Chapter 94

Episode 94: Erectile Dysfunction and Heart Disease

Amy slammed the lab door and barged in before even getting a response. I knew it was Amy even before opening the door.

Istina wouldn’t do that. She’s too cautious to enter without waiting for a response.

“Professor.”

“Report on the patient.”

“Ah, yes. A patient collapsed during alchemy class. Breathing is unstable, but there’s a pulse. They’re currently lying down in bed now.”

“What’s your suspected cause?”

“I don’t know… But it’s the Alchemy Department…”

Poisoning, probably. They use lots of toxic chemicals.

“First, do a gastric lavage and administer activated charcoal.”

“Yes, sir.”

“Do you know how?”

“Uh… What’s activated charcoal exactly?”

“It’s made from charcoal powder. You’ll find it at the hospital.”

“Ah, understood.”

Amy nodded her head.

The patient lay peacefully in the ward. No foaming at the mouth, breathing was just slightly slow, no signs of cyanosis.

The young male patient looked like an Academy student. No visible trauma or self-harm marks.

I checked the patient’s eyes. No nystagmus, normal bilateral pupil constriction reflex. At least this patient avoided the worst.

If they frequently faint, there would likely be bruises or scars on elbows and knees…

I rolled up the patient’s sleeves but found nothing unusual. Not many clues here.

Is there immediate danger of death?

I checked the patient’s pulse again. The heart seems to be beating well, but without an ECG or blood tests… It’s so frustrating!

Should I give epinephrine injection?

While I was thinking, Amy arrived with the gastric lavage equipment and activated charcoal. Since the patient was still breathing fine, I stepped back while Amy inserted the tube into the patient’s esophagus.

“Is that the esophagus? Not the trachea, right?”

“Uh… How can you tell?”

“The vocal cords and epiglottis. Also, the gag reflex.”

I opened the patient’s mouth with my fingers. Seems to be in the esophagus. With that confirmation, Amy began the gastric lavage.

Actually, for unconscious patients, we should use anesthesia and endotracheal intubation for gastric lavage. But we don’t have mechanical ventilators, intubation would be difficult, and anesthesia itself is risky.

The tail is bigger than the dog. So we had to start with the gastric lavage anyway.

The patient woke up after about a minute. Started dry heaving with the tube still in their esophagus. Amy looked at me in panic.

“Uh… What do we do now?”

“What else? Remove the tube.”

The patient seemed confused about the situation, muttering curses with their mouth while dry heaving. They haven’t fully regained consciousness yet.

Amy removed the gastric lavage tube, and I handed a towel to the patient. They wiped their mouth while repeatedly coughing and gagging.

“Ughhh…”

“We thought you might have ingested something harmful.”

“Uuuuuugh…”

“Have you ever fainted before? Anyone around you recently?”

“Uuuuuuuuugh…”

The patient doesn’t seem to have a headache or inability to speak. Just unable to answer due to continuous gagging and vomiting.

If I had known they’d wake up so quickly, I wouldn’t have done the gastric lavage. Now I feel bad.

“Have you eaten anything strange recently?”

“No…”

Even if it’s poisoning, there’s no guarantee it was ingested orally. Inhalation or skin absorption are possibilities too.

Well, since they’ve woken up, maybe that’s all that matters?

“Have you been doing alchemy experiments recently?”

“Yeah, pretty often.”

“Can you give an example?”

“Turning iron into gold.”

There are so many dangerous things involved, it’s hard to list them all. After some thought…

“Did you swallow anything?”

“No.”

That gives us something to try…

Unithiol. Developed for arsenic poisoning but effective against heavy metal exposure too.

“Amy, hand me that.”

Amy passed me a tissue soaked in alcohol. I cleaned the patient’s shoulder with it and prepared the Unithiol.

“What are you going to do?”

“An injection.”

Let’s see if the patient improves after administering Unithiol. I took out the syringe and injected Unithiol into the patient’s shoulder.

“Ow!”

“Already done.”

Unithiol is effective against mercury, arsenic, heavy metals, snake venom and various toxins. With luck, the patient can return to normal within days.

We can take our time figuring out the exact cause. Though we should consider prevention of recurrence…

“What’s your name, patient?”

“Bernard.”

The patient was still feeling nauseous, repeating coughs and gags. I patted Bernard’s back. They looked uncomfortable.

