驻院医生

The Resident S03E14

Part 6 Feb. 19, 2020, 9:48 a.m.

I-i...
我必须通知合伙人
I have to call the partners.
你的术后血常规很稳定
Your post-op CBC is stable.
不再出血了
No more bleeding.
远端脉搏很有力
Distal pulses are strong.
贝基能动一下脚趾吗
Becky, can you wiggle your toes?
很不错
Looks good.
大手术的术后恢复并不轻松
Recovering from major surgery is challenging,
我们会密切监护你的情况
so we will be monitoring you closely.
谢谢
Thank you.
约翰怎么样了
And what about John?
我们还没给他做手术
He didn't have surgery yet.
为什么
Why?
我们也不知道
We don't know.
但他的医生正在处理
But we do know his doctors are working on it.
那是什么意思
What does that mean?
他不会有事吧
Will he be okay?
我能和他在一起吗
Can I be with him?
你得先好起来
First, you must get well.
才能为他坚强起来
Then you can be strong for him.
他八年前做脑部手术的时候
When he had brain surgery eight years ago,
我一整夜都握着他的手
I held his hand all night.
好像握着手就能让他活下来
Like I could keep him with me, just by physically holding on.
而且管用了
And it worked.
等到情况允许
Well, as soon as we can,
我们就会让你们在一起
we'll get you two back together again.
现在我们给尿样晒太阳了
And now we have urine in the sun.
霍金斯医生我快没耐心了
Dr. Hawkins, I'm starting to lose my patience.
等一等
Just wait.
我不会站在这里
I am not gonna stand here
和你一起盯着另一个男人的尿
and stare at another man's urine with you
与此同时约翰的肿瘤还在肿胀
while John's tumor continues to swell.
我们没时间搞这些
We don't have time for this.
这时间花得值
It was time well spent.
发生了什么
What-What's happening?
约翰你的尿变色了
John, this urine changed color.
这就解释了手术室发生的一切
That explains what happened in the OR
也帮我们诊断出你得的是卟啉病
and gives us a diagnosis: porphyria.
卟啉病就是你体内有过量的卟啉
Porphyria's when you have an excess of the chemical porphyrin
并在你器官上堆积
and it builds up in your organs,
这种情况下一些刺♥激♥ 比如
and when that happens, certain stressors, like...
手术室强烈的光照会使患者发病
the intense lighting in the OR, triggers a crisis
症状有起水疱肚子疼
that causes things like blisters, stomach pain,
甚至是器官损伤
and even organ damage.
你从我的尿中就能看出这么多
You got all that from my pee?
还结合了你的检查
Combined with your exam
以及以前皮肤起疱和胃疼的病史
and history of previous stomach pain and skin blisters.
但是没错
But yes,
当你尿液中的卟啉在阳光下颜色变深时
when the porphyrins turned your urine dark in the sun,
我就确认了我的临床怀疑
my clinical suspicion was confirmed.
所以我一直都有这个病
So I've had this my whole life?
很罕见所以经常被忽略
Incredibly rare, easily missed,
但好消息是
but the good news is...
我们能治好你
we can treat you.
我们当然也会做检查来确认
We'll be sending confirmatory labs of course,
但我相信你很快就能做手术了
but I am confident you will be back in the OR soon.
我和凯恩医生会为你准备好
Which Dr. Cain and I will be prepping for you.
我列了个单子
I made a list
对卟啉病患者致命的药物都在上面
of all the meds that can be fatal to a porphyria patient.
无论如何避免使用这些药物
Avoid these at all costs.
住院医师培训以来我就没见过卟啉病
I haven't had a porphyria patient since residency.
是啊这个病例很独特
Yep, this is a unique case.
所以我为大家列了这个单子
That's exactly why I made a list for everyone.
用异丙酚麻醉是安全的
Propofol for anesthesia, that's safe.
吗♥啡♥也可以用
Morphine's okay.
