So you see the right optic nerve?
它很细 就在双极钳正下方
It’s really thin as it gets sort of right under his bipolar.
这是右视神经
This is his right optic nerve here.
大卫是从这个角度俯视这条视神经
So David’s basically looking right down on this optic nerve from this angle.
问题在于 这个非常硬
Problem is, all of this is very, very tough,
gritty tumor, and you’re basically now working in between the optic nerves,
坚硬的肿瘤 基本上 是在两条视神经之间操作
以这种方法保护视力要安全得多
so this is a much safer approach to protect your vision.
-肿瘤在那里 -是的
– There’s tumor there. – Oh, yeah.
How long did she have symptoms until she couldn’t see?
在她失明之前 症状持续了多久?
很慢
It was slow.
很奇怪 人们往往 要过很长时间才会注意到
It takes time for people to notice it, it’s really weird.
但她的病情严重得多 剪子
But she got much worse. Scissor.
神经在肿瘤上面拱起
The nerve’s all humped up over the tumor here,
被挤在肿瘤和大脑前动脉之间
and it’s squeezed between the tumor and the anterior cerebral artery,
就是这里
which is right here.
无法再往上移♥动♥了 然后你会逐渐失去视力
Can’t be moved up anymore, then you start losing vision.
就像把一个桃核按进桃子里
It’s like a peach pit pushing into a peach.
需要帮忙吗?
You want some help?
Well, you can scrub in.
好的 去洗手吧
大卫回来了 感觉就像强击手回到了你的棒球队
Just having David back, it’s like getting your slugger back on the baseball team.
改变了整个出场阵容
It changes the entire lineup.
不要认为这是理所当然的 所以我回到家
You don’t take it for granted. This is why I go home and hug my dog, kids, and wife.
会拥抱我的狗、孩子和妻子
这不是按重要程度排序 但今天真是鼓舞人心
Not in that order of importance, but it really is… it’s an inspiring day.
我们去挽救视力吧
Let’s go save some vision.
(莱诺克斯山医院)
-嗨 -你好
– Hi. – How are you?
我丈夫在你手上 请你务必好好照顾我丈夫 好吗?
You have my husband. Please do take care of my husband. Okay?
你好 一切还好吗?准备好了吗?
How are you? All good? Ready?
-好的 -告诉他“好好照顾爸爸”
– Alright. – Tell him, “Take care of Daddy.”
– Tell him. – Take care of him.
-告诉他 -好好照顾他
我会的
– I will.
Thank you, Dr. Fahmy.
谢谢你 法赫米医生
过去几个月 萨尔瓦托一直要求进行手术
Salvatore has been asking for the surgery for the past couple of months.
我们讨论了各种可能的并发症
And we talked about all the possible complications,
但他非常急切地想捐肾给他的儿子
but he is very, very eager to donate to his son.
-有个惊喜访客来看你了 -你好 伙计
– You got a surprise visitor! – ‘Sup, buddy?
我的天!我都没…
– Oh my God! I didn’t even–
– I saw you, I didn’t see him! – You good?
-我看到你了 我没看到他! -你还好吧?
嗯?准备好了吗?
– Yeah. You ready? – Mm-hmm.
-是吗? -是的
– Yeah? – Yup.
你确定吗?确定?
You sure? Yes?
– I love you.
我爱你
我也爱你 儿子 一会儿见
I love you too, buddy. See you in a little while.
好好照顾我的肾
Take good care of my kidney.
-我爱你 -一会儿见…
– I love you. – I’ll see you…
摘掉该死的口罩
Take the fucking mask off.
– Love you, son. – I love you too.
-我爱你 儿子 -我也爱你
好 祝你好运
Alright, good luck.
– We’ll take care of him, okay? – Thank you.
我们会好好照顾他的 好吗?
我们在做最后的安全检查 你的各种文件
We’re just doing our last safety checks, all your paperwork.
这个病人有两条肾动脉 两条动脉通往左肾
This particular patient has two renal arteries,
two arteries going to the left kidney, so he has an anomalous anatomy.
所以他存在解剖学异常
这既是巨大的情感冲击 也是一个重大的伦理决定
So that’s a huge emotional impact and a huge ethical decision.
如果他父亲有可能出现并发症 我们应当让他成为供体吗?
Should we use the father as a donor if he potentially develops complications.
器♥官♥移♥植♥总是会有 情感和道德方面的问题
So there is always an emotional and ethical aspect to transplantation.
父亲将器官捐给儿子 我觉得这再自然不过了
A father donating to a son, I think, is just… is– is natural.
-神经看起来很好 兄弟 -我知道
– The nerve looks great, bro. – I know.
是啊 很漂亮
Yeah, that’s beautiful.
看起来很不错 你在那条神经上开始有进展了
That looks really good. You’re starting to make some progress on that nerve.
我觉得你做得不错
Um, I like what you’re doing.
我不喜欢牵引 如果可以避免牵引…
I don’t like pulling. If we can avoid pulling–
我们可能不得不牵引右侧 或者推按
We may have to pull the right, this side. Or push.
我去看一下
Let me take a look for a second.
还能通过鼻子进入吗?
Could we still go through the notes?
他回来了!天啊!
He’s back! Oh my God!
