
Chinese: 
翻译：LR         修饰：由早
Theodore Watkins 是一位31岁的住院医生，来自美国新墨西哥州罗斯威尔市
平时他规律锻炼、吃素食、熟练地做冥想
在很多方面，他是健康生活的典范。
Theo——他的朋友和家人这样称呼他——
和他的女朋友、他们的狗狗 Misty 一起住在两室一厅的公寓里
一天晚上，他正在逗 Misty，这时传呼机响了
他要在急诊室值一个夜班，
挠了挠 Misty 的肚腩，他说：“得走了～明早见！”
这次夜班在一开始相当平常：
几例伤口修复、枪伤、
一个严重恐慌的女人，还有一些其他症状。
这时，急诊室的时钟显示早晨 5:39，
护士告知有一名43岁的男性
因胸痛突然发作被抬进来。

English: 
Dr. Theodore Watkins was a 31-year-old resident
physician from Roswell, New Mexico. He regularly
went to the gym, ate a plant-based diet, and
practiced meditation - in many ways he was
the picture of healthy living. Theo, as his
friends and family called him, lived in a
2 bedroom apartment with his girlfriend and
their dog Misty. One night, while he was playing
with his dog, his alarm rang - he had a night
shift in the Emergency Room. He scratched
Misty’s belly "Time to go! See you in the
morning!”
The night shift was fairly routine - some
laceration repairs, a gunshot wound, a woman
with severe panic attacks, and a mix of other
complaints. The clock in the emergency department
showed 5:39am when a nurse announced that
there was a 43-year old male with a sudden

English: 
onset of chest pain being carted in. Dr. Watkins
quickly drank up the rest of the coffee and
replied: “Bring him in.” A few moments
later, a man was wheeled in on a gurney. He
was breathing heavily, holding his chest,
and turning and twisting in pain. Dr. Watkins
asked the man some questions as the team begin
to set up monitors, get IV access, and give
pain medication. Through gasps - the patient
explained the pain started abruptly when he
got out of the bed, and that he felt it everywhere
including in his back.
Within moments information was flowing in.
The blood pressure in one arm was lower compared
to the other one, the ECG was normal, and
the lab work had been sent off. The nursing
team had also paged the overnight attending
physician, Dr. Chapman, and when he called
back - the phone was handed to Dr. Watkins.
“Dr. Chapman on the phone,” said the sleepy
voice from the other side. During the next
few minutes, Dr. Watkins explained that they
have a 43-year-old patient with unusual chest
and back pain over the last couple hours,
and that there was an irregularity in the
inter-arm blood pressures. He mentioned that
the ECG showed no signs of a STEMI. Dr. Chapman

Chinese: 
Watkins 医生很快喝完了剩下的咖啡，应道：“推他进来”
在喘息声中，患者描述说：早前起床时，突然感到疼痛，
现在他感觉全身疼痛，包括他的后背。
短时间内，患者做了不少检查：
其两侧胳膊的血压不一致，
心电图正常，实验室检查也已送检；
护理团队还呼叫了夜间主治医生 Chapman 医生，
当他回电时，Watkins 医生接过了电话。
“这里是 Chapman 医生”，话筒另一边传来困倦的声音
在接下来的几分钟里，Watkins 医生解释道
他们有一个43岁的患者，在过去数小时里，因不明原因胸背痛
双臂血压不一致
心电图没有 ST段抬高型心肌梗死 的指征

English: 
seemed a bit more awake and spoke with intensity.
“Alright, listen up kid. Give him aspirin,
clopidogrel, and enoxaparin. I’ve seen plenty
of cases like this. He has an NSTEMI and I’ll
see him in the morning. You got it?” Dr.
Watkins was shocked, because Dr. Chapman seemed
so certain. Nevertheless he managed to blurt
out some questions, “Are you sure we shouldn’t
consult a vascular surgeon or perhaps get
some imaging study?” Dr. Chapman angrily
responded, “I know what I’m doing and
I know my job. Do you know yours?” The call
ended on that note, and Dr. Watkins hung up
and did what the attending physician told
him to do.
Over the next few hours, the patient’s condition
steadily worsened, but Dr. Watkins wasn’t
willing to get yelled at again so he stuck
to the plan they had put in place. He also
hoped that Dr. Chapman would come in soon
so that he could take over. Unfortunately,

