驻院医生
The Resident
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驻院医生
The Resident S01E04
Part 4
Jan. 15, 2020, 3:30 p.m.
Yes, that's my son.
谢谢你 霍金斯医生
Thank you, Dr. Hawkins.
他在做手术 出来以后你就能去看他了
He's in surgery; you can see him just as soon as he's out.
-好的 -我们需要了解他的病史
- Okay. - We need his medical history.
他对什么药物或食物过敏吗
Is he allergic to anything? Medications, food allergies?
有我需要知道的健康状况吗
Any health conditions I should know about?
-心脏病 糖尿病 -我想想
- Heart condition, diabetes? - Let's see,
他的医生说他缺钙
his doctor said that he has low calcium.
颈部修补时太不稳定 按住他
Too much tension on my carotid repair. Hold him still.
-按住他 -低血钙
- Hold him still. - Baseline is hypocalcemic!
输血会让情况恶化 他需要补钙
The blood transfusion made it worse-- he needs calcium!
好的 静脉注射补钙
Okay, well, add calcium to his IV.
哪个静脉注射 刚从他手臂脱开
What IV? It tore right out of his arm.
没有注射渠道了
We don't have access.
我来开放新的静脉通道 按住他的手臂
I'll put in a new IV. Hold his arm.
我把手臂扯出来
I'll rip his arm out of the socket.
除非补上钙 否则他会一直抽搐
The seizure won't stop until we get calcium into his veins.
不管怎样都不要放手
Don't let go, no matter what.
我需要立即注射 抽搐得太厉害了...
I need access now. There's too much tension...
马上好了 马上好了
Almost there. Almost there.
-我们马上要撑不住了 -进去了
- We're about to have a blowout on our hands. - I'm in.
立刻推入钙
Pushing calcium now.
谢谢
Thank you.
这会帮助
It's gonna help
你呼吸 莉莉 好吗
with your breathing, Lily, okay?
-呼叫霍金斯医生 -我已经呼过他了
- Page Dr. Hawkins. - I already paged him.
-把肾上腺素给我 -护士不能在没有指令时
- Give me the epi. - Nurses can't administer meds
注射药物
without orders.
看起来是可以的
Looks like they can.
-你刚才去哪了 -在一个闷热的屋子里
- Where have you been? - In a stuffy room
说服一群假正经的医院管理者重新
with stuffier administrators trying to get them to rehire
雇佣亨得利护士 当我指出
Nurse Hundley-- once I pointed out
他们可能会面对诉讼时 他们就屈服了
they could be looking at a lawsuit, they caved.
她一小时之内就会回到急诊室 她发生喘息
She'll be back in the ER within the hour. She's wheezing.
-在给她打什么 -生理盐水和亚胺培南
- What's hanging? - Saline and imipenem.
我刚给她打了肾上腺素
I just gave her epi.
停掉亚胺培南 加大生理盐水的量
Stop the imipenem. Open the saline wide.
莉莉 你会没事的 我现在要给你打麻醉
Lily, you're gonna be all right. I'm gonna sedate you
然后放入气管插管
and put in a breathing tube
-来保证你的呼吸道畅通 -发生了什么
- to keep your airway open. - What's happening?
我在这儿 莉莉 我会处理好的
I'm here, Lily, and I'm gonna take care of this.
我得找出她的药物中
I have to figure out which one
是哪一种引起的这种反应
of her meds is causing the reaction.
-这太多了 -我不记得
- There's... there's so many. - Well, I don't remember
她对什么药物过敏 所以不管是什么
her having any sensitivity, so whatever it is,
肯定是什么新的东西
it's got to be something new.
她唯一的新药就是亚胺培南
Her only new med is the imipenem--
如果是那样的话 我们就麻烦了
if it is that, we're screwed.
她对其他抗生素过敏吗
Is she allergic to any other antibiotics?
-这个嘛 -等等 等一下
- Well... - Whoa, whoa, wait, wait, wait, hold on.
她的医疗记录只有这次住院之后的
Her chart only goes back as far as this current admission.
我知道 我从今早就在让
I know, and I've been trying to get it sent over
亨特医生的诊所把记录发过来
from Dr. Hunter's clinic since this morning.
他们坚持说发过了 但我一直没收到
They keep insisting they sent it, but it never arrived.
因为莉莉的感染 我不想让她
With Lily's infection, I don't want to keep her off
停用广谱抗生素太久 我们需要她的病历
the broad-spectrum antibiotic for long. We need her chart.
黛比 你能帮我顶替
Hey, Debbie, can you cover for me
一个小时吗 你可以待在这儿吗
for an hour? Can you stay?
