良医

The Good Doctor S06E09

Part 4 Oct. 10, 2023, 10:30 a.m.

他把食道弄破了通知墨菲医生并准备手术室
He's ruptured his esophagus. Page Dr. Murphy and prep an OR.
胸管放置好了
Chest tube placed.
肺部引流呈橙色
The lung drainage is orange.
残留的饮料
What's left of the smoothie.
推进内窥镜
Advance the endoscope.
佩雷斯医生你的反应非常迅速
He is fortunate that you responded so quickly, Dr. Perez.
我强迫泰迪向他弟弟承认他有暴食症
I pushed Teddy to admit his bulimia to his brother.
他们吵了架然后他就做了这个
They fought and then he did this.
不行
That was not helpful,
损伤太大做不了主要食管修补
and there is too much damage for primary esophageal repair.
置入内镜支架等水肿好转
Place an endoscopic stent, wait until edema improves?
它会泄漏
It will leak.
网膜作为贴片怎么样 -组织太脆了
What about omentum as a patch? -The tissue is too friable.
胃转位呢虽然它通常是针对儿童的
It's usually for kids, but what about gastric transposition?
切除食管
We could resect the damaged esophagus
用胃组织重建
and reconstruct it using stomach tissue.
好主意佩雷斯博士这会提高你的分数
Good idea, Dr. Perez. This will improve your score.
我们得给他开胸
We need to open him up.
脓肿对抗生素没有反应
The abscess is not responding to the antibiotics.
感染仍在大脑中
The sinus infection is still seeding to the brain.
我可以再钻一个孔加大排放
We could drill an additional burr hole, get more aggressive with the drainage.
同样的方法同样的结果 -谢谢你的老生常谈
Same approach, same results. -Thanks for the unhelpful cliche.
她需要进行双额开颅手术和鼻窦清除术
Lily needs a bifrontal craniotomy with sinus exenteration.
去除两侧颅底然后重建以阻止细菌进入
Remove the skull base on both sides, then rebuild it to stop bacterial entry.
我不会去除她的额骨
I'm not taking off Lily's forehead
并让她做多年的重建手术
and consigning her to years of reconstructive surgeries.
你是想救她的命还是保她的脸
You want to save her life or protect her pretty face?
你是说我的行为不道德吗
Are you seriously accusing me of acting unethically
因为你带着花搬家后我已经和她约会了两次
because I've been on two dates with her, after your move with the flowers?
什么花 -闭嘴
What move with the flowers? -Shut up.
我是说你的判断被蒙蔽了
I'm accusing you of your judgment being clouded
因为你不想同意我的意见
because you don't want to agree with me.
我在为病人做正确的决定
I'm making the right call for the patient. Disagreeing is a bonus.
准备好莉莉和手术室
Get Lily and the OR prepped.
去除食道的失活部分
Removing the devitalized segment of the esophagus.
我们还有很多的健康组织
We have a good plane of healthy tissue.
佩雷斯博士
Dr. Perez,
你可以进行两层倒置手缝吻合术了
you may perform the two-layered, inverted hand-sewn anastomosis.
我昨晚熬夜做研究项目我的手不够稳
I had a late night on a research project. My hands aren't stable enough.
应该让鲍威尔医生来做
Dr. Powell should take this.
开始缝合
Starting to suture.
我准备好回家了
I'm ready to go home.
我还不行
I'm not,
安德鲁斯让我重新配置远程接口
thanks to Andrew's dumping reconfiguring the remote interface in my lap.
调试代码需要数周时间
It's weeks, if not months, of debugging code.
这么快
Well, that was fast.
当我让安德鲁斯医生给你分配一个新项目时
When I asked Dr. Andrews to assign you a new project,
他一个都想不出来你的手怎么样
he couldn't think of any. How is your hand?
很烦人你为什么那么做
Annoy... Annoyed, along with the rest of me. Why would you do that?
因为你一直在为我们要孩子的事难过
Because you have been sad that we have to wait to have a baby.
工作比修复旧房♥子更能分散注意力
Work will be a better distraction than restoring an old house.
这不是你能决定的肖恩
That's not a judgment for you to make, Shaun.
我会自己选择
I'll pick my own distractions.
我是很伤心
And I have been sad.
那房♥子是让破碎的东西重新变得美丽的机会
And that house is just a chance to make something broken beautiful again.
重新配置远程接口也是如此
So is reconfiguring the remote interface.
那房♥子对我来说就像向前迈进了一步
The house feels like a step forward.
我可以看到我们在那里过得很开心肖恩
