I Became a Plague Doctor in a Romance Fantasy Novel

Going to the Ward (3)

Going to the Ward (3)

Now, I have to set the arm bone. I already feel sorry, this is going to hurt a lot even if I just try. I gritted my teeth and looked at the patient’s arm.

It depends on how the arm bone is broken.

If the bone is broken in one or two places, there will be a sense of alignment. If it’s broken in multiple places or crushed, it won’t align just by fiddling with it from the outside.

It will just hurt a lot.

I grabbed the patient’s hand tightly with my left hand and placed my right hand over the wound. It’s going to hurt. It will really hurt…

“On the count of three, I’ll set the bone.”

“uuugh!”

Come to think of it, I had put a gag on. It might be difficult for the patient to respond.

“One, two!”

I tried to set the patient’s broken arm, but I couldn’t feel the broken bones touching each other. Should I consider this a comminuted fracture?

Judging by the free movement of the broken arm, it seems both sides of the humerus are broken. It was completely bent when it first came in.

With this, I confirmed the patient’s diagnosis.

“Ugh! uuugh! Ugh!”

“Look, Istina. As I said, if it’s a comminuted fracture, the bones won’t align and it will just hurt like hell.”

“Ugh!”

The patient tried to say something, but it was not understood. It seemed to mean something like “it hurts.”

“That’s why I said to use the gag. If the patient bites their tongue, it will be a big problem.”

“Ah, I understand.”

Istina nodded vigorously.

I made eye contact with the patient again.

“Patient! It looks like you have a comminuted fracture. Your bone is crushed. If left like this, you won’t be able to use your arm properly for the rest of your life, regardless of healing magic. This requires surgery.”

Istina frowned.

“S-Surgery? That sounds dangerous. Can’t we just use a splint or bandage?”

“uuugh!”

No. I shook my head.

“Your arm is swollen to twice its size. Can you even wrap it with a bandage? Of course not.”

“Uuugh! uuugh!”

The suspected condition is compartment syndrome.

It is a disease where the pressure inside the fascia increases, preventing proper blood circulation within the muscles.

In this patient’s case, it is thought that the pressure inside the fascia increased due to trauma and swelling.

“Istina, look. The arm is broken, but apart from the bruised area, the color is poor and the pulse is weak. This is a typical compartment syndrome. The pressure inside the fascia is abnormally high due to the trauma. Doesn’t it look like surgery is needed?”

Again, a look of confusion. Istina frowned deeply and looked at the patient’s arm before sighing.

“H-How am I supposed to know that…? I mean, Professor, can you tell just by looking at the arm?”

“Don’t drag your words. I’m busy.”

“I don’t know.”

It’s natural not to know, but if you don’t, the patient could die. That’s the reality of our industry. Well, it’s a good thing I know now.

I made eye contact with the patient.

“Patient. You urgently need surgery now. If you agree, please nod your head.”

“Mm! Mmmmmm!”

I don’t know if that was agreement or not. Should I take it as a nod? Or was it just a shake of the head out of fear? Either way, if we don’t operate, the patient could die.

The problem isn’t limited to just the arm.

“Nurse! Prepare for surgery.”

Several ward nurses rushed over. I turned to Istina.

“Let’s get ready for surgery too. Remember? Wash your hands, sterilize the equipment, and make sure no hair or dust gets in.”

Preparation for surgery.

Istina and I disinfected our hands, put on robes and masks, and went into the operating room. The masks looked a bit strange.

They were plague doctor’s beak masks, but it’s better than nothing. There’s no proper operating room here.

No anesthesiologist, no ventilator…

Well. It’s not a situation where we can do general anesthesia. We have to perform orthopedic surgery while the patient is conscious.

My plan was this.

Administer propofol in a sedative dose. Use a fentanyl patch, then locally anesthetize the forearm. It will hurt quite a bit, but it’s better than not being able to use the arm properly for life.

Probably?

Istina looked worried.

The patient also had a worried expression.

Come to think of it, should I have tied the patient up since it would be troublesome if they moved? Although they were barely moving due to the effect of the fentanyl patch.

Modern medicine was summoned by ability. Other preparations were also completed. It was the first time performing a real surgery in this world…

I am nervous.

“Estina. When the surgery starts, hold the patient down. If they move during the surgery, it could go terribly wrong.”

