LGHTNOVELBOOK Chapter 77
Episode 77. Return to Normal Life (2)
Today’s first patient.
Name is Joseph, a middle-aged uncle who looks slightly older for a young man. He works in farming and says he has been engaging in a lot of outdoor activities recently.
The reason for his visit is due to redness on the skin, palpitations, rapid breathing, dizziness, swelling around the neck, and various overlapping symptoms.
However, most of these symptoms are non-specific.
This made me think of Tsutsugamushi disease. The season fits, the outdoor activity fits, and symptoms like swollen lymph nodes and high fever fit too.
Amy concluded pneumonia based on the given information. It was worth checking, even though it didn’t seem like pneumonia.
I looked at Amy.
“Differential diagnosis for pneumonia. What should we do?”
Amy tilted her head. Probably not pneumonia, but it’s good for her to try reaching a conclusion herself.
“Auscultation.”
“Then auscultate it.”
“Yes.”
Amy seriously auscultated the patient’s back. I did it earlier and heard wheezing caused by bronchial constriction rather than crackles from pneumonia.
“Oh, the auscultation seems normal.”
“That’s right… no phlegm sounds.”
Definitely not pneumonia.
It could be due to underlying conditions like smoking, but if we consider these new symptoms as a result of this illness… could it be that systemic inflammation has narrowed the bronchi?
I glanced at Mr. Joseph lying in bed. The conclusion is clear. This is either Tsutsugamushi disease or something similar.
A well-known insect-borne bacterial infection often attributed to mites.
Insect-borne bacterial infections are generally treated with doxycycline. Even the Black Death.
It would be great if we could pinpoint the exact bacteria, but there are quite a few similar ones.
Even in Korea alone, diseases grouped under “killing mite disease” include Tsutsugamushi disease, leptospirosis, hemorrhagic fever with renal syndrome, severe fever with thrombocytopenia syndrome, etc. Quite diverse indeed…
Luckily, the treatment approaches are similar: monitoring vital signs, symptomatic treatment, and doxycycline.
We need to pay attention to complications from hemorrhagic fever with renal syndrome and severe fever with thrombocytopenia syndrome though.
“It’s killing mite disease.”
“Killing? Am I going to die?”
True, it’s treatable, but the nickname “killing” isn’t undeserved. Many people died from it, hence the name.
I underestimated this. No, who came up with such a nickname? It scared the patient.
“Ah, it’s commonly called that.”
“So, will I die?”
“No, you’ll get better with medication.”
I shook my head, and Mr. Joseph looked at me suspiciously. Understandable after hearing the word “killing.”
“We suspect your condition is an insect-borne infectious disease caused by a mite bite. In such cases, pathogens can directly enter the bloodstream without a mediator, causing non-specific systemic symptoms.”
“Ah, is that so…?”
“Symptoms appear all over the body.”
The patient, who had been lying down, nodded with a somewhat confused expression.
“Yes. We believe your illness is caused by mites. You’ll recover in a few days with medication, but for safety, you need to stay hospitalized for two days. It might take about a week for the disease to fully disappear.”
In a modern hospital, we’d confirm with blood antibody tests, but that’s impossible here.
“Ah, I understand.”
“Still, it’s a treatable disease.”
“Before administering the medicine, to confirm the diagnosis, we need to find the bug bite wound, right?”
“Huh?”
“The mite might still be attached, or there could be a scab where the mite bit you. We need to find it.”
It’s usually called an eschar — a red lesion with a scab in the center or a mite still attached. The patient frowned.
“How should I do that?”
“I’ll come back later to give you the medicine, so before then, either find the mite or the mite bite scab. Either one will do.”
Mite bites are different from mosquito bites.
They’re usually not itchy, and people often don’t realize they’ve been bitten. Mites typically bite hidden areas where the skin folds. Unless carefully searched, they’re generally hard to find.
I hope you find the mite. If not, the medical staff will have to search, and if that fails, we’ll have to reconsider the diagnosis.
“By the way, patient. One more thing. If you notice any abnormal bruising or changes in urine color, please let us know immediately. Has anything like that happened?”
“No.”
“Great job. Please check thoroughly for any attached mites, and I’ll see you later.”
I stepped aside with Amy.
Amy was writing something on the medical record propped against the wall, then glanced over her shoulder to recheck the patient’s condition.
– Patient’s consciousness: Clear.
“Is it a disease caused by mites?”
