episode_0116

Episode 116. Euthanasia (2)

****

The temple’s plague ward was thick with the smell of strange flowers and incense. It could be felt even through the mask.

I scratched my head.

‘why……?’

There was only one possible reason.

I wonder if these people thought it would help treat the patient. I disinfected my hands again, put my plague doctor mask back on, and walked towards the hospital bed.

The diagnosis was not difficult.

Blackened limbs, skin lesions. Fortunately, I can’t hear any coughing. Could this be the pneumonic plague spreading?

If you think about it, there was no guarantee that it was exactly the same as the Black Death in the original world. Even if it was indeed an insect-borne bacterial disease, there’s no guarantee that the detailed progression of the disease would be the same.

“Is this the person you are applying for?”

“Professor Asterix.”

He was a white-haired man who looked quite old. He was wearing something like an apron over his priest’s robes, and his mouth and nose were covered with a cloth.

The ward was much noisier than I expected. The priest pulled me aside to talk.

“Oh my, thank you for coming. I am Archbishop Karl, and a healer. I am out on the front lines because we are short on manpower.”

The old man is having a hard time.

“Yes. What is the flower scent?”

“I burned incense to fight the stench. It’s better than nothing, I guess.”

I had a lot to say, but I didn’t say it. It wasn’t a situation where I could fight over the scent of flowers or the theory of miasma. If only that would give me some peace of mind.

“I heard that you are the best healer in the empire. I didn’t know you would come all the way here. What kind of treatment would you like me to do?”

The archbishop looked at me with sad eyes.

I thought about the answer. It was not an easy question to answer. Here is the most realistic and public-interest-oriented answer.

“Euthanasia.”

****

This may seem like an overstatement, but… … .

The Black Death.

The name says it all.

Turns black and dies. In other words, turning black means dying.

In the case of septicemic plague, improvement of symptoms cannot be expected unless antibiotics are administered within one day of the onset of symptoms. Here is why.

The reason the limbs of people with the Black Death turn black is because the bacteria that enter the bloodstream cause disseminated intravascular coagulation.

Micro-clots spread and block blood vessels, causing tissue necrosis and appearing black.

To cut to the chase. The necrotic tissue had built up on the limbs to the point where they looked black… … .

There is no cure. As the necrotic tissue begins to break down, hyperkalemia causes the heart to beat abnormally, and as it rots, inflammatory substances fill the blood vessels.

We have no choice but to amputate the limb before the necrotic tissue rots. Is this the right solution? Can we survive if we cut off the limb?

I don’t know exactly.

You must have seen a plague patient.

If it’s only one or two people, it’s worth a try, but if we try to operate in the current situation, there’s a high risk of the medical staff getting sick because of the blood.

You can’t expect a patient dying of the Black Death to consent to surgery, and even if the surgery goes perfectly, you can’t expect them to survive.

“Once the limbs turn black, there is no chance of the patient surviving.”

“Um… ….”

“I think the best treatment is to ask the patients their opinions and give them opium to relieve their pain.”

The archbishop shook his head.

“You haven’t even seen the patient yet. You’re in a hurry.”

“Tomorrow, sand, and glopi. I don’t know how many patients will come rushing in. I will cure all the patients who have not yet come down with septicemic plague, that is, black necrosis.”

“We have listened carefully to the professor’s advice, but we will not give up so easily.”

“No, Bishop.”

“There may be some who can easily make ruthless decisions. That may be true, but I think that priests are not like that.”

It’s not that simple.

Take a look around the ward.

Aren’t we using half of the city’s medical resources to treat someone who will die within two days? We need to know what we are giving up for what.

“I know it’s a sad situation, but we’re using half the city’s healing staff to treat people who will die in two days. I’m not the one making the callous decision.”

The archbishop shook his head firmly.

“I understand the professor’s opinion, so I’ll decide after seeing the situation tomorrow. Even if I have to give up, I’ll do my best until the very end.”

I sighed.

