Mangahelpers Translationshttps://mangahelpers.com/translators/rss2011-12-08T08:44:13+00:00/favicon.icoMangaHelpers Adminsadmin@mangahelpers.comhttps://mangahelpers.com/t/cookie-on-fire/releases/32492[English] [Translation] Saijô no Meii 33 by cookie_on_fire2011-12-08T08:44:13+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 1 Chapter 33: My Own Rule
Page 2 Mikoto: Chest cut complete. Box: To be honest, I'm not completely confident of what I'm doing. Box: The procedure for complete transposition of the great arteries is not that simple... *Complete transposition of the great arteries: An operation to correct the positions of the two major arteries. Mikoto had the same illness in the past. Mikoto: Cutting the pericardium. Box: And since I'm currently ill myself, I'm not at my best operating condition. Mikoto: Removing the pericardium. Box: But even so... Mikoto(thought): I will never give up on saving someone. Mikoto: I will now begin the installation of the artificial heart-lung apparatus.
Page 3 Box: Yes, ever since that day more than ten years ago--- Mikoto: What~~~!? So Shindou-sensei, you're saying you've operated while drunk before? Shindou: Yep, I have. Shindou: Even doctors are humans, so when we're completely off-duty, we do drink you know. Shindou: It's just that I was unlucky that day, and there were many patients with serious illnesses. Shindou: So they had no choice but to call on me even though I was off work... Shindou: And that's all it was. Mikoto: Th-that's all, you say... Mikoto: That's the worst! I was mistaken about you, Shindou-sensei! Shindou: Hey now.
Page 4 Shindou: So are you saying it would have been better if I just let the patient die? Mikoto: ...!! Shindou: Of course, it would have been easy to turn down the request by saying that I have been drinking. Shindou: However, when I'm the only one who could save the person... Shindou: If I give up for a reason like that, then I shouldn't be a doctor. Shindou: And that's why there is no medical practice law that says "a surgeon cannot operate while intoxicated". Mikoto: ... Mikoto: B-but, what if the patient dies from malpractice because of that... Shindou: who knows.
Page 5 Shindou: I don't know until that happens...but for me... Shindou: It's better to kill someone than to let someone die. Mikoto: Wh-whaaat~~!? Mikoto: That's so messed up! Shindou: Yeah, it's messed up. Shindou: When it comes to work that involves dealing with people's lives. Mikoto: ... Shindou: Listen up, Mikoto.
Page 6 Shindou: If you are really serious about becoming a doctor, then you have to clearly define your own rules. Shindou: Beyond saving people's lives, no one can decide what's good and what's evil. Mikoto: ... Mikoto(thought): ...Shindou-sensei. Mikoto: Installation of artificial heart-lung apparatus complete. Mikoto: Clamp the aorta using forceps, and inject cardioplegic solution to cause a cardia arrest. Sadame: ...Nicely done.
Page 7 Sadame: If I hadn't known about it beforehand...I would not have believed this to be the working speed of someone who's currently ill. Mikoto: Not at all. Mikoto: Associate director, you are amazing yourself to have so much blanks between each step. Sadame: Oh, why thank you. Maria: B-both of them are so amazing. Sakamoto: This is out of the ordinary. Sakamoto: Even though Mikoto is ill, he's not any different from usual, and even the associate director is following him precisely as the first assistant. Sakamoto: The slowest one is me, the second assistant with no major responsiblities. Maria: Tha... Maria: That's somehow so sad. Sakamoto: Like you can say anything! Text: You're not helping at all!
Page 8 Mikoto: Cardiac arrest successful. Now I will proceed to sever the aorta that was clamped earlier. Diagram: Aorta, Severing the arota/Coronary arteries, Cut away the coronary arteries in button shapes/Pulmonary artery, sever the pulmonary artery Mikoto: After severing the aorta, cut away the coronary arteries while leaving button-shaped edges, and then sever the pulmonary artery. Sadame: Understood. Mikoto: Severing the aorta, cutting the coronary arteries, and severing the pulmonary artery complete. Mikoto: Next, switch places of the two arteries, and perform anastomosis on the aorta. Diagram: Reconnect Mikoto: ...Alright.
Page 9 Mikoto: Aorta anastomosis is complete. Sadame: ...Hm...? Sadame(thought): S-something is strange. Sadame: Please wait a moment, Saijou-sensei. Sadame: In this procedure, before correcting the positions of the great arteries, it's common to practice to first attach the coronary arteries... Diagram: A heart with complete transposition of the great arteries -> Cut each of the arteries -> First reconnect the coronary arteries to the opposite side, and then switch the position of the great arteries. -> Reconnect the arteries -> Operation complete Sadame: If you were to reconnect the aorta first, you would have to open up some holes when you reconnect the coronary arteries, so it's more troublesome. Diagram: The normal way/Make small openings and connect the coronary arteries./Connect the coronary arteries first. Mikoto's way/The coronary arteries can't be connected unless holes are made./Connect the aorta first. Mikoto: Yes, there's that too...
Page 10 Mikoto: But there is my own rule. Sadame: ?? Mikoto: Now then, please remove the clamp on the aorta. Sadame: !? Sadame: Wha-what are you saying, Saijou-sensei. Sadame: Right now, the heart is stopped, and the artificial heart-lung apparatus is sending blood to the entire body from the aorta... If we were to remove the clamp, then the blood will flow to the heart valve. Diagram(starting from the heart): Heart/Blood flowing out/Artificial heart-lung apparatus/Blood flowing in/To the rest of the body/Clamp Heart/Blood flowing out/Artificial heart-lung apparatus/Blood flowing in/To the rest of the body/Release the clamp/Blood flows to the heart valve/*Because of the valve, blood can't enter the heart itself.
Page 11 Sadame: If blood were to flow, then it will seep out of where we just performed the anastomosis to say in the least... Diagram: Blood flowing in/Blood/Blood flowing in/Blood/Blood seeps out of the seams. Sadame: And if we were to make holes somewhere in the aorta later on in order to connect the coronary arteries, then there should be hemorrhage... Diagram: If holes were made -> Hemorrhage Mikoto: There is no need to wory. Mikoto: The clamp will be reapplied before I open up the holes. Sadame(thought): Then...then for what purpose...? Sadame: ...P, please excuse my rudeness, Saijou-sensei... Sadame: But you are sure that your correct state of mind isn't altered by medications? Mikoto: Haha, What are you saying, associate director.
Page 12 Mikoto: Medications for the heart have no such side-effects. Sadame: Is...is that so. Sadame(thought): Oh, oh well... Sadame(thought): It may be so for other people, but for him, there must be a reason for it... Sadame: I-in that case, I will remove the clamp. Sadame: Th-this is unexpected. Sadame: Even though the aorta is expanding, virtually no blood is coming out of the seams. Mikoto: Well, that's the case if the anastomosis is done well.
Page 13 Mikoto: Now then... Sadame(thought): J-just what is he thinking? Sadame(thought): Don't tell me...he just wanted to show off the fact that he can do anastomosis well, and that blood won't seep out even if it flows through? Mikoto: And now we will determine the locations in which the coronary arteries will be connected. Mikoto: Using the tip of a hypothermic perfusion apparatus, inject cardioplegic solution. Make the coronary artery swell... Mikoto: And while both the aorta and the coronary arteries are swelling, determine the locations in which they are to be connected. Diagram: Search -> Determine!! Sadame: !
Page 14 Sakamoto: Wh-what's going on? Sadame: ...I see! So that's what it's about! Sakamoto: I have absolutely no idea... Sadame: Sakamoto-sensei, how will you determine the locations in which to attach the coronary arteries? Sakamoto: We-well, I don't specialize in this area, so I don't really know... Sakamoto: But I guess I'll just go by feel and pick somewhere that will give the least amount of strain to the aorta. Sakamoto: For this child, the coronary arteries looks kind of like this from directly above, so probably something like this. Diagram: This child's coronary arteries/Pulmonary artery/Aorta -> Completion *Looking from directly above, the aorta is more to the front, so it's slanted. Sakamoto: Depending on the person, there are unlimited number of ways to do it... Diagram: The locations in medical books Sakamoto: And in the medical books, they are shown in this easy-to-understand way...
Page 15 Sakamoto: But in this case, they should be positioned as such. Diagram: The locations of this child Sadame: Well done. Sadame: However, even if you correctly imagine everything like in the diagram, the coronary arteries in actuality are only 1mm in thickness... The slightest misplacement will cause them to be folded or clogged up... Diagram: Correct way of connecting Mistake while connecting (1)/Bend it too much and it will fold. Mistake while connecting (2)/Pull it too much and it will become thinner. Sadame: Even if there are no problems in the short run, in 20, 30 years... The patient may potentially run into problems like what Saijou-sensei is experiencing right now. Sakamoto: Th-that's true...but there isn't any way of making it perfect that will last into the future... Sadame: That's why Saijou-sensei is using that method of his. Sadame: Usually, when coronary arteries are to be connected, both the pulmonary artery and aorta are already cut. Sadame: In other words, unlike in the diagram, the arteries are limp from without actually having blooding flowing through them. Diagram: Diagram/Reality/Limp
Page 16 Sadame: While the vessels are normally swollen with blood flow, if you determine the locations in that limp state, there will for sure be slight miscalculations... Sakamoto: I, I see! Sakamoto: Like Mikoto has done, if both the aorta and the coronary arteries are expanded, then they look exactly like how they would normally! That way, he can know for sure! Sadame: That is correct. Sadame: And then, as long as he determines the correct locations, the clamp can be reapplied and the procedure can continue on without without too much blood loss... Sadame: This is the perfect technique. Sakamoto: ...
Page 17 Sadame: Seriously...how in the world... Sadame: Do you always think of such terrifying ways of doing things? Mikoto: Haha, no way... It's not as big of a deal as you make it sound. Mikoto: All I do is to make simple rules of my own. Box: Yes, at that time... Box: I decided on my own rule. Mikoto: Alright then, I'll make rules that won't lose to yours, Shindou-sensei~~ Shindou: Hahaha, can you really do that? Mikoto: I definitely can! Mikoto: I also think it's better to kill than to let someone die, but that's not all. Shindou: Oh? Shindou: Then, what is it? Mikoto: Um--- That is...
Page 18 I'm operating on a child. But I'm also operating for the future in 20, 30 years, and not just the present. I have decided on it... That is all.https://mangahelpers.com/t/cookie-on-fire/releases/31537[English] [Translation] Saijô no Meii 32 by cookie_on_fire2011-09-24T12:50:37+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 1 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.
Page 2 Mikoto: There is no need. Mikoto: Actually, I was just thinking of talking to you about that. Ayame: ... 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. Ayame: ...
Page 3 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: Yes. 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.
Page 4 Yourou: This is great, since even he... Sadame: No. Sadame: Rather, that makes me anxious. Yourou: ? 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: Yeah... 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. Diagram: 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.
Page 5 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. Diagram: Example(1)(clockwise from top right), Pulmonary artery, Coronary artery, Aorta, Coronary artery Example(2) Example(3) *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.
Page 6 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.
Page 7 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: Hm... 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...
Page 8 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.
Page 9 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.
Page 10 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? Sadame: Huh? Man: Well, it's just that you're making such a serious face... Sadame: Ah... Sadame: Is that so? Man: Yes, sir.
Page 11 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.
Page 12 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: ...Matsunaka-sensei. Sadame: What's wrong? Matsunaka: It's about Saijou-kun... Matsunaka: He has started an emergency operation on a newborn baby! Sadame: !? Sadame: Saijou-sensei did...? Sadame: But didn't he check into the hospital for examinations last night? Matsunaka: He did, and that's why.
Page 13 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: ... 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 ------ Healthy Heart 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.
Page 14 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. Matsunaka: Alright. Sadame(thought): Heh, what a sudden turn of luck.
Page 15 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: We-well... Matsunaka: But there isn't anyone else who can... Sadame: No, there is. Matsunaka: Huh? Sadame: Matsunaka-sensei, please go to the operation room and tell them something. After changing into an operating gown...
Page 16 Sadame: I will be an assistant! Matsunaka: ...!? Sakamoto: Wha-what!? That man will be the assistant!? Sakamoto: What is he planning at a time like this... Mikoto: Sakamoto-sensei.
Page 17 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.
Page 18 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: Hey... Mikoto: ... 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.
Page 19 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: ... Sadame(thought): I see.
Page 20 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. Mikoto: Scapel. 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.https://mangahelpers.com/t/cookie-on-fire/releases/29746[English] [Translation] Saijô no Meii 31 by cookie_on_fire2011-05-24T07:59:08+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 3 Mikoto: Maybe I'm a bit tired. I tripped on the steps. Daiki: Saijou-sensei... Daiki: P-please don't scare me like that. Daiki: You collapsed so suddenly, so I wasn't sure what to think... Mikoto: Haha...sorry, sorry. Ayame: What is it? Maria: Wha...what happened!? Ryuuma: What's with the commotion? Mikoto: Ah! Everyone... Mikoto: Good timing. Mikoto: Sena-san probably knows already, but this person is Shiranui-kun--- Daiki: ...
Page 4 Sign: Pediatrics Ryuuma: But are you really alright, Saijou? Suddenly collapsing like that... Ryuuma: If you're tired, you can give me your shifts for 2 or 3 days, and go home... Maria: That's right. Maria: Sakamoto-sensei is like a dump truck, so he won't break so easily if you give him a bit more work. Ryuuma: Wh-why you... Mikoto: But thank you for the offer. Mikoto: Recently, I've been working non-stop, so I get tired easily... Ryuuma: Oh, I see.
Page 5 Ryuuma: Alright then, let me and Sena be on duty for a while. Daiki: Ah, in that case, I'll help out as well. Daiki: I'm not on Saijou-sensei's level, but among the newcomers... Ayame: Hmph, how fishy. Daiki: Ah...by fishy...do you mean me? Ayame: Yeah. Ayame: To begin with, why are you trying to get close to Mikoto when you have only met Sena? Maria: There were three young doctors who are interested in the Pediatrics department. Ayame: I see. Daiki: My name is Shiranui Daiki. Daiki: I'm interested in Pediatrics because I look up to you--- And I have met Sena-san before... Mikoto: Ok. Daiki: A-about that, isn't it obvious that it's because I decided to transfer to Pediatrics little by little? Daiki: First of all, if you say that, then the other two haven't... Ayame: That's right. Ayame: In short, the three of you are garbage that can't make up your minds because you're scared of bro and ties of obligation.
Page 6 Ayame: We don't need wusses who are scared by stuff like that in our department... Ayame: Bwh! Ayame: What the hell are you doing~! Maria: You know~~ Maria: Pediatrics this, Pediatrics that! Even though you are still a cardiovascular surgeon! Maria: Besides, Shiranui-sensei is the best young doctors in the gastroenterological department you know! Maria: Don't just dismiss new members as you please! Ayame: Tch.
Page 7 Ayame: You don't know anything. Ayame: About how the honor student types like him always have some kind of dirty secrets. Ayame: Like maybe he's really a huge pervert... Ayame: Or that he's actually a traitor... Mikoto: That's enough, Ayame. Mikoto: Shiranui-kun is crying. Ayame: ... Ayame: W-well, um...
Page 8 Ayame: S-stop crying, oi! You're a guy you know... Ayame: F-fine, I got it. Ayame: I'm the bad guy here. Miyabi: ... Ayame: You see, I just say exactly what comes to mind, so... Miyabi: Ayame, saying that doesn't help anything.
Page 9 Sadame: I see. Sadame: According to my research, Saijou Mikoto received a operation for the transposition of great vessels soon after his birth? Yourou: Yes. Yourou: There are many people who aim to become doctors after surviving major illnesses when they were young, but it seems like Saijou is one of those as well. Sadame: I see... Sadame: However, what can we really do with that information? Sadame: Even though he had that operation, he has been healthy this whole time... Yourou: That's true. Yourou: But, there are people who become ill with bad luck.
Page 10 Yourou: Take a look at this. Sadame: Chancellor...this is... Yourou: This is Saijou's health certificate. Yourou: The results...of the annual health checkup, mandatory for doctors in Heisei Central Hospital. Sadame: Does he know of this? Yourou: Not yet. Yourou: The "premature ventricular contraction" written here is even occasionally present in healthy people, but for someone who had crossed great vessels, that's a completely different matter...
Page 11 Yourou: There is a very high possibility that he has begun to develop a very serious heart disease. Yourou: Don't you think so? Sadame: O-of course. Sadame: Even if say that he shows no symptoms now, there is a possibility that dangerous one will appear when he works in the future. Yourou: Right? Yourou: Of course, there is nothing in the medical practitioner's law that parevents doctors with illnesses to treat patients... Yourou: If his conditions become worse, then there's no doubt that he will not be able to stay in the Pediatrics department. Sadame: Th-then... Yourou: Let's keep him busy for a while.
Page 12 Yourou: With enough work that the few people there won't be able to handle. Box: The next morning--- Sign: Pediatrics Mikoto: Good mor... Mikoto: H-huh? Mikoto: Wh...what's wrong with everyone? Maria: Mmm~~
Page 13 Maria: I can't anymore... Daiki: Me too... Mikoto: H...hey... Ayame: Nothing you can do about it. Mikoto: Ayame. Ayame: There was a huge number of patients last night. Ayame: I helped out halfway through as well, but everyone seriously had their hands full. Mikoto: Huh... Then they should have called me... Ayame: Then you can't take a break. Ayame: They all worked to the bone so that you can rest. Mikoto(thought): Everyone...
Page 14 Ayame: But something's not right. Mikoto: Not right? Ayame: Yeah. Ayame: I don't know the reasons for it, but patients who would usually be sent to Teiou University Hospital or Heisei Secondary Hospital are all sent here. Ayame: Maybe they are busy as well, but still...it feels off. Mikoto: ... Mikoto: Pediatrics department. Speaker: Ah! Is it Saijou-sensei? Speaker: Y, yes. Woman: Excuse me, but this is the receptionist...
Page 15 Speaker: Currently there is a great number of patients who came to you at the recommendation of other hospitals--- Mikoto: ... Mikoto: ...Is that so. Yes, yes, I understand. Ayame: ... Ayame: What is it? Mikoto: It sounds like other hospitals recommended me to many of their patients. Ayame: ? Ayame: Wh-why so suddenly? Mikoto: Who knows? But... Mikoto: Since they came all the way here, I can't just turn them back.
Page 16 Mikoto: I have to go examine them! Ayame: ... Box: Many hours later... Mikoto: There is nothing wrong with her in particular. Woman: Phew, I'm so glad. Mikoto: I'm really sorry that you had to wait this long, since we had many patients today... Woman: It's fine. Woman: I came here because I was told that you are an excellent doctor... So I knew that I had to wait a long time for my turn. Woman: Well then, thank you very much for today. Mikoto: See you.
Page 17 Ayame: Oi, Mikoto, do you have a second? Mikoto: What is it? Mikoto: Need you ask? This is definitely not right. Ayame: I saw the examination results of some of the patients from this morning... Ayame: And there are some kids, like the one just now, who are obviously healthy. Ayame: There's no way anyone would recommend them to go see another doctor. Ayame: This is definitely their trap. Mikoto: ... Ayame: I don't know if it's because of bro or that devil, but they probably found out about your weakness.
Page 18 Mikoto: Weakness...? Ayame: Don't play dumb. Ayame: I didn't really think much about it until yesterday, but...for you to collapse, and for someone like you to ask for help with your shifts, something must be wrong. Ryuuma: If you're tired, you can give me your shifts for 2 or 3 days, and go home... Maria: That's right. Mikoto: But, thank you for the offer. Mikoto: ... Ayame: I want a detailed physical examination, Mikoto. 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.https://mangahelpers.com/t/cookie-on-fire/releases/27104[English] [Translation] Saijô no Meii 30 by cookie_on_fire2011-01-12T02:56:13+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 1 Chapter 30: What Isn't Perfect
Page 2 Mikoto: I will be making an incision on the seventh intercostal vein. Mikoto: The latissimus dorsi muscle will be pulled out and made into the new diaphragm... Diagram: The muscle is passed through the ribs -> It is made into the diaphragm Diagram: Intercostal artery + Blood vessels of latissimus dorsi muscle -> (arrow) Supercharge Mikoto: And I will perform a supercharge, which is to connect the blood vessels of the latissimus dorsi muscle with the intercostal artery.
Page 3 Yourou: Wh...what a thing to do... Sadame: It's our utter defeat, chancellor. Sadame: At Teiou University, we just attach an artificial diaphragm with Gore-Tex material in the procedure. Diagram: 5 years old -> Growth -> In the future Sadame: The boy is just 5 years old right now, but when he grows in the future, we would have to operate on him one more time. Sadame: In addition, because Gore-Tex doesn't grow, using it may also have the potential to greatly hamper the development of of the side of the chest. Sadame: On the other hand, his procedure is perfect. Sadame: The latissimus dorsi muscle will grow, so of course there is no need for another operation. And there would be no obstruction in the chest development. Yourou: B-but! Yourou: He's making a big fuss over the nerves that aren't necessary in the first place... Sadame: Chancellor.
Page 4 Sadame: In reality, you know as well, don't you? Sadame: It's true that like you said, if the muscle is used for the diaphragm, the nerves would not really be necessary... Yourou: Other than having it become part of the diaphragm, there's no need for it to be anything more than just a piece of normal flesh... Sadame: But in five, ten years...making a comparison in the long-term, the latissimus dorsi muscle with nerves will be significantly more robust than it without. Diagram: Muscle with nerves (robust), Muscle without nerves (weak) Sadame: If enough blood flow is maintained, it's definitely better to keep the nerves. Yourou: Grr---! Yourou: We-well, what about the operation time? Yourou: He's doing the time-consuming supercharge, so it must take quite a while! Yourou: At Teiou, the whole procedure doesn't take longer than two hours...
Page 5 Yourou: With his troubesome way, it should take four hours no matter what! Mikoto: Ok, the operation is over. Maria: Wooow, sensei! It's only been two and a half hours! Man: Only two hours and a half. Yourou: ... Man: Unbelievable. Sadame: And the operation time has only changed by half an hour. Yourou: ... Yourou: Sadame-chan, what is the meaning of this? Yourou: Whose side are you on? Sadame: Are you saying that there is something for me to gain by being on his side?
Page 6 Sadame: Look at the condition around us, even with your presence. Sadame: To think that it would turn out this way... Yourou: Hmph. Yourou: Far from being an elite after all. Yourou: Like the tropical fish, dead too soon. Sadame: ? Yourou: I'm talking about you, Sadame-chan. You have to be more desperate. Sadame: ... Yourou: I do have to admit that that boy has some amazing medical skills.
