Saijô no Meii 21

*******For use in Trinity BAKumA scanlations ONLY*******

p100:

Sadame: Ho, I see, I see.

Sadame: Well, Dr. Sakamoto, you're telling me that you won't be joining

me in getting rid of pediatric surgery?

Sakamoto: Yeah.

Sadame: It's so like you to come and tell me all this yourself.

Sadame: If you hadn't, at least you'd have fooled me for a little

while...

Sakamoto: Well, that's right.

p101:

Sakamoto: But delaying things would only cloud my judgment.

Sakamoto: I've realized that I've been wrong all along.

Sadame: Oh dear.

Sadame: You get involved with Saijou and now this.

Sadame: That guy is a freak, he even went and opened a hole in his own

stomach just to test out an operative procedure.

Sadame: What you see in him, I just don't...

Sakamoto: Of course that is unusual.

Sakamoto: But, what about Werner Forssmann (two 's's and two 'n's plz),

who inserted a catheter into his own heart...

p103:

Sakamoto: Jesse Lazear who deliberately allowed himself to be infected in

order to test whether mosquitoes can transmit yellow fever, and died as a

result...

Sakamoto: Barry Marshall, who drank a petri-dish of Helicobacter pylori

(capital H, italics) to show that can cause gastritis and gastric ulcers

and received the Nobel Prize for it...

Sakamoto: For typhus, Helena Sparrow...
Cholera... Max von Pettenkofer...
Polio... Jonas Salk...
Leprosy... Socrates Lagoudaky...
Carrion Disease... Daniel Carrion...
And many more, doctors who experimented on themselves in order to save

lives.

Sakamoto: Without such self-sacrificing heroes, modern medicine wouldn't

be where it is today.

Sadame: Kukuku, now that you say it like that...

p104:

Sadame: As you say, there are too many unknowns with any new therapies...

animal experiments alone cannot guarantee safety in most cases.

Sadame: Even the NOTES through the stomach had been tested in pigs, but

pigs' resistance to peritonitis is very different to that of humans. It

wasn't surprising that the medical community hadn't embraced the

procedure yet.

Sadame: Yet this man devised a method using a "Sando" Balloon (TL note: a

Japanese invention, probably meaning "Sandwich" Balloon) and not only

that, went on to prove its safety on himself... a true "hero"...

Sadame: If NOTES gets developed further, that man may go on to become a

Nobel laureate someday.

Sakamoto: .....

Sadame: However, Dr. Sakamoto, I think it'd serve you well to remember

this.

p105:

Sadame: The saying that "The best-doctor falls into hell"!

Sadame: This saying has been around for around 2000 years, and originally

meant, "Even the best doctor is human, and will go to hell because of

his/her greed"...

Sadame: But nowadays, "The better the doctor, the more they will strive

and struggle for the patient, but finally will end up failing"... this is

the cry of the doctors of today.

Sakamoto: ?

Sakamoto: Just what are you getting at?

Sadame: In other words,

Sadame: If you're going to side with that man, I hope you're ready for

the same hell as him!

Sakamoto: .....

p106:

[Pediatric Surgery]

Sena: Oh, wow- that's awesome, Dr. Sakamoto!

Sena: So you really parted ways with the associate director?

Sena: You're too cool, sir! I'm going to stick with you forever!

Sakamoto: Ho, you mean you're going to come with me even if I get exiled

somewhere?

Sena: Teehee, well... that's kinda...

Sakamoto: Hey, I'm just kidding.

Sakamoto: As long as Kazuma gets better, even if I get posted somewhere

else, it'll be alright.

Sakamoto: After this, Saijou, it'll all up to you.

Saijou: Hehe, leave it to me.

Ayame: Right.

p107:

Ayame: So, anyways, since that's taken care of, what's the plan for the

operation?

Ayame: I don't know what you're thinking about with this new procedure,

but somehow you say we can lengthen Kazuma's 20cm long small intestine by

4-5 times?

Saijou: Right. So first, we take the small intestine which has been

getting wider all this time, then double the length using the Bianchi

procedure...

Sena: Oh, I've heard of that too.

Sena: You take the widened small bowel, divide it down the middle, then

join them end to end, right?

