I Became a Plague Doctor in a Romance Fantasy Novel

Severe Trauma Patient (2)

Severe Trauma Patient (2)

The suspected condition of the patient is splenic rupture.

Internal bleeding caused by trauma usually results from organ damage. Typically, the liver or spleen ruptures during trauma.

If the liver ruptures, a surgery called a lobectomy is required, which is impossible for me. Fortunately, considering the location of the trauma, the damaged organ this time seems to be the spleen.

This is much easier. You can live without a spleen, so we just need to remove it entirely.

The surgery we are about to perform is a splenectomy.

It is not an impossible surgery, nor is it a delicate one. The risk is high, but if we leave it as it is, the patient will likely die.

I have no choice but to pick up the scalpel.

“The first principle of Hippocrates. Istina, do you know what it is?”

“Hippo… what? What is that?”

“Do no harm.”

“Ah, right. That is indeed the most important thing. There is no bigger problem than the patient getting hurt because of us.”

Nothing else. This is the thought we must keep in mind as we prepare for surgery.

I cannot be certain of this diagnosis with the equipment at hand, I cannot guarantee the success of the surgery, and I cannot guarantee the outcome even if the surgery is successful. That is the unavoidable reality.

One thing is certain.

Despite the efforts made before the surgery, the patient’s blood pressure continues to drop, and their consciousness continues to decline.

The current heart rate has risen to around 120, and the respiratory rate is 30 breaths per minute. At this rate, hypovolemic shock will set in within a few hours.

Whether it’s because of the medicine, the healing magic, or some other reason, I don’t know, but this person is going to die soon.

There’s no choice but to operate.

Things needed for the surgery:

A sterilized mask. Since we don’t have one, a plague doctor’s mask. It covers the mouth and prevents hair from falling. Sterilized gloves. Hands. Purification magic.

A cautery heated by fire. This is probably being made right now.

[Purification.]

[Purification.]

Istina is on standby next to me.

Two ward nurses have also been drafted. They have undergone a similar sterilization process.

However, this is merely an imitation of a modern operating room. We can’t even prevent dust from flying in this space.

The anesthetic is the same as last time.

General anesthesia is not about the drug but the machine. In the case of large surgeries, a gaseous sedative, an anesthesiologist, and even a respirator are used. It’s not something I can replicate.

It’s questionable whether the patient can be awakened if general anesthesia is administered.

A sedative dose of propofol. A fentanyl patch to block pain, and lidocaine local anesthesia for the surgical site. Anything beyond this is realistically difficult.

“Nurse, please cover the surgical site with something like a cloth so the patient can’t see it.”

Three types of anesthetics have been administered.

“Will this work?”

“It will.”

It will. Can I do it here?

That’s a completely different matter.

Ah, it’s really horrible.

The whole process of the surgery is the problem. Splenectomy is usually diagnosed through laparoscopy.

“Is it going well?”

“Please try to sleep as much as possible.”

“Why are you pressing down on my arms and legs?”

Well, because if you move while the knife is in, who knows what could happen.

Using special machines, injecting carbon dioxide into the abdominal cavity, and cleaning around the organs with saline to remove the liquid is the usual process.

Well… none of that is available to me.

There’s only one way.

Open, and go in.

Skin incision. Subcutaneous fat layer incision. And muscle incision. Now the connective tissue inside the abdominal cavity is exposed. Since I don’t know where the blood vessels are, I carefully cut the connective tissue.

The position of the internal organs in the abdominal cavity is visible.

No, it’s not visible.

Damn it.

I didn’t think of that. When looking at a patient, there’s one thing that students and novice doctors (like me) easily forget. We are not dealing with a normal human body.

We are dealing with a patient’s diseased body.

In this patient’s case, the spleen has ruptured, and because of the ruptured spleen, the blood loss is enormous. It seems about 1 liter is gone.

Where could all that have gone?

The inside of the patient’s abdominal cavity looked as if someone had painted it red.

Inside the abdominal cavity, there are thin membranes called mesentery, but they are all covered in blood, making it impossible to see anything. What should I do?

Should I just sew it up and say I can’t do it?

Well… If there’s no teeth, use the gums.

There’s only one way.

Insert the hand, feel the organs, and locate the target point, the spleen. Gently, so as not to damage any blood vessels or nerves along the way.

How difficult, complex, and painful must the surgery be for death to be a better option? But if everything is normal when the surgery is over, does it matter?