Could be side effects from the gastric lavage…

“Patient, please take the medicine we gave you and wait a moment. We’ll figure out what’s wrong and come back as soon as possible.”

Bernard weakly nodded.

Amy scratched her head while leaving the ward.

“But… Could there be other causes for fainting besides arsenic poisoning?”

“That’s true.”

There are many possibilities. Even ignoring the context of being an alchemist, causes of fainting include vasovagal syncope, arrhythmia, psychogenic syncope, hypotension…

“An electrocardiogram would be helpful. Then we could check for arrhythmia.”

“What’s an electrocardiogram?”

“It exists.”

I heard that a hundred years ago, ECG machines measured by submerging hands and feet in salt water… Interesting, but…

I don’t know how to make one.

“Have you heard of orthostatic hypotension?”

“No.”

“When you stand up, blood pressure can temporarily drop due to posture change. Reduced blood flow to the brain can cause fainting. Or psychological stimulation could trigger it too.”

Amy nodded.

“But… This patient doesn’t seem to have fainted from specific stimuli. They just passed out during class. Others thought they were sleeping.”

“Exactly. Hold on.”

Without any particular reason, suddenly losing consciousness while standing – the conditions presented by this patient fit hypoglycemia, psychogenic syncope, and arrhythmia.

None of these are good. Especially for such a young patient, familial diseases are likely if they have hypoglycemia or arrhythmia.

Psychogenic syncope isn’t good either. There’s no clear treatment for such conditions…

“Let’s check the Alchemy Department lab. There might be disease-causing substances.”

“Yes!”

We headed over. We need to see what the patient was doing right before collapsing. Perhaps they were exposed to unusual toxins.

I decided to check the Alchemy Department practical room with Amy. Once again, we carefully put on masks before entering the research building.

Luciana, who introduced herself as Bernard’s senior and friend, was guiding us.

“Luciana. Long time no see.”

“Hello.”

“What’s up?”

“Ah. Some student… Anyway, I was attending the same class when they collapsed. I’m the teaching assistant for that class.”

“Thanks for your hard work.”

“Yes. Trying to delay graduation as much as possible… I might collapse too.”

“Hmm, does graduation happen just because you want it to? Would the professor allow that?”

“Yes.”

What a great professor. Quickly graduating graduate students who want to escape…

Anyway, I looked around. The lab didn’t have anything special, already tidied up with little evidence of experiments remaining.

“Luciana, has anyone conducted experiments here since that student collapsed?”

“No, we just cleaned up.”

I turned to Amy.

“Amy, do you smell anything?”

“Uh… Let’s see… Sweet smell? Something like bathroom odor… Don’t know what it is though.”

I think I know what it is.

I briefly took off my mask. As expected, there was a sharp, strong smell. Mixed with a slight sweetness, but overall unpleasant and intense.

That’s it, that’s it.

“Luciana, what kind of experiment was being done here?”

“I don’t know.”

“Judging from the smell?”

Though it was an unusual request, Luciana sniffed a bit and furrowed her brow.

“Ah, maybe metal separation? Smells like acidic substances used to dissolve metals.”

My thoughts were similar. The chemical used in the experiment was probably nitric acid. The substance causing fainting would be nitrogen oxides produced from nitric acid.

“Do you know what it is?”

“It’s nitrogen oxide. Inhaling nitrogen oxide relaxes blood vessels, lowering blood pressure and making one more susceptible to fainting.”

As a bonus, it also treats erectile dysfunction. Nowadays there are better medications, but it used to be prescribed for that purpose.

Additionally, it’s used to treat heart disease.

It relaxes cardiovascular muscles, stopping ischemia. Nitroglycerin is a representative example, used to treat acute chest pain.

If normal people ingest excessive amounts of these substances, blood vessels relax, making them prone to fainting like our previous patient.

And if unlucky, they really do faint. Consider the mystery solved.

“Ah, really?”

Amy and Luciana looked at me with expressions of hearing this for the first time. True, not many people have directly consumed nitric acid.

Our patient is quite an unusual case.

“Go inform the patient. They collapsed due to chemicals used in the experiment. Tell them to be more careful in the future, wear a mask or improve ventilation.”

“Yes.”

No additional treatment seems necessary. Case closed. Amy rushed to the ward, and Luciana sighed in relief.

By the way, there was something I wanted to ask Luciana.

“So… Where will you go after finishing graduate school?”

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