我在切子宫壁 I'm incising the uterine wall.
你表现很好 非常好 You're doing great, really great.
会没事的 It's gonna be okay.
你保证 You promise?
-宝宝出来了 -脐带钳 抽吸 - Baby's out. - Umbilical clip. Suction.
求你们 Please --
我能看看我女儿吗 can I see my daughter?
可以 Yes.
当然 Of course.
抱歉 Sorry.
我们需要对她进行手术 We'll need to get her into surgery.
我们会照顾好她的 We'll take good care of her.
你的新主任很时髦地迟到了 Your New Chief is fashionably late.
是我们的 Our Chief.
虽然是我向医委会介绍的韩医生 Just because I endorsed Dr. Han to the Board
但不意味着我一点担忧也没有 doesn't mean I don't have any concerns.
请韩医生这样的人代价高昂 Connections like Dr. Han's come at a premium
鉴于我们目前在医委会面临的困境 and, he assures me, will be well worth it
他向我保证雇他是物有所值 given our current predicament with the Medical Board.
我不仅是在担心钱 I'm not just worried about the money.
当你付如此高工资 When you pay that much,
他们容易自以为是 they tend to think they're worth it.
他们就会连自己的欢迎早午餐会 Makes a person think they don't have to show up
都懒得现身 for their own welcome brunch.
宝宝的肠突出 The baby's bowel protrusion
在产前影像诊断里看上去没那么严重 seemed less severe on the prenatal imaging.
而我们得先解决 And it'll have to wait
她的心脏问题才能轮到肠子 until we're done with her heart problem.
我现在能看到她的隔膜和瑞士奶酪一样都是洞 Now that I'm in here, her septum looks more like Swiss cheese.
呼叫新生儿心脏外科值班医生 Page the on-call neonatal cardiac surgeon.
没有必要 我来就好 That won't be necessary. I'll scrub in.
请问你是 And who are you?
我是杰克森·韩 I'm Jackson Han.
你们的新外科主任 Your new Chief of Surgery.
良 医
第二季 第十五集
给我回波探头 Echo probe, please.
让我们来放点音乐 And let's turn that music on.
传送鞘管往前点 Advance the delivery sheath.
在患者心脏里 莫菲医生 It's in the patient's heart, Dr. Murphy.
我觉得音乐有点让人分神 I think the music is a little distracting.
做手术没有音乐才让人分神 I feel the same way about operating without music.
我来用一根长一点的 I'll take a longer sheath,
而莫菲医生需要夹钳 and Dr. Murphy will need some forceps.
BGM: Ancient Names, Pt.I by Lord Huron
♪ Well, the neon lights ♪
♪ Glowed red and gold ♪
♪ I came to hear my fortune told ♪
五秒内捡起还能用 5-second rule.
♪ I can't imagine what she saw ♪
我开个玩笑 It was a joke.
♪ While gazing in her crystal ball ♪
她的肠子怎么了 What about her bowels?
为什么利姆医生现在不把它放进腹腔 Why isn't Dr. Lim inserting it into the abdomen right now?
空间不够 There is not enough room.
如果要放进去 There's -- there's not enough room
不升高腹腔压是不可能的 without increasing abdominal pressure,
这会导致肠道血流量锐减 which would critically decrease blood flow to the bowel.
根据哪个血流动力学原理 According to what hemodynamic principle...
布朗医生 Dr. Browne?
血流阻力 血流是由 Vascular impedance -- blood flow is driven
压差驱动的 by the force induced by the pressure gradient.
该如何计算 And how do you calculate it?
我得去查一下 I-I'd have to look it up.
八乘血管长度和血液粘滞性 8 times L.Nu. divided
除以圆周率乘半径的四次方 by Pi.R.4.
很好 莫菲医生 Very good, Dr. Murphy.
所以这个封堵器用不了 That's also why this occluder won't work.
它扛不住她心脏内部的巨大压差 It won't hold up against the huge pressure gradient in her heart.
有解决方案吗 Is there a fix?
我现在没有长期的方案 Long-term, I don't have one.
现在把脐带胶布和PE管给我 Right now, I need umbilical tape and PE tubing.
♪ I gotta get away from here ♪
♪I 'll never see the golden sunrise ♪
♪ Oh, I gotta get away from her ♪
你在做肺动脉束带 You're making a pulmonary artery band.
这样能争取点时间 That should buy us some time
想到办法救这个婴儿 to come up with a plan before we lose this baby.
检验技术员请到第六手术室 Lab technician to O.R. 6.
你取消了我的疝气修补术吗 You canceled my hernia repair?
没有提前通知你 真是不好意思 With no advance notice. Sorry about that.
但很高兴见到你 But so great to meet you.
我是杰克森·韩 Jackson Han.
-尼尔·梅伦德斯 -我知道 - Neil Melendez. - Oh, I know.
你那个背驮式心脏移植做得很不错 You did great work on that piggyback heart transplant.
我需要你去给米那什·戈雅尔做会诊 I need a consult on Minesh Goyal.
他是一家公司的创始首席执行官 He's the founding CEO of a company --
-他的诊断结果是什么 -没有 - What's his diagnosis? - He doesn't have one.
他是来做全面诊断检查的 He's here for a full physical, complete diagnostic workup.
我有一个长期的高管健康... I have a long-standing Executive Wellness --
我是外科医 不是内科的 I'm a surgeon, not an internist.
我不做预防医学 I don't do preventative medicine.
不论患者多有钱 No matter how rich the patient is.
