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1、地铁隧♥道♥坍塌There*s been a collapse in the subway tunnel.这边，我叫积戴顿Over here! fm Jack Dayton.在那里，他是我的手下Over there. He works for me.他可能已经肺衰竭了His lung is likely collapsed.-把他抬出来不行-Lets get him out here. -No, no, no.如果要让他活下来，就得在这里动手术If were gonna save him, we got to do it right here.我的意思是，如果找不到
2、I mean, what do you do if you cant get治疗感染的唯一药物，该怎么办？the only drug that will treat an infection?我会打电♥话♥到处问-我问过所有人,大家都没有-Ill start calling around. -Everyone I talk to is out.我认识一个能拿到所有药物的人I know someone who has access to everything.你这样说话很像毒贩You*re talking like some kind of drug dealer.听
3、着，不能让任何人知道这件事Look, no one can ever know about this.以后至少先跟我说一声In the future, maybe at least page me再使用大剂量的抗精神病药，行吗？before administering a very high dose.六毫克在标准治疗之内Six milligrams is well within the standard of care.标准治疗不是你要遵循的The standard of care is not some blanket template一个笼统模板you follow without an
4、y regard你要考虑的是眼前应该帮助的病人for the person youre supposed to be helping.我总是没办法相信自己的直觉I just dont always trust my own instincts.我可以跟你保证，你会成功的I can promise you, you will get there.所以他不知道自己的名字年龄、住的地方So he doesnt know his name, age, where he lives, 也不知道自己是怎么流落街头的 or how he ended up wandering the streets. 我是说
5、，你认为他无家可归吗？I mean, you think hes unhoused?我没有那种感觉Im not really getting that vibe.他的衣服很干净合身His clothes are clean, they fit.嗯-指甲干净-Mm. -Fingernails are trimmed.但他显然很焦虑Well, hes clearly anxious 而且处于某种游离状态 and in some sort of dissociative state.可能是药物诱发或者是自我药疗的精神疾病Could be drug induced or self-medicating
6、 mental illness. 对，有可能，除非他有中风Yeah, perhaps. I mean, unless its a stroke. 我没看到任何面瘫或肌肉无力的症状I didnt see any facial paralysis or muscle weakness. 我想的是非♥典♥型的小中风I was thinking more atypical TIA. 好吧，既然现在有可能是任何情况 Okay, well, since right now it could be anything, 我就去预约头部电脑断层扫描、化验Im gonna order
7、head CT, labs, 毒理检查、胸部X光、心电图 tox screen, chest X-ray； EKG, 脑电图检查亚临床癫痫EEG to check for subclinical seizures, 跟电脑断层扫描检查中风 and CT to check for stroke.太好了，听起来很好Excellent. Sounds like a plan.好Okay.不好意思，请问你能帮我吗？Excuse me. Please, could you help me?我叫埃丽诺惠普尔，我昨晚摔倒了My name is Elinor Whipple. I fell last nigh
8、t.事实上，我儿子给我的这支手表Actually, this watch that my son gave me打给了医护人员，我儿子住在俄勒冈州called the paramedics. He lives in Oregon.天啊，你现在还好吗？Oh, boy. Welt are you all right?.好多了吗？ .好多了-You feeling better? -Oh, yeah.我只是屁♥股♥上有块瘀青I just have a bruise on my hip.医生几小时前就让我出院了You know, the doctor discharged
9、me hours ago本来会有车子来载我回家的and the van was supposed to drive me home,但等了很久，都没人来but its been a long time. Nobody*s come.我去看看能不能搞清楚是怎么回事Let me see if I can figure out what*s going on.好吗?-谢谢-Okay? -Thank you.玛姬，埃丽诺惠普尔的接送有消息了吗？Mags, do you have an update on Elinor Whipples transportation?医疗车还没来吗？ 还没-Medica
