episode_0198

Episode 198. A Village for Children (2)

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Idiopathic.

The English medical term ‘idiopathic’ is often translated that way. This is also a type of transcendental translation.

The original text’s tone is closer to ’cause unknown’. The fact that the disease occurred in a special way means that the cause is unknown.

It is also a word that patients hate. There are some patients who ask how the diagnosis can be ‘a disease of unknown cause’.

But what can I do with a diagnosis like that?

‘Idiopathic nephrotic syndrome.’

This is the name of the disease this child has. It is a disease in which kidney function is abnormal due to an unknown cause, and is treated with steroids.

Still, it’s a curable disease, so that’s a good thing.

It is a disease that can cause death if left untreated, but if treated in time, it does not leave any serious consequences.

My advisor called it ‘a disease that’s good for pretending to be a doctor when receiving patients.’

It’s a disease that can be completely cured with just medicine.

To be exact, he said it like this.

-The patient’s guardian brings in a child with a proliferative glomerulonephritis that is not getting better. He bows his head like a sinner and says, “I’m sorry, I’m sorry, but I keep repeating it.”

– But, since diseases like idiopathic nephrotic syndrome can be cured with just medication, you can proudly say, “Oh, you’ll get better if you take the medication.” In fact, children can get better too.

– He said that. He may have expressed it humorously, but it was true. I think you can understand it as the importance of building a relationship of trust with the patient.

I didn’t know that case would come up exactly.

Well, he was a teacher who was famous in the community. As expected, he was a person who was as good at speaking as he was at medicine.

anyway.

I gathered my thoughts and looked up at Gloria. She was frowning with a worried expression.

“The child seems to have a disease called idiopathic nephrotic syndrome. The cause is unknown, but it will get better quickly after a few days of medication.”

“I’m so glad… … .”

Ms. Gloria’s eyes filled with tears.

What my advisor said was true. It was the perfect disease to pretend to be a doctor. I could confidently say that if I just took medicine, I would get better.

“Is this a fatal disease?”

“No.”

I shook my head confidently. If it can be treated, it is absolutely not a fatal disease.

“It’s not a contagious disease, right?”

“Yes.”

It’s just a disease that suddenly appears one day.

“It would be better to stay hospitalized for a few days and eat and stay well than usual. This is because nutrients are continuously being lost through urine.”

“Okay.”

Gloria nodded. I should tell her to eat whatever she wants.

It is a disease that is treated with oral steroids and prednisolone prescriptions. Of course, oral steroid prescriptions are not without side effects.

“This medicine may have some side effects. It has the side effect of causing weight gain.”

“Really?”

A disease caused by steroid use. Called iatrogenic Cushing’s syndrome. Although not a common side effect.

“You don’t have to worry too much because it will go away again if you stop taking the medicine. It’s not dangerous either.”

“How much medicine do you take?”

As little as a few days, as long as a few weeks.

Steroids aren’t a good medicine if you take a lot of them. They can have side effects, like making you more susceptible to infections or gaining weight.

“It will take a few days.”

Teacher Gloria sighed again as if she was relieved. She didn’t show it much, but it seemed like she was having some trouble.

“Finally. If the condition does not improve even after taking medication, other diagnoses should be considered.”

“Yes.”

There are literally hundreds of causes of nephrotic syndrome, or glomerulonephritis. The only condition that fits this description, and that occurs most often in young boys, is idiopathic nephrotic syndrome, but if not… … .

It’s the beginning of a difficult journey, you know.

“I heard that Professor Asterix donated a large sum of money to an orphanage a while ago.”

“Ah.”

I disposed of the gifts and bribes I received at the end of the year at the daycare center. At least I’m glad I used them for a good cause.

“I know it’s nonsense, but I’m worried that we might be indebted to you too much.”

I shook my head.

“There is no such thing.”

I felt a little sorry.

It’s a bit ridiculous. I just took all the presents that were difficult to dispose of to the daycare. The rumors are getting distorted.

An anonymous professor donated a large sum of money, or someone called Daddy-Long-Legs, and things like that.

I wasn’t expecting that.

Istina was at the back of the examination room, diligently writing something down in her notebook. The patient’s guardian greeted her a few times and then stood up.

The child will need to be hospitalized for a few days.

“But. Why is the child sick?”