你知道有钱患者的好处是什么吗 You know what's great about rich patients?
他们让我们能治疗贫穷的患者 They allow us to treat poor patients.
并且我向米那什保证给他最好的医生 Also, I promised Minesh the very best.
所以我还能找谁呢 So, really, who else am I gonna get?
约翰森医生请去手术准备室 Dr. Johansen to pre-op.
血压高压110 低压70 BP's 110 over 70.
杰克森 韩医生 Uh, Jackson -- Dr. Han --
说了你很多好话 says great things about you.
谢谢 That's very kind.
心电图正常 体质指数很好 Normal EKG, optimal BMI,
心脏和肺都没有问题 heart and lungs sound good.
有什么原因让你忧心到 Any reason you're worried enough about your health
能忍受一天的各种检查呢 to endure an entire day of tests?
我并不是担心 I'm not worried.
知识就是力量 Knowledge is power.
每次我进入新市场 Whenever I enter a new market,
我都尽力了解这个领域的方方面面 I learn everything I can about the landscape --
消费需求 目标市场 竞争者 consumer needs, target market, competitors.
你知道你的身体并不是公司吧 You're aware your body isn't a business.
我知道我听上去像是个有钱的疯子 I know I sound like a rich lunatic
妄图掌控我生活中的每一个方面 with fantasies about controlling every aspect of my life.
我猜我算是吧 And I guess I kind of am.
我父亲也曾经保养得很好 My dad was in good shape, too.
直到他猝死于每日都进行的慢跑中 Until he dropped dead on his daily jog.
化疗处
马奇埃尔医生请到心理健康科 Dr. Markiel, please come to the mental health unit.
我是拉瑞·查兹 I'm Larry Childs.
我想跟你握个手 但是 I'd shake your hand, but, you know,
我的免疫系统已经挂了 no functioning immune system.
-我叫亚伦 你好 -很高兴见到你 - Aaron. Hi. - Good to meet you.
你得了哪味癌症啊 What flavor cancer do you have?
-哪味 -对啊 - What flavor? - Yeah.
神经胶质瘤 Glioma.
不是吧 Shut the front door.
脑部还是脊椎 Brain or spine?
-脑部 -老兄 - Brain. - Dude --
咱俩是肿瘤双胞胎啊 we're tumor twins.
他们给你用了什么药 Wh-What do they have you on?
长春新碱 我听说药效很强 Vincristine. I hear that's intense.
我的医生认为这药能干掉我 My doc thought it would wipe me out.
你恢复有望还是想着赶紧死 You doing okay or longing for death?
我撑着呢 谢谢 I am hanging in there. Thank you.
这是我用替莫唑胺的第三轮了 I'm on my third round of temozolomide.
我在这看到过你几次 I've seen you in here a few times.
你喜欢独来独往 对吧 You kind of keep to yourself, huh?
嗯 Yeah.
我很乐意介绍一下大家 Well, I'm happy to introduce you around.
大伙都很友好 It's a really friendly group.
不用了 谢谢 I'm okay. Thank you.
你有互助小组吗 You have a support group you go to?
没有 I do not.
所有人都需要有个癌症小圈子 Everyone needs a cancer community.
尽量别动 And try to hold still.
谢谢你 Thank you.
让我们参与 For bringing us in.
这是新外科主任的病人 是个绝佳机会 This is the new Chief's patient. It's a great opportunity.
或一大堆无用的检查 Or it's a bunch of pointless tests.
但我依然感谢你 Uh, for which I thank you.
跟我们说说韩医生 Tell us about Dr. Han.
他说话直接 有魅力 He's direct, charming,
非常自信 very sure of himself.
很自负 Big ego.
自负没什么 只要有能力 There's nothing wrong with an ego if you can back it up.
韩医生的动脉转位技术 And Dr. Han's arterial switch technique
普及到了世界各地 is performed all over the world.
这些检查不全是毫无意义 The tests aren't all pointless.
好一个见风使舵 朴 Way to stand firm, Park.
不 看屏幕 No, look at the monitor.
他有肿瘤 He has a tumor.
珀西稳定了吗 Percy's stable?
我们打算给她起名珀西芬 We're naming her Persephone.
是的 我开了一条中心静脉输送营养 Yes. I put in a central line for nutrition.
珀西现在稳定了 Percy is stable right now.
我们正在寻找治疗方案 We're looking for solutions to her problems.
为什么 W-wh-why does...
为什么她会有这些先天缺损 Why does she have all these birth defects?
戴安 Diane.
我们跟产科医生谈了 We spoke to our obstetrician.
她说这些先天缺损可能找不到原因 对吗 She said these defects can happen for no reason, right?
没错 That's true.
有五成多的缺损原因未知 Over 50% have no known cause.
我之前服用帕罗西汀治疗临床抑郁症 I was taking paroxetine for clinical depression.
但你一发现自己怀孕 And you went off the meds
就马上停药了 as soon as you found out you were pregnant.
她那时最多怀孕五六周 She was five, six weeks at most.
我的产科医生说研究表明 My OB told me studies show
怀孕期间可以服用抗抑郁症药物 antidepressants are safe to take during pregnancy.
这是真的 But is that true,
还是她在保护我 or is she protecting me?
有一项研究表明帕罗西汀和 There was a study that associated paroxetine
这种先天缺损有关 with these kinds of defects.
有这个可能 It is a possibility.
你无法确定肿瘤是恶性还是良性的 You can't tell whether it's cancerous or benign?