10、r still hasnt come? -No.我去打个电♥话♥,然后骂他们一顿Im gonna make a call and light a fire.谢谢你Thank you.护士长玛姬Maggie, the charge nurse,会打给接送公&hearts词♥看看是怎么叵【事is gonna call the company and see whats happening.我只想回家I just want to go home.我先生的最后几周是在安宁病房♥度过的My husband spent his final weeks
11、 in hospice.我不喜欢医院I dont like hospitals.我们看看能不能给你找个地方Why don*t we see if we can find you a place to.让你坐着等To sit while you wait.-谢谢你-好吗？-Oh, thank you. -Okay?-对了，我是查理斯医生-谢谢你，查理斯医生-Im Dr. Charles, by the way. -Thank you, Dr. Charles.男性，20多岁，神志不清Male, late 20s. Stoned out of his mind.有人发现他在跟一个信箱说话他不肯透露
12、自己的名字Picked him up talking to a mailbox. Wouldnt give a name. 一天啊，戴文你认识他吗？-Oh, my God, Devon. -You know him?对，算是，在医学院认识的Yeah, sort of. From med school.-慢着放开我-Wait, wait! -Get off!我要走了Im out of here.来啊，动手啊！Come at me! Lets go!退下Get back. Get back.嘿Hey.放开我电他-Get off, man. -Taser, Taser!不行，别电到伊芬No. Don
13、t hit Ethan.上啊Pile on.好了All right.伊芬，你没事吧？Ethan, are yall all right?我没事，迪恩被打得最严重Im good. Dean got the worst of it.嘿Hey.等一下，那就是戴文，真的假的？Wait. Thats Devon. Seriously?那个像新变形侠医一样的家伙Guy who just went all Incredible Hulk就是我们找来帮萝丝的毒贩吗？is the dealer were using to treat Rose?状况更糟了It gets worse.他的毒理报告出来了吸食掺有天使
14、尘的可♥卡♥因♥His tox report just came back. Cocaine laced with PCP.天使尘？PCP?等等，你跟我说这家伙喜欢派对药Hold on, you told me this guy was into party pills和药房♥药物and medicine cabinet pharma.我也以为他是I thought he was.但我们不得不利用他我是说，萝丝需要那些药We had to use him, though. I mean, Rose needed those meds.不然
15、她就会死She couldve died.我们别无他法，但那都已经过去了We didnt have another play, but that was then.我是说，我们现在得报♥警♥ 了I mean, now, we have to call the police.这是毒品，别犹豫了Laced drugs? Come on.不管药是谁给戴文的肯定都不在街上了Whoever gave them to Devon, they have to be off the street.如果我们打电♥话♥给警局他们会问戴文很多问题If we c
16、all PD, theyre gonna ask Devon a lot of questions我的名字可能会被提及and my name could come up.云妮莎，外面只要有毒品Vanessa, as long as theres a bad batch out there,就会有人吸毒过量someone else could OD.对，你说得对，我们联络芝加哥警署No, youre right. We call CPD.如果我早知道戴文有涉毒If I wouldrve known Devon was involved in hard drugs,我绝不会建议去找他I would
17、ve never suggested going to him.嘿，我知道Hey. I know.我觉得他们可能在交往I think they might be a thing.别多管闲事，朵莉丝Keep walking, Doris.慢慢来Easy, easy.算你走运，我帮你把他力气耗尽了Youre lucky I tired him out for you.是啊，你用脸和肋骨攻击他的方式Yeah, the way you went at him with your face and ribs, 让我印象深刻that was impressive.就连笑都会痛，好吗？Even smilin
18、g hurts, all right?因为你的下巴肿了，让我看看你的肋骨Cause your jaws swollen. Let me see your ribs.好，交给我All right, I got it. I got it. I got it.好All right.皮肉伤？Flesh wound?对，没错，好大一片Oh, yeah, yeah. Nice one.嘿，硕克，交给你了Hey, Zach, do a work up.不行，他第一年当住院医生，不行No, no. First year resident, no, no.我不这么认为嘿，来吧-I donrt think so.
