Episode 53: Blood Transfusion [3]
Episode 53: Blood Transfusion [3]
In conclusion, the effect of the transfusion, which wasn’t even a proper Blood Transfusion, lasted only a few minutes. The Acute Hemolytic Transfusion Reaction triggered by mismatched blood was killing the patient helplessly. I wish there were a better word for this, but with my limited insight, I couldn’t find one. All I knew was that the patient was dying right in front of us.
“This one’s gone.”
Blundell, who had just finished dealing with another patient, shook his head. I used the phrase “dealing with” because I couldn’t tell whether he had helped or simply ushered that patient toward death. Chances were high it was the latter. I didn’t bother asking. It felt like Schrödinger’s cat. Until I checked, the patient could be both alive and dead.
“Why am I seeing hematuria?”
Blundell let out a sigh as he looked at the bloody urine. This was probably unlike most deaths he had seen, so it was understandable that he was shaken.
“Wow… So there’s really nothing we can do?”
By then, the patient had already lost consciousness again. Blood Pressure? I couldn’t even reliably detect a pulse. Based on experience, it was probably down to 50 or 60 systolic. And no, that wasn’t just her being relaxed.
“Hey, Dr. Pyeong, can you at least give her more water?”
Blundell, frustrated that he couldn’t administer more blood because the needle was clogged, turned to me in desperation. I quietly shook my head.
“No… I think her body is already too swollen.”
“Ah. You think it’s from the water?”
“I don’t know… but maybe.”
“Crazy. The human body still surprises me. I used to think I knew everything…”
Blundell, clearly shaken, was rambling. No doctor, especially in the twenty-first century, would claim to know everything about the human body. But maybe it was better to leave it at that than crush him with facts.
Then again… maybe I don’t know enough either.
I turned back to the patient. Honestly, this was the first time I had seen this kind of reaction in person. I had read about Acute Hemolytic Transfusion Reactions in textbooks, but seeing it with my own eyes was a whole different experience. And no, it wasn’t a pleasant one.
Her kidneys are already damaged. Dialysis? In a place where transfusion itself is a miracle?
It was laughable. Dialysis required knowledge of physiology and microanatomy far beyond what they had here. Understanding how kidneys even worked was centuries away.
“Can I go check on the patient I saw yesterday?”
“Huh? Oh, sure. By the way, isn’t this one my patient? That’s good.”
This patient was beyond saving. Death was inevitable. I was just grateful I had managed to speak briefly with the family while the patient was still conscious. Without that, they wouldn’t even have gotten to say goodbye. But the real tragedy wasn’t just the death itself. It was the pain it would cause those left behind. Especially the child. Still, the living had to go on.
At the very least, I shouldn’t cause more pain.
That was why I didn’t leave the patient’s side right away. She wasn’t just unconscious anymore. She was in a coma. She could no longer feel pain. So no matter what Blundell did from here, it wouldn’t hurt her. Of course, Blundell himself was a wreck and likely wouldn’t do anything anyway. The botched transfusion had been a turning point. With the patient dying helplessly, any fight had left him.
If I want to teach them the concept of a proper transfusion… where do I even start?
The only thing I could think of was to save the patient I had treated yesterday. That would be proof. Once I could point to a success, I could begin advocating for change. Then, maybe, one day, a real Blood Transfusion would be possible.
“How are you feeling?”
I approached the patient from yesterday with Joseph and Alfred. Even before he replied, I was relieved. He looked much better.
“Ah… I’m much better. I think I can manage…”
He even tried to stand. That alone was progress, regardless of whether he succeeded.
“Oh, not yet.”
Of course I stopped him. In this place, no one even seemed aware that fall risk was a thing. Neither patients nor staff, whether nurses, doctors, or anyone else, understood the danger of getting up too soon. There weren’t even bed railings.
Ha…
I held back a sigh as the thought of all the uphill battles ahead weighed on me. Where was I supposed to start?
“For now, lie down. Have you urinated?”
“Yes? Ah, yes. In that… container you gave me. But, um, do I really have to use that? I want to go to the bathroom…”
He pointed at the bowl I had given him earlier. It was hard to obtain, and now it held precious, concentrated urine. I looked at that pale yellow liquid like it was the water of life. Strange, maybe, but that was how it felt.
“Good. You passed quite a bit, didn’t you?”
“What? No, not really… I hadn’t peed for over a day. That’s all.”
“No, this is good. Very good. Let’s get up slowly.”
Urine output meant blood was reaching the kidneys. It also meant the body had enough fluid to excrete some. In other words, the patient had overcome his Hypovolemic Shock. His red blood cell count might still be low, but the bleeding itself hadn’t killed him.
“No, no. Slowly now.”