I can really see us being happy in that home, Shaun.
我只是希望你也能看到这一点
I just wish you would try to see that too.
好的
Okay.
那我们可以出价吗
Okay, we can make an offer?
不我的意思是我会试试的
No, I meant, okay, I will try.
谢谢
Thanks.
待会儿家里见
I'll see you at home later.
对不起我来晚了我有一种冲动
Sorry I'm late. I had an impulse.
NBA2K系列准备好被打败吧
NBA 2K. Prepared to get smoked.
篮球游戏得先放放我有很多工作
Tip-off will have to wait. I'm buried.
也许我可以帮忙病人有问题吗
Maybe I could help. Trouble with a case?
是的
Yeah.
我自己的 -发生了什么事
My own. -What's happened?
格拉斯曼发现我的腰肌和臀大肌能活动
Glassman found movement in my psoas and glutes.
他和墨菲找到了一种内窥镜解决方案
He and Murphy found an endoscopic solution.
那就能分离出你的脊髓太好了
They'll detether your spinal cord. That's great.
是不是手术方案有问题
Is there a problem with the surgical plan?
方案非常周密
It's quite elegant.
那你在犹豫什么
Then what's holding you back?
我们一直生活在这个完美的泡泡里
I feel like we've been living in this bubble, this perfect bubble,
如果我走出去它就会破开
and if I step outside of it, it'll pop.
这个手术会改变你
This surgery would change you.
但不会改变我们
Not us.
我们拥有的东西不会因为你能重新走路而消失
What we have isn't going to disappear if you walk again.
你要相信这一点
You need to believe that.
我想相信
I want to.
拜托我不能成为你拒绝的理由
Please, I can't be the reason you say no.
我们用重建的胃组织成功修复了
We successfully repaired Teddy's distal esophagus
他的远端食管
with reconstructed stomach tissue.
他将能够正常进食和吞咽
He'll be able to eat and swallow normally,
但他再催吐的话会造成无法弥补的损伤
but any further purging will cause irreparable damage.
我以为我们终于又亲密了
I thought we were finally close again.
他一直很痛苦而我
He's been hurting and I…
我都不知道
I had no idea.
我该怎么做
How do I fix this?
有时试图解决问题就是问题本身
Sometimes... trying to fix the problem is the problem.
我也经历过艰难时期
I went through some tough times too,
很多人都想帮我
and plenty of people had ideas about how to fix me.
但我不需要
See, I didn't... I didn't need that.
我只是需要他们
I just needed them…
爱我
to love me.
不管好或坏
Broken or not.
尽管我不喜欢打磨而且油漆闻起来很糟糕
Even though I don't like sanding, and paint is sticky and smells terrible,
电动工具声音巨大而且危险
and power tools are loud and dangerous,
我很肯定我们主要是你可以把那个待修房♥
I am positive that we, mostly you, can make that fixer-upper
打造成一个美丽的家园
into a beautiful home for us and the family we will have.
你是说我们应该买♥♥那套房♥子吗
Are you saying we should buy the house?
如果它能让你快乐
If it will make you happy.
因为我强迫了你是不是
I bulldozed you, didn't I?
是的但我不介意
Yes, but I do not mind.
但是我介意
But I do. I'm being selfish.
谢谢你让着我
Thank you for letting me.
我现在唯一要做的就是
But the only step forward I need right now is one we make together.
找一个我们都喜欢的地方
Let's find a place we both love.
这是个好方法
That's a good approach.
快看一下我的手它真的很痛
And, also, let's get my hand checked out. It does really hurt.
进入脓肿
Advancing into the abscess.
你不放心吗
Couldn't stay away?
莉莉是我的病人
Lily is my patient. I admitted her.
从脓腔中切除最后的囊体
Resecting last bits of capsule from the cavity.
好了撤出内窥镜
Got it. Pulling the scope.
心率32 血压210\122
Heart rate's 32. BP 210 over 122.
开始出现脑疝
Her brain is starting to herniate out of the burr holes.
给他100克甘露醇大剂量异丙酚
Give 100 grams of mannitol, high-dose propofol.
得让血液里的二氧化碳含量低于30
That won't be enough. Get her CO2 below 30.
我知道放置心室外引流
I'm aware. Place an EVD.
要做双额开颅手术吗 -没时间了
Should we pivot to the bifrontal craniotomy? -No time.
你能把钻孔连起来做开颅吗
Connect the burr holes and run a small craniotomy flap?
不行但半侧颅骨切除术会降低脑压
No, but a hemicraniectomy will reduce brain pressure.
然后就能清除感染部位了
And then you can debride the skull-base infection.
很好 -很好
Good. -Good.
真厉害
That was hot.
你选择做这个手术是正确的
Doing this surgery is a good decision.