Katawa Shoujo Forums

Hello! first post, but I had some questions on the MCs medical condition. I'm not an expert on cardiac conditions, but I have a lot of knowledge on treatments of various medical conditions. I'm a Biomedical Engineer with a focus on tissue engineering and regenerative medicine, or wound therapy might be a more general term. Again, I'm not an expert, I'm not so much on the patient treatment or after care side as the development of treatments side. however i do need to know what's currently available, and in designing new treatments the ability for the caretaker to use those treatments must be taken into account. But in a nutshell what i want to know is: Why say 'arrhythmia' instead of 'weak heart'? why don't conventional treatments work for the MC if arrhythmia is the main problem? Why was his chest cracked (or scarred)?


While playing through the demo, The first thing i noticed was a large number of inconsistencies very early in the game. After the MC passes out and the scene shifts to the hospital an image of an ECG is displayed. The wave form shown is not a normal heart rhythm (called sinus rhythm). At first i thought this was on purpose, as nearly immediately after it is mentioned the poor bastard has arrhythmia. I was surprised the conditioned was even named, but moving on. The wave form displayed does show a type of arrhythmia. The p wave is missing, but a complete spectrum would need to be seem to complete diagnose the problem, which i'm not really interested in, but i don't like inconsistencies so i'm pointing it out. The p wave indicates the beating of the atrium, during the wave is the atrium contracts, followed by the contraction of the ventricles (The large spike, called the QRS). the final wave is a 'reset' or relaxation phase where nothing is really beating, but an electrical signal is still picked up. The absence of the P wave shows the MCs atrium is not beating. Very good reason to be in a hospital. This type of arrythmia would need to be treated with a pace maker, or a new heart, depending. (The head nurse mentions 'congenital muscle deficiency'. congenital means the problem arose in the fetus, if i remember right. and muscle deficiency would suggest that the basic problem is his heart is too small or weak. Could explain the no-atrium contraction, but no amount of pills will fix or treat that. he would need a new heart, end of story.) It would also cause the ventricular muscles of the heart to beat inconsistently, as it usually looks for the P wave before beating. Muscle efficiency could cause the atrium not to beat, But the arrhythmia briefly described in the text is not this type of arrhythmia, as it focuses on the hear beating too fast. Also the mention of the MC being on beta blockers (saw that somewhere on the forum) is somewhat inconsistent with the missing P wave. This suggests more that he suffers from Atrial or ventricular fibrillation. This is usually treated with a defibrillator. Heparin is also listed in the 'sea of text' that accompany a couple other medicines and side effects etc. Heparin can be used in the treatment of A. Fib. But it is more often used in surgery, as it's a pretty powerful anti coagulant and not really used widely outside of a hospital where you can be watched constantly. Also, it MUST be injected. Heparin degrades when taken orally. an anticoagulant also suggests that he has something implanted. As an anticoagulant would only be needed if there was something his blood could stick to, or he had a blood disorder. Things the blood could stick to would either be an artificial heart valve, or pace maker leads. an anticoagulant could also be used to lower blood pressure, to a degree, but that's not it's primary purpose. Seeing as he has muscle deficiency his cardiac output is likely low. why does he require anti-coagulants? (But i'm not a pharmacologist, but i do know that heparin is way too strong for this kind of disorder) a prescription strength asprin (or acetylsalicylic acid since asprin sounds kind of lame) would be safest. there are stronger ones available, but it seems very odd that heparin would be prescribed. anyway, Most pacemakers nowadays contain both a defib and a pacer. solving two of the previously mentioned problems. This might not work however if the MC had a severely damage heart, meaning the could not do the surgery required. But that is also inconsistent as the mention of scars on his chest. and pacemaker leads are usually installed through the brachial artery, so the scar would be closer to his armpit. If they cracked his chest, then they would have had to repair a ruptured vessel (bypass surgery, he did have a heart attack, but bypass isn't always needed. It doesn't seem Hisao would need that) or installed a heart valve. This type of damage is typically not caused by arrhythmia alone, but also neo-intimal hyperplasia, or overgrowth of the endothelial in a blood vessal, cause the vesal to become compromised and blocking the flow of blood. (there are other causes, but this is more likely considering the age of the MC) A heart valve could be needed if he somehow had compromised valves. possible due to the muscle deficiency. They would not need to crack his chest to diagnosis 'weak heart' as an echo cardiograph would help indicate that, because of very thin heart walls. The most likely explanation i can see is that they cracked his chest to put in new heart valves. which would explain the anti-coagulants and other hoard of medications.

If his heart was severely damaged, he would need a transplant. Considering his age, he would be high on the list. But Japan is well known for it's lack of donors, so that can be explained. However, his parents were willing to sell their house to pay for treatment. The most logical course would be to ship the poor lad to america, most likely california due to it's larger asian population and the fact it's a 'biotech hub'. Furthermore, if his heart was that damaged a large number of medications would not be recommended, as they would further damage the cardiac tissue. Seeing as his heart is already weak, a large number of medications seems very odd. but all of that is inferred, and after reading most of the 'explanation' of the MCs condition, someone like me who has a lot of knowledge is left with "...WTF!?" as there are a large number of inconsistencies in the described treatments, images, and text explanation. so...what exactly is wrong with the guy? because his condition doesn't seem untreatable to someone with more medical knowledge. There is another Doujin game, I think it's come see me tonight but i can't remember, where one of the girls has a similar (less severe) condition i think you are going for. In the end her and the protogonist do end up flying over seas for treatment. It was cute. It's been a long time since i've played that game though, and all i really remember is her hair was blue, she had a scar next to her left breast, and she had a 'rare heart condition.'

