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1、把C型臂移开！Move the M.R.!坚持下去Stay with me.所以就这样了吗？So this is how its gonna be?你一整天都在用居高临下的口气跟我说话All day long, youve been talking down to me.我应该相信你的I should have given you credit.你差点害死我们病人，你太厉害了I was very impressed with the way you nearly killed our patient.我们有些关键物资快用完了We are running low on a number of k
2、ey supplies.不行，你先不要动我需要显影剂No, no, no, no, no! Stop! Stop! I need that dye.我们不能让一个病人耗尽所有物资We cant have one patient depleting our supplies.那就跟医院说啊So call into the hospital.我们所有人都要同舟共济We*re all in the same boat.奎瓦斯医生和我都强烈怀疑Dr. Cuevas and I have a strong hunch大卫患有分♥裂&hearts 7情感性障碍that David is de
3、veloping schizoaffective disorder.不可能，我儿子不是疯子No! My boy isnt crazy.你最好离我远一点Stay away from us.这样一来，有谁能帮那孩子呢？How is that boy supposed to get any help?很高兴终于见到你了，霍桑医生It is a real pleasure to finally meet you, Dr. Hawthorne.我在医院的同事，大卫关My colleague at Med, David Kwan,大肆赞扬你的医术he sings your praises highly.哦
4、，我不是霍桑医生Oh, Im not the doctor.我最近才发现自己怀孕了I only just recently found out I was pregnant.还没抽空去看医生I havent gotten around to see a doctor just yet.既然这样的话我们就做个超音波检查吧Well, in that case, we*ll go ahead and run an ultrasound. 朵莉丝，你能找艾莎医生来吗？Doris, will you mind grabbing Dr. Asher?没问题-谢谢-Sure thing. -Thanks.呕
5、吐和腹泻是从什么时候开始的？So when did the vomiting and diarrhea start?昨天晚上Just last night.你没有服用任何药物吗？And you havent taken any medication?没有，我什么都吃No, nothing.我怀孕期间不想服用任何药物I dont want to take anything while Im pregnant.你知道有些止吐药Well, you know there are some nausea medications 对胎儿是安全的吧that are safe for pregnancy.但我
6、还是Still, I just.宁愿不吃I would rather not.我不会有事的Ill be fine.我只是来看看孩子有没有事I just really came in here to make sure the babyrs okay. 明白了，介意我按一下你的肚子吗？Understood. Mind if I press on your belly?我只是想看看会不会有摸起来很软的问题I just want to see if anything feels tender.嗯Mm-hmm.不行No, no； no. No, no, no.我不要给她看I dont want her
7、.你替我找其他医生Youll have to get me another doctor.艾莎医生吗？Dr. Asher?汉娜艾莎，对吧？Hannah Asher, right?是的，她是个出色的医生Yeah. Shes an excellent physician.她有毒瘾Shes an addict.你帮我找其他医生，不然我就走了You get me another doctor, or Fm leaving.慢着我知道了Whoa, whoa, whoa. Okay, okay, okay.你稍等一下Just hold on a moment.汉娜，抱歉，我♥操&hearts
8、;之过急了Hey, Hannah, sorry, I jumped the gun, actually.我们都解决了Were all good.哦，好的Oh, okay.这样的话，如果有人找我Well, in that case, Fm grabbing breakfast就说我去吃早餐了if anybodys looking for me.田中里德医生，请等一下Dr. Tanaka-Reed, hold up a minute.你能请他们告知最新状况吗？Can you have them update that for me?谢谢Thank you.听我说，我我想消除误会Look, I. I
9、 wanted to clear the air.前几天，我可能表现得有点居高临下The other day, I may have come off a little condescending. 谢谢你承认，马素医生I appreciate the acknowledgment, Dr. Marcel.当然，如果你有什么想说的Of course, and if theres anything youfd like to say.没有，我没有话要说No, dont think so.我们没事了Were all good.好了There you go.怎么？你没时间What； you didn