He is a healer by name. It must not be easy to make the decision to euthanize. Although he had different opinions from the archbishop, he had no intention of being stubborn.

We can’t fight over a matter of killing people, let alone saving them. I sighed.

****

Let’s take a look at the patient first. I turned my back to the hospital bed, and Istina followed me.

“Do you really think that euthanasia is necessary? Isn’t it too extreme?”

“Because there are no pneumonic plague patients yet. Euthanizing septic plague patients with no chance of survival is also a method.”

Ultimately, it comes down to a question of what ends justify what means. There is no guarantee that a utilitarian approach is the right approach.

“There’s nothing to diagnose. Give seven pills to every plague patient. Tell them to take one a day, and note any other problems.”

“Yes.”

“Oh, right. Go and make some oral rehydration with 0.9% salt water. 0.5% sugar will do too.”

Istina left.

I’ve been looking at the patients. Let’s set a goal. The important thing now is to see if there are any patients here with pneumonic plague.

The transmission rate is different. The bubonic plague, or septicemic plague, is an infectious disease transmitted through insect bites. It is not transmitted from person to person.

On the other hand, pneumonic plague is a disease that is transmitted directly from person to person, so it spreads much faster.

What if it exists?

The method I suggested to the Archbishop was to administer painkillers to make the patient feel better. But I told him not to do that.

The ward was a living hell.

People crying, people screaming, people in pain. As I walked towards the hospital bed, the patients’ facilities all turned towards me. Well, there was nothing to do but wait for the healer.

Patient number one. The first patient was an ordinary-looking man. His hands and feet had not turned black, and his eyes were half-open.

“Patient! Are you awake?”

“Yes… … .”

I poked the patient with the spoon next to the patient’s bed. As I said before, you can’t just say, “Oh, you’re sleeping well,” and pass by while the patient is sleeping.

There may be a loss of consciousness. Even if the patient curses at me nine times out of ten, I have to wake them all up for the sake of one unconscious patient.

“Eww, why is it like this?”

“I thought you were dead.”

I put down the spoon.

The patient blinked and reached out his hand weakly toward me. I stepped back. I didn’t know how good the protective suit was.

“Listen carefully. I will give you seven pills, so take one pill every day.”

“Yes.”

The patient nodded.

“Are there any unusual bruises, bleeding from the mouth, nosebleeds, or discoloration of the fingers and toes?”

“Um, yes. There was nothing like that.”

If there was a patient with disseminated intravascular coagulation, I thought about prescribing an antithrombotic agent. Fortunately, this patient does not have one.

“The situation in the city is not good right now. Get your mind right, eat well, and drink plenty of water. Do your best.”

“Yes.”

“Finally. Try coughing.”

“Coloc, coloc.”

The patient coughed forcefully. The cough sounded normal. There was no phlegm-boiling sound, and it seemed like he didn’t have pneumonia.

The patient took a pill in front of me. If treated with antibiotics, the chances of survival will increase by about 10%. Maybe?

Let’s move on to the next patient.

****

Knock, knock, knock.

This time it was a young male patient who was coughing. I gritted my teeth.

This patient may already have developed pneumonic plague. Ironically, he may have survived until he developed pneumonic plague because he was a young man.

The method I suggested to the Archbishop was euthanasia, but if that is not an option, how should we treat this patient?

I sighed.

“Patient. Look at me.”

“Yes?”

Now is not the time to beat around the bush. I need to be completely honest and get a completely honest answer, even if it’s a little brutal.

“How long do you want to live?”

“I don’t know what that means… … .”

There’s no time for that. I shook my head.

“It is true that the patient is putting everyone in this city at risk right now. If the patient really says that he or she must live, we will do our best to treat him or her.”

“Or what?”

Or what else?

“There are many ways to die comfortably.”

“Do I have a choice?”

“Yes.”

The patient quickly burst into tears.

“I don’t know about that. If I can survive, I definitely want to survive. Sorry… … .”