episode_0137

Episode 137. Pickles and Sore Throat (2)

****

The most noticeable symptom is a high fever of 40 degrees.

My throat is sore and my gait is strange.

Although you speak clearly, your judgment may be clouded. Or your threshold for pain may be extremely high… … .

“What is the patient’s name?”

“I’m Sebastian, 35 years old. Right now I feel like I’m going to die soon… … .”

I nodded.

The medical term for it is ‘a feeling of impending doom’, but it is difficult to explain precisely. It seems to occur for physiological reasons, such as after surgery, blood transfusions, or stroke.

“Amy!”

Amy ran straight into the examination room.

The patient looked around with difficulty at the sound of someone running towards him. I gave him an aspirin and a glass of water.

“Take it. It will help relieve pain and fever. The diagnosis will take about 10 minutes.”

The patient swallowed the aspirin right away.

Just now, the patient tried to turn his head at the sound of Amy coming in, but failed and turned his torso around to look back.

Was your neck stiff rather than sore?

There are several possible causes.

Heatstroke is possible. Given the impaired judgment, it could be stroke. The high fever could be due to sepsis.

Sepsis? I rested my chin on my hand and pondered.

Breathing appears normal. I don’t know if there’s a way to check for coagulation. Blood pressure seems okay. Consciousness is relatively good.

It doesn’t seem to be sepsis.

Next in line is heatstroke.

First of all, it could be heatstroke, as it seems like the body’s temperature control function has been disrupted. But since it’s late fall now, heatstroke is unlikely.

If it were modern times, I might have gotten heatstroke in a factory or other work environment, but that doesn’t seem to be the case.

“Amy. 40 degrees. Bottles to consider first.”

“Oh, it’s not hot outside, so it’s infection.”

It was entirely possible.

“What infection.”

“Pneumonia?”

Every time he brings up the topic of pneumonia, I scratch my head. I don’t think it’s pneumonia though.

“Take a stethoscope.”

Amy carefully placed the stethoscope on the patient’s back. The patient exhaled deeply. Amy thought hard. It probably wasn’t pneumonia.

“How is it?”

“I don’t think so.”

It’s not pneumonia.

“Patient, have you been coughing recently?”

Although stroke can sometimes cause fever, this patient was not at an age where a stroke could occur, and the 40 degree temperature did not appear to be due to a stroke.

Still, I guess I know what the disease is. There is only one infectious disease that can cause a stiff neck and high fever.

“It’s meningitis.”

Meningitis is a contagious disease that can be spread by a variety of bacteria. I disinfected my hands and covered my face with a plague doctor’s mask.

“What are you doing?”

“It could be a contagious disease.”

Meningococcus is not only contagious through close contact, but is also highly fatal if left untreated. Amy nodded with a serious expression.

****

Amy followed me to disinfect, then put on her mask and returned to the patient’s side. The patient frowned at the sight of us wearing masks.

“Is this a serious illness?”

“Yes.”

It is a serious illness.

Amy tilted her head.

“But what is meningitis?”

“Literally. Inflammation of the meninges.”

The brain and spinal cord are surrounded by a membrane called the meninges. The interior is filled with cerebrospinal fluid, and this structure protects the brain and spinal cord.

Meningitis is literally an inflammation of the meninges, usually caused by bacteria.

The method for confirming meningitis is simple: insert a needle into the lumbar spinal canal, extract cerebrospinal fluid, and see if there are white blood cells or bacteria inside.

Although removing cerebrospinal fluid is difficult, there are ways to extract it without surgery.

The spinal canal in the lumbar region is relatively wide. If you puncture the space between the vertebrae in the lumbar region with a needle, you can reach the cerebrospinal fluid with just one needle.

Well… … but.

I doubt it’s worth it.

In modern times, using ultrasound and other methods, lumbar punctures can be performed safely. But since there is no ultrasound here, I was a bit worried.

“That, Healer. Explain it to me… … .”

I looked at the patient, wrote something down in the medical record, and then started talking again.

“The patient appears to have a disease called meningitis. It is a disease in which the membranes surrounding the brain become inflamed, and it is treatable. However, it may be contagious. The patient must be isolated until he or she recovers.”

“Really?”

This time, Amy raised her hand.

“Professor. But what does that have to do with a stiff neck? And how can you tell it apart from other infectious diseases?”

