Chapter 92: The Intentions Were Good (3) |
*
Right after pulling the patient out from under the rebar.
The first thing I checked was the patient's thigh, which had been trapped under the rebar.
At the time, the thigh was swollen to its limit and gleaming.
As soon as I confirmed this, I immediately prepared for surgery.
The patient didn't have the luxury of waiting for a healer to use Detoxification Magic.
However, Gregor's Adjutant, unaware of the situation, stopped me in shock.
"Lord Saint!? Didn't you say you wouldn't amputate?"
"I won't amputate. I'm just going to make an incision."
"Compartment Syndrome has set in."
Compartment Syndrome.
A condition where a fracture or bruise causes the muscle to swell severely within the fascia, compressing blood vessels and nerves in the process.
If this condition persists for a long time, the patient's leg could undergo necrosis.
There was only one thing to do to prevent this.
Open the leg to allow the pressure to drop.
The principle was the same as a craniotomy.
You just open the leg and relieve the pressure.
"Could you lend me a hand?"
"I don't know how to perform surgery!?"
"It's fine. You just need to hold things in place."
And so, with Gregor's Adjutant as an Assistant Doctor and the inside of the car as a Temporary Operating Room, I began the surgery.
I roughly disinfected the surgical tools and the affected area.
Reaching my hand out to the adjutant, I said.
"No. 10 Blade."
"Pardon?!"
"Ah, never mind."
Out of habit, I had treated the adjutant like the healers at the Merkur Clinic.
Naturally, there was no way the adjutant would understand that.
'It's been a while since I've had to do everything by myself.'
It was a sensation I had forgotten.
Surgeries had been much easier since I trained the clinic healers to be as good as 21st-century assistant doctors.
It was my first time leading a surgery alone in a long time.
"Do you know how to use Refresh?"
"Yes. Even Holy Knights can at least use that."
"Then please cast it every time I say 'Refresh'."
Tap, tap, tap.
Saying that, I felt my way down from the patient's flank.
First, I checked the hard bone felt on the side of the hip, the great trochanter.
Going further down, I checked the outer edge of the knee, the lateral femoral epicondyle.
As if connecting the two points in a straight line, I sliced down with the Dwarf-made modified No. 10 razor blade.
Beads of blood began to form.
"Refresh."
"Yes."
The adjutant achieved hemostasis using Refresh.
As the bleeding stopped, the opened side of the thigh became visible.
"Metzen... no, give me the scissors."
"Y-Yes."
The adjutant handed it over with the blades of the scissors pointing toward me.
It was a mistake that would have earned a severe scolding had he been an official healer.
I took the scissors from the adjutant and brought them to the long white band over the muscle.
I cut the iliotibial band of the fascia lata with the scissors along the grain of the fascia.
Freed from beneath the fascia, the muscle bulged outward.
"Give me the hook-like thing. ...No, that's a curette. Yes. That big hook."
I received the retractor from the adjutant and inserted it between the muscles.
"Keep pulling it in this direction."
After having the adjutant lift the vastus lateralis.
I incised the lateral intermuscular septum with the scissors just like before.
Once again, the muscle trapped beneath the fascia popped out.
With this, I had freed the muscles on the outer and front sides of the thigh.
The remaining process was just a repetition of these actions.
The adjutant pulling the vastus lateralis, and me cutting the posterior fascia to free it.
Around the time I freed the thigh muscles in three directions.
"I've arrived, Lord Saint!"
Gregor arrived at the scene with a healer slung over his shoulder.
"I am here, Director Schun... Urp..."
The healer, barely enduring his motion sickness, approached the patient.
He examined the thigh and said.
"Did you finish the Fasciotomy in that short amount of time?"
"I had to handle it before using Detoxification Magic."
Detoxification Magic was a magic meant to resolve the toxins pooled in the leg.
However, if Detoxification Magic was used without resolving the Compartment Syndrome, the trapped muscles could simply generate more toxins.
That would be no different from pouring water into a bottomless pot.
So I resolved the Compartment Syndrome before the healer arrived.
"I'm amazed every time I see your surgeries, Director."
The healer muttered as he cast Detoxification Magic on the patient's leg.
