Episode 52: Blood Transfusion [2]
Episode 52: Blood Transfusion [2]
Isn’t it true that if you just keep at something, you’ll eventually make it work? That was how it felt when I started making Distilled Water. It took less time, and it looked cleaner. It also didn’t involve anything as ridiculous as sticking a finger into anything.
Hmm…
Anyway, I approached the patient with the Distilled Water I had managed to prepare. Although I moved as quickly as I could, around twenty minutes had passed, and during that time, the patient’s condition had deteriorated significantly. It would have helped to measure her Blood Pressure, but that wasn’t possible, so I couldn’t make an objective assessment. So when I say she looked unwell, I mean she looked really unwell. It might sound like a layman’s description, but based on my experience, it was accurate enough.
Can she make it?
Even with a proper Blood Transfusion, it would have taken several full packs of blood. In modern terms, one unit of whole blood was 320 mL, which meant she would have needed at least a liter. But what we had given her so far was maybe 100 mL, and even that was a random mix from multiple people. At this point, that wasn’t blood. It was poison.
Hooked.
I inserted a fresh needle instead of reusing the old one. I’m not sure how they managed to find it earlier, but they inserted the previous needle into a superficial vein near the wrist. Worse, the needle was relatively narrow. Given how crudely everything was made, it was probably no more than 21-gauge at best.
Was there even any blood going in?
Modern transfusion standards used 18-gauge needles, and ideally 16-gauge, so the fact that they used something so narrow made me suspect that only plasma entered, not whole blood. Of course, antibodies still entered the bloodstream, which meant complications were inevitable. But perhaps fewer red blood cells meant the reaction would be less severe?
“Hmm. Should I set another line?”
After watching me poke the new vein, Blundell asked without a hint of reproach. He now seemed to view me as a colleague. Perhaps not in obstetrics, but certainly as someone to take seriously when doing something new.
“I think… if it’s not enough, we’ll need more blood. It’s still slowly infusing here.”
“Ah… But what if the blood and water mix?”
“It’s going to mix inside the body anyway. There’s no need to do it externally.”
“Yes, you’re right. Better to be cautious. You’re very thoughtful.”
There was a scientific reason, but I wasn’t at Liston’s level, where I could just state things confidently. Still, I couldn’t stay quiet either, so I made a mental note to explain it to the kids later, perhaps using a more digestible metaphor.
Blood Pressure has dropped… Wait, they don’t even know what Blood Pressure is. In a situation where there’s too little blood in the vessels, it’s dangerous to access peripheral veins. If you want to give a large volume of fluid, you need to access a major vein.
What I secured was the Jugular Vein. The subclavian vein might have been easier from the patient’s standpoint, but without a blood pressure cuff or even the ability to detect a pulse, finding a deeper vein was nearly impossible. I could have made a small incision to access it, but that might have been… misunderstood. But hey, I’m pretty good at this, right?
And it’s better for blood to go where it’s supposed to. With clotting like that, the needle is probably blocked too.
In this era, when a needle clogged, the medical staff would just push harder. Which meant the clot would go directly into a vein.
Sigh.
Just imagining it made me groan. They say ignorance isn’t a sin, but honestly? It felt like one. These people thought they were helping, but they were just killing.
Growl.
And here I was, still pouring water despite all this. I really was the only one trying to save lives. I felt tears of frustration coming. Then Joseph spoke up.
“Uh… I think the patient moved a little?”
“Huh? Really?”
The guy had actually been watching the patient closely. And yes, she was stirring, slowly regaining consciousness. This was a critical moment. The Jugular Vein was easy to access and infused well, but if the patient moved too much, things could turn dangerous fast.
“Hold her.”
“Uh, uh, okay.”
Together with Alfred, I pressed her forehead and shoulders down. She had lost a lot of blood, and her nutrition wasn’t great to begin with, so restraining her wasn’t difficult. In fact, it was so easy I felt a little awkward.
“Eugh…”
With time, I might have been able to tell if she was really in pain just by her expression. But honestly, it didn’t feel like she was resisting out of fear or panic. Her shoulders were thin. Too thin.
I mean… is this really surprising?
People died from infections here all the time. Maybe what some of them really needed more than medicine was just food, meat, soup, nutrition.
I wish I could use the money from selling condoms to buy them soup.
Of course, I had my own problems right now. What use was soup when I was stuck in this place?
“Eugh…”
Despite everything, the patient blinked in pain. Her stomach?
Based on common sense, that seemed likely. But—
“How is the patient?”
“Patient, this is Dr. Blundell. How do you feel?”