做了活检才能有定论 Not until we do the biopsy,
已经约了一会做活检 which I've scheduled for later.
早上就会知道结果 We'll know what's going on by the morning.
好 Good.
很好 That's good.
你想给谁打电话吗 Maybe you'd like to call someone?
家人或朋友 A family member, a friend?
等确定是癌症我再担心 I'll worry when I know it's cancer.
我们可以用经导管路线 We could use a transcatheter route
分别修复每个洞 and patch each hole individually.
她的心脏只有核桃那么大 Her heart's the size of a walnut.
太小了无法在里面操作 It's too small to maneuver inside.
用一个大的补丁堵上所有洞 A single large patch to close the holes
就能承受住压力 would withstand the pressure.
没错 Yes.
还能阻断导电 It would also block electrical conduction,
造成致命性心律失常 causing deadly arrhythmias.
莫菲医生 Dr. Murphy...
你是不是告诉那个母亲是她造成了孩子的先天缺损 did you tell the mom that she caused her baby's birth defect?
不是 我说可能是她的抗抑郁药 No. I said that her antidepressants could have.
你为什么说这个 Why did you tell her that?
这是事实 It's the truth.
这与她现在的身体状况有关联吗 And is that relevant to her current medical situation?
没有 No.
你觉得你的回答让她有什么感受 And how did you think that answer would make her feel?
你觉得会发生什么 What did you think would happen?
母亲悲痛欲绝 The mother is devastated.
父亲气疯了 The father is furious.
换了我也会 I would be, too.
肖恩只是住院医师 Shaun is a resident.
住院医师会犯错 Residents make mistakes.
管理这些病人的情绪 Managing these parents' emotional concerns
以及给他们的女儿做手术都是这份工作的一部分 is as much a part of this job as operating on their daughter.
肖恩不太懂社交信号 Social cues are hard for Shaun,
但我们一直在帮助他 but we've been working with him --
你应该注意改进自己的缺点 You should be focused on your own shortcomings,
比如记住血流助力计算公式 like retaining the formula for vascular impedance.
韩医生 Dr. Han.
如果能切开心室 我们就可以 We could patch each individual hole in the heart
单独修复心脏的每个洞 if we cut open the ventricle --
别转移话题 莫菲医生 Don't change the subject, Dr. Murphy.
我没有 韩医生 I didn't, Dr. Han.
我们之前在谈论婴儿的手术方案 We were talking about the baby.
真的吗 Really?
你不知道在我进来前和进来后你们的讨论 You don't see a difference in the nature of your discussion
发生了本质性的变化吗 before I arrived and after?
我们之前在谈论婴儿的手术方案 We were talking about the baby.
洛杉矶儿童医院尝试了你说的方案 They tried the approach you suggested at L.A. Children's.
婴儿一周后去世了 The baby died a week later.
缝合线撑不住 心脏壁破裂 The suture line didn't hold, and the cardiac wall ruptured.
接着找 Keep looking.
莫菲医生 Dr. Murphy,
别再和那对父母说话了 do not talk with those parents again.
我跟你一起 I'll walk with you.
你对我的住院医师很严格 You're pretty tough on my residents.
在公共场合指责他们 Rebuking them in public,
在手术时用问题为难他们 pimping them with questions during surgery.
羞辱式学习不是我的风格 Shame-based learning isn't my style.
我会记住 I'll bear that in mind.
但这不是我对待医师的问题 But this isn't about my treatment of "the residents."
你担心莫菲医生 You're concerned about Dr. Murphy.
很多医生对病人的态度都不太理想 Well, a lot of doctors have less than ideal bedside manner.
-他还年轻 -你作为住院医 - He's young. - Would you ever have said
或是作为医学生时 something like that to a patient as a resident?
会对病人说这样的话吗 As a med student?
而莫菲甚至都不明白他到底做错了什么 And Murphy doesn't even understand he did anything wrong.
肖恩对于事物的感知 Shaun has hard-wired differences
-和常人大不一样 -正是 - in the way he perceives things. - Exactly.
不管他多么努力 No matter how hard he works,
不管你多么努力地帮助他 no matter how hard you try and help him,
他的局限性不会改变 his limitations are not going to change.
他会继续以多样性和包容性的名义 He's going to continue to inflict them on our patients
给我们的病人带来伤害 all in the name of diversity and inclusion.
肖恩有能力留在这 Shaun deserves to be here.
一旦你看到他的能力 你会认同的 Once you see what he's capable of, you'll agree.
我期待被证明我是错误的 I look forward to being proven wrong.
再坐二十分钟 Stay seated for 20 minutes.
不希望你在大堂里昏倒 Don't want you passing out in the lobby.
我知道 我知道 谢谢 I know, I know. Thank you.
这种病改变了我的关系 This disease changed my relationships,
改变了我生活的重点 改变了 changed my priorities, changed...
我是谁 who I am.
癌症是一种身份 Cancer is an identity.
癌症是细胞突变 Cancer is cellular mutation.
这个房间里的人都是我的人 The people in this room are my people.
你多大 20岁 我是你的三倍 What are you? 20 years old? I'm triple your age.
我不认为你是我的同类 I don't think you're my "people."
上次我和法学院的朋友出去玩 The last time I hung out with my law-school friends
史诗般的失败 epic fail.
你用「史诗般的失败」这个词 The fact that you use the phrase "epic fail,"
完全证实了我的说法 kind of case in point.
