episode_0105

Episode 105. Mortality Rate Cut in Half (1)

****

Mint stared at me.

“There is.”

“Yes?”

“I’ve been getting quite a few letters lately. They’re saying they’re sick, someone they know is sick, and they heard that the best doctor in the empire knows someone. Can you introduce me to them? I usually ignore those.”

“Everyone is thinking wrong.”

“What?”

“You have to see patients busily to gain experience and become good at it. It’s not like you can gain skills by only seeing rich patients in an ivory tower.”

“I guess so.”

“I’m not saying that making a lot of money is a bad thing. It’s just weird to expect a healer who’s only done easy work to do better.”

It can’t be helped. Skill comes from hard work… no, experience. Mint nodded after thinking about it carefully.

“That’s not what I meant to say.”

“Yes.”

“I’m worried because there are a lot of people who have their eyes on you, teacher. Last time, it seemed like Baron Lapis was trying to take you away.”

“I won’t go. Don’t worry, hold on tight.”

“Hmm. Okay… … .”

Mint still looked a little uneasy.

“That’s right. I picked out two suits for the teacher to wear. Come and see them later.”

I nodded.

“I have class, so I’ll take my leave now… … . See you later!”

“Yes.”

After a brief sound of someone packing their bags, Mint waved and left the lab.

****

“Professor! Emergency!”

Boom, boom. Istina burst into the lab through the door. There was only one possible reason for that. A seriously injured patient must have come in.

Judging by her intense reaction, she might be more severe than any patient I’ve seen so far. Or maybe Istina is just a bit on the weak side.

“What is it?”

“A young male patient with a broken leg, his thigh completely broken. The patient was in so much pain that they couldn’t even set the bone.”

I was walking briskly to the ward with Istina. Istina was mumbling, almost sobbing.

“I tried to see the patient, but his leg was so swollen that I couldn’t even bandage him and there was nothing I could do. So I just laid him down on the bed and went to find the professor… … .”

“Yeah. Are you talking?”

“No. He just keeps screaming. I couldn’t even ask him questions. He’s just a male patient in his 30s or 40s.”

Do you only see patients like that for a day or two?

If you’re in too much pain, you won’t be able to speak. You’ll need anesthesia to be able to speak. But if you’re still screaming, that means you’re not going to die right away.

A broken thigh bone would most likely be a fractured femur. A bent leg would mean that the femur isn’t just cracked, it’s split in two.

It is a dangerous disease. It is so serious that it is almost a death sentence for the elderly.

During World War I, the mortality rate from femoral fractures among soldiers in 1916 was 80%.

They say it dropped to 20% after the introduction of the Thomas splint. It’s a good thing they made it.

The Thomas splint is a simple tool. It’s hard to believe that it had such a big impact.

“Femoral fracture.”

“Ah. I tried to do something, but you kept screaming, so I put a gag on you first. I was afraid you would bite your tongue or die from shortness of breath from screaming.”

“Oh, good job.”

Femur fractures are different from other bone fractures because of the muscles. The femur is connected to very powerful muscles.

Once the femur is broken, the muscles attached to the bone begin to pull on the bone fragments.

Bones like the ribs fuse together on their own, but the powerful muscles attached to the femur actually pull the bones together, preventing them from fuseing together.

The muscles pull on the bones to allow the leg to move, but the direction in which the lower part of the femur is pulled is opposite to the direction in which the upper part is pulled, so they have to be misaligned. There is a solution, but it is very painful.

“How do I fix it?”

“Pull your leg.”

“The leg you just broke?”

“Yeah.”

“Until when?”

“Continue. Until you can apply a splint.”

The leg with the broken femur must be pulled hard enough against the pulling force of the thigh muscles to bring the bone back into alignment.

“I’m going to faint from the pain… … .”

“It’s better than dying.”

Of course, it is not an easy task. This level of pain could be shocking.

****

When I arrived at the ward, I saw two nurses holding wet towels on the patient’s legs. It might help relieve the fever a little, but… It didn’t seem to have much effect.

“Go and get that.”

“What is that?”

“That. A splint that covers the entire leg.”

“Oh, yes!”

The Thomas splint is a very simple device.

Hugh Owen Thomas, the father of orthopedic surgery. He was a British military doctor who served in World War I. The device he invented is the Thomas splint.

