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1、霍士迪医生，药局不肯释出药物Dr. Halstead, pharmacy wont release the medication.我有个点子Ive got an idea.全区都面临短缺Theres a region-wide shortage.我不能任由它发展成蛮荒西部I cant have it turning into the Wild West.我想事情已经到那个地步了I think were already there.我是一名正在戒断的瘾君子Im a recovering addict.我需要在大家面前重新赢回我的信誉I need to earn my reputation bac
2、k with everyone.可是在你面前我好像永远做不到But with you, it doesnt feel like thats ever gonna happen.你中风了You suffered a stroke.如果我不能动手术，这有什么意义？If I cant operate again, what does it matter?如果躺在手术室的是我If it had been me on the table,我很肯定他会做出同样的选择Im pretty sure he would have done the same thing.嘿，抱歉，我迟到了，迪恩Hey. Sorry
3、 Im late, Dean.我没想到今天会堵车I dont know what was going on with traffic today.我也塞在车阵中I got caught up in it too.都怪高速铁路的揭幕典礼You know, you can blame the HyperTrain unveiling for that one. 他们把红线关闭了It shut down the Red Line.路上的人更多A lot more people on the road.-高速铁路？ 没错-HyperTrain? -Yeah.你知道的，积戴顿的新玩具You know,
4、Jack Daytons new toy.她很擅长词汇Words are her thing.有些一听就很尴尬Some are just naturally embarrassing,像是有霉菌like having a fungus.这个嘛，在这里没什么好尴尬的，萝丝Well, no need to be embarrassed here, Rose.上面写说只对伏立康嘤和两性霉素敏感It says its sensitive to voriconazole and amphotericin only.那就静脉注射200毫克的伏立康嘤So voriconazole. 200 milligra
5、ms. IV.嗯，我也是这样想，可是有个问题Um, I had the same thought, but theres a problem.-那个药在短缺清单上已经三周了-Its on the shortage list. -For three weeks now.那其他药呢？What about this other medication?让我们讨论一下，马上回来Let us talk it over. Well be right back.两性霉素B太过时了Amphotericin B is old-school.大家都叫它两性霉素我知道-They call it amphoterrib
6、le. -I know.而且萝丝的肾脏因为糖尿病已经出问题了And Roses kidneys are already compromised because of her diabetes. 她的肌酸酊从2.8起跳Her creatinine is 2.8 to start.两性霉素会让她的肾脏坏掉、害她洗肾Ampho will knock them out and put her in dialysis,也可能更糟，让她丧命or worse, kill her.一定要用伏立康嘤It has to be voriconazole.那我们打电♥话♥给其他医院、药局L
7、ets start calling around hospitals, pharmacies,-问问看谁有-没有，我已经打了-see if they have any. -No, I already did.所有在芝加哥和我通话的人都没有Everyone I talked to in Chicago was out.我不知道下一步该怎么做Im not sure what the next move is,所以我才找你来which is why I dragged you into this.我是说，如果你拿不到唯一能够治疗感染的药I mean, what do you do if you ca
8、n*t get the only drug 你该怎么做？thatll treat an infection?疼痛只出现在她的下背The pain is localized to her back.上面写说她的尿酸有问题It says here her UA is dirty.嗯，尿液检查结果不正常Yeah, thats not normal for a urine dip, 可是也不能排除感染but it also doesnt scream infection either.-嗯-我看过短缺清单-Mm-hmm. -I checked the shortage list, 我知道现在显影剂供应
9、量不足and I know that the contrast dye supply is low.目前它是被管控的药品嗯-Its currently restricted. -Yes.可是管理规则上也说如果患者需要做电脑断层扫描But protocol also states that if a patient needs a CT. 嗯，你有帮她做超音波检查有没有肾结石吗？Okay, did you ultrasound her for a kidney stone?-没有-为什么不做？-No. -Why don*t you?通常有腹膜炎或腰痛的孕妇Kidney stones usuall