The easiest way to 'fix the problem' would be to forego the mention of a disease altogether, and say 'rare heart condition' it's a little lame, but prevents people like me from picking it apart at every detail. also, as he's a highschool student, he likely wouldn't know every detail that was wrong with him. he might only be able to understand the fact that he has a heart condition. Namely, his heart is weak, and he sometimes suffers from arrhythmia as a result. As arrhythmia isn't the real problem, a weak heart is. if that is the case, this should be mentioned somewhere. probably before any attempt to explain the disease instead of after by the head nurse, in a way most people probably won't understand. you may not even mention arrhythmia, because arrhythmia's are VERY treatable and the MC could lead a fairly normal life. He would just need to watch his level of activity, namely intercourse, sports, and on bad days going up and down stairs. a special school wouldn't really be needed. If he lived in a very rural area, he might have to move to a city, but unless he was in danger of having a heart attack nearly every day, he wouldn't need constant nursing. Aka, his heart is EXTREMELY weak, which is likely the case. But as mentioned previously that should be said instead of arrhythmia. I like seeing technical lingo, but it implies certain things about his condition. arrhythmia is emphasized a lot, but that doesn't seem to be the real problem and could confuse someone.

God that's a lot of text. but hopefully it helps you guys out. (and appeases my curiosity)

WALL OF SCIENCE

Not to tl;dr you (as I got most of the way through but then I realized I had no idea about anything you're talking about), but I guess weak heart would be technically more apt than cardiac arrhythmia. In my opinion, though, arrhythmia seems fine enough an excuse to release Act 1 on. Maybe he has some other complication to prevent his recovery/treatment from going smoothly that we don't know about yet.

Plot devices are serious business.

Nack wrote:Plot devices are serious business.

Let's hope they don't mention why Shizune is deaf or mute.

omg, incorrect or incomplete medical facts in a work of fiction? The world must end.

You're really picking it apart too much. I see things in novels that are incorrect ALL THE TIME. Even by authors that spend quite a lot of time researching the subjects that they're talking about. Unless the plot itself hinges on exact details of the subject matter, it's not worth worrying over. In this case we know he has a serious heart condition. They give a name to it because it's nice to have a name to put to it. Other than the fact that he has to take meds, and can't exert himself too much, that's all we really need to know for the plot. Heart condition, got it. Get off the scientific facts and get into the story and the characters.

ETA: Actually read some of your post now. The game you're thinking of is Narcissu, and there is a HUGE FREAKING PAGE dedicated the medical conditions the characters face. I could do without reading it, but as I understand it there are inconsistencies there, too.

In fact, I believe Rin said it best.

Heart thingy.

Onisake wrote:The easiest way to 'fix the problem' would be to forego the mention of a disease altogether, and say 'rare heart condition' it's a little lame, but prevents people like me from picking it apart at every detail.

I think everything comes down to this. I don't want to sound like a douche, but I doubt many people are gonna pick it apart as much as you are doing now, I mean we are talking about a VN here.

Fidelas wrote:

Nack wrote:Plot devices are serious business.

Let's hope they don't mention why Shizune is deaf or mute.

I always assumed she doesn't talk because it's hard to know what you're saying when you've been deaf since you were born. From what I know, most IRL deaf mutes aren't actually mute, they just don't know how to talk since they can't listen to themselves.

Ah, I love walls of science. Highly educational post, Onisake, thanks. I enjoyed reading it.

Now, regarding inconsistencies in games. I agree that they can be highly annoying to a professional at times, but let's face it, there aren't that many doctors who play visual novels these days. The vast majority of players have little to no medical knowledge on the matter, and probably don't care much for accuracy. I'll admit, I've never heard of Arrhythmia before I played the game. Minor mistakes are practically inevitable, especially if the developers don't have a medical expert to consult. I'm sure that they just do their best when it comes to technicalities like these, and focus their attention on what's truly important: the story itself.

Whether or not they'll correct it is up to them. It may cause complications on the storyline, though, so I wouldn't bet on any drastic changes.

I read through, and although many people, and I could, say 'so what, artistic licence', I don't think it's the best option.

Obviously, the disease should be matched to the requirement of the game, but I, for one, know how annoyed I get when I see TV shows blatently making up computing stuff.

If one knows about a subject, it is incredibly annoying to see people not having done good research and actually made something believealbe.

Lattyware wrote:I read through, and although many people, and I could, say 'so what, artistic licence', I don't think it's the best option.

Obviously, the disease should be matched to the requirement of the game, but I, for one, know how annoyed I get when I see TV shows blatently making up computing stuff.

If one knows about a subject, it is incredibly annoying to see people not having done good research and actually made something believealbe.

You make a very good point. Perhaps Onisake or someone could join the developers team, to proof read anything regarding the characters' conditions. That seems like the best solution so far.

I think that would slow the project down.

I mean, having to re-write a ton of dialog just because a doctor happens to dislike some minor medical mistakes in a visual novel seems like a waste of time to me. Not trying to offend you, Onisake, but that's how I see it.

Lattyware wrote:I read through, and although many people, and I could, say 'so what, artistic licence', I don't think it's the best option.

Obviously, the disease should be matched to the requirement of the game, but I, for one, know how annoyed I get when I see TV shows blatently making up computing stuff.

If one knows about a subject, it is incredibly annoying to see people not having done good research and actually made something believealbe.

LOL Sneakers.

GODDAMN THAT'S ONE HUGE WALL OF TEXT THERE

I think I understand what you're saying about the whole "using the term arrhythmia" instead of something more general, or having a better idea of his exact condition. Makes sense, and if his condition was explained better then there could be less inconsistencies if we knew the more exact nature of his weak heart.

Though, I think going off of the "for show" heartbeat thingy during the intro for any sort of insight is a bit much XD I doubt the nature of that graphic was supposed to represent Hisao's actual heartbeat.