episode_0187

Episode 187. The Secret of the Imperial Family (3)

****

“Please help me.”

Violet came to the royal lounge where I was sitting. There was no way Violet would have come out on her own to find work.

“Why?”

“A patient came in.”

“To the infirmary?”

Violet nodded.

I was a bit worried. Should I help you?

“Why me? It’s your job.”

“The patient is a father of three children. It depends on how much the professor trusts me.”

I don’t believe it, unfortunately.

Honestly, I didn’t really want to help Violet, but I had to go because I felt bad for the patient who entrusted her life to that human.

I sighed.

“What kind of patient is this?”

“A male patient with sudden onset of jaundice, fever, and pain. The whites of his eyes are yellow.”

The whites of your eyes are yellow?

Usually, when there is a problem with the liver, the eyes become yellow. This yellow pigment is deposited when there is a problem with the process of breaking down bilirubin.

“It’s a problem.”

“gan… … . I guess so.”

Of course, there may be a problem other than a liver problem, such as a hemolytic disease.

It’s most likely a liver problem.

Let’s make a diagnostic plan.

“Are you sure your liver hurts?”

“The professor said that too, right?”

“Um… … . That kind of thing. When I tried to stimulate it, it hurt when I touched the area near the liver. The liver felt hard, and there was ascites.”

Violet tilted her head.

Well, it’s hard to expect too much from someone like Violet. It’s fortunate that she’s properly organized her military records.

“Then. Let’s go see the patient.”

“Yes.”

I looked over my medical records again.

A patient who spends most of the day sitting down. Since a proper abdominal examination has not been performed yet, there may be ascites, cirrhosis, or enlargement of the liver.

Liver disease is often chronic.

The patient said that the illness came on suddenly. Was it a chronic disease that had passed the critical point, or an acute disease?

You’ll know when you see it.

“You have a fever and chills. Could it be a systemic infection? I gave you some fever-reducing medicine and painkillers.”

“Well done.”

I guess I’ll have to wait and see, I guess. I got up from my seat. If this was a patient who was going to die right away, they wouldn’t have waited for me to come, right?

I hope nothing happens.

****

Now let’s get started. I walked into the infirmary with Violet. The patient was sitting on the bed, quietly reading a book.

“I will do an abdominal examination.”

“Ah. Are you Professor Asterix?”

I nodded.

The patient put down the book and lay down on the mat. I disinfected my hands and examined the patient’s abdomen with my eyes. There was nothing unusual.

My stomach is a little bloated, but is it ascites or just fat?

Fluid in the abdomen is a pretty serious condition. Ascites often occurs in patients with cirrhosis. When I pressed on it, it just felt like belly fat.

“Since when has patient distribution been like this?”

“Just killing.”

Let’s move on.

I started to stimulate the liver.

There is a liver under the right rib cage. I tapped the area where the liver should be with my fingertips.

“Ugh.”

“Does it hurt?”

“Yes.”

There were still tests to be done. I continued to tap along the shape of the liver and listened for sounds, and the patient complained of pain.

“That hurts.”

“Yes, it will be over soon.”

There’s still a long way to go.

This time, I pressed hard on the patient’s abdomen. The patient complained of pain this time too, but I had to finish the examination.

Finally, the rebound pressure.

If pressure pain is pain that occurs when the body is pressed, rebound pain is pain that occurs when the pressure is removed. They may seem similar, but they are different.

Rebound tenderness is a finding of peritonitis. Fortunately, this patient did not appear to have rebound tenderness.

I looked at Violet.

“I don’t see any liver cirrhosis, hepatomegaly, or ascites. It looks like some kind of acute hepatitis, so I’ll think about the treatment a little more.”

“Is this a fatal disease?”

“I don’t know.”

It wasn’t something you could tell just by looking at it. Liver disease is often a serious illness, and it can leave behind chronic conditions that don’t go away.

It’s too early to jump to conclusions.

****

Prometheus, the god in Greek mythology, brought fire to mankind and was punished by having his liver eaten by eagles for eternity.

There is some controversy as to the exact reason.

Some say that the Greeks did this because they greatly admired the liver’s regenerative abilities.

Some say that bile produced from the liver symbolizes anger among the four humors.

People usually know it as electron.

“So. What’s next?”

“I’ll wait a few more days.”