10、y present in pregnant women才会有肾结石没错-with peritonitis or flank pain. -Right.坎迪丝只有下背痛Candace only has low back pain.是的，你还是可以帮她做超音波检查Sure. You can still ultrasound her to check.我可以，可是我们都知道I could, but as we both know, 超音波对结石不是很灵敏 ultrasound is not very sensitive for a stone.电脑断层扫描更能搞清楚A CT would give m
11、e a much better picture问题在哪里一嗯-of whats actually going on. -Okay.如果超音波上看不出什么结果So if the ultrasound doesnt show anything conclusive,那你再去安排电脑断层扫描，可以吗？youll order the CT, yeah?我会去做超音波嗯-1*11 do an ultrasound then. -Right.你也应该开始给她经验性抗生素And you might want to start her on empiric antibiotics too.万一是肾盂肾炎，你最
12、好提早治疗In case its pyelonephritis, you should get ahead of that.我是说，青少年想要I mean, like, its perfectly natural跟父母保持距离for a teenager to want distance from.这是很自然的事，对吧？可是我不知道From their parents, right? But I don*t know.最近，她似乎完全不想Recently, it just seems like she doesnt want anything跟我有任何关系to do with me at al
13、l anymore.这可能只是暂时的That may only be temporary.而且寻求这种独♥立♥And it*s healthy for your daughter对你女儿来说是很健康的to seek out this kind of independence.你觉得我会不知道吗？You think that I, of all people, wouldnt know that?可是我真的不懂，天啊，这真的But I dont know, man. Its been a.意外地让人难以接受，你知道吗？surprisingly difficult pi
14、ll to swallow, you know?这件事跟我在工作上遇到的其他问题And that kind of dovetails with this other issue又相互呼应that Im having at work, right；陪伴病人面对困难的时光involving being there for patients in difficult times.我是说，我很习惯处在那种让人不安的环境，对吧？I mean, Im used to living in those uncomfortable moments, right?我是说，那就是我们的工作I mean, its w
15、hat we do.你懂我的意思，你做这行很久了You know what Im talking about. Youve been doing this a long time.嗯可是最近-Mm-hmm. -But recently,譬如说，当我必须跟病人说when, say, I have to give a patient,坏消息的时候like, a really tough diagnosis, right,像是告诉他们或他们所爰的人like, tell them or the people that they love说他们患有终生精神疾病that they have a lifel
16、ong mental illness.他们这辈子完了Their lives are over.嗯Yeah.这些时刻一直困扰着我，你懂吗？And Ive been haunted by these moments, right?它们一直跟着我They stick with me.有时候它们会回头盯着我看It*s like sometimes they stare back at me.有时候他们会哭泣Sometimes they cry.有时候他们不知道怎么办他们本来就不会知道Sometimes they dont know what to do, nor should they.可是你知道吗？
17、或许我应该要知道的But you know what? Maybe I should.葛林威尔医生？Dr. Greenwell?继续说Please, go on.你还好吗？Are you all right?我胸口My chest.我想我好像心脏病发作I think. I think I might be having a heart attack.葛林威尔医生！奥的斯！Dr. Greenwell! Otis!葛林威尔医生？Dr. Greenwell?葛林威尔医生？Dr. Greenwell?-什么状况？ 奥的斯葛林威尔，52岁-What do we got? -Otis Greenwell,
18、 52 years old.昏倒撞上玻璃咖啡桌Collapsed into a glass coffee table.心电图正常EKG was normal.前臂上有多处撕裂伤Multiple lacerations to the forearm.我们在路上先用压力绷带包扎并且给他阿士匹灵We applied pressure dressings en route and gave him an aspirin. 他当时胸口痛He was having chest pains.一定要帮他做全套心脏检查Make sure he gets a complete cardiac workup.没问题