As soon as I confirmed the magic had worked properly, I untied the tourniquet I had placed.
"We'll dilute the remaining toxins with IV Fluid."
Detoxification Magic is not perfect.
It merely resolves the toxins trapped in the leg to the point where they won't stop the heart.
That's why, unlike in my previous life, I had tied a tourniquet.
It was to attenuate the toxins as much as possible first, then untie the tourniquet and dilute the rest with IV Fluid.
In a way, you could call it an another-world version of emergency dialysis.
"Then, Director. Since I happen to have some divine power left, I'll immediately cast Heal on this person..."
"No, don't do it."
I stopped the healer from trying to Heal.
"I checked while performing the Fasciotomy, and right now, internal fractures and blood vessel damage are suspected."
I could see the back of the knee very slightly while opening the back of the thigh.
Blood was surging up from there like crazy.
It meant that while the wound didn't look severe from the outside, the inside below the knee was completely wrecked.
'Well, there's no way a Crush Syndrome patient would be easy.'
Originally, the biggest problem with Crush Syndrome patients was this part.
There's no visible trauma right after being rescued.
But when you actually open them up, the inside is often a total mess.
Compartment Syndrome, complex fractures, severed blood vessels...
Anyway, it's a variety gift set.
'It would've been great if I could just freeload off a single IV Fluid...'
Unfortunately, things were never easy with trauma patients.
As soon as I confirmed that fact, I had no choice but to immediately plan the next surgery.
"Multiple fractures are also suspected right now, so if you cast Heal, Heterotopic Ossification could occur."
Heterotopic Ossification.
A condition where broken bone fragments grow inside the muscle and tear the tissues apart.
Heterotopic Ossification was a disease that tormented trauma patients even in a world without divine power.
But in this world, the infamy of this disease was incomparable to my previous life.
'Anyone would be terrified if bone tore through flesh after casting Divine Magic.'
There was a reason why treatments in this world developed towards amputation.
Cast Heal, but germs remain, leading to death from sepsis.
Cast Heal, but blood pools inside, leading to death.
Cast Heal, but a bone tears through flesh from the inside out, leading to death.
After experiencing things like this, you have no choice but to make a clean cut and use Advanced Divine Magic.
Anyway.
"We've handled the urgent matters, so I'll perform debridement at the clinic."
"Understood."
The healer seemed to understand what I was talking about.
"Which sector is your clinic in, teacher?"
"It's the Civitas Sector 3 Clinic."
"Is surgery possible at that clinic?"
"The facilities for trauma patients are a bit lacking... I think it will be difficult."
"Understood. We'll transfer to the D-1 Clinic."
I immediately loaded the patient into the car and headed to the D-1 Clinic.
'Ugh. It's cold.'
Facing the cold wind blowing in from the door panel Gregor had ripped off.
*
As soon as we arrived at the clinic, I immediately called for the Trauma-specialized Healers.
"Male in his 30s. A patient rescued 3 hours ago after his right thigh was crushed in the overpass collapse accident. For the Crush Syndrome, emergency detoxification was performed with Detoxification Magic after full loading with 0.9% saline. Suspecting Compartment Syndrome accompanying Crush Syndrome, a Fasciotomy was immediately performed on-site."
I explained the situation to the trailing healers as the patient was loaded onto a stretcher and moved to the operating room.
"Decompression of the anterior, posterior, and medial compartments is complete. The muscles protruded, and edema has partially decreased, but distal perfusion below the knee joint is very poor. Having checked during the Fasciotomy, severe damage to soft tissue and fractures below the knee joint are suspected."
The trauma team leader healer of the D-1 Clinic immediately replied.
"I will have the setup for Radical debridement and an external fixator prepared."
Right, this was the thrill.
Was it because we had coordinated together so much?
As soon as I inputted the values, the exact answers I wanted were immediately output.
This is why having synchronized medical staff is important.
The level of tempo is just different.
I placed an additional order to the trailing team leader.
"Please prepare a Silver cannula and a vulcanized rubber tube."
"Where are you going to use them?"
"It's a surgical method I'm showing for the first time today, so I'll explain it during the surgery."
"Understood."