他们关注的都是要去什么公司上班 They're all focused on what firm they're gonna land at,
而我只想知道… and I'm all about whether...
新的化疗方案对 Candice's leukemia is responding
坎迪丝的白血病有没有作用 to her new chemo regimen.
顺便说一句 她的薄荷油 By the way, she has this peppermint oil
对头痛很有效 that is great for headaches.
我知道那种表情 I know that look.
给 给 Here, here.
有我呢 兄弟 Got you, brother...
不管你喜不喜欢 whether you like it or not.
现在什么情况 Show me where we are.
这个角度非常接近骶神经根 That angle runs pretty close to the sacral nerve roots.
情况如何 How are we doing?
肿瘤贴着髂动脉 Tumor's abutting the iliac artery.
我在想办法不阻碍他下半身的 I'm trying not to disrupt the entire blood supply
全部血液供应 to his lower body.
韩医生 我是摩根·雷兹尼克 Dr. Han, I'm Morgan Reznick.
我很喜欢你那篇婴儿 I really enjoyed your article on Myotomy
先天肥厚性幽门狭窄肌切开术的文章 for infantile hypertrophic pyloric stenosis.
我很欣赏你为了拍马屁做的功课 I appreciate the thorough research behind your sucking up.
你是 And you are?
亚力克斯·朴 Alex Park.
朴 你以前是警察 Park, you were a cop.
医学作为第二职业 不错 Medicine as a second career, good stuff.
会带来新的视角 Tends to bring a fresh perspective.
我碰到动脉了 拿着针 I hit an artery. Take the needle.
血液在涌向盆腔 Blood's pooling in the pelvis.
-我们要开刀吗 -不 - Should we open him up? - No.
准备股动脉 给我一套动脉导管 Prep the femoral artery. Get me an art cath set.
血压在下降 Presure is dropping.
铂金弹簧圈 Platinum coil.
干得漂亮 Nice save.
下次不要碰到血管 Next time, don't hit the vessel.
没有下次了 There is no next time.
活检太危险了 The biopsy's too dangerous.
很有可能是良性脊索细胞瘤 It is likely that it's a benign notochord cell tumor.
那看起来像是脊索瘤 They look like chordomas,
但是无害的 而且更常见 but they're harmless and way more common.
可是你不知道 But you don't know.
因为我们不能做活检 所以不知道 Since we can't do the biopsy, no.
这就是全身检查的问题 This is the problem with broad testing.
每个人都有异常的地方 Everyone has abnormalities.
大多不是什么问题 Most of them are nothing.
但当我们确实发现问题时 But when we do find them,
我们必须做出艰难的选择 we have to make some tough choices.
那我的艰难选择到底是什么呢 So, what exactly is my tough choice?
我们可以切除肿瘤 We could remove the tumor.
这是一个非常危险的手术 This is a very risky surgery.
有瘫痪或更坏的可能 There's a chance of paralysis or worse,
你可能下不了手术台 you may not make it off the table.
或者就不做手术 Or you do nothing.
我们可以继续观察 We'd continue to monitor it,
每隔几周做一次成像 do imaging every few weeks.
但是脊索瘤转移得很快 But chordomas move very quickly.
一旦影像出现任何变化 By the time any change showed up on imaging,
很可能是全身转移 it's most likely metastasized throughout your body.
所以这可能不是癌症 So it probably isn't cancer,
但如果是癌症而我等着 那我就会死 but if it is and I wait, then I'll die.
是这样的 That's true.
如果我不等 直接做手术 And if I don't wait and I get the surgery,
那我很有可能会死 then there's a good chance I'll die.
是的 Yes.
我得好好考虑一下 I'm gonna need to think this over.
这是五月份出的《新生儿手术记录》 This is the May Annals of Neonatal Surgery.
我刚看完三月的 我现在得看四月的 I just finished March. I need to read April now.
我在看四月 肖恩 Oh, I have April, Shaun.
不 No.
不 你应该去看 No, you're supposed to be reading
《新生儿外科新思路》 New Approaches in Neonatal Surgery.
克莱尔那有《英国新生儿学杂志》 Claire has the British Journal of Neonatology.
肖恩 Shaun...
我觉得韩在的时候你或许应该安静一点 I think maybe you should be quiet around Han for a little while.
可是我怎么回答他的问题呢 But then how will I answer his questions?
直接的问题 当然回答 Direct questions, absolutely answer.
否则 在手术室外 Otherwise, outside of the O.R.,
你应该避开他 you should stay out of his way.
如果有人说服肖恩这样对梅伦德斯医生 If someone had convinced Shaun to do that with Dr. Melendez,
他现在还在做抽吸的工作 he would still be on suction.
蓝色警报 新生儿重症监护室4号床 Code blue. NICU, Bed 4.
氧饱和度下降 中心静脉压升高 O2 SATs dropped and central venous pressure shot up.
肺动脉带在衰竭 The Pulmonary Artery Band is failing.
-注射八个单位的巴胺 -给她上呼吸机 - Eight of dopamine. - Let's get a mask on her.
她坚持不了多久 我们需要想其他办法 She won't last much longer. We need other options.
我去通知父母 I'll update the parents.
给她上全套心脏支持系统 Let's get her on full cardiac support.
你查到什么了吗 What have you got? Anything?
这个克利夫兰的团队 This Cleveland group
用肠溶解术修复肠突出 repaired a bowel protrusion using enterolysis.
我可以切除多余的炎症组织 I could cut out this excess inflammatory tissue
以及部分肠道闭锁 and segment of bowel atresia.
