Polite Dissent

Continuing the medical annotation of Naoki Urasawa’s Monster. This time, I’ll take a look at the first half of the recently released Volume 3, chapters one through four.

Nothing medical happens in the first chapter, so the annotation begins with:

Chapter Two
Tenma is taken to treat a terrorist injured in a gunfight with the police. He realizes that the man was shot through his axillary artery and is bleeding to death.

The axillary artery is an important artery. It starts off as the subclavian artery, coming off the aorta. As it dives under the shoulder it is known as the axillary artery. It then becomes the brachial artery (the main artery of the arm) as it leaves the shoulder. It’s a large enough artery that an injury to it could lead to death from blood loss, and fairly quickly.

Tenma apparently* stops the arterial bleeding with direct pressure, a valid approach, but he succeeds conveniently quickly. Next he announces that he needs to close the injury to the skin which he proceeds to due with a handy stapler. This makes little sense. I have no problem with the use of the stapler — it’s nearby and it works — I’m just not clear on why he closed the wound in the first place. Tenma knows the patient will require a surgical repair of the artery, so the doctors will just have to open the wound up again. The closed skin may provide a little pressure which will help keep the artery from bleeding, but a simple pressure dressing would do the job much better.

After closing the wound, Tenma places the injured arm in a sling, picks the man up fairly roughly (especially considering he is nearly dead already) and moves him outside for the police to find.

Chapter Three
While wandering the streets of the city, Tenma runs across Dieter, a young German boy with an injury to his elbow (it looks like a scrape). Tenma tells Dieter that the wound is infected. He cleans it and wraps it in bandages, then sends Dieter off.

Infected wound need more than a one-time treatment. Many can be treated with topical antibiotics, such as Bactroban, but more serious wounds required oral or even intravenous antibiotics. I suspect a translation error, as it makes more sense if you substitute “dirty” for “infected.” So it is a dirty wound that Tenma manages to clean up and bandage with his stock of supplies, not an infected one requiring more treatment.

Chapter Three and Four
Later in the story, Tenma returns to the apartment of Dieter’s foster father to find Dieter in pain and injured on the floor. He diagnoses a dislocated shoulder and several fractured ribs. He also notices many old bruises, suggesting Dieter has suffered more than his share of injuries, a strong indicator of child abuse. Tenma picks up Dieter and makes a run for the nearest emergency room, where he leaves the boy in the care of the charge nurse.

Ideally, it is best to reduce a dislocated shoulder quickly because it immediately stops nearly all the pain. It also becomes harder to reduce a dislocation the longer one waits. Of course, when you’re in a small apartment with a dangerously violent man, it makes sense to run first and fix the shoulder once things are safe.

*I use the word “apparently” because the action here is a little vague. and it’s not precisely clear how Tenma stops the bleeding.