“I’m sorry, but even if the patient’s bone is broken, what can we do by opening the wound? I don’t know if this is a good idea.”

I looked at Estina.

“Estina. Be quiet. Don’t make the patient anxious and assist properly. We will open the broken part of the arm and reassemble the bone.”

“And after assembling it through surgery?”

“Huh? We will use mesh and metal plates to hold the bone in place. If we don’t do this surgery, they might never be able to use their arm properly again.”

Still looking doubtful.

“It’s the first time I’ve seen this method…”

There is a plan.

I laid a boiled and sterilized cloth on the floor, then placed a similarly boiled and washed hole sheet over the patient’s arm. Up to this point, it’s done.

“Purification magic.”

Estina used purification magic. I applied alcohol around the patient’s wound.

“Administering the drug.”

The patient nodded.

There were three types of planned anesthetics.

I attached a fentanyl patch to the patient’s chest, injected propofol into the arm vein, and finally injected the local anesthetic lidocaine into the patient’s arm.

As soon as the lidocaine needle was removed, fluid seeped from the patient’s wound like a punctured water balloon. This was indeed indicative of compartment syndrome.

Currently, this patient is suspected of having fractures in the radius and ulna, and with hemorrhage and swelling within the fascia, compartment syndrome is also a concern.

In a real hospital, the former could be confirmed with an X-ray, and the latter with a blood test.

Here, the only option is to open the arm directly.

“The scalpel is going in now.”

I took a deep breath and placed the scalpel on the patient’s arm. Skin incision, subcutaneous fat layer incision, fascia incision. As I cut through the patient’s fascia, blood-mixed fluid gushed out.

“Istina. Look at this. The pressure within the fascia must have been quite high. If a few more hours had passed, the arm would have necrotized, right?”

“Gasp, really…?”

“Argh! It hurts like hell!”

Hmm, that’s enough anatomy lesson for now.

It’s better to finish the surgery quickly rather than continue exploring the inside of the arm. Even though I used an anesthetic, it seems to hurt a lot. Maybe the patient has a resistance to anesthetics?

When performing a sedated endoscopy, propofol is often used for sedation. Laypeople call it sleep anesthesia, but strictly speaking, it’s not anesthesia.

Propofol is a sedative, and if administered in large amounts, it can induce a state similar to sleep. The correct term is conscious sedation.

If too much propofol is used, side effects such as respiratory distress or narcotic overdose can occur. Finishing the surgery quickly is the best option.

“Patient, are you conscious? We’re using three types of anesthetics right now. You must have a unique constitution that doesn’t respond well to anesthesia.”

“aaagh!”

“……”

“I’m sorry. We’ll finish the surgery quickly. Istina, gag the patient again. They might bite their tongue while screaming.”

Istina placed the handkerchief back in the patient’s mouth. I looked at the bones through the open wound in the arm, pushing aside the muscles.

“Istina. Look here. You see the broken bone between the muscles? We’re going to insert a metal pin to straighten the bone. It will be difficult, but…”

“How fascinating.”

I am not an orthopedic surgeon.

The only experience I have with surgery is observing during my training and assisting a few times as an intern. But now, I am this patient’s only hope. If I don’t do it, they will never be able to use their arm again.

If the surgery doesn’t go well, I can use healing magic to somehow save them. This approach might make it difficult for the patient to use their arm properly, but that’s a problem for later.

A metal rod. More precisely, a titanium plate. Strictly speaking, it’s not a drug, so I was worried if I could summon it. But for some reason, it was possible.

It seems I can bring objects smaller than my palm. Or maybe it’s because it goes inside the body?

I don’t know.

I attached the titanium plate to the bone. I’m not sure if this is the right way to do it. Nails went into the holes in the titanium plate one by one.

It seems to be fixed. There’s no way to check it right now, though.

“Estina. I’ve only attached the plate to the radius, should I leave the ulna as it is, or should I make another incision? I don’t have the confidence to attach the plate to the ulna as well.”

Estina turned her beak mask towards me.

“Well, yeah. Making another incision seems a bit much, doesn’t it? And. Even if you ask me, I wouldn’t know.”

“Right, I guess we just have to dig in.”

“Mmmph! Mmmmmmph!”

Making another incision seems a bit much. I nodded. The patient also seems to be saying not to make another incision.