Page 7 Yourou: But, as long as he's human, he isn't perfect. Yourou: I don't know what, but he must have a weakness. Sadame: ... Yourou: Well, just watch. Yourou: I will show you how I managed to climb all the way up... Yourou: To the position of chancellor. Sign: Pediatric Surgery
Page 8 Maria: Wow, Saijou-sensei was really perfect in there. Maria: I was dumb, so I thought that by properly calculating the size of the muscle beforehand, the operation wouldn't be all that difficult... Maria: But he has to make the incision without being able to see, so there's no way to correctly calculate the size. Ayame: That's right. Ayame: And as you know, it's an iron rule that the newly created diaphragm can't be loose... Diagram: Correctly attached diaphragm, loosely attached diaphragm Ayame: For that reason, he has to be able to grasp the correct size at the time of the cutting. Diagram: Correctly imagine the size, Incision Ayame: The latissimus dorsi muscle isn't really necessary for everyday life, so it's possible to cut more than what you need, and then stitch up the extra parts... Diagram: The part leftover from cutting more than what's necessary
Page 9 Ayame: But in the end, it's still a muscle, so it's obviously better to waste as little of it as possible. Maria: You're right-! Maria: In Saijou-sensei's case, I was surprised that in the end, when he was sewing up the diaphragm, the size was pretty much just right... Diagram: Just right Maria: Huh? Speaking of which, where is he? Maria: He didn't come back with you after the operation? Ayame: Yeah, pretty much. Ayame: In the locker room, he said that he was a bit tired, so he's going to sit down for a bit.
Page 10 Ayame: He is, after all, still human. Wouldn't it be better for him to have a bit of a charm like that than to be too perfect? Maria: I-I see! Maria: Then in the future, I will also try to be less per... Ayame: No, you have to try to be better. Maria: I-I didn't ask for your opinion! Sign: Locker Room Mikoto: Phew... Guy: Fufu, Guy: You seem to be really tired.
Page 11 Guy: After completing the operation so well with so much pressure, you should take a rest. Mikoto: ... Mikoto: What's your name? Daiki: ...Shiranui. Daiki: Shiranui Daiki. Daiki: I look up to you, and I'm interested in the pediatrics department--- Although I have met Sena-san before... Mikoto: Oh. Mikoto: She did mention to me that there were three people who wanted to join... Maria: Three young doctors has come to make inquires. They said they were interested in the pediatrics department. Ayame: I see. Maria: All three of them are said to be pretty skillful, with great expectations for the future. Daiki: Yes, I am one of the three doctors.
Page 12 Daiki: I wanted to introduce myself to you sooner... Daiki: But I actually just joined the gastroenterological department of Teiou University. TN: Gastroenterological is about digestive organs Daiki: If I suddenly transfer to the pediatrics department, the associate director's eyes would be on me, and there are annoying obligations... Mikoto: Yeah, that's what they say. Mikoto: Although I wouldn't know much about it... Daiki: Fufufu, I have heard that not being tied down to any obligations is one of your good points. Daiki: I'm jealous. Wish I could work together with you soon... Mikoto: Haha, then come visit us at the pediatrics department. Mikoto: Since Ayame is actually from another department, but he's there all the time. Side: And recently Miyabi is there a lot too.
Page 13 Daiki: Really, I can visit!? Daiki: I will really be going there then. Mikoto: Feel free, feel free. Mikoto: And I'll also tell Ayame to not bully you around. Daiki: H-huh~~ Now I'm scared. Mikoto: Ahahaha. Sign: Locker Room Sadame: Chancellor, you have my admiration.
Page 14 Sadame: To think that you have slipped a spy into one of the three interested in pediatrics. Yourou: I told you. Yourou: That I'd show you how I came into the position of chancellor. Yourou: You should constantly give it your all. Win by always making the first move. Yourou: Sadame-chan, you are lacking in that respect. Sadame: ... Yourou: I told you this just now, but you have no sense of desperation. Sadame: Please forgive me. Sadame: But will there really be some result from using a spy? Sadame: Even though he's human, he gives me the impression of having high morals... Yourou: But we don't know that.
Page 15 Yourou: Despite how he looks, maybe he actually abuses the patients... Yourou: Or maybe he over-spends, and embezzles hospital funds to pay off his debts... Sadame: ...I-is that so? Yourou: Well, probably not. Yourou: Even if there is nothing, as long as we have someone on our side, things can always be fabricated. Yourou: Isn't that right? Sadame: Yes. Yourou: Doctors are easily criticized by society you know. If, say, some evidence were to surface up, people's confidence in him would drop to the floor...
Page 16 Yourou: And Saijou would be destroyed without being able to resist. Sadame: ... Box: The next day--- Mikoto: Good morning, Shiranui-kun. Daiki: Ah, Saijou-sensei. Daiki: Will you be going to work now? Mikoto: Yeah. Mikoto: It was Sakamoto-sensei's shift yesterday, so I actually got to go home. Daiki: Oh yeah, Sakamoto-sensei. Daiki: He's also a pretty cool person. Daiki: I'm actually a fan of his. Mikoto: I see... Mikoto: In that case, although it's on the fourth floor, do you want to come with me? Mikoto: If I introduce you to everyone, it'll be easier for you to drop by. Daiki: Is that ok!? Daiki: I-I will definitely go! Daiki: Let's go by stairs then! Side: It's faster this way. Mikoto: Ah...o-ok.
Page 17 Mikoto: Wa...wait, Shiranui-kun, you don't have to go so quickly... Daiki: Ah, sorr... Daiki: Hm? Daiki: You don't look well, Saijou-sensei. Big SFX: *Bump* SFX: *Thud* Daiki: S-Saijou-sensei...?https://mangahelpers.com/t/cookie-on-fire/releases/26919[English] [Translation] Saijô no Meii 29 by cookie_on_fire2010-12-30T20:34:25+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 1 Saijou Mikoto, this will be the final battle between you and I! Chapter 29: Conventional Wisdom
Page 2 Woman: Excuse me, Saijou-sensei. Woman: The gentlemen up above would like you to wear headphones for the live surgery. Mikoto: Understood. Ayame: Hey, are you fine with that, Mikoto?
Page 3 Ayame: Usually it's used for the sake of the observers, who would ask questions to the surgeon when they don't understand something... Ayame: But this time, it's those two. Mikoto: But there must be people among them who really want to learn something from the operation. Mikoto: If they want to ask something, I would have to answer. Ayame: ...But... Mikoto: I wouldn't be operating on people if I am easily swayed by words.
Page 4 Mikoto: Aren't you the same, Ayame? Ayame: Mikoto... Ayame: Hmph, that's true enough. Ayame(thought): I didn't need to worry after all. Ayame(thought): It's just that...this time, bro brought a man here who is probably his trump card. Ayame(thought): I have to think ahead of time if there are any special odds... Mikoto: We shall now commence the diaphragm reconstruction procedure. Mikoto: The patient is Takahashi Yuuma-kun, a five-year-old boy. Mikoto: To have the minimum amount of cutting, we will begin at the scar left by the operation performed right after his birth. Mikoto: Entry at the scar.
Page 5 Mikoto: I will an incision on the latissimus dorsi muscle, which is the muscle on the back. Mikoto: Ayame, use the hooks. Ayame: Got it. Mikoto: I am removing the Gore-Tex that was previously attached.
Page 6 Mikoto: The surgeon and first assistant will be switching positions, and the patient will be turned to his side. Diagram(clockwise): First assistant, Surgeon, first assistant, surgeon Yourou: Hm, so fast... Yourou: It's been only about 20 minutes? Sadame: Yes. Sadame: He is quite the monster. Sadame: To cut the latissimus dorsi muscle his way...first, he needs to go around the rib cage and start cutting from the side, and then go inward to finish the job...
Page 7 Sadame: But as we are talking like this, he probably would finish the incision on the side of the muscle. Mikoto: The side of latissimus dorsi muscle has been cut. Sadame: See? Yourou: Fufufu. Yourou: But the real challenge begins here... Yourou: Is the preparation done? Sadame: Yes. Sadame: Saijou-sensei, I have one question. Mikoto: What is it? Sadame: It's true that people have used latissimus dorsi muscle for the diaphragm before...
Page 8 Sadame: But it's common sense to make the incision on the muscle from the top. Diagram: Conventional Way: Cut from the top to make the diaphragm Mikoto's Way: Cut from the bottom to make the diaphragm Sadame: But why are you making the incision from the bottom? Mikoto: ... Ayame: I see, so that's their angle of attack. Maria: Wh-what is it? Ayame: To be honest, there have been procedures in the past where the upper latissimus dorsi muscle is used as the diaphragm, but this is the first time the world has seen... Ayame: Mikoto's original technique. Maria: What!? Mikoto: The reason is that I do not want to damage the nerves in the muscle.
Page 9 Mikoto: The nerves are located in the upper area, so if I cut off that portion, the nerves will be severed and it will simply become a piece of flesh. Sadame: I see. Diagram: The nerves Sadame: But there is a problem with that. Sadame: Isn't that right, chancellor? Yourou: Yes, that's right. Yourou: Nice to meet you, Saijou Mikoto-kun. I am the chancellor of Teiou University, Yourou Shigetoshi. Yourou: This is going away from the topic a little bit, but I used to be a plastic surgeon, so I know more about muscles than anyone else. Yourou: And coming from experience, I would have to say that... Yourou: This operation is extremely dangerous, and you are being irresponsible.
Page 10 Yourou: Just now, you said that having the nerves severed in the latissimus dorsi muscle would make it simply a piece of flesh... Yourou: And what exactly is wrong with that!? Yourou: Other than having it become part of the diaphragm, there's no need for it to be anything more than just a piece of normal flesh... Yourou: If you must cut from the bottom, then don't do it at all. You will end up severing several blood vessels. Diagram(clockwise): Nerves in the muscle, Incision, Several blood vessels, Lower portion, Upper portion Yourou: Isn't that just conventional wisdom? Mikoto: Oh, is that so? Mikoto: Then to overturn what you said...
Page 11 Mikoto: From today, this will become the common procedure! Yourou: !? Yourou: H-how impertinent...! Yourou: I'll chew you to bits, you insignificant brat!! TN: He probably means literally, lol.
Page 12 Sadame: C-chancellor, your mike is still on. Sadame: Not only the surgeon, but the observers all around can hear you as well, so please be careful. Yourou: Ah...ok... Yourou: I was trying to say, you are a bit cheeky. Yourou: It's true that it would be better to not sever the nerves, but in a procedure where you just need to make a diaphragm, it's more advantageous to save the blood vessels than the nerves. Diagram: Nerves in the muscle, Preferable, Several blood vessels Yourou: When you make the incision on the lower portion, there is the possibility of not having enough bloodflow... Mikoto: That will not happen. Mikoto: It's true that I will have to sever several blood vessels in the process...
Page 13 Mikoto: Because the dorsal thoracic artery in the upper portion will remain connected, having enough blood flow will not be a problem. Diagram(clockwise): Nerves in the muscle, Dorsal thoracic artery, Incision, Several blood vessels, There will be enough blood flow with just dorsal thoracic artery. Yourou: Hmph. Yourou: That is just your own theory. Yourou: And since you have never done it before, how do you know it will work? Yourou: You're just using him as a human experiment!! Mikoto: ...Alright. Mikoto: Incision on the latissimus dorsi muscle is complete. Mikoto: Um, and now, What were you saying?
Page 14 Mikoto: I wasn't listening because the part just now was the most difficult... Yourou: Guh! Yourou: T-that brat... Guy: Woah, did you see that just now!? Guy: Yeah, I did! Guy: The hardest part was just now...when he was cutting near the rib cage, right? Guy: Of course. Guy: It's in the deepest part of the back, so no matter how much you try to pull the opening, you can't really see much inside.
Page 15 Guy: But he didn't even use the endoscope... Guy: Yeah, his skills rival those of a god. Maria: Ayame-sensei, the most difficult part you mentioned before the operation... Ayame: Yeah, it was that. Ayame: But in reality, it's not that easy you know. Mikoto correctly grasped the size of the muscle, so that's why he doesn't need to be able to see. Maria: Saijou-sensei is really amazing! Sadame(thought): ...Th...this is bad. Sadame(thought): Even the observers around us up here on the second floor are all speaking out in excitement...
Page 16 Sadame(thought): At this rate, it'll turn out to be like always. Yourou: Listen up, if you didn't hear it before, I'll say it again... Yourou: When you cut the lower portion, the bloodflow... Mikoto: Oh yeah, you were talking about that before. Yourou: So...so you were listening after all!! Mikoto: But there is no need to worry about the blood vessels. Diagram: The muscle will go through the rib cage. Mikoto: I will make the muscle go through the ribs... Mikoto: And supercharge it! Yourou: !? Yourou: Su...supercharge!?
Page 17 Yourou: Sa-Sadame-chan, what is it? Some kind of nutrient? Sadame: Probably not. Sadame(thought): Supercharge...I have heard before that it's a new technique of some kind... Mikoto: Please start preparing the microscope. Woman: Yes sir. Sadame: Oh no, that's right! The microscope...!! Yourou: Wh, what is it? Sadame: To be honest, I didn't pay attention to the fact that the microscope was placed in this room. Sadame: Like you already know, microscopes like that will not be placed in operating rooms unless the surgeon is planning to sew up blood vessels thinner than 1mm. Sadame: In other words, from the very beginning, Saijou already predicted our objections...
Page 18 Sadame: In addition to saving the nerves, he is planning to connect the tiny vessels surrounding the cut, in order to increase the bloodflow that was slightly weakened! Yourou: Wh-what did you say!? Sadame(thought): That's right...this is the so-called supercharge! Sadame(thought): Heh, how ironic. Sadame: To lose so completely actually feels good. Sadame: Excellent! Sadame: This is my utter defeat!https://mangahelpers.com/t/cookie-on-fire/releases/26796[English] [Translation] Saijô no Meii 28 by cookie_on_fire2010-12-24T07:08:00+00:00cookie_on_fireadmin@mangahelpers.comReserved for Trinity BAKumA. Do not use without my permission.
Page 1 Chapter 28: The Mystery of Life
Page 2 Maria: Listen up everyone, This is how it went. Maria: "I'm going to make myself the standard!" Maria: So it must mean that Saijou-sensei is determined to become the "Best Doctor" right? Maria: I'm so electrified. Ayame(thought): Electrified, you say... Beside the head: Who still says that these days... Ayame: Oh well, if Mikoto has the motivation, then I welcome the idea whole-heartedly. Ayame: Miyabi, did you push him into it? Miyabi: What a terrible way of putting it.
Page 3 Miyabi: I would like you to say that I gave some sound advice. Miyabi: Normally, I also hate sticking my nose into anything so political... Miyabi: In this case, I don't want the hospital to be directed by the associate director, who's only concerned about power. Miyabi: That's why... Ayame: I know. Ayame: Besides what you said, I want Mikoto to be chosen as the "Best Doctor". Ayame: Although he said before that admin stuff is a pain... Mikoto: If I did that, I would have less time for operations, Mikoto: And I'll have less patients to examine. Maria: Th..that's true, but...
Page 4 Ayame: He can just leave all that work to Sakamoto-san. Maria: Yeah, yeah. Miyabi: That's true. Ryuuma: Hey! Ryuuma: Why does it have to be me!? Ryuuma: First of all, I came from Teiou University. Ayame: That's got nothing to do with it. Ayame: Sakamoto-san, you're not bound by Teiou or Saihama, right? Ayame: Besides, the person in charge of human resources or making important decisions should be someone who has gone through painful experiences. Ayame: I bet my bro put pressure on that doctor called Sakamoto using his powers. Ayame: He can't just buy however many houses he wants, and having to take a sick son to an unfamiliar place... Ayame: Am I wrong? Ryuuma: W-well...when you put it that way, I can't really say no to it...
Page 5 Ryuuma: Although that's not easy to achieve you know. Ryuuma: At this point in time, the person who's most likely chosen as the Best Doctor is probably the associate director, who's both young and competent... Ryuuma: From now on, the more he wants to destroy Mikoto, the more likely he's going to make some kind of bargain with Teiou itself. Maria: ...Teiou itself? Ryuuma: Yeah. Ryuuma: I don't really want to say anything bad about my own school, but... Ryuuma: In Teiou University, Ryuuma: There exists a devil. Maria(thought): Devil...!?
Page 6 Box: Teiou University--- Sign: Chancellor's Office Man: Sadame-chan, I hear that these days you have it pretty rough. Sadame: ...No, that's not the case. Man: There's no need to hid it. Man: Isn't it amazing though? The secret weapon from Saihama.
Page 7 Yourou: That rumor travelled all the way to me you know. Box: Teiou University Chancellor, Yourou Shigetoshi Yourou: Ah~~ More of them died. Yourou: This is a problem. Tropical fishes are so weak that they die right away. Sadame: ...Chancellor... Yourou: But, if you scoop them up with a net like this... Yourou: There are some that will suddenly revive.
Page 8 Yourou: See? Yourou: Just a while ago it was out of energy and simply floating around... But when it instinctively sensed a foreign enemy, it's using its last strength to struggle. Yourou: See~~ I'm a foreign enemy. Above head: Hm~~~ Foreign, foreign. Yourou: This is the mystery of life.
Page 9 Yourou: We also want to learn this sense of desperation, don't we? Sadame(thought): Tch. Sadame(thought): What a fiend...!! Maria: D-devil you say? You must be exaggerating... Ryuuma: I'm not really exaggerating. Ryuuma: There are people in the world who deal with life and death for decades and decades. Some of them become crazy.
Page 10 Ryuuma: In that way, calling him a devil makes him sound cuter. Maria(thought): ... Maria: B-but Saijou-sensei will be just fine. Maria: If the opponent is a devil, then he is hero. Maria: He will definitely defeat a guy like that! Ryuuma: ... Ryuuma: That would be nice... Ayame: But he sure is late, that hero-sama. Ayame: Even though today we're supposed to have a meeting for the diaphragm reconstruction procedure... Diagram: Slice back muscle -> Slip the muscle through the rib cage -> The back muscle will be used for part of diaphragm SFX: *Creak---*
Page 11 Mikoto: Sorry I'm late. Mikoto: The Sawa Nasuka-chan that was discharged a while back came to visit me. Mikoto: So we were talking for a bit--- Maria: ...But sensei, what is that kiss mark? Mikoto: Huh? Mikoto: Ah, you're right. Mikoto: I didn't know what to do when Nasuka-chan suddenly clung on to me... Mikoto: Sena-san, Mikoto: If you have something to wipe with, Mikoto: Can you please bring it... Beside head: Woah!
Page 12 Ayame: Um... Ayame: Being a hero is fine and all, but what's with being knocked out so easily by a resident? Miyabi: Well, it is pretty tough to defend against the thing used for wiping (sofa). Box: The day of the operation--- Mikoto: Alright, let's get going. Ayame: Ok. Maria: Alright.
Page 13 Maria: For some reason there are more people here than usual. Maria: Are there a lot of observers? Ayame: Maybe. Ayame: Using back muscle to reconstruct diaphragm is pretty ground-breaking compared with other procedures... Diagram: Teiou's Method: Simply use Gore-Tex material. When the body grows, follow-up operations are necessary. Saihama's Method: Use stomach muscle for diaphragm. The stomach wall becomes thinner, and can potentially swell. Mikoto's Method: Use back muscle for diaphragm. Although the muscle will become thinner, it will not swell due to the bones. Ayame: To be honest, this procedure feels extremely difficult to complete, even for me. Maria: E-even for you, Ayame-sensei? Ayame: Well, and that I originally specialized in heart surgeries...
Page 14 Ayame: Besides that, do you know what you have be careful the most for this diaphragm reconstruction procedure? Maria: O...of course I know at least that much! Maria: Don't loosen the newly attached diaphragm. Ayame: That's right. Ayame: If the new diaphragm is loose, it can cause a dangerous phenomenon called "see-saw respiration". Diagram: Correctly Attached Diaphragm, Inhaling, Exhaling Loosely Attached Diaphragm (See-saw Respiration), Inhaling, Exhaling As the picture shows, "see-saw respiration" is when both sides of the diaphragm move in opposite directions. In this case, the lungs have to breathe through the difference in pressure on the two sides of the diaphragm and not by themselves. Ayame: To prevent it from getting loose, tightening it a little bit more than necessary would be better. Maria: Ok... Maria: But what does that have anything to do with the difficulty of this procedure?
Page 15 Maria: Since we're using the back muscle, if we properly calculate the correct size, then it shouldn't be that hard... Ayame: Um, you know... Ayame: ...Oh well. Ayame: You'll understand the difficulty when you assist us. Ayame: Rather than that... Maria: Wh-what is it? Ayame: Isn't this strange, no matter how you look at it?
Page 16 Ayame: The operation room is full of people. Maria: ! Maria: Wh-why are there so many? Ayame: Beats me. Miyabi: Oh, everyone's here. Ayame: Miyabi, what's happening here? Miyabi: This is big. Miyabi: It's the devil that Sakamoto-san mentioned. Miyabi: He came to observe the procedure.
Page 17 Yourou: There are a lot of observers. Yourou: At this rate, I won't be able to see who the secret weapon is. Sadame: Seems like he hasn't come into the room yet. Sadame: This turnout is probably thanks to your influence. Sadame: All I did was to send an email to all the Teiou graduates saying that "The chancellor will be observing". Yourou: Hohoho. Sadame: Ah, He's here. Sadame: It's the one walking in the front. Yourou: Oh, what a cute lad.
Page 18 Yourou: It makes me want to eat him. Sadame(thought): ...Hmph, he is a complete demon. Sadame(thought): But, even the demon has his uses. Sadame(thought): His influence, authority, and connections are all useful. Sadame(thought): However, besides bringing him here, I don't have any more schemes. Sadame(thought): Saijou Mikoto, this will be the final battle between you and I!https://mangahelpers.com/t/phichan/releases/25428[English] [Translation] Saijô no Meii 27 by phichan2010-10-17T07:22:47+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 27 By phichan, to be used exclusively by Trinity Bakuma
Page 39
Chapter 27 – Ties of Obligation
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Sena: That’s a nice looking clinic.
Sena: Is this postcard from Dr. Haga? Mikoto: Yup.
Mikoto: He wanted us to know that he opened up a place in his hometown. Sena: Cool. Can I read it?
Sena: Let’s see…Dear Saijou Mikoto, Postcard: I found a great looking place to start a clinic, so I went ahead and rented it.
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Postcard: I was able to hire a wonderful nurse, and we are frantically preparing for our grand opening.
Haga: Isn’t she pretty? Though she doesn’t stand up to Toujou Meiko-chan. Mikoto: Haha.
Postcard: PS: Opening my own place means there are no ties of obligation, and it feels pretty nice. Sena: Wow. Miyabi: I’m glad he’s happy about how it all turned out. Ayame: Yeah.
Ayame: In the end, he was tied to his University like everyone else. This is for the best.
Mikoto: Hey Ayame. Mikoto: I don’t really get what he means by “ties of obligation”.
Ayame: Oh. Ayame: They don’t have that system in America do they.
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Ayame: It refers to the system in Japan where a medical department becomes a human resources organization, headed by a single professor.
Ayame: For example, let’s say there’s a Prof. A at Tokyo University.
Ayame: Prof. A not only is able to dispatch doctors to affiliated hospitals, but he actually also has the authority to send them to other various hospitals.
Ayame: He was talking about being stuck in that system.
