Saijô no Meii
-> RTS Page for Saijô no Meii 32
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Chapter 32: Mikoto's Illness
Ayame: If you refuse, then I will do everything in my power to make sure that you won't be a doctor for a while.
Mikoto: There is no need.
Mikoto: Actually, I was just thinking of talking to you about that.
Mikoto: I'm not lying.
Mikoto: I'm worried about my own body.
Mikoto: I'll go get myself checked up right away, and rest for a while.
Box: The next day---
Yourou: Looks like we did it.
Yourou: Which means that Saijou is out of the pediatrics department sooner than we anticipated?
Sadame: He was hospitalized for checkups as of last night.
Sadame: He probably will not be able to perform any hospital duties for a while.
Yourou: Good, good.
Yourou: This is great, since even he...
Sadame: Rather, that makes me anxious.
Sadame: Because Saijou had complete transposition of the great arteries, if he realizes that he has premature ventricular contraction in a physical examination...
You believe that he would think that he has some kind of heart disease, chancellor?
Yourou: Well, it's probably going to be something like heart attacks...or disease involving the coronary artery.
Yourou: Complete transposition of the great arteries means that the two major arteries, the aorta and the pulmonary artery, are switched when a person is born. However, the most important ones are the coronary arteries.
A Healthy Heart, Aorta, pulmonary artery, coronary artery
A Heart with TGA, Aorta, pulmonary artery, coronary artery
Box: When comparing the two hearts, the parts where the arteries connect to the heart are switched. Furthermore, the coronary arteries carry nutrients to the heart itself. They wrap around the surface of the heart, and if clogged up, the heart becomes abnormal.
Yourou: In the procedure to fix the problem, first the coronary arteries should be reconnected to the correct artery, and then the two major arteries should be swapped, but...
Diagram(from bottom right):
A Heart with TGA
(1)Cut the arteries.
(2)First, reconnect the coronary arteries to the correct artery. Then, swap the positions of the two major arteries.
*Incidentally, the holes will be filled with the patient's own cardiac membrane.
(3)Once everything is swapped, sew up the arteries.
The end of the procedure.
Yourou: The thickness of the coronary artery for infants is just one millimeter...and the placement and lengths vary by people as well.
Text: The below diagram shows all the arteries from directly above. In reality, the aorta is to the front a little bit, so it's slanted.
Example(1)(clockwise from top right), Pulmonary artery, Coronary artery, Aorta, Coronary artery
*Above shows three examples, but there could be infinite arrangements.
Yourou: Even though I say to simply reconnect them...one has to predict where they should be placed. Even if the angles are off by a bit, they could break or get clogged up easily.
Diagram: Example(1), Example(2), Example(3)
*The dotted lines show where the arteries are predicted to be reconnected to.
Yourou: And yet, even assuming that everything seems to have been reconnected properly...
Arrow: 20 years later, 30 years later
Yourou: 20, 30 years later, because the operation has not anticipated that far into the future, there is the possibility that the person will suffer from clogged coronary arteries or heart attacks.
Yourou: In other words, Saijou will also...
Sadame: No, I agree with you in that regard.
Sadame: Saijou will probably suffer from heart attacks.
Yourou: Huh? Then-then why are you so anxious?
Sadame: Please think about it carefully.
Sadame: It's true that heart attacks are very dangerous, and there is a high chance that serious illnesses such as cardiac infarction could lead to death.
Sadame: However, if the detected early like this time, then the illness will not pose a serious threat.
Sadame: If the problem is minor, then the clog in the coronary artery can be removed with a catheter...
Sadame: Even if say his case is serious, and that he needs a bypass surgery...there is no way that Ayame would fail with that.
Sadame: And his hospitalization probably wouldn't take longer than a month.
Yourou: So Sadame-chan, are you saying that even if Saijou faces potential heart attacks, he would recover quickly?
Sadame: That is not all.
Sadame: Everyone sympathizes with hospital staff who are ill, and if he isn't treated well, there is the possibility that his reputation will only improve.
Yourou: I-I see...
Yourou: That's certainly a problem.
Sadame: oh well, there is nothing we can do.
Sadame: Even though he is an enemy, he is still a patient, so we should follow the situation and wait for the next opportunity...
Yourou: You really are a naive man. Why are you sympathizing with the enemy?
Sadame: You never win against him precisely because of that.
Yourou: ...You know, Sadame-chan,
Yourou: I do not merely wish to have the title of chancellor...
Yourou: But also to become the chairman and control all the assets of Teiou University.
Yourou: Of course, for me to become the chairman of the university, I have to obtain approvals from more than half of the members in the board of directors...
Yourou: But if you gain control of Heisei, then my authority in the board meetings will increase as well.
Yourou: I am looking forward to it. Make sure that you do not forget that I...backed you up.
Sadame(thought): Hmph, what a complete fiend.
Sadame(thought): When it comes to giving himself more power, he doesn't care at all for human lives...
Sadame: To Heisei Central Hospital.
Man: Sir, are you alright?
Man: Well, it's just that you're making such a serious face...
Sadame: Is that so?
Man: Yes, sir.
Man: I don't know what has happened, but one should enjoy life without making such scary faces.
Sadame: Hahaha, I will do just as you say then.
Sadame(thought): Well, but then...
Sadame(thought): Looking at it from another angle, both of us probably climbed out of the same hole...
Sadame(thought): ...Hmph, enjoy life, huh.
Sadame(thought): If I could still afford to do that, then I wouldn't be having so many troubles.
Matsunaka: Oh, associate director!