It seems like this is going to be a long story, so let’s lay the patient down and think about it. I grabbed the patient’s arm and led him to the most remote hospital bed.

The patient lay down carefully as if his back and neck were hurting. I started talking.

“Because the membrane surrounding the brain and spinal cord becomes inflamed. When you move your neck, that part gets stimulated. That’s why you can’t move it.”

“Aha.”

I checked the patient’s pupillary reflexes. He still looked relatively fine. I tried to lower the temperature as much as possible with a wet towel, and the decision was-

Are you recommending a lumbar spine or not?

“Patient. You have a decision to make.”

“What is it?”

“The way to confirm meningitis is to extract cerebrospinal fluid and check for bacteria, white blood cells, or inflammatory substances. In this case, cerebrospinal fluid is extracted from the spinal canal.”

“Yes?”

“Simply put. If you take something from the lumbar vertebrae, you can confirm this disease.”

“You already know what it is.”

Is it sharp?

“Until proven, it’s just a guess. So, you have to decide now. Do you start treatment based on the guess that it’s meningitis, or do you confirm the diagnosis with a lumbar puncture?”

The patient and Amy were a bit worried.

“What’s wrong with recommending a yo-yo?”

“This is. They put a needle in your spine. Accidents can happen. There can be some pretty serious side effects.”

“What does the needle look like?”

I cursed inwardly.

The lumbar puncture needle is longer than a finger and is as thick as a toothpick. If you show it to them, there’s no way they’ll agree to lumbar puncture…

Well, there’s nothing I can do.

“Oh my god, shit.”

I showed the patient the lumbar puncture needle, and the patient waved his hand in horror.

As if I had forgotten the pain in my throat. It was as expected. I let out a quiet sigh.

“Shouldn’t we?”

“Yes.”

It’s a bit of a shame.

I wish I could have tried a lumbar puncture. For now, what I’ll do for this patient is to inject antibiotics and see how the treatment progresses.

We placed a wet towel on the patient’s forehead and disinfected his arm to inject the patient with antibiotics.

Since we don’t know what type of bacteria you have, you need to give one or more broad-spectrum antibiotics. I was given vancomycin and cefotaxime.

If that doesn’t work, there’s an extreme way to inject antibiotics directly into the cerebrospinal fluid. But it doesn’t seem like it’s at that stage yet.

I breathed a sigh of relief.

I was flustered when two emergency patients came in at the same time. But I’m glad that treatment started without any problems. I wonder if I can get some rest.

****

We rented a psychiatrist’s office. Amy was lying on the consultation couch. I sat next to her with my legs stretched out.

It was Professor Agasa’s examination room.

There are no psychiatric consultations today, but psychiatrists usually have large, comfortable consultation couches in their offices… … .

“Professor.”

“Huh?”

“I really don’t understand pickles. What do pickles have to do with the brain and muscles? Or injecting saline solution into the blood vessels.”

Oh, that.

It might seem strange, if you don’t know how muscles and nerves work.

“Amy. Do you know why pickled cucumbers are wrinkled?”

“Oh, it’s been a long time?”

Wrong. I shook my head.

“Did you know that salt absorbs water?”

“Yes.”

“Same goes for salt water. Salt water also absorbs water. That’s why when salt water draws out the moisture in cucumbers, the cucumbers become shriveled.”

“Aha… … .”

By the same principle.

“If you drink a can of pickle water and salt your body, where will the water escape?”

“In the body?”

It comes out of the body. The organs turn into pickles.

“There is a lot of water stored in the muscles. If you drink that much salt water, it first takes the water from the stomach. The water is drained from the muscles that store a lot of water. So-”

“So that’s why the patient couldn’t move properly! Because the muscles were shrunken.”

I nodded. In fact, electrolyte concentration does affect muscle function in addition to physically shrinking.

There is no big problem if you understand it as muscles shrinking due to dehydration. That is also correct.

“That’s amazing.”

Amy tilted her head as if she still had some concerns.

“Meningitis?”

“As explained to the patient. Since there is inflammation near the brain, it can’t be good for the body.”

I thought both patients would be fine, but if I had been a little late, it could have been a disaster.

“Let’s check later to see if it’s okay.”

The mystery remains. We will have to find out when the patient regains consciousness. Why did he eat a whole jar of pickles and why did he get meningitis?