このコラムは、海外ドラマ「ER 緊急救命室」を教材として活用し、リスニング力のみならず、TOEFLに対応できるスピーキング力を身につけることを目的としている。
　１　TOEFLに対応できるスピーキング力
　　(1) 映像なしで、音声のみを聴きいてどのような場面かを理解す
　　　　る
　　(2) ドラマの中では、次々に問題が発生し、一刻を争う判断が求
　　　められるが、医師・看護婦あるいは患者それぞれの立場で判断
　　　を下し、その理由を英語で１分以内に述べる。

　２　医学用語
　　　専門用語や略語の他、実際の医療現場で使われている表現を身
　　につける。

　３　リスニング力
　　　緊迫した医療現場で飛び交う難度の高い英語を聴き取る訓練を
　　する。

　現在手元に「Season Ⅵ」があるので、とりあえずこれから始めます。次回は、Vol.1からの予定。
　このサイト上で提供している内容は、次のような構成になっている。
　１　医学用語
　２　取り上げるシーンの概要。
　３　Speaking Taskに必要な場面のスクリプト。
　４　Question
　５　Answer

ER 緊急救命室　Season Ⅵ　
Episode 19 The Fastest Year

Episode 20 Loose Ends

Episode 21 Such Sweet Sorrow

Episode 22 May Day

　 Episode 19 The Fastest Year 「一番短かった一年」
　白血病(leukemia)の子供に合う骨髄移植(bone-marrow transplant)のため、離婚(terrible divorce)した妻のもとにいる娘に協力を求める。娘は弟のために骨髄移植に積極的だが、母親は許そうとしない。
　I don’t care what my daughter thinks.
meningitis 髄膜炎
LP 腰椎穿刺
lethargic 昏睡状態の、弱弱しい
Question:Do you allow your daughter to donate her bone marrow to the ex-husband's son?
　(自分の娘が、離婚した夫のもとにいる子供に、骨髄移植を提供しようとしている。元夫とは、二度と関わりを持ちたくないと思っている。あなたは、娘の骨髄移植を認めますか？)

Episode 20 Loose Ends 「ほつれたロープ」
　EMS=electric muscle stimulation, emergency medical service　　potassium level is low カリウムレベルが低い
　replenish 補給
　CHF=chronic heart failure
　furnace かまど
　CBC=complete blood cell account 全血球計算値
　plus ox= plus oxygen
　ingest 摂取する
　blood glucose 血糖値
　seizure 発作
　insulinoma 膵島細胞腫
　dextrose 　D形グルコース

Episode 21 Such Sweet Sorrow 「決意の日」
１　ハサウェイは、末期症状の癌患者に点滴を打ち、意識を回復させる。
　We are giving you fluid through IV because you are not drinking. That’s why you woke up today.
　その患者は、DNR(do not resuscitate) を意思表示しており、生命維持装置は使えない。

(12’40”→13’33”)
　自宅に帰ることを強く望んでいる。
　I want to go home. You don’t want to put on any machines?

(15’30”→16”15)
　ウィーバーは、患者の意思を尊重し、hospice careのためにsocial servicesへの連絡する。
　Please start a morphine drip. I think we should explore home hospice care. Take the IVs and pain medication.
Don’t you think she deserves to die where she wants at home with her family in her own bed.
Good. Why don’t you tell her? It’ll help her calm down.
I know it’s not pleasant, but we have to respect her wishes.
She’s excruciating pain. We didn’t explain the options to her.Just call and set it up.

(27’53→29’05”)
　患者の夫は、仕事第一で妻のそばにいなかったことを悔いる。子供たちは、看護師と一緒に病院内のカフェにいる。
　(Breathing’s agonal. Resps are seven.)
　So she’s not getting any better.
　No, I’m afraid not.
　You should’ve seen her two years ago. She was so beautiful, alive and vibrant. She’s always laughing. I wish I could have it back. The time I missed with her. Traveling with work late at the office. All the weekends I was preparing for trial. When she was first diagnosed, I kept working. Do you believe that? Instead of spending time with her, I kept working.
　Question 1: The husband was working when his wife was declared cancer. Which do you prioritize, your job or your family? (妻が癌を宣告された時も、仕事をしていた夫。さて、あなたなら仕事と家庭、どちらを優先しますか？)

Answer:
　I would rather put my family before my job. I work to support my family and I think I am supported by my family. I believe it is my duty to protect my family and without my family, I would live a life not worth living.
　If my family members were diagnosed as having a fatal disease, I would be around and encourage them whenever possible. If I found it impossible to juggle the work place and home, I would rather choose my home and seek a new job to spend time staying with my family.
　 Though it may be true that wealth makes people happy, it seems to me something like putting the cart before the horse if you rupture family ties and sacrifice family for your career. Building strong family ties brings happiness home to the family members.