Chinese: 
Chapman 医生似乎更清醒了，说话也更紧张了
“好！听我的。给他阿司匹林、氯吡格雷和低分子肝素
我见过很多类似的病例，他是非ST段抬高性心肌梗死。
我待会儿早上来看他，明白吗？”
Watkins 医生很震惊，因为 Chapman 医生听上去很笃定
尽管如此，他还是试着追问了一些问题，
“你确定我们不应该咨询一下血管外科医生
或者做一下影像学检查吗？”
Chapman 医生很生气：“我知道我在做什么，
我知道我的工作职责！你知道你的吗？”
电话就这样结束了，Watkins 医生放下了话筒
他按主治医生说的去做了
接下来的几小时内，患者情况逐步恶化
但是 Watkins 医生不愿再被训斥了
所以他坚持了 Chapman 医师指示的治疗计划
他还盼着 Chapman 医生可以尽快赶到，这样他就能接管了
不幸的是，病人的情况很快恶化，呼吸心跳骤停，蓝色警报响起

English: 
the patient’s condition worsened and a code
blue was called. The patient died in the emergency
room that morning from internal bleeding due
to an aortic dissection.
A few weeks later, Dr. Watkins received a
letter stating that his hospital was being
sued and that he was being named specifically
because he didn’t follow hospital protocols
that may have saved the patient’s life.
The letter specified that he should have consulted
a vascular surgeon and obtained imaging more
quickly. Dr. Watkins said that he specifically
followed the directions he got from his attending
physician. But the attending physician Dr.
Chapman said that Dr. Watkins didn’t explain
the severity of the patient’s condition
and that he wasn’t kept informed about what
was happening in the emergency room.
Now - to rewind this back - let’s imagine
that Dr. Watkins had asked Dr. Chapman to
document his plan and had also documented
his concerns about it. In addition, let’s

Chinese: 
这天上午，患者在急诊室去世
死于主动脉夹层导致的内出血
几周后，Watkins 医生收到一封信，
信中称他的医院被起诉了
由于没有遵守医院的诊疗规程，他被特别点名
院方规程本可以挽救那名病人的生命。
信中特别指出他本应咨询血管外科医生
并且更迅速地推进拍片。
Watkins 医生辩解说他明确遵循了主治医师的指示
但主治医师 Chapman 医生说
Watkins 医生没有解释清楚病人的严重情况
他也不知道病人后来在急诊室里的状况。
来回顾下事件进展：
试想，如果 Watkins 医生坚持就患者的临床症状
对 Chapman 医生表达自己的想法，同时记录这些问题；

English: 
imagine that Dr. Watkins had continued to
call back and give regular updates with changes
in the patient’s clinical condition. It’s
possible that Dr. Chapman would have agreed
to change the plan or that Dr. Watkins could
have convinced him to come into the hospital
to see the patient. It’s very possible that
the patient would have been correctly diagnosed
and treated sooner and that he wouldn’t
have died. The moral: Document conversations
about critical decisions, and keep lines of
communication open.

Chinese: 
同时，如果 Watkins 医生能就病人的临床症状进展
与 Chapman 医生持续跟进；
Chapman 医生也很可能会同意改变诊疗计划
但哪怕没有（同意），他也应该顺着管理系统联系上级。
如果遵循了这样的规程，病人很有可能获得明确诊断
并尽快被治疗，这样他就不会去世
这一案例的启示是：及时上溯管理层级
记录关键决策的对话
保持沟通渠道通畅。
