episode_0010

Episode 10. Graduate Student Istina

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The surgery went well. Now that I’ve seen the patient, I need to keep a record of what treatment was done.

In my previous life, at a homeless clinic that didn’t have a computer system, this is how medical records were kept: Each patient had their own brown envelope and put all their relevant records in it.

Wouldn’t it be possible to do it in a similar way?

Istina tilted her head as she looked at me.

“Professor, how do you keep patient records?”

“What… … Is there another way? I should prepare an envelope, write the date, and write down everything that happened to the patient that day.”

It’s going to be hard, but I’m going to do the same here. I started writing my medical records. First, I’ll write the date at the top.

– Surgery was performed to implant a titanium plate into the humerus and fix it in place. The surgery was successful.

– Since general anesthesia is not possible, sedatives, analgesics, and local anesthetics are administered concurrently. Liver and kidney toxicity monitoring is required, but is expected to be without problems.

Actually, if there is a problem in that area, there is no solution. The fact that you cannot do a blood test is the real problem. If you make a mistake and have to treat renal failure only by looking at the face… … .

It’s terrible.

– No allergic reactions or side effects were observed for the anesthetics used: propofol (intravenous), fentanyl (patch), and lidocaine (subcutaneous injection).

– The patient’s condition is stable.

Istina, does she have anything to add?

“How is the patient? Report the condition.”

“Okay.”

The apprentice healer nodded.

“How do you report it?”

“You can report in the following order: patient identity, reason for hospitalization, treatment performed, and current condition. Then, you can discuss what to do next and what to consider in terms of patient management.”

Istina nodded and took out her notebook.

I have also reported patients in my past life, and the most important issue in reporting patients is this.

If I don’t know the patient’s condition well, then of course I can’t report the patient’s condition to others.

So, you need to be familiar with all the relevant information to be able to report, but that’s easier said than done. If there’s something wrong, it can often break again.

“Benjamin patient. He is said to be an academy student. He was hospitalized with a fractured arm and compartment syndrome after falling from a horse. His current condition is stable after fascial incision and bone reassembly.”

That’s right. I picked up my pen and continued writing down the contents of the medical record. Istina looked over my shoulder at the medical record.

– Suspected compartment syndrome. Compartment syndrome confirmed and resolved after fasciotomy, observed.

– Suspected of a comminuted fracture. Confirmed by exploratory surgery, then treated with fixation on a titanium arm. Currently able to move all fingers normally.

“Okay. What’s next?”

“Isn’t it discharge?”

How great would it be if patients could be discharged from the hospital the same day after surgery? Unfortunately, that is not the case.

“It’s a bit difficult to be discharged right away. After the bones heal a bit, you’ll need to undergo rehabilitation treatment. There will be damaged bones and tendons, so it will take time and effort to get them back to their original state.”

This patient is not in a position to be discharged immediately.

Because I need to check if the surgical wound is healing, if the bone is healing, and if I can move my arm.

Shouldn’t it take a week?

It depends on how strong your healing magic is. It should take a few days for the wound to heal, but I’m not sure how long it’ll take for functions to return.

“Let’s see for a week. Since you’re my first patient.”

“Okay.”

Istina nodded, but didn’t go anywhere. It seemed like she had more to say. Judging from the way she was hesitating, it seemed like she had more questions to ask.

“If you have any more questions, sit down and ask.”

Istina sat right in front of my desk.

As if I had been waiting for it.

“Professor. I was curious about that too. Aren’t bones made of hard, stone-like material? Then, what is the principle by which bones can be attached and grow?”

“Trees have rings too. It’s similar.”

“There are no teeth on the bones?”

Wow… … You’re smart?

Here’s the exact mechanism by which bones grow and fuse. First of all, most of the bones are made up of fibers and calcium phosphate crystals made by cells.

There are several types of cells in bones: osteoclasts break down bone, and osteoblasts build bone. These processes occur simultaneously, forming a kind of dynamic equilibrium.

