I Became a Plague Doctor in a Romance Fantasy Novel - Chapter 96



Episode 96. How Do You Do Auscultation? (2)

Episode 96. How Do You Do Auscultation? (2)

Let’s structure the problem.

What’s the problem we gotta solve?

That, besides me and Istina, there’s no one in this world who knows how to properly use a stethoscope. Truth is, just putting your ear to someone’s chest or back ain’t gonna tell you much.

They’ll probably just go, “Oh, the heart’s beating,” and that’s it, right? The important thing is *how* you auscultate. Just listening isn’t enough.

You gotta use a stethoscope, have set rules and orders, and background knowledge for it to mean anything.

“Istina. So, did you understand what it was?”

“Yes.”

I grabbed a piece of paper and a pen, thinking it over.

“I gotta make a manual… Ugh, what a pain.”

“But it won’t take that long, I think!”

Taking long is a problem too, but right now I don’t even have enough stethoscopes for practicals. Actually, according to my plan, I wanted to give each student one and let them practice.

Looks like that ain’t happening.

I only have two stethoscopes in my possession right now. One I made for myself to use in the Imperial Palace, and the one I gave Istina. That makes two.

“You still have your stethoscope, right?”

“Yes.”

From noble mtl dot com

Istina nodded.

“How long would it take to make more?”

“Probably a few weeks? If we need dozens, or hundreds even.”

I was originally going to get Istina to do it. Istina, who’d built up some serious skills, had slipped out like a slippery eel. Guess it’ll be hard to make her.

If I’m going to give them out to everyone working at the hospital, that’s how long it’ll take.

First things first, let’s have the next class as planned, and as the stethoscopes get made, distribute them to the people around. That’s the only way we can actually have proper conversations and cooperation with other people.

“Did you auscultate? Did you take blood pressure?”

These were things I didn’t even need to ask about in my past life. Now, I have to teach each one to my disciples and create them anew.

“You prepared for the class, right?”

“Yes. I prepared diligently.”

Still, I managed to create a way to measure blood pressure, and I’m accumulating methods for making essential medications like antibiotics.

I can teach them auscultation this time and distribute stethoscopes. This too, we’ll have to build together. Because I have people who can help.

The lecture hall was peaceful today. There were a few grad students from other professors who came to snoop, but not many professors came to the class.

Anne, a grad student, was sitting in the front row.

As soon as I stood at the podium, I began to speak.

“So. Today, I’m going to explain in detail exactly how this thing called auscultation is done. The art of listening to the sounds inside the body.”

I scanned the lecture hall.

“What are some of the major organs that produce sounds that can be heard from inside the body?”

A student I hadn’t seen in a while raised their hand this time. I looked at the student. They seem to have recently moved to the front row, this one.

“What’s your name?”

“It’s Lewis.”

“Good. What do you think?”

“The heart seems to be the most important.”

That’s true.

“That’s right. The heart has the loudest sound. The heart beats every second, so it’s easy to hear.”

I roughly sketched a human torso on the chalkboard, then marked it with five dots.

“So, does anyone know how many important structures are inside the heart?”

There are a lot of important structures in the heart. The heart is divided into four chambers, and thus there are four valves inside the heart. Lewis looked around before raising his hand.

“Four, there are four compartments inside the heart.”

“That’s right.”

I turned my head towards Istina.

“So. How many points do we listen to for heart auscultation?”

“Five.”

“Right, including one in the center of the heart.”

Aortic valve regurgitation is said to be heard best at Erb’s point. I’m not sure of the exact reason. Is there a reason why aortic valve regurgitation and aortic valve stenosis are heard at different locations?

Anyway.

So, next question.

“Istina. Why do heart sounds occur?”

“Because the heart beats.”

“When we move our arms, there isn’t a special sound. Do you know where the sounds, *lub*, *dub*, *lub* *dub*, that we hear from the heart are coming from?”

No one had a clear answer.

“It’s the sound of the valves. The sounds of the heart are the sounds of the heart’s valves closing.”

Even if people know that heart sounds occur because the heart is beating, not many people know that it’s the sound of the valves closing.

I pulled out a preserved heart. The heart had already been cut open in every direction. I held up the valves so the students could see them.

