Chapter 76: Good Healer (4) |
***
I met Ayla in the hallway just now.
Since it was her first day, I wanted to give her a tour of the clinic.
But the situation didn't allow for it.
"Patient report, please."
"Male, 40s. Fall from a construction site. Decreased consciousness, and left pupil has begun to dilate."
For the past few months.
The report came from a Healer who had been intensively trained only on strokes at this clinic.
Of course, he was still lacking by 21st-century standards.
"What is the size of the dilated pupil?"
"8mm."
"Understood."
I examined the patient's head with my naked eye.
The head shaving and disinfection of the surgical site had already been done.
The Assistant Healers had taken care of it before I arrived.
It has already been a few months since we started working together.
Now, we were perfectly in sync.
"How many minutes has it been since the cocaine application?"
"Five minutes have passed."
"Then we will begin the Craniotomy."
I picked up a scalpel from the instrument stand.
It was my custom scalpel, created after repeatedly modifying a silversmith's razor blade.
The tip of the scalpel touched the small protrusion in front of the patient's earhole.
Starting there, I traced a large arc around the ear up to the crown of the head.
I made an incision line in the shape of a question mark.
The thin, thread-like red incision line gradually widened.
I immediately spoke to the Assistant Healer.
"Refresh."
"Refresh."
The Assistant Healer, repeating my order, used divine magic on the incision line.
Refresh is a magic of a lower grade than even Minor Heal.
It's at a level where it simply bathes the target in divine power, without any catalyst, symbol, or runic formula.
Being simple, its only effects are hemostasis at the capillary level and some fatigue recovery.
But this was enough to stop the bleeding from the incision line.
"Forceps."
"Forceps."
I clamp the incision line firmly and peel back the scalp.
The white skull is exposed.
"Hammer and chisel, please."
"Yes."
I aim the chisel at the skull.
Tap, tap!
First, I make a groove in the skull,
"Trephine."
and drill a hole with a device that looks like a wine opener.
One might worry about what would happen if I couldn't control my force and went too deep.
It's a question other Healers often ask, in fact.
My answer to that was always the same.
— "That would be unfortunate."
In the world I used to live in, this was how they opened up skulls.
Surgical perforators have a feature that stops them automatically upon touching the brain, but that's 21st-century technology.
In the 20th century, where romance was alive and well, they performed brain surgery with nails, hammers, and wine openers.
And if they made a mistake?
You just had to count it as a contribution to the advancement of medicine.
Well, anyway.
Five holes were completed along the border of the skull.
"Gigli saw."
I received the thin, durable wire saw.
It was an expensive wire saw plated with Mithril, that staple of fantasy stories.
I push the wire saw into the first hole and pull it out through the second.
Gripping it with both hands, I saw back and forth.
After repeating that several times, a fine line is created on the skull.
"Elevator."
I inserted the elevator into the edge of the bone fragment cut along the dotted line.
Applying force with the principle of a lever—
Thud.
Lid-opening successful.
"Place the bone in saline solution."
The opened lid is placed in saline solution.
Now, it's time to examine the brain.
"The hematoma is severe."
A dark red blood clot on the meninges was pressing on the brain.
As I was checking the hematoma, I sensed a presence behind me.
It was Ayla.
She was leaning against the wall, staring blankly at the surgery from a safe distance.
Her complexion looked pale.
It was a common reaction for medical students entering an operating room or dissection practice for the first time.
"Student Ayla."
Ayla flinched at my call.
"Other theology students usually collapse at this point. You seem to be doing fine, Student Ayla."
Other Healers sometimes bring their acquaintances or children to the clinic.
Most of them were seminary students aspiring to become Healers.
Most of them would collapse on the spot upon seeing such scenes.
But Ayla wasn't collapsing.
"Do you feel like you can't bear it?"
Ayla shook her head.
"That's good. Tell me if it gets too hard."
I know this is harsh for a child who has just awakened to divine power.
But it's a reality she must face someday.
This is a rite of passage she would have had to go through anyway, even if not in my operating room.
According to what I've heard from other Healers, novice healers typically go through this kind of rite of passage.
They show the newbie a drawing, a remnant, or the actual scene of the most gruesome sight to strengthen their resolve.
They say if you don't undergo this mental preparation, you'll break down at the most crucial moment.