Mikoto: How are they able to do that? Mikoto: The other hospitals are other hospitals right? Ayame: True, but…
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Ayame: Since all doctors are unique in their skill and experience, if left to their own devices, they would all want to work in the city. The rural areas wouldn’t have enough doctors.
Ayame: So the professors from various universities got together and decided that it was better for everyone if they evaluated their employees and dispersed them accordingly, to some extent forcefully. Mikoto: Hmm.
Mikoto: So, Dr. Shindou dispatches his workers too? Ayame: However
Ayame: This system has a glaring flaw.
Mikoto: A flaw? Ayame: Yeah.
Ayame: If this were a perfect world, the professors would all be unbiased in their decisions, but in the end they’re only human.
Ayame: The bad ones will abuse their power and send anyone they don’t like to waste away in the middle of nowhere.
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Ayame: Academic harassment, power harassment, sexual harassment…you name it and there’s probably a professor doing it.
Academic Harassment – Things like taking your employees papers for your own Bad Doctor: This paper is mine, right?
Power Harassment – Verbally and emotionally abusing your workers. Bad doctor: You’re the worst piece of trash I’ve ever seen!
Sexual Harassment – Using your authority to extort sexual favors. Bad doctor: You and me, tonight?
Mikoto: I wonder which one Dr. Shindou is. Shindou: I wouldn’t do any of those things!
Mikoto: So everyone is competing to get that kind of power? Ayame: Of course they are.
Ayame: And if it was only that, then it’d just be like any other company, employees looking to climb up the ladder. Ayame: But for doctors, it isn’t just vertical they climb, but also horizontal. Even the departments compete with each other within a hospital.
Page 45
Ayame: This is one reason why everyone hates you here.
Ayame: Let’s pretend this Heisei Central Hospital is a private hospital of equal scale called Alpha University Hospital.
Ayame: In Alpha hospital, the gynecology, pediatric surgery and orthopedic surgery departments are made up mostly of doctors from KO University.
Orthopedics Pediatric surgery Gynecology
Ayame: And the gastrointestinal surgery, neurology and cardiovascular surgery departments are made up mostly of doctors from TO university.
Cardiovascular surgery Neurology Gastrointestinal surgery
Ayame: The plastic surgery department was mostly KO University, but due to a certain incident the torch was passed from KO to HO, then from HO to TO university. At which point, doctors are brought in from different hospitals.
Plastic surgery
Ayame: And that’s how, even within a hospital, the balance of power can affect from which hospitals doctors are brought in from. As a result, there are constant struggles for power that are constantly changing the balance.
Page 46
Ayame: It’d be like if you took workers from Toyota, Nissan and Honda and put them to work in the same factory. They would be constantly competing with each other.
Ayame: That’s why faction forming is very common.
Ayame: Every department in every hospital wants to increase the number of posts they can dispatch to, so there isn’t much socializing between different university doctors. Mikoto: I see.
Mikoto: But what does that have to do with me being hated? Ayame: Everyone is scared of you.
Ayame: The primary powers of this hospital are Teiou University, lead by my brother, and Saihama University, lead by the Director. The departments from those hospitals are constantly fighting for hegemony.
Ayame: You came here by the recommendation of Prof. Shindou of Saihama right?
Page 47
Ayame: Everyone from Teiou sees you as Saihama’s secret weapon, no matter your actual intentions. Mikoto: What?!
Mikoto: That’s not my intention at all… Ayame: It’s not your fault.
Ayame: A normal hospital has enough competition as it is, but this hospital also has the “best doctor” privilege.
Ayame: If someone from Saihama or Teiou were to come out on top Ayame: It’s thought that not just he would hold all the power, but also the university he comes from.
Page 48
Ayame: It’s no surprise that someone as skilled and famous as you would be feared and hated.
Mikoto: *sigh* This just got a lot more complicated. Miyabi: No. Miyabi: This is only the beginning.
Miyabi: I’ve worked at several other hospitals.
Miyabi: I’ve seen a university’s entire surgery team get swapped out at a chairman’s single word.
Miyabi: It’s not uncommon that surgery teams from different schools use different procedures and techniques.
Page 49
Miyabi: Suddenly changing the attending physician only hurts the patient. Mikoto: Hmmm.
Mikoto: This is starting to anger me. Miyabi: Good.
Miyabi: Channel that anger into reforming our hospital.
Miyabi: Even if you won’t admit it, everyone else is starting to see you as the “best doctor”.
Miyabi: It seems you were only intent on fixing the lack of pediatric surgeons.
Miyabi: But for your sake,
Miyabi: The patients’ sakes,
Miyabi: And for the sake of all the doctors trapped in this god forsaken system
Page 50
Miyabi: I think it’s time you stepped up and became a leader.
Mikoto: A leader…
Miyabi: But that’s just me.
Sign: The next day Sign: Examination room 32
Page 51
Mikoto: So Mikoto: Your son had a surgery to repair a herniated diaphragm? Mom: Yes.
Mom: Because he was born without half his diaphragm, they immediately inserted a Gore-Tex prosthesis.
A healthy person’s diaphragm
Gore-Tex This patient’s diaphragm
Mom: It’s just, according to him, his stomach has felt taut. Mikoto: I see… Mikoto: Gore-Tex…
Mikoto: Where was that first surgery done? Mom: At a Teiou affiliated hospital.
Mom: But that attending physician got sent out to the countryside.
Mom: And I happened to hear that some amazing doctor has come to this hospital… Mikoto: Hahaha Mikoto: Is that so?
Page 52
Mikoto: We’ll take a closer look his stomach. If you could take him to the ultrasound examination room. Mom: Okay.
Sena: Um…Dr. Saijou. If his stomach feels taut, does that mean… Mikoto: Yeah.
5 years old 0 years old Growth
The body grows, but the Gore-Tex doesn’t. As a result, it becomes taut.
Mikoto: Since Gore-Tex doesn’t grow, it’s become too small for his body.
Mikoto: It doesn’t look too serious yet, but there might be a tear already. We’ll probably have to operate after the tests are done. Sena: I see…
Page 53
Mikoto: What’s wrong? Sena: Oh, nothing! It’s no big deal, but…
Sena: I’ve heard that Teiou and Saihama use different procedures for this surgery.
Sena: At Teiou, they just put in another, bigger piece of Gore-Tex.
Instert a larger piece of Gore-Tex
Sena: At Saihama, they peel off muscle from behind the ribs and use it as a surrogate diaphragm.
Peel muscle from the flank
Turn the muscle into a surrogate diaphragm.
Sena: Both procedures have their pros and cons and are in constant debate.
Teiou’s method: Replacing the Gore-Tex - Pro: The surgery is easy. - Con: Will need more surgeries as the body continues to grow. Saihama’s method: Peel off the flank muscle and use as a surrogate diaphragm. - Pro: As it is muscle, it will grow along with the body. Only one surgery needed. - Con: Since the flank muscle is thinner, when the abdominal pressure increases due to breathing, only the flank muscle expands. Page 53
Sena: Oh, but, Sena: Don’t get me wrong.
Sena: Although I’m from Saihama University, I’m still a resident and not yet interested in departmental competition. I’m okay with either procedure.
Sena: It’s just…no matter which you choose, some people will come to hate you more. Mikoto: I know.
Mikoto: You’re just worried about me. Sena: Yes. Sena: Phew.
Sena: But, there’s still not one more beneficial than the other, even for the patient. Guess he’ll end up alienating one faction or the other… Mikoto: But you know what?
Page 55
Mikoto: I won’t do either procedure.
Mikoto: First, we’ll go through the old incision and make our way around the rib cage to the back.
Enter through the old incision.
Enter the back.
Mikoto: Then, we’ll peel off the back muscle, pull it through the rib cage, and turn it into the diaphragm.
Peel the back muscle.
Pull the back muscle through the rib cage.
Turn the back muscle into a surrogate diaphragm.
Mikoto: Unlike the flank muscles, the back has bones for support so it won’t expand. There shouldn’t be any ill-effects. Sena: He’s right!
Sena: But, if you do that… Mikoto: I don’t care who I make an enemy.
Page 56
Mikoto: I’ve made up my mind.
Mikoto: To make others believe that I’m right,
Mikoto: I’m going to make myself the standard!
https://mangahelpers.com/t/phichan/releases/24735[English] [Translation] Saijô no Meii 26 by phichan2010-09-18T12:27:24+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 26 By phichan, to be used exclusively by Trinity Bakuma
Page 21
Title: A Kind Person.
Page 22
Miyabi: My name is Koushima Miyabi. I’m an anesthesiologist.
Miyabi: I liked being an anesthesiologist because you weren’t often mixed up with what other doctors were doing, but…
Miyabi: Because of the incident earlier, I’ve gotten myself into big trouble.
Miyabi: I’ve realized one thing from this incident though: nothing good comes from getting into the affairs of others.
Miyabi: The kinder a person is, the more he risks losing.
Page 23
Miyabi: Saijou Mikoto is the perfect example. Mikoto: C’mon, please stop crying.
Sena: But, you were doing everything for the patient, yet…
Sena: You might get torn down by the evil mayor (the Asst. Director) just like the statue from the picture book “The Happy Prince”!
Page 24
Mikoto: What is she talking about? Miyabi: Yes, this is the harsh reality.
Sena: And his friend the sparrow (Ayame) will die from the cold. Mikoto: Um, isn’t that just a fairy tale? Miyabi: Mikoto did the right thing, but in the world of medicine Miyabi: It’s a thin line between life-saving and reckless acts. Miyabi: And there are always people who take advantage of this ambiguity.
Miyabi: As a result, potentially effective treatments would be constantly nitpicked and taken apart, and have been piling up over the years to collect dust.
Page 25
Miyabi: It’s the same for medical errors. There’s no one who can draw a perfect line between the unavoidable errors and the criminally negligent.
Miyabi: Because of that, it is unpredictable whether a court judge will favor or disfavor the doctor.
Miyabi: In other words, medicine is all about interpretation.
Miyabi: There is ample room for politics and evil to intervene. Mikoto: Hey. Mikoto: Where’re you going Miyabi?
Miyabi: Oh, just for a walk. Miyabi: Of course, it’s not just a walk.
Page 26
Miyabi: I wouldn’t normally get involved, but I am partially responsible for this mess.
Miyabi: If that man were to abuse his power as the chairman of the ethics committee and twist the truth on the report…
Miyabi: Then, as someone who witnessed the entire operation, I can’t stay quite. Miyabi: Excuse me.
Miyabi: I have to stand up to this wily, notorious, poker-faced man…!
Miyabi: This is odd…
Page 27
Miyabi: This is beyond poker-face.
Miyabi: He’s like a statue…no, a Haniwa! Miyabi: Um, Asst. Director?
Miyabi: Asst. …
Sadame: Ah.
Sadame: Oh, well if it isn’t Dr. Koushima. Sadame: What can I do for you? Miyabi: Well…
Page 28
Miyabi: It’s about yesterday’s surgery’s incident report… Sadame: Oh, you don’t need to worry about that.
Sadame: Please leave. Miyabi: But, I need to say something… Miyabi: What’s going on?
Miyabi: It’s like he’s lost all of his energy. Sadame: Oh, and another thing.
Sadame: If it’s about Dr. Saijou receiving a commendation from the ethics committee, the answer is no. Miyabi: A commendation?!
Miyabi: What are you talking about? Sadame: Enough talking.
Sadame: Please, just leave me alone for today.
Page 29
Miyabi: What was all that?
Miyabi: And what did he mean by a commendation from the ethics committee? Haga: Oh, Dr. Koushima.
Haga: I suppose I should apologize to you also about yesterday. Miyabi: Dr. Haga…
Miyabi: You’re actually just the person I was looking for.
Miyabi: If you’re even thinking about bending the truth in the incident report… Haga: Ah, yes.
Haga: I suppose I did bend the truth a little.
Page 30
Haga: In Dr. Saijou’s favor.
Haga: Oh, it was brilliant.
Haga: To see the Asst. Director freeze into a Haniwa like that…
Haga: And just for the hell of it, I also recommended that Dr. Saijou get a commendation from the ethics committee. Miyabi: For the hell of it…?
Miyabi: What in the world were you thinking?
Page 31
Miyabi: If you write the incident report in Mikoto’s favor, then your mistake will be made even worse looking.
Haga: True. Haga: Writing that report will end my career as a heart surgeon.
Haga: But more importantly…
Haga: I can stay a doctor.
Page 32
Miyabi: Dr. Haga… Haga: Saijou-kun opened my eyes during that surgery.
Haga: That licenses, colleges and titles don’t make you a doctor.
Haga: It’s your heart.
Miyabi: But… Haga: Aren’t you the same?
Haga: From what I’ve heard, you’re supposed be the lone wolf, mercenary anesthesiologist, scouted by the Director himself.
Haga: And yet here you are, talking up the Asst. Director and me. Miyabi: Well, that’s…
Page 33
Haga: Honestly, I’m very jealous. Maybe if I had friends like you guys when I was younger…
Haga: Dr. Koushima, please tell Dr. Saijou for me.
Haga: That his righteousness has gotten through to me.
Sign: Pediatric surgery. Sena: Dr. Ayame!
Sena: Is it true that Dr. Haga is leaving this hospital?! Ayame: Yeah…
Page 34
Ayame: Apparently, he’s quitting heart surgery and moving back to the little town where he’s from and opening a small cardiovascular medicine practice.
Ayame: Really… Ayame: He’s such an idiot.
Ayame: It takes so long to refine the technique for heart surgery, and now he’s thrown it all away.
Ayame: Well, that loser probably wouldn’t have gotten any better anyway. At least he was able to show off one last time. Sena: Hold on…
Sena: That’s enough, Dr Ayame!
Page 35
Sena: You don’t have to go that far! Sena: Dr. Haga ended up doing the right thing!
Page 36
Miyabi: Hey, Sena-san.
Miyabi: It’s about this picture book. Sena: Yes?
Miyabi: It’s true that in the end, the prince’s statue gets torn down and the sparrow dies. Miyabi: But, in the very, very end…
Miyabi: Don’t the prince and the sparrow get taken to heaven?
Sena: Oh…!
Page 37
Sena: That’s right…
Miyabi: My name is Koushima Miyabi. I’m an anesthesiologist.
Miyabi: I’ve come to realize something from all this.
Page 38
Miyabi: Kind people don’t always lose everything.
Miyabi: Eventually, they gain something important and irreplaceable. https://mangahelpers.com/t/phichan/releases/24256[English] [Translation] Saijô no Meii Omake 1 by phichan2010-08-26T11:34:39+00:00phichanadmin@mangahelpers.comSaijou no Meii – Volume 4 Omake (cover) + Table of Contents By phichan, to be used exclusively by Trinity Bakuma
K: This is rather sudden, but we can only have three Omakes in this volume K: It’s a page issue. Hat: That…really is sudden.
Hat: Oh well. It’s gonna hurt the “Real-life Accounts of Pediatric Surgeons” section though. Hat: Since it takes up a lot of pages. K: I know, which is why it’s been decided that we’ll do real-life accounts of a different sort.
K: It’ll be called “Hashiguchi’s Real-life Account of Quitting Smoking”!! Hat: Quitting Smoking?!
K: It’ll be a way for you to inform our young readers of the toxins and other dangers of cigarettes through your abstinence from smoking. Sfx: *swipe*
K: So, you are now prohibited from smoking. Hat: Are you serious?!
Table of contents
Chapter 25 – The Happy Prince Chapter 26 – A Kind Person Chapter 27 – The Obligations of Medicine Chapter 28 – The Mystery of Life Chapter 29 – Conventional Wisdom Chapter 30 – What isn’t perfect Chapter 31 – Mikoto’s Weakness Chapter 32 – Mikoto’s Illness Chapter 33 – My Own Rule Chapter 34 – The Skilled Newcomer https://mangahelpers.com/t/phichan/releases/24086[English] [Translation] Saijô no Meii 25 by phichan2010-08-16T05:17:23+00:00phichanadmin@mangahelpers.comSaijou no Meii – Chapter 25 By phichan – for exclusive use by Trinity Bakuma
Page 3
Chapter 25 – The Happy Prince
Page 4
Sign: Pediatric Surgery
Ryuuma: Hey, I remember this.
Sena: A picture book?
Sena: Oh, isn’t that “The Happy Prince”? Ryuuma: Yeah.
Ryuuma: I read this to Kazuma a few years ago.
Ryuuma: I found it while I was sorting my things. Sena: Fufufu.
Page 5
Sena: I liked that story too.
Sena: If I remember right, it’s about a statue of a happy prince that helps the town’s poor and sick.
Sena: The prince’s statue asks a sparrow to take his sapphire eyes and gold leaf to the people in need…
Sena: And in the end, the statue gets torn down because it lost all its beauty. Ryuuma: That’s right.
Ryuuma: It’s a sad but moving tale…
Page 6
Ryuuma: It reminds me of Saijou… Sena: Huh?
Ryuuma: The happy prince.
Ryuuma: Saijou is always saving people, no matter what the cost.
Sena: You’re right!
Sena: He’s so cool! That’s what a doctor should be! Ryuuma: True…
Ryuuma: But, I’m a little worried.
Page 7
Ryuuma: Just like how the happy prince’s statue gets taken down because it loses all its jewels and gold leaf…
Ryuuma: Saijou may end up losing something really important.
Ryuuma: Doesn’t it feel that way?
Haga: Are you crazy?!
Haga: How can you not care if you lose your medical license?!
Page 8
Haga: Besides! I’m the one who messed up the surgery! Haga: Why would you… Saijou: It’s okay.
Saijou: I’m doing this for myself, not anyone else.
Ayame: …(sigh).
Ayame: Alright Mikoto, I’ll assist you.
Ayame: Here’s what we’ll do.
Ayame: First, we’ll administer heparin into the patient, then you and I will stick an indwelling needle into the aorta and the pulmonary artery respectively.
Pulmonary artery Aorta
Pull out Blood flow External needle Internal needle
O – The indwelling needle is used for IV drips. There is an internal needle (a hard needle) inside an external needle (a soft tube). Once inserted into a blood vessel, you pull out the internal needle, leaving behind the external needle.
Page 9
Ayame: Once they’re inserted, I’ll hold onto both of the needles so they don’t pop out while you pull out the internal needle from the one in the aorta and connect the tube.
*The two hands holding the needles both say “Ayame”. The hand(s) holding the tube says “Mikoto”
Ayame: Then you’ll do the same with the one in the pulmonary artery to secure the blood flow.
Ayame: Lastly, you’ll suture in the needles so they don’t pop out on their own.
Ayame: Okay? Mikoto: Yeah.
Ayame: Still, this is way easier said than done. You can’t imagine the kind of blood spurt that’ll come when you pull out the needle from the aorta.
Ayame: So Miyabi… Miyabi: I know.
Miyabi: I don’t particularly like this plan either, but there’s no other choice.
Page 10
Miyabi: I’ll do my best to keep the patient stabilized when the time comes. Ayame: Good.
Mikoto: Let’s start.
Mikoto: Inserting the indwelling needle into the aorta.
Mikoto: Insertion complete. Saijou: Ayame!
Ayame: Insertion into the pulmonary artery complete.
Ayame: We’re running out of time, Mikoto! Ayame: I’ve got the needles. Just pull them out and connect the tube! Saijou: Okay.
Page 11
Sfx: *heart thumping*
Ayame: Once that needle comes out, it’s gonna be a geyser of blood.
Ayame: It all comes down to how fast Mikoto can connect the tubes.
Saijou: Here I go!
Page 12
Sfx: *Woosh*
Sign: Pediatric Surgery.
Ryuuma: What’d you say?!
Ryuuma: There was trouble? Sena: Yes.
Page 13
Sena: I just heard this from a nurse. Dr. Ayame is gathering clinical engineers to setup a heart-lung machine.
Ryuuma: Are you serious?
Ryuuma: A heart-lung machine during a pulmonary atresia surgery means big trouble!
Ryuuma: I hope it all goes okay… Saijou: We’re back! Ayame: Yo. Miyabi: Hello.
Sena: You’re all back?! Ryuuma: Hey! You guys!
Ryuuma: We heard something went wrong! Is everything okay?! Saijou: Yeah.
Page 14
Saijou: There was a mishap during the surgery, but it all ended okay.
Saijou: Right, Ayame? Ayame: Indeed.
Ayame: Thanks to Mikoto, we were able to buy enough time to attach the heart-lung machine. The patient is fine.
Ayame: In the end, we were able to connect the artificial blood vessel and complete the original purpose of the surgery. Sfx: *phew* Ryuuma: That’s good…
Ayame: But, no matter how well the patient does…
Ayame: There’s no telling what’ll happen to us.
Page 15
Ryuuma: I see…
Ryuuma: So because Mikoto thought that setting up the heart-lung machine would take too long, Ryuuma: You guys thought it necessary to first connect the aorta and the pulmonary artery? Ayame: That’s pretty much it.
Ayame: If we hadn’t done that, that kid would’ve definitely lost brain function from lack of oxygen. Miyabi: Exactly.
Miyabi: As an anesthesiologist, I agree with them on that point.
Miyabi: Even looking back on it now, there were no other options. I can say with certainty that it was the only way.
Page 16
Miyabi: It was the only way, but… Sena: But what?
Sena: You guys saved the patient. Shouldn’t you be getting praised for it? Ayame: That’s not how it works.
Ayame: It was a success so I can’t imagine we’d lose our licenses for it, but it doesn’t change the fact that it was an unorthodox procedure.
Ayame: It’s anyone’s guess as to how the ethics committee will react once they see the incident report.
Sena: It’s not that big a deal if it gets reported is it?
Sena: Dr. Haga was the one who screwed up, Dr. Saijou did nothing wrong. Ayame: Now listen closely…
Ayame: Do you know who writes the incident reports? Sena: No…
Page 17
Ayame: The lead surgeon does!
Ayame: In this case, Haga does.
Sena: But, if he lies about anything someone will notice… Ayame: Maybe.
Ayame: But at the very least he can downplay his own mistakes.
Ayame: “I accidentally nicked the arterial duct, but it wasn’t that serious of a problem. Rather, Dr. Saijou’s actions were more dangerous.”
Ayame: …is something he could write. Sena: But that’s…
Sena: Wait, hold on a second!
Page 18
Sena: The ethics committee should be able to see through that kind of incident report! Ayame: Ideally, yes.
Ayame: But normally, the ethics committee chair is held by the hospital’s Asst. Director. Sena: Normally?
Sena: Then, you’re saying… Ayame: Yeah, that’s what I’m saying.
Ayame: This hospital’s ethics committee chairman is my brother.
Ayame: He now holds enough power to get rid of Mikoto and the rest of us.
Page 19
Sign: Asst. Director’s Office.
Haga: I am very sorry. Haga: I can’t even begin to apologize for my carelessness. Haga: It was all my fault.
Haga: I was too preoccupied with Saijou and attempted a surgery I wasn’t prepared for. Haga: Of course I’ll accept whatever punishement… Brother: Dr. Haga.
Brother: I don’t know what you’re talking about. Haga: Huh?
Brother: If we punished every doctor that accidentally cut one or two blood vessels, we wouldn’t have any surgeons left in Japan.
