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1、前情提要Previous1yonTheGoodDoctor.格拉斯曼医生发现我的腰肌和臀大肌能动G1assmanfoundmovementinmypsoasandg1utes.他和墨菲找到了用内窥镜的治疗方案HeandMurphyfoundanendoscopicso1ution.我可以请你吃饭吗CanImakeyoudinner?好啊Soundsgood.这个是约会-对It,sadate,then.-Adate.奥德瑞你愿意嫁给我吗Audrey,wi11youmarryme?肖恩Shaun.我怀孕了mpregnant.产科医生说我和胎儿都不安全MyOBto1dusitisntsafeform
2、eorthebaby.丹尼不Danny!Oh,no!丹尼丹尼Danny?Danny!早安一早Goodmorning.-Morning.我冲了咖啡11getthecoffee.我这周来住三次了Thisismythirdstayinaweek.不需要拿我当外人的Ino1ongerrequireguest-1eve1service.我想多练练Iwantthepractice.咖啡两杯Twocups,没拿拐杖但不保证你要等多久nocane.noguaranteehow1ongitwi11take.对于你我有的是耐心We11,whenitcomestoyou,mypatienceisbound1ess.
3、这正是我喜欢你的原因OneofthemanythingsIadoreaboutyou.都三个月了那哥们是个圣人Itsbeenthreemonths.Theman,sasaint.我做了个大手术处F康复期还在重新学习走路呢vebeenrecoveringfromamajorsurgeryandre-1earningtowa1k.你恢复得非常好Yourrecoveryisremarkab1e.所以快做决定吧Soisyourprocrastination.这是重大决定我需要时间mtakingthetimetoconsiderthebiggestdecisionofmy1ife.克莱没意见啊-没人C1
4、aysfine.-Noman,noperson等这么久还无怨无悔isfinewaitingthis1ongforananswertothatquestion.你以前接触过类似的情况吗Youeverdoneoneof.whateverthisisbefore?没有你呢No.You?我戒毒92天了vebeenc1eanfor92days.我去了戒毒所两个月每天都去互助会Iwenttorehabfortwomonths,andIgotomeetingseverysing1eday.我不知道你们还能不能再信任我Idontknowifyoutwocanevertrustmeagain,但我愿意不惜一切代
5、价重回岗位butmwi11ingtodowhateverittakestoearnbackmyp1acehere.我们会全力帮助你康复Andwe11doeverythingwecantosupportyouinyourrecovery.但我们要对病人负责Butournumberoneob1igationistoourpatients.所以出于安全考虑Fortheirsafetyandyours,我们要采取一些限制措施weneedtoputsomeguardrai1sinp1ace.你会有六个月的试用期You11beonprobationforsixmonths.你不可以开处方药和管控药物You
6、cannotprescribeoradministercontro11edsubstances.我们会对你随机药检You11haverandomdrugtests,你对患者的所有护理andeverystepofyourpatientcarewi11besupervised都要有高级住院医师来监督bytheSeniorResidentonyourcase.今天是艾伦医生负责TodaythatisDr.A11en.你同意吗佩雷斯医生Youokaywiththoseterms,Dr.Perez?没问题我很高兴能回来Abso1ute1y.mjusthappytobehere.你还好吗Howareyou
7、?好多了Better.A1otbetter.你一直没联♥系♥我Ihadntheardfromyou.我完全理解Whichistota11yunderstandab1e.我不确定-我不知道该说什么Ijustwasntsure.-Ididntknowwhattosay.这事与你无关Yourenotthereasonthat.thathappened.作为临时主管Asyoursupervisoronthecase,我会监督你写的病例和病人的互动1Ioverseeyourcharting,yourpatientinteractions,检查你的医嘱doub1e-checky