10、t have time to grab him去礼品店买♥♥花送他吗？flowers from the gift shop?嗯？Huh?我是说，我认为其他医生I mean, I expect the other docs会对住院医师手下留情to go soft on the residents.我以为你有意志力I thought you had grit.人不能独自存活，对吧？Well, no mans an island, right?哈Aha.你知道，独活其实没那么糟You know, island lifes really not so bad.也许只是不合你
11、的口味Maybe you just dont have the stomach for it.马素医生，有个外伤病人来了Dr. Marcel, youve got a trauma incoming.谢谢你的鼓励，教练Well, thanks for that pep talk, coach.不客气Any time.什么情况？What do we got?马古斯获加，50岁男性，站着摔倒Marcus Walker, 50-year-old male, fall from standing.路上注射了 500升液体Gave him a 500 liter bolus en route.血压在10
12、0左右，收缩压Pressures hanging around 100, systolic.心率是120Heart rates 120.我从没见过他这么痛苦Yeah, Tve never seen him in this much pain.他倒在人行道之后就一直这么不舒服It hasnt let up since he hit the pavement.这是他的妹妹，珍纳This is his sister, Janet.珍纳，你亲眼见到他摔倒吗？Did you witness the fall, Janet?他从人行道要走下来时失去了平衡He lost his balance steppi
13、ng off the sidewalk.看起来没怎样，但他却站不起来了It didn*t look that bad, but then he couldnt get up. 好，我们会给他一点止疼药Okay, well give him something for the pain.我们得先找到原因We just got to find the source of it first.有什么过敏药物我们需要知道的吗？Any medications we should know about?他有洗肾Dialysis.还有吃雷米普利降血压Oh, and he takes ramipril for
14、his blood pressure.好，大家准备Okay, here we go, guys.我数到三，大家小心一点，好吗？Nice and easy on my count, okay?One, two, three.不好意思，马古斯Im sorry, Marcus.我就在这里，马古斯，我在这里Im right here, Marcus. Tm right here.珍纳，给医生一些工作的空间，好吗？Janet, lets give the doctor some room to work, okay?我们会照顾好他的，珍纳，交给我们Were gonna take care of him,
15、 Janet, we got this.挂一单位的全血Let*s hang a unit of whole blood.压进去，罗恩Pressure it in, Ron.马古斯，把你的手臂放在身体两边Hey, Marcus, put your arms by your side for me.很好，兄弟，深呼吸There you go, bud. Deep breaths.好，肺部没问题Okay, lungs are clear.他还处于休克.对Hes still shocking. -Yeah.他体内有出血Hes bleeding from somewhere.替他检查一下吧，泰勒医生Le
16、ts fast him, Dr. Taylor.腹部没问题Bellys negative.真的吗？Really?是的Yeah.好吧，让他转到侧面All right, lets get him on his side.赫伯特，麻烦你来一下Herbert, come over, please.好了，大家准备，动作轻一点，好吗？All right, here we go. Nice and easy, all right?一，二，三One, two, three.很好，你做得很好There you go. Youre doing great.你做得很好，马古斯Youre doing great, M
17、arcus.这是什么？What is it?哎呀Oh.是脓肿An abscess.应该是，受到了压力Looks like it. Pus under pressure.肯定是疼痛的原因Its gotta be the source of the pain.好，进行引流All right, lets drain it.手术刀Scalpel.血肿Hematoma.是的Yep.压住后进行包扎Hold pressure and pack it in.-压住了吗？-好-You got it? -Yeah.-好-压住了-Okay. -Got it.好,再输一单位全血All right, give me a
18、nother unit of whole blood.注射去氨加压素和一单位的血小板，动作快Start DDAVP and a unit of platelets, stat.大家动作快Come onsets move, folks.艾莉亚小姐，又见面了Ms. Arya, hello again.叫我因德拉妮就好Indrani, please.因德拉妮，检查结果出来了Indrani, I got the results back on your culture.不幸的是，你感染了耐甲氧西林金黄色葡萄球菌Unfortunately, you tested positive for an infe