19、 -Hey, come on.我们这里是教学医院，迪恩Were still a teaching hospital, Dean.今天已经够漫长了，好吗？Ifs already been a day, okay?帮我拍个肋骨X光片Just order me x-rays for my ribs下巴要拍电脑断层扫描，好吗？and a CT for my jaw, will you, please?好，没问题，兄弟Yeah, you got it, man.嘿Hey.天啊Ooh, man.我上楼接生结果错过了好戏I go upstairs to deliver a baby and miss all
20、 the action.你还好吗？How you doing?-死不了 -很好-Ill live. -Okay.如果你需要什么，就跟我说If you need anything, Im around.好All right.这是纳撒尼尔入院时的胸部X光片This is Nathaniels chest x-ray from when he was admitted.左胸有血气胸The left chest had a hemopneumothorax.不过，右胸没有大碍，基恩The right chest, however, was okay. Gene.这是他30分钟前的胸部X光片Now, h
21、is chest x-ray from 30 minutes ago.天差地远Night and day.等等，这是36小时内发生的吗？Wait, this happened in 36 hours?我也吓了一跳It caught me by surprise too.是啊Yeah.彼得很抱歉打断你-Peter, -fm sorry to interrupt.彼得，发生什么事了？Peter, what*s going on?纳撒尼尔允许医院Nathaniel has given permission for the hospital与戴顿先生分享他的医疗信息to share his medic
22、al information with Mr. Dayton.我知道这不合乎传统但那地铁是我盖的Now, I know this is unorthodox, but I built that train.纳撒尼尔，他跟了我很多年Nathaniel, hes been with me for years我的团队不仅仅是员工and my team, theyre more than just employees.他们就跟我家人一样They may as well be family.法律部门签了字Legal signed off on it.好的，彼得，谢谢你Okay. Peter, thank
23、 you.双侧多处大小肺叶的实质化病变Bilateral multi-lobar consolidation.很深的疤痕跟发炎这是什么意思？-Heavy scarring, inflammation. -Which means?他的肺坏了His lungs are destroyed,但这么严重又这么快，怎么会？but this much damage this fast, how?我唯一能想到的是火车的电池-Only thing I can think of.-Trains batteries.嗯Mm-hmm.他被困在列车长车厢时From when he was trapped in the
24、 conductors compartment.隧♥道♥里很潮湿The tunnel was full of moisture.泄漏的锂离子电池加上湿气？Leaky lithium ion batteries plus moisture?氢氟酸Hydrofluoric acid.高腐蚀性又有毒Highly corrosive, toxic.-纳撒尼尔吸入了氢氟酸有什么解决方法？-Nathaniel inhaled it. -So whats the fix?只有肺移植At this point, a lung transplant.我马上把纳撒尼尔列入名单PH pu
25、t Nathaniel on the list immediately.同时，我会停掉呼吸器，改用人工肺In the meantime, Id like to get him off the vent and onto ECMO.减轻他肺部的压力Take some pressure off his lungs.恐怕无法使用人工肺Im afraid ECMOs not an option.我们导管不够Tubing shortage.在货到之前，机器都无法使用The machines down until the shipment arrives.什么时候会到货？When will that be
26、?可能要两三天吧？Maybe two days, three?一般人都能靠呼吸器活好几周People spend weeks on ventilators.有时候更久，对吧？所以也许我们不会有事Sometimes longer, right? So maybe were in good shape. 不是这样的Were not.纳撒尼尔的肺伤得太严重了Nathaniels lungs are so injured, 呼吸器几乎起不了作用，我只能在 the vents barely doing the job and Ive only got a little 不造成进一步损伤的情况下稍微调整一
27、下设备 wiggle room with the settings without risking further damage. 就算有呼吸器，我们的状况也不妙Even with the vent, were sinking.发烧变得更严重了Fever notched up a bit.虽然我一直躺着，但我已经筋疲力尽了Ive just been laying here, but Im spent.你的身体在奋战Your bodys at war.不幸的是，我还不知道它在对抗什么Unfortunately, I dont know yet what its fighting against.