19、，查理斯医生Will do, Dr. Charles.我就在外面，葛林威尔医生，好吗？Ill be right out here, Dr. Greenwell, okay?他是医生？He*s a doctor?嗯，其实他是我的心理治疗师Yeah. My therapist, in fact.好好照顾他，好吗？So take good care of him, okay?脉搏很弱Pulse is weak.他应该是因为失血过多出现失血性休克Hes likely in hemorrhagic shock from all the blood loss.拜托，我会死吗？Please, am I go
20、ing to die?我会尽我一切所能Im gonna do everything in my power确保你活下来，好吗？to make sure that doesnt happen, okay?好的All right.有人吗？里面有人吗？Anyone there? Anyone in there?有，有！嘿，帮帮我们！Yeah, yeah! Hey, help us!嘿，西弗莱德？Hey, Severide?西弗莱德，是你吗？Severide, is that you?是我，哥罗基！Its Crockett!哥罗基？嘿，这里发生什么事？Crockett? Hey, whats goin
21、g on in there?什么状况？Whats the situation?我们有三个人在里面！Theres three of us in here!其中两个人没事，可是列车驾驶Two of us are okay, but the trains conductor, 他伤得很重hes badly hurt.他休克了He*s pretty shocky.这条通道太窄了This passageway is too narrow.我们会试着把它弄宽一点，让担架过去Well try and widen it and get a backboard through.可能要花点时间不行-It migh
22、t take a while. -No.不行，听我说，我们不能等了No, listen to me. We canrt wait.我需要你帮我从救护车拿些医疗用品过来I need you to get me some supplies off the ambo, 然后帮我联络医院and I need you to call Med.我需要他们带一些你们没有的东西过来I need them to send some things you dont have.收至U !Copy that!等我，哥罗基！Just hold tight, Crockett!纳撒尼尔没办法等那么久Nathaniel d
23、oesnt have that long.如果我们要救他我们必须现在在这里进行If were gonna save him, we got to do it right here, right now. 各位，我知道的不多People, I don*t have many details, 不过哥罗基现在在隧♥道♥里 but Crockett is down in the tunnel 试着帮助那些受伤的人trying to help those who are injured.我知道他有跟芝加哥消防队联♥系♥上I do know tha
24、t he is in touch with CFD目前人是安全的and appears to be safe at this time.一旦我收到其他消息就会尽快告诉你们And PH update you as soon as I hear anything more. 谢谢你Thank you.天啊Jeez.我希望他没事I hope hes okay. 嗯Yeah.走吧Come on.葛云女士，我们正要去找你Ms. Goodwin, we were just coming to find you.你有空吗？ 有-Do you have a second? -Sure.我的病人，萝丝佛蒙特My
25、 patient, Rose Fremont, 有严重的霉菌感染，需要治疗 has a serious fungal infection that needs treating. 而整个芝加哥都拿不到And the only drug that can help her, 唯一能治疗她的药物，伏立康嘤 voriconazole, is unavailable all throughout Chicago. 嗯，可能是另一项全区短缺的药品Well, could be just another region-wide shortage.我会跟我们在其他州的供应商联络Fil reach out to
26、 our suppliers out of state.陆军、海军和国民警卫队The army, navy, and national guard也可能会有might be resources as well.现阶段你们先尽量帮她Just do what you can for her in the meantime.嗯，她需要加压药来维持血压Okay. Shes gonna need pressors to keep her blood pressure up.说到陆军，我听说你弟弟的事了Speaking of the army, I heard about your brother.嗯，积
27、需要改变Yeah, Jay needed a change.我想那样对他比较好I think itll be good for him.啊，嗯，我知道你们两个很亲Ah. Well, I know you two are close.我去打电♥话♥吧PH make those calls.阿迪亚，请说Adia, talk to me.崔布鲁索，22岁，血压138、80Trey Bruso, 22. BP 138/80.心跳104,油漆房♥屋的时候从梯子上摔下来Heart rate, 104. Fell off a ladder while paintin
