episode_0064

Episode 64. Summer Vacation Plan (1)

****

The event ended successfully. The Dean of the Academy’s Faculty of Healing, Fredolin Fischer. The old professor with white hair sat haughtily at his desk.

“Did it go as I said?”

“Yes.”

Alain, one of Professor Fisher’s graduate students, nodded. Things really did go according to Professor Fisher’s plan.

This was the gist of what Fisher was saying.

In this monster hunting festival, if possible, send all patients to Professor Asterix.

That was the lesson of the fencing competition.

It was thanks to that professor. This time, there were quite a few serious accidents, but the event ended without anyone dying or being seriously injured.

In fact, it’s rare to find a professor in the Department of Healing who doesn’t have a strange personality. Rather, Professor Asterix is considered normal…

If I say that, it’s honestly a lie. Anyway.

“What did that professor say?”

“You didn’t say anything.”

“Good job.”

Professor Fisher nodded.

Among the patients Professor Asterix saw during the event, there were some with rather serious illnesses.

A patient had lost consciousness and collapsed for some reason, or a patient had suffered a heart attack from a monster attack. That was the rumor going around the ward.

The rumor that they had opened the heart of a living patient was the most shocking. Professor Fisher thought it was a false rumor.

“What happened to the patient with the heart injury? There’s a rumor going around that Professor Asterix had heart surgery. I wonder if that’s too much of an exaggeration.”

Alain thought for a moment and then answered.

“I asked the nurse about that. She said that the wound was made under the fourth rib and then reached the heart through the ribs.”

It wasn’t an easily believable claim. It was also unknown what benefit there would be from opening the heart.

Professor Fisher’s eyes narrowed in disbelief.

“Are you serious?”

“I’m serious.”

“This is more magical than magic. You opened the place where the real heart is? Is the patient alive?”

“I saw you alive.”

“That’s strange. Bloodletting is a theory that was abandoned a long time ago. Why would Professor Asterix, who likes new things, use such a method?”

“That’s… Isn’t it necessary?”

“Hey. Why would you do that when you didn’t need to?”

“Oh, no.”

Professor Fisher looked at his graduate student with a look of absurdity. Of course he did it because he thought it was necessary. It was something along the lines of, “If you’re hungry, eat.”

That wasn’t wrong, though.

“Mr. Alain. Go ask Professor Asterix. What on earth did he do to that heart patient? He said it was surgery?”

“Yes.”

“Heart surgery was originally impossible. Why did you open the heart and how did it succeed?”

Alain nodded.

I was curious, too. Why on earth would they cut into the ribs and drain the blood? Would that help?

Common sense tells us that if you open the heart and drain the blood, the person should die, right? But the professor saved the person’s life even after draining the blood.

****

Diagnosis of sepsis, the king of internal medicine diseases.

In fact, this is a topic that even modern doctors have different opinions on. Even if body temperature is like that, a heart rate of 90 and a respiratory rate of 20 can also occur due to intense exercise.

Body temperature, heart rate, respiration, white blood cell count. If two or more of the four criteria are abnormal, it is considered a systemic inflammatory response syndrome, and the corresponding protocol should be performed as per the textbook.

There was some ambiguity. Some doctors argued that the very concept of ‘systemic inflammatory response syndrome’ should be abandoned.

There are many patients with a heart rate of over 90 and a respiratory rate of over 20, so it is not reasonable to suspect and treat all of them as sepsis.

After a long debate, the concept of systemic inflammatory response syndrome was completely abandoned in academic circles, although it did not disappear from clinical practice.

I don’t remember clearly whether it was the staged organ failure assessment score or something like that, but anyway, they introduced the SOFA score for the diagnosis and evaluation of sepsis.

But, no matter what anyone says, the systemic inflammatory response syndrome is a useful concept.

Heart rate, breathing rate, body temperature. It was a huge advantage to be able to suspect and respond to sepsis using indicators that could be checked with the naked eye. Just look at the current situation.

I hope the message was delivered well?

As I explained, the story became a bit long.

****

I was explaining to Istina what sepsis is and how to deal with it. It might be a bit complicated, but

“To sum it up, yes.”

“Ah… … . Yes.”