19、ction called MRS A. 因为趾甲内生？From an ingrown toenail?耐甲氧西林金黄色葡萄球菌很难治疗，不是吗？MRSA is really hard to treat, isnt it?虽然它对许多抗生素都有耐药性While it is resistant to many antibiotics,但幸运的是，仍有几种抗生素能解决这个问题luckily, there are a couple that still work for it.我得吃多久抗生素？How long do I have to be on antibiotics?-大约七到十天-太好了-Ab
20、out seven to ten days. -Oh.看吧，我就说你不用取消旅行吧See, I told you you wouldnt have to cancel your trip.是吗？你要去哪？Oh, yeah? Where are you headed?我几周后要去苏格兰Well, Im going to Scotland in a few weeks 徒步走西昌地步道to hike the West Highland Way.那是一条穿越苏格兰高地的步道全长96英里Its a 96-mile trail through the Scottish Highlands.96英里？96
21、 miles?我从去年开始就在训练了Ive been training for the last year.我可能快60岁了，但我身强体壮I may be pushing 60, but I donrt feel it.我们先用万古霉素进行治疗Lets start with vancomycin.不行，我不能用万古霉素，我会过敏No, I can*t take vancomycin. Tm allergic.我看到了Aha, I see that.我小时候过敏反应很严重I had a terrible reaction when I was a kid.我的喉咙会哽住My throat clo
22、sed up.那我们就避开不用，南茜？Then we will steer clear. Nancy?利奈喋胺？知道了-嗯-Linezolid? On it. -Mm-hmm.我们会让你的苏格兰之旅保持在最佳状态的，因德拉妮Well get you in tip top shape for Scotland, Indrani. 这件事我想做很久了Ive been wanting to do this a long time.霍士迪医生，药局Um, Dr. Halstead, the pharmacy 无法给药wont release the medication.什么？What?有什么问题吗？
23、Is there a problem?没事，可能是系统故障No, just probably a system glitch.坐好，我马上回来Sit tight, and Ill be right back.听我说，根据新规定Look, per the new protocol,你得先通知传染病科you*re gonna have to go through Infectious Disease first.他们会要你先尝试切开伤口And theyre going to want to try incising引流感染组织and draining the infected tissue才会批准
24、你利奈嘤胺before they approve giving linezolid.切开伤口引流？Incising and draining?也就是要控制传染源So source control.这可不行，葛云小姐That is not gonna cut it, Ms. Goodwin.她需要利奈嘤胺She needs linezolid.我是说，难道我们就不能说I mean, cant we just say that, um,传染病科已经同意了吗？you know, Infectious Disease already signed off?不行，不能这么做，霍士迪医生No, we ca
25、nnot, Dr. Halstead.利奈唾胺由于库存极低Linezolid is on the restricted list而被列入限制清单due to extremely low inventory.所有地方都出现了短缺Theres a region-wide shortage.我们要处理的是影响全身的耐甲氧西林金黄色葡萄球菌感染And we are dealing with a systemic MRS A infection.你看到的是眼前的病人Youre looking at the patient in front of you.但监督委员会设计的指导方针But the Over
26、sight Committee designed the guidelines是把这些药物配给最严重的病例to ration these drugs to the most severe cases.我看过早期控制传染源的奇迹I have seen early source control work wonders.试试看吧Give it a shot.马素医生Dr. Marcel.怎么了 ？ 我拿到了马古斯的电脑断层扫描-Yeah? -I got Marcus* CAT scans.好Uh-huh.有两处非常严重的腰椎爆裂性骨折Two very severe lumbar burst fra
27、ctures.都是因为在人行道上摔倒吗？All from a spill on the sidewalk?你看Take a look.天啊Oof.肾脏病肯定加速了他的骨质流失Renal disease definitely sped up his bone loss.他需要做脊椎稳定手术Hes gonna need spinal stabilization surgery.对，你说得没错这是唯一能让他重新走路的办法Yeah, agreed, only option to get him walking again. 考虑到他的共病症，不动手术Given his co-morbidities,
