良医

The Good Doctor S06E10

Part 2 Oct. 10, 2023, 10:30 a.m.

不用我知道怎么做
No, I know everything that could go wrong.
都可能是错的
All I can see is what can go wrong.
你不用马上给答复
You don't have to decide now.
我们继续监测 -如果再等下去
We can continue to monitor you... -If we wait,
子♥宫♥最薄的地方会扩张会给手术增加风险
the uterine window could expand and make the surgery more risky.
现在做是最安全的
Now is the safest time.
别逼她肖恩
Don't pressure her, Shaun.
好吧我信任你
Okay. I know I trust you.
如果你认为应该做手术
If you think surgery is the right decision,
那就做
then we should do it.
我有个条件
On one condition…
你要进手术室
I want you in the O.R.
不是为了我
Not for me. But,
如果万一孩子没了
if something were to go wrong and we lose our baby,
我想你陪在她
I need you to be with her.
或他身边
Or him.
有我从旁指导我觉得胎儿没事的几率很大
With my guidance, I think there is a very good chance our baby will be fine.
镊子解剖剪
Forceps and Metz.
重回手术室感觉如何
How's it feel to be in the O.R. again?
非常好先生
Very good, sir.
你能回来我们都很高兴
We're all very glad to have you back.
肝脏已经露出来了
We've exposed the surface of the liver.
肿瘤侵入肝包膜和实质化
The tumor's invaded the liver capsule and parenchyma.
实际大小是影像中的两倍
It's twice the size it appeared on imaging.
切除肿瘤的话他就剩半个肝脏了
If we take out all of the tumor, he'll only have half a liver left.
没别的办法了
We don't have a choice.
给我超声剥离器
Ultrasonic dissector for resection.
一定要尽可能覆盖在子♥宫♥膜最薄的上面
Make sure to approximate the edges so it overlaps with the uterine window.
你已经说了三次了肖恩
I internalized that the first three times you told me, Shaun.
你和莉亚要面对这些我很难过
I'm sorry you and Lea are going through this.
利姆医生放贴片比你快7秒
Dr. Lim was able to place the fleece patch seven seconds faster.
但你的腹腔镜缝合技术更胜一筹
But your laparoscopic suturing technique is superior.
你来做缝合
You will be in charge of that.
请开始练习吧
Practice it now. Please.
肖恩我缝过无数次了
Shaun, I've done it a million times.
你没给我太太缝过
You have never done them on my wife.
有道理
Fair point.
因为切除的肝脏部分比预想的多
Because we had to take more of your liver than we'd hoped,
你的肝功能正在下降
your liver function is declining.
你的身体很难通过静脉注射获取营养
Getting your nutrition through an IV is tough on your body.
维持我生命的全肠外营养会要了我的命
The T.P.N. that's keeping me alive is also killing me.
这太难了
That's… gnarly.
有什么让他获取营养的替代方法吗
So what's the alternative to T.P.N.? How do we get him nutrients?
我们正在想办法
We're looking into it. For now, we'll manage your symptoms
保持病情的稳定等待肠源
and keep you stable until a small bowel becomes available.
这下那些人不会再觉得我非常健康了吧
There's no way those organ cops can say I'm too healthy now.
我会开消胆胺来止痒
I'll order cholestyramine for the itching
每隔几小时查一次肝功能
and liver function testing every few hours.
我会联♥系♥器官捐献组织尽我所能
I'll call UNOS and do whatever I have to…
让他早些接受移植
To get him moved up the list.
你要去哪
Where are you sneaking off to?
我在全是人的大厅里
I'm walking down the hall, in plain sight.
手♥机♥铃♥声♥ 药丸经典的摩根逃离技巧
The alarms, the pills, the classic Morgan evasion techniques…
你要植入受精卵对不对
You're getting your embryos implanted, aren't you?
恭喜你破解了一个不是秘密的秘密
Congrats on cracking that already wide open case.
我现在得给自己打♥针♥了
I have to give myself a time sensitive injection now,
然后再去吼器♥官♥移♥植♥的负责人 -我可以帮你
then yell at transplant people. -Why didn't you tell me? I can help.
上次见面你原话是这么说的
I'll refer you to the minutes of our previous meeting.
我们需要划清界限