I prompted her to answer, but her first response was to Blundell’s voice. Naturally. People reacted better to voices they recognized.
“Ah… My stomach…”
“Yes, you had a baby. You may feel some abdominal pain.”
“But… why does my back hurt so much?”
“Your back?”
“Yes, here…”
I leaned back and watched the exchange. Her expression didn’t look good. She was pointing toward her lower back. It hurt enough that her hands trembled.
“Why does my back hurt? And I have a bit of a fever. Did someone not wash their hands? No, it’s not that. A fever shouldn’t come on this quickly.”
Blundell placed a hand on her forehead and frowned. Even he knew it took time for a fever to set in after an infection.
“Ugh, uweeek.”
Then she vomited. Blundell’s face grew darker. He clearly didn’t understand what was happening.
“Uhm… Should I give her more blood?”
That was my cue to jump in.
“No, let’s just keep giving water for now. Drawing more blood would be extremely difficult. Besides, she’s more conscious than before.”
“Uhm… No, I think more blood is necessary.”
“No, just… a little water for now.”
What was I supposed to do? Just then, someone entered and called out.
“Professor Blundell, we’ve got another woman about to give birth!”
“Ah, all right. I’ll be back later.”
What a relief. If removing a dangerous doctor from the room was a kind of salvation, then that guy was my savior. I watched Blundell leave and turned back to the patient. She trembled, gesturing toward her lower abdomen and back. Occasionally, she pointed toward the injection site in her arm, but that couldn’t be helped. We needed several people to hold her down. Anyway, her symptoms could be summed up like this:
Chills from fever, abdominal pain, back pain… and this… this is textbook.
There was probably hematuria, though I couldn’t confirm it due to all the blood loss. If I had a catheter, I could have checked, but I didn’t have the materials to make one. I only had iron, and I wasn’t going to make a catheter from that. Then again, maybe I could have…
There are people here who wouldn’t even think twice about using an iron tube.
The horrifying part was that they knew the structure of the bladder well enough to try.
Yikes.
I shivered at the thought. If I asked, they might really go fetch something out of a torture chamber.
But I knew what her symptoms meant.
Acute hemolytic transfusion reaction.
In modern medicine, it was mostly a cautionary tale, something you studied to avoid. It happened when incompatible blood types were transfused. It was a textbook medical error. Even militaries engraved blood types on dog tags just to prevent this kind of mistake.
“I’ll pour more water. Joseph, make another batch.”
“Huh? Will water help? Don’t we need more blood?”
“No, water first. Let’s do what we can.”
“Uh…”
“Oh, and if I ask you to do something, will you do it?”
“Uh, okay.”
Treatment? There was no treatment. All I could do was pour more water. In a modern setting, I’d give a diuretic to flush things out, but not only were there no diuretics here, even if there were, giving one now would be murder. After all, we gave her blood because her pressure was low. If her system was already backed up, forcing her to urinate more would be a death sentence.
Growl.
Still, I poured. It had been about forty minutes since the transfusion. Reactions usually occurred within fifteen. The delay gave me hope. Maybe my sap worked. Maybe the dilution helped.
But even 2 to 30 mL can trigger a reaction…
Still, it was too early to hope. I poured water and called in a family member to speak with her. It didn’t matter what was said. I just didn’t want there to be regrets. Even in an era where death was common, losing a wife or a mother was a terrible thing.
Translator’s Notes:
Blood Pressure — The force of circulating blood against vessel walls. Here, Taepyeong is frustrated because he cannot measure it objectively with modern tools.
Blood Transfusion — The transfer of blood into a patient’s bloodstream. In this historical setting, doctors know the concept but do not yet understand blood type compatibility.
Distilled Water — Water purified through boiling and condensation. Taepyeong uses it here as an improvised fluid replacement because proper IV fluids do not exist.
Jugular Vein — A large vein in the neck. It can allow faster fluid entry than small peripheral veins but is dangerous to access without proper tools.
Acute Hemolytic Transfusion Reaction — A severe reaction caused by incompatible blood transfusion. Red blood cells break down, causing symptoms such as fever, chills, back pain, abdominal pain, vomiting, and potentially fatal organ damage.
Hematuria — Blood in the urine. It can occur during severe transfusion reactions due to red blood cell destruction and kidney injury.
Diuretic — A drug that increases urine production. In this situation, using one could worsen shock if the patient’s circulating volume is already too low.
Dog Tags — Identification tags worn by soldiers. Modern versions often include blood type to help avoid incompatible transfusion during emergencies.