28、without it,他就会死了hes just gonna circle the drain.好吧，那我们去跟神经外科谈谈All right, lets. Lets go talk to neurosurgery.大卫，你听到的这个声音And David, this voice that youre hearing, 是男的还是女的？is it male or female?我不知道I dont know.它更像是有自己的语言Its more like it has its own language,自己的交流方式its own way of communicating.然后我的大脑会翻译信
29、息And then my brain translates messages-所以我才听得懂嗯-so I can understand them. -Mm.你现在有听到任何信息吗？Are you getting any messages right now?你把我说的话都记下来是因为你是他们的手下That you*re writing down everything I say because you work for them.你是他们的间谍吧？You*re one of their spies, arent you?我不是间谍No, Im not a spy.那就把你的笔记本给我Then
30、give me your notebook.我不会把笔记本给你的，大卫Im not gonna give you my notebook, David.把笔记本给我Give it to me.大卫，你听清楚了，我是个医生David, I need you to listen to me. Tm a doctor.我把事情写下来，这样我才能好好理解你发生了什么事Im writing things down so I can better understand whats going.滚出去！Get out of here!马上滚出去！Out, now!大卫如果奎瓦斯医生David, David,
31、 how about Dr. Cuevas先把笔记本收起来会好一点吗？puts her notebook away for now.这样会让你好一点吗？Would that make you feel better?我注意到你一直在检查这个通风口And I notice yourve been checking out this vent.里面有个摄像头Theres a camera in there.是吗？Huh.他们一直在监视我They*re always watching me.里面没有摄像头，大卫There isnt a camera in there, David.我是她助理，凯瑟琳
32、Im her assistant, Katherine.好Okay.请在这些表格上签字并写上日期Sign and date these forms； please.在有画萤光笔的地方Just wherever you see a highlight.等你签完表格之后While youre finishing up with that, 我会把我们的政策和程序过一遍Fil go over our policies and procedures.你和霍桑医生讨论的所有事情Everything you discuss with Dr. Hawthorne 全都会保密，除非她认为is confiden
33、tial, except in the event she feels你会危及自己的安全-你知道吗，凯瑟琳？youre a danger to yourself. -You know what, Katherine? 其实我自己也是执业心理医生Fm. Fm actually a practicing psychiatrist myself, 所以，如果可以的话你可以跳过这个部分 so, I mean, if youd like, you can skip that part. 我完全理解I totally get it,但你下周就会见到霍桑医生but Dr. Hawthorne, who yo
34、ull meet next week, 她要求我们一起浏览过这些规矩requires we go through the policies together.如果医生认为你会危及自身或他人安全If the doctor feels that youre a danger to yourself or others,她需要通报-这样吧，凯瑟琳shes required to report. -You know what, Katherine? 我很感谢你这么尽责I appreciate youre just trying to do your job.但也许你可以帮我跟霍桑医生转达But, um
35、, maybe you could tell Dr. Hawthorne 等她有机会亲自见我的时候to give me a call when she has a chance 再打给我，好吗？to meet me herself in person, okay?你知道吗？是啊，我很确定里面没有Yeah, Tm pretty sure that there isnt.但，你知道，我们But, you know, were.如果能让你舒服一点我们可以把它盖起来Were happy to cover it up if itll make you more comfortable.好，很好Okay,
36、 good.不如我去看看能找到什么东西So why don*t I go see what I can scrounge up.我还要去看看And I have another couple of patients其他几个病人，除了这个之外I need to check in on, but in the meantime,你还需要什么吗？is there anything else I can get you?可以给我一罐可乐吗？Can I have a Coke?当然可以Absolutely.好，我马上回来Okay, so back in a bit.奎瓦斯医生，我能跟你聊聊吗？And D
