episode_0098

Episode 98. A disease that gets better, a disease that doesn’t get better (1)

****

Today is another enjoyable outpatient clinic day.

No, they are people who come in sick, so it would be a bit odd to say that it is a fun outpatient clinic time. But wouldn’t it be fun if they got better?

Knock knock.

“Come in.”

Anyway, the patient listened to what I said and slowly walked into the examination room.

Let’s see. An elderly patient who doesn’t look like a nobleman or a student. He seems to be having trouble walking because he’s shaking his legs a little. Is it diabetic foot?

I looked closely at the patient’s sitting posture. There was no apparent deformity or muscle atrophy in the legs. They looked symmetrical.

What could be the problem?

It could just be a sprained ankle.

“Oh my, Doctor. Hello. I heard you are the best doctor in the empire, but you treat ordinary people like me.”

I nodded. I considered saying something humble and brushing it off, but I couldn’t find a good reason to do so.

“Anyway, please tell me your name and age. What is causing you discomfort?”

“Ryard, 41 years old. My feet hurt.”

He was younger than I thought.

“How are you sick?”

“My feet keep getting blisters, bruises, cuts, and I’m dying from pain.”

“Since when has it been like that?”

“It’s been about 10 years.”

“Oh, let’s take a look.”

The patient took off his shoes and socks.

I looked at the patient’s feet.

This is a typical case of hallux valgus.

It’s a condition where the big toe bends outward, toward the other toes. It will probably get worse over time.

“Is there any medicine for sore feet?”

“There is no medicine for this.”

I’ve heard something about hallux valgus. I thought about it a bit.

Is there a separate treatment for hallux valgus? It would be better not to touch the ankle joint. The patient looked at me and looked around.

As expected, the expression was like that.

“Oh my, there is no cure, right? Other healers said similar things. But thank you for taking care of me… … .”

Oh, I remembered.

I interrupted the patient.

“It’s not over yet. There’s still more that can be done… … How uncomfortable is your foot, patient?”

The old man shook his head as if to say, “Don’t talk nonsense.” I gestured for him to explain further.

“How much?”

“Yes.”

“Ah. It gets worse every year. Now it’s hard to even walk. It’s a big deal. I have to do farm work and stuff, but it’s hard to even stand up and walk.”

“Your big toe is over your second toe, or vice versa? So your feet don’t fit well in your shoes, and you get blisters here and there.”

“How did you know that?”

The patient looked surprised. He looked like he was wondering how I could figure it out without saying anything. Of course, I’ve seen a few people with similar illnesses.

If it gets worse, you may not be able to walk.

“Yes. My toes are getting rubbed and twisted, and I get blisters after walking for just a few minutes. I’m dying.”

I’ve been thinking about how to bring this up. But no matter how much I think about it, I can’t think of a way to say it in a polite way. I’ll just say it.

“Um. Do you need all your toes?”

****

There is a simple treatment method for hallux valgus. It is not commonly used these days, but it is by no means ineffective.

Most of the symptoms of hallux valgus occur when the big toe bends outward and invades the area of the second toe.

Without thinking too much, just cut off the second toe. One toe can be safely removed at the hospital.

“Toes? Don’t you need them?”

“If you take out the thumb, you don’t have any necessary toes.”

“Ah… … ?”

“There is no other treatment available here at the moment. Instead, the second toe can be safely removed at the hospital. It won’t hurt.”

Correcting the foot, toe angle surgery, this is realistically difficult. There is no X-ray machine. But amputating the toe can be done.

“Choose.”

“Just a moment.”

The patient looked at his feet.

Looking at the second toe in question. This isn’t exactly a shady cure, I’ve seen it done in hospitals in the real world.

At that time, I said, “The patient is a real man,” but now I don’t see any other solution.

“Think about it slowly. Think about whether the symptoms are so bad that you would need to cut off your toe, and how much you need your toe.”

“Hmm, I’m worried.”

“You can think about it slowly. It’s not a disease that changes every day. You can come back in a few hours. You can come back in a few months.”

“What do you think, doctor?”

“What?”

The patient hesitated.

“If it was you or a family member who had this disease, what would you have said? What would you have chosen?”

If it were me, I would have thought about it, but I would have just chosen to cut it off. Even if it was my family, I would have recommended just cutting off the toe.

