episode_0150

Episode 150. Appendicitis (2)

****

Early morning. But the hospital wasn’t empty even early in the morning. People don’t come to the hospital at a set time when they’re sick.

Istina rubbed her sleepy eyes as she went to the ward. Since the ward had to be guarded day and night, shift work was a matter of survival.

Still, it was a shame to miss the opportunity to observe the surgery. Istina looked at the medical records.

-When pressing the abdomen with a finger, there is tenderness and rebound tenderness at the point where the appendix is located.

– The appendix appeared to be inflamed, so it was removed. Inflammation was confirmed in the removed appendix.

What on earth happened?

So, you’re saying that part of the colon was surgically removed from this patient. Does that make sense? I guess they did it because it was possible, but…

The more I thought about it, the more amazing it became.

-Using antibiotics.

-Discharged as soon as recovery from surgery.

The operation that Professor Asterix performed yesterday may have been the first appendectomy performed on a living patient. It is not known whether it is truly the first, but it is the first reported to Imperial academia.

Moreover, this time, it was a surgery that other healers could follow if they tried. Find the point where the thirds are divided and cut open with a knife, and the appendix would be removed.

Maybe so.

I didn’t observe the surgery.

All Istina can see is blood clots, so how does she find the right place to put her knife between the organs? If she puts it in the wrong place, the person dies.

Istina stood in front of the patient, holding the medical records carefully. The patient was lying still, holding his stomach and looking up at the ceiling.

“Please tell me the patient’s name.”

“Simon.”

“Hello. Are you feeling better? Do you remember what kind of surgery you had?”

The patient shook his head as if to ask what was going on. Istina tilted her head.

“I did it while I was sleeping.”

“Ah. You don’t remember at all?”

It seems different every time.

While some people scream and curse throughout the surgery even after being given a lot of medication, there are also people who just go through the surgery as if they were sleeping soundly.

“Yes.”

“Okay, let me take a look at the surgical site.”

Well, I don’t think he would have had the surgery while sober. He would have taken opium, alcohol, or some other drug to make himself feel a little better.

Istina lifted the hospital gown to examine the wound. The wound was covered with gauze and bandages, and when the gauze was removed, the surgical incision line was revealed.

An incision line about one span long.

I don’t know about anything else, but the stitches that sewed up the wound were so clean that it was scary. Istina touched the area around the wound with a sterilized stick.

“Does it hurt when you press it?”

“A little.”

The patient’s speech was brief.

Istina thought for a moment. If her stomach hurts, it might be difficult to talk. If she had a keen eye, she would have seen that the patient was lying on his right side.

The surgical site is on the right side. The surgical site is pulled and causes pain, so the asymmetrical pain leads to an asymmetrical posture.

Istina pressed the wound again.

Even if I pressed a little, the wound did not open.

If you open this branch and go in, the appendix will be right there. So, the incision will be made and the surgery will be over right away, without any complications.

When I think about it, it was scary. There are quite a few people who die from sudden, severe abdominal pain. Could it be that they all have this disease? The treatment is to cut open the stomach and remove the appendix?

Istina looked at the surgical site again.

If it was complicated, it was complicated, and if it was simple, it was simple. All you had to do was open the spot the professor called the McBurney point with a knife and go into the abdominal cavity.

“It seems to be going well. Are you feeling any pain?”

“My butt hurts.”

“That’s how it is.”

Istina wrote down the patient’s information in the medical records. There was nothing special to record. The surgical site was sore, and he didn’t talk much.

Oh, right. Istina thought back to the questionnaire Professor Asterix had written down for her. What questions did she need to ask?

“Did you urinate normally?”

“Yes.”

“How many times?”

“Twice today.”

It was still morning, so twice was not too little. Istina nodded. She wrote down everything she needed. All she had to do was finish it.

“Oh, thank you for your hard work. If your symptoms change or you feel more sick, please let me know right away.”

Istina left the hospital room, holding the medical records and leaving the patient lying still behind.

****

I sat quietly in my lab. A surgical patient came in, but he was young and seemed to recover quickly.

Istina came into the lab.

There was a faint smell of bread around. As soon as Istina entered the lab, she hung up her gown and placed a bag of cookies on my desk.