就这样 很漂亮 继续切后面
That’s it. It’s beautiful. Just keep buzzing that back.
很好 伙计们 他在剖开视交叉
Yes. Guys, he’s dissecting right on the optic chiasm.
给我一块棉纱
Give me a cottonoid here.
宝贝!
Oh, baby!
太兴奋了 对!哦耶
Just buzz up. Yes! Oh yeah!
-我想要 -总算搞定了!
– I want that. – Fuckin’ A!
Oh!
Mazel tov!
恭喜!
-冲洗 -过来 布莱恩 看看这个
– Irrigation. – Come here. Brian, look.
他刚刚取出了一个肿瘤
He just took a tumor out.
我认为全都取出来了 毫无疑问 肿瘤全在这里了
I think it’s all out. I mean, tumor’s all out here for sure.
把外视镜拿进来 谢谢
Bring the exoscope in, please.
– I’m going back to the office. – That was great.
-我回办公室了 -好的 刚才非常棒
我们又搞定一个病例
We got another case.
说真的 谢谢你 我爱你 碰下头
Seriously, thank you, man. I love you. Head bump.
I think we deserve a drink after work.
我觉得下班后我们应该喝一杯
– David, great job. That was sick. – That was great, man.
-大卫 很精彩 太棒了 -表现太棒了 伙计
-非常了不起 -欢迎回来 朗格2.0版
– That was really tremendous. – Welcome back. Langer 2.0.
抱歉我刚才大呼小叫的 吸 卡罗琳
I’m sorry if I ever yelled at anybody. Suction. Caroline.
-你为什么觉得不行? -说到大呼小叫…
Why do you think it’s not working?
Speaking of yelling…
他就像个正在康复的酒鬼 他必须道歉
He’s like a recovering alcoholic. He’s got to apologize.
-对不起 -他是个正在康复的工作狂
– I’m so sorry. – He’s a recovering workaholic.
我们搞定了 没有残留 我很确定
We were done. Nothing left. I’m pretty sure.
冲洗后给我一点止血胶
Give me a little Floseal after the irrigation.
-她癫痫发作了 -对
– She’s seizing. – Yup.
你在给她用药吗? 可以把简叫来吗?
Are you giving her anything? Can you call Jane?
-给她用开浦兰了吗? -给她用了500毫克开浦兰
– Did she get Keppra? – Keppra, we gave her 500.
再给她用500毫克
Give her another 500, please.
然后找个神经科医生来会诊 谢谢
And then can we get a neurology consult, please?
手术结束后 好吗?
After post-op, okay?
她有过一次轻微的癫痫发作 有时候会有这种情况
She had a little seizure, which sometimes happens.
这会让她苏醒后反应迟钝 我会告诉她的家人的
It’ll slow her down when she wakes up. I’ll tell the family.
我们给她用了一些额外的药物
We gave her extra medication,
但是癫痫发作后 你会有点犯困
but after you have a seizure, you’re really a little sleepy.
所以今天可能无法拔掉呼吸管了
So we may not be able to retake the breathing tube out today.
-你在放大镜下很帅 -谢谢
– You look great under the scope. – Oh, thank you.
没有发现癫痫发作的原因
So no identifiable source of seizure was noted, period.
打算术后对患者进行评估
Plan was to assess the patient postoperatively,
确定是否需要做CT扫描
determine whether a CAT scan would be necessary, period.
Ugh.
所以这是肾脏
So this is the kidney.
这块隆起是肾脏 那是脾脏
This pump here is the kidney. That’s the spleen.
肾脏不是坐在腹腔中等着你来摘取
The kidneys are not sitting there in the abdomen waiting to be picked up.
肾脏的周围有大血管、重要器官…
The kidney is surrounded by major vessels, major organs…
你可以看到 心脏在横膈膜上方搏动
And you can see the heart pumping up there above the diaphragm.
…所以可能会伤及邻近的器官
…so injury to adjacent organs can happen,
使手术过程变得更复杂 同时延长住院时间
requiring a more complicated procedure and a longer hospital stay.
这是肾静脉
Now, this is the renal vein.
格罗斯坦医生来了
There is Dr. Grodstein.
他的静脉很不错
So he’s got a nice vein out.
腰部以下看起来不错
Go now a lumbar down, looks good.
我觉得对一个年轻健康的孩子来说 肾脏的尺寸完美匹配
I’m thinking that on a young, healthy kid,
that’s a perfect size match potentially.
我们来看看它的样子
With– We’ll see what it looks like.
他更需要他的髂外动脉
He needs his external iliac more.
他需要所有血管为 下面的所有器官供血
He needs all the things to supply all the things down there.
-对 没错 -对吧?
– Yeah, correct. – Right?
因为他才14岁
Because he’s 14!
你准备好了吗?
You ready or not?
– Uh, fifteen minutes. – Okay.
-15分钟 -好
好吧 该开始了
Alright. Go time.
你还好吧?
You okay?
你怎么样 泰勒?还好吧?
How’re you doing, Tyler? Okay?
My baby.
– Thank you, Mom. – Thank you.
-谢谢你 妈妈 -谢谢
我们谈谈
We will talk.
(小儿转运)
我没见到明显的严重外伤
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