Far from being flustered, the team leader headed to the operating room with sparkling eyes.
It wasn't a desirable attitude in a situation where a patient was dying, but,
A doctor is a creature whose heart inevitably flutters upon hearing about a new surgical method. It couldn't be helped.
"Student Ayla."
"Yes! I will observe!"
Our Saintess of the Lamp—my personal unlimited Refresh-providing healer—was also summoned.
After sending the patient to the operating room.
While the anesthesia-specialized healer diligently anesthetized the patient with ether.
I threw on my gown, tied my mask for the last time, and washed my hands.
It was right when I was about to cross the threshold of the operating room.
"...Lord Saint."
Gregor called me quietly from behind.
It was a completely different tone from his usual energetic voice.
It was so different that, for a moment, I was slow to realize it was Gregor's voice.
Looking back, Gregor was standing a step away from the entrance of the operating room.
He wasn't in his usual posture of puffing his chest out or boasting his muscles.
With drooping shoulders, Gregor spoke to me with both hands politely clasped in front of his chest.
"Lord Saint. May I make one request?"
"Go ahead."
"Could this one... perhaps observe that surgery by your side?"
A question mark popped up above my head for a moment.
What for, when he's a Holy Knight?
Holy Knights, unlike healing priests, are people who cannot use Divine Magic to heal others.
Watching the surgery wouldn't be of any help to him.
The adjutant also panicked and tried to stop Gregor.
"Lord Gregor! What weird stunt are you pulling so suddenly..."
"I want to see that patient survive with my own two eyes."
The large man cut off the adjutant's words, speaking in a heavily subdued voice.
"There is a reason why I must see the person I saved survive with my own two eyes."
His voice was incredibly earnest, unlike his usual self.
Was it because of that?
Even the adjutant, who was trying to stop Gregor, shut his mouth.
"...Understood."
I granted Gregor permission to enter the operating room.
I didn't ask for the reason.
Because I felt like I knew what the reason was.
"Be careful not to touch the patient or the other healers."
"Thank you, Lord Saint."
Gregor bowed to me, then cautiously entered the operating room.
Crushed into the corner of the operating room like a borrowed sack of barley, Gregor stood awkwardly.
I left him be and began the surgery.
"DeBakey forceps."
"Forceps."
"Clamp."
"Vascular clamp."
The surgical tools were placed perfectly into my hand alongside the repeating of orders as soon as I called their names.
We were perfectly in sync.
While searching for the patient's arteries amidst the pulverized muscles, I began to explain to the healer.
"Team Leader. Do you know what artery this is?"
"It's the femoral artery and popliteal artery trifurcation. It's almost severed."
"That's right. What surgery did we usually perform in this situation?"
"We performed a TIVS (Temporary Intravascular Shunt)."
The trauma team leader answered, entering trainee mode for the first time in a while.
I was so proud that the exact answer I wanted came out right away.
This was why I made this person the team leader.
When I leave for the Academy, this person will have to run the clinic, won't they?
"That is the correct answer. When a blood vessel is severed, we perform a TIVS surgery, followed slowly by reconstructive surgery."
TIVS (Temporary Intravascular Shunt).
A surgery that temporarily connects the two ends of a severed blood vessel with an artificial blood vessel.
Greater Heal is in woefully short supply compared to the demand, and high-rank healers aren't personnel who can always reside at the clinic.
We used to perform this surgery to buy time for the leg before tracking down a High-rank Healer or reconstructing the blood vessel.
"Do you think we can perform TIVS on this patient too?"
"I was thinking... that it might be possible, but."
"Unfortunately, no."
However, it was a surgery that couldn't be done on this patient.
"First of all, the injured area is a special part."
The currently damaged blood vessel is behind the knee.
The part of the human body with the most movement.
An area that moves even if the patient just tosses and turns without walking.
What happens if you connect an artificial blood vessel to such an area?
"If you do a TIVS on an area with this much movement, the blood vessel can slip out."
The temporary blood vessel would pop right out!
Then it's a major accident.
There's another reason too.
"The inside is also too much of a mess. I don't see any soft tissue to hold the blood vessel in place."
Another reason was that the damage to the tissues near the knee blood vessels was too severe.
