NOVEL NEXT WORLD Chapter 9
Chapter 9. Reporting to the Ward (4)
***
This is the operating room.
We were just now performing surgery to realign the patient’s arm bone. Lucky for us, the joint wasn’t damaged—because at my level, I wouldn’t have been able to fix that.
Right now, we need to decide whether to reopen the wound from behind to realign the bone or go deeper directly.
“……”
Looking at the patient’s expression, I get it. Yeah, this is gonna hurt, but properly fixing the radius and stabilizing everything will be best. Reopening the incision would be too much of a burden.
“Uuuuuugh! UUUUUUUUGH!”
Istina tightened her grip on the patient’s arm. Any sudden movement could lead to further injury.
“What’s your criterion for the surgery?”
“Good question. If it was just a crack, a splint might’ve sufficed, but with the bone shattered in multiple places… Without surgery, the arm would never function again.”
“Uuuuugh! UUUUUUUUGH!”
The patient screamed despite having a gag in their mouth.
Wait, didn’t I just administer both a fentanyl patch and propofol sedation? Why are they still so alert? Could they be resistant to the meds?
Anyway, we’re almost done with the surgery.
“Well done, patient.”
All the nails are secured into the steel plate. I set down the surgical tools I was using.
Phew. Performing bone realignment surgery on a conscious patient… this was definitely a first for me.
***
Alright, the bones are all aligned. Hopefully, I didn’t mess with any blood vessels or nerves inside there. If I did, can healing magic take care of it?
Honestly, even if something went wrong, I doubt I’d be able to perform vascular surgery here. That’s probably beyond my current skill level.
I carefully repositioned the torn muscles and tendons and began closing the incision. No apparent muscle damage so far. The swelling should subside soon.
Now it’s time to stitch up the wound.
“Istina, what do you use for stitching wounds?”
“Uh… I think it’s made of silk threads…”
“It has to be silk thread. Anything else could cause an allergic reaction due to immune response. For suturing humans, only silk works.”
Silk thread—it’s extracted from silkworm cocoons.
Most materials trigger strong antigen reactions and aren’t suitable for human sutures. Nylon might work, but obtaining it in this world seems impossible.
Silk, however, was commonly used even in the imperial palace. In my past life, I often used silk sutures as well. It’s hard to explain precisely, but the molecular structure of silk seems to provoke fewer immune responses.
The exact mechanism is a bit complicated to go into right now.
“Istina, do you know how to suture wounds?”
“Well, I’ve done a lot of sewing, but I’ve never stitched a person before. Since surgeries aren’t frequent, I imagine it’ll be difficult.”
I nodded.
“In that case, watch closely.”
“Yes.”
“You can practice later on pig carcasses. Next time, you’ll handle the suturing.”
“Ah, understood.”
The needle moved slowly.
“Since this is an arm, I’ll place knots about 4 millimeters apart. We should be able to remove the stitches in about a week, depending on recovery…”
With healing magic, the healing process could speed up. A week isn’t set in stone. Stitching the arm took quite some time.
It’s done.
Still, I’m relieved. If there had been tendon or vessel issues, I wouldn’t have known what to do.
“Istina, bandage it.”
“Does the patient need a splint?”
No splint needed. Whether it’s a splint or cast, nothing beats the effectiveness of the steel plate we already fixed onto the bone.
“In cases like this, since we’ve directly stabilized the bone, a splint isn’t necessary. It’d only inconvenience daily life.”
“Aha.”
I looked at the patient’s face.
“Once the swelling goes down, probably starting tomorrow, you should be able to move your arm. Full recovery might take a few weeks, but it could happen sooner.”
Finally, the medication seems to be kicking in. The patient only gave a slight nod.
“Istina, monitor the patient until they fall asleep, and record their condition every three hours.”
“Yes, understood.”
“If the bone breaks like this, fat globules from the bone marrow can escape, causing fat embolism. Compartment syndrome could also lead to kidney failure due to muscle breakdown products.”