[Top to bottom, duodenum, stomach, large bowel, small bowel]

Saijou: Yep.

Ayame: Well, that's correct.

p108:

Ayame: However, in actual fact you must also consider the mesentery,

which supplies blood to the bowel... so to avoid cutting the blood

vessels, you should first part the mesentery of the widened small

bowel...

[Top to bottom, Widened small bowel, Blood vessels, Mesentery]

Ayame: then you need to stretch the mesentery whilst joining the cut ends

of the bowel into an 'S' shape, it's a bit tricky you know.

Sena: Oh...

Sena: On top of it being a difficult procedure...

Sena: In the end you only double the length of the bowel, that's why gut

transplantation is the standard treatment, or so I've heard...

Saijou: Yes, that's why on top of the Bianchi, we use another procedure

to lengthen it 4-5 times.

Saijou: But first, we need to succeed with the Bianchi...

p109:

Saijou: then we wait another 3 months to allow the small bowel to

recover, then do another operation.

[3 months]
[Next procedure]
[A little while post-surgery, the small bowel will widen again, and in

addition the mesentery will lengthen.]

Sena: Another operation?

Sakamoto: Hold it right there.

Sakamoto: I think your idea for the operation is great, but don't tell

anybody just yet.

Sakamoto: I don't want Kazuma to end up hearing about it and then to get

his hopes up for nothing...

Sakamoto: In any case, if this Bianchi doesn't succeed, then the next

operation won't happen anyway.

Saijou: Understood.

Sena: Awwww~~

Sena: I won't tell anyone, please please tell me~~~~

Ayame: Quit it.

p110:

Ayame: If you can't tell anyone anyway, there's no point in hearing about

it.

Ayame: You'll just have a hard time trying to keep your mouth shut.

Sena: Oh, I see!

Sena: I see your point of view!

Sakamoto: .....

Sakamoto: Definitely shouldn't tell this girl...

Ayame+Saijou: Exactly.

[A few days later]

[Day of the operation]

Saijou: The patient is Kazuma Sakamoto, who is 9 years old. We will be

performing a small bowel extension on him.

p111:

Saijou: Scalpel.

Sakamoto: .....

Sadame: Well well, if it isn't Dr. Sakamoto.

Sadame: Aren't you going to help out with your son's operation?

Sakamoto: No.

Sakamoto: It's not that I think it a taboo to cut my own family, but I'm

just not feeling like it.

p112:

Sakamoto: It's good enough for me to just watch from here.

Sadame: Fufufu, a wise decision.

Sadame: You love your son too much, if you were to harm him in any way,

it would be most terrrible.

Sakamoto: Mind your own business.

Sakamoto: And so what? Why the hell are you here anyway?

Sakamoto: This operation's just a Bianchi, nothing you'd be interested

in.

Sadame: I wonder about that.

Sadame: Bianchi is a well known procedure, but it's so difficult that

only a few surgeons in Japan have actually done it.

Sadame: I think that makes it interesting enough for me to watch? [Though

I see there are other spectators]

p113:

Sakamoto: Hmph, do whatever you want.

Sadame: Well about that, Dr. Sakamoto...

Sadame: I'm a little worried, you know.

Sakamoto: Wha, about what?

Sadame: I'm talking about the best doctor going to hell, of course.

Sakamoto: !?

Sadame: Didn't I tell you? "The better the doctor, the more they will

strive and struggle for the patient, but finally will end up failing".

Sadame: A few days ago, you listed for me the names of a few of these

good doctors...
They were fortunate that people still remember their names!

Sadame: Many other good doctors tried brave new approaches to therapy,

but ended up being forgotten.

Sadame: Others have been labeled 'murderer' or 'crazy', and took these

burdens to the grave!

Sadame: So I'm just trying to point out that Saijou, too, won't always be

successful.

Sakamoto: !

Sakamoto: Pfft, what garbage.

Sadame: Oh, you really think so?

Sadame: No matter how perfect you think Saijou is, what happens in

surgery, one can never predict...

Sadame: Take this operation, for example- what about the formation of

adhesions?

p115:

Sadame: In anyone who's been operated on once before, adhesions will form

so that their organs will be stuck together...

