驻院医生

The Resident S04E08

Part 4 May 30, 2021, 8:01 a.m.

- 在加勒比海潜水 - 嗯
-Snorkeling in the Keys. -Mm-hmm.
- 但我们不能离开亚特兰大 - 是但
-But we can't leave Atlanta. -Yes, but...
- 我有个好主意 - 救命啊
-I have an idea. -Someone help!
怎么了
What is happening?
打给血库要两件血进行仪器检测
All right, call the blood bank for two units, stat,
呼叫康拉德她有胃肠道出血
and page Conrad. She's having a GI bleed.
- 怎么回事 - 她说有点恶心
-What happened? -She said she felt sick
- 然后就吐♥血♥了 - 帮我把她扶着坐直
-and then blood was just everywhere. -Help me sit her up.
临床吐♥血♥
Pretty decent episode of hematemesis,
生命体征稳定
Vitals stable.
给她注射奥美拉唑 80毫升
All right, let's give her a bolus of omeprazole, 80 mil.
然后呼叫贝尔我们需要他
And call Bell. We need him here.
- 不会是因为摔倒造成的吧 - 不是
-This can't be from the fall. -I don't think so.
应该是其它问题造成了她的胃肠出血
Something else is causing her GI bleed.
梅根醒醒醒醒
Megan, stay with us. Stay with me. Stay with me!
天哪帮帮她帮帮她啊
Oh, my God. Help her! Help her!
- 需要插管 - 约思科你需要在外面等
-Need to intubate now! -Hey, Josko, you need to wait outside!
- 需要去外面等 - 抱歉
-You need to wait outside. - Sorry.
准备插管
Can you prep the ET tube?
管子呢
Where's the pipe? Ah...
什么都看不到
I can't see a damn thing.
好我看到声带了管子
All right, I see the cords. Tube.
她需要做个内镜检查
She's gonna need an endoscopy to locate
出血部位
the source of the bleeding.
对必须马上做
Yeah, and she needs that now.
- 新来的实习生怎么样 - 一言难尽
-How's the new intern been doing? -Mixed bag.
有时候过分自信其它时候又完全不在状态
Sometimes total confidence, others a flailing mess.
跟其他实习生一样包括你普拉维什
Just like every intern. Including you, Pravesh.
我觉得不止这样吧
I think there's more to it than that.
如果你想当艺术家你自便
If you'd rather be an artist, by all means go do it.
至少你把线画到外面不会害死人
At least no one dies when you color outside the lines.
现在你该好好关注你的病人
Right now, you really should be focusing on your patients.
尤其是经过今天的表现之后
Especially after today's performance.
普拉维什医生我第一天
So kind of you to give me that advice
来切斯廷医院你就给我建议
on my first day at Chastain, Dr. Pravesh.
很感谢你
Thanks so much.
想知道我画的是什么吗
Do you want to see what I was drawing?
你不了解我我也不了解你
You don't know me and I don't know you,
不过你要知道一点
but you need to understand this.
努力成为最棒的医生
There is nothing that matters to me more
对我来说是最重要的事
than learning to be the best doctor that I can be.
至于我今天的表现
And as far as my performance goes,
你也当过实习生你当时就无可挑剔吗
when you were an intern, did you perform flawlessly?
这是个学习过程
It's a learning process,
我希望你是帮助我成长
and I was rather hoping you'd help me learn,
而不是起反作用
not tear me down.
慢着
Hold on.
- 下方静脉鼓起 - 嗯静脉曲张出血
-Bulging vein at six o'clock - Yeah, a variceal bleed.
得包扎起来
I need to band it.
我给她准备静脉滴注
I'll get her started on a drip.
找到病源了
Okay, I have the culprit.
转动管子
Twisting the dial...
贴上了
And the band is on.
切断异常静脉的血液循环
Cutting off circulation to the abnormal veins and...
止住血了
...stopping the bleed.
梅根因为静脉曲张而出血
So Megan was bleeding due to varices.
她可能有肝硬化
She likely has cirrhosis.
这就解释了为何她的瘀血消失了
Yeah, it explains why her coags are off.
