Chapter 47: Intravenous Fluid [3]
Chapter 47: Intravenous Fluid [3]
“That patient was Dr. Jémel’s?”
“Yes.”
“Hmm… he’s probably going to make a huge fuss. Did you contact the family?”
“No. We don’t even know this patient’s name.”
“Ah.”
Once the situation was roughly sorted out, Blundell came over and asked.
I did not know whether it was because Dr. Robert Liston had asked him to look after us while he was away, or because he had been impressed by the abilities I had shown so far, but either way, he was taking things seriously and looking after us well.
“Then for now, let’s admit him under my name. They won’t know anyway.”
“Yes.”
It was not as if there were any computers, nor was there anything properly organized.
Everything was managed on paper, and even that had no real system, so it was a complete mess.
They said more than ten patients a month ran off without paying, and no one even thought of trying to catch them.
So if we admitted the patient to a ward that Jémel did not frequent, there would not really be any need to keep people quiet about it, either.
“The problem is… this patient still has a very high chance of dying.”
Blundell was still looking down at the pale patient.
Compared with when we had first taken him out of the coffin, his complexion had improved.
But no matter how active hematopoiesis became… he had still lost a great deal of blood.
Since we had not replaced the blood itself, there was no way to describe the patient’s condition as good, even as an empty courtesy.
His pulse is fast too… Blundell’s right. But how does he know that this well?
Instead of merely looking down at the patient, I was checking his radial artery.
Earlier, the pulse had been so weak that it was hard to feel at the wrist, but now it was at least strong enough to measure.
One hundred twenty… if it’s this bad even at rest… then his circulating volume is still clearly insufficient. Damn it, and since I can’t tell whether this is getting worse because the infection is progressing or not…
Fever?
There was none to be had even if I wanted one badly enough to die for it.
In fact, his body temperature was rather lower than normal.
That did not mean I could conclude there was no infection, though.
Fever was, after all, ultimately a defense mechanism our body used to fight viruses or bacteria.
There was no way he had any strength left for that.
Still, I have to give him more.
I looked at the central venous catheter I had already improvised and blocked off.
Calling it a catheter was generous. A needle was still stuck in there.
It was thick enough that it might as well have been called a knife, so someone had to stay beside him and keep watch.
Even if the patient regained consciousness, he would not be in a proper state, and if he started thrashing that thing around carelessly, I could save him only for it to kill him afterward.
That absolutely could not happen.
“One moment.”
With that thought in mind, I had just picked up the water I had boiled and distilled in advance when Blundell called out to me.
I turned to see what it was, and Blundell was staring at the fluid.
It was so crude that I was not sure it even deserved to be called an IV fluid, but still… he was looking at it.
“That there.”
“Ah, yes.”
“Were you perhaps thinking of putting that in instead of blood?”
Then he asked a question that seemed completely obvious by my standards, yet was rather advanced considering this was the nineteenth century.
“Uh… yes.”
I could only nod helplessly, and Blundell immediately looked moved.
“I see, so such a method… Huh. Then this… hmm. But doesn’t that cause a problem? If water is circulating together with the blood in the vessels where only blood ought to flow?”
And then he kept asking questions, and it really seemed like he had spent a long time thinking about this issue.
He seemed to know something?
Not exactly know, but…
Yes, that was not a question that would come easily.
“Hmm… well. Since we can’t give blood right away… I thought I’d try giving water first.”
“You don’t seem like the sort to do something like this without thinking it through. Didn’t you have some reason?”
Blundell’s face was serious.
So was mine.
For different reasons.
By then, I had already set the funnel in place and was slowly pouring water into the patient’s central venous catheter.
It could not go in too quickly.
There was no reason for it to.
We had already made it past the first crisis.
“As for the reason… my thinking was this.”
In the middle of all that, having Blundell beside me was, in a way, fortunate.
The whole thing was very likely to be rather thankless, and what surgeon would enjoy becoming one only to spend his time pouring water into someone?
And not only that, I had to regulate the entire difficult process of pouring it in slowly, and do all of it myself.
It was obviously going to become a tedious and painful stretch of time, but talking with Blundell made the burden feel somewhat lighter.
“Blood is, after all, a liquid, isn’t it?”
“That’s true.”
“And water is a liquid too.”
“That’s true.”
“So if the two mix, then even if it’s diluted blood, couldn’t it still be considered blood?”
“But aren’t there liquids in the world that don’t mix very well, like water and oil?”
“Ah.”
I needed to change what I was saying.
So no, he was not necessarily lightening my burden.
He probably had not meant to, but something about that comment had abruptly lodged in my throat.
Ha…
Water and oil, really.
Then was blood oil… no, though if you thought about it, there really was fat in blood.
Terms like hyperlipidemia existed for a reason.
“When blood spills, there are times we wash it with water, aren’t there? I’ve seen it then. The two mix immediately.”
“Aha. So that was your basis. I see, that was your line of thought… instead of replenishing the missing blood… hmm.”
I could not very well tell him the real explanation, so I worked my brain a bit and gave him an incomplete answer.
Even so, Blundell still looked impressed.
Even if it was truth in a somewhat diluted form, truth was still truth.