Haga: But, that’s not… Brother: While it’s true that the one you cut was particularly bad,
Page 20
Brother: The ones who really need to be punished are the one who performed a dangerous life-saving measure just to show off their skills.
Brother: Well, at the very least…
Brother: It would be in your best interest to write that in the incident report.
Brother: But that’s just my opinion. Sfx: *glare* Haga: What is he saying…?! https://mangahelpers.com/t/phichan/releases/22722[English] [Translation] Saijô no Meii Omake 3 by phichan2010-06-04T04:12:06+00:00phichanadmin@mangahelpers.comSaijou no Meii - vol3 Omake By phichan To be used exclusively by Trinity Bakuma
Page 180
Omake <3 *A continuation from the 5 panels on the front cover.
Afro: Hello, everyone.
Afro: This is Irie Kenzou. For some reason, I’ve been brought out to show you how amazing real pediatric surgeons really are. K: Enough with the introduction, just get on with it. Hat: Yeah, yeah!
Page 181
Hat: I gotta draw up 9 pages of this you know!
Afro: Then let’s begin!
Afro: As far as surgeons in the field of pediatrics go, this is the man we have to mention.
Afro: He is Dr. Iwanaka Tadashi, a professor of Tokyo University, and he is also the supervisor for our medical content.
Afro: There are numerous things about Dr. Iwanaka we could talk about, but first we’ll talk about his amazing surgery speed.
Page 182
Afro: One day, when we were interviewing him for ideas… K: Um, I have a question for you Dr. Iwanaka. Iwanaka: What is it?
K: You said earlier that a normal doctor could take up to two hours on an adrenal gland tumor removal, right?
K: So isn’t Mikoto doing it in forty minutes too fast? Iwanaka: Not at all.
Iwanaka: Since I can do it even faster.
Afro: And so, most of Mikoto’s surgery times are based off of this man’s surgeries.
Page 183
And so, page 93 of the first volume seemed sort of ridiculous as they were based off of this interview. Flashback: Refer to ch2 p21
Afro: So for those readers who are skeptical that people as good as Mikoto exist, there is actually someone even better in real life.
Afro: Also, Dr Iwanaka is very particular about the medicine.
Afro: For example, while interviewing for the ovarian cysts from this volume… Iwanaka: By the way, K-san, Irie-san.
Iwanaka: When Mikoto is pulling the cyst through the stomach, you should have him cut it with a laser rather than draining it out. K: Eh?
Page 184
K: Draining is no good? Iwanaka: Nope.
Iwanaka: The contents of most ovarian cysts have the viscosity close to water so it’s easy to drain, Iwanaka: But sometimes the cyst has mucinous contents, which are thick and syrupy.
Mucinous (syrupy) Most Ovarian Cysts (watery)
Iwanaka: First of all, it’s impossible to tell what the contents of the cyst are before surgery
Iwanaka: so if it happens to be mucinous, you would be unable to drain it because it’s too thick.
It’s too thick to drain! Iwanaka: A surgeon of Mikoto’s caliber would use the laser to prepare for either outcome. K: I see…
Afro: …and that’s why on page 24 of volume 3 Mikoto cuts the cyst with a laser.
Afro: Unfortunately we were unable to fit this explanation into the manga itself, but we’re giving it to you now.
Hat: Wow, Dr. Iwanaka really is amazing. K: Right?
K: What’s more, even though he’s made professor, he still goes to sleep at 12 and wakes up at 5 every day to save children’s lives.
Page 186
K: No matter what time I go to sleep, it’s all I can do to wake up by five in the evening. Hat: That’s pretty amazing too.
Hat: What kind of lifestyle is that?! K: Now, let’s put my sleeping habits aside…
K: In a way, Dr. Iwanaka is the closest real life semblance of Mikoto. Afro: True.
Afro: Then next, we will introduce the man closely resembling Ayame.
Afro: This is Dr. Suzuki Takaaki, a pediatric heart surgeon and professor at the Saitama Medical University, the man whom I think is the closest to Ayame.
Page 187
Afro: This man boasts an attractive face and figure. I wonder if this is what Ayame will look like when he gets older?
Afro: He listens to every question in a calm and collected manner. Afro: And answers in a cool voice.
Afro: For example, when we were interviewing for this last chapter…
K: I see. So he would directly connect the aorta and the pulmonary artery with an IV tube.
Afro: But, Dr. Suzuki, if he chose to use such a high risk life-saving technique, wouldn’t he later be criticized for it? Suzuki: Most likely, but…
Suzuki: It’s what I would do.
Page 188
Afro: And so, Dr. Suzuki Takaaki’s true power… Hat: Hold up a sec, you guys.
Hat: We only have a few panels left. Afro: Oh really?
Afro: Then, we’ll put the setup here. Hat: Think about the page distribution!
Hat: What about the punch line?! Afro: Hell if I know! Sfx: *various hitting/punching sounds
K: And as you can see, not only are the doctors we interview amazing, but our writer and artist are amazing as well. K: They're fighting (lol). Sfx: *BAM*
Sfx: *more fighting sfx* K: So I ask our readers to watch over us with open hearts <3
Text: Volume 4 is amazing too! We’ll see you there! https://mangahelpers.com/t/phichan/releases/22555[English] [Translation] Saijô no Meii 24 by phichan2010-05-28T04:30:27+00:00phichanadmin@mangahelpers.comSaijou no Meii – ch24 By phichan
To be used exclusively by Trinity Bakuma
Page 159
Title: Primary and secondary.
Page 160
Ryoma: kukuku Ryoma: So Saijou is gonna dress like a girl so he can observe?
Ryoma: That’s gotta suck for him. Sena: Yeah.
Sena: I do feel bad for putting through this, but… Sena: I just have this really bad feeling…
Ryoma: Well it’s not surprising.
Ryoma: Among pediatric surgeries, pulmonary atresia isn’t an especially difficult one to fix, but… Ryoma: The littlest mistake can turn into a huge problem fast. There are a lot of cases that end up that way.
Page 161
Sena: Mistakes? Ryoma: Yeah.
Ryoma: Do you know what pulmonary atresia is? Sena: Yes.
Sena: In a healthy heart, the blood circulates like this.
From the upper body To the rest of the body To the lung To the rest of the body From the lung To the lung From the lung From the lower body.
A healthy heart
Sena: A heart with a pulmonary atresia has its pulmonary valve closed. Instead a hole forms between the atriums for the blood to flow through.
Hole (how the blood flows through)
Closed off (pulmonary valve)
A heart with a pulmonary atresia.
Ryoma: That’s right.
Ryoma: But in that state, no matter how much blood flows through the hole, blood never gets to the lungs. The blood doesn’t get enough oxygen and the child will die.
To the lungs – To the lungs
Closed off Where the blood should flow. Where the patient’s blood is flowing.
Even with a hole opened up, since the pulmonary valve is closed off, blood can’t get to the lungs.
Page 162
Ryoma: It’d all be okay if you have this arterial canal, though. Sena: Right. *Arterial canal.
Sena: With the arterial canal connection, blood can still make it to the lungs.
From the upper body To the rest of the body Arterial canal. To the lung From the lung The Pulmonary Atresia To the lower body. To the lung From the lung From the lower body.
Sena: Unfortunately, this canal naturally closes up soon after birth, so we have to surgically insert an artificial vessel in its place.
Artifical vessel. The arterial canal naturally closes on its own.
The pulmonary atresia.
*Everyone has this arterial canal and it always closes up on its own. For healthy people this isn’t a problem, but people with a pulmonary atresia will die without it. Ryoma: But this arterial canal is narrow and extremely fragile.
Ryoma: In an actual case, one doctor unknowingly severed this arterial canal while peeling away other blood vessels in the vicinity. Sena: Realy?!
Page 163 Sena: If the arterial canal gets severed before the artificial canal is put into place, the blood won’t get to the lungs and get any oxygen…
Sena: That’d be the worst thing that could happen… Ryoma: Hey, hey.
Ryoma: I understand that you’re worried, but there’s no need to be so scared is there?
Ryoma: It’s not like there’s definitely going to be a mistake.
Ryoma: No matter how stupid this guy is, he’s not gonna be stupid enough to cut what he isn’t supposed to cut.
Ayame: If I was cutting, this’d be no problem but…
Ayame: Our lead surgeon is this tool. Sign: (Ayame’s dumbass senior) Chief physician of the cardio-vascular department – Haga Jyunichi *The chief physician is like a chief in a regular company.
Ayame: This douche bag, all he does is show-off and brag about himself even though he has no skills or experience. Miyabi: We have a problem Ayame.
Page 165
Miyabi: Your chief is talking to Mikoto.
Miyabi: If he finds out who she is… Ayame: Nah.
Ayame: It’ll be fine.
Haga: Toujou Meiko-san, is it? What a beautiful name. You’re the first one here to observe my surgery. Meiko: Y-yes…
Haga: Recently, there’s been this upstart pediatric surgeon who apparently got the MSA in America, acting all high-and-mighty.
Haga: You know, pediatric surgeons aren’t even a big deal in America.
Haga: I would know, since I’ve been to Harvard.
Page 166
Miyabi: That guy worked at Harvard? Ayame: No, it was a study abroad.
Haga: I must have performed on at least a thousand bodies…
Miyabi: A thousand is an impressive amount. Ayame: They were all on mice.
Ayame: You know how it goes.
Ayame: People who use their connections with their university medical department to study abroad, but all they do is practice on mice. Miyabi: Ah yes, those people.
Miyabi: They have no skills or know any English, so all they can do is practice on mice. Sfx: *Hahahaha Ayame: Yeah, that’s this guy.
Ayame: All he’s ever done is cut up mice, but when he comes back to Japan he starts bragging to everyone. Haga: I’m sure there will be much to learn from observing a top notch surgery by an adult heart surgeon.
Page 167
Haga: You appear to be quite the beauty, but you can’t become a great surgeon like me with looks alone. Ayame: The only good thing about him is he’s too much of an idiot to be so close to Mikoto and not realize it’s him.
Haga: Oh, and Dr. Ayame. Ayame: yes.
Ayame: What is it? Haga: Well, it’s not a big deal, but…
Haga: There’s only one observer so far, so maybe we should wait a little longer. Ayame: This dumbass…
Ayame: Did he really think he’d get observers for this surgery? Ayame: Listen, Dr. Haga.
Page 168
Ayame: All we’re doing for this surgery is implanting an artificial canal in place of the arterial canal that will close up on its own. We’re only cutting through two thirds of the pericardium.
Artifical canal Arterial canal
2/3 incision
Pericardium.
Ayame: It’s one of the simplest of pediatric surgeries and is hardly anything new.
Ayame: So one observer is enough. Haga: That’s where you’re wrong.
Haga: When that Saijou person operated, I heard that many people came to observe, even though it wasn’t an especially new procedure.
Haga: I bet he was just so jealous of my skills that he pressured the young doctors to come watch. Haga: He’s such a deceitful man. Sfx: *shake Ayame: Miyabi, can I please punch this guy? Miyabi: Hold it in.
Page 169
Haga: We will now begin the operation on a one month old with a pulmonary atresia. Haga: Hmph. In the end, only one observer came.
Haga: Oh well. Haga: Scalpel.
Haga: Even if it’s just one person, at least someone is learning from my abilities.
Page 170
Haga: I’ll show her just how amazing a cardiovascular surgeon really is!
Haga: Cutting through the middle of the chest. Haga: Removing the right thymus.
Haga: Debakey forceps. Miyabi: Hmm. He’s quicker than I thought.
Miyabi: Despite his loudmouth and idiocy, could he actually have above average skills?
Haga: Beginning severing of the brachiocephalic trunk.
brachiocephalic trunk
Pericardium.
* The bottom diagram is a view of the heart without the pericardium. The brachiocephalic trunk is circled. In the diagram there are gaps between the blood vessels, but in actuality there aren’t any. When performing surgery, it is necessary to peel them apart.
Miyabi: No, he’s just trying to show off by speeding through. He’s not being careful at all.
Haga: Hand me the electric scalpel. Ayame: Heh, his speed as surpassed his actual skills.
Page 171
Ayame: When it comes to surgery, it’s more important to do everything properly and carefully, rather than quickly. But this guy…
Ayame: Hm? Ayame: What’s that?
Ayame: There’s something…
Ayame: Wait a second, Dr. Haga.
Haga: Finished peeling away the brachiocephalic trunk.
Ayame: I said wait a second! Haga: Shut up!
Haga: The surgery is going well. Ayame: Like hell it is!
Ayame: Look! There’s a major bleed! Sfx: *glub*
Page 172
Haga: Oh that.
Haga: While I was peeling away the brachiocephalic trunk, I had to cut an abnormal blood vessel. It doesn’t go anywhere important.
Abnormal blood vessel. Aorta Pulmonary artery.
Haga: An abnormal heart like this is bound to have extraneous blood vessels like this.
Haga: Anyways, I’m binding them with a ligature now, so be quiet. Ayame: Listen to me!
Ayame: It’s true that extraneous blood vessels aren’t surprising for a heart like this, but… Ayame: What you just cut…
Ayame: Was probably the second arterial canal!
Page 173
Haga: The second arterial canal?! Ayame: Yeah!
Ayame: Some children have two arterial canals, but the one on the right (the person’s right, the diagram’s left) is hard to find before you open the person up.
From the upper body To the body To the body Hard to find To the lung The Pulmonary Atresia From the lung
* Not only is the right arterial canal rare, but when it does exist it gets hidden behind the lung on images (x-rays, sonogram, etc.) so it is extremely hard to find during examinations.
Ayame: You don’t even know about that?! Haga: I-I do know about that!
Haga: But, even if that’s what I cut, if I connect the artificial canal right away… Miyabi: This isn’t good, Ayame.
Miyabi: I started transfusion and administered phenylephrine, but the oxygen is still dropping!
Miyabi: It looks like he did cut the arterial canal. Ayame: Shit! Haga: Now, everyone calm down.
Page 174
Haga: I told you, since there are two, if the other one can hold… Ayame: Are you fucking serious?!
Ayame: That’s sometimes the case, but since the oxygen saturation is still dropping, the one you cut must have been the primary canal and while the other one is the secondary canal!
From the upper body To the body Secondary To the body Primary To the lung The Pulmonary Atresia From the lung
Ayame: The secondary canal hardly does anything! Haga: No way…
Haga: This can’t be happening…
Page 175
Haga: I, I didn’t know. It’s not my fault…
Haga: Do something about this. Ayame: Useless piece of shit.
Ayame: But now’s not the time worry about him. Ayame: Get a heart-lung machine ASAP!
Ayame: And call for any clinical engineers to get in here! Doctor: Okay!
Ayame: Miyabi, have you given him prostaglandin?! Miyabi: I did!
Ayame: Good, then lower his body temperature as low as you can and… Miyabi: Already on it!
Page 176
Miyabi: I’ve lowered the room temperature and am preparing ice packs and cooled down transfusions.
Miyabi: You don’t need to worry about my end. You just concentrate on your part. Ayame: Thanks! Ayame: Thank god he’s reliable!
Ayame: But no matter how good he is…
Ayame: It’ll take at least fifteen minutes to setup and attach the heart-lung machine.
Ayame: Even if we do save his life, the lack of oxygen will affect his brain. Ayame: Cutting the pericardium!
Ayame: poor thing…
Page 177
Ayame: He’s just a little baby…
Ayame: Damn! Ayame: What would…
Ayame: What would Mikoto… Ayame: What would he do?
Ayame: That’s right! Mikoto! Ayame: What’s he doing?!
Ayame: With his help, maybe we can do this quicker… Mikoto: It’s no use Ayame.
Page 178
Mikoto: We won’t make it in time with that. Ayame: Mikoto!
Haga: Mi-Mikoto…?
Haga: Is that Saijou Mikoto?! Haga: What did he…
Ayame: What do you mean we won’t make it? Do you have another idea? Mikoto: Yeah.
Mikoto: I prepared these while I was putting on my gown.
Mikoto: We’ll stick these right into the heart! Ayame: Two indwelling needles and…an IV tube…
Ayame: Wait! Are you thinking…!
Page 179
Ayame: Are you thinking of sticking them into the aorta and the pulmonary artery to act as the arterial canal?!
Mistakenly severed (ligatured to stop the bleeding) Aorta Pulmonary artery
IV tube
Sfx: *nod*
Ayame: Are you serious?! That’ll cause a major bleed! Mikoto: If we attach the tube right away, we can avoid enough bleeding.
Mikoto: Right now, getting oxygen into the blood is more important than some bleeding. Ayame: But…
Ayame: Are you sure, Mikoto?! If you mess up, you could lose your medical license! Miyabi: He’s right Mikoto.
Miyabi: Even if you succeed, who knows what repercussions there’ll be. Mikoto: But I can’t just let him die.
Page 181
Mikoto: There’s this one doctor whom I respect the most.
Mikoto: He sacrificed everything to save a child.
Mikoto: I don’t care if I lose my license.
Mikoto: I’m still a doctor.
https://mangahelpers.com/t/starfox/releases/21877[English] [Translation] Saijô no Meii 23 by StarFox2010-04-25T13:02:01+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p142:
[Nap room]
[HAAAAAA~~]
Saijou: Good morning, I'm Mikoto Saijou.
Saijou: The pediatric surgery department has finally been revived, and
I'm normally quite a positive person...
Saijou: But recently, I realized something terrible.
Saijou: I couldn't totally follow what Ayame was saying, but it seems
that I'm not a popular guy in this hospital...
[For inset, see Chapter 22, p139&140]
p143:
Miyabi: fuu..
Saijou: Maybe I should ask that person.
Saijou: Uh, excuse me...
Miyabi: Oh, hello.
Miyabi: Dr. Saijou.
Saijou: ?
p144:
Saijou: Do you know me?
Miyabi: Of course.
Miyabi: There's no one in this hospital who hasn't heard of Mikoto
Saijou.
Saijou: Oh... [Oh dear, it looks like I'm VERY unpopular...]
Miyabi: I'm an anesthetist, Miyabi Koushima... Just call me Miyabi.
Saijou: Alright. Saijou: You can call me Mikoto.
Saijou: Pleased to meet you, Miyabi.
Miyabi: Oh, the pleasure's mine.
Miyabi: To be honest, I've been thinking about you the whole time.
p145:
Miyabi: I'm really happy to finally meet you in person.
Saijou: Huh?
Saijou: So you don't hate me?
Miyabi: ???
Miyabi: Hate you? Why?
Saijou: Errr... well to be honest...
Miyabi: Oh, I see... so it's like that, huh...
Miyabi: Well, putting aside the reason why there's so much conflict... The world of doctors in Japan is quite unique, it's very insular...
p146:
Miyabi: It's not exactly like elementary school, you can't be friends
with all 100 people.
Saijou: AWWWW~~
Saijou: Well, what about 99 people?
Miyabi: Ahaha, you just don't give up, do you Mikoto? You're such a
typical doctor.
Miyabi: I'm not sure about 99 people, but do you really need to worry so
much about those around you?
Miyabi: I've been recruited to this hospital, but whether it's here or
the hospital I was at before, I don't have a single friend.
Saijou: .......
Saijou: So you were REALLY unpopular.
Miyabi: That's right, just like you, bud.
Miyabi: However, there is a saying...
p147:
Miyabi: "Being hated by those one has not met or know is testimony to
one's greatness"
Miyabi: So we must have some great talent that people are jealous of.
[Pediatric Surgery]
Saijou: I'm back.
Sena: Welcome back, doctor.
p148:
Sena: Did you rest well?
Saijou: Oh, Miss Sena, it's good that you're here.
Saijou: Actually, I made a new friend in the corridor...
Sena: [a new friend?!]
Saijou: Let me introduce you, this is Dr. Miyabi Koushima.
Saijou: Dr. Miyabi will do.
Sena: ! [What is this pretty woman...?!]
Sena: [This is bad, this is dangerous!!] Oh, Dr. Miyabi, you're so beautiful...
Sena: Can you give me some tips on how to look gorgeous? [Ohohohoho]
149:
Sena: [I won't lose to you, you old hag!!]
Miyabi: Hmm.
Miyabi: Please excuse us for a second, Mikoto.
Miyabi: Miss Sena, I am a man.
Sena: !!
Sena: Wha...what... oh.. no.. I mean, of course, I already knew that!
Miyabi: Don't overdo it.
Miyabi: I get it quite often.
Sena: I'm sorry...
Saijou: ?
p150:
Saijou: What did you say to Miss Sena?
Miyabi: The magic word.
Miyabi: Don't worry about it.
Saijou: Huh...
Saijou: There are others I'd like you to meet- Dr. Sakamoto, the
department head, but he isn't here right now...
Saijou: And then there's Ayame Kiryuu of cardiovascular surgery...
Miyabi: You're really nice, Mikoto. [fufufu]
Saijou: ..... what do you mean?
p151:
Miyabi: Because you're trying share what's yours with others.
Miyabi: But I think you should be careful.
Miyabi: That side of you may be your gift... but sometimes, kindness brings
misfortune.
Saijou: ...... oh bother.
Miyabi: Exactly, that's why I think it's better not to worry too much
about what goes on around...
Ayame: [GRRRRR~~]
Ayame: Man, Ayame: This really sucks!
p152:
Saijou: ...Ayame. What's the matter? You look pissed off.
Ayame: Oh it's nothing really.
Ayame: I was supposed to be the surgeon in this surgery coming up, and
all of a sudden, they make me assistant.
Saijou: Huh, but why?
Ayame: Well actually... I have a surgery from 9 tomorrow morning in
theater 5. It's a pulmonary artery atresia*. [TL note: Atresia is the congenital absence of a normal opening.
Pulmonary artery is the artery taking deoxygenated blood from the heart
to the lungs.]
Sena: Huh?
Sena: Pulmonary artery atresia... isn't that in newborn babies?!
Ayame: Uh huh.
Ayame: There's this dumbass who's my senior- he went to the director and
nagged him for permission.
Sena: But why, all so sudden?
Sena: I thought our cardiovascular surgery department doesn't do
pediatric cases...
Ayame: That's why I'm telling you, this guy is a real dumbass!
p153:
Ayame: Pediatric surgery's been revived, and Mikoto is qualified to
operate on infant hearts.
Ayame: That idiot is so conscious of Mikoto that he's using this
operation to show off our skills [the cardiovascular surgery department].
Sena: But... a reason like that...
Sena: It's absurd for an adult-heart surgeon to operate on an infant
heart, though maybe not the other way around.
Ayame: My thoughts exactly.
Ayame: There are many cases of medical accidents where surgeons with only
experience in operating on adults have tried to do surgery on children.
Ayame: That's why I was originally scheduled to be the surgeon, and him
as the assistant.
Miyabi: So he got all up himself, and because of your links with Mikoto,
scheduled you as the assistant and himself as the surgeon...
Ayame: That's right.
p154:
Ayame: Uh, so who are you, anyway?
Saijou: Oh, Miyabi is an anesthetist.....
Miyabi: I'm Miyabi Koushima.
Miyabi: Pleased to meet you.
Ayame: Sure. [Miyabi Koushima..... that sounds familiar....]
