episode_0162

Episode 162. Cat Suin (1)

****

I looked at the patient, who was a cat.

Should I insert a chest tube to drain the blood and air? Should I open the chest and surgically stop the bleeding? How can I survive?

He must have a hole in his lung, making it hard for him to breathe. I wish I could check his oxygen saturation, but it doesn’t seem normal.

The cyanosis hasn’t come yet.

“Patient, open your eyes!”

“Yes?”

“We will now drain the blood that has collected in the patient’s chest cavity. It may hurt a little.”

“Oh, wait a minute.”

I touched the arrow stuck in the patient’s side. It’s important to know what kind of arrow it is. If you just pull it out, blood might spurt out.

“Is this just an arrow? Or did it have a hook-like thing that curved backwards?”

“I don’t know-! Oh no!”

The patient screamed in one word.

“Can’t you not touch that?”

“It’s something that can’t just be left alone.”

“Ouch! This really hurts!”

“Are you coming to your senses?”

I motioned to Amy, and Amy grabbed the patient’s arm. The patient’s injured arm seemed too sore to move, and she was trying to push me away with her other arm.

“Patient. Let me explain.”

“Can’t we stop?”

I told you not to.

“I will now stitch up the wound. The chest tube will be inserted safely after making an incision in another suitable location. Do you understand?”

“Ouch, I get it-”

“Breathe, breathe. Stop talking.”

“Yes.”

After carefully moving the arrow, it did not seem to have a hook. I carefully began to pull out the arrow in question.

Blood began to flow out.

“Please give me some gauze.”

The arrow was pulled out with a crisp sound. Blood began to spurt out, and I turned my head backwards. Now I had to stop the bleeding.

“Patient. We need to stop the bleeding.”

“Yes?”

I took the gauze from Amy and pressed it against the wound. If the bleeding continues, I won’t be able to get stitches. I have to clean up the wound first.

I pressed the wound with gauze.

“Eww! Wait a minute!”

“I’m sorry.”

There’s nothing I can do.

We need to stop the bleeding.

Amy brought some saline solution from somewhere, and we poured it on the wound and wiped away the red blood. I can see it now.

I took out the local anesthetic, lidocaine, and injected a small amount into the side around the wound. Lidocaine also has a blood vessel constricting effect, so the injection may reduce bleeding.

Amy cleaned around the wound again.

“Can you breathe?”

“Maybe?”

“Take a deep breath. Before you put the ball in your mouth.”

“Yes?”

“Take a breath.”

“Yes.”

I looked around the ward.

“Nurse! I need to sew this up right now, please hold the patient!”

I feel like a gangster. They hold patients down all day long, immobilizing them, and repeating procedures that are almost like torture.

Of course, it’s to get better.

It’s true that it looks like that. If a passerby saw it, they would think it was torture.

If you have a hole in your lung, you can’t even scream properly. The patient was still talking in a semi-panic state, but it was hard to understand.

Let’s start with repairs first. I put on sterilized gloves and checked the wound. First, I sewed up the wound in the muscle layer inside the chest wall, and then I started to repair the skin.

Because it can be dangerous if you sew it all at once.

“Wait a minute!”

“Please don’t disturb me.”

You won’t need to insert many needles. The wound made by the arrow is only about 5cm long. You’ll only need to insert a few needles…

“If you keep moving it, it will be sewn crooked.”

finish.

****

The patient is breathing and the wound is almost stitched up. Let’s move on to the next step.

The chest tube needs to be inserted immediately.

We need to get the water out of your lungs quickly so you can breathe properly again. There are painkillers in pill form, but since you’re coughing and bleeding and making a mess right now, let’s give you an IV.

I injected a small amount of propofol into the patient’s arm vein, then cleaned everything up and grabbed the scalpel. I had to find a place to insert the chest tube…

I counted the number of ribs. In the space between the fifth ribs, if I make an incision above the rib, I can insert a chest tube.

Let’s do it quickly.

There’s no benefit to wasting time.

I took the knife, made a cut in the lower part of the chest cavity, and inserted a pre-sterilized rubber tube into the chest cavity. As if a faucet had been opened, a reddish-brown liquid flowed out of the chest cavity.

After I confirmed that the chest tube was properly inserted, I sutured the flesh around the tube with silk thread to correct it. Fortunately, the patient was on the thin side.

