episode_0165

Episode 165. Breath of Life (1)

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“Class starts now. Are you all here? Since it looks like you all are here, I won’t take attendance.”

It’s up to me whether I take attendance or not. It seemed like the classroom was full anyway.

I started talking.

The plan for today was this: I would use Daisy’s case as a basis for explaining the physiological causes of the lungs.

“A while ago, a patient came to my hospital with an arrow wound in his side. The other doctors gave up, saying they couldn’t save him.”

I roughly drew a person on the board, then drew an arrow on the side of the figure.

“Let’s say a patient comes in with an arrow shot in the side. What would you do first?”

No one answered. I pointed to a student sitting in front of me.

“What is the student’s name?”

“Lucy.”

“If this patient comes into Dr. Lucy’s ward. What would you do first?”

I pointed to the scribbles on the blackboard.

Lucy didn’t open her mouth for a long time, and I picked up the pink chalk and added a few traces of blood from the patient’s wound.

“Dead.”

“First, you have to pull out the arrow… … .”

“No, it’s already dead.”

I could hear a faint snickering in the classroom. I erased the bloodstains, or rather the pink chalk marks, from the blackboard.

“You can’t just pull it out. When a person gets pricked by a sharp object, the muscles in the area where it was pricked contract and grab the sharp object.”

“Yes.”

Lucy nodded.

“If you pull this out right away, blood might spurt out. You can pull it out after you’ve finished stopping the bleeding or getting ready to stitch up the wound.”

I looked around the classroom again.

“So let’s say we pull out the arrow, stop the bleeding, and stitch up the wound. What’s next? Mr. Oliver, can you answer that for me?”

“Uh, isn’t that all you can do?”

“What organs are here?”

“I don’t know because the picture is too rough.”

“Above waist, side.”

“What is the triangle above the patient’s head?”

“Cat ears. Patient was a human.”

“Aha.”

Oliver nodded.

“There must be a lung.”

“Okay. Lung puncture. So, Mr. Oliver, what happens if you have a punctured lung?”

“I feel like I can’t breathe.”

“If he can’t breathe, why is the patient still alive? It must have taken at least several hours to get to the hospital.”

Oliver looked at me with blank eyes, as if to say, “What the hell am I talking about?” But, if you think about it for a bit, you’ll get the conclusion, right?

“Ah! Because I have two lungs.”

“That’s right. Since he had two lungs, his breathing didn’t stop completely. That’s why he was able to survive until he got to the hospital.”

****

So far so good.

“Okay. The arrow was pulled out and the wound was stitched up. There is no more bleeding, but the patient is still having trouble breathing.”

Now we need to think about what to do next.

“Mr. Lucy. Think about it. What would you do next in this situation, and why do you think you have difficulty breathing now?”

“Of course. There’s a hole in my lung.”

“How are you going to solve it?”

Lucy lowered her head to think, then changed her mind and began to speak. Just now, the imaginary patient died because of worrying, right?

“Ah. First, I think we need to check if there is any blood clot in the patient’s lungs!”

“Okay. How do you do that?”

“To Cheongjin.”

“Very good. You can check for blood clots in your lungs with auscultation.”

Actually, I didn’t do auscultation at that time.

There was a hole in the lung, so of course it would be soaked with blood. The problem was that there wasn’t much new information that could be found out through auscultation.

“The outside of the lungs, inside the thoracic cavity, has air instead of water. It is an empty space.”

“Yes.”

“So, if half of the blood from the patient’s wound flows out, where do you think the other half is?”

Lucy frowned.

“Is your blood clot?”

That’s correct.

Blood collects inside the chest cavity. I drew a small box on the board, then drew the lungs. And, the main point of today’s lecture, the arrow.

Swish. The arrow hit the lung in the picture.

I grabbed the pink chalk.

“Roughly speaking. If half of the blood flows out of the body, the other half must have entered the chest cavity where the lungs are. This pooled blood is what is preventing the patient from breathing.”

Pink blood surrounded the lungs in the painting.

“Ms. Amy. What should I do?”

“We need to drain the deceased’s blood.”