或许能让她的肠子小到可以放进去 Might make her intestines small enough to fit.
有希望 Promising.
因为她腹部空间太小 Given the size of her abdomen,
所以我得截掉一大段肠道 I need to remove a lot of bowel.
她很有可能无法吸收食物 There's a good chance she wouldn't be able to absorb food.
我们必须找到一个恰当的平衡点 We'll have to find the right balance.
这是唯一可行的方案 It's our only workable plan.
最好的办法是切开心室 Best bet on the heart is to cut through the ventricle,
就像莫菲建议的那样 like Murphy suggested.
你担心的是缝合线的支撑强度 you were concerned about the suture line holding.
没错 我还在担心 Well, I still am.
希望水平褥式缝合法能起效 Hopefully, horizontal mattress sutures will work.
它们应该能承受得住缝合线的拉力 They should be able to withstand the tension at the suture line.
还是有在下面的组织中 There's still a risk of an aneurysm forming
形成动脉瘤的风险 in the tissue underneath.
聚四氟乙烯阀瓣
利姆医生 Dr. Lim?
即使韩医生没有问我问题 I have an idea I'd like to share,
我也有个想法想分享一下 even though Dr. Han didn't ask me a question.
好 说吧 肖恩 Yeah, go ahead, Shaun.
如果我们从心房穿进去 If we go in through the atrium,
就不用担心缝合线的问题... we wouldn't have to worry about the suture line...
这个问题我们已经讨论过了 It's the same issue we discussed.
婴儿的心脏内部没有足够的空间 There's not enough room inside the baby's heart
可以把补丁缝上去 to stitch the patches in the place.
我们不需要这样做 韩医生 Oh, we don't need to, Dr. Han.
我们可以做个塞子 We can make a plug
小到跟她的心脏相符... small enough for her heart...
带有茎部的聚四氟乙烯阀瓣 像个小蘑菇 a PTFE disc with a stem like a mushroom.
然后我们把它的茎部插入其中一个洞里 Then we can insert the stem through one of the holes
直到这个阀瓣贴在心脏外壁上 until the disc presses against the wall,
把所有洞都覆盖住 covering all the holes.
就像浴缸里的塞子 L-like a stopper in a bathtub.
没错 Yes.
她左侧心脏的受到的压力更大 The higher pressure on the left side of her heart
这样就可以把塞子固定住 would keep it in place.
我们都不用缝针了 We wouldn't even need to stitch.
好主意 Great idea.
我们应该去跟她父母谈谈 We should take this to the parents.
是治疗心脏的好主意 Great idea for the heart.
但是还是得告诉他们目前 But we need to tell them that our current plan
修补腹部的方案 for the abdominal repair
风险还是相当高的 is considerably more of a long shot.
而且修补心脏让我们又少了一个选择 And that fixing the heart takes an option off the table.
也就是撤除治疗 Withdrawing care.
你不能动那张牌 You can't move that card.
什么意思 Excuse me?
谁玩单人纸牌会作弊 Who cheats at solitaire?
你其实是在欺骗自己 You're literally only cheating yourself.
又一次 Again.
早上好 拉瑞 Good morning, Larry.
这样就是有男子气概吗 Is it a macho thing?
真男人就不能被贴上癌症患者的标签 Like a real man should be able to make it through
也不需要人陪 只能靠自己挺过去吗 without leaning on a label or the people who go with it?
把拥抱癌症作为自己的人物设定 Embracing cancer as an identity
是我们这种人最不应该做的事情 is the last thing any one of us should be doing.
这样会更加凸显所有可怕的事情 It underscores everything horrible right now.
我们每天都在为活下去而斗争 We're in a daily battle for our lives.
整天纠结这些事情没有任何意义 I see no value in dwelling on that.
坎迪丝迟到了 Candice is late.
可能是她侄女忘记去接她了 Which means either her niece forgot to pick her up.
又一次 Again.
也可能是她病情恶化了 Or she got some bad news.
或者她已经死了 Or she's already dead.
我们每天都在战斗 We are in a daily battle.
但我宁愿有人陪伴 I'd rather have some company.
我已经跟我的母亲和兄弟谈过了 I spoke to my mother and brother,
他们都觉得我不应该做手术 and they both think I shouldn't do the surgery.
显然他们更害怕的是你的手术技能 Apparently they're more scared of your surgical skills
而不是那个肿瘤 than they are of this tumor.
那你怎么看 And where do you stand?
我需要数据 I need numbers.
请坐 Please.
关于类似情况的统计数据 The stats on something like this, it --
有很多变数 there are a lot of variables.
那我手术成功 没有并发症的几率 What are the odds I make it through the surgery
有多大 without any complications?
这个手术很有挑战性 It's a challenging procedure.
我觉得有八成把握没有并发症 Zero complications, I'd say 80%.
但是这个肿瘤很有可能不是恶性的 But it is very unlikely this tumor is malignant.
给我具体数据 Give me a number.
它是脊索瘤的可能性只有百分之五 About 5% chance it's a chordoma.
从这个数据来看你家人的意见是对的 The numbers agree with your family.
我也同意 So do I.
我一直都喜欢主动采取措施而不是坐以待毙 I've always been more comfortable with action than inaction.
我想让你来做这个手术 I want you to do the surgery.
要确定一件事是要付出代价的 Certainty comes at a price.
她有可能撤掉生命维持系统吗 She'll be able to get off the life support machines?
