良医

The Good Doctor S02E05

Part 2 Jan. 5, 2020, 3:40 p.m.

你第一次排便活动
Your first defecation event
是整个排泄指标里的重要一环
is a vital part of the discharge criteria.
活动这是术后十项全能运动吗
Event? What is this, the post-op decathlon --
-排便排尿走路说话 -没错
- pooping, peeing, walking, talking? - Yes.
你得在这层楼走一整圈
You have to walk a full lap of the floor.
但你取消了今早的理疗
But you canceled physical therapy this morning.
这些护士嘴巴真大
Those nurses have big mouths.
我取消是因为腿有点酸
I canceled because my leg is a little sore.
那可能是静脉炎
That could be phlebitis
静脉血栓
or a DVT or a --
也可能是给我的脑桥动手术后
Could also be an unsurprising complication
意料之中的并发症
from a surgeon poking around in my pons.
每在医院多呆一天
Every day in the hospital
你感染的概率就上升1.37%
increases your risk of infection by 1.37%.
你需要排便你现在就起来走走
You need to move your bowels, and we should walk right now.
我会慢慢走的
I'll go very slow.
肖恩你现在
Shaun, is there any chance
是不是需要去忙别的
that you are needed elsewhere right now?
八分钟后
I-I have 8 minutes
我得去给病患做膀胱内窥镜检查
until my patient's cystoscopy.
很好要早点到
Good. Be early.
尿道很干净
Urethra looks clean.
目前没有病变和结石
No lesions, no stones so far.
我们怎么进一步检查有没有堵塞或结石呢
How do we check for obstructions or stones further up?
膀胱对比造影
Contrast cystogram.
鉴于是你发现的这个患者
Since you found this patient,
就由你来做怎么样呢
how about you do the honors?
你知道这个人曾经约有170公斤吗
You know this guy used to weigh 370 pounds?
穿过导尿管进入膀胱
Thread the catheter further into the bladder.
减了这么多他可真行
That's a big drop. Good for him.
他做了胃旁路手术
He did have gastric bypass.
那就不厉害了吗
That makes it less impressive?
-现在注入造影剂 -是啊
- Now infuse the contrast. - Well, yeah,
比起节食和运动这是种简单的办法
it is the easy way, compared to just diet and exercise.
造影剂散开了
The contrast dye is dissipating.
正常的
It's supposed to.
你说他在为比赛训练
You said he's training for a race.
很显然他完全改变了自己的生活
Obviously, he turned his life around.
还在扩散
Still dissipating.
胃旁路手术让他
Bypass made it physically impossible
不能想吃多少吃多少了
for him to eat as much as he wanted.
不见了造影剂不见了
It's gone. The contrast is gone.
-这没道理 -去哪儿了
- That makes no sense. - Where did it go?
他可能有瘘管
He probably has a fistula --
接通了他的膀胱和肠
a tunnel connecting his bladder to his intestine.
往另一个方向移♥动♥的空气和细菌
Air and bacteria moving the other direction
导致他的尿液有气泡
caused bubbles in his urine.
她的肝和甲状腺是正常的
Her liver and thyroid are normal,
但她的体内电解质不足
but her electrolytes are off.
她的白蛋白在2.1
Her albumin is at 2.1.
她严重营养不良
She's severely malnourished.
她将会非常脆弱抵抗不了术后感染
She'll be totally vulnerable to post-op infections.
她要活命就得做这手术
She needs this surgery to survive,
但她太虚弱了根本撑不过手术
but she may be too sick to survive the surgery.
为了安全进行手术
In order to operate safely,
我们得增加你的热量摄入
we need to boost your caloric intake,
优化蛋白质摄入
optimize protein.
不能通过静脉注射吗
Can't you do that through my IV?
更有效地方法是把营养物质
It's more efficient to pump a nutritional supplement
直接送进你的胃里
directly into your stomach.
我们会用管子从你的鼻子送进去
We use a tube running down from your nose.
我试过鼻胃管
I had an NG tube once.
但不管用
It didn't work.
她受不了那个
She couldn't tolerate it.
因为其实不是因为食物
