驻院医生

The Resident S03E19

Part 3 June 20, 2020, 5:04 p.m.

So this is like Christmas for me.
拜托你再给我一份礼物
Uh, tell me there's a cure
告诉我肺纤维化是可以治愈的
for pulmonary fibrosis under the tree, too.
抱歉艾萨克
Uh, I'm sorry, Isaac.
恐怕你的肺部损伤无法被修复了
I'm worried the damage to your lungs cannot be repaired.
我们会用药物来缓解你的症状
We're gonna try to ease your symptoms with medication,
-但是... -但我们需要给你做肺活检
- but, um... - But we need to take a biopsy
来进一步确诊
of your lungs to be certain.
怎么了吗
What's wrong?
是德瑞克的事
It's Derek.
我以为他有所好转了
I thought he was doing better.
的确
He was.
但他接着又是一阵咳嗽
But then one cough led to another,
还没等我们反应过来他就呼吸急促
and before we knew it, shortness of breath.
我和康莱德讨论过了德瑞克的肺有问题
I discussed it with Conrad, and it's Derek's lungs.
他有弥散性双肺啰音
He has diffuse bilateral crackles.
肺水肿吗
Pulmonary edema?
康莱德也是这么想的
He thinks so.
自从化疗后德瑞克的体液增加了两公斤多
Derek's gained five pounds of fluid since chemo,
可他的肾脏还没有恢复
and his kidneys still haven't bounced back.
他们没给他用利尿剂吗
Well, haven't they given him diuretics?
用了但这可能不够
Yes, but that might not be enough.
如果情况如此...
And if that's the case...
他们想让你用呼吸机以帮助你呼吸
They want to put you on a ventilator to help you breathe,
希望这能让你的肺得以恢复
and hopefully allow your lungs to heal.
呼吸机
A ventilator?
要用多久
For how long?
这无从得知
There's no way of knowing.
我能保持清醒吗能与人交流吗
Will I be awake, able to communicate?
不我们得给你注射镇静剂
No, we have to sedate you.
你可能会出现其他并发症
And there's a chance you could develop other complications that
导致无法摘除呼吸管
could prevent the breathing tube from being removed.
所以他们给我注射镇定剂后
So, when they p-put me under, there's...
我有可能醒不来
there's a chance that I might not wake up,
有可能再也见不到我的家人了
that I might not see my family again.
你是这个意思吗
Is that what you're saying?
那是最坏的情况
That's a worst-case scenario,
但这是恢复肺功能的唯一办法
but it's the only way you recover lung function.
姬特一定还有别的办法
Kit, there has to be another way.
-一定还有别的办法 -不亲爱的
- There has to be another way. - No. Honey, honey.
没有别的办法了
I don't think there is.
我要是这么做
If I do this,
可能会死
I could die.
但如果不这么做
If you don't do this...
就一定会死
you definitely will.
我能延迟多久插管
How long can I delay being intubated?
按照你现在的情况
The way things are going,
除非有所变化否则需要尽快进行插管
unless something changes, it will need to happen soon.
好我得再见见乔茜
Okay, well, I just, I have to see Josie one more time.
-好的 -我知道我们同意
- Yes. - Okay, I know that we said
今天她需要去换换心情但...
that she needed a day a-away from all this but...
不我叫保姆马上去学校
No, I'll-I'll let the babysitter pick her up from school
把她接过来
and bring her here immediately.
这是一包抗真菌药
This is a bag of antifungals.
-没错我知道 -你是怎么拿到的
- Yes, I'm aware. - How did you get this?
没几个盟友是走不到我现在的位置的
You don't get to where I am without making a few allies.
你认识药房♥的人吗
You know someone in pharmacy?
不是药房♥有我的人
No, I have someone in pharmacy.
到处都有我的人
I have someone everywhere.
他们还在给索菲娅输胰岛素加低浓度葡萄糖吗
Is Sophia still being treated with the insulin drip and D5?
-是的 -这是她的输液的标签
- Yes. - Here's a label for her fluids.
贴到抗真菌药上换掉现在的药
Put it on the antifungals and hang it.
你有什么疑虑吗
Are you having doubts?
没有我想帮你我...