When a bone is cracked or broken, osteoblasts work harder, and when there is a bump in the bone, osteoclasts work harder.

Then, as we age, osteoclasts become dominant, which can lead to osteoporosis.

The content is like that. How do you explain all this?

I pondered the choice of words for a moment. How should I explain it so that Istina would understand it better?

“Istina. How much do you know about the microscopic structure of human tissue? Have you ever heard of a cell?”

“I don’t know.”

The structure of cells is common knowledge to modern people, but in the original history, until Hooke observed the structure of cells under a microscope, most people did not believe in the cell theory.

I used to think that the tissues of the human body were not made of brick-like components when viewed microscopically, but rather a kind of continuum. In fact, the former is correct.

First, let’s explain without mentioning the word “cell.”

“Bones dissolve. The components that make up bones dissolve the bones, and the process of rebuilding the bones is repeated over and over again. That’s why bones can grow and reattach.”

“So that’s why there was no night light.”

I nodded. Since bones melt and regenerate, there is no reason for them to grow rings like trees. Except for children, bone size doesn’t change much.

Istina wrote down my words in her notebook.

“Then. Are you saying that bones are also part of a living organism? Not something like a stone.”

“Bones are alive too. You just saw blood vessels running inside the bones. Haven’t you ever done an autopsy?”

Istina nodded.

“We don’t do it as undergraduates. Normally graduate students do it, but as you know… … .”

I got kicked out of graduate school.

Istina became a little gloomy.

“Don’t worry.”

“What is it?”

“Learn from me, conduct research with me, and use your skills to suppress those who judge others by such inadequate standards.”

“Thank you.”

More than that, I guess I’ll have to look into anatomy classes later. It’s not right for a doctor who hasn’t even done a proper dissection to be looking at patients under me.

****

Here are the studies I think should be prioritized for publication: four papers from real-world history.

first.

Robert Hook’s , a basic book on microscopy. As a side note, Hook did not discover bacteria because he did not know how to stain bacteria so that they could be seen under a microscope.

This provides a basis for observing bacteria.

Of course, it is difficult to see bacteria with a normal optical microscope. It requires a process such as staining the bacteria or forming colonies.

second.

sent by Pasteur to the French Academy of Sciences.

The famous goose-neck flask experiment was an experiment that disproved the hypothesis that factors causing decay and disease occur spontaneously.

This proves that bacteria are the cause of decay and disease, and that they can be killed by methods such as heating.

Third.

by Hans Christian Gram, who discovered the Gram stain.

Honestly, I don’t remember the name of the report that Gram wrote, but it is true that Gram staining of bacteria began with that report.

With Gram staining and a microscope, you can observe bacteria directly. From here, you can classify them by their characteristics, and if you go a little further, you may be able to use antibiotics that are appropriate for the type.

Fourth.

And. Joseph Lister’s . Lister came up with a method to sterilize wounds and operating rooms to prevent infection after surgery.

When you use Listerine, that’s right. With this, we can inform people how to act in actual hospital settings to prevent infections.

First of all, the structure of the plan prepared to persuade the academic world is like this. The direction I am thinking about now is also like this.

I will re-examine the four papers mentioned above in this world and submit them to the academic world.

Then, the world would have recognized the existence of bacteria hundreds of years ahead of time and developed aseptic surgery. This seems possible.

As long as you write your thesis properly.

****

Istina, who had been quietly listening to me, thought about it for a while and then scratched her head.

“So I have to write four papers?”

“That’s the plan.”

“Isn’t that too much?”

“We’re all doing the same thing, Mr. Teacher. Are we strangers?”

Where are you getting your footing? We all suffer together.

It’s like a puzzle.

The sooner we publish our research, the easier it will be to treat and conduct the next research.

Let’s work hard for a few more years, Istina.

We can change the history of imperial medicine.

Istina already had a look on her face that said she was having a hard time.