I Became a Plague Doctor in a Romance Fantasy

8th Episode. Reporting to the Ward (3)

****

Now, I need to set this arm bone. Sorry in advance; even attempting this is going to hurt like crazy. Clenching my teeth, I stared at the patient’s arm.

It depends on how the arm bone broke.

If it’s broken in one or two places, there might be some semblance of alignment we can work with. But if it shattered into multiple pieces or got crushed, simply manipulating it from the outside won’t fix it.

It’ll just cause immense pain.

I tightly gripped the patient’s hand with my left hand and placed my right hand over the wound area. It’s going to hurt—really hurt—but…

“One, two, three, and I’ll try to set the bone.”

“Uuuuuugh!”

Come to think of it, they have a gag in their mouth. The patient might be in a situation where answering verbally isn’t possible.

“One, two!”

I tried aligning the broken arm, but I couldn’t feel the fractured bones meeting. This must be a comminuted fracture.

Judging by how freely the broken arm moves, both sides of the humerus seem shattered. And when they were brought in, it was completely bent.

This confirms the diagnosis.

“Uuuuugh! Uuuuuugh! Uuuugh!”

“See, Istina? Just as I said—if it’s a comminuted fracture, the bones won’t align, and the pain will be excruciating.”

“Uuuugh!”

The patient seemed to attempt saying something, but it was incomprehensible. Probably something along the lines of ‘it hurts,’ right?

“That’s why I suggested using a gag. If they bite down on their tongue during this, it could be disastrous.”

“Ahh, understood.”

Istina nodded vigorously.

****

I locked eyes with the patient again.

“Patient! It seems like you have a comminuted fracture. Your bone is crushed. If we leave it as is, regardless of healing magic, you’ll never use your arm properly for life. Surgery is necessary.”

Istina frowned.

“Surgery? Isn’t that kind of risky? Can’t we just use splints or bandages?”

“Nope.” I shook my head.

“The arm has swollen to twice its size. Do you think we can wrap it with bandages? Obviously impossible.”

“Uuuugh! Uuuuuugh!”

Right now, the suspected condition is compartment syndrome.

It’s a disease where increased pressure inside the fascia prevents proper blood flow to the muscles.

In this patient’s case, due to trauma and swelling, the pressure inside the fascia has likely risen.

“Istina, look. The arm is broken, and apart from the bruised areas, the skin looks pale. The pulse is barely detectable. This is classic compartment syndrome. The pressure inside the fascia has abnormally increased due to trauma. Doesn’t it seem like surgery is necessary?”

Once again, she wore an expression of uncertainty. Istina squinted while staring at the patient’s arm and sighed.

“H-how am I supposed to know that…? Professor, are you really sure just by looking at the arm?”

“Don’t dodge the question. I’m busy.”

“I don’t know.”

Of course, she wouldn’t know. But ignorance can cost the patient’s life. That’s the reality of our field. Luckily, I do know what’s happening here.

I locked eyes with the patient again.

“Patient, we urgently need surgery. Please nod if you agree.”

“Ugh! Uuuuuugh!”

I’m not sure if that was a nod or not. At this point, I’ll take it as a nod. Was it fear that made them shake their head? Regardless, without surgery, they might die.

Given the current state, this isn’t just about the arm anymore.

“Nurse! Prepare for surgery.”

A few ward nurses rushed over. I turned my head toward Istina.

“Let’s prep for surgery too. Remember? Wash your hands, disinfect the tools we’ll use, and ensure no hair or dust interferes.”

****

Surgical preparation.

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

It was a plague doctor’s beak mask, but it’s better than nothing. There’s no proper operating room here.

No anesthesiologist, no ventilator…

Hmm. We can’t perform general anesthesia under these conditions. We’ll have to conduct orthopedic surgery while the patient is conscious.

Here’s the plan:

Administer propofol in sedative doses, apply a fentanyl patch, then locally anesthetize the lower arm. It’ll hurt quite a bit, but it’s better than losing the ability to use the arm forever.

Right?

Istina looked worried.

The patient also wore a worried expression.

Thinking about it, we should probably tie the patient down since movement would complicate things. Though they’re barely moving thanks to the fentanyl patch.

