Polite Dissent

Finishing up the medical annotation of Volume 3 of Naoki Urasawa’s excellent manga Monster. In these chapters, Dr. Tenma and Dieter are hiding out in a small village in the German countryside. True to form, Tenma cannot resist helping others and before long is assisting the local physician, Dr. Schumann.

I. The Drunk (pp. 133-137)
A drunk patient has been hit by a car. There are two main medical concerns with this situation: First, the injuries inflicted by the accident itself. Second, the patient is so drunk that he could choke on his own vomitus or suck it into his lungs, leading to a fatal aspiration pneumonia. To prevent this, Dr. Tenma has suctioned the patient’s airway and then intubated him in case he vomits again. He has also set his injured leg as well as placed a band-aid or two. (Personally, I’m just impressed that such a small clinic has its own ventilator — not to mention it’s own operating room).

II. The Old Lady (pp. 150-168)
Petra has an aneurysm (a bulging weak spot) in the middle cerebral artery, a major blood vessel in the brain. This aneurysm is leaking blood which has collected in the tissue surrounding the brain (the subarachnoid space) and caused a subarachnoid hemorrhage. Blood is very irritating to the tissues around the brain and spinal cord, and this irritation makes it extremely painful to bend the neck. That’s why Tenma is paying attention to Petra’s neck — he’s seeing how much she can move it. She can barely move it and that scares him. If this aneurysm is not treated it can burst, causing a massive stroke which can lethal. Even if patients survive the aneurysm, there can be complications afterward — this is actually one of Dr. Tenma’s specialties as suggested in the first volume of the series.

(Page 157) Dr. Schumann: I should have sent her to the hospital in Krupp after the first stroke.

Apparently Petra has had a stroke in the past — which may or may not be related to her current predicament. Quite possibly she has high blood pressure which can lead to strokes and aneurysms.

The only hope for Petra’s survival is to clip the aneurysm before it ruptures further. In modern neurosurgery, this can be done with minimal fuss. However, Tenma is in a small clinic and doesn’t have all the fancy equipment he’s used to. He and Dr. Schumann clip the aneurysm the old fashioned way — they remove a large part of the skull, exposing the brain. They carefully open the tissue layers surrounding the brain and drain as much blood as possible. The brain is then carefully explored and when the aneurysm is found, it is carefully clipped. Petra does well and her vital signs remain strong throughout the surgery and recovery.

(Page 164) Dr. Schumann (yelling at Petra’s son — a police officer — who just entered the operating room): This is a sterile room! You’re putting your mother at risk! She could die from meningitis!!

Meningitis is an inflammation of the outer layer of tissue that surrounds the brain and spinal cord. The worst kind of meningitis is caused by an infection and this is what Dr. Schumann is referring to. He’s telling the cop to get out of the operating room because he’s not sterile and he’ll give his mother a deadly brain infection.

III. The Wife (pp. 170-171)
Cirrhosis is a chronic liver disease that can lead to liver failure and death. The most common cause of cirrhosis is excessive alcohol intake. That’s what the author is implying here: Dr. Schumann’s wife drank herself to death because he wasn’t paying any attention to her.

Several of the topics mentioned in this post were covered more extensively in earlier annotations of Monster, particularly Volume 1: Chapter 1 (aneurysms and subarachnoid hemorrhages) and Volume 1: Chapter 2 (the middle cerebral artery).

All previous Monster medical annotations.