This time Oliver raised his hand.

“Well, isn’t blood originally inside the body? I honestly don’t know why having blood pooled in the chest cavity is a serious problem.”

I nodded.

“There are two reasons.”

“Yes.”

“First, if blood is outside the blood vessels, it can irritate and damage tissues. In severe cases, it can even cause an inflammatory reaction.”

“Oh. Really?”

“Second. Fluid in the chest cavity is often the cause of the problem. Think of a paper bag full of air.”

“Yes.”

“What happens if you soak this in water?”

“Ah! It’s going to break. It’s going to shrink.”

The lungs are balloons.

“Like that. Now, the lungs have less room to expand, and it becomes difficult to breathe. The blood that has pooled needs to be drained.”

Now, next step. Today’s main topic.

“There are no muscles in the lungs themselves. The muscles surrounding the chest cavity move the air to induce breathing. That’s why even a small amount of blood can cause one lung to become unusable.”

“Aha.”

“We’ve established that the blood pooled in the chest cavity is the root of the problem, so we need to drain it. Dr. Oliver. How do we drain this blood?”

“Uh… ….”

I asked how to get the dead blood out, but in reality there was only one way to drain the water: by cutting open the chest cavity.

“I have to use a knife, is there any other way?”

“That’s right.”

I went back to the patient picture.

“You can think about how to place the knife and where to put the tube, but in the end, you have to open the chest duct a little with the knife and drain the blood.”

This concludes the case of this patient.

****

“Then. Let me ask you a question.”

I leaned against the podium. There were a few professors behind me. They must have come because today’s class was going to cover a somewhat unusual topic.

“How did you remove the deceased’s blood?”

“This. If you change your position, doesn’t the blood in the chest cavity move? If you adjust the position of the tube and adjust your position, you can remove it.”

It didn’t seem like he was convinced yet.

“By the way, you likened the lungs to a wet paper bag. Is there any evidence to support this analogy? Aren’t they supposed to be wet?”

A roaring sound.

Anyone can make an analogy, but what matters is how much you can justify the similarity with the subject. What is the basis for saying that lungs are similar in structure to balloons or paper bags?

“You all know that your lungs are inflated. You can check it just by taking a deep breath.”

“Yes.”

“When the muscles of the body move to increase the internal volume of the thoracic cavity, the pressure of the air around the lungs decreases, causing the lungs to inflate and draw air into them. Do you understand this far?”

“From that. Is it true that the lungs don’t have muscles? They move without stopping for even a moment.”

“There are muscles that adjust the width of the bronchi, but no muscles that move the lungs themselves.”

“That’s strange. Wouldn’t it be more reasonable to think of the lungs as being able to move actively, like the digestive tract? They’re such important organs.”

I thought about it for a moment.

“First of all, it can be confirmed through dissection that there is no muscle in the lungs.”

“There is another difference. Unlike the gastrointestinal tract, the respiratory system is controlled by muscles that can be consciously controlled. The diaphragm attached to the bone, the muscles between the ribs, etc. ”

“Oh, I see.”

“So it’s not an internal muscle.”

Professor Kropelter sat down.

“Oh, and one more thing. There is a reason why the lungs stay moist and don’t collapse like a wet sponge or paper.”

“What is that?”

“That’s what I mean. The reason why wet objects shrink is because of the surface tension of the water, right? If there were a substance that could control surface tension, we could control this.”

The classroom was deathly quiet.

Amy, who was sitting at the front of the classroom, frowned. As if she was hearing it for the first time.

“Surface tension?”

“Yes.”

“To put it simply, water tries to minimize its surface area. That’s why wet objects shrink and sag, and that’s why water droplets are round.”

“What does that have to do with anything… … .”

Amy sighed. Professor Klaus looked at me. Well, as always. There was still a lot of distrust in the classroom.

****

A student in the Academy’s Department of Healing.

Melissa Madison.

‘What is this?’

She was a student who had come from the Kingdom of Lutece a few days ago. She had come to study medicine at the Imperial Academy, the center of learning.

The class I took today was shocking.

Is it like this usually?