be the one that saves me
毕竟
And after all
我只是在热身
I was just warming up.
人都去哪了? -有很多食物
Where is everyone? - There is a lot of food.
是的我预定的你们是最先到的
Yeah, I had it catered. You're the first to arrive.
最后一秒放鸽子的有摩根、帕克、阿舍和丹尼
And so far, last minute rain checks from Morgan, Park, Asher, Danny.
还有杰罗姆
And Jerome.
所以只有我们四个人
So it's just us four.
这意味着所有这些零食
Which means that all these snacks
和歌♥曲单归我们独享了
and song binders are for us.
是的人少正好可以讨论症状
Yes. The low turnout is the perfect opportunity to discuss symptoms.
在你最近和格拉斯曼医生一起手术时
In your recent surgeries with Dr. Glassman, do you recall observing
有注意到任何♥平♥衡问题、颤抖或运动无力吗?
any balance issues, tremors or motor weakness?
这听起来是个完美的选择
That sounds like the perfect option.
什么时候可以进行分流手术?
How soon can you do the shunt procedure?
我会尽量安排在明天
I'll try to schedule it for tomorrow.
我自己也度过了奇怪的一年
I've had a strange year myself.
十一个月前我遭到袭击腰部以下瘫痪
Eleven months ago, I was attacked and paralyzed from the waist down.
我以为它是永久性的几乎每个人都这样认为
I thought it was permanent. Almost everyone did.
起初我满脑子都是要能重新走路
At first, all I wanted was to walk again.