Chapter 137

137. The Pickle and Sore Throat (2)

****

The most noticeable symptom is a high fever of 40 degrees.

Neck feels stiff, walking’s off-balance…

Even though speech is clear, there’s a possibility of impaired judgment. Or maybe an incredibly high pain tolerance…

“May I have your name, patient?”

“35 years old, Sebastian. I feel like I’m about to die any second…”

I nodded.

In medical terms, it’s called a ‘sense of impending doom.’ Hard to describe precisely, but it often occurs post-surgery, after blood transfusions, or following strokes for physiological reasons.

“Amy!”

Amy rushed into the clinic.

The patient weakly looked around at the sound of someone running. I handed them a single aspirin and a glass of water.

“Take this. It should help with pain and reduce the fever. Diagnosis will take about ten minutes.”

The patient immediately swallowed the aspirin.

Just now… When Amy entered, the patient tried to turn their head but failed, instead twisting their entire upper body.

So it’s not just stiffness—it’s rigidity.

Possible diseases are numerous…

Heatstroke could be plausible. Considering the impaired judgment, a stroke might also be possible. The high fever could be due to sepsis…

Sepsis? I rubbed my chin thoughtfully.

Breathing appears normal at a glance. No easy way to check coagulation. Blood pressure seems fine. Consciousness level is relatively stable.

Doesn’t seem like sepsis.

Next up: heatstroke.

While the body’s temperature regulation system does appear broken, it’s late autumn—heatstroke isn’t very likely here.

If this were modern times, they might’ve contracted heatstroke in a factory or occupational environment, but that doesn’t seem applicable.

“Amy. 40 degrees. What illness should we consider first?”

“Well, since the weather outside isn’t hot, it’s probably infection.”

That makes sense.

“What kind of infection?”

“Pneumonia?”

She always brings up pneumonia. I scratched my head. Doesn’t seem like pneumonia…

“Do auscultation.”

Carefully, Amy placed the stethoscope on the patient’s back. The patient exhaled deeply. Amy pondered seriously. Probably not pneumonia.

“How’s it looking?”

“Nothing there.”

Not pneumonia then.

“Patient, have you had any coughing recently?”

A stroke can sometimes cause fever depending on the case, but this patient isn’t the right age for a stroke, and 40 degrees seems unlikely to stem from one.

Still… At this point, I know what it is. There’s only one infectious disease that causes such a high fever along with neck rigidity.

“Meningitis.”

Meningitis is a disease that may spread depending on the type of bacteria. After disinfecting my hands, I covered my face with a plague doctor mask.

“What are you doing?”

“It might be contagious.”

Meningococcus spreads through close contact and has a high mortality rate if untreated. Amy nodded gravely.

****

After disinfecting herself, Amy donned her own mask and came to stand beside the patient. The patient frowned at our masked appearances.

“Is it serious?”

“Yes.”

It’s indeed serious.

Amy tilted her head curiously.

“What’s meningitis?”

“Exactly as it sounds. Inflammation of the meninges around the brain.”

The brain and spinal cord are surrounded by the meninges, filled with cerebrospinal fluid, which protects these structures.

Meningitis refers to inflammation of these membranes, typically caused by bacteria.

Confirming meningitis is straightforward. Insert a needle into the lumbar spine, extract cerebrospinal fluid, and check for white blood cells or bacteria.

Extracting cerebrospinal fluid is difficult, but it can be done without surgery.

The lumbar spine has relatively wide spaces between vertebrae. Carefully inserting a needle between the lumbar vertebrae can reach the cerebrospinal fluid.

Still… Is it worth it?

In modern times, ultrasound helps perform safe lumbar punctures, but we don’t have ultrasound here. I hesitated.

“Teacher, could you explain…”

Looking at the patient, I jotted something down on the medical record before continuing.

“The patient seems to have meningitis—an inflammation of the membrane surrounding the brain. It’s treatable, but due to its potential contagion, isolation is necessary until recovery.”

“I see.”

Amy raised her hand.

“Professor, how does this relate to neck stiffness? And how do we differentiate it from other infections?”