肝出毛病了
Liver disease.
- 吸毒酗酒 - 不会
-Drugs, alcohol... -No.
我们问她以前的情况
When we took her history,
她说她只喝茶和苏打水
she said she only drinks tea and seltzer.
我会送去研究
I'll send off studies.
肝病专家组审核自身免疫性血清检测
Hepatitis panel, autoimmune serologies.
肯定能告诉我们点什么
They have to tell us something.
厉害嘛
Impressive.
我有动力
I'm motivated.
我想回到以前的生活
I want my life back.
我也是
Me, too.
镰刀细胞症很严重
Sickle cell is, um, it's brutal.
今天我
Earlier today, I was, uh...
我有点
I was a little...
我会抗争到最后一刻
I'll fight it till my last breath.
我还想跳舞这给了我奋斗目标
I want to dance again. It gives me a goal.
我可以理解
I can understand that.
我是个外科医生
I'm a surgeon
没了双手我什么也不是
and I'm nothing without my hands.
你怎么弄伤自己的
How did you hurt yourself?
被车撞了
I was hit by a car.
真惨我很抱歉
Oh. Damn. I'm sorry.
那个
Well...
你还会手术我也还会跳舞
you'll cut again, I'll dance again.
我们都是斗士对吗
We're both fighters, right?
我想你前面的路更艰难
I think you have a far harder road.
不过祝你好运
But good luck with that.
不要轮椅
No, no wheelchair.
我要自己走着离开这里
I'll be walking out of here on my own two feet.
在我工作中我发现
In my career, I've found that
关于预后病人必须对自己
patients need to be honest with themselves
诚实
about the prognosis.
只有这样才能为将来做最好的打算
And only then can they truly plan for what the future holds.
好说的很对
Okay. It's a good point.
根据我今天早上的所见
Based on what I saw this morning,
你可能永远不能做手术了
you will never likely operate again,
不过你对自己很诚实
but you're honest with yourself about that.
对吧
Right?
精细操作技能
Fine motor skills.
你连把一个东西放在另外一个上面都不行所以
You couldn't even put one block on top of another, so...
还是祝你好运
Good luck with that.
- 嗨梅根 - 嗨
-Hey, Megan. -Hey.
你有肝硬化症状
You have cirrhosis of the liver
我们需要找出原因
and we need to find out why.
你之前说你不喝酒
You already said you're not a drinker.
- 只是喝茶和苏打水 - 好的
-Just tea and seltzer. It's all I do. -Okay.
你是否曾经感染过乙肝或者丙肝
Um, have you ever had a hep B or hep C infection?
据我所知没有
No, not that I know of.
你第一次以为自己得了亨廷顿舞蹈病时
When you first thought you had Huntington's,
有哪些征兆
what were the signs?
我开始感觉手脚不灵活
I started to be clumsy all of the time
然后感觉疲劳
and then came the fatigue
记忆缺失吞咽困难
and the memory loss, difficulty swallowing.
我记得我爸得这病时也是这些症状
I remember very similar symptoms when they started with my dad.
这是个新症状
And this is a new one
而且越来越频繁
that happens more and more all the time.
乔思科说好像
Josko said it looks like
- 我要飞起来了 - 对
-I'm trying to fly away. -Yeah.
- 做我这个动作 - 好的
-Put your arms up like this for me? -Yeah, yeah.
- 对再高一点儿 - 好
-Yeah, just a little higher. Higher, higher. -Yeah.
好了
There we go.
梅根谁给你诊断的亨廷顿舞蹈症
Who diagnosed your Huntington's, Megan?
我自己
Uh, I did.
有医生给你确诊过吗
Was it ever confirmed by a doctor?
没有不过我知道自己得的什么病
No, but I know what I have.
这病没什么治疗方法所以
There's not really a treatment, so, like...
- 嘿你怎么了 - 嗨
-Hey, what's going on? -Hey, hey, hey.
- 嗨 - 没事了没事的
-Hey. -Oh, it's okay. It's okay.
你好乔思科
Hey, Josko, I...
我需要再做几个检查我马上回来
need to run some more tests. I'll be right back.
好的
Okay. Hi.
嗨亲爱的
Hey, baby. Yeah?