Sadame: Even with modern technologies, there's no way of knowing how the

organs are stuck together before you actually open them up!

Sakamoto: .....

Sadame: Kazuma's had a major surgery to remove his small bowel, so

maybe...

Ayame: It's no good, Mikoto!

Ayame: It looks like the greater omentum (the mesentery hanging down from

the stomach and the transverse colon) is too extensively adhered to the

small intestine!

[L to R: mesentery, small intestine, greater omentum, large intestine,

stomach, Diagram of adhesion]

Mikoto: ...Yeah.

Mikoto: It's too bad...

Mikoto: But in this case we'll have to give up on the Bianchi...

Sakamoto: !

p116:

Sadame: Oh, just what I was saying.

Sadame: I understand how you must feel about bowel transplants, with the

high risk of rejection...
But any form of small bowel extension, including the Bianchi, is an

extremely difficult task.

Sadame: Sometimes the adhesions are sooooo extensive that operating

itself becomes impossible.

Sakamoto: No... no way...

Sakamoto: So then, Kazuma...

Sadame: It looks like transplantation is the only way now.

Sakamoto: .....

Sadame: It's not too late for you yet, Dr. Sakamoto.

Sadame: If you come back to my side once more...

p117:

Sadame: I can use my contacts to arrange for you the small bowel of a

brain-dead patient who has the lowest risk of rejection for Kazuma, no?

Sakamoto: What the hell...

Sakamoto: Kazuma, what am I supposed to do now...

Sakamoto: Must I betray your savior, Saijou, yet again?

Saijou: Dr. Sakamoto!

Saijou: I want to give up on the Bianchi and try a totally different

approach, please give the guardian's consent!

p118:

Sakamoto: A totally different approach?

Saijou: Since the adhesions on the small bowel opposite the mesentery are

so extensive, I'll split it transversely instead of down the middle!

[L to R: Circle: Transverse cut, X: Cutting through the middle]
[* The explanation's useless, it's evident from the picture!]

Sakamoto: What...!!

Sakamoto: That's crazy! If you do that, the part of the gut disconnected

from the mesentery will die off!
[L to R: Mesentery, Ischemia]

Sakamoto: Without the mesentery, there'll be no blood flow!?

Saijou: Don't worry!
[L to R: Blood supply, No blood flow]

p119:

Saijou: Please trust me!

Sakamoto: .....!

Sadame: Fufufu, what an unexpected place for a decision, eh?

Sakamoto: .....

Sadame: On one hand, you can throw in your lot with Saijou and stake it

all on a mystery procedure without any prior explanation....

Sadame: Or, you come with me and take the plain old bowel transplant.

Sakamoto: ...Alright, I understand.

p120:

Sakamoto: Saijou, I will trust you!

Saijou: Yessir!

Sadame: Fufufu, that's right, that's right, I thought you'd see things my

way...

Sadame: Or not!?

Sadame: But why!?

p121:

Sadame: The bastard hasn't even explained to you the risks and possible

complications of what he's about to do!

Sakamoto: An explanation, huh...

Sakamoto: Well, I'll ask you. Why do YOU explain risks and complications

before a surgery?

Sadame: Hahaha, isn't it obvious?

Sadame: If you don't explain these things beforehand, then something goes

wrong, there'll be trouble, right?

Sakamoto: Is that so...

Sakamoto: In other words, the explanation before the surgery is to get

you, the doctor, out of trouble...

Sakamoto: It has nothing to do with respect for the patient!

Sadame: ....!

p122:

Sakamoto: I understand just how much you want me back, but it's probably

best that you shut your arrogant mouth.
[To say that bowel transplant, with a 5-year survival rate of 50% is the

easy, standard way...]

Sadame: But I... I...

Sakamoto: I've said it before, haven't I? The more one worries about

these things, the more it clouds one's resolve!

Sakamoto: What's important is how far he's willing to go for Kazuma, not

some silly explanation.

Sakamoto: Without making any excuses, with honest eyes...

Sakamoto: Prepared to accompany Kazuma right down to the depths of hell,

this is the kind of doctor that I trust!