Let’s think while laying the patient down.

Grabbing the patient’s arm, I moved them to the farthest bed.

The patient carefully lay down, seemingly in pain from their back and neck. I began explaining.

“Inflammation affects the membranes surrounding the brain and spinal cord. Moving the neck stimulates the inflamed area, making it hard to move.”

“Ah-ha.”

I checked the patient’s pupil reflexes—they seemed relatively intact. Using a damp cloth to lower the fever as much as possible, the decision remains—

To perform a lumbar puncture or not.

“Patient, there’s a decision you need to make.”

“What is it?”

“To confirm meningitis, we extract cerebrospinal fluid and check for bacteria, white blood cells, or inflammatory substances. This involves extracting fluid from the lumbar spine.”

“Huh?”

“In short, we’ll extract something from your lower back to confirm the diagnosis.”

“But you already know what it is, right?”

Sharp observation!

“Until proven, it’s just speculation. So, the choice is: start treatment based on the assumption of meningitis, or perform a lumbar puncture to confirm the diagnosis.”

Both the patient and Amy deliberated.

“What’s bad about the lumbar puncture?”

“Well, it involves inserting a needle into the spine. Accidents can happen, and there’s a risk of severe side effects.”

“What does the needle look like?”

Cursing internally…

The lumbar puncture needle is longer than a finger, with a thickness similar to a toothpick. Showing it would definitely discourage consent…

Oh well.

“Yikes, damn it.”

I showed the patient the lumbar puncture needle, and they recoiled in shock, waving their hands frantically.

Seemingly forgetting their neck pain. As expected. I quietly sighed.

“Shall we skip it?”

“Yes.”

A bit disappointing.

It would’ve been good to try the lumbar puncture. For now, administering antibiotics to the patient and monitoring progress is the best course of action.

We placed a damp cloth on the patient’s forehead and disinfected their arm to administer the injection.

Since we don’t know the specific bacteria, we’ll need to use broad-spectrum antibiotics. I injected vancomycin and ceftazidime.

If this doesn’t work… We could directly inject antibiotics into the cerebrospinal fluid as a last resort, but it doesn’t seem necessary yet.

I sighed in relief.

Though two emergency cases arriving simultaneously was stressful, starting treatment successfully is reassuring. Can I finally rest?

****

We borrowed a psychiatrist’s office. Amy lounged on the consultation couch while I sat nearby, legs stretched out.

This was Professor Agatha’s clinic.

There’s no psychiatric consultation today, but psychiatrists usually keep large, comfortable couches for consultations…

“Professor.”

“Hmm?”

“I really don’t understand pickles. What do pickles have to do with brains and muscles? Or injecting saline into blood vessels?”

Ah, that.

It could seem strange if you don’t know how muscles and nerves function.

“Amy, do you know why pickled cucumbers get wrinkly?”

“Um, because they’re old?”

Wrong. I shook my head.

“Do you know that salt absorbs water?”

“Yes.”

“Saltwater works the same way. It draws water out, so when saltwater extracts moisture from the cucumber, it shrivels.”

“Ah-ha…”

By the same principle…

“If someone drinks an entire jar of pickle brine, soaking their insides in saltwater, where do you think the water will go?”

“From the body?”

Yes, from the body. Organs become pickled.

“Muscles store a lot of water. If you drink excessive saltwater, it first pulls water from the stomach, then from muscles where water is stored. That’s why—”

“So the patient couldn’t move properly! Because the muscles shrank!”

I nodded. While dehydration physically shrinks muscles, electrolyte concentration also affects muscle activity.

Understanding it as muscle dehydration is fine—it’s accurate enough.

“That’s amazing.”

Amy still seemed puzzled.

“What about meningitis?”

“As explained to the patient, inflammation near the brain isn’t good for the body.”

Both patients’ prognoses looked good. A little later would’ve been dangerous.

“We should check on them once they recover.”

One mystery remains. Once the patient regains consciousness, we’ll need to verify why they drank an entire jar of pickles and why they got meningitis.