28、g a house.我恨医院I hate hospitals.嗯，我们不会放在心上的Okay, we won*t take that personally,我们还是会试着让你but well still try to get you back up尽快回到梯子上，好吗？on that ladder soon, all right?好的，各位，准备把他搬到病床上Okay, everyone. Lets get ready for a transfer.准备好了吗？Okay, ready?、 、 One, two, three.右侧没有呼吸声，这里需要照X光！No breath sounds on
29、 the right side. We need an x-ray!我要出去！I want out of here!我们越快处理好The faster we can get this done,你就能越快出去，崔，好吗？the faster you can leave, Trey, all right?放轻松Just relax. Relax.后退Stand back.右胸40%气胸40% pneumothorax to the right chest.准备28号♥胸管Let*s get a chest tube. 28 French.抱歉，伊芬Sorry, Ethan.有个问题
30、Theres a problem.我把最后一台胸腔引流器送去隧♥道♥坍塌现场了I sent the last Pleur-evac out to the tunnel collapse.哥罗基需要用到Crockett requested it.这太荒唐了 放轻松，凯-This is ridiculous. -Relax, Kai.马素医生根本就不应该在那种环境下Dr. Marcel shouldnt be putting a chest tube帮人插胸管in someone under those conditions anyway.那里又不是无菌环境哦，是这样吗
31、？-Its not a sterile environment. -Oh, really?你认为我该写张纸条跟他解释那点吗？You think I should have sent him a note explaining that?所以现在我们的病人需要胸管So now our patient needs a chest tube,我们却无法接上引流系统and we cant connect it to a drainage system.这样要怎么力、？How is that supposed to work?赫尔曼德省，记得吗？The Helmand Province. Remembe
32、r?哦，对，我去跟中♥央♥供应室要Oh, yeah. Til hit up central supply.嗯，需要帮忙吗？ 不用，我可以-Yeah, you want help? -No, Tm good.就像骑单车一样Ifs like riding a bike.你们有人要告诉我你们在说什么吗？One of you guys want to tell me what youre talking about?专心点，凯，你应该能学到一些东西Pay attention, Kai. You might learn something.我可以进来吗？Mind if I j
33、oin you?坎迪丝，他是艾卓亚医生，急诊室主任Candace, this is Dr. Archer, Chief of the ED.他一直参与你的诊疗Hes been consulting on your case.-你还好吗，坎迪丝？-我的背真的很痛-How you doing, Candace? -My back really hurts.嗯，希望很快就会不痛了Well, hopefully, that wont be the case much longer, 所以再耐心点so bear with us.肾结石有被我说中吗？Was I right about the kidney
34、 stones?我没看到任何结石，不过我在她的左肾Im not seeing any stone, but I am seeing some hydronephrosis看到一些肾积水on her left kidney.啊-那是什么意思？-Ah. -What does that mean?你的肾脏无法有效地排掉水分Your kidney is not draining effectively,所以它有点肿so its a little swollen.我担心它可能被感染了Im concerned that it might be infected,好消息是艾莎医生so its a good
35、thing that Dr. Asher here已经先帮你注射抗生素has already started you on antibiotics.那会伤到宝宝吗？Will it hurt the baby?哦，对Oh, yeah.积戴顿，对，那个有钱人Jack Dayton. Right, Mr. Megabucks.嗯没错，那个天才Yeah. Yeah, sure, genius.那条高速铁路本来应该是That HyperTrain is supposed to revolutionize public transportation 以地铁的两倍速运行来改革大众运输by moving tw
36、ice the speed of the L.结果，让我们这些开车的笨蛋多花两倍的时间来上班Meanwhile, it takes us schmucks in cars twice as long to get to work. 为什么布力的置物柜是空的？How come Blakes locker is empty?你没听说吗？布力递出辞呈了You hadnt heard? Blake tendered her resignation.她要去布莱根妇女医院上班Shes taking a job at Brigham and Womens.-波士顿?-嗯哼-Boston? -Uh-huh.我
37、想她的状态好到可以再次进行手术了Guess shes good enough to perform surgery again.这是什么时候的事？ 哦，我不知道-When did all this happen? -Oh, I dont know.我是昨天晚上收到电子邮件知道的I got an email about it last night.她什么时候要走？她不能离开When is she leaving? She canrt leave.我必须跟她谈谈I need to talk to her.你大概在自责，对吧？You probably blame yourself, huh?没人接？