37、r. Cuevas, can I just get a quick word, please?所以对于有妄想症的病人So with patients experiencing paranoia,我发现对他们提出的看法Fve found that its probably not the best idea to push back进行过度反驳可能不是个好主意too hard on their version of events,尤其是在一开始的时候you know, especially at the outset.事实上，有循证研究的结果Theres actually evidence-ba
38、sed research恰恰相反suggesting the opposite,你不该助长病人的妄想that you shouldnt reinforce a patients delusion.相反的，你应该试着向他们解释Instead, you should try to explain to them为什么他们的看法不同why theyre experiencing things differently.我明白你的意思，但如果你没有I hear you, except that thats pretty much impossible先建立起信任，那几乎是不可能的if you haven
39、t first established trust.但很高兴听到你有继续读文献But very glad to hear that you are keeping up on the literature.做得很好Way to go.天啊，崔是你的顾问Ooh, got Choi as your advisor.你运气还真差Luck really isnt on your side.怎么会？Why?他对我很好啊Hes been really cool with me.是我的话，就会把皮绷紧一点Yeah, well, I wouldnt get too comfortable.听说他是个狠脚色Wo
40、rd is, hes a real hard-ass.他上一个住院医生被开除了Got his last resident fired.奥尔加，你怎么会在这里？Olga, what are you doing down here?我才想问你这个问题呢I was gonna ask you the same thing.我以为你今天没上班为什么这么说？-I assumed you were out today. -Whys that?崔医生要我替他的怀孕病人做超音波Oh, well, Dr. Choi asked me to ultrasound his pregnant patient. 我不明
41、白你的意思他为什么要找你来？I dont understand. Why would he ask you?急症室是我在负责的I cover the ED.你对我的资历So do you have a question about my qualifications-有什么问题吗？-当然没有，汉娜-or something? -Of course not, Hannah.那你为什么找其他产科医生Then why would you ask another obstetrician取代我到急症室做超音波？to do an ultrasound in the ED when Im here?很显然
42、是你不信任我Obviously, you dont trust me.不是这样的，我Its not that. I.病人要求换一位医生The patient requested another doctor.她她知道你以前的事She. she knew about your past.什么？怎么会？What? How?她认识我吗？Does she know me personally?她没有主动跟我说She didn*t volunteer that information,所以我没有追问算了-so I didnt press it. -Fine.随便汉娜-Forget it. -Hannah
43、.我只是受够了，我的过去总是跟着我Im just so sick of this following me everywhere I go.不管我进步了多少No matter how much progress I make, 大家还是会用过去的事来评断我everyones still judging me for who I used to be.不行Nope.从医学上来说，这太冒险了Medically, its just too risky.慢性高血压，末期肾脏病Chronic hypertension, end-stage renal disease.这个病人的病史不胜枚举The lis
44、t goes on and on with this patient.真正的关键是血小板计数The real kicker is that platelet count.我不会替血小板低于十万的人动刀Im not touching anyone whose platelet counts below 100k. 听我说，我们知道他不是理想人选Listen, we know that hes not an ideal candidate.哦，等等，我差点忘了Oh, wait, I almost forgot.你们还在急症室切开了他的背部You guys also hacked his back
45、open in the ED,所以我没办法从背后动刀making a posterior approach impossible.我还要继续说吗？Should I go on?听我说，我可以让你从前方动刀Look, I can give you great anterior exposure.你只要稳住他的脊椎All you have to do is stabilize his spine.其他的事我来处理Fil take care of everything else.原来你会跟我一起动手术啊Oh, youd be assisting me on this one?哇，把你最有力的论点留到最后才说Wow, way to save your strongest argument for last.也许你只是在担心你的纪录，森Maybe youre just worried about your stats, Sam.送他去放射线介入性