Ayame: Hey hang on! You're the anesthetist for the operation tomorrow,
aren't you? [I saw your name on the schedule board]
Miyabi: Oh, you noticed?
Miyabi: The director, after being pushed by your superior for permission,
seemed quite worried about this operation.
Miyabi: So the director asked me himself to be in the operation tomorrow.
Saijou: Wow.
Saijou: I knew you must be really good.
Miyabi: You're probably just as good, Mikoto.
Miyabi: But to be honest, I too am worried.
p155:
Miyabi: Of course, I intend to do my job without mistakes...
Miyabi: In pediatric heart surgery, one mistake by the surgeon means
instant death on the operating table... It doesn't matter what the anesthetist does.
Sena: .....
[Dying on the table...]
Sena: Please, can't you do anything, Dr. Ayame?
Sena: Like maybe ask the director to put you back in as the surgeon.....
Ayame: The director probably wants that too.
Ayame: But that dumbass is stubborn, there's no way he'll cooperate.
p156:
Ayame: Let alone skill level, I'm his junior after all, so all the
director could say was to bear it just this once.
Sena: Oh, I see...
Sena: Well, there's a first for everyone right? So I get that even
inexperienced people operate sometimes...
Sena: But something like this has happened before... I have a bad feeling
about this...
Saijou: ...... [Yeah...]
Saijou: Well, how about I stand in on the operation?
Saijou: With Ayame as the assistant, Miyabi as the anesthetist, and with
me watching as well, it'll be okay.
Sena: Erm, in that case, maybe...
Miyabi: Ah, that sounds like a plan.
Miyabi: I also agree. Please stand in.
Ayame: Yeah, that sounds good.
Ayame: However, Mikoto.
p157:
Ayame: If you're going to stand in tomorrow, you can do so on one
condition.
Saijou: ?
[Next day-]
Saijou: Uh, Ayame.
Saijou: Do I really need to look like this, just to stand in?
Saijou: Maybe it's okay for Miyabi, but I'm a little...
Ayame: There's no choice.
Ayame: As I said yesterday, my senior is openly jealous of your talent.
[Inset, refer p152, p153]
p158:
Ayame: If he finds out that you're watching, and starts trying to compete
with you, it'll only help cause an incident.
Ayame: Therefore, just for today...
Ayame: You will be standing in as the mysterious Dr. Meiko Toujou*. [TL note: The kanji for Sai in Saijou's name is 'West', Tou is 'East'.
The kanji for Mikoto and Mei in Meiko are the same.]
Saijou: ...... [Scratch scratch]
Miyabi: I told you so. At times, kindness brings misfortune.
Saijou: ..... [You're the one who asked me to do this...]https://mangahelpers.com/t/starfox/releases/21805[English] [Translation] Saijô no Meii 22 by StarFox2010-04-22T10:34:34+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p123:
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!
p124:
Sadame: Pffft...
Sakamoto: What's so funny?
Sadame: Oh, excuse me.
Sadame: I'm not making fun of you.
Sadame: In fact, I absolutely agree with what you just said.
Sakamoto: Eh?
Sadame: To be absolutely honest...
Sadame: If I myself were to become sick, I'd want him to be the surgeon.
Sakamoto: Huh? [What the hell is this guy saying...?]
p125:
Sadame: What are you so surprised about?
Sadame: Taking like/dislike out of the equation, there's no mistaking
that he is a top-class surgeon.
Sadame: It's the same in this operation.
Sadame: Dr. Sakamoto, have you caught onto what Saijou is trying to do to
Kazuma?
Sakamoto: Uh, no...
Sakamoto: I still don't get it...
Sadame: Well since I think I get it now, why don't I tell you.
Sadame: Just now, my brother Ayame said that the greater omentum is
firmly adhered to the small bowel....
[From p115 (Chapter 21) 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]
p126:
Sadame: ...and also, Saijou said that the adhesion was mainly on the
opposite side to the mesentery...
[From p118 (Chapter 21)] [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]
Sadame: So just to recap, putting it all together... The greater omentum, connected to the stomach, is basically stuck to the
small intestine.
Sakamoto: Obviously. [Diagram 1(top right): same as on previous page] [Diagram 2(main diagram): From top to bottom, Liver, gall bladder,
stomach, Greater omentum (Large letters+hiragana in the middle), large
bowel (right hand side), small bowel (lower left)]
Sakamoto: That's why he cut transversely, obviously.
Sakamoto: That way they can separate the adhesions as little as possible
and still get away with it.
Sadame: Exactly.
[Diagram: ] [Top 4, L to R: Greater Omentum, Adhesion, Small intestine, Colon] [Left side: Transverse Cut, On either side of curved arrows: Reflect,
Reflect] [Right Side: Midline cut, in between arrows: separate] [Box label: To cut through the middle as shown on the right, all
adhensions need to be removed first. To cut transversely, however, only
partial removal of adhesions is required.]
p127:
Sadame: However, as you were saying, dividing transversely would result
in the part of the small intestine, separate now from its mesentery, from
Sadame: It's because blood vessels have grown in from the greater omentum
through the adhesions.
Sakamoto: !
Sadame: Normally, the formation of adhesions by themselves wouldn't
result in angiogenesis (formation of blood vessels), but if the adhesions
are so extensive that removal is difficult, then that's a different
story...
Sadame: In that case, angiogenesis can occur.
Sadame: That man, most probably...
p128:
Sadame: He's already seen that this adhesion isn't like most adhesions,
he's seen the new blood vessels coming in from the greater omentum. [Diagram: Upper left: Greater Omentum, Bottom left: Normal adhesion
(transparent), Right: Adhesions with penetrating vessels, Bottom right:
Small intestine]
Sakamoto: But how... that's...
Sadame: Well, if you think of all the other things this man's been doing
up till now, it's probably not that surprising.
Sadame: Operations using adhesions in this way have been done before...
Sadame: even though there are only a few cases in the whole world of it
being done in humans.
Sakamoto: ......
Sadame: Oh.
Sadame: I didn't notice till just now...
Sadame: What's really amazing is that there. [What he's wearing on his head]
Sakamoto: ?
p129:
Sakamoto: The surgical loupe... what about it?
Sadame: Remember, he's doing a bowel extension on a 9 year old child.
Sadame: If he didn't need to visualize very fine vessels, why would he be
wearing a loupe?
Sakamoto: !!
Sadame: Actually it's rather odd that Ayame, as first assistant, is not
wearing a loupe in the first place.
Sadame: Normally, since both the surgeon and the assistant should be
viewing the same operating field, unless there's a special reason,
there's no reason for the surgeon to be using the loupe.
Sakamoto: So, you mean that Saijou...
Sadame: Exactly. He foresaw the adhesions forming in this way, and that
he would need to confirm the presence of those vessels himself, right
from the start...
p130:
Sadame: Even with the current medical technology, it is impossible to
vizualize the extent of adhesions before opening up the abdomen...
meaning that he was already anticipating these eventualities.
Sakamoto: What... what a freak...
Sadame: How fortunate...
Sadame: ...for Kazuma, to have met with such a talented surgeon.
Sakamoto: .....
Saijou: OK, let's wash out the abdominal cavity.
Ayame: Yessir.
Sadame: Oh look, it looks like the operation is drawing to an end.
Sadame: Well, it looks like it's time for me to go now...
p131:
[Please stay tuned for the upcoming antics of the Associate Director]
Sakamoto: Wait, just hang on a sec!
Sakamoto: I mean, just what the hell are you, anyway?
Sakamoto: You realize what a genius Saijou is, yet why do you try to get
in his way?
Sadame: Kukuku... well, I'll ask you.
Sadame: Who the hell would try to tear down someone they don't even
recognize?
Sakamoto: !
Sadame: When one understands that they don't have a chance against one's
opponent, they have 2 options...
Sadame: You can train and train, in the hopes of surpassing them...
Sadame: Or to try and pull them off their pedestal!
Sakamoto: Hmph.
p132:
Sakamoto: So let me guess, you're the latter, huh?
Sadame: ...I won't say that you've hit the nail on the head...
Sadame: People are weak... I'm not the only one who believes this...
Sadame: ...especially those who do not have that man's resolve.
Sakamoto: ?
Sadame: Well, whatever. [SNAP!]
Sadame: If you're still thinking of sticking with him, I hope you're
prepared to face the consequences.
Sakamoto: .....
p133:
[A few days later-] [Pediatric Surgery]
Internist: Hmmm, it seems that Kazuma is doing well since the operation.
Internist: I'll wait a little longer, then I'll start getting him to eat
normally again.
Internist: Especially since his small bowel needs a workout in
preparation for Dr. Saijou's next, novel procedure.
Sakamoto: Hey, hey! Don't think you can say things like that then overdo
it!
p134:
Sakamoto: Kazuma isn't a pig like you, you know.
Internist: Hey, I know, I know! [HAHAHAHAHAHA]
Sakamoto: ..... [Hahaha]
Sakamoto: Thank you, Saijou. I don't know how to thank you...
Saijou: No, no, please don't mention it. [Oh]
Saijou: You needn't thank me.
Sakamoto: Oh yeah, I get it.
Sakamoto: Rather than my thanks, you'd rather me work hard for pediatric
surgery, right?
Sakamoto: I don't know when I'll get sent off somewhere else (TL note:
e.g., rural posting. There is an implicit negative connotation. ), but
wherever I go, that won't change a thing!
p135:
Sakamoto: I'll give it my best from now on, believe me!
Saijou: Dr. Sakamoto...
Internist: Oh yeah, Dr. Saijou, there's something I want to ask you.
Internist: It's regarding the novel surgical procedure... [BAM]
Internist: Uh, what are you doing?
Sena: I musn't tell anyone, so it's better that I don't hear about it!
Internist: Huh???
Sena: ~~~~
Ayame: You idiot.
p136:
Ayame: The first operation was a success, so it's okay to talk about the
second one.
Sena: Oh, is that so.
[Teehee] Ayame: I'm sorry, Dr. Itou. She's a bit stupid. [Please ignore her]
Itou: Oh... right.
[Diagram: (Top to bottom) This operation, Planned operation] Itou: Since we ran into some unexpected adhesions, the small intestine
didn't end up looking like as planned...
Itou: Will this affect the next operation in any way?
Saijou: No, not at all.
Saijou: My new procedure involves cutting the small bowel in a zig-zag
fashion, it really doesn't matter whether it's curved or straight... [TL note: This procedure is actually called 'Serial Transverse
Enteroplasty', developed by Heung-Bae Kim's team at Harvard Medical
School (J Pediatr Surg 2003, 38(3):425).]
Itou: Is that so.
Sena: Zi...Zig-zag?
Saijou: That's right.
p137:
Saijou: For example, let's say that this is the bowel.
Saijou: I just make cuts like so...
Saijou: And here we go.
Saijou: I'm not sure exactly how many times, but now it's many times
longer!
Sena: Oh, I see!
Sena: That's amazing! So this is the new procedure!
Sakamoto: Yes, that's right.
p138:
Sakamoto: I was really surprised too, the first time I heard it- but the
small bowel does get fatter after a while, so it's fine to cut it this
thin.
Sakamoto: Cutting with the GIA stapler, you don't even have to suture the
cut ends, so it's much safer. [GIA Stapler (See Chapter 2) can cut and simultaneously seal the cut end
automatically.]
Sakamoto: It's such a brilliant idea, it's only natural to think that
he's no match for... [Sadame: When one understands that they don't have a chance against one's
opponent, they have 2 options...]
Sakamoto: .....
Sena: ?
Sena: Did you say something?
Sakamoto: Well, to be honest, I...
p139:
Ayame: I see, so my brother actually...
Sakamoto: Yeah.
Sakamoto: Maybe he was just trying to provoke me, I don't know...
Sakamoto: but I got the impression that there are many others who don't
think good of Saijou.
Saijou: Hey Ayame, why do people hate me?
Ayame: It's because you're stupid as well.
[Sena: You and I are alike, doctor(heart)]
Ayame: I'm joking.
Ayame: Okay, seriously though, we really need to take this seriously.
p140:
Ayame: Tales of the medical world in Japan have been told through
countless novels and TV shows... that's just how political it is.
Ayame: Let's face it, even if you were to become a professor, medical
faculty get paid less than those doctors who run their own practice, and
it's not like they have a whole lot of power, either.
Ayame: So, why do they fight each other...
Ayame: Do you understand why, Mikoto?
Saijou: .....https://mangahelpers.com/t/starfox/releases/21552[English] [Translation] Saijô no Meii 21 by StarFox2010-04-13T14:20:50+00:00StarFoxadmin@mangahelpers.com*******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!https://mangahelpers.com/t/phichan/releases/20357[English] [Translation] Saijô no Meii 20 by phichan2010-03-02T01:23:42+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 20 By phichan, to be used exclusively by Trinity Bakuma
Page 80
Title: Hero
Page 81
Ryuuma: You want to treat my son?!
Ryuuma: Keep talking bullshit and I won’t let you off easy, punk!
Ryuuma: Because of my son’s intestinal malrotation, his intestines got constricted and they had to remove the small intestine.
Ryuuma: Now he only has 20 cm of small intestine.
Duodenum | Stomach | 20cm | Same as left diagram, without Small intestine | the “20cm” Large intestine |
Kazuma’s small intestine Normal Small intestine
Ryuuma: So don’t… Mikoto: I know about it.
Mikoto: That’s why he’s unable to naturally absorb the nutrients he needs and has to stay in the hospital to get nutrients intravenously.
Page 82
Ryuuma: Hpmh. If you know all that, then why would you bring it up?
Ryuuma: Although the small intestine will expand as a result of malnutrition, it almost never lengthens itself.
Duodenum stomach Small intestine Doesn’t Large intestine Lengthen X Expands
Ryuuma: No matter how great a surgeon you are, you can’t make something short get longer without transplanting!
Mikoto: I know, but… Ryuuma: Oh, I get it now.
Ryuuma: You were thinking of trying all too popular intestinal transplant, huh?
Ryuuma: Well I thought about that too.
Page 83
Ryuuma: But you know what? Of all the organs, the small intestines are one of the most prone to rejection after transplantation. Only 50% live for more than five years after the transplant.
Ryuuma: So I’ve decided not to transplant… Mikoto: I wasn’t going to transplant.
Ryuuma: You dumbass! I said I’m not going to…
Ryuuma: Wait. Then what were you planning to do? Mikoto: Lengthen the small intestines.
Mikoto: I’m going to cut apart the small intestines and reconnect them to make them longer!
Ryuuma: What do you mean?! Mikoto: I’ll show you.
Page 84
Mikoto: First, take this piece of paper Mikoto: And roll it into a cylinder and pretend it’s the 20 cm of small intestines.
Mikoto: In reaction to being so short, it naturally expands itself in order to absorb more nutrients.
Mikoto: At this point, we cut it lengthwise. Mikoto: And reconnect them end to end… Mikoto: And without transplanting, we can greatly increase the length of his intestines.\
Mikoto: This is called a Bianchi procedure.
Mikoto: With a new method that I’ve devised, I can increase it to four to five times the result. Maybe even more. Ryuuma: Five…five times?!
Page 85
Box: The next day. Sign: Pediatric Surgery.
Ryuuma: Phew… Sfx: *sip*
Ryuuma: I couldn’t get any sleep last night ‘cuz of that guy.
Ryuuma: It’s true that if he can do what he says, Kazuma won’t be stuck in the hospital for the rest of his life.
Ryuuma: No, he could probably even live a perfectly normal life.
Ryuuma: But I don’t trust that Saijou guy yet…
Page 86
Ryuuma: Besides, why did he bring it up now? Sena: Good morning!
Sfx: *glance around*
Sena: Is Dr. Saijou not here yet? Ryuuma: Hpmh. You didn’t know?
Ryuuma: He’s been working consecutive shifts so he’s off today.
Sena: Th-then I’m trapped with this guy in this desolate room?! Ryuuma: Kukuku.
Ryuuma: You look nervous. Ryuuma: But wait til I tell you this.
Page 87
Ryuuma: Last night, Saijou said he would quit this pediatric surgery department.
Ryuuma: There were conditions of course… Ryuuma: How’s that? Surprised?
Sena: …I see. Sena: Aw man. Guess we’re moving again.
Ryuuma: What the hell?! Aren’t you the least bit surprised?! Sena: Uh, not really?
Sena: I mean, there has to be a reason behind it.
Sena: If Dr. Saijou thinks it’s necessary, I’ll follow his decision. Ryuuma: What the hell…
Page 88
Ryuuma: Who the hell are these people?!
Ryuuma: A guy who’s willing to sacrifice everything he’s worked for for a complete stranger’s son. Ryuuma: And an idiot who follows his decision without hearing the details.
Ryuuma: What a weird group of people. Sign: Internal Pediatrics. Sfx: *knocking*
Ryuuma: Hey, is Metabo here? *Short for Metabolic Syndrome (overweight) that he’s using as a nickname. Metabo: Yeah I’m here. Sign: Internal Pediatrics – Itou Hiroku.
Page 89
Metabo: I’ve gotten a little fatter recently. That nickname suits me more now. Ryuuma: Seriously?
Ryuuma: I don’t care how fat you get, but don’t let it affect your health.
Ryuuma: You’re my beloved son’s primary physician you know? Metabo: I know, I know.
Metabo: If I got sick, I’d be scolded out by a scary yet surprisingly indulgent father. Ryuuma: It’s not that surprising is it?
Ryuuma: Pediatricians, regardless of whether they’re in internal or surgery, all like kids unconditionally.
Ryuuma: For me, it’s to the extant where I almost want to play a masked hero on TV. Metabo: Whoa!
Metabo: I really can’t picture that. Ryuuma: Shut the hell up.
Page 90
Sfx *laughing*
Metabo: So, what brings you here today?
Metabo: If you’re here to see Kazuma, he’s studying with a volunteer teacher right now. Ryuuma: Ahh, the hospital classes.
Ryuuma: It’s nice that teachers volunteer to teach kids who can’t leave the hospital.
Ryuuma: The fact that Kazuma can live here happily and that I can continue working is all thanks to them.
Ryuuma: But that’s not why I’m here. I have something to ask you. Ryuuma: Last night, a doctor suggested an interesting type of surgery for Kazuma.
Page 91
Ryuuma: I came right away to see what you thought about it. Metabo: I don’t see a problem with it. Metabo: Do the surgery.
Ryuuma: But…I haven’t even told you about the surgery…
Ryuuma: Weren’t you the type of internal doctor who hated the simple surgeries?!
Ryuuma: What I was a pediatric surgeon back then, you would always butt heads with me on whether someone needed surgery or not. Metabo: Yeah, we did didn’t we.
Metabo: But I don’t make judgments based on just the surgery. I also look at the surgeon. Metabo: It’s my job to leave things in the hands of surgeons I trust.
Metabo: And I believe in Dr. Saijou. Ryuuma: I see…Well if you say so…
Page 92
Ryuuma: Hm?
Ryuuma: Wait, you knew that it was Saijou who suggested it to me? Metabo: Of course I did.
Metabo: Dr. Saijou spends his days off with the kids in internal pediatrics.
Metabo: It’s Dr. Saijou that’s teaching today. Ryuuma: What was that?!
Ryuuma: Isn’t it school teachers that come to teach?! Metabo: They do.
Metabo: But they can’t come every day, and doctor’s are capable of teaching some things.
Metabo: But Dr. Saijou is the real deal. Metabo: Apparently he did the same thing while he was in America.
Page 93
Metabo: He gives fun lessons that actual teachers are impressed by. Ryuuma: I can’t believe it!
Ryuuma: Kazuma would talk about a funny bugman doctor teaching his lessons.
Ryuuma: It must’ve been that guy.
Ryuuma: Which means, I’ve been mistreating the man who’s been helping my son the most.
Ryuuma: Hey, Itou.
Ryuuma: Why did he wait until now to bring up the surgery?
Ryuuma: If it’s such a great idea, he should’ve mentioned it sooner… Metabo: It wouldn’t have mattered.
Page 94
Metabo: It’s only just recently that Kazuma’s intestines have expanded enough for the surgery.
Ryuuma: So that’s why…!
Ryuuma: Honestly, I had doubted him. Ryuuma: I thought that he only brought up the surgery in order to win me over and save the department.
Ryuuma: Damnit! I’m such an idiot! How could I be so dense?
Ryuuma: When did I become such a twisted doctor that I couldn’t see other people’s virtues? Kazuma: Ah! Daddy!
Page 95
Kazuma: I didn’t know you were coming today. Ryuuma: Kazuma.
Kazuma: I wanna show you the bugman doctor that’s been teaching me stuff! Kazuma: He’s right…
Kazuma: Huh? Where’d he go?
Kazuma: He was here a second ago.
Page 96
Ryuuma: You know what, Kazuma?
Ryuuma: I bet he doesn’t want to see me.
Kazuma: Eh? Why?
Ryuuma: Isn’t it obvious?
Ryuuma: The bugman doctor
Ryuuma: Doesn’t seek the gratitude of others. Ryuuma: Saijou, I will entrust you with my son’s surgery.
Page 97
Ryuuma: So please make it a success. Ryuuma: He’s a hero just for kids. Kazuma: Okay. https://mangahelpers.com/t/phichan/releases/20275[English] [Translation] Saijô no Meii 19 by phichan2010-02-26T23:02:14+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 19 By phichan, to be used exclusively by Trinity Bakuma
Page 62
Title: A Strange Sort of Doctor
Page 63
Box: Heisei committee meeting.
Doctor: Well then. We are all in agreement that we will revive the pediatrics department in the Heisei Central Hospital.
Doctor: Right, Mr. Chairman? Taira: Yes. Brother: Hold on a second.
Doctor: Associate Director…was there something you wanted to add? Brother: Indeed.
Brother: After seeing that man’s abilities, I am in full support for reviving the pediatrics department, but… Brother: Hpmh. I’m actually against it.
Page 64
Brother: No matter how good a doctor he is, the more patients that pediatrics gets the more money we’ll lose. Brother: I was just wondering who will be chief of the department.
Brother: Of course Dr. Saijou is one possibility, but… Brother: If he becomes chief, he will be laden down with administrative work on top of surgery.
Brother: It would be a great loss for this hospital if a genius such as he were to burn out from all that extra work. Doctor: I see.
Doctor: But, is there anyone else qualified for the position? Doctor: All the pediatric surgeons have been abolished from this hospital, so there isn’t anyone else as experienced…
Brother: No, there is one.
Brother: He transferred to respiratory surgery and currently has nothing to do with pediatrics, but he does have experience.
Page 65
Brother: The former Asst. Chief of the pediatrics department, Dr. Sakamoto Ryuuma.
Sign: Emergency Department.
Sena: We did it, Dr. Saijou!
Sena: The committee has officially revived the pediatrics department. Mikoto: Yup.
Mikoto: We have our own room now, so let’s get ready to move. Sena: Hehe. Just leave the heavy lifting to me! Ayame: Hpmh! Ayame: Sheesh.
Page 66
Ayame: Don’t get too happy. Ayame: Though pediatrics is back, Mikoto isn’t the chief.
