Monster: the Medical Annotation (Volume 1, Chapter 6)
Continuing the medical annotations of Naoki Urawawa’s Monster. We’re now up to Chapter 6.
Previous Annotions: Chapter 1 (part 1), Chapter 1 (part 2), Chapter 2, Chapter 3, Chapter 4 and Chapter 5.
The narrative picks up nine years later. Not much has changed for Dr. Tenma. He remains Chief of Surgery at Eisler Memorial Hospital in Düsseldorf and still doesn’t have much of a social life because he always puts his patients and medical practice first. As the chapter starts, Tenma is operating on a complicated patient with a parasellar meningioma1. Meanwhile, a brutal murder has taken place across Germany in Kõln. The police have their eye on a suspect, but he is hit by a car trying to flee. He suffers a skull fracture and an epidureal hematoma2. Dr. Tenma is brought in to operate on the suspect to save his life. While in Kõln, Tenma runs into Inspector Lunge, who all but accuses him of murdering the other physicians at Eisler nine years before.
Notes:
1A meningioma is a very slow growing tumor of the meninges, the thin membrane that covers the brain. “Parasellar” refers to a tumor near the sella turcica, a protusion of bone on the inside base of the skull. It is located several inches behind the eyes. To remove this tumor, Dr. Tenma is going to use a pterional approach — this means that he will be going through the pterion, an area at the side of the skull where several of the bones join together. It is one of the thinner areas of the skull and it makes since to use it as an entry point. Once the brain is revealed, Tenma retracts the Sylvian fissure and proceeds to the deeper portions of the brain to remove the tumor. Finally, “extirpation” refers to a surgical removal.
2The injured suspect has suffered a skull fracture. This has torn one of the blood vessels supplying the brain and led to an epidural hematoma (a blood clot between the brain and its thick outer covering). This hematoma is so large that it has increased the pressure on the brain enough to cause the brain to herniate — in other words, the increased pressure is forcing the brain down through the posterior of the skull toward the spinal column. This has damaged the third cranial nerve on the right side of the brain and caused a dilated right pupil (better known as a “blown pupil”). If untreated, a brain herniation can rapidly lead to death.
Tenma performs a craniotomy (basically, he drills a hole in the skull) to drain the hematoma and take the pressure off the brain. It is a successful operation though the patient continues to have some paralysis on the left side and a dilated right pupil afterwards. The left-sided paralysis is residual damage from the hematoma, which caused damage to the right side of the brain (remember the right side of the brain controls the left side of the body, and vice versa). Cranial nerves are different, and damage to one side is reflected on that same side, hence the right-sided herniation leading to a right dilated pupil. Both the paralysis and papillary dilation should improve as the brain recovers, but may never recover 100%.
A final note: while the medicine remains sound, there are several misspellings in this chapter. It’s not really a surprise as these are complex medical terms and spelling them correctly is never easy. Furthermore, remember that the book is translating from Japanese to English a story about a surgeon in Germany, so it’s frankly impressive that this hasn’t been a problem before now. Anyway, Terional should be Pterional and Optic Chasm should be Optic Chiasm.
NOTE: Chapters 7 and 8 of Monster have no medical scenes, so this post is effectively the final Medical Annotations of Volume 1. Stay tuned for annotations of Volume 2 soon.
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