“I don’t know, what.”

Although idiopathic nephrotic syndrome is said to be related to trauma, infection, or family history, the cause has not been clearly identified.

Even with modern medicine.

It is also questionable whether there is a separate cause for the disease. It is comforting to think that it is a disease that occurs due to bad luck, and it is not a preventable disease.

“Just. It was just bad luck. There is no evidence that it was because of the child’s environment.”

Isn’t this what I was wondering about?

Gloria’s expression seemed to ease slightly when she heard that it wasn’t the environment’s fault.

The situation is over.

At least until the medicine starts working. If it doesn’t, we’ll need to adjust our strategy, but we’ll think about that then.

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This is how to confirm the diagnosis of idiopathic nephrotic syndrome. A test that involves inserting a large needle into the kidney and removing it as if drilling it.

‘It’s not easy.’

It was a very difficult and dangerous test. But I couldn’t help but do a kidney biopsy. There was no other way to confirm kidney disease.

Can you do a kidney biopsy here? Yes, you can. They have anesthesia, a needle, dye, and a microscope, though they’re crude.

It is possible, but… … whether a renal biopsy is of diagnostic value now is another matter.

“Istina. Would you like a kidney biopsy?”

“How do you do that?”

“Put a needle in the kidney.”

“Does the needle go into the kidney?”

“If you put it in your back, it won’t reach your kidneys.”

“That’s terrible… … . I disagree.”

Regardless of the test results, treatment was likely to involve steroids anyway.

There was some merit to the idea of not doing invasive tests. I wanted to show my graduate students a kidney biopsy, but… … .

Because it might be an experience close to torture.

“Do not do a biopsy.”

“Yes.”

Istina scratched her head.

“Professor. The patient’s condition seems stable now. Should we go eat now?”

“Why. Did you run out of money?”

“These days, the price of school cafeteria food has gone up. Sometimes, I wonder if it wouldn’t be good if the professor bought me a meal… … .”

How shameless.

Yes, I’m the one who pays your salary. But I nodded generously anyway. It’s not hard to buy meals for graduate students, after all.

Oh my.

****

Istina returned from her morning appointment to the Academy Library. Professor Asterix had probably gone to see the princess.

Amy looked at today’s medical records. There was a new patient admitted. A young patient who had come in with hematuria.

Playing with children is hard work. Amy scratched her head. Is it because she’s sick that she’s quiet? I don’t know what to expect.

First, follow the instructions.

Care of hospitalized patients. Ask if there is anything uncomfortable every day, and check with your own eyes. It is no different for children.

“Is the hospital okay?”

Amy was in charge of caring for the hospitalized child Chase. Amy stood in front of Chase’s hospital bed, holding a medical record in one hand.

The adult-sized beds looked ridiculously large to a small child. But the beds weren’t allocated to patient sizes.

“Yeah.”

“Not scary?”

“It’s nice because it’s warm.”

It was an unusual reaction. Patients, especially children, are often frightened by the unfamiliar environment of the hospital. Amy tilted her head.

“Hospital?”

“Yeah.”

A word that seemed to have a story. Amy took out a pen and wrote down something special in her medical records.

-They say it’s nice because the hospital is warm.

Is the daycare cold? It may be because it is winter and the daycare center is not properly heated. Or the bedding is insufficient.

It was a bit of a sad story.

“I see.”

Amy looked at her medical records again. It said that she had been in a foster home and that she was suspected of malnutrition due to her medical condition.

“Want some candy?”

“Yeah!”

Amy took all the candy out of her bag and placed it next to the child’s bed. Chase clapped his hands with a look of delight on his face.

“But, Nurse Sister.”

“Not a nurse.”

The boy blinked.

“Can I save this and take it with me? I think my younger siblings might want to eat some candy too… … .”

Amy was silent in regret. She was a kind and strong child, just like in a novel.

“I’ll give you as much candy as you need, so eat as much as you want and I’ll give you some to take with you when you leave the hospital.”

“Really?”

The professor will pay for the candy, it’s nothing special. Amy agreed, and Chase’s expression became happy again.

He was a poor child.

It’s fortunate that there are orphanages to help children, and that there are professors who can save sick children. As they say, it takes a village to raise a child.

It was fortunate that there was someone at the academy who could become a village on his own.