Polite Dissent

Continuing the medical annotations of Naoki Urasawa’s Monster with Chapter Three (the annotations for Chapter One can be found here and here, and Chapter Two can be found here). Chapter Three is when the story really begins to pick up speed. The cocktail party scene is so masterfully written it still gives me chills. Pick up your copy of Monster and follow along.

As the chapter begins, Dr. Kenzo Tenma is struggling to remove the bullet from the boy’s brain.

Dr. Tenma: Make use of the gunshot wound when cutting
Dr. Tenma: Make sure the debridement is done thoroughly.

NOTES: Tenma is starting his incision at the wound site to provides less trauma to the patient. It also makes it easier on him. As I mentioned in the previous installment, it is a dirty wound. Tenma and his team are debriding the wound, removing all the dead tissue and foreign matter from the wound so that it has less chance of infection and a better chance of healing.

It is a delicate operation, but Tenma successfully removes the bullet and repairs the damaged blood vessels.

NOTES: Proline is a brand of suture (the “thread” used in surgical stitches). It is a non-absorbable (permanent) monofilament (single-stranded) suture made of polypropylene. The “8-0″ denotes the size of the suture, which in this case is very small, about a hundred times less than the diameter of a single hair. Wikipedia has a good article on sutures, if you would like more information.

The boy survives, but remains in a coma. The mayor is not so lucky, he dies during the operation and the other neurosurgeons blame Dr. Tenma for not helping them. The Director shares the bad news at a press conference.

NOTES: “Emphraxis,” one of the words the Director uses is just an old fashioned word that means “clot.” The Director is saying that part of the Mayor’s brain did not get enough blood flow because of a clot and died off. Enough of the brain died that the Mayor did too. Basically, the Mayor had a stroke. As the Director points out, the Mayor’s Inner Carotid (we Americans would say “Internal Carotid”) Artery was clotted off. Because this artery supplies most of the blood to the brain, this was a very serious condition and it is likely the Mayor would have died even if Dr. Tenma had been there.

NOTES: Halcyon is the European spelling for the drug Halcion, generic name triazolam. This drug is a type of drug known as a benzodiazapine that works as a relaxant and a sedative. Valium is probably the best known drug in this family.
A book very critical of Halcion was published in the early ’90s, and whether the books complaints were justified or not, the sales of Halcion suffered in American and have never fully recovered. It is used more in other countries.
You’ll notice that Dr. Tenma does not give a dose for the Halcyon — not a good idea. It’s likely that he has an algorithim the nurse will follow, but it’s always a good idea to give a dose when ordering any medicine, let alone a powerful sedative.

Tenma attends the Director’s cocktail party in an attempt to redeem himself, but the damage has been done. While the Director seems friendly at first, Tenma quickly discovers he’s been demoted and is no longer head of the neurosurgery department. The Director also makes sure that he understands that he no longer has any chance of advancement at Eisler Memorial Hospital and that the Director does not intend to make it easy for him to leave to practice medicine elsewhere. On the way out of the party, his fiancée returns the ring and all but laughs in his face. The cocktail party scene is chilling, and the best scene of the book so far.