２　延命拒否のシーラ(末期がんの母親)
(29’10”→30’42”)
　シーラの呼吸が突然止まるが、娘たちは病院内のカフェに行った。
　She’s not breathing.

　父親は、母親が死ぬ前にもう一度娘たちに会わせてやりたい。
　Please, girls aren’t here. I didn’t expect it would happen this fast.
　Can you help me?
　She is DNR.
　It doesn’t mean we can’t stimulate her breathing.

　ハサウェイは、コバチに応援を頼み、nasal trumpetsを使って、蘇生させる。
　End-stage ovarian cancer,
　Let’s intubate.
　She can’t. She’s a DNR.
　Then, let her go.
　Her daughters haven’t said goodbye yet.
　Please. I thought we had more time.
　Can we use a nasal trumpet? It’s not a ventilator.

(30’43”→31’34”)
　ウィーバーは、ハサウェイが患者本人の意思(DNR)に反して蘇生させたことを責める。
　We’re helping the airway open.
　You resuscitated her. You deliberately violated a patient’s wishes.
　I did what I thought is best under the circumstances.
　That’s not your decision to make. We discussed this earlier. I disagreed. I listened to your point of view. I told you exactly what I wanted done. If you can’t respect my authority, then you shouldn’t be working here. If she calls again, I don’t want either of you to touch her. Is that clear?
Question 2:Do you think doctors should not resuscitate the patients who express "DNR" in any case?
（DNRの意思を表明している患者に対しては、いかなる場合も延命治療をするべきではないか?)
Answer:
　It is commonly believed that doctors' mission is, out of question, to prolong the life of a patient; however, this is not always the case. Sometimes doctors need to put the patient' life to an end solemnly－when the patient clearly wishes to die with dignity. Everyone has the right to die a natural death, which should not be infringed upon even by doctors. DNR is based on the idea of dying a natural death without pain. A DNR patient's life should neither be prolonged nor shortened. In other words, we should let people do as they wish.

第21話　Such Sweet Sorrow「決意の日」
３　医者の器でない
　PID患者を退院させたが、症状が悪化した。退院を認めた医師の責任を追及する。
(25’05”)
Corday: Why was a critical patient like this discharged from ER?
Lockhart: She wasn’t critical at the time. Her vitals were stable. I thought she was PID(pelvic inflammatory disease).Corday: You didn’t appreciate the mass on the exam.Lockhart: No, I didn’t.
Corday: Who was supervising? You, Dr.Malucci? Didn’t you appreciate anything?
Malucci: No, I didn’t.
Corday: What are you wearing? Oven mitts?
Lockhart: Actually Dr. Malucci never had a chance to examine the patient.
Corday: I think you two need a moment alone to get your story straight.
Lockhart: He didn’t examine her because I never called him in.
Corday: Have you recently unexpectedly graduated from med school?
Lockhart: I thought my OB/GYN experience qualified me. Obviously I was wrong.
Corday: You signed discharge order for patient you never saw, who was examined and treated only by a medical student? This woman could have died. You’re years away from having the necessary experience for these decisions.Lockhart: I know.
Corday: Oh, good. I’d like a moment alone to speak with Dr. Malucci.
Malucci: Can I say something?
Corday: I think your cause would better be served by keeping your mouth shut.
(26'23")
　When residents arrived here, we size you up. We have great hopes for you. We want you to succeed. But gradually over times through interaction, we form opinions.Do you want to know the staff’s opinions of you? You are lazy, sloppy. Your careless attitude towards responsibility as a physician endangers patients’ lives as witnessed today. In other words, none of us thinks you’re much of a doctor.

Question3
Dr. Malucci is severely accused of his mistake by Dr. Corday. How do you defend Dr. Malucci?
(自分の判断ミスで引き起こした事故で、コーディーから言い訳することさえ許されず、激しく責められるマルッチ。そんな可哀そうなマルッチを擁護してあげてください。)
Answer:
　First of all, I think Dr. Malucci should be given a chance to excuse himself from his mistake. There might be some particular reason why he made a mistake.
　Second, Dr. Malucci is still a young doctor who needs experience as a physician and support from other doctors.
　Third, the woman doctor should recognize that this is not just the matter of his mistake but that of a flaw of the ER system. Mistakes can happen and there should be a system to prevent them from happening; for example, a safety check conducted by another doctor.