28、 化验和扫描都没有结果吗？The labs and scans didnt show anything?无法帮助判断Nothing definitive.肝脏和脾脏轻度肿大A mild enlargement of the liver and spleens, 淋巴结肿大、全身肠道炎症swollen lymph nodes, global intestinal inflammation.全部都是病毒症状So all viral symptoms, 但没有指向一个特定的方向but not pointing in a specific direction.布洛克，你有大量的疫苗接种史Brock,
29、youve got an extensive vaccination history.我看到有强制要求的腮腺炎、麻疹、德国麻疹I see the requirements like mumps, measles, rubella. 也有非强制的流感和冠状病毒疫苗Some optionals like flu and COVID,但也有一些but there are a few that are只适用于国际旅行的疫苗only for international travel.你最近有出国吗？Have you left the country recently?没有，从来没有No. Never.我
30、来自芝加哥Im from Chicago.我高中毕业后我就一直在佐治亚州I. Ive been in Georgia since graduating high school.先待在亚特兰大南部，然后搬到海边First the south of Atlanta then near the coast.我最近才搬回家I just recently moved back home.我们应该考虑传染病吗？Should we bring in infectious diseases?我可以找个人来看看但如果没有旅游史的话I could call a fellow, but if theres been
31、 no travel 我想她也不会有什么新的想法要补充then I dont think shell have anything new to add.那我们接下来该怎么办？Where do we go from here then?进行更多化验More labs.血液跟大便培养、本抗体测定Blood and stool cultures, a mono spot test, 但我一定会给你用but Fil definitely put you on经验性广效抗生素empiric broad-spectrum antibiotics.希望能让你退烧Hopefully, we can get t
32、hat fever down.所以我们的神秘病人So our mystery patient.脑电图和电脑断层扫描都是阴性EEG and CT, both negative.他没有癫痫或中风He didnt have a seizure or stroke.毒理也呈阴性，所以不是毒品Tox also negative, so not drugs.他的电解质有点紊乱His electrolytes were a little off,但我不信他会失忆but Im not buying amnesia.我也不信No, me neither.输液刚换了第二袋I just hung a second
33、bag of fluids.他看起来比刚进来时反应灵敏多了He seems more alert than when he came in.-谢谢，南茜-很好-Thank you； Nancy. -Good.你还好吗？How you doing?又是我们，查理斯医生和奎瓦斯医生Its Dr. Charles and Dr. Cuevas again.你记得我们刚刚见过吗？-稍微记得-Do you remember us from before? -Kind of.你知道你在哪吗？Do you know where you are?好像是医院急症室Uh, looks like the hospi
34、tal. Emergency room.嗯，你知道你是谁吗？Mm-hmm. And do you know who you are?哈里斯，我是哈里斯贝维尔Harris, fm Harris Bevel.-你多大了，哈里斯？-28岁-And how old are you, Harris? -28.你住在哪？And where do you live?我心中没有一丝怀疑I dont have a shred of doubt in my mind. 早安Good morning.嗨 Hi. 夜班留给我们三个病人 So night shift left us three patients. 患有
35、躁郁症的女性，38岁，自己来的A bipolar woman, 38. Checked herself in.6♥4♥岁男性，患有慢性创伤性脑病变 A gentleman with CTE, 6♥4♥. 被赶出公♥寓♥跟看护中心 Got booted from his board and care home. 让我猜猜，因为他违规吸烟吗？Let me guess, smoking violation? 是的Yeah.最后是一位31岁的精神病人者And lastly, a 31-year-old psychoti
36、c 出现锥体外系症状 in an extrapyramidal state. 那位先生看来需要You know, that gentleman looks like we probably 重新调整他的药物，但另外两位just have to rebalance his meds, but these other two, 我想我们得让他们入院I think we*re gonna have to admit. 我同意，但同样情况Agreed, but once again, 精神科没有床位了 there are no beds in the psych unit 其他医院的急症室都满了 an