Normally, when you insert an artificial blood vessel, there must be muscles or other tissues to support it.
But this patient's inside was mashed into a pulp.
Considering the area was the knee of all places, it was a given that it would definitely fall out if TIVS was performed.
"Lastly, Hypercoagulability is suspected due to the Crush Syndrome. The risk of thrombosis (Blood Clot) is extremely high."
On the way here, I drew a tiny bit of blood from the right leg.
It clotted way too fast.
"If we connect the artery near the right knee to save the top of the foot on the right side in this patient right now, the blood will clot and block the blood vessel."
It would be frustrating if it clogged after going through the trouble of connecting it.
That's why TIVS isn't used for such patients.
Instead, a different surgical method was prepared for patients like this.
"I told you not to cover the left leg here with a drape."
I pointed to the left thigh of the sleeping patient.
"We're going to connect the relatively healthy left femoral artery to the right ankle to save it. The surgery's name is Cross-Limb Vascular Shunting (CLS)."
After finishing the explanation.
I had the trauma team leader move to a position where they could clearly see the surgery.
Then, I opened the left thigh and found the femoral artery.
"Apply a Heparin coating and give me the Silver cannula and vulcanized rubber tube."
I applied heparin generously and connected a Silver cannula to both ends of the vulcanized rubber tube.
Then, I tied off the left femoral artery and the upper part of the pulverized right popliteal artery with thread.
"Vessel loop."
"Vessel loop."
"Clamp."
"Clamp."
"Ah, that's too far inside. A bit further out. Yes. That way. Yes. We'll go side-biting. Tighten the clamp when I say so. Not right now."
The clamp stopped above the healthy femoral artery.
After having the team leader wait, I connected the Silver cannula to the artery below the right knee.
And then.
"Start Clamping on my mark. One, two... Now."
"Clamping."
While the team leader blocked the artery for just a brief moment.
I punctured the femoral artery with the Silver cannula.
"Release the clamp."
"Releasing."
The team leader released the clamp.
A portion of the blood from the left artery flowed past the patient's groin and down beneath the right knee.
With this, the surgery was almost over.
Once I was able to catch my breath to some degree, I asked the healers.
"When did they say a High-rank Healer could come?"
"There are still many people with reservations. They said one will come the day after tomorrow."
As expected.
The CLS treatment was necessary.
A leg begins to rot rapidly just 4 hours after its blood flow is cut off.
That's why such a surgery is needed.
Because if it's not done, they might have to amputate the leg by the time the High-rank Healer arrives.
"Good. When they arrive, please assign them to this person."
"Yes."
Whether it be the 21st Century or now.
Medical resources are not equal for everyone.
Just like the people waiting for organ donations or reconstructive surgery.
Even in a world where divine miracles exist, this is the reason why time-buying surgeries are necessary.
"Let's check if the blood flow has returned. Teacher Healer."
"Yes."
The bat-eared healer placed a stethoscope on the patient's leg.
Usually, it's good to have a Doppler ultrasound device.
Naturally, it was equipment one couldn't expect in a world like this.
So I substituted it with a stethoscope.
By teaching a beastkin healer with a sense of hearing dozens of times better than mine.
'Good thing I learned that stethoscope technique.'
For reference, it's originally a technique not used in 21st-century Republic of Korea.
Because the Republic of Korea is an advanced country in medical equipment where you can find Doppler ultrasound devices even on an island.
This kind of technique was usually only used by doctors who frequently went on overseas volunteer work.
Right.
People like me, a pushover Fellow who was tricked by the promise of being bought pork cutlets.
"Blood flow has returned."
"Alright... Next is..."
Like that, the urgent matters were settled.
"Let's start the debridement."
*
Afterwards, I sutured the wrecked muscles, removed the bone fragments,
And went through a time of barbarism, assembling the bones with nails and hammers.
"Phew..."
Performing a CLS for the first time in a while made me feel completely drained.
Still, I felt somewhat proud.
Handling blood vessels after a long time caused adrenaline to pump through me.
Thanks to that, I entered a bizarre state where I was drained but not tired.
"Student Ayla worked hard too."
"You worked hard, Director."