“Hello.”

“I heard you had a new patient operated on yesterday? While I was away. I came to see you this morning because I was curious about what kind of surgery you had and what kind of patient you had.”

Istina wasn’t there at the time. I thought it would be nice to show the appendectomy, but I couldn’t call Istina.

“Well done. How was it?”

“Just be well.”

“What did you check?”

Istina lowered her head and looked at the medical records she had written. I waited for a moment.

“After the surgery, I asked the patient whether he or she had urinated, whether there was any inflammation around the surgical site, and whether it was painful when pressed.”

Of course… … . It would hurt if you pressed on the surgical site. But it was a good idea to check. To see if there was any inflammation, if the stitches were done incorrectly, or if there was any blood clots.

“It doesn’t hurt when you press on the surgical site.”

“Based on my inspection, there doesn’t seem to be any problem near the surgical site.”

I nodded.

“Still, you did well. Since he’s a young patient, I think he’ll recover quickly. I’ll go and check on him later.”

“Yes.”

Istina put her medical records down on the desk in her lab. She started eating the cookies she had bought.

“But, Professor. Is appendicitis a common disease or a rare disease? I’ve seen a lot of people die from sudden stomach pains.”

I don’t know if it’s a common disease, but it’s something we see quite often, especially in emergency rooms.

“Common? There are a few other diagnoses that can cause similar symptoms. If you press the McBurney point and say that it hurts the most, it’s more likely to be appendicitis.”

Istina diligently wrote down what I had said. With a very serious expression on her face.

“Is there no treatment other than surgery?”

“Well, antibiotic treatment might be better than just surgery. There are quite a few people who get better from appendicitis with antibiotic treatment.”

“Then why do you have surgery?”

Istina tilted her head at these words.

That’s a good question.

“The colon is basically where the stool is. No matter how much medicine you use, there is no way there will be no bacteria, right? No matter how strong the antibiotics are.”

“Oh, now that I think about it, that makes sense.”

“There is no guarantee that antibiotics will work. There can’t be no bacteria in the colon. It might work, it might not.”

The best treatment for appendicitis is surgery.

If the infected appendix bursts, the patient’s condition can spread to uncontrollable peritonitis, so it is best to have surgery as soon as possible.

Istina scratched her head.

“But how did you know this, Professor? If it were me, I wouldn’t have thought of cutting open the stomach and cutting out the appendix.”

I wonder why he first thought of removing his appendix. I don’t know his exact thought process, but he did feel like removing it.

The appendix looks like a tail sticking out of the end of a long balloon. The developmental principles of the large intestine are not much different.

“Hmm. It looks like you want to cut it off?”

“That’s right.”

My graduate student put down the medical records he was looking at, sat down comfortably, and sipped his tea.

“That’s difficult. I never thought I’d be able to survive with part of my organs removed?”

“The gastrointestinal tract is a bit less important. The large intestine is almost as long as an arm, so it’s okay to cut it off.”

****

Istina sat with her legs crossed. The Academy’s daily newspaper was spread out on the desk.

“That’s right, Professor. I saw it in the paper a few days ago. I guess they’re finally introducing the medicine we made in our lab?”

“Where?”

“I saw it in the newspaper. There was a plague going on in the north. They sent medicine packages on dog sleds to every village. Thousands of lives were saved thanks to that.”

“Oh.”

It seemed like Violet had mentioned it too.

In late fall, in the north it is now winter, so if there is pneumonia that spreads like an epidemic in winter, it is likely pneumococcus. It is a disease that requires antibiotic treatment.

Aspirin would have helped with symptoms like fever and cough. No, Violet. Tell me more before you go. It was worse than I thought.

“Thank goodness.”

****

Dalgrak. The sword on the knight’s waist made a metallic sound every time the soldier’s hand moved. The priest of the temple was blocking the soldier.

“You are not allowed to enter the ward with a weapon. Please return when the patient is better.”

“A headless body was found in the house of that family. Even if you don’t arrest them right away, can’t you ask them questions?”

“Contact is prohibited due to the possibility of an epidemic. I will ask the higher-ups.”