Chapter 165

Episode 165. The Breath of Life (1)

“Let’s begin the lecture. Everyone’s here, right? Looks like everyone’s present, so I won’t bother calling the roll.”

Who cares about attendance anyway. Besides, it seemed like the classroom seats were all filled to the brim.

I began speaking.

Today’s plan went like this: I’d use Daisy’s case as an example and explain the physiological causes related to lung injuries based on that.

“A while ago, a patient came to my hospital after being hit by an arrow in the ribs. Other doctors had given up, saying there was no way they could survive.”

I roughly sketched a person on the blackboard and drew an arrow sticking out of their side.

“Imagine a patient comes in with an arrow in their side. What should we do first?”

No one answered. So I pointed at a student sitting in the front row.

“What’s your name?”

“Lucy.”

“Alright Lucy, if this patient were in your ward, what would you do first?”

I gestured toward the crude drawing on the board.

Lucy stayed silent for a long time, and then I grabbed a pink chalk and added some “bloodstains” around the wound.

“He’s dead.”

“We should pull out the arrow first…”

“Nope, already dead.”

A few giggles started rippling through the lecture hall. I erased the pink chalk marks from the board.

“You can’t just yank the arrow out. When someone gets pierced by something sharp, the muscles around the wound contract and hold onto the object.”

“Ah, understood.”

“If you pull it out immediately, the patient might bleed uncontrollably. You need to stop or stitch the bleeding before removing it.”

I scanned the room again.

“Alright, let’s assume the arrow is removed, the bleeding has stopped, and the wound is stitched up. What’s next? Oliver, care to answer?”

“Uh, isn’t everything done?”

“What organ is located where the arrow struck?”

“I can’t tell because the drawing is too rough…”

“Above the waist, near the ribs.”

“What’s the triangle above the patient’s head?”

“Cat ears. It was a feline patient with cat ears.”

“Ohhh!”

Oliver nodded.

“There must be lungs there.”

“Correct. Lung injury. So, Oliver, what happens if a lung gets punctured?”

“The patient wouldn’t be able to breathe properly.”

“Assuming they can’t breathe, why is the patient still alive? They must’ve taken at least a few hours to reach the hospital.”

Oliver stared blankly at me, clearly thinking I was making no sense. But if you think about it, the answer is obvious!

“Ah! Because humans have two lungs!”

“Exactly. Thanks to the second lung, breathing doesn’t completely stop, allowing the patient to survive until they reach the hospital.”

***

So far, so good.

“Alright. We’ve pulled out the arrow and stitched the wound. The bleeding has stopped, but the patient is still struggling to breathe.”

Now, we need to figure out what to do next.

“Lucy, think about it. What should we do next, and what do you think is causing the breathing difficulty?”

“Obviously, the lung has been punctured.”

“How do you plan to fix it?”

Lucy hesitated, then decided to speak up. She didn’t want another imaginary patient to die like last time!

“Ah, we should check if blood has pooled inside the lung!”

“Good. How do we do that?”

“By auscultation!”

“Very good. Auscultation allows us to check if blood has pooled inside the lung.”

In reality, I didn’t perform auscultation back then.

If the lung is punctured, it’s obviously soaked in blood. There wasn’t much new information auscultation could provide.

“The space outside the lung, within the chest cavity, is filled with air instead of liquid. It’s an empty space.”

“Understood.”

“If half the blood from the wound flowed out of the body, where do you think the other half went?”

Lucy furrowed her brow.

“Did the blood pool somewhere?”

That’s correct.

Blood pools inside the chest cavity. I drew a small box on the board, added a lung, and then today’s main focus—an arrow piercing the lung.

An arrow pierces the lung in the drawing.

I picked up the pink chalk again.

“Roughly speaking, if half the blood flowed out of the body, the other half likely pooled inside the chest cavity near the lung. This pooling blood is what’s preventing the patient from breathing properly.”

Pink streaks surrounded the drawn lung.