你要去哪
Where you going?
琳的诊所 很明显我们没法信任他们
Lane's clinic. We obviously can't trust them
把病历给我 那我就自己去拿
to get us her chart, so I'm gonna go get it myself.
把那个再调清楚一点
Just enhance that a bit more.
有什么新发现
What have you found?
雪莉·哈里斯的超声内镜检查
Shirley Harris's EUS,
CT和实验室结果确诊胆囊癌
CT and supporting lab work confirm gallbladder cancer.
但好消息是癌症处于早期
But the good news is it's early stage
并且局限在胆囊内
and confined in the gallbladder.
那就说明她有很大概率
So there is a real chance
可以被治愈
the treatment could be curative for her?
我们肯定可以降低复发率
Well, we can certainly reduce the chance of recurrence.
肿瘤位于
The tumor's located
胆囊颈部
in the neck of the gallbladder.
为了彻底切除 我们还要
In order to get clean margins, some of her liver
-切除她的一部分肝脏 -这不大好处理
- will have to be removed as well. - It is tricky.
不好处理
Tricky?
那里布满了血管
It's a minefield of blood vessels
和胆管 而且她贫血
and bile ducts, and she's anemic.
如果夹错了血管 一旦开始出血
Clip the wrong vessel, once the bleeding starts,
我们可能止不住
we might not be able to stop it.
在她这个年纪 她很有可能
At her advanced age, there's a real chance
撑不过整台手术 为什么要冒险
she won't make it through surgery-- why risk it?
我强烈建议姑息治疗
I highly recommend a palliative consult.
雪莉根本不像八十岁
Shirley's 80 is a young 80.
更像是六十岁 还有大好的时光
More like 60, full of life.
她男朋友准备向她求婚
Her boyfriend's about to propose to her.
她还有好多可以期待
She has a lot to live for.
如果她下得了手术台
If she makes it off the table.
这手术有成功的先例
It has been done successfully before.
癌症
Cancer?
胆囊癌
Gallbladder cancer?
是的 但因为我们发现得早
Yes. But because we caught it early,
所以治愈的可能性很大
there's a real chance for a total cure.
通过手术和放疗
With surgery and radiation.
听起来很简单 但我想可能不是那样
That sounds simple, but I'm guessing maybe it isn't.
手术本身比较复杂
The surgery itself is-is complicated.
有多复杂
How complicated?
雪莉会因手术丧命吗
Could the surgery kill Shirley?
这种癌症扩散很快
This is a highly aggressive cancer.
如果不做手术 你大概有不到一年时间
Without the surgery, you could have less than a year.
但做手术 你还可以活很久
But with the surgery, you can have many more years.
你还好吗
Are you okay?
雪莉 说说你的意见
Shirley, say something.
我可能会死
I might be dying.
我只想知道一件事
And there's only one thing I want to know.
豪伊·格林...
Howie Green...
...你愿意娶我吗
...will you marry me?
不应该是你问我 雪莉·哈里斯
You're not supposed to ask me that, Shirley Harris.
-我准备要问你的 -别装了
- I'm going to ask you. - Don't be difficult.
-回答我 -我愿意
- Answer me. - Yes.
我会娶你
I will marry you,
-只要你愿意嫁给我 -我愿意
- only if you marry me. - Yes!
我会嫁给你
I will marry you.
我们该如何确保
So, how do we make sure
这个救命的手术不会害死我
this lifesaving surgery doesn't kill me?
因为我还有个婚礼
'Cause I got a wedding to go to.
如果是一般的外科医生
In the hands of a lesser surgeon,
我不会这么有信心 但你会得到最好的
I wouldn't be as confident, but you're getting the best.
伦道夫·贝尔医生有最高的成功率
Dr. Randolph Bell has the highest success rate.
广♥告♥牌上的那个人
The man on the billboards?
对 他是我们的首席外科医生
Yes. He's our chief of surgery.
你确定贝尔医生是这个手术的最佳人选
Are you sure Dr. Bell is right for this case?
他做过很多例肝胆手术了
He's done hepatobiliary surgeries many times.
其他人的记录都没法和他比
There's no one else here who can touch his record.
我担心的就是他的记录
It's his record I'm worried about.
他的并发症率最近特别高
His complication rates have risen dramatically lately.
而我提这个只是因为我知道
And I only bring this up because I know
主治医师并不总是了解他们的同僚
attendings aren't always aware of their colleagues.
每个医生都会犯错
Every doctor makes mistakes.
当然了 但这有些过了
Of course, but this is far beyond.
等等 康莱德
Conrad, hold on.
我现在是作为你的朋友和导师跟你说
驻院医生
The Resident
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