"Since you came in after disinfecting your hands, don't touch anything and just stand there. You'll be participating in the surgery in a little while."
"Yes..."
Leaving the weakly responding Ayla be,
I moved on to the next step.
"Incision of the dura mater. Prepare for suction."
"Suction is ready."
I place the scalpel on the dura mater and make a cross-shaped incision.
Gush.
The moment the membrane split,
the trapped bloody water—the subdural hematoma—poured out.
The blood clot that had pooled between the brain and the dura mater burst out all at once.
"Suction."
"Suction."
Repeating the order, the Assistant Healer brought the manual aspirator to the blood pooled on the brain.
It began to pump the blood with a shhk, shhk sound.
Meanwhile, I turned back to Ayla.
"Student Ayla."
"Yes!"
"Do you happen to know why Heal can't treat someone with a head injury?"
"I don't know, sir!"
Well, of course.
She's a seminary student before she's a Department of Healing student.
I explained in a loud voice, both to teach Ayla and as a review for the other Healers in this operating room.
"Heal is a magic that cures wounds. It's excellent for mending torn blood vessels or setting broken bones."
As the assistant continued pumping, the extracted blood clot was collected in a bucket.
"But Heal can't remove blood that has already pooled. Nor can it extract rotted toxins."
Heal is regeneration.
Not removal.
"This patient lost consciousness because the pooled blood in his head is pressing on his brain. So even if we regenerate the torn blood vessel with Heal, the blood that has already escaped will still be pressing on the brain."
I pointed at the hematoma being suctioned out by the aspirator.
"That's why we open them up directly like this to remove the blood."
"Ah..."
"Until I explained this surgical method, it was misunderstood as black magic. Right, Assistant Teacher?"
The Assistant Healer let out a dry laugh.
When he first heard me say I'd open the skull, this person accused me of planning to use black magic.
But the misunderstanding was cleared up quickly once I explained the principle.
"Back then, Director, you just suddenly said we had to open the unconscious man's head and touch his brain without explaining the principle, so..."
"Did I use that expression?"
I don't really remember.
Anyway.
"Are you feeling a bit better now?"
I asked, checking Ayla's complexion.
Ayla nodded.
Her color was much better than before.
"The hardship of entering an operating room for the first time only lasts a moment."
I continued speaking as I examined the surface of the brain to find the source of the bleeding.
"The reason people can't watch cruel things is because of the malice that lies at the bottom of the act. But even if it's the same scene, it's bound to feel different once you know it's an act to save someone."
I said, glancing sideways at Ayla.
"How is it, now that you know the reason for opening the head? Does this surgery still feel as scary as it did at first?"
Ayla shook her head.
"No... I think it's much better than before."
"Isn't it fascinating? Nobility has a way of making humans this strong. We can gain such courage just by embracing goodwill and faith."
Ayla nodded.
As if agreeing with me, the Assistant Healers also nodded silently.
A doctor's stomach for gore is proportional to their knowledge.
Why this surgery is necessary.
Why this person is dying.
What I can do for them.
The better you know these things, the stronger your stomach becomes.
Of course, there were peers who could never enter the operating room no matter how much they knew, but that's innate nature, so it can't be helped.
"Good. Then, student, come closer."
The pumping had finished while we were chatting.
I had also identified the blood vessel that was bleeding.
The upper left parietal lobe.
A bridging vein was torn.
After immediately performing ligation on several spots of the vein with thread, I called Ayla closer.
"Student Ayla. You said you know how to use Refresh, right?"
"Yes? Yes..."
"Now, did you learn that Refresh can perform hemostasis?"
Ayla shook her head.
"I was told that hemostasis requires at least a Minor Heal. And that Refresh should only be used for its fatigue and stamina recovery effects."
"Correct. You've studied well. That is the textbook correct answer."
I pointed to the ligated bridging vein.
The bleeding had been stopped by tying it with thread.
But the blood vessel itself hadn't regenerated.
It was in a state where it would bleed again if the thread came loose.
"Now then, try casting Refresh here."
Next to the torn blood vessel.
I pointed to the torn vessel.
"...Here?"
"Yes. Shall we try using Refresh on this part that I've tied with thread?"
Ayla cautiously reached out her hand.
A faint light bloomed from her trembling fingertips.