Istina stared blankly at me.
“Um…”
“Just document it. I’ll be nearby.”
“Yes, thank you.”
Even undergraduates in my previous life weren’t this clueless. Of course, it’s not Istina’s fault. The era limits knowledge like this.
Still, with healing magic, we should be able to keep patients alive until I return. I need to publish research findings soon.
If everyone’s skills improve even slightly, my job will become easier, and we can save more patients.
[Heal.]
Istina raised her staff again, and warm light filled the ward.
***
The surgery was successful. Istina and I returned to the research lab.
Whatever system is in place here, we need to keep records of surgeries and ward logs. Paper charts would help too.
Paper-based medical records—I haven’t seen them since volunteering at a homeless shelter. Usually, we rely on digital systems.
I’ll need to organize these medical records.
“Professor, excuse me…”
Istina hesitated. What does she want now?
“What?”
“Am I really accepted as a graduate student?”
I completely forgot. A few days ago, I said I’d decide whether to accept her as a graduate student.
“Yeah.”
“Thank you! I’ll work hard.”
Istina bowed deeply.
“Professor, if you’re not too busy, I have a few questions about today’s patient.”
“Okay.”
Fumbling around…
Istina pulled out paper and a pen from somewhere.
“First, I couldn’t fully understand what compartment syndrome is. I didn’t get the chance to ask earlier.”
Compartment syndrome.
It’s a condition we see relatively often.
“There’s a membrane surrounding muscles, right?”
“Yes.”
“It’s when bleeding or swelling inside the fascia causes pressure to rise. Treatment involves cutting open the fascia to relieve pressure.”
Istina scratched her head.
“Oh, one more thing. Why is increased pressure inside the fascia problematic?”
“Well, if the pressure exceeds capillary blood pressure, circulation stops. Don’t you know what capillaries are?”
Explaining from the basics presents challenges. She doesn’t know what capillaries are, nor does she fully grasp the concept of pressure, so she can’t follow my explanation.
Hmm, no choice.
We’ll prove the existence of capillaries another time. Once I finish the microscope, we should be able to observe them.
“For now, just think of it as the fascia being too tight for blood to flow in.”
“I understand. What happens if we don’t perform fasciotomy in time?”
***
They die.
Even if the person survives, the muscles won’t.
“Eventually, muscle tissue necrosis occurs. The dead tissue releases debris into the bloodstream, causing systemic issues. Adding healing magic complicates things further.”
Istina nodded.
“I understand. Thank you for explaining.”
“Rest a bit and head back to the ward.”
Istina left, and I thought about it. Microscopic capillaries were discovered in the 17th century, so it makes sense they wouldn’t know about them here.
We definitely need more graduate students. More hands mean faster compilation of research, and sooner, I can communicate better with people here.
***
Meanwhile, in Professor Asterix’s ward.
Patient Benjamin Brisbane slowly opened his eyes. The last thing he remembered was the healers administering medicine before surgery.
Though the surgery itself seemed painful, the details were blurry. Only the taste of the handkerchief clenched in his mouth lingered.
Benjamin was the heir of the Brisbane clan and a student at the Academy. While riding at full speed, his horse had thrown him off…
Lucky to only break an arm, maybe.
“Where… am I?”
“The hospital.”
The excruciating pain in his arm had mostly subsided, though the surgical cuts still stung.
A plain-looking healer stood beside the bed. Dressed in a black robe and wearing a plague doctor mask, they resembled a grim reaper.
“We performed surgery on your arm. You should be able to move it slightly by tomorrow, and full recovery will take a few weeks.”
“Did you fix it?”
Istina shook her head.
“The new professor handled it. They previously served as the royal physician.”
“When can I meet them?”
Benjamin looked worried, and Istina hesitated. How should she explain?
“They might return to the ward later today, but I’m not sure. Still, we’ll call them immediately if anything happens.”
“Will I be able to use my arm?”
Istina nodded. The professor said Benjamin should regain arm function within days, so it should be fine.