21st Century Necromancer

Chapter 19: Chapter 19 Acute Kidney Injury

At night, inside a bar that wasn't particularly noisy, Kube Rokuro was sitting alone at the counter, sipping his drink in a somewhat gloomy manner with his head down, seemingly deep in thought.

When Chen Yu walked into the bar, he spotted Kube Rokuro at a glance and walked over, slapping him on the shoulder, "Hey, Kube!"

"Ah! Chen-san!" Startled by the slap on his shoulder, Kube Rokuro suddenly jumped, quickly turned around to see it was Chen Yu, and then relaxed, "Don't suddenly slap me from behind! You nearly scared me to death."

"Inviting me for a drink and here you are brooding over a solo drink, what's up? Work not going smoothly, or did something happen, little Kube? Let me guess, it couldn't be that you've fallen for one of those female forensic doctors at your institute and got rejected when you confessed, could it?" Chen Yu sat down next to Kube Rokuro, looking at his troubled face, he couldn't resist teasing him.

"That's not it!" Kube Rokuro hurriedly denied it, but after he did, he seemed a bit embarrassed, adding unnecessarily as he explained to Chen Yu, "There ARE two very beautiful female forensic doctors at UDI, but I haven't confessed to them."

"Oh~!" Chen Yu responded with a meaningful "oh," his gaze full of teasing as he looked at Kube Rokuro, "So it's not that there are no female forensic doctors, but that you haven't confessed, is that it?"

However, faced with Chen Yu's teasing, Kube Rokuro wasn't in the mood to joke around this time, and just shook his head saying, "Those female forensic doctors are really..."

"Really what? With that troubled look on your face, what's really bothering you, Mr. Kube?" Seeing Kube Rokuro's gloomy demeanor, Chen Yu put aside his teasing and seriously inquired, "It couldn't be that you can't handle seeing bodies being autopsied, could it?"

"Not at all. If it's just the autopsy of a body, although visually shocking, I think I can accept that," Kube Rokuro denied Chen Yu's guess, explaining, "It's just that a body was sent for autopsy recently and it turned out to be related to another death. Today, I visited the deceased's home with the two female forensic doctors, intending to investigate the cause of death, but since the body was already cremated, we could only pay our respects and then come back."

Hearing what Kube Rokuro said, Chen Yu could somewhat understand his mood, patted his shoulder, and comforted him, "Life and death are unforeseeable; choosing the medical profession, whether it's forensic science or clinical healing, one must face life and death. Try to take it more lightly!"

"I know I should take it more lightly, but... but the family we visited today, the daughter had just died, the mother was still crying, and it's all still vivid in my memory... Yet on the way back, those two female forensic doctors were already joking and laughing..." Mentioning this made Kube Rokuro's expression turn even darker, as if he couldn't accept the attitude of the two female forensic doctors.

It seemed as if to emphasize his own attitude, Kube Rokuro added one more comment at the end, "Those autopsy doctors simply don't treat people as human beings."

However, upon hearing Kube Rokuro's words, Chen Yu didn't show much of a reaction, but simply ordered himself a glass of Absinthe, his tone turning somewhat melancholic, "That's normal, isn't it? If everyone got as emotionally burdened by every incident as you, Rokuro, those in this profession would be susceptible to emotional breakdowns over time. The attitude of those autopsy doctors isn't surprising. Only by facing their work with a relaxed attitude can they avoid the pressure it brings."

"Like us who perform clinical healing, if we empathized with each patient that comes to us and something went wrong during surgery, or if there were a mistake and the patient died, we would be burdened with guilt for a lifetime. Without taking a detached view, one simply can't stay in this field."

"Is that so?" Having listened to Chen Yu, Kube Rokuro seemed to gain some understanding, but it was unlikely that he was going to change his point of view anytime soon.

Perhaps finding the topic too heavy, Chen Yu promptly moved on, asking about something else, "Rokuro, you said earlier that a body was brought in for an autopsy at your place, but it involved another deceased person. What's that all about?"

"Oh, it was commissioned by a pair of parents whose son was found dead in his own home. The police concluded that the cause of death was ischemic heart disease. His parents didn't believe that their son could die of such a cause, so they sent him to our UDI for a forensic autopsy, wanting to know the true cause of their son's death. But after the autopsy, the creatinine levels were three times the normal, leading to a diagnosis of acute kidney injury, suspected to be poisoning." Perhaps also wanting to divert from the previous subject, Kube Rokuro explained the case he encountered in detail, perhaps seeking the opinion of his senior colleague, Rokuro was very thorough.

"Poisoning? That's not necessarily the case!" After hearing Kube Rokuro's explanation, Chen Yu disagreed with the judgment of the UDI autopsy doctor, "While toxins are indeed a primary cause of acute kidney injury, they are not the only cause. Acute kidney injury refers to the sudden onset and persistence of a rapid decline in kidney function, defined as at least a 0.5mg/dl increase in serum creatinine, presenting with azotemia, disorders of the water, electrolyte and acid-base balance, as well as symptoms affecting various systems throughout the body, possibly accompanied by oliguria or anuria."

"As for the causes..." Chen Yu said, seeming quite unsatisfied with Kube Rokuro's bewildered look, "Mr. Kube, how can you not know this? You attended medical school after all, albeit a third-rate one, but as a clinical doctor, shouldn't you understand these things?"

"Sorry! I wasn't paying attention in class." Chastised by Chen Yu, Kube Rokuro knew he had embarrassed himself and quickly apologized, but he was more concerned about the causes Chen Yu had mentioned, "But what are the causes of acute kidney injury, senior brother? Why do you say it might not be poisoning?"

Chen Yu gave Kube Rokuro a speechless look, clearly even more dissatisfied with this medical student's ignorance of the causes of acute kidney injury, but proceeded to explain, "The pathogenesis of acute kidney injury includes prerenal factors leading to acute kidney injury, kidney parenchymal or vascular disease-related acute kidney injury, and postrenal acute kidney injury caused by urinary tract obstruction."

"Acute kidney injury from toxic poisoning comes from nephrotoxins causing tubular necrosis, which belongs to kidney parenchymal or vascular disease-related acute kidney injury. Potential toxins include aminoglycosides, contrast agents, heavy metals, organic solvents, or other antibiotics. As for what specifically caused the deceased's acute kidney injury, I think you should investigate further. It's very likely to be another disease and not poisoning."

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