I Became a Plague Doctor in a Romance Fantasy Novel

Episode 63. Monster Hunting Festival (3)

Episode 63. Monster Hunting Festival (3)

Alain, a healer belonging to the Academy.

The eldest senior among Professor Fisher’s graduate students, who is the Dean of the Healing Department and a healer himself. He was one of the people in charge of this event. He had a lot of worries but…

This time, that professor is here, right?

The professor who healed all those imbeciles who were trying to kill each other at the sword tournament. Not a single person died or was injured beyond recovery.

I heard he was the royal physician before his new appointment. He must be truly skilled.

The order from the Dean’s office was this:

Send all patients, even those with minor issues, to Professor Asterix. Send all patients, even those who don’t seem to have big problems, to that professor.

Alain, who was on site, did just that.

I wish we could get through this without anyone getting hurt again, but the female knight we just sent over seemed quite severely injured…

Let’s trust in him for now. There isn’t another way. Alain anxiously shuffled his feet in front of Professor Asterix’s ward.

That student. They’ll make it out alive, right?

This patient, they’re going to die like this.

Ugh, my head aches. If I leave it, blood won’t circulate to the brain and they’ll die, but if I pump in epinephrine to raise their blood pressure, their limbs might die.

No matter how much I think, this seems like the only way. I sighed, then picked up the scalpel again.

“We don’t have time. Hold on tight.”

“No, wait a minute. Doctor-“

The patient mumbled something with a shocked expression, and Istina was waving her hand at the edge of my vision. What is it this time?

“Professor. Are you really not going to use anesthesia?”

“Hey. We don’t have time, so get them to bite down on the blanket. It won’t hurt too much.”

It’s because I can’t use anesthesia, jeez.

Even as I spoke, my hands didn’t stop moving.

Lidocaine, a local anesthetic, can also act as a vasoconstrictor. I can’t administer any more of that.

“You’re opening my heart, you say. There’s no way it won’t hurt-“

“Istina. Quiet.”

Istina shut her mouth. I want to explain properly, but. There’s no time now.

I very carefully brought the scalpel to the patient’s fourth intercostal space on the left side.

There’s no need for a big incision at all.

Two centimeters should be plenty.

The muscle between the ribs is thin. It’s made of three layers, only a few millimeters thick-

A moment later.

The pericardium peeked through the small incision. The patient flinched, but didn’t seem to be in much pain. Now the pericardium was visible.

No risk of puncturing other structures.

Just slowly drain the fluid.

“Almost done. Just a little longer.”

“Ugh…”

The patient scrunched their eyes, but didn’t move or cry out. Pericardiocentesis, dangerous as it is, shouldn’t be too painful.

I gripped a part of the pericardium with forceps, and inserted the needle inside. A reddish-brown fluid mixed with blood began to fill the syringe.

The effect will be immediate.

Considering all the fuss made, the process of treating cardiac tamponade wasn’t that big of a deal. Just draining fluid with a needle.

The opening I made between the ribs was the size of a fingernail.

The incision in the pericardium, a pinprick. It wasn’t the complexity of the actual procedure, but the risk of touching the area around the heart that made it delicate.

“All done. I’ll stitch you up now.”

A few minutes later.

Miss Eleanor was sitting upright on the bed. Looking nauseous. She did gag and cough a few times, but…

She’s alive.

“Ugh.”

“How do you feel, ma’am?”

Her pallid complexion was better. She seemed to be breathing properly again too.

“Ugh. Still feeling shaky…”

“Because the knife touched the pericardium.”

“Are you going to be okay now?”

“The procedure itself went well. You should be fine in a day or two.”

If the blood pressure stabilizes, you live. But if it doesn’t stabilize even after all this, well. Then there’s no solution.

You have to keep draining the fluid from the pericardium so the heart can keep beating. If you die, you die; if you get better, you get better.

“Do I have to sit up?”

“Yes. We can’t let fluid build up in your lungs.”

Because her lungs filled with exudate earlier. You can’t lie down. If you lie down, the fluid in your lungs could cause breathing problems again.

The reason is a bit complicated. The fluid inside the lungs also shifts with gravity, and when you lie down, the fluid spreads, increasing the surface area it occupies.

The hydrostatic pressure created by the height of the lungs also prevents exudate from leaking out, anyway.

I was worried because it was a high-risk procedure, piercing the pericardium with a needle and draining the fluid.

But the procedure was a success, and the knight is alive.

