I Became a Plague Doctor in a Romance Fantasy

Episode 47. Cause Unknown Plague (3)

The Mayor of Imentia sighed deeply.

The situation in the city was grim. The somber mood in today’s meeting room perfectly reflected that reality.

“Let’s recap the current status.”

“There’s heavy backlash against the curfew.”

“What choice do we have? Disease could spread from the sewers at night due to the stench.”

“Every night, lunatics reportedly scream and pray in tongues, keeping people awake.”

No way to stop them yelling indoors, especially when there are so many…

“Ugh…”

“The Temple found about ten more cases with similar symptoms yesterday.”

“Is that a lot or a little? At least it hasn’t exploded yet, so that’s fortunate, right? What does the Professor say?”

“He said he doesn’t know what it is and will examine the patients further.”

“So even the Professor doesn’t know what this disease is? Hasn’t returned yet?”

“Nope.”

The situation was hopeless. Nobody knew what the disease was, how to combat it, or how far it would spread.

All they could do was wait for the Professor to identify the illness and provide solutions. There were no other options.

***

Medicine isn’t such a cold field that it prioritizes dying sons as secondary concerns—but maybe Imperial Studies is exactly that kind of discipline.

We arrived in Imentia, briefed on the situation, and now plan to visit the mayor’s second son, Mantar, who is quarantined in one of the towers of Imentia Castle after contracting an unknown illness during his overseas expedition.

Symptoms include hemoptysis (coughing up blood), rash, cough, and phlegm. While pneumonic Black Death is a possibility, there are some suspicious points…

I can’t fully trust Headwig’s examination notes. She may be skilled by this world’s standards, but…

Even if her methods seem rational, you never know when she’ll prescribe heroin to a toddler or call hacking off limbs with a dirty saw “treatment.”

Might be exaggerating a bit, but still… direct observation is necessary. Reading a hundred reports is no substitute for seeing a patient once.

Why is the hospital room so high up?

“What’s with all these stairs?”

“It’s a tower!”

Istina muttered quietly.

“Why keep the patient in a tower? My legs hurt.”

“Probably to isolate him further.”

Oof, my legs… This has to be at least six stories. Even for quarantine, this seems excessive.

How do they eat? Surely they don’t carry food up six floors every day?

Poor delivery staff…

A few minutes later, we reached the son’s room. Istina and I stopped briefly to check our plague doctor masks before knocking on the door.

“Doctor here. May we enter?”

No response.

“Um… Doctor here. May we enter?”

“Ghack… Cough…”

Guess that means yes. We entered the well-lit, normal-looking room. In the center stood a bed, where a frail-looking individual lay.

Based on visible evidence:

Recent movement indicated by items placement and slippers suggests the patient was walking around until recently. Still mobile, then.

Not surprising since the condition doesn’t require intensive care—why not keep him in a tower?

A wooden tray sat by the door with what looked like steak and porridge. Despite odd choices, it seemed mostly eaten.

Still able to walk and eat. Room also relatively clean, though likely not self-cleaned.

Time to examine the patient.

The patient appeared tired but sat up upon seeing us. Expression was grim, with noticeable red spots on the skin. Sunken eyes, and significant brown hair loss evident near the bedside.

Looks like a week’s worth of hair fell out—quite alarming. I paused to think.

We need to treat this quickly.

The mayor didn’t have much hair either, but losing so much at this young age isn’t normal.

More importantly…

Hemoptysis, red skin patches, hair loss—all classic radiation poisoning symptoms. But is it really radiation poisoning? Probably not…

No exposure source in a fantasy world without uranium mines or abandoned reactors nearby.

Enough detective work for now.

“Hello, patient,”

“Cough, cough. Who are you?”

“We’re doctors sent from the Imperial Capital. Heard about the outbreak in Imentia and were urgently dispatched to examine patients.”

The patient furrowed their brow.

“Thought you were death or undertakers. Figured I was almost gone.”

“Not quite yet.”

“Could you remove your mask?”

“Afraid not…”

Anyway, let’s start the examination.

“When did your symptoms begin?”

“Right after disembarking.”

“No issues during the expedition?”

“Tension kept me healthy, I guess. No sickness while adventuring.”

I sighed. No leads. What kind of disease causes this?

“Hemoptysis was reported. Did you notice blood in your phlegm? When did it start?”

“After returning.”

“Blood mixed with phlegm?”

“Yes.”

“Cough again please.”

“Cough, cough, cough.”

Not deep or severe coughing. Pneumonia or serious respiratory infections usually produce deeper, rattling sounds.

And not frequent coughing either. Maybe not as serious as expected?

I checked the patient’s conjunctiva and skin turgor. Skin turgor seemed normal, and no signs of dehydration.

“How much water do you drink?”

“Three bottles.”

Patient scratched their head briefly.

“Do you know what’s wrong with me?”

“Not yet.”

“Old sailors called it ‘sailor’s disease.’ Happens after long sea voyages or distant travels.”

“Is that so?”

“They said it clears up after two weeks on land. Thought that might be it.”

Sea-sickness? What exactly is this supposed illness? Perhaps a rare foreign contagion…

I stepped back and looked at Istina, who tilted her head.

“Istina, what do you think this is?”

“Don’t know. Could it be Black Death?”

That was Headwig’s and the city government’s conclusion. Possible, but…

Black Death, named for the blackened skin before death. This patient only had rashes, no blackened skin, and didn’t appear terminal.

Treatment for Black Death: doxycycline. Antibiotics would suffice, but…

Upon reflection, this doesn’t seem like Black Death. Bubonic plague would show bite marks and tissue necrosis. Pneumonic plague should’ve been fatal already.

Moreover, human-to-human transmission only occurs with pneumonic plague. Based on gathered information, Black Death can be ruled out entirely.

“Doesn’t seem right. No black discoloration or imminent death here. Hard to call this Black Death.”

“Then what is it?”

“Need more thought.”

No clue. Let’s rethink…

Hemoptysis was mentioned…

Hemoptysis is a rare symptom…

Most common causes: lung cancer or bronchial cancer. Though persistent coughing could cause bleeding too.

Back to basics.

“Istina, what is hemoptysis?”

“Condition where blood mixes with phlegm.”

“Differential diagnosis?”

“Hematemesis.”

“Anything else?”

“Not sure…”

Oral cavity bleeding. Since phlegm exits through the mouth, even if blood appears mixed in, it could originate from the mouth rather than lungs or bronchi.

Thus, perhaps all these wild diagnoses—lung cancer, radiation poisoning, Black Death—are based on flawed assumptions.

Re-examine the premise of hemoptysis. I turned back to the patient.

“Patient, open your mouth please.”

“Uh…”

Gloved, I gently lifted the patient’s lips to examine the gums. As suspected, they were bleeding slightly.

“Hmm… gingivitis?”

Nope. Not nearly as serious as Black Death, radiation poisoning, or lung cancer. Then again, could anything be worse than those three?

“Istina! Look at this.”

“Yes. Oh, bleeding gums…”

“See the blood?”

“Yes.”

“Not hemoptysis. Never was. Just oral bleeding that mixed with phlegm or sneezes.”

“Ah…”

Istina didn’t fully grasp the implication. A modern doctor would’ve instantly recognized the issue upon hearing about gum bleeding.

I spoke up. The patient and Istina watched expectantly.

“So, what is this illness…”

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