38、No answer?语♥普♥信箱Voicemail.好，我要去找她谈谈All right. I got to go talk to her.-我一个小时内回来，好吗？-没问题-1,11 be back in an hour, okay? -All right.不要把事情弄得更糟我们越快处理掉它越好The sooner we get ahead of it, the better.给她四单位吗♥啡♥止痛并且呼叫泌尿科Give her four of morphine for the pain and call urology. 失陪，坎迪丝
39、Excuse us, Candace.我们不能肯定这是肾脏感染We don*t know for certain that its a kidney infection. 如果它怎么看都像是If it walks like a kidney infection 肾脏感染and talks like a kidney infection.肾积水在孕妇身上很常见Hydronephrosis is not uncommon in pregnant women.当子♥宫♥变大时，会导致尿液回流When a uterus gets enlarged, it can cause
40、 urine to back up 让肾脏肿大and dilate the kidneys.那不等于感染It doesnt confirm an infection.我很欣赏你想找出真正病因的决心I appreciate your determination to get a definitive diagnosis, 不过在这个病例上，你想太多了 but you are overthinking this one.你知道吗？我有一种感觉You know, I just have this feeling我永远无法通过你那些考验that Fm never gonna pass some tes
41、t of yours.哦，天啊，好的Oh, God. All right.听着，我被一堆短缺弄得绑手绑脚的Look, Tm getting squeezed by a lot of shortages, 包括显影剂including contrast dye.如果抗生素没用，或是她的背痛变严重And if the antibiotics dont work and if her back pain gets worse；那你再送她去做电脑断层扫描 then you can send her for a CT.我把碎片清掉，并且重新帮他包扎伤口I removed the shards, redr
42、essed his wounds.你拿到他的检查结果了吗？Did you get his labs back yet?拿到了，他没有心肌梗塞Yeah, hes not having an MI.尽管他刚入院时心跳比较快Though his heart rate was elevated when he came in, 可是看起来心脏完全没有问题theres no sign of a cardiac event at all.我是说，他很健康，不过他说他没睡I mean, hes in good health, but he said hes not sleeping.嗯，把他的病历寄给我Hu
43、h. Shoot me his chart.嗯Yeah.嗯，这好奇怪Well, this is awkward.哦，拜托Oh, come on.我们都是医生，奥的斯这是难免的，好吗？Were both doctors, Otis. Stuff happens, right?我们就直说吧，丹But let!s face it, Dan.应该是我照顾你才对Im supposed to be taking care of you.嗯，你以后有的是机会，好吗？Well, youre gonna have plenty of opportunity to do that, all right?-你觉得发
44、生什么事？-我不知道-What do you think happened? -I dont know.我我一定是昏过去了I just. I must have passed out.以前这样过吗？ 没有-Happen before? -No.哈金斯医生说你睡不好Dr. Hudgins said that you were having a hard time sleeping.嗯，我最近唾很少Yeah. I havent been sleeping much recently, no.你觉得那有可能是What would you say to the idea恐慌症发作吗？that mayb
45、e what you had was a little panic attack?嗯，假设那是恐慌症发作好了WelL lets say that it was a panic attack.我猜那可能是I guess maybe it could have been the result压力源一直累积的结果of a buildup of stressors.好的All right. All right.我在想那些压力源是什么Im wondering what those might be.我是说，事情发生时，我正在说I mean, when it happened, I was talking我这阵子很难开口about the difficulty that Ive been having对患者说坏消息giving bad news to patients.是这样吗？Does that sound right?其实我不记得了I actually dont remember.听着，我真的只想回家，好吗？Look, I really just want to go home, OK?好的Okay.可是你的心跳又上升了Except your heart rate