如果一切顺利 没错 If everything goes well, yes.
她会有一颗强大的心脏 She'll have a strong heart.
多快可以做手术 How soon can you do it?
你们应该知道我们对于她肠道治疗的 You should know we feel less confident
方案还不是很有信心 about our plan for her bowel.
失败的可能性非常高 The chance of failure is quite high.
有多高 How high?
我觉得有九成的可能修补不会起效 I put it at 90% that the repair won't work.
这可能会导致无法复原的营养不良 Which would lead to irreversible malnutrition.
术后的几个月你女儿可能会慢慢饿死 Your daughter would slowly starve to death over months.
现在 她的身体正在努力地 Right now, her body is working very hard
活下去 just to stay alive.
如果我们关闭生命维持系统 If we were to turn off the machines...
关闭生命维持系统 Turn off the machines?
她很快就会平静地离开 She would pass quickly. And peacefully.
如果心脏手术成功 If the heart surgery is a success,
那就不用担心了 that won't be an option.
那为何不先尝试修复肠道 Why not try to fix the bowel first
看看是否起效呢 to see if it works?
因为在心脏手术成功之前 We won't know if the bowel is viable
我们都无法知道肠道是否存活 until after the heart is.
我们必须做手术 We have to do the surgery.
但是如果失败 她会饿死的 But if this doesn't work, she could starve to death.
这值得冒险... It's worth the risk...
这不是我们在冒险 而是她 It's not our risk. It's hers.
所以 你就准备放弃我们的女儿了吗 So, instead, you're ready to give up on our daughter?
就像当初我们一起站在超声波图像前 I mean, it's like we're right back at the ultrasound.
一起决定 带她来到这个世界 We decided together to continue this pregnancy.
所以这件事你和我一样有错 So this is as much my fault as it is yours.
这是我的错吗 My fault?
就因为那些药物 Because of the medication?
我不能关闭生命维持系统 I cannot turn off that machine.
你的负罪感在阻止我们做该做的事 Your guilt is stopping you from admitting what we need to do.
我的负罪感与这件事无关 My guilt has nothing to do with this.
-我在为我女儿争取 -我也是 - I am fighting for my daughter. - So am I.
既然父母的观点无法达成一致 Since the parents can't agree, the decision
那将由一位法官根据我们的意见 about the baby's care will be made by a judge
为婴儿的治疗做出决定 who will rely on our recommendation.
所以我们做决定 So we make the choice,
父母听之任之吗 but the parents live with it?
也许那是件好事 Well, maybe that's a good thing.
父母不得不在 For parents to have to decide between
眼睁睁看着女儿死去 letting their daughter die
和痛苦对抗病魔间抉择 or fighting for her life, knowing she may suffer horribly,
也许让我们担起这份重任更好 maybe it's better if we carry that burden.
利姆医生 Dr. Lim?
你的决定是什么 Your decision would be?
关掉生命维持系统 Take her off life support.
肠道修复可能对她不利 The odds are stacked against the bowel repair working.
那些数据反应的只是普通医生 Those numbers reflect the general population of doctors.
我认为利姆医生和我能够做得更好 I think Dr. Lim and I are better than that.
我们可以逆转局势 We can beat the odds.
作为外科主任 One of the things I'm not going to miss
我不喜欢的一点 about being Chief of Surgery
就是得为这样的抉择负责任 is being responsible for choices like this.
韩医生 你的部门 Dr. Han, it's your department --
由你来决定 it's your call.
你一整晚都在这吗 You've been here all night?
我一直在和新任的外科主任 I've been working on a case
韩医生进行一桩手术 with the new Chief of Surgery, Dr. Han.
-进展得如何 -不太顺利 - How's that going? - Not very well.
他在手术室放音乐 He plays music in the operating room.
天哪 又是这种人 Oh, geez. One of those.
他还说我需要集中注意在 And he says I need to focus on
我们病人的情感需求上 our patients' emotional needs.
这任务对你来说挺困难 Well, that's a tough assignment for you.
你有没有想过结交 You ever wish you had, you know,
患有自闭症的朋友 同事 friends, co-workers on the spectrum?
并没有 Not usually.
也许韩医生不会太注意到我 But maybe Dr. Han wouldn't notice me as much
如果我不是唯一一个患自闭症的医生 if I weren't the only doctor with ASD.
有个在化疗的孩子 There's this kid in chemo,
痴迷于患癌 just obsessed with having cancer.
他一直在谈论癌症 It's all he talks about.
他想和病房里的每个人都做朋友 He wants to be friends with everybody in the ward.
他非常聪明 That's very smart of him.
《明镜周刊》等杂志发现乳腺癌病患 Speigel et al showed an increase in overall survival
如果结识了其他同病相怜的人 and quality of life measures in breast cancer patients
那他们的存活率及生命质量都有所上升 who formed social bonds with others battling the disease.
我该怎么应对韩医生 What should I do about Dr. Han?
我不知道 I don't know.
做好你的本职 just do your work,
成为好的外科医生 杰出的外科医生 be a good surgeon, be an excellent surgeon.
时间久了 他就忘记自闭症这事了 Over time, he'll forget about the autism.
为什么会这样呢 Why would that happen?
他会发现你的专业水平 你的奉献精神 He'll see that you have the skill, you have dedication.
我有自闭症 I have autism.
我生来如此 It's part of who I am.
法官 The judge...?
接受了我们的提议 Accepted our recommendation
并同意手术 and ruled in favor of surgery.