No, I want to help. I, uh...
有
Yes.
我有满脑子疑问
Chock-full of doubts.
我懂
I get it.
我以前做实习医生时
You know, when I was an intern,
我面临很多选择
I was faced with so many choices.
令人很困惑我也纠结过
It was all confusing. I struggled, too.
但最终我学会了比我懂得多的人让我做什么
But eventually, I learned to just do what I was told to do
我就做什么就好
by the people who knew better.
我因此而得到了回报
And I got rewarded for that.
我今天的位置不是一步步爬上来而是飞上来的
I didn't climb up the ladder, I flew up it.
你也可以埃兹拉
That could be you, Ezra.
血压90/50 心跳过速130
Blood pressure 90/50, tachycardic in the 130s.
我的心脏怦怦直跳
My heart, it's pounding.
埃兹拉检查她的肺
Ezra, check her lungs.
她烧得很厉害体温达到38.6摄氏度
She's burning up. Temp is 101.5.
呼吸音减弱
Breathing sounds are diminished.
她感染了
She's septic.
马上给她输两升生理盐水
Two liters of normal saline now.
我头晕发热把暖气关小点
Dizzy. Hot. Turn down heat.
我们要给她用升压药吗
Should we start her on pressors?
我们先看看输液有没有效
Let's see how she responds to volume.
我来把她调整成头低脚高卧位
I'm putting her in Trendelenburg.
挤压输液袋
Squeeze the bag.
她的血压升高了
Her BP is rising.
起效了
It's working.
有别的病因导致她病情恶化
Something is causing her to deteriorate.
但她的检测结果并没有显示
Yeah, but there's nothing in her labs that's suggesting
-是什么问题 -病情有变化
- what that could be. - Well, something's changed.
我们需要再做一组化验
We need a new set of labs.
还要增加给她用的抗生素种类以防万一
And broaden her antibiotics, just in case.
我去开单子
I'll put in the orders.
我们会让护士来照看你的索菲娅
We'll have the nurse come check on you, Sophia.
埃兹拉你在干什么
Hey. Ezra, what are you doing?
我说「开单子」是让你去
When I said, "Put in the orders", I meant you would.
好的我这就去
Yeah, right. Coming.
你的肺活检结果出来了
We got the results from your lung biopsy.
很遗憾艾萨克
I'm so sorry, Isaac.
你需要做移植手术
You need a transplant.
那我排到一个新肺的几率有多大
Well, what are my chances of getting a new lung?
你是合适的候选人
Well, you're a good candidate.
你还年轻除了肺以外身体健康
You're young, otherwise healthy.
不过所有病人必须要有帮扶人
But in order to be eligible for a transplant,
才有资格进行移植手术
all patients must have a support system.
你需要两个术后能照顾你的人
Two people who can take care of you after the surgery,
带你去见医生注射药物
take you to appointments, administer medication
一直到你痊愈
for as long as necessary.
他们得全程陪护直到你康复
They'll have to commit to your recovery,
这可能会是一个漫长的过程
which can be a long process.
我是别人的帮扶人
Yeah, I am the support system for other people.
我自己没有帮扶人
I don't have one of my own.
肯定还是会有人能来帮你的对吧
Well, surely there's someone who can step up, right?
过去的寄养家庭父母朋友
Old foster parents, friends?
这是我自己的错
It's my own fault.
从小到大我心里一直有根刺
Growing up, I had a huge chip on my shoulder.
愤怒毁掉了我和所有亲朋好友的关系
Anger cost me every relationship in my life.
我吸食毒品寻求寄托
I found my companionship in drugs.
我丢了工作然后丢了家
I lost my job and then my home.
我一直一个人生活
I've lived my life alone.
现在看来我也会一个人死掉
Now it sounds like that's how I'll die.
好吧
Okay.
不如给我们点时间
Why don't you give us some time,
看看我们能不能想出什么办法好吗
see if there's something that we can figure out, okay?
我确实是认识
You know, I do have a contact
一位在肺部纤维化群体的熟人
in the pulmonary fibrosis community.
或许他们有人力可以帮艾萨克
Maybe they have some resources that could help Isaac?
从没想过我会说这种话
Never thought I'd say this,
不过一言不发可不是你该有的样子