Ayame: I’m sure my brother has something to do with that. Sakamoto Ryuuma? I bet he’s some no good doctor. Sena: Aww…
Sena: It’s true, I haven’t heard anything about this doctor…
Mikoto: Apparently, he used to be a great doctor, worthy of his name, but… TL note: She is referring to Japanese historical icon, Sakamoto Ryoma.
Sena: After the pediatrics department got dismantled, his son has been hospitalized for his condition. Now he’s become a strange sort of doctor. Mikoto: His son…
Mikoto: Do you mean Sakamoto Kazuma? Sena: Oh? You already knew?
Sena: His son has some condition that can’t be fixed through surgery, so he’s been under the care of internal pediatrics*. * The internal medicine for children.
Page 67
Sena: As expected, you’ve been checking up on the children in internal pediatrics while you’ve been working in the ER.
Sena: Ehehe, I guess I wasn’t much use after all. Ayame: …I thought you said you could handle all the heavy lifting…
Page 68
Sena: But I’m so happy now!
Sena: Up until now, we were only borrowing space from the emergency department, so our examinations and our desks were in the same room.
Sena: But now we have this room all to ourselves!
Sena: We can do examinations in another room, and our desks can be filled with our own stuff rather than medicines! Sfx: *lala~~* Ayame: That’s not something to be so amazed over.
Ayame: Well, whatever. Since we’re done moving, I’m gonna head back to my department.
Page 69
Ayame: Later. Mikoto: See you later, Ayame. Sena: Thank you so much!
Sena: By the way, is that desk for Dr. Sakamoto? Mikoto: I would imagine so. Mikoto: No one else should have one.
Sena: It looks old, but kept very clean.
Sena: Maybe it’s because he just moved, but there doesn’t seem to be any personal items on it. Ryuuma: It’s not that I don’t put any on, sweetheart.
Sena: I’m the resident… Ryuuma: I already know you guys’ names. Ryuuma: No need for introductions.
Ryuuma: And as long as I’m the chief here, you’ll need to follow two rules.
Sena: Two rules…? Ryuuma: Yeah. Simple right? Just two.
Page 71
Ryuuma: First, don’t disobey me.
Ryuuma: And second…
Ryuuma: Don’t ever, disobey me.
Page 72
Sena: What the hell is his problem?! Sfx: *whispering*
Sena: “Don’t ever, disobey me” Sena: What a jerk! Sena: Rawr!
Sena: I get why everyone calls him strange. Sfx: *whispering* Ryuuma: I’m not strange or anything, sweetheart.
Sena: Geh!
Ryuuma: I have pretty good hearing, so I can hear everything you say from over here.
Ryuuma: From now on, no more whispering in this room at all possible. Sena: Wha…!
Page 73
Sena: That’s ridiculous… Sfx: *chair clattering* Ryuuma: I told you not to disobey me.
Ryuuma: In this hospital, the department chiefs are especially powerful. Ryuuma: I could send anyone I want to another hospital if I wanted.
Sena: You like it here, don’t you?
Sfx: *inhale* Sena: Ready, and…
Page 74
Sena: Sakamoto, you jerk!
Echo: jerk, jerk, jerk…
Sena: Phew, that felt good.
Sena: Maybe I’ll do another one. Ayame: Hey now…
Ayame: No matter how deserted this place is, this isn’t the ocean or the top of a mountain. Sena: Dr. Ayame…!
Page 75
Sena: Just the person I wanted to see! Here me out! Sena: That Sakamoto guy… Ayame: I got the jist of what’s going on.
Ayame: This must be a huge disappoint for you guys. Sena: It is!
Sena: Just because he could transfer us wherever, he thinks he can do whatever he wants… Ayame: No…
Ayame: My brother is the one doing what he wants…
Sena: What do you mean? Ayame: You just said that the chief could send you wherever. Ayame: Well, then who can forcefully transfer the chiefs?
Sena: You mean… Ayame: Yeah, my brother and the director himself.
Page 77
Ayame: My brother probably used his power to put pressure on Sakamoto. Sena: E-even so…
Sena: I still can’t forgive Sakamoto!
Sena: Just because he doesn’t want to get transferred doesn’t mean he has to take it out on us… Ayame: Normally, yes.
Ayame: But that guy has a sick son, doesn’t he?
Ayame: Unless he opens up his own practice, he’s not gonna make much money.
Ayame: So if you were going to be sent away with your sick kid, forced to buy a new house in an unknown place…
Page 77
Ayame: What would you do?
Ryuuma: Kazuma…
Ryuuma: I’d do anything for you… Mikoto: Fufufu.
Mikoto: So you do have some personal items. Mikoto: Dr. Sakamoto.
Page 78
Mikoto: You sure put Kazuma’s picture in an elegant frame. Ryuuma: Damn. So you already know about my kid.
Ryuuma: Of course I have more belongings around, Ryuuma: But there’s no reason to bring them here.
Ryuuma: This department is just gonna get trashed soon anyway.
Ryuuma: I’m the Associate Director’s lap dog. Now that you know, you should just leave pediatric surgery. Mikoto: I don’t mind.
Ryuuma: Hpmh. I heard you were stubborn. But I have no intention to stop harassing you…
Ryumma: …wait, what did you say? Mikoto: I don’t mind leaving.
Page 79
Mikoto: But in return, I want you to follow two rules. Ryuuma: What?!
Mikoto: First, let me treat your son.
Mikoto: And second…
Mikoto: You must let me treat your son! https://mangahelpers.com/t/starfox/releases/20087[English] [Translation] Saijô no Meii 17 by StarFox2010-02-20T13:52:19+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p24:
Sena: [EEEEEH?!]
Sena: So you mean, that time, Dr. Saijou...
Sena: He spilt the contents of the cyst in the stomach!?
Ayame: Yep.
Ayame: Cyst diameter: 8 cm... the gastric incision being only 2cm, you'd
think that there's no way for it to pass through...
Ayame: but Mikoto, as soon as he started pulling the cyst through the
incision, made an incision in the cyst itself using the laser.
p25:
Ayame: So as you pull on the cyst, its contents would get queezed out
like toothpaste...
Ayame: and the cyst is through in no time.
Sena: Oh, I see.
Sena: But won't there be a risk of the cyst cells metastasizing if you
release them within the body like that?
Sena: Considering that...
Ayame: Even if it's within the body, if it's the stomach, it's fine.
Ayame: The internal lining of the stomach, unlike other parts of the
body's interior, is made of ectoderm, so tumor cells can't attach to it.
* All organs and tissue of the human body are composed of either
ectoderm, mesoderm and endoderm. Parts composed of ectoderm (such as
skin, esophagus, and stomach lining) can not be infiltrated by tumor
cells by simple contact. Cancers or tumors do occur in the ectoderm, but
occur by different reasons, not through external contact.
p26:
Ayame: Well, I'm sure there are a lot of interns who don't know this.
Sena: Eheheh...
Sena: The Assoc. Director didn't seem like he knew either.
Ayame: No, my brother knew about it.
Ayame: However, though he knew about it, he didn't realize it at the
time.
Sadame: Sto..sto..stomach..!?
Ayame: Perhaps because it took Mikoto only a split second to open the
hole in the tumor...
Ayame: or rather, since it was a world-first operation, he probably
couldn't imagine anyone going to such lengths to care for the patient's
best interests.
Sena: .....
Ayame: In other words, THAT is the difference in their attitudes towards
the patient.
Ayame: It was because Mikoto was looking out for the patient's best
interests to the very end...
p27:
Ayame: that he was able to far surpass my brother's imaginations.
Sena: .... Looking out for the patient's best interests to the very end, huh...
Sena: Dr. Saijou sure is amazing...
[508: Sewa, Nasuka] [Ahahaha]
Mikoto: You're laughing too much. [Ahahaha]
Nasuka: But, it's so fun being with you, Dr. Saijou.
Mikoto: But, even though we didn't open you up, an operation is an
operation.
p28:
Nasuka: You should at least rest yourself today.
Nasuka: Hmph.
Nasuka: .....
Nasuka: Erm... Dr. Saijou...
Nasuka: Since one of my ovaries was operated on, does that mean it'll be
harder for me to have kids?
Mikoto: Not at all.
[Tumor] [Operation (Arrow)] [Recovery (Arrow)] Mikoto: Ovaries are kinda strange organs... as long as you leave a
healthy part, it regenerates back to its original form.
Mikoto: So, not really...
Nasuka: Oh, I was soooo worried...!
p29:
Nasuka: Err... since I want to be an actress, I haven't really thought
about having children till now...
Nasuka: ...but... I've kinda got a crush on this guy all of a sudden...
Mikoto: Oh really? Mikoto: Looks like she's in puberty.
Mikoto: You don't have to worry! I'm sure you'll be able to have a cute
baby, Nasuka-san!
Nasuka: You really think so!?
Mikoto: Yeah...
Nasuka: Okay then, Dr. Saijou.
Nasuka: Please go out with me!
Mikoto: !?
p30:
Nasuka: Maybe not right now, but if it's you and me, I'm sure it'll be a
cute and clever child!
Sena: .....
[Oh doctor~~~ doctor~~~~]
Nasuka: Doctor, PLLEEEASE~~[heart]
Sena: Is that what you mean by looking out for the patient's best
interests till the end?
Ayame: Well...
[Emergency]
Mikoto: Uh, Sena-san...
Mikoto: We seem to be running low on Ringer, could you... [BANG]
p31:
Sena: Yes, heres the Ringer!!
Mikoto: Oh... y,you're so prepared...
Sena: Yes! Thank you!
Sena: Without a doubt, I'm going to have an ugly baby. Therefore, this
is the least I can do!
Mikoto: B..baby?
Mikoto: Hey, Ayame...
Mikoto: Why's Sena-san acting so pissed off?
Ayame: It's your fault, you know.
Mikoto: Huh!? What'd I do wrong this time!? [Snicker snicker]
p32:
Ayame: Yes you did, you did.
Mikoto: Huh~~~~?
Mikoto: In that case, I guess I should apologize...
Ayame: Before you do that, let me take care of it first.
Ayame: Thanks to you, we were able to drive my brother into a corner
again...
Ayame: So I want to return the favor.
Mikoto: ?
Ayame: Hey Sena.
Sena: Dr. Ayame.
Ayame: Are you going home now?
Sena: err, yes.
Ayame: In that case, you're having dinner with me.
p33:
Sena: This... isn't this like the most high-class Western hotel peninsula
in town?
Sena: Dinner at a place like this...?
Ayame: I'm not only going to have dinner with you.
Sena: What!?
Ayame: Well, you'll see soon enough.
p34:
Staff: Well well, if it isn't master Kiryuu. Welcome, welcome.
Staff: I've reserved the VIP lounge, so please head in this way.
Ayame: Thanks. [Wobble wobble]
Sena: Wow... we're being treated like VIPs.
Ayame: VIP... well you could say that. The owner used to be a patient of
mine while I was overseas.
Ayame: So I kinda get treated special.
Sena: Oh, is that so...
Sena: Oh this is so delicious... this is authentic, Dr. Ayame...
p35:
Sena: This beef, sauted in red wine as well as this purple reduction
is... taste like this takes quite a bit of work.
Ayame: Hmmm...
Ayame: Seems like even you know your food. [Chew chew]
Ayame: A lot of people who become doctors are rich... [tuition's
expensive, y'know] Perhaps you're a daughter of some wealthy family?
Sena: Um?
Sena: Oh no, no... I wouldn't call it anything like that...
Ayame: I see. Well, you don't have to answer that question, but...
Ayame: You like Mikoto, right?
Sena: Well, yes...
[COUGH COUGH]
p36:
Sena: What's the big deal, all of a sudden!! I mean, I'm not....
Ayame: You can't fool me.
Sena: Who..who's trying to fool...
Ayame: It won't work even if you have to heads.
Sena: Yes, I admit it. I'm sorry.
Ayame: Well, you don't need to apologize...
Ayame: If that's the case, couldn't you at least act a little more lady-
like?
Ayame: Hitting, yelling, crying, acting overall like an idiot... even if
it's Mikoto, you think he'll ever warm to you?
Sena: You're right...
[I'm really getting it this time... but he's absolutely right, I can't
answer back...]
Ayame: And also, how come you don't wear any make-up, aren't you an
adult? [I mean I know you're busy and all, but...]
Ayame: Having succeeded such a big operation in front of chairman Taira,
my brother can't do anything against you.
As my brother was saying, you can even revive the pediatric surgery
department right now...
Ayame: In that case, you're the female face of pediatric surgery.
Sena: ....!
Ayame: All the more reason why you should aim to become an attractive
female doctor, inside as well as out.
Sena: [It's just as Dr. Ayame is saying...]
Sena: Health work is busy, and it's so easy to become loose with such
things...
p38:
Sena: Even when I look at my seniors, the neat and tidy ones are more
attractive than the untidy ones.
Sena: If I don't become more like that, I won't be able to energize the
newly revived department...
Sena: Plus there's no way I'll be able to win Dr. Saijou's heart without
doing that.
Sena: But, to be really honest, I'm not so good with putting on make-
up....
Ayame: Hmph.
Ayame: That is why I said that I'm not only going to have dinner with
you.
Ayame: The expert make-up artist/stylist of this hotel will guide you on
how to apply make-up suitable for a tidy healthcare professional.
Ayame: Well, that'll at least take care of the outside...
p39:
Ayame: And that is where you'll be born anew!
Sena: !
Ayame: How about it? Are you done?
Sena: Just a little more.
Ayame: Hmph.
Sena: Please stop rushing already~~~~
Ayame: Well, I don't know how much this will change things...
Ayame: She doesn't seem too bad, so maybe...
Sena: Sorry for keeping you waiting, Dr. Ayame.
p40:
Sena: How do I look?
Ayame: Woah...
Ayame: Not bad, I thought you were someone else.
Sena: Yessss!
Sena: Oh dear, what'll I do~~~~??? Dr. Saijou is such a man of action...
Sena: What if he suddenly proposes to me tomorrow?
Ayame: ....... [It seems that only the outside has changed...]https://mangahelpers.com/t/phichan/releases/19894[English] [Translation] Saijô no Meii 18 by phichan2010-02-13T03:27:07+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 18 By phichan, to be used exclusively by Trinity Bakuma
Page 40
Title: What can’t be fixed.
Page 41
Sena: Hello, everyone. Sena: My name is Sena Maria. A resident. Sena: If you’re wondering why I’m introducing myself, it’s because…
Sena: I’ve been reborn!
Doctor: Whoa. Doctor: That girl is really pretty. Doctor: Do you know who that is? Doctor: No… Sena: Fufufu, no one even recognizes me…
Page 42
Sena: Until now, I was useless and kind of dumb, Sfx: *glistening* Sena: But from now on, I’ll be a female doctor worthy of being the face of the revived pediatrics department.
Sena: Maybe I can get Dr. Saijou to notice me too… Mikoto: Good morning Kid: Good morning, doctor! Sena: Ah. Sena: Good morning, Dr. Saijou!
Mikoto: Good morning Sena-san.
Sena: But this guy is pretty dense.
Sena: What do I do if he doesn’t notice at all?! Sena: Fufufu, let’s do our best today— Mikoto: Ahh!
Mikoto: Sena-san…are you wearing make-up? Sena: Yay! He noticed!
Page 44
Mikoto: Yea, you look really cool! Sena: Wow! I’m so happy I could die!
Sena: Are you off to take a nap, Dr. Saijou? Mikoto: Yea.
Mikoto: I had a lot of patients last night and didn’t get any sleep. Sfx: *Yawn*
Sena: So while we were eating last night, Dr. Saijou was on duty.
Mikoto: Dr. Matsunaka from the emergency department will be with you while I’m gone. Mikoto: Though at this hour it should just be normal outpatient examinations, so there shouldn’t be any problems.
Mikoto: If something happens, don’t hesitate to wake me up. Sena: Okay! Sena: Gotta do my best!
Page 45
Sena: I’m a little nervous since Dr. Saijou isn’t here, Sena: but I need to take this opportunity to build up experience to become a better doctor! Sfx: *Hmph!*
Sign: Emergency Department.
Matsu: Hello there, Sena-kun. Happy to be working with you.
Sena: Same here. I look forward to working with you.
Matsu: Hmmm. You have very cute hands. Sena: Eh? Sfx: *rubbing*
Matsu: Oh, I’m sorry. Sfx: *hahaha*
Page 46
Matsu: You’re just exceptionally beautiful today. Sfx: *smirk* Sena: Thanks… Sena: Come to think of it…
Sena: I remembering hearing rumors from the nurses that this guy is actually just a perverted old man…
Matsu: I’m envious of Dr. Saijou for being to work with such a cute girl every day.
Sena: Please…don’t say that… Sena: What do I do?
Sena: How long are we gonna be alone together…
Sena: Oh yeah! Maybe Dr. Ayame will come visit like he always does!
Page 47
Sena: I have to thank him for last night anyway… Sfx: *click*
Doctor: This is the cardiovascular department. Sena: Um… This is Sena from the emergency department.
Sena: Is Dr. Ayame available? Doctor: Oh, Dr. Ayame is operating right now.
Sena: …I see. Sena: Of course. Dr. Ayame has his own work.
Matsu: Hey, Sena-kun.
Matsu: Since there won’t be any patients any time soon, shall I show you the basics of an emergency examination? Sena: Eh?!
Sena: No, that’s quite alright. Matsu: No need to be shy.
Page 48
Matsu: Why don’t you lay down right there. Sena: What?!
Sena: Yes! This is the ER! Receptionist: This is the front desk. Matsu: Tch.
Receptionist: There’s a child here who says his stomach started hurting on his way to school.
Receptionist: Shall I send him to you? Sena: Yes please!
Sena: We have a patient, Dr. Matsunaka! Matsu: I see.
Page 49
Matsu: So…how do you feel now?
Boy: Umm…it feels better now, but my stomach hurts and I feel like throwing up.
Sena: Nakajima Tetsuya, 12 years old. Sudden stomach pain and fever, nausea…
Sena: He looks a little pale, but he came here on his own and isn’t covering his stomach in pain.
Sena: It doesn’t look too serious from the outside. Matsu: Okay, we’ll get x-rays and blood tests.
Matsu: And Sena-san, ready the ultrasound.
Page 50
Matsu: Hmm, it looks like some bacteria got into the gastro-intestinal tract and is causing inflammation.
Matsu: Bacterial gastroenteritis. Basically, your stomach has the flu. Boy: The flu?
Matsu: I’ll get you some medicine, so you can go home once that IV runs out. Boy: …okay. Sena: Gastroenteritis…?
Sena: Hey, Tetsuya-kun. Could I feel your stomach too? Boy: Um…okay.
Sena: Does it hurt here? Boy: Yeah.
Sena: I knew it.
Sena: Dr. Matsunaka, a word…
Page 51
Sena: Dr. Matsunaka, isn’t there a chance that he has appendicitis?
Sena: His stomach is pretty swollen for gastroenteritis, and his blood test came back with a CRP of 2.4…That’s a little high. Matsu: Hahahaha.
Matsu: Please, you’re just a resident. Yet you have a problem with my diagnosis?
Sena: That’s not… Matsu: Well, whatever.
Matsu: Did you actually see the ultrasound?
Matsu: If it was appendicitis, the appendix would be swollen and easily visible, but Tetsuya’s appendix was perfectly normal.
Appendix \ \
A typical ultrasound showing appendicitis.
Appendix \ \
Tetsuya-kun’s ultrasound.
Page 52
Matsu: Do you intend open up a child’s stomach in his condition? Matsu: I couldn’t take responsibility if something happened.
Matsu: Not to mention he said he was starting to feel better.
Matsu: We can’t afford to get so involved with every patient with a minor illness. Sena: Yes, but… Sena: What…what would Dr. Saijou do in this situation?
Sena: He has always had the kindness and courage to stand up for his patients… Sena: Then, how about this.
Sena: We can at least admit him for observation. Sena: And if it turns out to be nothing…
Page 53
Sena: I’ll let you teach me those basics of emergency examination. Just the two of us. Sfx: *gulp*
Sign: On-call room. (The sign literally says “nap room”, but I’m pretty sure it’s the Japanese equivalent of an “on-call room”.)
Sfx: *yawn* Mikoto: That was a good nap. Mikoto: I didn’t get any calls. Did everything go okay?
Ayame: Hey, Mikoto! Ayame: Sena’s in trouble! Mikoto: Ayame…
Page 54
Mikoto: What trouble? Ayame: Just come with me!
Ayame: One of Sena’s patients’ had a sudden change in their condition. Mikoto: A sudden change? Mikoto: Why?
Ayame: I’ve been in surgery and a nurse just told me, so I don’t know the details, but…
Ayame: While you were sleeping, a patient came in with a perforating appendicitis.
Mikoto: Perforating…so the appendix ruptured and made a hole? Ayame: Exactly.
Ayame: Normally, appendicitis just means an inflammation of the appendix, but perforating is different. (the author’s * at the bottom is just explaining what perforation means, so I just melded it into the dialogue)
Page 55
Ayame: When the appendix ruptures, pus spills into the abdomen, so it doesn’t looked swollen on the ultrasound.
Appendicitis
Ruptures l V Perforated Appendicitis Typical appendix.
<-- Pus spills out O – As shown in diagram above, if the pus spills out, the swelling goes down and looks like a normal appendix.
Ayame: When the pus spills out, the pain goes away and you think you’re okay.
Ayame: It’s easily misdiagnosed as bacterial gastroenteritis, but it’s a big problem.
Ayame: Since his condition changed so suddenly, it must’ve caused peritonitis. If we don’t take care of the pus, there’s a chance that abscesses will form in his pelvis. Mikoto: Yeah.
Sign: Operating.
Mikoto: Dr. Matsunaka!
Page 56
Matsu: So you came, hotshot.
Matsu: Did you get a good rest?
Mikoto: Yeah. How about the patient?
Sfx: *point*
Matsu: He’s fine.
Matsu: It’s all thanks to your disciple.
Matsu: She’s one hell of a woman.
Matsu: I completely misdiagnosed it, yet she literally put herself on the line to stop me.
Page 57
Matsu: How in the world did you raise her to be like that? Mikoto: Hehe. I didn’t do anything.
Mikoto: She just has the potential. Matsu: Maybe.
Matsu: I bet she’ll become an amazing doctor.
Matsu: Just like you.
Ayame: Huh. So she held out her own.
Mikoto: Where is Sena-san? Matsu: Dunno. Bathroom maybe?
Matsu: Well, next time you see her, tell her I was impressed. Mikoto: Okay.
Page 58
Matsu: Just one more thing.
Matsu: During surgery, you have to match up with the lead surgeon.
Matsu: If she keeps assisting at your pace, I’ll never catch up. Mikoto: I’ll be sure to tell her that.
Sena: Oh man…
Mikoto: Hey, Sena-san! Sfx: *surprised*
Sena: Don’t come any closer! Don’t look at me!
Sena: My make-up got all messed up during surgery! Mikoto: What are you talking about?
Page 59
Mikoto: This is the prettiest I’ve ever seen you.