And the moment Ayla's divine power touched the ligated area, the torn vein twitched.
Soon, the hole in the blood vessel closed.
Ayla didn't seem to have noticed this change yet.
So, I untied the thread to show her.
"See? Hemostasis was achieved with Refresh, right?"
"Huh? Uh... How?"
"Because the necessary conditions were met."
Divine magic is, in the end, a branch of magic.
Only the resource is divine power; everything from the catalyst, symbolism, and conditions follows the same principles as magic.
"Now, Student Ayla. When lighting a fire on wet wood and dry wood with magic, which of the two would be easier to light?"
"The dry wood, I'd assume?"
"Correct, right? Dry wood can be lit even with low-rank flame magic, but wet wood would require more magical power and a more complex runic formula."
A prime example is the Curses of Pestilence, which are now dying out.
Because of the immunities formed by vaccination, the amount of magical power needed to cast the curse has increased exponentially.
That's why the Plague Sorcerers are so desperate to kill me.
This surgery is an extension of that principle.
"It's the same for divine magic. If you just meet the right conditions, you can perform the same miracle with less divine power and a lower level of mastery in divine magic."
With just an oil barrel, a low-rank flame magic can produce the firepower of a mid-rank one.
In the cold northern region, you can use more powerful ice magic with less magical power.
And a patient who has received proper emergency treatment can have a miracle performed on them with less divine power.
Depending on the case, you can even save a patient with a cerebral hemorrhage using only a Minor Heal.
"Healing magic has developed in that direction until now. This vein ligation is the same kind of technique."
A blood vessel gushing blood can barely be staunched with only a Greater Heal.
But a blood vessel whose torn part has been sutured with thread can be closed even with Refresh.
Of course, this was only possible because it was torn, not completely severed.
"Now, shall we wrap this up?"
Afterward, I regenerated the severed blood vessels with Minor Heal.
The rest were not vessels that Ayla could handle yet.
What could be regenerated with Refresh was possible only because they were slightly torn vessels.
The rest could only be regenerated with Minor Heals.
After regenerating the blood vessels and achieving hemostasis,
"Once the brain's swelling goes down, I'll cover it with the bone in a few days."
Since the brain was severely swollen, I decided not to replace the skull and just cover it with skin.
Of course, I could cast Heal to reduce the swelling.
But if I did that, this priest wouldn't have any divine power left for the next patients.
Selection and concentration.
It was an unavoidable choice in a world with limited resources.
"Pupil has returned to 4mm."
The decompression was a success.
"Shall we close the scalp now?"
It was time to cover the exposed area with the scalp and suture it.
"Student Ayla, are you good at sewing?"
"I sometimes help mend my mother's priest's robes."
"Good. It's beneficial for a Healer to be skilled with thread. Watch carefully how I do it."
I handed the suture thread and needle to the Assistant Healer and said,
"Teacher Tai (Assistant), please suture from the left. I'll take the right."
"Yes, Director."
The Assistant Healer took the needle and began to stitch the head, one painstaking stitch at a time.
Meanwhile, I quickly sutured the wounds on the right side as I always do.
While the Assistant Healer barely managed to suture one incision line, I sutured all the remaining ones.
After one final check of the thread's tension,
"It's finished. We will now check the surgical tools."
While the other Healers checked the used gauze and tools,
I placed a disinfected gauze over the sutured scalp.
Just then, Ayla asked a careful question.
"Director... I think this will leave a big scar later... Can't you finish it cleanly with Heal?"
"That's a good question, Miss Ayla."
Cosmetic aspects are also something a surgeon must consider.
Especially for head surgeries, methods that leave fewer scars are a separate field of research.
Treatment isn't just about removing the disease, but a process of returning the patient to their daily life.
Cosmesis can never be ignored.
"Cosmesis is important. But not right now."
"Why not?"
"Because in a month, I have to open it up again to replace the skull."
I pointed to the skull soaking in saline solution.
"And the scar needs to remain so I don't get confused when I put the skull back in later. I'll heal it all then."
Ayla made an 'ah' expression of understanding.
"I didn't know."
"It was a good question, Student Ayla. It would be good if you continue to always think of the patient's perspective first like that."
I took off my gloves and left the operating room.
"Now then, it's late, but I'll give you that tour of the clinic."
