良医

The Good Doctor S06E19

Part 2 April 18, 2023, 11:58 a.m.

我来负责器官损伤方面 -我负责骨盆骨折
I'll work on organ damage. -I'll focus on pelvic fractures.
我需要术中成像来建立一个模型
I need intra-operative imaging to build a model.
我和你一起我需要看看受伤的程度
I'll go with you. I need to see the extent of the injuries.
你要想办法让这些修复的地方痊愈
You figure out how to help these repairs heal.
我看看我能找到什么
I'll see what I can find.
这就是孩子的妈妈？ -我们认为是
This is the baby's mom? -We think so.
她是从一个无家可归者营地被送来的
She was brought in from a homeless encampment
患有产后感染她是败血症患者
with a delayed postpartum infection. She's septic.
他们认为她会挺过来
They're optimistic she'll pull through.
希望她尽快醒来
Soon, let's hope.
我们要为她的孩子做一些重大决定
We've got some big decisions to make for her baby.
她的名字叫贾斯敏韦斯特无家可归有双相情感障碍
Her name's Jasmine West. She's homeless and has bipolar disorder.
县记录显示这个婴儿是在七周前出生的
County records show the baby was born seven weeks ago.
记录里没有爸爸没有其他家人
No dad in the picture, no other family.
当急救中心把她送来时她身上只有这些东西
This was all she had on her when EMS brought her in.
我们需要您的同意为宝宝做诊断性血管造影
We need your consent for the baby's diagnostic angiogram.
当然
Sure.
特纳综合症使婴儿在每一个环节
The baby's Turner syndrome makes every procedure,
甚至是诊断测试都会有一点风险
even a diagnostic test, a little riskier.
嗯这是你的专业领域
Well, this is your area of expertise.
（伊登）
她孩子的名字叫伊登
Her baby's name is Eden.
相当接近上肺分叉处的位置
Pretty close to the upper lung bifurcation.
我用密封剂加固了 -用合成移植物？
I reinforced it with sealant. -With a synthetic graft?
你是在质疑我的手术技巧吗？ -你是在为自己辩护吗？
Are you questioning my surgical skills? -Are you getting defensive?
完成了我们测试一下
Okay. We're done. Let's test it.
干得漂亮
Good job.
心脏功能稳定你可以走了
Cardiac function's stable. You're good to go.
插入导尿管
Inserting the catheter.
好可爱的小姑娘
What a cute little girl.
小女孩很可爱我女儿会很可爱
Little girls are cute. Mine would be really cute.
她会很可爱的 -一个男孩也可以很可爱
She'd be adorable. -A boy could be adorable too.
在挑选你的胚胎吗？
Trying to pick your embryo?
我倾向女孩我有一本手册可以参考
I'm leaning towards a girl. I have a playbook to work from.
我的手册没有帮到我
My playbook didn't help me.
我和凯兰的问题来自于我试图
My issues with Kellan came from me trying to
阻止他犯我犯过的错误
stop him making the mistakes I made.
如果我有一个女儿我就不会把我的包袱甩给她
If I'd had a daughter, I wouldn't have dumped my baggage on her.
你应该选择一个女孩
You should choose a girl.
但是你要迎接一个男孩
But you're having a boy.
我们没有机会选择
We didn't get to choose.
在健康指标方面女性的表现很可能超过男性
In health metrics, females are likely to outperform males.
尽管她们挣得少一点
Although they'll make less money.
狭窄程度比回声测量的要长
The narrowing is longer than it measured on echo.
我们应该切除狭窄的部分并做主动脉吻合术
We should resect the narrowed segment and do an aortic anastomosis.
这对婴儿来说是个大手术 -这是唯一明确的治疗方法
Huge surgery for a baby. -It's the only definitive treatment.
如果她死在手术台上那就非常确定了气囊扩张更安全
Very definitive if she dies on the table. Balloon dilation's safer.
我们可以在几年内做一个更大的手术
We can do a bigger procedure in a few years.
她的心力衰竭可能在两次手术之间复发
Her heart failure could relapse between surgeries.
你的两步法是比较安全的
Your two-step approach is safer.
但只有在每天用药和定期随访护理的情况下才行
But only with daily medication and regular follow-up care.
对一个无家可归的母亲来说这很难
A lot to ask of a homeless mom.
我会给儿童保护机构打电♥话♥取得同意你们两个练习一下手术多多练习
I'll page CPS and get consent. You two practice the surgery. A lot.
他的骨盆看起来像一个缺了100块的拼图
His pelvis looks like a jigsaw puzzle with 100 missing pieces.
贾里德可能是对的
Jared may be right.
你要站在他那边？ -我没有站在任何人一边
You're taking his side? -I'm not taking anyone's side.
扫描不会说谎 -行吧
Scans don't lie. -Okay.
我不知道你是在生他的气还是在生我的气但我们都需要好好相处
I'm not sure if you're mad at him or me, but we all need to get along.
你俩在塔可车里似乎相处得很好
You two seemed to be getting along well at the taco truck.
那没什么
That was nothing.
你在监视我？ -我在买♥♥塔可
You were spying on me? -I was getting a taco.
这种眼红可不是什么好形象
This green-eyed-monster thing isn't a good look for you.
我并不嫉妒但你是对的
I'm not jealous. But you're right.
我们应该是一个团队只是他不适合
We're supposed to be a team. He's just not a good fit.
让我们专注于病人
Let's focus on the patient.