４　カーターのミス

カーターが躁鬱病ではないかと心配

He is not forthcoming. Let’s get out of the hallway. Can you give us a minute?

he DMS IV, violent mood swings, deeply depressed or he’s manic, bipolar,

Episode 22 May Day 「危機」

Listening

Police: Three gunshots. One looks fatal.
Benton: We should’ve landed 10 minutes ago.
Police: The suspect is pinned down. He is firing.
Kovac: Is he shooting at school?
Police: He’s shooting everywhere. A unit responded to a (robbery). The suspects opened fire.
Benton: I’ll take this one.

Boy: Where are my glasses?
Benton: Is he alert?
Police: Sort of.
Police: His name’s Daniel.
Benton: Daniel, do you know where you are.
Boy: I lost my glasses.
Benton: Can you tell me where you are.
Boy: School.
Nurse: Exit wound out the right temple.

Kovac: What kind of ammunition are they using?
Police: A large assault rifle. Shot through the engine block.
Kovac: We’ll never get her back with a head wound like that.　Stop compressions.

Nurse: How is he doing?
Kovac: Chest is clear. Good radio Pulse. Titrate 4 of morphine. Don’t worry. I’m sure school has it.
Police: It’ll take a while. We’re evacuating.
Kovac: Why?
Police: We apprehended two suspects. There might be another one.
Kovac: Might be?

Kovac: Can you feel your leg?
Boy: It’s going to sleep.
Kovac: Like pins and needles? Where’s paramedic?
Police: Coming now.

Benton: Let me examine him.
Police: We have to search him first.
Benton: Is he still breathing?
Police: Yeah. He’s clear. All right. Come in.
Benton: You shot him through the vest?
Police: Yeah. Right chest.
Benton: All right. BP. I’m a doctor. I’m here to help you. Can you talk?
Criminal: Go to hell.
Benton: OK. I’ll take that as a “Yes.” Diminished (breath) sound on the right. BP’s 100/65. His (pulse) is 88. OK. Get a large bore IV. Let’s roll him. No exit (wound). All right. He needs chest tube. Let’s get him betadine, a Steri-Drape. Take that (mask) off.
Kovac: You got this? Yeah. Lidocaine. (The eye’s) going by ambulance, (the leg) in the chopper.
Benton: Hold on, hold on. I might need to fly him.
Kovac: No long. Take him by ground.
Benton: I want to make sure he’s stable.
Kovac: Got to Mercy. County has the closest pediatric trauma center.
Benton: Just wait (until) I get the chest tube in.
Kovac: Chris, take two units of O-neg to the chopper. I’m loading my kid.
Benton: I said wait, Kovac.

The suspect is apparently alive. We are waiting for confirmantion on that. If you are just joining us, this is the live shot Thalin Elementary School.…

(5'46")
Police: Morning traffic’s faster.
Benton: Your call.
Nurse: Hold on. (Pulse) is weak.
Benton: Hey, man. Are you still with me?
Nurse: Heart rate’s 120.
Police: Chest output 500cc’s.
Benton: He’s bleeding out. A unit of O-neg.
Nurse: BP’s down to 70 palp.
Benton: Follow me.
Police: Where are you going?
Benton: We’ll transport by chopper.

Kovac: Half liter bolus, the TKO.
Benton: He’s bleeding out!
Kovac: What?
Benton: He’s bleeding out. I need the chopper.
Kovac: Where will we put him?
Benton: Get the boy off.
Kovac: He has a pulseless leg.
Benton: We need to revascularize.
Kovac: I’m not going to waste time transporting by ground.Benton: His blood pressure is crashing.
Kovac: Then give him blood.
Benton: Come on. Get out.
Kovac: No way.
Benton: My patient is more critical.
Kovac: Your patient killed people.
Benton: That’s not our (call).
Kovac: Close the door. Let’s go. Let’s go.
Benton: Open up the door.
Kovac: Stand back.

Question 1 Episode-22
Which patient do you choose to transport by chopper, less critical victim of school shooting or critical perpetrator shot by the police?

Answer:
　I think the doctor should decide the priority of treatment just in accordance of the degree of severity, which means “how seriously ill or hurt the patient is.” If a doctor decide the priority at their discretion, there will be other factors like doctor’s preference, patient’s wealth and status. Everyone has the right to get medical treatment equally. So there should be a clear and fair standard of treatment―it is the degree of severity, I think.