Mikoto: Right Ayame? Ayame: If that’s what you say.
Sena: Waa~~~nnh, Dr. Saijou~~~ Sfx: *sobbing*
Sign: Emergency Department. Ayame: It seems recently, Ayame: that Dr. Matsunaka has gotten pretty amazing.
Page 60
Ayame: The nurses say he’s taken more interest in patients and has become a better doctor overall, like he’s a different person. Sena: I know.
Sena: He said I reminded him of his old self when he had more passion.
Sena: I didn’t really do anything, but I’m really happy about it. Ayame: Heh.
Ayame: Thanks to Mikoto, now even the girl he’s nurtured has started to affect others.
Ayame: Like an infinite tree diagram.
Ayame: Oh, by the way.
Page 61
Ayame: Why did you stop wearing make-up?
Ayame: Was it because it gets messed up? Sena: Well no…I just realized something from that incident.
Sena: You know how… Ayame: Oh, I get it.
Sena: Even without make-up I’m so pretty… Ayame: No matter how much she grows as a doctor…
Ayame: You can’t fix stupidity. Sena: I wouldn’t want to get so pretty that everyone falls for me <3 Sena: You be careful too, Dr. Ayame. https://mangahelpers.com/t/phichan/releases/19752[English] [Translation] Saijô no Meii 16 by phichan2010-02-07T18:46:36+00:00phichanadmin@mangahelpers.comSaijou no Meii – chapter 16 By phichan, to be used exclusively for Trinity Bakuma
Page 4
Title: The Difference in Size
Page 5
Sena: Geez, I was really worried about you Dr. Saijou! Sfx: *punching*
Sena: Even if it’s for the sake of the patient, don’t ever do that again! Sfx: *punching* Mikoto: Sorry! Sorry! Ayame: Hey, come on, Sena.
Ayame: I get how you feel, but I think you should forgive him already. Sena: How can you say that?!
Sena: You hit him too, you know! Ayame: True…but… Sfx: *scratch*
Ayame: I actually held back. Sena: Oops… Sfx: *stinging pain*
Sena: Oh man…I really lost it… Sfx: *cough* Sena: A-anyway, it’s almost time for that important surgery.
Page 6
Sena: Time to refocus ourselves and do our best! Sena: Yea~~! Ayame: …well, I guess that was all an expression of her affection, but…
Ayame: Women are scary, Mikoto. Sena: Yea~~! Mikoto: …yeah. Sfx: *stinging pain*
Sfx: *Bang*
Sfx: *a lot of people are there*
Page 7
Ayame: Wow. Ayame: I’m surprised. Even the observation room is full.
Sena: Of course it is.
Sena: After all, this is the first NOTES procedure done through the stomach. Mikoto: Hehe Mikoto: Everyone really wants to learn. Ayame: I don’t think so.
Ayame: There are some here for other reasons. Brother: Well, if it isn’t Dr. Saijou.
Brother: I heard from the patient’s mother.
Brother: To think you tested on yourself in order find out how to safely pass through the stomach.
Brother: You are indeed the best of the best.
Brother: I was just speaking Chairman Taira up there.
Page 8
Brother: With a doctor of your caliber, we thought it would be okay to revive pediatric surgery.
Mikoto: What? Really? Brother: Of course.
Brother: If this surgery is completed in a proper manner, the Chairman, Director and I will all support it. Brother: We will be happy to revive pediatric surgery.
Brother: I am only here to observe, but… Brother: The rest of you have an important task ahead of you, so give it your all! Mikoto: I will.
Sena: Isn’t that great doctor? We just need to succeed in this surgery. Ayame: Hold on, something isn’t right.
Page 9
Ayame: It’s true that my brother’s initial plan went to hell, and there’s not much he can do at this point, but…
Ayame: I doubt that that conniving man has given up. Sena: You’re over thinking it, Dr. Ayame.
Sena: The more conniving a man is, the more likely he is to change character and take sides with the better man.
Sena: The Associate Director must have realized he couldn’t match up to Dr. Saijou and decided instead to take his side. Ayame: I really wish I could be that idiotically optimistic.
Sena: Hm? Did you say something? Sfx; *turn* Ayame: Nope.
Ayame: I can only pray that you’re prediction is right.
Page 10
Brother: Now, everyone, are we all ready? This is the Associate Director of Heisei Central Hospital, Kiryuu Sadame.
Brother: Today, Dr. Saijou will attempt the first ever NOTES procedure through the stomach.
Brother: And since there are many young doctors at this hospital, most of you probably won’t know what will be going on.
Brother: Hence, I will provide simple commentary on during the surgery, so please don’t worry. Ayame: Bah. He neglected to mention that earlier. Sena: Does it really matter?
Sena: He probably wants to ask us for forgiveness by praising Dr. Saijou during the commentary
Sena: Depending on how well praises us, I might just forgive him. Sfx: *Ahem Ayame: How optimistic can you be?
Page 11
Ayame: I don’t care what you say. There’s no way he would go that far.
Ayame: I’m betting he’s figured out some critical flaw to this surgery that we haven’t realized yet.
Ayame: So I’m sure this commentary is… Mikoto: It’s alright.
Mikoto: Even though it’s a world first, I’ve done it already on myself. There’s no flaw.
Mikoto: So it doesn’t matter what the Associate Director is thinking.
Ayame: …I hope so.
Page 12
Mikoto: Now then, we will begin the extirpation of the ovarian cyst using the NOTES technique.
Mikoto: Inserting the endoscope.
Mikoto: Passing through the esophagus.
Mikoto: Inserting air through the forceps. *Inflating the stomach makes the surgery easier.
Mikoto: Ayame, I’m going to cut open the stomach. Ayame: ‘kay.
Mikoto: Incision complete. Sfx: *whirrrr*
Mikoto: Once we’re through the stomach wall, inflate the SAND balloon. Ayame: Got it.
Page 13
Sfx: *inflate*
Sfx: *Whoa* Brother: Amazing.
Brother: I imagine most of you already figured it out, but as soon as Dr. Saijou passed the endoscope through the stomach wall he inflated the balloons. O – Like in the picture below, you attach a rubber tube called an S-tube, and then inflate two balloons to pinch the stomach wall.
Brother: In doing this, they have prevented any leakage of gastric juices, which could lead to peritonitis.
Brother: By the way, it seems that Dr. Saijou tested the safety of this technique on his own body.
Brother: Although cutting your stomach doesn’t cause too much pain, it still shows his tenacity towards the surgery. Sena: See? He only wants to compliment him. Ayame: You just keep thinking that.
Page 14
Sena: Eehhh~~?! Mikoto: Next, send more air into the abdomen and head down.
Sfx: *whirr* Mikoto: Okay. Now approaching the ovary.
Mikoto: I see the ovarian cyst.
Brother: We have finally reached the ovarian cyst.
Brother: Now we reach the problem of suctioning out the inside of the cyst.
Brother: The hole made in the stomach is about 2 cm, but the ovarian cyst at the very least is 8 cm in diameter, even after removing the healthy ovarian shell.
Proper way to sever. 8 cm
cyst
Actual ovary.
O – Like in the diagram above, the ovarian cyst is normally gouged out from the actual ovary.
Page 15
Brother: So, if you don’t first suction out the inside of the cyst,
The shriveled cyst can be First suction out the inside of the cyst pulled through the hole <-- Shriveled <-- Suction before cutting it out of the ovary.
The cyst is too large Removing the cyst without to pass through the hole <-- X <-- Extraction first suctioning out the contents.
Brother: the cyst will be too large to pull through the stomach wall even after removing it from the ovary.
Brother: However, even if you were to stick a needle into the cyst for suction,
Brother: Some of the contents are guaranteed to spill out as soon as you stick it in.
Brother: I am sure you are all fully aware that spilling the contents of a cyst into the body has the risk of spreading it somewhere else.
Brother: Though I am sure that Dr. Saijou would never do something so dangerous…
Ayame: Oh crap!
Page 16
Ayame: I see. So this is what my brother was after! Sena: What do you mean?
Ayame: Like my brother said, when you extract a cyst using the NOTES technique, you have to first drain the inside of the cyst or else it won’t fit back through the hole.
Ayame: But if you do that, a good amount of tumor cells will definitely spill out into the body Ayame: Planting themselves around the peritoneum, leading to tumors.
Ayame: Of course, it’s not 100% that the spillage will lead to tumors,
Ayame: So there are doctors who don’t think twice about sticking the needle in during a laparoscopy, despite the risks.
Ayame: So we’re pretty screwed if they attack us on those risks we’re taking. Sena: R-really?!
Page 17
Sena: So the Associate Director plans to criticize us in front of all these people on the risks we’re taking? Ayame: Exactly. Mikoto: Removed the cyst from the ovary.
Mikoto: Okay, now we’re taking the cyst to the stomach without breaking it. Ayame: Hey, wait!
Mikoto: You can’t just remove the cyst like that, no matter what my brother says!
Ayame: If we don’t drain the cyst first, it’ll be too big to fit through the hole! Mikoto: Why?
Ayame: What do you mean, why…
Ayame: Don’t tell me he can’t whether the 8 cm cyst is larger than the 2 cm hole?!
Mikoto: Removing the balloons.
Page 18
Mikoto: We’re gonna push the cyst through the stomach. Ayame: Seriously?!
Brother: Oh may, what’s going on here?
Brother: They’re trying to pull the 8 cm cyst through the 2 cm hole.
Stomach )) Cyst As seen from the side.
Brother: The cyst is fully swollen with the fluids inside, so it should be impossible to squeeze it through. Brother: Hmph. You don’t know when to give up, do you?
Brother: Are you getting desperate because of the dangers I pointed out?
Brother: No matter how hard you try, you won’t be able to fit a large thing through a small hole unless you can use magic. Brother: What does Dr. Saijou plan to do?
Brother: Due to the size of the cyst, i…
Page 19
Brother: Iiiiiiiiii?!
Doctor: Iiiiiii? Doctor: What’s an iiiiiiiii?
Brother: Oh, excuse me.
Brother: Un…unbelievable.
Brother: The 8 cm cyst is passing through the 2 cm hole. Brother: Am I seeing things?
Brother: Is this man really a wizard?! Brother: No…of course not…
Doctor: Um…Associate Director?
Page 20
Doctor: We have no idea what’s going on. Doctor: Could you please explain it to us? Doctor: It’d be really helpful. Brother: Yes…of course…
Brother: Not good!
Brother: I can’t explain it to them since I have no idea what’s going on.
Brother: I won’t like it, but I guess I’ll praise him some more to buy some time.
Brother: Even though it’s a surgery that’s never been done before, Dr. Saijou already devised a special technique for it! Brother: But if I don’t start explaining it soon…
Brother: I’ll just be praising him for the rest of the surgery. Brother: Dr. Saijou’s demeanor itself…
Brother: Shows what a great doctor he is… SFX: *whisper whisper* Doctor: Hey, maybe he doesn’t know what’s going on himself. Doctor: Maybe…
Page 21
Brother: Damnit. This is so humiliating.
Mikoto: Okay. Ovarian cyst has been extracted. Brother: You’ll pay for this, Saijou Mikoto…
Brother: I’ll get you back for this for sure. Sfx: *shake with anger* Brother: A-anyway, to all the young doctors… Sfx: *whisper whisper* Mikoto: Surgery complete!
Brother: Let us take after Dr. Saijou and carry the future of Japan’s medicine… Sena: See? He just wanted to compliment him. Ayame: Yeah, whatever. https://mangahelpers.com/t/starfox/releases/19449[English] [Translation] Saijô no Meii 15 by StarFox2010-01-31T04:16:27+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p168:
[A few days after the ethics council meeting]
Ayame: So, finally, the operation is the day after tomorrow.
Sena: Right.
Sena: Speaking of which, we got through that council inquiry pretty well.
Sena: Especially since ethics approvals require unanimous agreement of the
members.
Sena: After all that, I thought the assoc. director would reject us
outright...
Ayame: No way that'll happen.
p169:
[World's first NOTES]
Ayame: To be able to do a cutting-edge procedure like NOTES is a pretty
big deal...
Ayame: Along with chairman Taira, most of the council members would want
the operation to go ahead, as long as there's parental consent.
Ayame: As long as that consent has been given, there's no way that power-
hungry bastard would go as far as rejecting the application and go against
the chairman and the other members.
Sena: I see...
Ayame: And, brother probably thinks there's a big chance that we won't
succeed.
Ayame: Since NOTES is just endoscopic procedure... with Mikoto's skill,
chances are in our favor...
Ayame: However, in this case, that won't be the end of the matter.
Sena: ...What do you mean...?
p170:
Sena: You mean because of the difficult angle of approach from the
stomach?
Ayame: Exactly.
Ayame: The stomach, unlike the vagina, is difficult to sterilize. On top
of that, even if you empty it by asking the patient to fast pre-op,
Ayame: you won't be able to stop gastric secretions.
Ayame: If you open a hole in the stomach, there is the danger of those
gastric secretions infiltrating the peritoneum, causing peritonitis*.
* See chp 13.
Ayame: Even if we circumvent that from happening, and there's no
peritonitis...
Ayame: My brother will go around spreading rumours of what a risky
operation it is.
NOTE: There are individual differences in the amount of gastric
secretions, and furthermore infiltration of the peritoneum by these
secretions doesn't mean peritonitis will absolutely occur. However,
clinically, such does not constitute a successful operation.
Sena: Oh no, what'll we do?
Ayame: Don't ask ME...!!!
p171:
Ayame: As I was saying, NOTES through the stomach is a world-first, no one
can forsee what'll go wrong. That's why Mrs. Sawa was so worried,
right...?
Ayame: ???
Ayame: Oh yeah, Mikoto! How on earth did you persuade the mother?
Ayame: We never got to hear the end of that story?
Mikoto: [Damn.]
Mikoto: You've found me out.
Ayame: Huh? Found out?
Ayame: What are you talking about? How can you hide these things from us?
Sena: That's right!
Mikoto: Well~~~, if I tell the truth, both of you will definitely get
angry at me...
Ayame: Wha? Me? Get angry?
p172:
Ayame: No way man!
Sena: I won't get angry either!
Ayame: Thanks to you, I was able to see my brother make a fool of himself
for the first time in my life!
[PFFFFF] [CRACK!]
Ayame: I am actually full of gratitude! Hehehe.
Sena: ... so he's grateful for THAT...
Mikoto: Is that so...
Mikoto: Alright, I'll give you a hint.
Mikoto: I copied Werner Forssman.
Ayame: Werner...
Ayame: Oh, the famous...
Sena: ?
p173:
Ayame: That would mean that you...
Ayame: You damn idiot!!
Mikoto: Upff... [WHACK!!]
Sena: ...he... hit him!?
Sena: What are you doing all of a sudden, Dr. Ayame?
Sena: You just said that you wouldn't get angry...
Ayame: I'm NOT ANGRY!
Ayame: It's just...
Ayame: I'm quite upset!!
Sena: Whaaaa!?
Sena: How's that different from being angry?
p174:
Ayame: Hey you, so you were okay with that?
Mikoto: Of course.
Ayame: Well, in THAT case, alright.
Ayame: But if you pull something like this again, I definitely won't
forgive you!
Mikoto: .......
Sena: Are you alright, Dr. Saijou!?
Mikoto: Yeah...
Sena: Even so, Dr. Ayame... that was just too much!
Sena: I don't really understand, but to suddenly use violence...
Mikoto: It's alright.
p175:
Mikoto: It's because, even so, Ayame has a good heart...
Sena: ?
Sena: Haa...
Yamada: Oh, it's Sena. Long time no see.
Sena: Yamada...
Yamada: Dr. Saijou is amazing, as usual.
Yamada: Tomorrow you're doing NOTES through the stomach, right? A world-
first...
Sena: Yeah... you heard, huh.
Yamada: Of course.
p176:
Yamada: Right now, the whole hospital is talking about it.
Yamada: A world-first... that means along with chairman Taira and all the
big-shots, every junior doctor who has time to spare will come and stand
in.
Sena: Oh... is that so...
Yamada: What's up with you? You don't seem very excited.
Yamada: Even if you're just assisting, to be part of a world-first
operation should be a really big deal for any surgeon. [I'm so jealous]
Sena: Oh, it's not that big a deal...
Sena: Yamada, to be honest...
Yamada: ?
p177:
Yamada: What? Dr. Ayame and Dr. Saijou had a fight!?
Sena: Yeah...
Sena: Because of that, we haven't even had the chance to discuss the
specifics of how to insert the endoscope through the stomach...
Yamada: Right...
Yamada: So then, you're saying that it's quite possible for the operation
to go terribly wrong, right in front of the entire audience....
Sena: Y..yeah...
Yamada: Well then, it's you're job to make sure that those two reconcile
with each other!
Yamada: From what you're saying, Dr. Saijou didn't seem to mind, even
though he was punched in the face... Why don't you find out why Dr. Ayame got so angry, then get him to cool
off?
Sena: ......... [He's right!]
p178:
Sena: I got it. Thanks, Yamada.
Sena: I'll go and try to persuade Dr. Ayame.
Yamada: That's right. You go do that.
Yamada: Good luck!
Sena: Thanks!
[Cardiovascular Surgery]
Sena: Is this it...? Is Dr. Ayame here...? (Click)
p179:
Sena: There he is! Dr. Ayame!
Sena: Teehee! He's sitting there reading a book about NOTES.
Sena: So he is seriously thinking about it.
Sena: I don't know why he got so upset before, but if that's the case,
it'll be fine.
[tap tap] Sena: Doctor.
Ayame: Oh it's you. What do you want?
Sena: Oh, um...
p180:
Sena: I thought, well, tomorrow's the big day, so maybe.. um.. the three
of us could get together and um... discuss the operative procedures...
Ayame: NO WAY. From now on, I'll be taking care of work here in cardiothoracic surgery.
Ayame: To talk to 'that' bastard is a waste of my time.
Sena: 'That' bastard...?!
Sena: Dr. Ayame called Dr. Saijou 'that bastard'...
Ayame: Anyhow, I'll leave time free just before the operation so it'll be
alr...
p181:
Ayame: Wh.. wh.. WHAT are you doing!?
Ayame: Hey! Don't cry! Oi! [Uuu... Waaaah~~~]
[Whisper whisper]
Ayame: O..Okay, I get what you want to say! But there are other people
here...
Sena: Oh... you're so mean... and to think that I trusted you so... [Wah~~~]
[Whisper whisper]
Sena: UWAAAAH~~~~~ [Waa waa]
Ayame: AARRGH! Alright alright, just get OUT!
p182:
Ayame: Man! Honestly, what the hell are you?!
Sena: Well, since you, Dr. Ayame, think badly of Dr. Saijou... [hic.. hic..]
Ayame: It can't be helped!
Ayame: Hey, have you not heard of Werner Forssmann? [He's a Nobel laureate, y'kno]
Sena: ...I tried searching that name on the net... but nothing came up... [hic.. hic..]
Ayame: Man, you probably typed in Berner, didn't you?
Sena: Huh?
Ayame: It's Werner.
Ayame: Werner Forssmann, the German physician.
p183:
Ayame: Back in 1929... at a time when there was hardly any technology
around, he put himself under local anesthetic and inserted a catheter into
his own arm.
Ayame: Not knowing when the catheter might pierce a vein... he risked his
own life and was able to pass a catheter into his own heart.
Sena: Oh wow...
Sena: So Dr. Saijou did what he did...
Sena: ...!?
Sena: You don't mean he actually...!?
Ayame: Exactly.
Ayame: That idiot actually went ahead and put himself under local
anesthetic without telling us, and put a hole in his own stomach with an
endoscope.
Ayame: In other words...
p184:
Ayame: Without giving us a chance to even think about anything, that
bastard had already figured out the safest way to open a hole in the
stomach. [It would be weird if the mother didn't give consent after that]
Sena: ........
Sena: ........
Sena: I'm not sure if I can forgive him...
Ayame: See?
Ayame: I mean, it was pretty immature for me to go and punch him, but dude, at least discuss things with us first, y' know?
Sena: That's right!
Sena: I won't forgive you, Saijou~~~~~~!!!
Ayame: ......I can't forgive you either! [For crying out aloud in my department!]
Mikoto: That's why I didn't want to say anything...
[The moral of the story: Always discuss things with your colleagues first!]https://mangahelpers.com/t/starfox/releases/19229[English] [Translation] Saijô no Meii 13 by StarFox2010-01-26T06:39:28+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p132:
Mikoto: Surgery... without any scars?
Nasuka: Yes.
Nasuka: I'm willing to do anything for that!
Nasuka: So please...
Nasuka: Doctor... I beg of you!
Mikoto: .....
p133:
Ayame: Hmmm...
Ayame: Surgically remove an ovarian cyst without leaving behind any scars,
huh.
Mikoto: Yeah.
Sena: Oh, dear... this is quite a situation.
Sena: No girl would want scars on their body, and on top of that this girl
is a current junior idol dreaming of becoming an actress...
Sena: I mean, I understand how she feels, but a scarless operation? Is
that really even possible?
Ayame: Exactly.
p134:
Ayame: What the hell did my brother refer this kid to you for?
Ayame: Since it is him we're talking about, there's no doubt that he's
trying to set up a trap for you, but...
Ayame: If it's a procedure that doesn't exist, then you can't really screw
it up either.
Sena: Oh, wait!
Sena: I think I understand.
Sena: The associate director must actually be a huge fan of this girl!
Ayame: No way.
Ayame: I thought I was bad, but the guy we're talking about doesn't show
his emotions, and is the ultimate narcissist.
p135:
Ayame: From way back, when beautiful women confessed their feelings for
him, my brother would treat them like idiots and send them away.
Ayame: The very reason that he's not afraid to use whatever means to rise
to the top is because he really thinks he's been chosen by some god or
something.
Ayame: I can't imagine a guy like that would even consider becoming a fan
of somebody else.
Sena: Oh... is that so...
Ayame: Anyhow, enough about my brother... what are you going to do about
this, Mikoto?
Ayame: Ovarian cysts, unlike other kinds of tumors, don't easily become
malignant so it may be possible to just let it be...
Ayame: but even so, leaving it for too long is dangerous as it may
rupture, or predispose to ovarian torsion.
Mikoto: Exactly.
p136:
Mikoto: So that's why I decided that I should operate on her according to
her wishes.
Ayame: Is that so?
Ayame: Well, good on you.
Sena: That's great.
Ayame+Sena: !!! What did you say??!! What do you mean, doctor??!!
Ayame: We can't do it, that's the whole problem!
Sena: Yes, yes, exactly!
Mikoto: It can be done.
Mikoto: There are actual cases...
Mikoto: You definitely know about it.
p137:
Ayame: Wha.. you don't mean...?!
Ayame: N.O.T.E.S.???
Mikoto: That's correct.
Sena: What's that? Something up North?
Ayame: Not North, it's NOTES.
Ayame: Natural Orifice Translumenal Endoscopic Surgery (NOTES).
p138:
Ayame: In other words, it is endoscopic surgery, where you insert the
endoscope through a natural orifice of the body: the mouth, the vagina or
the anus, in order to perform abdominal or thoracic surgery.