"We need boundaries."
我记得你上次也帮我穿了医院的袜子
I remember you put on my hospital socks for me last time, too.
我不喜欢这样
I hate that we have a routine.
这次不一样
This time is different.
嗨
Hi.
我爱你
I love you.
感觉怎么样有什么需要的吗
How are you? Do you need anything?
皮德那有个蛋糕是给霍克护士过生日买♥♥的
There's cake in Pede's for Nurse Hawk's birthday.
要给你拿一块吗
You want me to get you a piece?
你们能来就很好了
Just this is great.
出去吧
Please leave.
会客会提高手术期的感染风险
Having visitors increases the risk of peri-operative infection
并且会让血压升高
and stimulation can raise blood pressure,
这会增加术中并发症的风险
which increases the risk of intra-operative complications.
我给你做术前检查
I need to do your pre-op exam.
他突然缩成一团
He just doubled-over.
我肠子疼死了
My gut is trying to kill me.
拜托能给他点什么药吗
Please. Can you give him something?
我给他调高吗♥啡♥量你检查感染的地方
I'll up his morphine. Check the site for infection.
忍♥住没事的
Hang on. You're gonna be okay.
艾伦医生他的伤口裂开了
Dr. Allen, his wound dehisced.
那是什么意思
What does that mean?
他的肌肉把线崩开了伤口裂开了
His muscles couldn't hold the stitches. It tore open.
把贴片往右移三毫米
Move the patch three millimeters to your right.
要盖住伤口边缘
It should overlap the wound margin.
好的 -对
Got it. -Yes.
就是那
There. That is good.
沃尔克医生内窥镜缝线
Dr. Wolke, take the scope, please. Sutures.
在子♥宫♥肌层缺损处 5-0的聚丙烯缝合线
5-0 prolene sutures in the myometrium defect
需要精确间隔一毫米
need to be placed exactly one millimeter apart.
墨菲医生你再往前走一步就出去
Dr. Murphy, take one more step, I'm going to have to ask you to leave.
涂胶
Applying the glue…
不行太远了
No, no, that's too far.
视野被挡了 -肖恩你往左一点
The view is obscured. -Shaun. A little to your left…
她在出血
She's bleeding.
没有破裂的迹象
No signs of rupture.
因为视野不够清楚
You may have placed the sutures too deep
线可能缝深了
because you didn't have a clear view.
缝线没问题 -应该让我来
The sutures are fine. -I should take over.
肖恩
Shaun.
那里贴片下面有个小出血点
There. A small bleed underneath the patch.
肯定伤到血管了
We must've nicked a vessel.
我来夹住
I'll clip it.
吸
Suction.
好了可以继续缝合了
Okay. We can continue to close.
太好了莉亚和胎儿都没事
Yes. Lea and the baby are fine.
尽管存在一些可避免的错误
In spite of the avoidable errors.
腹壁本身太薄弱加上手术的损伤
His abdominal wall is too weak and damaged from
让它无法承受缝线
prior surgeries to hold the sutures.
虽然包扎了伤口但还是要再进行手术
We covered the wound, but we need to take him back to the O.R.
重新缝合
and close him up before it gets infected.
皮肉组织会再裂开的
The tissue will just tear open again.
他的皮肤和肌肉需要时间和营养才能恢复
His skin and muscles need time and nutrition to heal.
我给德鲁争取到了小肠
I have a small bowel for Drew.
德鲁的伤口裂开了
Drew's wound dehisced.
没办法移植了
We can't take that organ.
我不会放弃的这是他唯一的机会
I'm not turning it down. This is Drew's only chance.
跟器官捐献组织说我们需要再进行几轮测试
Tell UNOS we need to run some more tests.
争取几个小时的时间
Buy us a few hours.
在此期间得想办法把他的伤口缝起来
That's how long we have to figure out how to stitch this kid back together.
组织分离手术呢
What about component separation?
会让皮肤组织更薄弱
That could weaken the tissue even more.
好吧
All right.
也许可以用四步法比安手术
Maybe a four-step Fabian procedure.
但是德鲁的时间不够做这个
Except Drew doesn't have time for four steps.
嗨
Hi.
我来给莉亚检查术后体征
I'm here to check Lea's post-op vitals.
我还给你带了精神食粮
I also brought supplements.
你的术后超声波未见异常
Your post-op ultrasound looks good.
胎动和胎心良好
Fetal movement and heart tones are great.
谢天谢地
Oh, thank God.
我什么时候可以回家
When can I go home?