“If you listen closely to the heart sounds, it goes *lub-dub*, *lub-dub*, *lub-dub*. The first sound is the simultaneous closing of the mitral and tricuspid valves, the second sound is the closing of the aortic and pulmonic valves.”

Gotta draw a heart too. I roughly sketched a heart shape on the board, then drew two lines, dividing the heart into four sections.

“Okay then. The first *thump* sound is when the ventricles contract and blood goes out to the whole body, the mitral and tricuspid valves closing.”

I drew two arrows going up on the heart on the board. This is the process of blood going to the aorta and the pulmonary artery.

The moment of the first heart sound.

“The second *thump* is when the atria contract, filling the ventricles with blood, and the aortic and pulmonary valves closing. Got it so far?”

Predictably, only blank stares returned.

“So. When a living person’s heart goes *thump thump*, the first *thump* is the sound of blood leaving the ventricles to the body, the second *thump* is the sound of blood entering the ventricles.”

When things get vague, it’s Istina.

“Istina. You know what this is about, right?”

“Uh, yeah.”

Not exactly a convincing response, but still, Istina is smart. Istina even had her own stethoscope.

“So, the conclusion. By just carefully listening to a patient’s heart sounds, we can figure out which part of the heart, which function, is having problems.”

This time, I looked at Oliver.

“Mr. Oliver. You understand?”

“Yes.”

“So.”

“Yes.”

“If you hear a murmur right after the first heart sound, it means there’s backflow when the mitral or tricuspid valves should be closing, and by the location of the auscultation, you can tell whether it’s the mitral or tricuspid valve that’s the issue, right?”

Oliver frowned here. He didn’t seem to have understood up to this point.

“I’ll be handing out pamphlets, so don’t worry too much if you haven’t understood everything right now.”

The classroom was a low hum. Thankfully, the background knowledge for heart auscultation was pretty complex. Breathing sounds were much easier to hear and understand.

Only Istina’s eyes were shining.

I erased the messy heart drawn on the board and this time drew a picture of the lungs.

“Anyway. Heart auscultation is a much more complex process, and lung auscultation is much easier. Amy. Why is lung auscultation easier?”

“Because the lungs are bigger than the heart.”

“And?”

“Because there are two of them.”

Right. I picked up the chalk again and drew a few lines on the lung picture I’d already made.

“Mr. Lewis. When listening to breathing sounds, what’s the first thing you need to consider?”

“Uh, breathing… speed?”

“It’s right to start with speed. It’s normal to take a breath every 3 to 6 seconds, and if it’s outside this range, you should consider it a problem.”

There’s one more thing.

“And. As I said before, patients have two lungs, right? It’s more advantageous to auscultate while comparing the breathing sounds on the left and right.”

That was about it for the introduction.

Time to really get into the explanation. How to auscultate the respiratory system. Anyone who’s caught a cold and been to the hospital has probably experienced it.

“There are three main types of abnormal breathing sounds. Crackles, wheezes, and stridor. These are important.”

I wrote the three words on the board.

“In order. Crackles are short, rustling sounds. They’re caused by water in the lungs, bronchitis, or pulmonary fibrosis, among other things.”

“Wheezes are continuous, high-pitched sounds that occur when exhaling; they’re abnormal sounds caused by air passing through a narrow space. They often occur due to secretions like mucus and phlegm, or inflammation.”

It’s a sound often heard in asthma as well.

As a side note, crackles and wheezes often appear together. They’re frequently heard in patients with colds too. So, think of them as symptoms you’ll see a lot in patients.

“Stridor is a high-pitched sound that occurs when you inhale, and it usually comes from a large airway blockage. It indicates airway obstruction.”

Lots of confused faces. I hesitated for a moment, then continued the explanation.

“Um, respiratory sounds are different from heart sounds. It’s much more intuitive, if you hear a strange sound, understand that there’s a problem, that’s the starting point.”

It’s because I’m making it sound difficult.

Just listening to the coughing of a pneumonia patient, you’ll understand what it means.

You can immediately sense that this person is very sick, that they’ve caught a dangerous disease.

Anne, a graduate student who’d come to spy on Professor Asterix’s class, was scratching her head.

How can someone be like this? It was only this year that the process of blood flow through the heart was elucidated. It’s still a topic of debate in the academic community.

In just a few days, he’d invented a device to listen to heart sounds and created a technical method to evaluate blood flow? Is that even possible?

That professor is clearly not human.