I Became a Plague Doctor in a Romance Fantasy Novel

Monster Hunting Festival (2)

Monster Hunting Festival (2)

Stomach pump and atropine administered.

“Gag. Hrk. Ughh… urghh.”

The mage who was just lying down was now sitting on the edge of the bed, retching for a good while. Istina cast a healing spell on him.

“Are you feeling a little more with it?”

“No.”

This is what’s good about this world. Healing magic makes recovery incredibly fast. This patient, too, would’ve likely died from respiratory distress a long time ago if it weren’t for the healing magic from the healer who came with him.

“Just askin’ outta curiosity, but… why’d you eat the mushrooms?”

“Ughh. There’s some I usually eat to replenish mana, but I guess I ate too many, or maybe it was a different kind. Anyway… thank you.”

“Does that mean you just pick up any old mushroom off the street and eat it? If it weren’t for me, you could’ve really died, you know.”

“Yeah…”

Inati ducked her head sharply. Working at the hospital, you learn things. Never, ever underestimate people.

There are all sorts of crazy b*stards. Picking up and eating a random mushroom out of boredom is just the tip of the iceberg.

People come into the ER all hunched over because an cucumber broke and got stuck inside them and now they can’t get it out.

Let’s not think about it too deeply.

You should never underestimate ordinary people. Just because *I* don’t pick up weird mushrooms in the woods and eat them, doesn’t mean other people have the same common sense.

Anyway. The Mushroom Professor went home alive. Hopefully, he learned his lesson about not eating random, unknown mushrooms in the forest.

“There aren’t as many patients as I thought?”

“Dunno. Guess the monsters are fighting softly.”

I thought there’d be more trauma cases.

With that many people out hunting monsters, there’s bound to be some injuries. Instead, it’s just a bunch of weirdos hurting themselves in strange ways, and hardly anyone actually injured in a fight with monsters –

Ah. Now I see them.

“Oh, a gurney’s coming, just as I said it.”

“Istina… Don’t say ‘no patients’ out loud. Just think it.”

“Okay.”

The goddess of fate never ignores a provocation. Patients can show up anytime, so let’s just enjoy this moment when nobody’s hurting.

First patient in was some dude who ate mushrooms and passed out, bit of a letdown. This one comin’ in now, though, was a legit trauma case.

Me and Istina ran over, like, straight away.

“Patient info.”

“Academy student, Miss Eleanor. Decreased consciousness, left chest contusion! Broken left rib, weak pulse!”

“What happened to her?”

“Bear!”

Yeah, no further explanation needed, really.

But, like, do bears even count as monsters? What’s the point of getting hurt fighting some random wild animal that isn’t even a monster? Not that that matters right now, though.

Let’s see. Laceration on the side, chest bruised up.

This looks bad, real bad? Can’t even feel a pulse. She’s breathin’, but her face is pale.

I try for her pulse again. Can’t find anything on her wrist…I try again at her neck.

It’s there. It’s actually too fast. Low blood pressure and, like, a rapid heart rate. This is –

I turn my head to Istina.

“Hemodynamically unstable patient, need the OR ready and get nurses here! And bring a stethoscope too!”

Cyanosis, low blood pressure and rapid heart rate. You might just think it’s all from bleeding, but trauma could be so many things.

Punctured lung from the broken ribs? Bleeding in the chest cavity? There are a million possible problems, but not so many solutions.

One good thing, at least.

Doesn’t look like any internal organs got damaged. No bruising on her abdomen, not this time, anyway.

First, let’s get her blood pressure back up. I grabbed an epinephrine shot and jammed it into a vein in her arm.

Epinephrine’s a vasoconstrictor.

Injecting epinephrine intravenously makes the blood vessels throughout the body constrict, and blood pressure goes up a bit. It could also help with any possible internal bleeding.

The pulse was faint, but they seem a little more conscious. Did the epinephrine cause blood to rush to their brain?

Still, the epinephrine seems to have worked. I finished connecting the IV line to the patient’s arm. Hopefully, their blood pressure will stabilize.

Let’s wait a few minutes. Get them awake a bit.

“Patient! Wake up! I’m going to palpate your injuries, so tell me if it hurts!”

“Ugh, even without touching, it hurts—”

“Palpating.”

“Agh! It hurts!”

They were supposed to be lethargic, but they seem perfectly fine.

Like I’ve said before, if you get drowsy and fall asleep while you’re suspected of bleeding, you could end up crossing the river Styx. We have to force them awake.