If it’s viral hepatitis, you won’t die, if it’s liver cancer, there’s nothing the royal family can do, and it could be bacterial hepatitis.

I hope it doesn’t require surgical intervention, because if there’s an abscess, it may need to be drained with surgery or a needle.

Violet was sitting across from her desk, listing possible treatments to try in the infirmary.

“It needs to be resolved internally. Change the wet towel to lower the fever, and since alcohol damages the liver, give medicine with the opposite properties-”

I nodded. I need to think about what medicine to use and how to use it… … .

There are too many possible causes.

“Oh, doctor!”

A nurse from the infirmary came running.

Since there was only one patient in the infirmary right now, it was obvious why we had come in such a hurry. We rushed back to Mr. Aldenburg’s room.

****

The patient was lying on the floor in the hospital room.

The patient was only half conscious, and the nurses were trying to put him on the bed.

Ah. Now I know what the disease is.

He is not responding to the words.

Respiratory rate was 25 per minute, pulse seemed to be over 150 per minute, and body temperature had risen noticeably within a few minutes.

The skin is red.

“Let’s go straight to the operating room.”

“Oh, yes.”

Violet turned her head towards me.

“What kind of disease is it?”

“There is only one possible thing. Septic shock due to a ruptured liver cyst or abscess. You need surgery. If you leave it like this, you will die.”

“Okay.”

“I was lucky. It happened when I was there.”

After the stimulation, the stomach continued to hurt, so I tried to stretch and it may have burst. If it is not treated right away, it may develop into peritonitis.

The surgical preparations were completed in a hurry.

The patient was quickly moved to the operating table, and the surgical instruments were prepared almost immediately.

I would like to avoid death during surgery.

If you leave it alone, you will die one way or another.

“Go and get me some boiled water with 1% salt. About three sterilized buckets.”

“Yes.”

We disinfected the patient’s abdominal skin with an antiseptic. The patient was mumbling something, but since he had already taken opium, he did not scream or anything.

A mask attached to a ventilator was placed over the patient’s face. It is a type of respirator.

There’s no oxygen, and it takes one person to operate it by hand. But it’s better than nothing. It looks like general anesthesia is needed.

Lidocaine, propofol, and ketamine.

Ketamine is a powerful drug, but it is an unusual general anesthetic in that it causes anesthesia without blocking breathing.

With that combination of ketamine and fentanyl, we finally created something that resembles general anesthesia. It even has a pulse and respiratory rate monitor.

Even though there was only one nurse reading my pulse every ten seconds, I was secretly satisfied.

Finally, an operating room has been created in this world.

****

It was me and Violet holding the knife. One nurse was using the ventilator, and another was counting the pulse. A Ringer’s IV was being injected into the arm.

Masks, gowns, gloves.

I disinfected everything-

I picked up a knife.

The biggest surgery I’ve ever done in the world. I put the knife where the liver should be and started cutting open the stomach. The skin and fat layers were torn apart.

The next step is the muscle layer. There are organs inside this, so you have to be especially careful with the knife.

I held the scalpel sharply and very gently, slowly moved the tip of the knife to open the muscle layer.

You have to open it almost an inch.

“Traction device.”

A metal device to pull the peritoneum. Three are needed due to the size of the incision. Three nurses were assigned just to pull the peritoneum.

“Hey, don’t touch my liver.”

It was a funny sight when seen from a distance.

There was that scene in Snowpiercer, where they couldn’t make parts for the train, so they had people hold onto it and turn it. It felt a bit like that.

Finally, the liver was revealed. I used tweezers to clean up the connective tissue around the liver, and poured saline solution to remove the surrounding blood.

“Ms. Violet. Can you see it?”

“Oh, yes.”

“Like that. It seems like the problem was caused by inflammatory substances leaking out of this liver abscess.”

The abscess burst while moving, spilling out its contents. This caused septic shock and a systemic inflammatory response.

You’ll get peritonitis if you don’t open it right away.

I put a knife into the abscess.

The abscess is starting to leak. It might rot inside again, so I’m going to open it up. I don’t want the abscess to pool inside again.

“Saline solution.”

Three nurses holding the traction device, one counting the pulse, one turning the ventilator, and an assistant.

We started to wash the wound with saline solution. It would be good if we could just get rid of the abscess… … .