Simply put, it is a device that can safely pull the leg and prevent it from turning. It is a good idea to make it because the structure is simple.

Anyway, Istina hurried to the hospital storage room to get it. I looked at the patient who had just come in.

“Patient. Are you awake?”

The patient shook his head while holding the gag in his mouth. Hmm. Is there something he wants to say? Maybe it’s something that needs to be said.

I took a fentanyl patty out of my pocket, placed it on the patient’s bare chest, and released the gag. The patient gasped.

The fentanyl patch takes a while to work. I’ve been thinking about the propofol injection, and since I’m not bleeding and I’m hemodynamically stable, I wonder if that might work?

I felt the pulse of the patient’s wrist. The pulse seemed stronger because of the injury.

I disinfected the patient’s elbow with an alcohol swab and injected a small amount of propofol into the patient’s vein. I didn’t have time to calculate the amount.

The effects of the medicine started taking effect immediately.

“Is the patient okay?”

“Ugh.”

“The gag was tied to prevent the patient from hyperventilating or biting his tongue. Does it hurt a lot?”

“Yes.”

Oh no… … .

It’s going to hurt more now. I can’t keep giving him painkillers. Istina returned to the bed with a splint.

But since I used propofol, he started talking. It seemed to hurt less than before.

“Please be patient for a moment.”

“Hey, what is that?”

In my previous life, it was called a Thomas splint. It was a tool for straightening broken legs. Of course, at first glance, it looked like some kind of torture device.

“Just a moment-”

The patient tried to run away when he saw the splint, so I held him down on the bed. If he falls off the bed like this, he could get into a bigger situation by rupturing a blood vessel or nerve.

“Patient. If you leave it like this, your leg will return.”

“So you’re pulling it with that?”

The Thomas splint is a simple-looking device.

A thick ring for the thigh, a small ring for the shin, and two iron bars connecting the two. Think of it as a frame that can be used to pull the leg down and tie it so it doesn’t turn.

“Stay still, it’s dangerous to move.”

“Does this hurt a lot?”

“No. Nurse, please check the patient’s face to make sure he’s not in shock.”

“You said it doesn’t hurt?”

“Well… … . It’s a broken leg, so of course it hurts. I’m telling you to take it easy.”

“What is that.”

Sorry to say this, but you should have worried about the pain before your leg bone broke in two.

It’s fortunate that no other bones were injured, other than the leg. This patient must have injured his spine. It’s not something I can do anything about.

In fact, even if you are an orthopedic specialist, it is not possible to perform spinal surgery using only your eyes without an X-ray. It would be difficult to find the problem.

The patient protested, but perhaps fear was clouding his judgment. It wasn’t that difficult to press down on the patient who had broken his leg after receiving propofol. Istina quickly put a splint on his leg. Next in line was…

“Gag. Nurse, please come and gag the patient. Patient, if you have something to say, raise your hand instead of screaming.”

If it were a modern hospital, they would have put a titanium nail in my femur after general anesthesia. But that’s not possible here. I have no choice but to endure it with a propofol injection.

It’s going to hurt more than having my spleen taken out last time. And local anesthesia isn’t even possible.

Even if you were to anesthetize, you can’t anesthetize the bones, right? You could try sacral plexus anesthesia, but if that causes nerve damage, there’s nothing I can do.

This is the best under the given conditions.

“Nurse, one more person, please come. I need someone to hold the splint and pull the patient’s shin. Ms. Istina, check this out.”

“Yes.”

“Look closely. The patient’s left leg is about 3 centimeters shorter, right? That’s because the bones don’t match, so the leg is bent. So… … .”

Have to pull.

“Patient. Bite this hard. If you don’t come to your senses, you might actually pass out.”

“Uuuup!”

In times like these, you must remain calm.

“Nurses, please hold the patient upright. If you don’t straighten your legs properly now, you will be disabled for the rest of your life. I will pull you up after counting to one, two, three.”

It’s going to hurt terribly.

Sticking a finger into the spleen and taking it out might have been okay since there aren’t many pain receptors in the internal organs.

There are a lot of pain receptors in the legs.

It is about 50 times more than the internal organs.

It’s not just painful, this time I really need to worry about painful shock. It’s going to be 50 times more painful than the patient who had their spleen removed…

“One. Two. Three.”