谢谢你 医生 Thank you, Doctor.
好了 珀西 Okay, Percy.
妈妈爱你 Momma loves you.
我爱你 珀西 I love you, Percy.
我们还要再移除些肠道吗 Should we remove more bowel?
那样会接触到髂骨 That would take us to the ilium.
她的体重会达不到健康的标准 She won't gain enough weight to thrive.
BGM: Mind's Eye by Wolfmother
她腹部的肌肉太紧实了 Her abdominal muscles are tight
没法建一个空腹腔 from developing around an empty cavity.
♪ But the days, girl, just slip away, oh, yeah ♪
它们就像束腰一样缠着她的肚子 They're cinched around her tummy like a corset.
如果我们解开它呢 What if we unbuttoned it?
释放肌肉 Released the muscle
扩大腹部范围 and increased the abdominal circumference.
这些肌肉是她腹腔壁的一部分 Those muscles are part of her abdominal wall.
但如果我们将层与层分开 Not if we separate the layers --
在皮肤与肌肉之间建一个平面 create a plane between the skin and the muscle.
如果我和莫菲从心脏开始你没问题吧 You good if Murphy and I start on the heart?
布朗医生 你和我负责腹腔 Dr. Browne, you're with me on the abdomen.
清理手术区域 Clearing the field.
韩下周要值班 Han is on the call schedule next weekend.
也许卡曼能和我换班好让我替他的班 Maybe Carmen will switch with me so I can cover with him?
也许你可以别这么拼命 Or maybe you shouldn't try so hard.
牵引器 Retractor.
我们有些人并没有体面的前职业 Some of us don't have a cool former career --
也并不开朗成熟 or an easy-going, mellow demeanor.
人们永远不会 People are never gonna crowd in my corner
因为我很讨喜就拥护我 because I'm just so likable.
你可试试对他人友好点 Well, you could try being nice to them.
-这简单多了 -就是这 - Well, this is easier. - There it is.
看上去像癌症吗 Does it look like cancer?
光看可看不出来 It's not labeled.
我们需要等病理报告 We're all gonna have to wait for the pathologist's report.
探针 Probe.
有动脉挡住了 The artery is in the way.
要碰到肿瘤肯定会弄破动脉 We can't get at the tumor without him bleeding out.
只能从背面入手了 We're gonna have to take it from the back.
-但S1神经根 -可有可无 - But the S1 nerve root -- - Is something he can live without.
解剖剪 Dissecting scissors.
包扎锚点 Pledget anchor.
♪ You'll be leaving me soon, like hell you will ♪
BGM: Moonbeam by Lord Huron
♪ The owl gazing at the moon ♪
♪ Is the feeling that I get when I'm lookin' at you ♪
♪ The sun will rise and fade the stars ♪
塞子已就位 The plug is in position.
准备好检验肠道修复得如何了吗 You ready to test the bowel repair?
♪ And you're leaving me soon, like hell you are ♪
关掉心脏维持装置 Let's take her off cardiac support.
莫菲医生 这是你的主意 Dr. Murphy, it was your idea.
由你来 You do the honors.
腹腔压正常 Abdominal pressure is normal.
肠道在蠕动 The intestines are perfusing.
肺压在上升 Pulmonary pressure's spiking.
前列环素和氧化氮 Prostacyclin and nitric oxide --
我们需要让她的肺压下降 we need to get her lung pressure down.
血氧饱和度在下降 Oxygen SATs are dropping.
对肺部血管扩张剂无反应 No response to pulmonary vasodilators.
心脏跳动太强 给肺部施加很大压力 Now the heart's too strong. It's overpowering her lungs.
她需要心脏维持装置 She needs to go back on cardiac support.
珀西芬不会饿死 Persephone won't starve to death...
但会因积液过多而死 but she will drown in her own fluids.
我去跟父母说 I'll talk to the parents.
我可以一起吗 May I come?
珀西芬的心脏跳动太强 Now that Persephone's heart is pumping at full power,
她的肺部正在衰竭 her lungs are overwhelmed.
最人道的方法就是 The humane thing to do
关掉所有仪器 让她离去 is to turn off the machines and let her go.
不 我不可以 No, I-I can't...
我不可以放弃她 I can't give up on her.
因为自从她出生以来 Because you fought for her
你每分钟都在为她而战 every minute since she was born.
在那之前 当你在服用 Before that, when you were taking your medication
抗抑郁药的时候 for the depression,
你为了继续活下去而战 you were fighting to keep going
这样她才能出生 so you could bring her into the world.
但是让珀西走不是放弃她 But letting go of Percy is not giving up on her.
而是听从她的身体告诉我们的信息 It's listening to what her body is telling us.
她已经到达极限了 She's hit her limit.
好了 Okay.
为了珀西芬的父母 我想让她 I want Persephone to look as good as possible
尽可能好看些 for the parents.
关掉心脏维持装置 Let's turn off cardiac support.
呼吸器 Ventilator.
替她祷告一分钟吧 Let's take a minute.
肺动脉压峰值
血流助力计算公式
止回阀 Check valve.
每一次心脏收缩 Every time the heart contracted,
血液就会进入心脏的另一侧 blood went into the opposite side of the heart
提升肺部压力 and raised lung pressure.
当压力过大时 那个洞能降低压力 The hole reduced the pressure when it got too high
因为它允许返流 because it allowed backflow.
但我们修复缺口 阻止了那个返流 But our repair of the defect blocked this backwards flow.