Receiving a light Refresh from Ayla.
I called out to the forgotten sack of barley.
"Mr. Gregor."
"Yes, Lord Saint."
"Let's go to my office."
Nodding, the muscular man bowed his head and followed me.
Gregor and I sat facing each other on the sofa in the office.
"Will chamomile be alright for tea?"
"Thank you, Lord Saint."
Gregor replied while slumping heavily.
A teacup with rising steam was placed in front of the muscular man.
Sip.
We tipped our teacups in silence for a while.
A few minutes passed like that.
Gregor broke the silence.
"...Lord Saint. May I ask you one thing?"
"Go ahead."
Beneath the crow mask, I slowly took a deep breath.
It was because I could guess what he was about to ask.
Over ten years in Trauma Surgery, combining my previous life and current life.
The words that came out in this kind of atmosphere were always the same.
"...When saving someone crushed under something... did we always have to be this careful?"
Dropping his gaze, Gregor continued.
"Administering IV fluid, calling a healer who knows how to use Detoxification Magic, cutting open the leg... does someone only survive if we do these incredibly complex things?"
"...Yes."
Saving a person is never an easy task to begin with.
How could you easily save someone who was crushed under that massive structure?
You have to watch out for Crush Syndrome, resolve Compartment Syndrome, handle fractures, blood vessel damage, DIC, internal bleeding, infection, bone marrow embolism...
There was more than just one or two problems I had to consider during today's surgery.
"A person's life is... originally this heavy."
"Then..."
"..."
"Then... how many people has this one, who only knew how to lift things... killed with goodwill...?"
Just as I thought.
Hearing that question, I gently closed my eyes.
It was a common agony.
An inner demon that I, my seniors, and my juniors all experienced at least once.
"How many people... has my ignorance led to death?"
His voice flowed out from beneath his deeply bowed head.
I spoke toward his clearly exposed crown of the head.
"Probably countless numbers."
His voice trembled.
"Then... am I a sinner?"
"...Yes."
I continued to speak.
"Both you and I are sinners."
"?!"
Gregor swallowed a gasp and raised his head.
"Lord Saint?"
"Don't look at me like that. There were times when I fell short as well."
I, too, had days like Gregor's.
The firefighter I lost because I didn't know about blast lung injury.
The mothers in childbirth in Limbus Pit I lost due to my lack of Obstetrics and Gynecology knowledge.
The patients under the black flag whose treatment was delayed because of an incomplete emergency Triage.
No, I make a correction.
Perhaps I am still in those days.
I have never once been perfect.
It's just that results exceeding my abilities appeared thanks to the Misunderstanding Genre Correction.
I was always just a mere human, full of mistakes and ignorance.
"Why can't we grasp sand in our hands? Have you ever thought about it, Gregor?"
"..."
"Even mere sand slips away, so how many lives do you think have slipped through these hands?"
If I had been a little more skilled, if I had put in a little more effort.
There were many patients I could have returned to their families.
From my Resident days until now.
There wasn't a single day I didn't regret.
Even so, I was never buried in regret.
There are many methods I learned from my seniors.
Some relieved it with alcohol or cigarettes.
Some relieved it with games or movies.
Some converted to a religion.
However, I think the most effective method was this.
"Then, Lord Saint... how did you overcome it?"
"At times like that, I always think like this."
This is a method a Pediatrics senior taught me.
"It's a sorry thing for the individuals concerned, but what can we do? You bury it in your heart, vow to do better from now on, and move forward. To prevent the tragedies of those who passed through my hands from continuing to future generations, we endure this era. Hoping that in the distant future, a much better junior than me will appear."
My memory is a bit hazy, but.
I think that senior said it like this.
— [Future generations will probably call us quacks, but what can we do? It's our fault for being born early. Someday, a treatment method will appear even for this damn rare disease. Until then, we just have to endure. If we don't have the confidence to solve it.]
"Our sin is that we were born into the world too early. So, we have no choice but to endure this era and hope that this tragedy will be solved someday."
*
During the consultation with Gregor.
I remembered the words Gregor's godfather, the Diocesan head, had said before.
He said Gregor originally wasn't such a bright young man.
