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Episode 31. Severely Traumatized Patient (3)

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I almost forgot about a patient because of the splenectomy. He wasn’t going to die soon, and he wasn’t in urgent need of attention.

“But, Professor. When you just took out the organ, did you stick your finger in the organ… …?”

There was no choice.

Blood was still flowing out of the broken spleen, and it had to be removed as quickly as possible. There was no time to carefully remove it.

It’s fortunate that this patient seems to be fine.

Relatively speaking, yes. A torn Achilles tendon is a serious problem, although it is less serious than a ruptured spleen.

Best of all, there is no need for surgery.

“Hmm. Is this patient also a swordsman?”

“Maybe.”

It’s not right to make emotional judgments about the patient’s situation, but what the heck?

“How intense is the swordsmanship training? What good will it do if you make two people crippled in one day? There won’t be any knights left.”

“Oh, I have some left.”

“Really?”

“Even in noble families, only one child becomes a nobleman. The competition to become a knight is fierce. There must be a reason.”

Istina spoke softly, and I scratched my head. Could that be so…?

Hey guys, if I hadn’t been there guarding the ward today, or if my ward had been full, wouldn’t you have died or become disabled?

“But it’s a bit much to kill each other in a fight.”

“It’s a bit… … . It’s different than usual.”

“Is there any competition today?”

“I guess so. Here’s how it happened-”

“Oh, the patient seems to be awake. Come quickly.”

I got up from my seat, and Istina followed me. The event must be big. Now is not the time to worry about other people’s events.

There is a patient in a rather critical condition before your eyes.

During the three hours we saw the spleen patient, the patient only received emergency treatment and nursing care.

From the patient’s perspective, it may be a bit absurd, but a torn ankle ligament doesn’t mean that the patient will die. It’s not that I don’t feel sorry for them. In fact, a fatal disease is more urgent.

Anyway, let’s take a quick look now.

“I think the injury is a ruptured ankle ligament. Considering the banging sound, it’s probably the Achilles tendon. Istina, do you know what the best treatment for an Achilles tendon rupture is?”

Istina was a bit worried.

“Achilles tendon. You mean the heel ligament?”

“Yeah.”

“Oh, are you going to have surgery?”

Since Benjamin also had surgery, it is within the scope of Istina’s knowledge that surgery is correct.

Although surgery is certainly worth considering, there is no significant difference in prognosis between surgery and conservative treatment for patients with Achilles tendon rupture.

The professor said that in my orthopedic class.

If I were you, I wouldn’t have surgery.

All surgeries carry a risk of infection.

If bacterial Achilles tendonitis occurs after surgery, it is difficult to treat even with modern medicine.

Even if you administer antibiotics, well… …. Since blood vessels don’t pass through the ligament, antibiotics don’t make a significant difference in prognosis.

Of course, there is no way to guarantee that there will be no infections in these shady operating rooms.

Although difficult to quantify, recovery periods after non-surgical treatments may be shortened by healing magic or superhuman resilience.

There is no particular merit to the surgery.

Of course, surgery would get me back on my feet a few weeks sooner, but the bottom line is I have absolutely no confidence that I can ever fix the ligament.

The spleen was… … taken out whole, and the arm bone was just nailed in and reattached, but

Ligaments are a completely different matter.

This is a much more sophisticated surgery than anything I’ve ever done before, and I don’t know how they’re going to attach it.

To conclude, there is no reason to have surgery. It can be treated sufficiently with other methods.

“I won’t have surgery.”

“Then what happens?”

“The Achilles tendon will heal on its own without surgery. Instead, you’ll need to wear a splint or a cast. It’ll be like that for a few weeks.”

“Is that the best way?”

“If it were me, I wouldn’t have had the surgery.”

Istina nodded.

The policy has been decided, and the means have been determined. Now it’s time to begin treatment. I opened the curtains of the hospital bed and made eye contact with this patient.

“Patient. What is your name?”

“Oh, it’s Aires.”

Ayres. He looked a bit older, but he was still a young man. Come to think of it, he was an academy student, but he was just a knight, so he seemed a bit rough.

Come to think of it, the patient whose spleen burst earlier might have been in the same swordsmanship competition and in the same knighthood. They might even be around the same age.

I’m sorry, I thought you were an old man.

“Does your leg hurt now?”

“At the time I got hurt, it hurt so badly that I heard a loud bang. Now, it doesn’t hurt much.”

Everyone has strong mental strength.

“I see.”

“What kind of disease is this?”

I was worried about the expression.

“The patient has a ruptured ligament connecting the heel and calf muscles. This is called the Achilles tendon.”