Ayame: In the US in March 2007 and France in September of the same year,
there have been cases of successful cholecystectomies (gall bladder
removal) through the vagina.
Sena: Oh wow, that's amazing! You mean that kind of procedure
actually...!?
Ayame: Yeah, that's right.
Ayame: However, Mikoto, NOTES hasn't been registered yet as a standard
medical procedure...
Ayame: and unlike the cases in the States and France, this isn't a
cholecystectomy, we're trying to remove an ovarian cyst! That means
there's an angle problem, since you need to go from the mouth through the
stomach lining in order to carry out the excision.
(Author's Note: in order to go through the vagina, the endoscope must be
bent to almost a U-shape, making it terribly difficult to cut)
p139:
Ayame: If you were to do it, it would be a world-first. You can't do it
without passing it through the hospital's ethics council.
Mikoto: I know.
*: Ethics Council: a committee that approves new procedures such as NOTES
according to the associated humanitarian and ethical aspects.
Mikoto: However, she is a minor, so we first need the consent of her
parents.
Mikoto: So it depends on whether she can persuade her parents...
Mikoto: So we go from there.
Mikoto: So you're really okay with this?
p140:
Mikoto: As I just explained to you, this operation, if we go ahead with
it, will be a world-first.
Mikoto: Furthermore, there is the danger that when we penetrate the
stomach using the endoscope, that the stomach contents will leak into the
peritoneum*.
(* Translators' note: abdominal cavity surrounding the internal organs,
but normally sterile and closed from the outside world)
Mikoto: Hence there is the post-op risk of peritonitis*, making this a
highly dangerous procedure.
(* inflammation of the peritoneum, which can be life threatening)
Nasuka: I understand.
Nasuka: But I still want to go ahead with it.
Mikoto: Right.
Mikoto: Mrs. Sawa, is this fine with you?
Mum: Yes...
Mum: I leave Nasuka in your hands.
Mikoto: ....I understand.
Ayame: That's unusual...
p141:
Ayame: In times like this, it's usually the mother who has trouble
consenting...
Ayame: This person is unusually calm...
Mikoto: In that case, could you please sign this consent form?
Mum: Yes.
"Squeak squeak"
Mikoto: Well, take care then.
Mum: Thank you very much, doctor.
Ayame: ...seems that it all went a little too easily.
Sena: You think so?
Sena: It's probably because, as fellow woman, she understands her
daughter's feelings about scarring her body.
Ayame: Yeah, whatever.
Sena: Oh, that's right!
p142:
Sena: Now that I think of it, Dr. Ayame, something amazing's happened.
Ayame: What do you mean?
Sena: Because of fear of the associate director, there haven't been many
staff volunteering to join the department...
Sena: But recently 3 young doctors expressed an interest in pediatric
surgery.
Ayame: Hmph.
Ayame: Are you sure they're not a bunch of useless goons?
Sena: No no, that's not so.
Sena: I checked things out myself for that very reason.
Sena: All three seem to have good reputations for their skill, and on
their way to the top!
p143:
Sena: Dr. Ayame, if you don't hurry up and move to our department (from
cardiothoracic surgery), places in pediatric surgery are going to fill up!
Ayame: Hmph, well, fill up all you want.
Sena: [Oh, come on~~ You gotta be joking~~]
Ayame: Even so, everything's going as predicted.
Sena: [Wait up, Dr. Ayame~~ PWEEEASE~~]
Ayame: No matter how much brother tries to get in the way, Mikoto's
reputation is spreading within the hospital, through the nurses and even
people like this...
Ayame: Even fairly recently, we successfully completed a procedure of a
standard- enough to get the attention of the medical world.
No one will be able to stem the tide.
Ayame: But I am worried that this "tide" may be too strong...
Sena: [What would we do without you, Dr. Ayame~~?]
Sena: [Dr. Saijou and I are counting on you~~]
Ayame: I don't know about reviving pediatric surgery, but if, at this
stage, the situation arises that chairman Taira comes to esteem Mikoto...
p144:
Ayame: There's no doubt that brother will REALLY try to destroy Mikoto!
Sena: I'm exhausted!
Ayame: You sure are stubborn.
Sena: Well, that is my strong point!
Ayame: That's the spirit! Use that to endure the Ethics Council.
[Seating arrangement]
Bottom four below the square: leftmost label reads: In attendance: Then, names under the circles are (left to right): Maria, Ayame, Nasuka,
Mother
Bottom side of square: left label reads: Applicant for procedure: Name next to circle: Mikoto
Starting from lower left side of the square, going clockwise: Council member (Citizens' representative) Council member (Lawyer) Vice-chairperson of the council (Associate Director Kiryuu) Chairperson of council (Director Noguchi) Scribe Council member (Chairman Taira) Council member (Director of Internal Medicine)
Ayame: You probably haven't had to sit in one of those council meetings...
Ayame: The seating arrangement is something like this.
(Author's note: Typically, as above, the ethics council is comprised of a
couple of medical doctors, one legal professional, and one layperson to
represent public interest. )
Ayame: Not only the director Noguchi and my brother, the associate
director, but chairman Taira will be there as well as a council member...
Ayame: It'll be quite an intimidating council meeting.
[GULP...]
p145:
Ethics Council of Heisei Central Hospital
Sena: Uhmm... so... who was chairman Taira again?
Ayame: On the right, further in from us.
p146:
Ayame: The one giving off that "old man from the mountains" type of
atmosphere... that's chairman Taira.
Sena: Oh... oh.
[Chairman of the Board of Directors of Heisei Central Hospital, Masamori
Taira*]
*The characters for Taira and Masa can be pronounced as 'Heisei'.
Sena: Uh... and the monk over there looks scary...
[Head priest of Hanshoku Temple, Ryu Kuroyanagi]
Ayame: He's the citizens' representative, it's typical for them to be
monks like that.
Ayame: It seems that there are a lot of old men in this council.
[Director of Internal Medicine, Hitoshi Nekota] [Lawyer, Hajime Suzuki]
Ayame: We've been called here just in case there's a funeral.
Sena: EEH???
Sena: Is that for real?
Ayame: I'm kidding.
p147:
Ayame: Oh, don't get too nervous.
Ayame: Of course this council meeting concerns the application for the use
of NOTES...
Ayame: But if we were to make a bad impression on chairman Taira, it will
probably become impossible to revive the pediatric surgery department...
Ayame: So this is a real important meeting.
Sena: Tha, that makes me even more nervous!
Ayame: [he he he]
Ayame: I know.
Sena: This man... I really hate him... I really really hate him...
Noguchi: Alright then, I'd like to open the ethics council inquiry.
p148:
Noguchi: However, there is one problem, and I'm afraid that this council
dismisses this application for the use of NOTES.
Noguchi: The problem being that by the mother of Nasuka Sawa, Mrs. Megumi
Sawa...
Noguchi: The consent for this operation has been withdrawn.
[!?]https://mangahelpers.com/t/starfox/releases/19228[English] [Translation] Saijô no Meii 12 by StarFox2010-01-26T05:32:00+00:00StarFoxadmin@mangahelpers.com*******For use in Trinity BAKumA scanlations ONLY*******
p114:
Sena: Tremendous powers...?
Ayame: Yeah.
Ayame: Hey, do you know what kind of person typically owns these private hospitals?
Sena: Now that you mention it...
Sena: ...hospitals aren't corporations, so they're probably not shareholders...
so that means...
Ayame: So...
p115:
Ayame: There's a landlord. L.A.N.D.L.O.R.D.
*: The medical director of a hospital must be a medical doctor, but administrators such as the chairperson of the board of trustees are typically owners of the hospital grounds. They may or may not be doctors themselves.
Ayame: This hospital is also like that, the actual owner is the supposed descendant of the Taira clan, Masamori Taira.
Ayame: Along with this hospital, Heisei Central Hospital as the center, he is the owner of 57 branch hospitals around Japan.
Sena: Oh... for real?
Sena: but... what does that have to do with power?
Ayame: Two points. One is that Taira-san, unlike typical proprietors, has a personal interest in medicine, and once was a medic himself.
Ayame: And the other point being...
p116:
Ayame: ...that he is an elderly man, but has no children of his own.
Sena: In other words, you mean...
Ayame: Yes, exactly.
Ayame: Taira-san has already announced that "The one chosen as THE BEST DOCTOR in all the Heisei hospitals will inherit his fortunes".
Ayame: In other words, the one who is chosen...
Ayame: That person will rule over Japan's biggest family of 57 private hospitals in one night.
p117:
Sena: Yes, th..that certainly is a lot of power.
Sena: However, there is still something that I don't understand.
Sena: Even if the associate director wants to be chosen so badly, even if pediatric surgery doesn't make a lot of money... that shouldn't be a reason why he should oppose the revival of the department!
Sena: To treat people's lives lightly just for the sake of profit...!
Ayame: Well... the thing about Taira-san is...
Ayame: Of course he doesn't think people's lives should be taken lightly, but he believes firmly that administration skills are an important part of being an excellent doctor.
Ayame: Pediatric surgery is difficult, medical mishaps are common, plus will result in financial deficit.
Ayame: To my brother who has climbed the ladder this far to become the associate director and wants to earn points without any problems, the pediatric surgery deparment is nothing but a troublesome obstacle in his path.
p118:
Ayame: In other words, you and him are like oil and water... and will never be able to tolerate the other's existence.
Associate director's office.
Bro: Fu... I lost this time, eh.
Bro: If I were to join in the operation, no matter how skilled the surgeon, I should have been able to dig up at least a little bit of dirt...
Bro: That man... is not normal!
p119:
Bro: Instead of dirt, the pre-op preparations, execution of the surgery itself, was so so impressive that I was totally taken by surprise...
Bro: In this case perhaps it would be wiser to endorse the revival of the pediatric surgery department, and bear with the losses...
Bro: But if we did that...
Bro: I would also have to anticipate the worst case scenario, which I do not want.
Sena: I got it! I just had a really great idea!
p120:
Ayame: What?
Sena: Saijou-sensei should be chosen for that "Best doctor"! (He is the 'best' (saijou) after all...)
Ayame: Haha, I would second that.
Ayame: So, how about it? Wanna give it a shot?
Mikoto: Nope.
Sena: Huh??? But Why?
Mikoto: Well, devoting time to admin takes time away from the operating theater,
Mikoto: and also reduces the number of patients that I can see.
Sena: Well, sure, but...
p121:
Ayame: But it would be worth it, right?
Ayame: If you use the power of the chain of 57 hospitals, not only will you be able to achieve your dream of increasing the number of pediatric surgeons, you will also be capable of revolutionizing Japan's health care system!
Ayame: In the very least, you can't just sit back and let someone who's only interested in selfish ambition like my brother take the position.
Ayame: That's partly why I wanted to throw my brother out and take over this hospital.
Mikoto: Sure, I can understand that.
Mikoto: Well, if that's the case...
p122:
Mikoto: How about we let Sena-san take that role?
Sena: Wh... who me?
Phone: Ring ring...
Mikoto: Yes, this is E.R.
Phone: This is reception, is Saijou sensei...
Mikoto: Yes, Saijou speaking.
Phone: Oh, yes.
Phone: We have a patient here to see you, with a referral from the associate director.
p123:
Mikoto: From the associate director?
Mikoto: Oh, OK. I understand.
Phone: Click.
Ayame: What was that about? Something about big bro?
Mikoto: Yeah...
Mikoto: Apparently a patient has just arrived for me with a referral from the associate director.
Ayame: WHA???
Ayame: Did you get a patient referral from big bro?
Mikoto: Nope.
p124:
Mikoto: Maybe it's just a mistake...
Sena: Maybe.
Ayame: ...very suspicious...
Ayame: Hey, just be careful, Mikoto.
Ayame: Big bro is probably quite nervous, thanks to your superior skills exceeding his wildest imaginations.
Ayame: Recently there have been some incidents where patients have stabbed doctors or otherwise been quite violent.
Ayame: Even if it's just a kid, keep your guard up, and if it's some weirdo, it's better to politely send them elsewhere (N.B. it is actually illegal for doctors to refuse request for care, though they can refer to another doctor).
Mikoto: Sure, got it.
Mikoto: Thanks for your concern.
Ayame: Whatever.
p125:
Ayame: If anything comes up, just give us a call on this.
Ayame: Hmmm...
Ayame: Is that the kid?
p126:
Ayame: To be a pediatric patient, you need to be under 15, but she looks quite mature.
Ayame: And that face... I get the feeling I've seen her somewhere before...
Ayame: Well, whatever.
Ayame: At least she doesn't give off the vibe of someone who'd stab a person...
Ayame: ...plus I'm sure they'll call if something happens...
p127:
Mikoto: So, you're Nasuka Sawa-san, correct?
Mikoto: What brought you to hospital today?
Nasuka: I'm sorry?
Mikoto: Oh, I'm sorry.
Mikoto: I must have miscommunicated with the associate director...
Mikoto: To be perfectly honest with you, I haven't heard anything about your circumstances...
Nasuka: Oh, is that so...
Nasuka: Actually I was examined at a branch of Heisei Central, the Second Heisei Hospital.
Nasuka: These are copies of my patient history and test results.
p128:
Nasuka: It would probably be easier for you to read these rather than me try to explain, right doctor?
Mikoto: Ovarian cyst...
Mikoto: It doesn't look too good...
Mikoto: Do you experience any pain?
Nasuka: Not right now...
Nasuka: But sometimes the pain comes on quite suddenly, and it's hard for me to bear.
Mikoto: Oh, is that so...
Mikoto: If these test results are accurate, I am inclined to say you need surgery...
Nasuka: I thought so...
Nasuka: I was told the same thing by the doctor at Second Heisei.
p129:
Nasuka: But that complicates things.
Mikoto: Complicate things?
Nasuka: No matter what, I don't want any scars on my body.
Nasuka: To be honest, I'm actually like a junior idol, and want to become an actress in the future!
Nasuka: So, to have a scar on my belly would mean...
Mikoto: Sure, but...
Nasuka: Doctor, please! You're my last hope!
Nasuka: The doctor at Second Heisei, after consulting with the associate director here...
p130:
Nasuka: ...said that you might be able to do it.
Nasuka: Dr. Saijou, you can do it, right?
Nasuka: Without making incisions on my abdomen, without making holes with endoscopy...
Nasuka: the operation that leaves not a single scar on the body at all!https://mangahelpers.com/t/cookie-on-fire/releases/19022[English] [Translation] Saijô no Meii 11 by cookie_on_fire2010-01-17T21:09:52+00:00cookie_on_fireadmin@mangahelpers.comThis is not to be used by anyone outside of Trinity BAKumA without my permission.
Page 1 If he is as skilled as he seems Then I will have to change my strategy
Page 2 Mikoto: Anterior right bile duct branch severed. Mikoto: Ayame, tie up the cut vessel. Ayame: I'm on it. Sadame(thought): Although the liver removal process was perfect...It's still too soon to judge his abilities. Sadame(thought): To make this operation a success, there are still two points remaining.
Page 3 One is that no matter how much the liver is cut, no blood or bile would come out-
To begin with, because the liver contains many blood vessels and bile ducts, if it is cut, ligation procedure is necessary...
In the ice water, even if the blood vessels or bile ducts are cut, no liquid would come out, so it is hard to tell where ligation needs to be done.
The problems lie especially with the bile duct...
Because bile, in addition to being transparent, does not clot like blood...
If forgetting to tie even one bile duct,
After the operation, the transparent fluid would continue to overflow from the liver, and the damage becomes irreparable.
Page 4 The second point is the infiltration of the tumor inside the hepatic vein-
The tumor is not only inside the liver, but also in a part of the hepatic vein. Diagram: Tumor(right), Hepatic vein(left)
The hepatic vein, unlike other trivial blood vessels, can't just be cut and thrown away. Diagram: Tumor infiltration, Removal, Replace, (middle)Other blood vessel, (bottom)Reconstruct the blood vessel like this
2cm of the infiltrated section must be cut and replaced with vessels from elsewhere in the body, but...
No other vessel that can be safely cut in the body has the same thickness!
How will he solve this problem? I can probably tell how good he from this. Mikoto: Oh yeah, Sena-san.
Page 5 Mikoto: I need 5 centimeters of the patient's iliac vein... Mikoto: Can you do it? Maria: O, of course! Maria: I may not look it, but I'm very good at severing blood vessels! Mikoto: Ok, thanks. Sadame(thought): Iliac vein...? Sadame(thought): It's true that taking the iliac vein will not harm the body in any way... Sadame(thought): However, at the patient's age, the hepatic vein is about 8mm thick, and the iliac vein is 4mm thick... Diagram: Hepatic vein, Iliac vein Sadame(thought): I think it's too thin to replace the hepatic vein...
Page 6 Mikoto: Ayame, start injecting IC fluid*! *TL's Note: Not sure what that is. Mikoto: Check the bile duct! Ayame: Gotcha. Sadame(thought): Ah... Sadame(thought): He solves the first problem by injecting the liver with colored liquid. Diagram: No leaks (success), Leakage (failure), O The IC liquid is blue. One can tell if there are any cuts left untied by checking to see if there are any leaks. Sadame(thought): However, checking for leaks from the bile ducts would be... Ayame: Ok Mikoto, there are no leaks. Sadame(thought): No way! Is the tumor removal already finished!? Ayame: All of the bile ducts and blood vessels have been tied.
Page 7 Ayame: We now just have to reconstruct the hepatic vein. Mikoto: Yeah! Sadame(thought): I can't believe it... Sadame(thought): They are really done with the tumor removal...! Mikoto: Alright, let's start the reconstruction right away. Mikoto: Sena-san, were you able to extract the iliac vein? Maria: Y, yes! Maria: How is it? Mikoto: Yes, you are very good at this! Maria: I'm glad!
Page 8 Mikoto: The thing about severing blood vessels is that even though you are supposed to not think about it and just insert the scalpel, it is a very difficult thing to do... Mikoto: Sena-san has a very good sense for it. Maria: Really!? Maria(thought): Could it be, this is the first time that I am useful!? Maria: ...But, when I think about it, isn't its thickness very different from the hepatic vein? Mikoto: That's right. Mikoto: We will cut it open, spread it into a 5 millimeter by 1.2 millimeter rectangle, and then roll it up horizontally... Diagram: Thin vessel -> Cut open -> Rectangle -> Roll it up *Calculate with Pi as 3. 4mm of blood vessel cut open would be 4mm x 3(Pi) = 1.2cm Mikoto: See, you can change the thickness to anything you want. Maria: I see- Sadame(thought): However... Sadame(thought): We need about 2cm of the hepatic vein. Even though the thickness is right, the length is not enough this time... Diagram: Required vein, Mikoto's vein
Page 9 Maria: But now the iliac vein is not long enough... Mikoto: Right, that's why I asked you to get 5 centimeters. Mikoto: 8 millimeters of hepatic vein requires about 2.4 centimeters because 8mm x 3(Pi) = 2.4. If we had 5 centimeters, we can make two of them. Mikoto: If we overlap them we can also adjust the length. (smaller font)If it's too long we can always cut some off) Sadame(thought): Woah, doubling the blood vessel!! Mikoto: Just remember to not line up the sewlines. Maria: I see! Diagram: Good example, bad example, O Just like in the good example, it's best to make the sewlines face opposite sides. If it is done like in the bad example, blood is more likely to leak from the cross that is formed. Sadame(thought): I have never heard of this technique... Sadame(thought): This way, there is no problem in either the length or the thickness...!! Sadame(thought): It's regrettable...but this boy has genuine skills...no,
Page 10 Sadame(thought): He is the best of the best! Mikoto: Ok! Let's return the liver back into the body! Mikoto: The liver will be outside of the ice water so everyone please hurry! Everyone: Understood! Box: Several days later Woman: Thank you very much. Mikoto: It's nothing... Man: We really can't thank you enough...
Page 11 Boy: Thank you doctor! Mikoto: Hope you get to go home soon! Mikoto: The day you get discharged from this hospital, I will give you a Spiderman figure. Boy: Yay, really? Ayame: ...Hm? Is that the patient from the other day with his parents? Maria: Yes. Maria: Wow, even I'm moved by their deep gratitude <3 Ayame: I see... Maria: You don't want to say hello? Maria: They would surely be really thankful if they learn that you were the first assistant. Ayame: It's ok. Ayame: Unlike you and Mikoto, I'm not good at showing a smiling face in front of others.
Page 12 Ayame: Isn't it good to not get in their way? Maria: Wha~~t? but- Ayame: You two are just really good people. Ayame: If I really became the unworthy doctor like my brother says, what should I do then? Sadame(background): Even though he is my brother, he has done something- Ayame(background): Shut up!! Mikoto: That won't happen. Ayame: Mikoto... Mikoto: Both this time and during emergencies before, you helped out even when the operations had high risks. Ayame(background): Ok! Let's do it. Ayame(background, upper left): Mikoto, go contact the patient and prepare for the operation. Ayame(background, right): Mikoto, if it's ok, I would also like to help out. Ayame(background): Isn't it better to have more people? Mikoto(background): Yes, thanks! Mikoto: People like that can't be be bad doctors can they? Ayame: Fu, I don't know about that.
Page 13 Ayame: Maybe I'm the kind of freak who enjoys those high-risk challenges. Ayame: Actually, when I was overseas, without the hospital's permission, I did such an operation and killed a patient...The hospital was in big trouble. Ayame: Because I had the patient's permission, I escaped only with revoked license... Ayame: I guess what my brother said wasn't necessarily a lie after all.
Page 14 Mikoto: It must have been a difficult operation, carrying it out without permission. Mikoto: ...You wanted to save his life no matter what, didn't you... Ayame: ...Mikoto...
Page 15 Mikoto: No matter how good a doctor is, there are patients that he can't save. Mikoto: However, even knowing that, never giving up... Mikoto: Knowing the patient's feelings...especially... Ayame: ...I guess... Ayame(thought): If Mikoto had been there that time...
Page 16 Ayame(thought): They maybe I... Mikoto: Ayame... Ayame: Ok, that's enough about me. Ayame: Rather, my brother is the main problem. Ayame: He was awfully quiet in the operation room...
Page 17 Ayame: That's because he was surprised by your skill he couldn't do anything. Ayame: From now on, even suppose that the Pediatrics is brought back, he will still constantly apply pressure to you two. Maria: Wh... Maria: Why is he going so far to... Ayame: Don't you think it's strange? Ayame: You already know he interferes because Pediatrics bring in no profit and it's easy to make mistakes. However... Background: Unlike the director, the vice-director is very strict about the running of the hospital. Background: Sena, being a Pediatrician is hard and you won't earn much. Background: I knew my brother was trying to get in your way. Ayame: He is only the vice-director, and not the owner of this hospital.
Page 18 Ayame: Even when the children's surgical department is going in the red, or when there are incidents, unless the hospital is going bankrupt, his salary won't change that much. Maria: I guess it's true when you put it that way. Mikoto: ... Ayame: In other words... Ayame: The things he said, like there's not enough profit or too many incidents, are not the real reasons... Ayame: This hospital has some hidden agenda.