episode_0009

Episode 9. Going to work in the ward (4)

****

This is the operating room.

We were just doing surgery to realign the patient’s arm bone. It’s fortunate that the joint wasn’t damaged, because there’s no way to fix that at my level.

Now we have to decide whether to reopen the wound from behind and realign the bone, or just go a little deeper.

“……”

I can see it from the patient’s expression. I guess that’s how it is. It’ll hurt a little, but it’s right to open it up and fix it well to the spine. It’s too much of a burden to make another incision.

“Eeeeek! Eeeeek! ”

Istina pressed the patient’s arm harder. If she moved now, she might get seriously hurt.

“What are the criteria for surgery?”

“Good question. If it’s just a crack in the bone, a splint might be enough, but if the bone is shattered in multiple places like this… … . Without surgery, you’ll never be able to use your arm again.”

“Eww! Ewww! ”

The patient screamed again through the gag.

No, I just administered a sedative dose of propofol along with a fentanyl patch. Why are you still conscious? Are you a person who can’t take medication?

Anyway, this almost concludes the surgery.

“Thank you for your patience, patient.”

I finished driving all the nails into the iron plate. I put down the surgical tools I had been using.

Wow. I have to do a bone-alignment surgery on a patient with their eyes open. At least it was my first time doing it.

***

With this, the bones are all aligned. I wonder if there were any blood vessels or nerves inside that were touched? Even if there were, wouldn’t healing magic take care of it?

Honestly, even if there was a problem, I doubt I could do surgery to fix the blood vessel here. It would probably be difficult to get to that level.

I put the torn muscles and tendons back in place and closed the incision. There doesn’t seem to be any muscle damage. The swelling will go down, too.

Now it’s time to stitch up the wound.

“Istina. What do you use to stitch up a wound?”

“Us? Well, what are they made of……”

“If it’s not silk, you’ll get an allergy. Because of the immune response. Only silk thread is used for sewing people.”

That’s silk. It’s the thread that is pulled out from the cocoon of a silkworm.

Most materials are too antigenic to be used for human stitching. Nylon is possible, but it is hard to find in this world.

On the other hand, the silk was often used in the palace as well.

I used silk thread quite often in my previous life. It’s hard to explain exactly, but it seems that the molecular structure of silk causes less immune response.

The specific mechanism by which this happens is too complicated to explain here.

“Istina. Do you know how to sew a wound?”

“I’ve done a lot of sewing, but I’ve never sewn a person. I don’t do surgery often, so I think it’ll be difficult.”

I nodded.

“Then watch the sewing carefully.”

“Yes.”

“Later, try practicing while holding a pig corpse. Next time, you sew up the wound.”

“Okay, I understand.”

The needle moved slowly.

“Since it’s an arm, I’ll tie the knots at 4mm intervals. I think I can take out the thread in a week, but I’ll see how it heals,”

If you use healing magic, you might get better quickly. It’s too early to say for sure that it’ll take a week. It took a long time to sew up my arm.

It’s over.

That’s fortunate, though. If it had been a tendon or blood vessel problem, there would have been nothing I could do.

“Istina.Dressing.”

“Does the patient need a splint?”

There is no need for a splint. Whether it is a splint or a cast, nothing can be more effective than a metal plate placed on the bone.

“In this patient’s case, there is no need for a splint because the bone was directly fixed. It would only cause inconvenience in daily life.”

“Aha.”

I looked at the patient’s face.

“Patient. When the swelling goes down, you will be able to move your arm starting tomorrow. It will take a few weeks to completely return to normal, but it will likely be shorter than that.”

It seemed like the medicine was finally taking effect. The patient just nodded slightly.

“Istina. Watch the patient sleep and record the patient’s condition every 3 hours.”

“Yes, I understand.”

“When a bone is broken in this way, fat embolism can occur as the fat in the bone marrow is released. Renal failure can also occur as a byproduct of muscle damage due to compartment syndrome.”

Istina looked at me with fierce eyes.

“Uh……”

“Just write it down. It’ll be nearby.”

“Yes, thank you.”

The undergraduates I saw in my past life weren’t this stupid. Of course, it’s not Istina’s fault. What can you do about the times?

