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Translator: penny
Chapter: 8
Chapter Title: Heading to the Ward (3)
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Now it was time to set the arm bone. Sorry in advance—this was going to hurt like hell just from trying.
I gritted my teeth and stared at the patient's arm.
The way the arm bone was broken made all the difference.
If it was fractured in just one or two places, there'd be some satisfying click as it went back into place. But if it was shattered in multiple spots or completely crushed, no amount of prodding from the outside would fix it.
It'd just hurt like crazy.
I gripped the patient's hand tightly with my left hand and placed my right hand over the wound. This was going to hurt. Really hurt...
"On the count of three, I'll set the bone."
"Mmmph!"
Come to think of it, the patient had a gag in her mouth. She probably couldn't respond easily.
"One, two!"
I tried to align the broken arm, but there was no sensation of the bones touching. Looked like a comminuted fracture.
The arm moved too freely, suggesting both sides of the humerus were snapped. It had been completely bent when they first brought her in.
That confirmed the patient's diagnosis.
"Mmph! Mmmph! Mmph!"
"See, Estina? Just like I said. With a comminuted fracture, the bones won't align, and it'll just hurt like they're dying."
"Mmmph!"
The patient was trying to say something, but I couldn't make it out. Probably just screaming that it hurt.
"That's why I said to use a gag. If she bites her tongue in this state, we're in trouble."
"Ah, got it."
Estina nodded vigorously.
◇◇◇◆◇◇◇
I met the patient's eyes again.
"Patient! It looks like you've got a comminuted fracture. Your bones are smashed up. If we leave it like this, Healing Magic or not, you'll never use your arm properly again. We need surgery."
Estina frowned.
"S-surgery? That sounds risky. Can't we just use a splint or bandages?"
"Mmmph!"
No way. I shook my head.
"Her arm's swollen twice its size. You think we can wrap bandages around that? Obviously not."
"Mmmph! Mmmph!"
The suspected condition right now was compartment syndrome.
Increased pressure inside the fascia preventing proper blood flow to the muscles.
In this patient's case, trauma and swelling had ramped up the pressure inside the fascia.
"Estina. Look. Arm's broken, no bruising except in spots, poor color otherwise, and pulse is weak. Classic compartment syndrome. Pressure inside the fascia is abnormally high from the trauma. Doesn't it scream surgery?"
She still looked confused. Estina squinted at the arm, then sighed.
"H-how am I supposed to know...? No, Professor, you can tell all that just from looking at the arm?"
"Don't change the subject. I'm busy."
"I don't know."
It was natural not to know, but ignorance could kill patients. That was the reality of our field. Good thing it was me handling this.
I met the patient's eyes again.
"Patient. You need urgent surgery. Nod if you consent."
"Mmph! Mmmph!"
Hard to tell if that was consent. At this point, it counted as a nod, right? Or was it just shaking in fear? Either way, no surgery meant possible death.
This wasn't confined to the arm anymore.
"Nurse! Prep for surgery!"
A few ward nurses rushed over. I turned to Estina.
"Let's get ready too. I told you—wash hands, sterilize tools, no loose hair or dust."
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Surgery prep.
Estina and I scrubbed our hands, donned robes and masks, and entered the operating room. The masks looked weird.
Plague doctor beaked masks, but better than nothing. No proper OR here.
No anesthesiologist, no ventilator...
Full general anesthesia wasn't feasible. Orthopedic surgery under local, with the patient awake.
My plan: Administer propofol as a sedative. Fentanyl patch next, then local on the forearm. It'd hurt a lot, but better than a useless arm forever.
Probably?
Estina looked worried.
So did the patient.
Thinking about it, maybe I should've restrained her to prevent movement. The fentanyl patch had her mostly still, though.
Modern meds summoned via ability. Other preps done. First real surgery in this world...
Nerve-wracking.
"Estina. Once we start, hold the patient down. Movement mid-surgery could be disastrous."
"Sorry, but even with broken bones, what good is opening the wound? I'm not sure this is wise."
I looked at Estina.
"Estina. Quiet. Don't scare the patient—assist properly. We'll open the shattered part and reassemble the bone."
"And after assembling with surgery?"
"Huh? We'll fix it in place with mesh and plates. No surgery, and she'll never use the arm right."
She still seemed skeptical.
"I've never seen this method..."
I had a plan.
I laid out boiled, sterilized cloth on the floor, then draped a similarly boiled hole sheet over the patient's arm. So far, so good.
"Purification Magic."
Estina cast Purification Magic. I swabbed alcohol around the wound.
"Administering meds."
The patient nodded.
Three planned anesthetics.
I applied the fentanyl patch to her chest, injected propofol into the arm vein, and finally lidocaine as local into the arm.
Pull out the lidocaine needle, and serous fluid leaked from the wound like a popped water balloon. Classic compartment syndrome sign.
Currently suspecting radius and ulna fractures, plus bleeding and swelling causing compartment syndrome.
In a real hospital, X-ray for the fractures, bloodwork for compartment.
Here, only option was to open the arm.
"Scalpel going in now."
I took a deep breath, placed the scalpel on the arm. Skin incision, subcutaneous fat, fascia. Slice the fascia, and blood-tinged fluid poured out.
"Estina. See this? Pressure inside the fascia was sky-high. A few more hours, and the arm would've necrotized."
"Gasp, really...?"
"Ack! It fucking hurts!"
Okay, anatomy lesson over.
Enough sightseeing inside the arm—better finish fast. Even with anesthetics, she looked in serious pain. Resistant to them?
Propofol sedates for endoscopies. Called sleep anesthesia by laypeople, but technically conscious sedation.
Overdo propofol, and you get respiratory depression or opioid overdose effects. Best to wrap this up quick.
"Patient, you with us? Three anesthetics in, and you're still feeling it. Must be a rare metabolism."
"Gaaah!"
"..."
"Aigoo, sorry. I'll finish fast. Estina, gag the patient again. She'll bite her tongue screaming."
Estina stuffed the handkerchief back in. I peered through the open wound, parting muscle to eye the bone.
"Estina. Look here. See the bone shards between the muscles? Now we'll pin them straight with rods. Tough, but doable."
"Amazing."
I'm no orthopedic surgeon.
Just observed as a resident, assisted a few times as an intern. But I was this patient's only hope. No me, no arm.
If surgery flops, Healing Magic to save it. Arm function might suffer, but cross that bridge later.
The rod—titanium plate, technically. Worried if I could summon it since not a drug, but it worked.
Seemed palm-sized items were okay. Or anything implantable?
Whatever.
I attached the titanium plate to the bone. Hope this is right. Screws went into the plate holes one by one.
Looked fixed. No way to check right now.
"Estina. Plate on the radius only—leave the ulna like this, or re-incise? Not confident adding another plate this way."
Estina turned her beak mask toward me.
"Yeah, re-incising seems off. And don't ask me—I don't know."
"Right, gotta dig in."
"Mmmph! Mmmph!"
Another incision felt wrong. I nodded. The patient seemed to agree—no more cutting.