Modern medicines were summoned through ability. Other preparations were also completed. This is my first real surgery in this world…

It’s nerve-wracking.

“Istina, once the surgery starts, hold the patient down firmly. Moving during surgery could lead to major complications.”

“But, um, what exactly are we doing by opening the wound if the bone is already broken? I’m not sure this is a good idea.”

I glared at Istina.

“Istina, shut up. Stop making the patient anxious and focus on assisting properly. We’re going to open the broken part of the arm and reconstruct the bones.”

“And after the surgery?”

“We’ll stabilize the bones using mesh and metal plates. Without this surgery, you might never use your arm properly again.”

She still doesn’t believe me.

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

There’s a plan for everything.

After boiling and sterilizing cloths, I laid them on the floor and placed similarly boiled gauze over the patient’s arm. So far so good.

“Purification Magic.”

Istina cast the purification spell. I applied alcohol around the patient’s wound.

“Administering medication.”

The patient nodded.

We’ll use three types of anesthetics.

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

As soon as I pulled out the lidocaine needle, fluid resembling a punctured water balloon leaked from the wound. A clear sign suggesting compartment syndrome.

In a modern hospital, X-rays would confirm fractures, and blood tests would verify compartment syndrome.

Here, though, all we can do is cut open the arm.

“Now I’m going in with the scalpel.”

Taking a deep breath, I placed the scalpel on the patient’s arm. Skin incision, subcutaneous fat layer incision, fascia incision. Once I cut through the fascia, a significant amount of bloody fluid flowed out.

“Istina, look. The pressure inside the fascia must have been extremely high. If we’d waited a few more hours, the arm would have necrotized.”

“Huh, really…?”

“Aaah! It hurts so much!”

Alright, anatomy lesson ends here.

Let’s finish the surgery quickly. Even with the anesthetics, they seem to be in considerable pain. Is the patient resistant to anesthetics?

During endoscopic procedures, we often use propofol to sedate patients. Laypeople call it sleep anesthesia, but technically, it’s not actual anesthesia.

Propofol is a sedative, and administering large amounts induces a sleep-like state. The correct term is “conscious sedation.”

Using too much propofol can cause respiratory distress or side effects from opioid overdoses. Best to finish the surgery quickly.

“Patient regaining consciousness? We’ve used three different anesthetics, yet they seem ineffective. You might have a unique constitution resistant to anesthesia.”

“Kraaaaaaaagh!”

“…”

“Oh dear, sorry. I’ll finish the surgery quickly. Istina, reapply the gag. They might bite their tongue if they scream.”

Istina reinserted the cloth gag into the patient’s mouth. Through the open wound, I examined the muscles and peered at the bones.

“Istina, look. See the broken bone between the muscles? Now, I’ll insert the rod to straighten the bone. It’ll be tricky.”

“Incredible.”

I’m not an orthopedic specialist.

Back in school, I only observed surgeries during training, and assisted a few times during my internship. But right now, I’m the patient’s only hope. If I don’t do this, they’ll never use their arm again.

If the surgery fails, I’ll use healing magic to somehow save them. Using this approach, the patient might struggle to use their arm properly, but we’ll cross that bridge when we get there.

Titanium plate. Strictly speaking, it’s not medicine, so I was worried whether I could summon it. Somehow, it worked.

Seems like I can bring objects smaller than the palm of my hand. Or maybe anything that goes inside the body counts?

Not sure about that.

I attached the titanium plate to the bone. Not sure if this is the right way, but the screws fit into the holes on the titanium plate.

It seems secure enough. There’s no immediate way to confirm, though.

“Istina, we’ve only fixed the humerus so far. Should we proceed with the radius as well, or make another incision? Honestly, I’m not confident attaching a plate to the radius.”

Istina turned her beak mask toward me.

“Eh, yeah. Making another incision does seem excessive, doesn’t it? Besides, asking me won’t help—I don’t know either.”

“True, guess I’ll just dig deeper.”

“Uuuuugh! Uuuuuugh!”

Making another incision does seem excessive. I nodded. The patient seems to be signaling not to make another incision too.

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