“Ugh… My head…”
“Dizzy, right?”
“Yes, doctor. My vision… it’s going dark…”
“Knew it.”
“Huh? How did you know?”
“Why else would I be a doctor? So listen to me carefully.”
“Yes, sir.”
Of course, he had orthostatic hypotension. It was normal after prolonged bed rest and blood loss. I hadn’t given him any blood, only water.
“Let’s walk a little. You might feel dizzy, but you’ve got two people behind you.”
Joseph and Alfred followed my signal and stood behind him. He started walking, unsteady at first, but he improved with each step. That was natural. Walking helped Blood Pressure rise. As long as his heart didn’t race too much, it was safe. I kept my fingers on his Radial Artery to monitor it.
Hmm. Pulse is slightly elevated…
About 100 beats per minute. That was already a lot, considering he was only walking. Still, the fact that he could walk was enough for now.
“All right, let’s stop here for now. Feeling okay?”
“A little out of breath… I only walked a few steps.”
“That’ll improve with time. Let’s check your wounds now.”
“Wounds? I wasn’t injured anywhere.”
I helped him sit back on the bed. He looked confused by the word “wounds.” Probably because, to him, what had been done at the hospital wasn’t “wounding.” It was treatment.
“Your feet, arms, and forehead…”
“Ah.”
Once I pointed them out, he nodded. There were indeed clear punctures and scrapes. The wound on his foot was mildly inflamed. Ideally, I should have disinfected it first before using it for anything, but that wasn’t possible.
Still… aside from that, he’s surprisingly fine. It must be because he was healthy to begin with.
I was inspecting wounds with my eyes instead of lab tests. But humans adapted, and Koreans, especially, had a strong will to survive. The Miracle on the Han River hadn’t happened for nothing.
Now the headache… that might be an issue.
Something told me this wasn’t a typical headache. If it persisted for this long, especially if it hurt worse when bowing his head, it wasn’t something to brush off.
“Let’s talk about your headache too.”
I began the interview. Simple questioning techniques were basic in modern medicine, but here, they were almost revolutionary. There were people here who would respond to complaints of pain with a knife. And this guy? He was still full of confidence despite the disaster he had caused.
“Um… So…”
“How long have you had this headache?”
“Ah… It’s been a while.”
Of course, he didn’t think that was unusual. But I was a modern doctor. I needed specifics.
“How long, exactly? Over a month?”
“Yes? Ah… Yes, easily over a month.”
In modern medicine, a month was often the dividing line between acute and chronic. This was clearly chronic.
“More than six months?”
“Hm… Actually, it’s been quite a long time.”
“Has it been getting worse lately? Or is it the same as before?”
“I came because it’s been getting worse.”
Which made sense. You’d only come to a hospital in this era if you were truly desperate, unless it was for something urgent like childbirth. So this headache really was bad.
“Where exactly does it hurt?”
“My head.”
“No, I mean where on your head?”
“Ah… Umm… here…”
He pointed from the center of his head toward his forehead. Unfortunately, that wasn’t very diagnostic. Most people just said “here” when their head hurt.
“When does it feel worse?”
I continued my questions. I was hoping for something simple, like a tension headache. But his next answer dashed that hope.
“When I bow my head… it hurts more.”
“…Huh.”
“Huh? Why?”
“Do you have a runny nose?”
“Yes.”
“Yellow?”
“Sometimes. Sometimes it’s pitch black, but mostly yellow.”
Sinusitis. Damn. That surgery wasn’t going to be easy.
Translator’s Notes:
Acute Hemolytic Transfusion Reaction — A severe immune reaction caused by incompatible blood transfusion. It can destroy red blood cells and cause fever, chills, bloody urine, kidney damage, shock, and death.
Hematuria — Blood in the urine. In this scene, it suggests severe blood cell destruction and possible kidney damage after an incompatible transfusion.
Dialysis — A treatment that filters waste and excess fluid from the blood when the kidneys cannot function properly.
Systolic Blood Pressure — The upper number in a blood pressure reading. A systolic pressure of 50 or 60 is dangerously low and suggests severe shock.
Orthostatic Hypotension — A drop in blood pressure when standing up, often causing dizziness or darkened vision.
Radial Artery — The artery at the wrist commonly used to check the pulse.
Sinusitis — Inflammation or infection of the sinuses, often causing headache, nasal discharge, and pain that worsens when bending forward.
Schrödinger’s Cat — A thought experiment in quantum physics used here as a metaphor for not knowing whether someone is alive or dead until directly checked.
Miracle on the Han River — A phrase referring to South Korea’s rapid economic growth after the Korean War. Here, it is used humorously to describe Koreans’ survival drive.