“Then what happens?”

It’s becoming a bit difficult to walk.

“Until it gets better, you won’t be able to do any exercise that involves getting your feet wet, like standing on tiptoe. But if you get treatment, you’ll get back to normal.”

“What treatment will you do?”

“You will be put in a splint. You will not be able to use the heel splint for at least one month.”

“A month? That’s a bit long.”

“It’s better than not being able to run for the rest of your life.”

The patient became quiet at these words.

Surprisingly, you can still walk even if your Achilles tendon is ruptured. In fact, there are cases where people do not go to the hospital or miss the treatment period.

It’s a good thing I came to the hospital right away this time.

“Is there no other way?”

“None.”

The patient sighed.

“Oh, that’s not easy.”

I don’t see any other options. The only possible treatment in this situation is to wear a cast for a few weeks.

“Okay, I’ll do as you say, teacher.”

“Patient. We need to confirm the diagnosis, but is it okay if we take a quick look at your leg?”

Ayres nodded, then sat down on the bed and stretched out his legs.

Istina and I bowed our heads in front of the patient and checked his legs. Where was he hurt?

****

How can you be sure that your Achilles tendon is ruptured? If this were a modern hospital, you would of course have to take an X-ray.

There are no x-rays here.

Then what should we look at it as?

“Istina. It is an assumption that this patient’s Achilles tendon is ruptured. How can we prove that the Achilles tendon is ruptured?”

“Oh, if you press on the refund… … . Can’t you feel the broken part?”

The patient was terrified.

“Hey, don’t touch my hurt spot.”

Well, it’ll hurt if you touch it. Even without that, the injured leg looks quite swollen.

“Hmm. The best way is to compare both sides. It doesn’t necessarily apply to the legs. If you look at this patient, there is tension behind the heel on one leg, but not on the other, right?”

“Ah!”

Asymmetry. This is something that we always have to be aware of.

“Excuse me. I need to run my finger over that Achilles tendon to make sure it’s not twisted and not going to heal.”

Istina tilted her head.

“But how do you reattach something that’s broken?”

“Oh, it’s a bit complicated. Muscles are wrapped in something called fascia, right? Even if the Achilles tendon is torn, it’s still wrapped in a fascia, so if you maintain it well, it can be reattached.”

To be honest, it’s unrealistic to expect full functional recovery. Oh, I can feel where the Achilles tendon is torn. Align the top and bottom-

“Put your toes down.”

If you have your toes down, your Achilles tendon will go up. If the two pieces are closer together, the chances of them sticking together will increase. Let’s see.

“Yes. I’ll just fix it with a bandage.”

I don’t know if there is a plaster cast.

“When can I go back?”

“Uh, I think we’ll have to put a splint on the leg, or put a cast on it, or immobilize it as thoroughly as possible. It’ll probably take a few days.”

The patient nodded slowly as if he understood. I felt a little sorry for him. There was no guarantee that his function would recover.

“We can also make you crutches.”

I don’t think it will be a big problem though.

“The swelling is so bad right now, I think I’ll have to put on a cast once the swelling goes down a bit.”

What kind of medication is there to reduce swelling? You can use non-steroidal anti-inflammatory drugs, but as far as I know, these are not good for ligament healing.

It’s probably better to just leave it alone.

****

We left the ward for a moment.

I think I’ll be busy for a while with the new patients, so I should rest while I can.

The full story of the incident could only be properly grasped after a few minutes had passed.

Academy Knight Department Swordsmanship Tournament.

It is said that every spring, there is an event where knights, or people who know how to wield swords, gather from all over the country to compete in swordsmanship.

How many people get hurt every year?

Because of the good treatment I gave Benjamin last time, they say they brought all the patients from the swordsmanship tournament, which mostly consists of the great sword aristocrats, to me.

“That’s what happened.”

“Ah. You should have said that.”

Istina hesitated for a moment.

“I was going to say something, but the professor was running towards me, yelling at me, and telling me to bring a bucket of water. So I missed my chance to say something.”

Did I do that?

I think that may have been the case.

“Anyway, I’m glad it worked out well.”

Kailas. This is the patient who had a ruptured spleen. And Ayres is the patient who just came in. We put a splint on him until the cast was ready.

It’s not that plaster casts are impossible, but it takes a day to prepare the materials, etc.

“Usually, a few people get hurt every year, right? But this time, it looks like no one got into trouble. Everyone will be happy.”

I see.

I leaned against the wall, and Istina sank to the floor. I’m tired. I’ll just finish with the two patients I’m seeing now, and then I’ll lie down for a bit.