“aaargh!”

Ms. Eleanor… She has a good set of lungs. But, despite the clear reaction, her complexion is getting paler. And her pulse is weakening.

“Stethoscope!”

What’s taking so long. I snatched the stethoscope from Istina’s hand impatiently.

I need to check if the heart’s beating irregularly because of trauma, or if blood is accumulating in the chest or lungs. If only we had an EKG machine, I could’ve confirmed this a long time ago.

“Listening now.”

I frowned.

Let’s think this through. If there’s fluid in the lungs, there’d be a crackling sound, or rales. A sound caused by fluid building up in the lungs.

If fluid’s in the chest cavity outside the lungs, the lungs would move around and rub against the pleura, making a strange friction sound.

Looks like the lungs aren’t filling with fluid, for now.

Breathing sounds normal. No signs of bleeding in the chest cavity, nor did I hear the sound of fluid in the lung parenchyma.

Finally, the heart, the crown jewel of auscultation.

I could hear the heartbeat, but it was only fast and felt somehow stifled. And, more importantly… I hear a friction rub coming from the heart.

There’s bleeding in the pericardium, which is compressing the heart, and that’s why it’s not functioning properly. I can’t confirm it just from listening, but this was my conclusion.

“It’s the heart.”

Istina looked at me.

“Will you operate?”

“Let me think for a moment.”

Thoracic surgery is one of the most difficult. Even if I open this patient’s chest and operate… the probability of the patient surviving after surgery is… not high, it seems.

Even if the heart is the problem, it doesn’t seem like a problem I can touch. At least, not surgically. Then what can I do?

It’s not that there’s no way to resolve the cardiac tamponade. I can open the pericardium.

Cardiac tamponade is a condition caused by compression of the heart. Naturally, if fluid fills the pericardium and compresses the heart, various problems arise.

Pulmonary circulation fails, causing fluid to build up in the lungs, and arterial blood pressure drops.

The cause of the heart compression is the issue. If it’s a coronary artery or major vessel injury, there’s nothing I can do, but I can remove the fluid compressing the pericardium.

If there was an ultrasound machine, I could do it with just a needle, but there’s no ultrasound here. So the option of just inserting a needle is out, I have to perform the procedure while watching. It won’t be easy, but…

“We can’t find a source of bleeding surgically. We’ll incise the patient’s pericardium and remove the fluid compressing the heart. Prepare for surgery.”

Istina nodded.

It’s urgent. Surgery prep took less than two minutes. They’d been getting ready since earlier.

“Into position.”

Pericardiocentesis.

This, originally, is a procedure you could do with just a needle. Stick the syringe into the pericardium, and drain the blood filling it.

The problem is, usually you use an ultrasound in this process. Without an ultrasound, you can’t insert a needle for fluid removal into the pericardium.

If you insert the needle without ultrasound, you could end up puncturing the heart while trying to pierce the pericardium.

Then, well… immediate death.

“From now, I’ll be cutting through between your ribs. I’ll cut between the ribs to expose the pericardium, and I’ll open the pericardium while looking at it.”

“Then I can live?”

“Maybe.”

Istina frowned.

The patient looked up at me, face etched with terror. I felt a little sorry for them.

“Can’t I not have the surgery? I feel fine now, if I just lie down for a bit—”

“It’s the medication. You’ll die soon.”

“Die?”

“If you don’t have the surgery.”

The patient’s hands are already turning blue.

One of the side effects of epinephrine. If you constrict peripheral blood vessels on top of already low blood pressure, circulation to the extremities can be cut off.

Better than blood not getting to the brain, but if it’s not resolved within a few hours, fingers and toes will die. Can’t leave it as it is without draining the pericardial fluid.

The fact that they feel relatively fine now is just a delusion created by the medication.

“Can’t I get anesthesia?”

“No need for anesthesia.”

No time for anesthesia, not now. Anesthetizing near the heart, who knows what could happen.

“You’re opening my heart—cough, cough.”

A deep cough. I could feel the fluid in his lungs even without a stethoscope.

“That’s the sound of fluid building up in the lungs… We’re starting the procedure immediately.”

The goal is to avoid the heart. This requires precisely opening only the pericardium.

More importantly, did this patient get his lungs injured in the fight? Or is fluid accumulating in the lungs as a symptom of worsening cardiac tamponade?

Either way, there’s no time to waste. I couldn’t shut my eyes tight, so…! I opened them as wide as I could. The surgery will be a success.