So far, everything has gone smoothly.

If the patient is obese, simply inserting a chest tube can be a major surgery because it has to go deep. There is a difference between inserting a chest tube 4 cm deep and inserting a chest tube 8 cm deep.

I shook the patient again and woke him up.

“Can you breathe now?”

The patient did not answer. He was still breathing, but stared into space without blinking.

****

What the heck, this is. It’s true that propofol can cause a decrease in consciousness, but I didn’t think it would be to this extent.

For a moment I thought I was dead.

I thought I only used a little bit for pain control. I wondered for a moment whether the internal circuitry was different for cats.

Something is really strange.

We put the patient back in bed.

I figured out the cause of my discomfort.

“Ah. Why aren’t you blinking, patient?”

“I don’t know.”

“Since when has it been like this?”

“I don’t know. It was fine before.”

Is it because of propofol?

It’s obvious that it’s because of propofol.

Fluid continued to drip from the thoracic duct.

“Let’s just watch the situation for a few minutes. Please check carefully to see if the patient is breathing and has a stable pulse.”

I’m nervous. I took the patient’s pulse again. Propofol is not a drug that causes hemodynamic instability. The pulse is normal.

I turned my head to Amy.

“You were blinking earlier, right?”

“Yes.”

“Let’s take care to keep the cornea from drying out.”

I soaked a clean gauze in saline solution and wetted the eyes of the cat patient with it. If you do that, the cornea will dry out, which is a big problem.

****

It took me some time to figure out the situation.

Cats are different from people.

Cats have a faster metabolism than humans and blink less often. I’ve never studied cats, so I can’t say for sure.

So the reaction to propofol was different. If we assume that this patient has some of the characteristics of a cat, this patient had a faster and more intense reaction to the drug.

We carefully moistened the patient’s eyes with wet gauze. I hope the cornea didn’t dry out?

I almost got into trouble.

Don’t cats blink?

I looked at Amy.

“My hypothesis is this.”

“What is it?”

“Cats don’t blink, right? Cats don’t blink as much as people. Frozen, too.”

“That could be the case… … .”

I’m not sure.

It’s my first time seeing a cat.

I kept wetting the patient’s eyes with the soaked gauze. Humans don’t stop blinking completely just because they’ve been given some anesthesia.

It’s possible to forcefully wake him up with an opioid antagonist like naloxone, but I didn’t see any reason to do that. It didn’t seem like there was anything wrong.

****

The nurses cleared the blood-stained bed sheets, and Amy and I moved the patient to the upper bed in the examination room. It was quite difficult.

It took three people just to move the patient to the examination room. One to hold the feet, one to hold the head, and one to hold the water bottle connected to the chest tube.

Still, after some struggle, she succeeded. Amy sat the patient down on the bed next to the examination room and held him there to keep him from falling.

“Are you breathing?”

“Yes.”

About 10 minutes passed like that.

“Uh.”

The patient opened his eyes.

To be precise, he closed his eyes properly. Anyway, that meant he had come to his senses for this patient. Anyway, the patient woke up.

“Are you feeling better?”

The patient pricked up his ears and removed the damp eye patch that had been placed over his eyes. I wondered when he would wake up. Fortunately, it was resolved quickly.

“Where is this?”

“Clinic.”

“What about the arrow?”

The patient tried to get up, but Amy stopped him from doing so. He had a rubber tube in his side. He would have to carry a drain to walk around.

“Hey, don’t move. I have a chest tube in right now, and they’re draining blood from your lungs.”

“What is a wet eye patch?”

“I put it there so that your eyes wouldn’t dry out.”

“Aha.”

As I watched the cat’s ears flapping between its hair, I could tell it was a cat and not a human.

“The arrow was removed from the patient’s side, and the wound it left was stitched up.”

“Yes.”

“However, there was no way to fix the remaining wound on the lung itself, so I just left it alone. It seems like it will take a long time to heal.”

The patient nodded.

“We have just passed the critical point. There are still many areas where problems can arise… … . It looks like you will need to be hospitalized for at least a week.”

The cat with an anxious expression twitched its ears above the patient’s head, as if watching to see if there were any footsteps nearby.

The arrow hit somehow, though.