如果我们能让她在需要的时候 What if we made it so she still had a heart defect,
仍然保留有一个心脏的缺陷呢 but only when she needed it?
就像在心脏壁上开一个没拴上的门 It'd be like an unlatched door in the wall of the heart.
当右侧的心脏过高 When the pressure gets too high on the right side,
这个门就会打开 减轻肺部的压力 the door swings open, releasing the pressure on the lungs.
其余时候则保持关闭 The rest of the time, it stays shut.
那应该能减少三分之一的压力 够用吗 It should reduce lung pressure by a third. Is that enough?
那取决于 It depends on how high
她的肺血流阻力有多高 her pulmonary vascular resistance is.
肺血流阻力等于肺动脉压减去肺毛细血管楔压 PVR is pulmonary artery pressure
除以心排血量再乘以八十 minus wedge pressure divided by cardiac output times 80.
上次我去见医生时 The last time I saw my doctor,
他跟我说我还能活六个月 he told me I had six months to live.
他还跟我说我应该和一个会计结婚 He also told me I should marry an accountant
搬去北达科他州 and move to North Dakota.
不是吧 You don't say.
当我问他那对治好我的癌症有没有帮助 When I asked if it would help my cancer,
他说没有 he said no,
只会让这六个月看起来更长 just make the six months seem much longer.
癌症和新纳粹主义分子有什么区别呢 What's the difference between a Neo-Nazi and cancer?
癌症不区别对待每个人 Cancer doesn't discriminate.
我认识一个人 I knew a guy once --
他的星座是巨蟹[癌症] his Zodiac sign was Cancer.
这让他的死法看起来很讽刺 It was really ironic how he died.
为什么呢 how's that?
他被一个巨大的螃蟹吃了 He was eaten by a giant crab.
天呐 Oh, geez.
亚伦 神经胶质瘤 Aaron, glioma.
坎迪丝 白血病 Candice, leukemia.
玩金拉米纸牌还是21点纸牌 Gin rummy or blackjack?
你想多快赢走我的钱 How fast do you want to take my money?
21点 Blackjack.
切牌吧 Cut 'em.
你都取出来了吗 Did you get it all?
是的 Yes.
边缘都很清楚 Totally clear margins.
但是为了做到这个 But the only way to achieve that
不得不移除控制你左脚的神经 involved removing the nerve that controls your left foot.
康复治疗和矫形器也许有用 Rehab and an advanced orthotic may help,
但你只能跛着一条腿走路了 but you will walk with a limp.
最终病理检查会告诉我们这个代价是否值得 Final pathology will let us know if it was worth it.
结果出来的时候我会告诉你的 I'll let you know when it comes in.
不重要了 It doesn't matter anymore.
反正那个瘤也放不回去了 It's not like you can put the tumor back in.
她还好吗 Is she... okay?
她还有一两个手术要做 但是还好 She still has a surgery or two in her future, but, yes.
她会恢复的 She's gonna be great.
我能抱抱她吗 Can I hold her?
我觉得那对你们来说 I think that would be very nice.
都非常好 For both of you.
我的天使 Hi, angel.
我的宝贝 Oh, my baby.
来抱抱她 Come hold her.
你也为她而战了 You were fighting for her, too.
她多漂亮啊 She's beautiful.
做得好 Nice work.
谢谢 Thank you.
她很漂亮 She's beautiful.
你听她的声音 Listen to her.
谢谢 Thank you.
米那什的活检查结果 Minesh's biopsy results?
你不想知道我们是不是在浪费时间 You don't want to know if we wasted our time
还差点杀死了他 almost killing him?
反正肿瘤也放不回去了 Can't put the tumor back.
你好 韩医生 Hello, Dr. Han.
你也坐公车啊 You take the bus, too?
不 肖恩 No, Shaun.
我只是想和你谈谈 I just wanted to talk to you.
你确实有着不凡的诊断能力 You really do have remarkable diagnostic skills.
我必须得承认 你是这家医院难得的人才 I have to admit, you're an asset to this hospital.
我也觉得 Yes, I am.
我和住院病理部主任谈过了 I spoke to the Residency Director of Pathology.
我们都觉得你很适合待在那里 And we both agree you'll be a great fit there.
我是个外科住院医师 I'm a surgical resident.
作为病理住院医师 As a pathology resident,
你能接触到 you'll touch cases and lives
所有医疗部门的病例和病患 across all the medical departments.
这对你来说是个好机会 It's an opportunity for you to help patients
能帮助病患 但不用和病患打交道 without having to deal with patients.
鉴于你在沟通和理解社交信号上的困难 Given your difficulties with communication and social cues,
我觉得这对你更合适 I think it will be a much better fit.
不了 谢谢你 No, thank you.
我花了很大功夫 I have been working very hard
来提高我的沟通能力 at my communication skills.
光努力是不够的 Hard work isn't enough.
你必须完成好工作 You have to do the job.
我是个外科住院医师 I am a surgical resident.
曾经是 You were.
你在病理部门会很出色的 And you're gonna do great work in pathology.
BGM: At the End pt.1 by Wryder
♪ Oh, and when the storms come ♪
♪ Flooding through the hall ♪
♪ Rising to the landing ♪
♪ Tearing pictures from the walls ♪
♪ The currents pull us underneath ♪
♪ That bright tide rips us out ♪
♪ Into a tangled coral reef ♪
♪ Where we could never drown ♪
♪ Now that ♪
♪ We're at the end ♪