37、d all the other local EDs are at capacity. 那我们只好扩大范围了Well, we got to branch out.问看看治疗寄宿中心看他们有没有空病房♥Check the TRCs. See if they have any room.每天早上都这样Every morning it*s the same thing.精神病人都躲在急症室里瑞格利维尔，在棒球场附近Wrigleyville. Near the ballpark.哇，那里是芝加哥北边Wow. Thafs the north side of town.你知道你怎么会来到卢普区
38、西面的吗？Do you know how you ended up here in the West Loop? 不知道No. Im not sure.我不知道我为什么会到外面来I dont know why I would be outside.我不知道我为什么要冒这个险I donrt know why I would take that risk.这是什么意思？冒险What do you mean by that? Taking the risk.外面很危险，很难躲起来Its dangerous outside. It*s hard to hide.你必须要有个藏身之处You got to
39、 always have a hiding spot.好Okay. Okay.这个嘛，我注意到你几乎没碰Yeah, well, I noticed you havent really你的三文治，怎么了？没有胃口吗？touched your sandwich. What? No appetite?我没有力气Didnt have the energy.我累了Im tired.我睡得不多I dont sleep that much.所以你很难入睡So is that having a hard time falling asleep, 很难睡得久having a hard time staying
40、asleep.对，没错Yeah, yeah, that one.每天凌晨3点Every night, 3 a.m.,我都非常清醒地思考Im wide awake thinking,你知道的，我在担心you know, worrying.你有特别担心什么事吗？About anything in particular?没有，我只是担心所有的事No. Just. everything.我懂Yeah. I get it.我有时候也会这样That happens to me sometimes too.-真的吗?-是啊-It does? -Oh, yeah.有时候这个世界Sometimes the wo
41、rld just.变动得太快了，你懂吗？moves too fast. You know?你的家人呢？哈里斯，他们住附近吗？What about family? Harris, anyone live nearby?没有，他们住在图森No. Tucson.你有朋友吗？Any friends?我已经有好一阵子没跟他们碰面了I have. I havent seen them in a while.好Okay.你知道吗？你帮了我们大忙You know what? Thats been really helpful.堇瓦斯医生和我要出去一下Dr. Cuevas and I are gonna ste
42、p out for bit.你介意在这里待一下吗？Do you mind hanging out for a little while?不介意我们很快就回来，好吗？-No. -Well be back soon, okay?如果我是赌徒If I were a gambler,我就会赌哈里斯患有未确诊的心悒fd bet big on Harris having undiagnosed depression.我有同感，我不认为他有自杀倾向I dont disagree. I dont think hes a suicide risk, 但我也不想让他出院but Im just not crazy
43、about discharging him, either.对，我也是Yeah, me too.但有个问题，精神科已经满了One problem, psych units full,今天早上我已经问过了所有治疗寄宿中心and I used up all the TRC options this morning.我还是会再打一次，毕竟谁知道呢Im gonna call up there anyway. I mean, you never know.可能有人今天就要出院There could be somebodys on a hold whos expiring today, 或是提前出院了，值
44、得一试getting discharged early. Itrs worth a shot.好，我打给哈里斯的家人看看能不能查到更多病史Okay. Til call Harris1 family. See if I can get more of a history. 太好了Excellent.这里需要帮助，查理斯医生Need some help, Dr. Charles.病人越来越多了我需要用到创伤二号♥房♥Patients are piling up. I need trauma two back.埃丽诺还在这里吗？Elinorrs still here?对，
45、我打给医疗车三次了Yeah, I called Medicar three times.他们司机不够They*re short on drivers.还是要跳过医疗车，改叫优步或的土？Skip them all together and call Uber or taxi?不了还是用医疗运输吧No, no, no, lets stick with medical transport.我是说，至少我们认识他们I mean, at least we know them.知道了，但我还是需要那个房♥间Copy that, but I still need the room.玛姬，你介意我们Mags, do you mind if we just在护理站给她一张椅子吗？set up a chair for her in the nursing station?我知道这不是很理想但她今天过得很不顺I know its not ideal, but she*s just had a really rough day.好，我去找个角落非常感谢-Yeah. Ill find a corner. -Thank you very much.