Matsunaka: This is really bad!
Sadame: What's wrong?
Matsunaka: It's about Saijou-kun...
Matsunaka: He has started an emergency operation on a newborn baby!
Sadame: Saijou-sensei did...?
Sadame: But didn't he check into the hospital for examinations last night?
Matsunaka: He did, and that's why.
Matsunaka: Just now, from a neighboring maternity and gynaecology department, a newborn baby with type 1 complete transposition of great arteries needing urgent care was brought here...
TN: Type 1 means that there are no defects in the interventricular septum.
Sadame(thought): Oh yes,
Sadame(thought): It's because patients in nearby hospitals are being transferred to him...
Yourou: Let's make him busy for a while.
Yourou: With more patients than what the small department can handle.
Sadame: Wasn't BAS performed to avoid an emergency operation?
TN: BAS = Balloon Atrial Septostomy
Matsunaka: It was, but it didn't go well.
Diagram(oh.my.god. labeled clockwise from top left):
Memo on Different Kinds of Heart Conditions
From upper body, to upper body, to lower body, to lung, from lung, from lower body, from lung, to lung
This is a healthy heart, with normal blood flow. Blood that came from the entire body flows to the lungs for oxygen, and then flows back to the rest of the body.
Type 1 TGA
From upper body, to upper body, hole(large) to lower body, to lung, from lung, from lower body, from lung, to lung
Same illness that Mikoto once had. Even though the major arteries are flipped, thanks to the hole, the blood mixes and some goes to the lungs as well.
Type 1 TGA Likely Needing Emergency Care
From upper body, to upper body, hole(small) to lower body, to lung, from lung, from lower body, from lung, to lung
Because the hole is small, blood flows to the entire body without first going to the lungs. Death comes quickly due to the lack of oxygen.
*The BAS procedure that associate director mentioned involves sticking in a catheter to enlarge the hole and avoid an emergency situation. However, if the heart wall is too thick and the procedure is unsuccessful, a surgery is required.
Sadame: Wha-what about Ayame?
Sadame: Ayame can handle complete transposition of the great arteries no problem!
Matsunaka: Well, Ayame-kun is currently in another emergency operation...
Matsunaka: Even though Sakamoto-sensei is part of pediatrics, he specializes in respiratory organs...so the only who can handle infant hearts is Sajou-kun.
Matsunaka: And meanwhile...
Sadame: Someone must have informed Saijou-sensei.
Sadame: ...I see. I get the rough picture now.
Sadame: Let us go to the operation room.
Sadame(thought): Heh, what a sudden turn of luck.
Sadame(thought): There is no law against a sick surgeon operating on patients, but it will be a clear violation of morals.
Sadame(thought): Geez, I don't know if I should say that Saijou continues to do one stupid thing after another...
Sadame(thought): Or that he is an amazing doctor.
Sadame: And, who are the assistants and anesthesiologist?
Matsunaka: Sakamoto-chan and Sena-chan are the assistants.
Koushima-kun is the anesthesiologist.
Sadame: I see.
Sadame: Being the first assistant for heart surgery is probably tough even for Sakamoto-sensei.
Matsunaka: But there isn't anyone else who can...
Sadame: No, there is.
Sadame: Matsunaka-sensei, please go to the operation room and tell them something.
After changing into an operating gown...
Sadame: I will be an assistant!
Sakamoto: Wha-what!? That man will be the assistant!?
Sakamoto: What is he planning at a time like this...
Mikoto: Does the associate director have enough surgical experience?
Sakamoto: Yeah, he does have a lot.
Sakamoto: There are many doctors who transfer to the surgical department after studying in the anesthetic department, but for some reason he was the opposite...
Sakamoto: He gained fame as a genius surgeon when he was young.
Sakamoto: And he specialized in hearts, same as Ayame.
Mikoto: Is that so.
Mikoto: In that case, let's ask for his help.
Mikoto: It would be better for you as well, Sakamoto-sensei.
Sakamoto: Th-that's true, but...
Sakamato: It's him that we're talking about. If something happens...
Sadame: That is very rude of you.
Sadame: I'm not trying to kill anyone here.
Sakamoto: I-I didn't go that far.
Sadame: Oh well, do as you like.
Sadame: I believe that having a patient operating on a patient is the much bigger problem here.
Sakamoto: Saijou's not doing this because he wants to you know.
Maria: That's right! Saijou-sensei is...
Mikoto: It's alright, Sena-san.
Mikoto: There is no need to worry about my body.
The symptoms are light, and I have taken my medicine, so my work will be unaffected.
Sadame: I hope that is the case.
Sadame: But you really are an idiot.
Sadame: I'm helping because there is the possibility of the hospital itself having to take responsibilities for your actions...
Sadame: However, you should know that no matter what, you will be punished?
Mikoto: Of course I do.
Mikoto: But I can't just let the baby die.
Mikoto: No matter what, I don't want to have to regret my choices in life.
Sadame(thought): I see.
Sadame(thought): It feels as if I now understand a bit as to why my life is not enjoyable...
Mikoto: We shall now begin the operation for complete transposition of the great arteries.
Mikoto: First, open up the chest and peel open the pericardium. Then, place the artificial heart lung apparatus---
Sadame(thought): Unlike a normal person, this man's priories never change...
Sadame(thought): And that's why he is so strong.
Sadame(thought): Even if he gains nothing and stands to lose everything, he does not let go.
Sadame(thought): Against someone who does not calculate loss and gain,
Sadame(thought): It seems like I have lost.