“If it were me, I would cut it off.”

“Really?”

“I don’t know if I really need a second toe. I think my hallux valgus is going to get worse, since it’s a disease that gets worse over decades.”

The patient nodded with a determined expression. It won’t be a difficult surgery.

****

I decided to have the surgery right away while I had time.

The patient had his foot raised on a few pillows to be operated on. I cleaned his foot with alcohol and used a razor to shave off every last hair on his foot.

With this, preparations for surgery are almost complete.

“I’ll put you under anesthesia. It won’t hurt much.”

The patient nodded without opening his mouth. Istina was standing behind me.

“Okay, Istina. Look carefully. Just by looking at it, you can see why this toe needs to be cut off, right?”

“Yes. It will be difficult to walk like this.”

“Then. What are the possible complications of cutting off the toe like this?”

“Bleeding, infection, gangrene.”

As expected, that’s true.

“Then. Measures to block each.”

Istina thought about it for a long time.

“To prevent bleeding, raise your legs above your heart as in the current position, and keep a close eye on the bleeding so that you can stop it immediately if necessary.”

“Okay.”

“To prevent infection, surgical instruments must be sterilized, the patient’s feet must be disinfected, and all hair on the patient’s feet must be removed.”

“Good answer. Anything else?”

“I don’t know.”

It’s hard to expect more than one answer right now, but I think you did pretty well.

“The foot is where the shoe is inserted, and there are a lot of anaerobic bacteria in the shoe. If the shoe gets even a little sweaty, it gets worse. For about three days after surgery, you should actively monitor the infected area and change the bandage twice a day.”

“Yes.”

“If you have diabetic feet, the wounds may not heal, so you should check to see if there are any strange wounds on the patient’s feet. There aren’t any, right?”

“Oh, right.”

I looked closely earlier, and there were no strange scars or ulcers on the patient’s feet. I don’t think he is at risk for diabetic foot. I’m not sure if there is a way to measure blood sugar levels in this world.

“Before surgery, you can tie the patient’s leg with a tourniquet to limit bleeding.”

Istina nodded like she was being scolded. She answered well, but the problem was that she didn’t say everything she could.

Anyway, the surgical procedure was as usual. I was sedated with intravenous propofol, then local anesthesia with lidocaine.

Then cut along the incision line with a knife… … .

“Top.”

Istina handed me a small saw. Cutting off a toe wasn’t a difficult task, but I actually didn’t remember using a saw on a patient.

“This hurts a little.”

Usually, the anesthesia doesn’t reach all the way into the bone.

So I injected propofol. I started sawing, and the patient grimaced as if it was a little painful. There’s nothing I can do. It’ll be over soon.

“All done. Scissors.”

I’ve just finished cutting off the toes with surgical scissors. Now all I have to do is finish the surgery.

“Look carefully, Istina.”

“Yes.”

“Even if it looks easy on the outside, this is. If the skin folds inward when stitching, sweat glands, sebaceous glands, and hair can grow into the tissue.”

“Oh, I see.”

“You have to cover it carefully. Come and see.”

The preparation took a long time, but since my toes were so small, the procedure was over quickly. I took off the mask after suturing the surrounding flesh appropriately.

“That’s it. You shouldn’t walk today. I’ll change the bandage every day, and I recommend wearing only sandals for a week.”

The patient did not respond this time either.

It seems like the sedative hasn’t worn off yet. Thinking about it, it was a bit interesting.

When I think of the students at the Academy’s College of Engineering screaming and making a fuss while receiving propofol, fentanyl patches, and even local anesthesia…

There seems to be something different about him compared to ordinary people. There’s no way to find out what it is, though.

I took a step back, and Istina wrapped a white bandage around the patient’s wound. It ended without any major problems.

****

Meanwhile, Istina scratched her head. I think I must have put my stethoscope in my coat pocket, but I don’t know where it went… … .

It’s fortunate that the patient who came in today doesn’t have respiratory or heart disease.

“Professor, haven’t you seen my stethoscope?”

“I don’t know. You have to take care of it yourself.”

“Yes… … .”

“I’ll buy you one next time.”

Professor Asterix didn’t seem to be listening to Istina. He was preparing a vial of medicine to give to the patient he had just operated on.