But since we have healing magic, I think we can at least hold our breath until I get here… … . We need to publish our research quickly.

If the level goes up even just a little, my job will become easier and I can save at least one more patient.

[cure.]

Istina picked up the staff again, and a warm light filled the ward.

****

The surgery was a success though. I went back to the lab with Istina.

I don’t know how the system works here, but you’ll probably need to keep some sort of surgical or ward log. It’d also be nice to have a paper chart.

Paper medical records. I haven’t seen any since I started volunteering at a homeless shelter. They usually use computerized medical records.

I also need to organize my military records.

“Oh, Professor. I’m sorry.”

Istina was hesitating. What do you want this time?

“What is it?”

“Are you accepting me as a graduate student?”

I forgot. Didn’t you say last time that you would decide whether to accept me as a graduate student in a few days?

“That’s right.”

“Thank you. I will work hard.”

Istina bowed her head.

“Professor, I know you’re busy, but I have a few questions about the patient I saw today.”

“Yeah.”

Pick it up one by one.

Istina took out a piece of paper and a pen from somewhere.

“First of all, I didn’t clearly understand what compartment syndrome was. I couldn’t ask properly because the situation was urgent.”

Compartment syndrome.

It’s a disease that is seen more often than you might think.

“There’s a membrane around the muscle, right?”

“Yes.”

“This is a disease in which the pressure inside the fascia increases due to bleeding or swelling inside the fascia. The treatment is to cut the fascia to reduce the pressure.”

Istina scratched her head.

“Well, one more thing. Why is it a problem when intra-fascial pressure increases?”

“That’s because when the pressure inside the fascia becomes higher than the blood pressure in the capillaries, blood circulation is cut off. Don’t you know what capillaries are?”

This is the problem with explaining things from the basics. You don’t even know what a capillary is, and you only vaguely understand the concept of pressure, so you don’t understand what I’m saying at all.

Well, there’s nothing I can do.

Let’s prove the existence of capillaries at another opportunity. Once the microscope is perfected, we will probably be able to see them.

“Anyway, I think it’s because the fascia is full and blood can’t come in.”

“I understand. What happens if I don’t do the fasciotomy on time?”

Die.

Even if people don’t die, their muscles do.

“If it progresses to the end, muscle tissue necrosis. The necrotic tissue’s remains travel through the blood vessels and cause systemic problems. I don’t know what will happen if you add healing magic to it.”

Istina nodded.

“Okay, thanks for letting me know.”

“Get some rest and go back to the ward.”

Istina left for the ward, and I thought about it for a while. I think it was in the 17th century that capillaries were discovered.

It’s no wonder these people don’t know.

I think I need to hire more graduate students. That way, I can compile my research faster and communicate with people in this world faster.

****

Meanwhile, in Professor Asterix’s ward.

The patient, Benjamin Brisbane, slowly opened his eyes. The last thing he remembered was the healers administering medicine to him for surgery.

The surgery itself must have been incredibly painful, but I don’t remember the process clearly. All I remember is the aftertaste of the handkerchief I was biting.

Benjamin was the heir to the Brisbane family and a student at the Academy. He was riding a horse at full speed when he fell over once… … .

It might be a miracle that only his arm was injured.

“Where is this…?”

“This is a hospital.”

Most of the excruciating pain I felt in my arm was gone. Still, since I had surgery, I couldn’t help but feel some pain where the knife was inserted.

A healer of a plain appearance stood beside the sickbed. He was wearing a plague doctor’s mask over his black robes, giving him a somewhat grim look.

“I had surgery on my arm. I’ll probably be able to move it a little tomorrow, but it’ll take a few weeks to fully recover.”

“Did the teacher fix it for you?”

Istina shook her head.

“The newly appointed professor saw me. He used to be the royal physician.”

“When can I meet you?”

Benjamin looked worried, and Istina was a little worried. How should I explain it?

“I don’t know if you’ll be back in the ward today. But if there’s a problem, I’ll call you right away.”

“Can you use your arms?”

Istina nodded. The professor said she would be able to use her arm in a few days, so she probably would.