Because it's not really about food.
而是因为自我控制
It's about control.
你带着这个症状活了几十年
You've lived for decades
比起其他心理疾病
with a condition that has killed more people
它害死了更多人
than any other psychiatric illness.
你不止活下来了你还有个孩子
You didn't just survive. You had a child.
怎么做到的呢
Can you tell us how?
我怀孕的时候
When I got pregnant,
那就像个令人害怕的奇迹
it was like this terrifying miracle.
一想到会增重很多
And the thought of gaining all that weight, but...
但我太想要他了
I wanted him so much.
我们都是
We both did.
吃饭时我都会把他的超声波图像放在一边
Every meal, I would sit with pictures of his ultrasound,
想象着那些食物直接进入了他的身体
i-imagining the food going directly to him.
你能再做一次吗
Can you do that again?
为了格雷厄姆进食
Eat for Graham?
我们已经确定
We've determined the fistula
你膀胱和肠之间的瘘管
between your bladder and intestine
是由克罗恩病导致的
was caused by Crohn's disease,
一种发炎性肠道疾病
an inflammatory intestinal condition.
一旦我们把你的胃旁路手术复原
Once we reverse your gastric bypass,
-你得 -等等复原我的胃旁路手术
- you'll need -- - Wait. R-Reverse my bypass?
你确定
Are you sure?
胃旁路术缩短了消化道
Bypass surgery shortens the digestive tract.
有克罗恩病的患者需要利用他的每一寸大肠
People with Crohn's disease need every inch of intestine they have,
否则就会很危险
or they risk critical,
甚至会出现致命的营养不良
even fatal malnutrition.
好吧但我不想让我丈夫知道
Okay, but I don't want my husband to know,
他就快到了
and he'll be here soon.
没有你的许可我们不会透露任何信息
Well, we would never reveal anything without your permission,
但是治疗克罗恩病需要你
but Crohn's disease is going to require
做些重要调整
some major adjustments.
好吧我会告诉斯宾塞我有克罗恩病
Well, I'll tell Spence about the Crohn's,
也会告诉他要在我的膀胱
and I'll tell him I'm having surgery...
动手术
on my bladder.
你丈夫不知道你做过胃旁路手术吗
Your husband doesn't know you had gastric bypass?
那就要先告诉他我以前很胖
That would require him knowing I was obese to begin with.
这不可能
That's not gonna happen.
你丈夫一定很肤浅
Your husband must be very shallow.
即使我不说你复原了胃旁路
Even if I don't disclose
你的伤疤也会泄密的
that I reversed your bypass, your scars might.
这需要做个单独的切口
It requires a separate incision.
那就告诉他出现了并发症
Well, tell him there was a complication.
我们保护你隐私的义务不包括撒谎
Our obligation to protect your privacy doesn't include lying.
而且你不应该独自承受这些
And you shouldn't have to go through this without him.
单孔腹腔镜手术
The single abdominal umbilical port.
单孔腹腔镜手术
我们既可以修复韦德的瘘管
We can repair Wade's fistula
复原胃旁路
and reverse his bypass
全通过单孔完成
all through a single incision.
我们可以帮你向你的丈夫隐瞒
We can help deceive your husband.
亲爱的我很抱歉
Oh, honey, I'm so sorry.
没事的斯宾塞
That's okay, Spence.
-我已经尽快赶来了 -真的没事
- Got here... as soon as I could. - It's all right.
既然我丈夫已经被外科医生包围了
And since my husband is surrounded by surgeons,
那到底是什么问题你们准备怎么处理
what's the issue, what are you gonna do about it,
成功的几率是多少
and how often have you done it successfully?
你还好吗
How are you doing?
我很好
I'm fine.
格雷厄姆你能把这个装满吗
Graham, would you mind filling this?
你已经吃了一勺金枪鱼
You've had one spoonful of tuna,
两盎司苹果酱
2 ounces of apple sauce.
就这么点吗
That's it?
妈妈如果我也吃这么点
Mom, if that's all I had,
你根本不会让我下桌子
you'd never let me up from the table.
这不一样我...
This is different. I...
不能吃得太快