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Translator: penny
Chapter: 9
Chapter Title: Heading to the Ward (4)
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This is the operating room.
We had just been performing surgery to set the patient's arm bone. Luckily, the joint wasn't damaged—there's no way I could fix that at my skill level.
Now we had to decide whether to reopen the wound from behind to align the bone or just go in a bit deeper.
"..."
One look at the patient's face told me everything. Just as I thought. It'd hurt like hell, but we needed to dig in properly and secure the ulna nice and tight. Reopening the incision would be too much strain.
"Mmph! Mmmphh!"
Estina pressed down harder on the patient's arm. Any movement now could cause serious damage.
"What's the criterion for surgery?"
"Good question. A simple crack might heal with a splint alone, but when the bone is shattered in multiple places like this... without surgery, that arm's done for."
"Mmph! Mmmphh!"
The patient screamed again through the gag.
No way. We'd just given him a fentanyl patch and a full propofol sedative dose. How was he still this alert? Drug-resistant constitution?
Anyway, that just about wrapped up the surgery.
"You did great holding out like that, sir."
The plate and screws were all in place. I set down the surgical tools I'd been using.
Whew. Performing bone-setting surgery on a wide-awake patient? This was a first for me, at least.
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The bone was set now. Hopefully I hadn't nicked any vessels or nerves in there. Even if I had, healing magic might sort it out, right?
Honestly, even if something went wrong, I'm not sure I could perform vascular surgery here. That's probably beyond me.
I repositioned the torn muscles and tendons, then closed up the incision. No muscle damage that I could see. The swelling should go down soon enough.
Time to suture the wound.
"Estina. What do you use to suture wounds?"
"Me? Hmm, what was it made of again..."
"Catgut causes allergies—immune reaction. For suturing people, it's silk thread only."
Silk thread from silkworms.
Most materials trigger too strong an antigenic response for human use. Nylon works too, but good luck sourcing that in this world.
Silk, on the other hand, got plenty of use even in the imperial palace.
In my past life, we'd used it often too. Hard to explain precisely, but silk's molecular structure apparently provokes less immune response.
The exact mechanism is too complex to get into here.
"Estina. Do you know how to suture a wound?"
"I've done plenty of sewing, but never on a person. I don't do surgery often, so it'd probably be tough for me."
I nodded.
"Then watch closely. This is how you do it."
"Yes, sir."
"Practice on a pig carcass later or something. Next time, you'll handle the suturing."
"Ah, got it."
The needle moved slowly.
"Since it's the arm, we'll do knots every four millimeters. Stitches should come out in about a week, depending on healing."
With healing magic, it might close faster. Hard to pin down exactly to a week. Suturing the arm took a good while.
Done.
Thank goodness. If it'd been tendons or vessels, I wouldn't have had a clue.
"Estina. Dressing."
"No splint for the patient?"
No need for a splint. Whether splint or cast, nothing's going to outperform the plate we bolted straight to the bone.
"In cases like this, with direct bone fixation, a splint's unnecessary. It'd just get in the way."
"Ah."
I looked at the patient's face.
"Sir, once the swelling goes down—probably starting tomorrow—you'll be able to move your arm. Full recovery to normal might take a few weeks, but it'll likely be shorter than that."
The drugs were finally kicking in. The patient just gave a tiny nod.
"Estina. Once he's asleep, record his status every three hours."
"Yes, sir."
"When a bone shatters like this, fat from the marrow can embolize. Compartment syndrome byproducts could lead to kidney failure too."
Estina stared at me blankly.
"Uh..."
"Just make the notes. I'll be nearby."
"Yes. Thank you."
Even the undergrads from my past life weren't this clueless. Not that it's Estina's fault. What can you do about the era?
Still, with healing magic around, she should at least keep him stable until I get back... I need to publish that research soon.
Once my standing improves even a little, things get easier for me, and I save one more patient.
[Heal.]
Estina raised her staff again, and warm light filled the ward.
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The surgery wrapped up successfully. I headed back to the lab with Estina.
I have no idea how their system works here, but we should probably log surgeries and ward rounds. Paper charts would be ideal.
Paper medical records. Haven't seen those since volunteering at a homeless shelter. Everything's electronic back home.
Need to organize records too.
"P-Professor. Sorry to ask..."
Estina was fidgeting. What now?
"What."
"You'll take me on as a grad student, right?"
I forgot. I said I'd decide in a few days last time.
"Yeah."
"Thank you! I'll work hard."
Estina bowed her head.
"Professor, if you're not too busy, I have a few questions about today's patient."
"Shoot."
Rustle rustle.
Estina pulled out some paper and a pen from somewhere.
"First, I don't fully get compartment syndrome. Things were hectic earlier, so I couldn't ask properly."
Compartment syndrome.
More common than you'd think.
"Muscles have fascial compartments around them, right?"
"Yes."
"Bleeding or swelling inside raises pressure in the compartment. Treatment is fasciotomy to release it."
Estina scratched her head.
"One more thing. Why's the pressure rise a problem?"
"Because if compartment pressure exceeds capillary blood pressure, circulation stops. You don't know what capillaries are?"
That's the issue with starting from basics. No clue about capillaries or even pressure concepts, so my explanations fall flat.
Oh well.
I'll prove capillaries exist next time. Once the microscope's ready, we should see them.
"Anyway, think of it as the compartment swelling shut so blood can't flow in."
"Got it. What happens if you miss the window for fasciotomy?"
You die.
Or at least the muscle does.
"Full-blown muscle necrosis. Debris clogs vessels systemically. No idea what healing magic would do on top of that."
Estina nodded.
"Understood. Thanks for explaining."
"Rest up, then head back to the ward."
Estina left for the ward, and I pondered. Capillaries were discovered in the 17th century, I think. No surprise they don't know here.
Definitely need more grad students. Only way to accelerate research and start speaking the same language as this world sooner.
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Meanwhile, in Professor Asterix's ward.
The patient, Benjamin Brisbane, slowly opened his eyes. His last memory was the healers giving him meds for surgery.
The surgery itself had hurt like crazy, but the details were fuzzy. Just the aftertaste of the handkerchief gag lingered.
Benjamin was heir to the Brisbane family and an Academy student. He'd been riding at full gallop when he took a nasty tumble...
Just a busted arm might be a miracle.
"Where... am I?"
"The hospital."
The horrific pain in his arm was mostly gone. The incision site still stung, but that was to be expected.
A plain-looking healer stood by the bed. Black robe and plague doctor mask gave him a grim reaper vibe.
"We operated on your arm. You should be able to move it a bit by tomorrow, full recovery in a few weeks."
"You fixed it?"
Estina shook her head.
"Our new professor handled it. Came from imperial physician duty."
"When can I meet him?"
Benjamin looked worried. Estina hesitated. How to explain?
"Probably back in the ward sometime today, not sure. But if anything comes up, we'll call him right away."
"I'll be able to use my arm, right?"
Estina nodded. The professor said a few days, so probably.