“Yeah.”
“Will it be okay?”
“As long as the medication is taken properly, it should be fine.”
Just as long as it’s not Hemorrhagic Fever with Renal Syndrome or that platelet-decreasing disease. Kidney dialysis and platelet transfusions are difficult here.
We need to manage it well to avoid that.
“Keep checking the patient’s complexion and whether their hands are swelling. Also, ask how many times they’ve urinated.”
“Ah, is it that serious?”
I nodded. It wouldn’t matter if we knew exactly which bacteria caused the disease, but since we don’t know the specific type, we must be cautious.
Amy finished what she was writing.
“Did you organize the medical records?”
“Yes.”
“What about the second patient?”
“Apparently bitten by a dog.”
“That must have hurt.”
“We applied a band-aid earlier, though.”
This needs a direct examination. An infected wound could develop into a life-threatening condition, and other problems might overlap.
The patient lay in bed with a bandage wrapped around their calf. How much time has passed since the bandage was applied? Should we rewrap it?
“Hello, patient.”
“Ah, hello…”
“What’s your name?”
“Amanda.”
Amanda. She looked about student age but didn’t seem like an Academy student. Come to think of it, would an Academy student even get bitten by a dog?
“When did you apply the bandage?”
“Yesterday.”
“Let me take a quick look.”
After disinfecting my hands, I carefully unwrapped the bandage from the patient’s leg. It seemed slightly pressed, but the condition was surprisingly good. There was some redness, though.
“Amy, bring distilled water.”
“Yes.”
“It looks like it’ll heal well, but just in case, we’ll clean the wound again and use preventive medication to avoid gangrene.”
“Ah, yes.”
“Please extend your leg out of the bed.”
It must have been a large dog. Besides the tooth marks, there were also torn areas.
“Amy, take a look.”
“Yes.”
“If there’s redness or heat in the wound, there’s a risk of gangrene.”
“Yes.”
“Don’t directly disinfect the inside of the wound. Use distilled water to clean it instead so we can check for any remaining foreign objects.”
“Yes, understood.”
“Do you think we need to stitch this, though?”
“Yes.”
It’s probably better than leaving it untreated. The wound might not heal properly if left alone. I took out a needle and thread from the side.
“Uh… We might need to stitch your wound. It’s bigger than expected.”
“Ah… Will it hurt?”
“We’ll use anesthesia.”
Anyway, let’s hurry. After cleaning the wound with distilled water, we disinfected the surrounding area with red medicine and injected a local anesthetic.
That’s done. I pinched the area around the wound with forceps to check if the anesthesia worked properly. Seems good enough at this level.
“Needle.”
Amy handed me the needle.
“Amy… Watch closely. If the wound is one centimeter deep, the needle needs to go deeper to sew it properly. Otherwise, space will remain under the wound.”
“Ah, understood.”
“Tying the knot too tightly could cut off blood flow and kill the tissue. Tie it firmly but not overly tight. But make sure it closes properly.”
“Understood.”
Finally. The wound was larger than expected, so I had to tie six knots.
“You’ll cover the wound with a bandage or gauze, and the bandage should be checked daily if possible.”
“Yes.”
Luckily, it’s not a serious disease. I put the tools used for stitching aside and moved back next to Amy.
“I’ll give you two pills. Take them now.”
“Yes. Do I only take it today?”
Since it’s prophylactic antibiotics, once is sufficient.
The pre-surgical prophylactic antibiotic dose is 2 grams of amoxicillin. Things change if the wound gets infected. In that case, antibiotics must be taken until the infection clears.
Right, there’s something else to check.
“Why were you bitten? If the dog bit you without any reason, it could be rabies.”
“It was a guard dog from someone else’s house. It didn’t seem mad.”
While pondering, I remembered another task I needed to do for the patient. Since it’s a contaminated wound, tetanus prevention measures should also be taken.
We need to administer tetanus antitoxin too.
I gave the patient one last injection and stepped back from the bed.
“If there’s any change in your condition, please let us know immediately. Symptoms of rabies or tetanus could suddenly appear…”
“Ah, yes.”
Amanda nodded.
I thought for a while.
It’s really frustrating when molecular testing isn’t available. The probability of tetanus or rabies is low, but these two diseases are extremely dangerous and untreatable once symptoms appear.
No, I’m worried and can’t leave yet. Administering rabies antibodies as well would be better…