“Please, hold this.”

Let’s remember the position of the organs. From the perspective of looking down, the liver is on the left. Next is the stomach. The spleen is to the right and behind the stomach.

There are two major blood vessels to block. The splenic artery and the splenic vein. Can I do this?

“Pharyngeal scissors. Are the pharyngeal scissors ready?”

“What? Pharyngeal scissors?”

“Oh, they’re ready!”

“What are pharyngeal scissors!?”

This guy, is he invincible? I gave him three types of drugs, and he’s still listening to me. Couldn’t he be the type to fall asleep easily?

“Press down hard, patient. It’s going to hurt so much you’ll want to die, but if you move because it hurts, you’ll die.”

“What!?”

After a terrible, squelching sound of plunging into the mud, the fingers entered the abdominal cavity. First, the large organ is the stomach. There are blood vessels, and the mesentery tears wherever the fingers move.

“Argh! aaargh!”

The expected scream. Ugh.

But he didn’t struggle. No, he can’t struggle because of the propofol.

From the viewer’s perspective, the spleen is at the top right end. I need to cut this out… If I just cut the blood vessels, blood will gush out. That won’t do.

I need scissors heated in fire.

Still, it’s a relief that I can see the spleen now. I removed as much of the blood-stained mesentery as possible.

“Try to open the incision as wide as possible. Scissors are coming in now.”

“What, what are fire-heated scissors!?”

What do you think, they’re scissors heated in fire.

Fortunately, even in this process, the pain of the internal organs is not directly felt. Internal organs don’t hurt directly.

“Spleen artery. Vein. Needle.”

First, I cut the splenic artery and splenic vein with scissors. Just in case, I finished with stitches. What about the small blood vessels attached to the spleen?

I cut the small blood vessels with scissors and then cauterized the cut surface with the blade of the scissors. Wouldn’t this stop the bleeding?

I don’t know.

Now it’s time to take out the spleen.

The spleen was firm, but like a beaten acorn jelly, blood was oozing from everywhere. This might not come out easily.

If I put my hand in and stir it around, I might damage blood vessels or nerves, and the patient might struggle and get hurt more.

Well.

Anyway, the spleen is going to be discarded.

There’s no need to take risks. I just stuck my fingers into the spleen and carefully pulled it out as it was.

Let’s see. Is the patient alive?

“Estina. Check the pulse.”

“The patient still has a pulse in the neck.”

Alive.

“It’s all done. Now we just need to close it up. Thank you for your patience.”

It would be good to check if there’s any bleeding left, but I can’t think of a way to do that. Just looking carefully…?

For now.

There’s no bleeding from the blood vessels I cut. Isn’t that enough? There’s no way to deal with the microvessels, and they’ll probably block themselves.

Now, let’s close it up.

Even though I cut through several layers, the academic consensus is that separating and stitching the layers doesn’t improve the outcome.

Not that it’s never necessary.

Now, once I suture, the surgery is over.

It took a long time. Sweat pooled inside my mask, making it squelch, and my hands were wrinkled from the sweat inside my gloves.

Still, the surgery is finally over.

Patients with such severe bleeding usually need a transfusion. I don’t even know this patient’s blood type, and drawing blood from someone else to transfuse is a bit…

Assuming they’ve lost about a liter of blood, they can survive without a transfusion. For now, I’ll connect an IV and give them oral fluids.

I shook the patient awake again.

“Can I sleep now?”

“If you sleep, you’ll die.”

“Oh, understood.”

“Absolutely not until sunset.”

This patient shouldn’t be okay. Of course, their complexion is still pale, but they’ve been speaking relatively normally since a while ago. Why?

Adrenaline, perhaps?

Why is this patient fine? I can’t figure it out.

Before the surgery, they were on the verge of hypovolemic shock, barely conscious. The effects of the anesthetics shouldn’t have worn off yet, but they’re fine now. Surgery doesn’t magically create blood.

That much is unknown.

Some people have strange constitutions. Or maybe it’s the healing magic. If that’s the case, there’s nothing I can say.

[Healing.]

For now, it’s fortunate they seem okay. A week of observation in the hospital should suffice. It’s hard to say when they’ll be completely fine.

“Don’t fall asleep, just rest well.”

Was this patient’s name Kailas? The patient sat blankly on the bed. Beside them, a modern IV set dripped steadily.

Feels like I’ve forgotten something?