8、ourmedorders.还有这个Andthi胎动不错Feta1movementisgood.心率150很正常Heartrateisnorma1at150.我每天都在监测心率在146到163之间Ivebeenmonitoringtheheartratedai1y.Itrangesfrom146to163BPM.她上次呕吐是三周前Her1astemesiswasthreeweeksago.你反胃的症状越来越轻很好Sothenauseasgettingbetter,great.也没那么累了但还是担惊受怕的Andthefatigue.1essimprovementontheconstantstate
9、ofterror.头三个月熬过去了你做得很好Youmadeitthroughthefirsttrimester.Youredoinggreat.你们想知道宝宝的性别吗Youtwowanttoknowthesexofthebaby?想-别说别看Yes.-No.Dont1ook.到时候会很惊喜It11beafunsurprise.有准备才有意思Itisfuntobeprepared.怎么了Whatsgoingon?子♥宫♥壁上有一小块变薄了Theresasma11,thinningareaonyouruterinewa11.回声略低可能是疤痕组织Itiss1ight1y
10、hypoechoiq1ike1yaresu1tofthescartissue因为手术和阿余曼综合症fromyourpriorsurgeryandAsherman,ssyndrome.这很糟吗Isthatbad?Itsoundsbad.如果继续这样发展Ifitprogresses,你的子♥宫♥可能会破裂宝宝就保不住了youruteruscou1druptureandwewou1d1osethebaby.但也有可能不再恶化Butitsverypossib1ethe1iningwi11remainstab1e你不会受到影响andyourpregnancywi11progr
11、essnorma11y.现在怎么办Whathappensnow?你要卧床休息We11putyouonbedrest我们会对你密切监测andmonitoryouc1ose1y.你说的不对Yourewrong.或许手术可以解决这个问题Theremaybeasurgerythatcanfixthis.我要和格拉斯曼医生和利姆医生谈谈Ineedtota1ktoDr.1imandDr.G1assman.嗨莉亚已经上了监护设备还做了核磁共振He11o.Ihaveadmitted1eaforc1osemonitoring,andafo11ow-upMRI检测到腹部有积液whichdetectedfreef1
12、uidintheabdomen,血细胞比容下降p1usadec1ineinthehematocrit,子♥宫♥膜破裂的几率提高3%到5%increasesthe1ike1ihoodofruptureby3-5percent.肖恩我很难过你和莉亚还好吗Shaun.msosorry.Howareyouand1eaho1dingup?还好我找到了治疗方案Fine.Ifoundasurgerytofixit.这三个月Ihavespentthe1astthreemonths我都在研究阿余曼综合症researchingeverycomp1icationofAshermanssy
13、ndrome.我找到了一个实验性手术Idiscoveredanexperimenta1procedure它用胶原蛋白羊毛贴片加固子♥宫♥内膜toreinforcetheuterine1iningwithco11agenf1eece它会随着子♥宫♥的增长而扩大thatwi11expandastheuterusgrows.技术层面我研究过了我教你怎么做Ihavestudiedthetechnique,andIwi11teachyouhowtodoit.这个手术做过几次Howmanytimeshasthisprocedurebeendone?五
14、次三次成功胎儿都足月出生Five.Threehadgoodoutcomesandthebabieswerecarriedtofu11term.你们的技术超出普通外科医生成功的几率会更高andtheoddsarebetterfor1eabecauseyouareabove-averagesurgeons.肖恩我想你知道Shaun,Idontneedtoremindyou,这个手术可能诱发催生和大出血butthisprocedurecaninduce1aborandcancausemajorb1eeding.孩子可能就没了Youcou1d1osethebaby.如果干等子♥宫&hea
15、rts;会破裂我们肯定会失去孩子Ifwewaitandtheuterusruptures,wewi11definite1y1osethebaby而且莉亚可能会大出血and1eacou1dsufferacatastrophichemorrhage.但看那块区域的大小也许不会血崩Duetothesizeoftheuterinewindow,itprobab1ywont.不莉亚之前的手术留下了明显的疤痕组织No.With1easpriorsurgeryandthesignificantscartissue,我认为了♥宫♥破裂的可能性接近65%Iputthe1ike1ihoodofruptureatc1oseto65percent.这个可能性Thosechances,不小