To be precise, he was originally bright, but right before meeting me, he had lost that brightness.
— "He was originally just an ordinary boy. A naive kid who became a Holy Knight out of admiration for heroes."
But the tragedy began because he loved people too much.
He was a Holy Knight, but he couldn't cut down people.
So he only focused on rescuing people.
However, as one could infer from the questions he asked me.
His relief activities failed to save people.
He couldn't cut down people to be an Inquisitor.
He couldn't rescue people to be called a Holy Knight.
A world where one cannot hope for the best effort with goodwill alone.
Amid repeated failures, he was branded an incompetent human within the society known as the Order.
The people of the Order also gradually began to turn their backs on him.
As such things repeated for a year, then two.
Gregor supposedly became an increasingly silent young man.
The corner-most seat in the dining room.
The very back row at mass.
The most secluded patch of sand in the training grounds.
Right when only the edges of the room were becoming his nest.
— "You, Lord Saint... chose that son of mine."
It's said that I chose him.
— "That child is... currently hiding himself within his muscles. If he doesn't at least do that... it would be utterly unbearable for him."
Stepping out of the room because of me, Gregor possessed an imposing manner from our very first meeting.
A cheerful young man overflowing with confidence, loving his own muscles, and taking pride in the history of his Erdenu Sect.
But in reality, he was merely acting dignified while wearing the armor known as his muscles.
— "I understand that child is burdensome. But... that too will be temporary. He is getting better. If you could just... excuse him for a little while, I would be grateful. I will persuade him well."
It was a kind of bluff.
To hide his own incompetence.
And to avoid disappointing me, a Saint.
Therefore, I never disliked this confident demeanor of Gregor's.
Rather, I liked his method.
Because I too gushed and bluffed when things were hard.
If my surroundings gained strength because of me doing that,
Then usually, we were able to overcome it somehow.
So I tended to respect Gregor's method.
My acting like a clown was also one of my methods of overcoming the dog-like reality of my previous life.
"Gregor."
"..."
Returning to reality.
I called out to the thoroughly intimidated large, muscular man.
"Goodwill alone cannot save people. Both you and I are sinners. We might just barely be enduring. However..."
Gregor had broken down.
The moment he witnessed that his goodwill had been directed the wrong way.
Pouring tea into the empty teacup of such a pitiful man, I continued speaking.
"Even so, we must keep moving forward. If we chose the incorrect answer, we leave it in the records so that future generations do not follow in our footsteps. If you consider that at the very end, we simply become a bridge of hope leading to the solution, it puts the mind much more at ease."
"Lord Saint..."
"If you are still afraid of making a mistake, proudly puff out your chest and shout like you normally do. In that imposing manner of yours, someone will certainly find hope."
It's impossible not to make mistakes.
Therefore.
It's better to at least put effort into passing on hope.
"Wouldn't it be a bit better if you took pride in a role that ensures hope and composure aren't forgotten?"
Gregor's shoulders trembled slightly.
"...Then... you're saying I am not just some beetle?"
Beetle.
It was a derogatory term for Gregor.
A phrase mocking his muscles, calling them merely hard while being capable of nothing.
I didn't much like that derogatory term.
So I denied it. I told him he wasn't a bug.
"If you raise your head just a little, the people who love you are waiting for you to step out of the room. So you shouldn't demean yourself by calling yourself a bug."
People hope that bugs don't appear in front of their eyes.
To put it another way, if there is even one person waiting outside the room.
It means the existence inside the room is not a bug.
And among the people waiting for him, there's the Diocesan head.
There are Holy Knights who follow him.
There are also the citizens he saved.
To be called a bug, he was receiving far too much love upon himself.
"Isn't it because the gods love you too that they gave you such immense talent? Isn't that why you were offering a prayer of thanks every dawn?"
"..."
I smiled gently beneath the mask.
Even though he couldn't see it.
Gregor dropped his head without a word.
Drip, drip.
Drops of water fell into the teacup he was holding.
Feigning ignorance, I slightly lifted my mask and sipped my tea.
"A cup of tea drunk after saving a person is truly special. Isn't that so?"
Nod.
Gregor nodded his head without a word.