在使用抗生素之前告诉我一下
Just let me know before you give any antibiotics.
霍金斯医生说的没错
Dr. Hawkins is right.
我们都需要检查药物单
We all need to review the drug list.
约翰之前在手术室发病
And the reason John crashed in the OR before
是因为这些强光所以我们准备了滤光片
was because of these intense lights, so we got these filters.
我们还是看得见但它们会改变
We'll still be able to see, but they change the wavelength
照在约翰身上的灯光波长
of the light that hits John's body.
避免出现卟啉病危机
Avoiding a porphyric crisis.
到底发生了什么事
What the hell happened?
她术后的状况原本还不错
She came out fine after the surgery,
然后她出现了室速而且血压骤降
then she went into V tach and lost her pressure.
停止按压检查脉搏
Hold compressions. Checking a rhythm.
可恶她还在室颤我们需要再次电击
Damn, she's still in V fib. We need to shock again.
充电两百焦
Charging to 200.
离手
Clear.
继续按压
Restart compressions.
换我来
I'll take over.
急救血检结果回来了
Code labs are back.
血红蛋白稳定
Hemoglobin is stable.
她没有在出血
She's not losing blood.
她的血钙浓度低于五
But her calcium is under five.
这对她的心脏一点好处也没有
That's not doing her heart any favors.
好我们需要更多的钙
Okay, we need more calcium.
马上注射一克氯化钙
One gram of calcium chloride, now.
我们几小时前叫了货现在氯化钙短缺中
We ordered it hours ago. There's a calcium chloride shortage.
从急救车里拿
Take it from the crash cart.
给她输血的时候
She should have received more calcium
就应该注射钙的
with her blood transfusions.
药商不再生产能救人性命
This is what happens when drug companies
却不能赚钱的产品时就会发生这种事
discontinue products that save lives but don't make money.
注射氯化钙了
Calcium chloride is in.
继续按压
Continue compressions.
三十秒后进行下一次脉搏检查
30 seconds to the next pulse check.
希望这样有效
Hope this works.
正中红心
Bull's-eye.
是时候切除肿瘤了
Time to remove the tumor.
灯光怎么样
How are the lights?
够亮了病人的血流动力不稳定
Sufficient. My patient's hemodynamic instability
不再让我分心了
is no longer distracting me.
你最好也别烦我了
You might want to follow that lead.
手术钳
Forceps.
他妻子贝基刚才心脏骤停了
His wife Becky just coded.
他们还在抢救她
They're still working on her.
把这个送去病理科
Get this to path.
已经好几个小时了他怎么现在才切除肿瘤
It's been hours-- why is he just getting to the tumor now?
这是很精细的手术
It's a delicate surgery.
凯恩医生进行的是一场非常复杂的手术
Dr. Cain is in the middle of a very complicated surgery,
再加上应对卟啉病的预防措施
and with the added precautions for the porphyria...
约翰的运气很好
John's a lucky guy.
我能看见你们
I can see you.
你们所有人
All of you.
手术进行得很顺利
Surgery went well.
你的肿瘤切除了初步病理检查也显示良性
Your tumor's gone, and your preliminary path looks benign.
而且我们有控制你的卟啉病的治疗方案
And we have a plan to manage your porphyria moving forward.
今天你接受了查斯汀最好的照顾
Today you received Chastain's finest,
跟我们承诺的一样
as promised.
但贝基呢
But Becky...
她在哪里
where is she?
她在撞击中受到严重创伤
She sustained serious injuries in the crash,
但就像你之前说的
but, like you said before,
约翰你的妻子
John, your wife...
她对你们俩来说都足够坚强
she is strong enough for both of you.
她熬过了一场非常艰辛的手术
She survived a very grueling surgery.
但不用担心
But hey, don't worry,
我们会确保你们今晚不会分开度过
we will make sure you do not spend tonight apart.
你们的纪录不会打破了