好的
Fine.
不知道我们要如何修复所有的动脉损伤
Can't see how we're gonna repair all that arterial damage.
如果我们不修复呢？
What if we don't?
可以绕过它所有这一切
They could bypass it. All of it.
陈博士的这篇论文介绍了胶质母细胞瘤治疗领域的数据
This paper by Dr. Chen features data on tumor-treating fields for GBM tumors.
我正在努力享受我的金枪鱼
I'm trying to enjoy my tuna melt.
陈博士正在开始一项新的研究你应该联♥系♥她
Dr. Chen is starting a new study. You should call her.
我不会去追寻癌症治疗因为我没有癌症
I'm not gonna chase down cancer treatments because I don't have cancer.
因为你拒绝化疗
There is a higher probability of cancer relapse
癌症复发的概率更高
because you refused chemotherapy.
我不会谈论这个
I won't talk about this.
复发性胶质母细胞瘤引起的症状比替莫唑胺更严重
Recurrent GBM causes worse symptoms than temozolomide.
这是我做出的决定 -我快疯了
That's the decision I made. -I'm going crazy.
有三张我喜欢的婴儿床我无法决定
There are three crib sets I like. I just can't decide.
你们今晚下班后能不能去商店挑选你们中意的？
Could you guys go to the store after work tonight and pick your fave?
好吧
Okay.
我得去练习婴儿的手术下班后我再来看你
I have to go practice the baby's surgery. I will see you after work.
我的天啊
Oh, my God.
我应该担心吗？ -我吗？不用
Should I be worried? -About me? No.
为了挽救他的一片肺叶我们会杀了他
We're gonna kill him trying to save a lobe of his lung.
摘除掉他还有五分之四的容量
Removing it leaves him with four-fifths capacity.
当你可能失去一半的身体时你剩下的一切都很重要
When you might lose half your body, everything you have left matters.
我需要肺叶切除术的器械
I need lobectomy instruments.
这是我的手术室我的部门 -我的医院
This is my OR, my department. -My hospital.
当医生判断力受到影响时
And when judgment is compromised,
我有责任保护我们的病人
it's my responsibility to protect our patients.
我在什么方面受到了影响？
In what possible way am I compromised?
你是在暗示我坐轮椅的日子影响了我的客观性吗？
Are you implying my time in a wheelchair is affecting my objectivity?
怎么会没有呢？
How could it not?
这是我的病人
This is my patient.
我是你的老板
And I'm your boss.
你可以和我一起手术或者我找别人来做
You can do this with me or I'll find someone who will.
手持式牵引器
Deaver retractor.
在他们修复结肠后利姆可以像韩国人那样
After they fix the colon, Lim can use some preserved bowel
用保留下来的肠子来造一个新的膀胱
to create a new bladder, like the Koreans did.
这与我发现的情况相符
That would work with what I found.
我们可以通过两个达康绒导管绕过动脉损伤部位
We can bypass the artery injuries through two Dacron conduits
到达他的下肢
to his lower extremities.
血流的改善将有助于我对他的骨盆的想法
The improved blood flow would help my idea for his pelvis.
皮瓣
So, skin flaps,
达康绒动脉搭桥新膀胱用生物材料修复肠道和…
Dacron artery bypass, neo-bladder, bowel repair with biomaterials and…
像金刚狼一样的金刚骨架
a bad-ass Wolverine-like adamantium skeleton.
实验性的但这是相当酷的如何确保它全部愈合？
Experimental. But it's pretty cool. Now, how do I make sure it all heals?
在加拿大有一项研究
There's one study in Canada.
一种生长激素和己酮可可碱的混合物
A cocktail of growth hormones and pentoxifylline
显示伤口愈合率增加了三倍
showed a threefold increase in wound-healing rates.
那太棒了
That's great.
实验了四位病人他们都没有和布雷迪一样的伤势
It was four patients. None of them had the same injuries as Brady.
没有人被金属板切成了两半？
So, no one got cut in half with a metal sheet?
很好我想我们不用考虑这项研究了
Great. Guess we toss that study out.
我的意思是我希望我们有更好的方案
I'm saying I wish we had something better.
我很乐意接受三倍的增长这是一个可行的计划
I'll happily take a threefold increase. This is a workable plan.
很好利姆想知道最新情况
Good. Lim wants an update.
一些有希望的想法但有很多脆弱的组织需要愈合
Some promising ideas, but there's a lot of frail tissue to heal.
我发现了一项使用生长激素来加速愈合的研究
I found a study using growth hormones to accelerate healing.
有意思在这里行得通吗？
Interesting. Would that work here?
有一个…
There was a--
我想听听做研究的人怎么说
I want to hear from the guy who did the research.
我不相信它能做到
I'm not confident it would.
你们说有一个可行的计划 -可行的贾里德很谨慎
You said you had a workable plan. -It can work. Jared's cautious.
如果没有血管的支持它就会坏死
If we don't have vascular support, it will get necrotic.
我们会有很好的支持导管将恢复…
We'll have good support. The conduits will restore--
不是正常的流动不是很快
Not normal flow, not quickly.
你一直都很悲观 -够了
You've been doom and gloom-- -Enough!
找到一个方案治愈他我不在乎谁想到的但我需要尽快
Find a way to heal him. I don't care who it comes from, but I need it soon.
护士说她药物对她有效果