I handed a blanket to Eleanor. The knight was still sitting there looking annoyed.

Well, yeah. Sticking a needle into her heart, it’d be ridiculous to expect her to be happy, right? Still, I saved her life, it’s a bit disheartening.

“Give me your hand. I need to check your pulse again.”

“No, thank you. I appreciate you saving my life, but…”

“No…….”

Eleanor wrapped the blanket around herself, then clasped her hands on her lap. Her posture was somewhat defensive. Yeah… I guess she could be.

The knight looked at me.

Her eyes were still full of mistrust.

“So, what exactly did you do?”

“There’s a sac around the heart called the pericardium, and it had too much fluid built up, so we surgically removed it. Too much water in the pericardium can compress the heart.”

Eleanor tilted her head again.

“Is that heart surgery?”

“It didn’t actually go into the heart.”

“I see. And why did the fluid build up?”

“Due to trauma. It could be a coronary artery or major blood vessel injury, or damage to other blood vessels. There’s no way to know for sure right now.”

I’m still hoping it’ll be okay, though.

Her pulse and color are back. It’s possible the bleeding inside the pericardium has stopped. From here, it might be manageable with just medication.

There’s nothing more I can do either.

“Anyway. The procedure went well. If her blood pressure and pulse stabilize, there shouldn’t be any problems. We’ll monitor for sepsis, and since we opened the pericardium, we’ll administer prophylactic antibiotics.”

Eleanor nodded slowly.

“And if she’s unstable?”

“Then there’s no more we can do. We’ll address the symptoms as long as possible and help her recover.”

“You’re very honest. I understand.”

Eleanor was one to ask a lot of questions.

Usually, even if they’re in pain or tired, they don’t ask this much right after a procedure.

“You’ll need to stay in the ward for a few days and take medication. There’s a risk of shortness of breath, so stay seated. We don’t know when the fluid in her lungs will clear.”

If her heart rate keeps increasing, we can use beta blockers, and if the pleural effusion or lung exudate continues, we can consider loop diuretics.

This needs monitoring.

Preventative antibiotics will be ampicillin.

But. If endocarditis or sepsis really kick in, ampicillin won’t cut it.

We’d need something way stronger… Whatever, we’ll figure it out then. I placed the glass vial beside the bed.

“One pill every morning.”

“What is it?”

Dude was barely able to breathe a minute ago, now he’s all chatty… Can’t think that, I guess. Just a few days ago I saw a drug addict patient.

“It’s medicine that kills bacteria. You’re at high risk of bacteremia because you had your pericardium opened, so we’re going to try preventative medication.”

Eleanor stared at the vial for a moment, then nodded. Hope she’s a little convinced, at least.

“When do I get discharged?”

“Just wait three days. If there are no problems in three days, you can go home.”

“Thank you.”

“Rest well. Oh, sit up!”

I grabbed Eleanor as she tried to lie back down.

Seriously, stay seated. You can get breathing difficulties if you lie down now, why is she doing this.

Let’s just assume she’s still out of it from the shock. The knight’s examination is over.

I took Istina and left the ward.

That was a pain in the ass.

The monster hunt must be wrapping up by now. We came back to the lab, sat down at our desks. It was a long day.

“Did you document the patient’s record?”

“Yeah.”

Istina nodded.

“You come in with injuries from dumber reasons than I thought. Most of them, I figured, would be from fighting.”

“Yeah, right.”

Working in the ER, you get to the point where nothing surprises you. But someone collapsing from eating mushrooms by themselves was a bit much.

What’s going on inside that guy’s head?

Istina looked tired, slumped back on the sofa, staring into the distance.

Right, I haven’t told her about that.

“Istina, that knight dude from earlier?”

“Ah, yep.”

“Let me know if his temperature goes over 38, or his heart rate over 90, or his breathing over 20. He’s high risk for sepsis, gotta keep an eye on him.”

A brief silence. Istina looked like she was thinking it over for a bit, then tilted her head, like she was confused.

“What’s sepsis?”

“It’s when bacteria is running around in your blood.”

The king of internal medicine disorders.

“Okay. But if his temp is over 38, heart rate over 90, and breathing over 20, does that mean it’s sepsis?”

It’s complicated, but basically yeah.

I nodded.

“Uhm, explain it in detail, please.”

Maybe because she was tired, Istina sat cross-legged, lost in thought for a long time. Then she cleaned her glasses and turned her head towards me.