“It’s not exactly like that, but this patient is at high risk for sepsis. If he shows characteristic symptoms, it’s almost like a confirmed diagnosis.”

Istina wiped the glass from her glasses that she sometimes wore. That’s the expression of someone thinking hard. The expression that comes when you don’t understand what’s being said.

I thought hard about my choice of words. I wondered how I could explain it again so that it would be easier… Istina frowned after thinking about it for a while.

Well, that’s obvious. Now it’s Istina’s turn to say, ‘I don’t know what you’re talking about.’

“I don’t know what you’re talking about.”

I guess I explained it wrong.

Since Istina didn’t understand, we need to go back to the basics. First of all, what causes sepsis?

Specifically, a systemic inflammatory response occurs when cytokines, proteins that signal an inflammatory response, are released throughout the body.

This is the systemic inflammatory response that we were talking about earlier. If the cause of this systemic inflammatory response is bacteria, we can confirm the diagnosis of sepsis.

“Hmm. Do you know what inflammation is?”

“Yes.”

Nodding again.

“There will be physical reactions to inflammation, right? Swelling, fever, redness, things like that.”

“Right.”

“If an inflammatory response occurs throughout the body, symptoms such as rapid pulse, increased respiratory rate, and high fever may occur. That means we should monitor for that. It means the surgical site may be infected.”

Istina opened her notebook and wrote something.

“Then, sepsis is a disease that occurs when bacteria causing inflammation travel through the bloodstream and circulate throughout the body. This patient’s pericardium was exposed to the outside air, so it is prone to that?”

“Right.”

That’s correct.

If infection or hygiene management is not good, sepsis may occur after surgery. Such accidents are easy to occur here due to the conditions.

“Oh, I think I understand! Then. I will closely monitor this patient to make sure that his temperature does not rise or that he is breathing quickly.”

Originally, the conclusion is the most important thing to a doctor.

“Lastly, one more thing. How do you treat bacteremia or sepsis?”

“Oh, that?”

The most important thing is to monitor the patient.

“Provide antibiotics and intravenous fluids, and monitor the patient’s condition to ensure that he or she is not short of breath.”

As expected, it’s complicated.

For patients suspected of having bacteremia, blood is drawn for culture, antibiotics are administered, intravenous fluids are connected, and the patient is monitored.

Blood cultures are practically impossible here, so let’s skip that. And there are no antibiotics, right? Unless I call for them.

“What are antibiotics?”

“Bacterial killing medicine.”

We could probably make antibiotics, too. I wish we could make penicillin soon. It seems like it’ll take some time.

Question time was over. Istina folded her notebook and stretched out her legs as if yawning.

“That’s right, Professor. Your new graduate student’s name is… Amy, right?”

“Yeah. Him.”

“Okay. I’ll show him around as soon as he gets here. Let’s have a meal sometime… … .”

Istina looked at the distant mountains with a bright expression this time. There’s quite a bit of work to do.

I also have to prepare a new paper and, if possible, answer the questions that often come up about papers I’ve compiled in the past.

We should also try making antibiotics.

The most important task remains. I have to recruit and teach new graduate students. I wish I could hire more people than just Amy.

“Istina.”

“Yes.”

“Go home first. I have some things to take care of.”

“I’ll just sit down for a bit and then go… … .”

Yeah, do whatever you want.

Istina lay down on the sofa in the study.

****

The next day. When I went to work in the lab in the morning, there was a familiar face sitting in the lab.

Princess Mint.

“Long time no see, teacher.”

To be honest, it hasn’t been that long. I came by the day before yesterday. Anyway… … Mint gestured to her side. It meant for her to come and sit next to her.

I’m worried that mint is looking a little dull these days. It might just be because the weather is humid and rainy, making it sag a little.

The overall impression was the same.

A neatly-dressed uniform befitting a princess.

Soft light brown or blond hair. Her eyes were wide open, and her hands were restless as if she was restless.

Although her expression had become more colorful than before, Mint’s characteristically doll-like, slightly unapproachable impression remained.

“I saw it the other day.”

“Yeah… … . It’s not nice to see you often.”

“Nice to meet you, Princess.”

“Come quickly?”

What… … . I can’t help it. I sat next to Mint as she wanted. Mint covered her mouth with her hand and smiled slightly.

What kind of wind will blow today… … .