“Amy, what should we do?”

“We need to drain the pooled blood.”

This time, Oliver raised his hand.

“But… isn’t blood supposed to stay inside the body? Honestly, I don’t understand why blood pooling in the chest cavity is such a serious issue.”

I nodded.

“There are two reasons.”

“Yes?”

“First, blood outside the blood vessels can irritate and damage tissues. In severe cases, it can trigger inflammation.”

“Ah, okay.”

“Second, fluid pooling in the chest cavity often causes problems. Imagine a paper bag filled with air.”

“Yes?”

“What happens if you submerge it in water?”

“Ah! It collapses, right?”

The lung is like a balloon.

“Exactly. Just like that. The lung loses space to expand, making it harder to breathe. That’s why we need to drain the pooled blood.”

Next step—today’s main topic.

“The lungs themselves don’t have muscles. The muscles surrounding the chest cavity move the air, facilitating breathing. That’s why even pooled blood can render one lung useless.”

“Ah, I see.”

“Since we’ve established that the blood pooling in the chest cavity is the core issue, we need to remove it. Oliver, how do we get the blood out?”

“Uh…”

Though I asked how to remove the pooled blood, there’s really only one way—cutting open the chest cavity.

“Use a knife, what else?”

“Correct.”

I returned to the patient drawing.

“We can debate where to cut and where to insert the tube, but ultimately, we need to make a small incision in the chest cavity to drain the blood.”

That concludes this patient’s case.

***

“Any questions?”

I leaned against the podium. A few professors were seated at the back, apparently curious about today’s unusual lecture topic.

“How did you drain the pooled blood?”

“Well, when you change the patient’s position, the blood inside the chest cavity moves, right? By adjusting the tube’s position and the patient’s posture, you can successfully drain the blood.”

They still didn’t seem convinced.

“By the way, you compared the lung to a wet paper bag. Is there any evidence supporting this analogy? Aren’t lungs naturally moist?”

Murmurs spread across the room.

Analogies are easy to make, but the key lies in how well you can justify the similarities between the objects. What proof do we have that lungs resemble balloons or paper bags?

“Everyone knows lungs inflate, right? You can confirm it by taking a deep breath.”

“Yes.”

“When the body’s muscles move to increase the internal volume of the chest cavity, the pressure around the lungs decreases, causing them to expand and draw in air. Got it so far?”

“Wait, is it true that lungs lack muscles? They’re constantly moving without rest.”

“The lungs do have muscles that adjust the width of the bronchus, but there are no muscles that directly move the lungs themselves.”

“That seems odd. Wouldn’t it make more sense to view the lungs as actively moving like the digestive tract? Such an important organ.”

I thought about it briefly.

“First, the absence of muscles in the lungs is something we can verify through dissection.”

“There’s another difference. Unlike the digestive tract, the respiratory system is controlled by conscious muscles attached to bones, like the diaphragm and intercostal muscles.”

“Ah, that makes sense.”

“Which means they aren’t internal muscles.”

Professor Croftler took his seat.

“Oh, one more thing. Lungs maintain a moist state without collapsing like wet sponges or paper. There’s a reason for that.”

“What’s the reason?”

“Well, the reason wet things collapse is due to surface tension. If we have a substance that can regulate surface tension, we can control this effect.”

The lecture hall fell deathly silent.

Amy, sitting in the front row, frowned, clearly hearing this for the first time.

“Surface tension?”

“Yes.”

“To simplify, water tries to minimize its surface area. That’s why wet objects shrink and droop, and why water forms round droplets.”

“What does that have to do with anything…?”

Amy sighed. Professor Klaus glanced at me, and as usual, distrust lingered thick in the lecture hall.

***

A student from the Healing Department of the Academy.

Melissa Madison.

‘What is this?’ she thought.

She had arrived a few days ago from the Kingdom of Rutece to study medicine at the prestigious Imperial Academy.

Today’s lecture was shocking.

Is this normal?

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