To a scientist whose profession was to pursue truth, even a fragment of twenty-first-century knowledge would have seemed almost mystical.
“But how much water have you put in?”
“Ah…”
That question was also an excellent one.
Maybe it was just an ordinary question, but still.
How much fluid had gone in? That was something people asked constantly even in twenty-first-century university hospitals, wasn’t it?
You had to replace what had gone out.
In other words, you had to balance input and output.
That was a truly important concept.
“About two liters. Once this finishes going in… it’ll be three liters.”
“Three liters.”
People had figured out how much blood was in the human body rather earlier than one might think.
It was not difficult, after all.
Even in the anatomy lab, drawing blood was something done all the time.
Not because of dissection itself.
Ever since ancient times, humanity had slaughtered animals, and people knew very well that removing blood delayed putrefaction.
“No matter how much blood this patient lost, I don’t think he lost three liters… so wouldn’t that be wrong?”
Oh.
Today this man kept surprising me.
He actually understood the concept that you should give back what had been lost?
Or maybe not?
Was this simply what anyone capable of thinking should naturally arrive at?
No, that’s not it…
I thought of Joseph and Alfred and shook my head.
Even though they had been too flustered from digging up the body, neither of them had asked a question like that.
They were not even here now.
They had gone home because they were tired.
Those bastards…
Just look at Blundell, clearly in his late thirties, sitting here rubbing his sleepy eyes and keeping watch.
“Hmm… but if the concentration has been diluted, then maybe it can’t be helped?”
“Wouldn’t diluting it further make things worse?”
“But… hmm. This is only my personal thought.”
Would it be too arrogant to say I found Blundell admirable?
Thinking it was not, I continued.
A man like this deserved to know more.
And this man Blundell is in obstetrics, at that.
It was not as though pregnant women died only from infection.
Of course not.
Humans were animals with large heads, so maternal mortality had always been higher than in other species.
And if the baby was not turned properly, then that was almost certainly death.
The thing that solved that was the caesarean section, but that surgery had not yet become widespread.
Anesthesia had only just become possible. How could it already be widespread?
How many people must have died from bleeding?
Come to think of it, it was no coincidence that Blundell had worried and worried over this problem.
An obstetrician was bound to be exposed to massive bleeding, no matter what.
The placenta was practically a lump of blood.
Massive hemorrhage could occur from problems like placenta previa and other complications.
There were no transfusions in this era, and severely injured patients did not always make it to the hospital, so perhaps Blundell had seen more patients die from bleeding in the hospital than anyone else.
“When we first found the patient earlier, his pulse was impossible to feel.”
“Pulse? Ah, this? You mean this?”
“In the end… what is a pulse?”
“Hmm.”
I had no intention of teaching him the whole concept of blood pressure right then and there.
That was not really possible, and it might even have been dangerous.
I only meant to give him some kind of clue.
“I thought about it.”
“Yes, and what did you think?”
“When blood moves through the vessel, isn’t it striking the vessel wall, thump thump?”
“Striking the wall?”
“Yes. It only beats in the arteries, doesn’t it? Think of the arteries in the anatomy lab. Aren’t their walls thicker? Would God really have made them that way for no reason? Isn’t it because blood keeps striking them?”
Of course, while explaining, I worked hard to demonstrate my burning faith here and there.
I did not know whether that helped or not, but in any case, Blundell listened carefully.
“Hmmm… striking… yes. Well, one could think of it that way.”
“So if it’s hard to feel that beating… couldn’t that also mean there isn’t enough blood?”
“That’s true.”
“But how is it now? You can feel it, right?”
“Hm. Yes, because you replenished it. But still, it’s weak… Ah. Then does that mean you can give more? That’s strange. Why does it work like this?”
Blundell looked genuinely confused.
Which made perfect sense.
How could he possibly understand the complex structure of blood vessels?
That would not become clear until microscopic anatomy had advanced much further.
He was probably imagining water flowing through a copper pipe.
How could he possibly imagine that the water we were giving was crossing into the body by osmotic pressure?
It was not because Blundell was lacking. It was simply the limit of the age.
Science in this era was underdeveloped overall, and the fields were all boxed off from each other, so no integrated progress could really happen.
“I don’t know that part, but… in any case, shouldn’t this pulse at least become strong enough that it’s not too weak, even if it doesn’t quite match someone who isn’t sick?”
“Yes, it should. Hmm. What you’re saying makes a great deal of sense. Hmm. If only we could apply this… to our patients. Hmm.”
Blundell nodded again and again.
In the meantime, I finished pouring in the remaining water and then covered the area around the needle with dough paste.
It was nowhere near a sterile dressing, but now that his blood pressure was slowly starting to recover, if I simply left it there, blood would start leaking steadily from the hole.
At the same time, I could not pull it out and then stick it in again every time I needed to give him water.
That was out of the question.
“Then I’ll stay with this patient through the night.”
“Alone?”
“Yes.”
“That won’t do. I’ll keep watch as well. If anything comes to mind, let’s discuss it the way we just did. I’m not just saying that lightly—I genuinely feel as though something I’ve been puzzling over for years has just begun to resolve.”