I Became a Plague Doctor in a Romance Fantasy Novel

Return to the Routine (2)

77. Return to the Routine (2)

The first patient of the day.

His name is Josef, a young man who looks a little older than he is. He works on a farm, and he’s been doing a lot of outdoor work lately.

He came in because of a combination of symptoms: skin redness, heart palpitations, rapid breathing, dizziness, and swelling around the neck.

But most of the symptoms are non-specific.

I immediately thought of scrub typhus. The season, the outdoor activity, the symptoms like swollen lymph nodes and high fever – it all fit.

Amy, based on the given information, concluded it was pneumonia. Worth checking, I guess, though it didn’t seem like pneumonia.

I looked at Amy.

“Differential diagnosis for pneumonia. What should we do?”

Amy tilted her head. It probably wasn’t pneumonia. Still, it’d be good for her to draw her own conclusions.

“Auscultation.”

“Then auscultate.”

“Okay.”

Amy, with a genuinely serious face, auscultated the patient’s back. I’d already done it myself and heard not the crackles of pneumonia, but the rapid breathing and wheezing from bronchial constriction.

“Uh, the auscultation is normal.”

“Yeah… no rattling sound.”

Definitely not pneumonia.

Could be due to smoking or other underlying conditions, but if we assume these symptoms are new, due to this current illness… maybe the bronchi are constricted due to a systemic inflammatory response?

I looked at Mr. Josef, lying on the bed. I’d pretty much figured it out. This is scrub typhus or a similar disease.

A bacterial, insect-borne infectious disease, popularly known as caused by “killer ticks.”

For insect-borne bacterial infections, the treatment is usually doxycycline. Even for the plague.

It would be ideal to pinpoint the exact bacteria, but there are so many similar ones.

Just take the illnesses in Korea, commonly lumped together as “killer tick disease.” Scrub typhus, leptospirosis, hemorrhagic fever with renal syndrome, severe fever with thrombocytopenia syndrome, and more—quite a variety…

Luckily, the solutions are similar. Monitor vital signs, treat the symptoms, and doxycycline.

Hemorrhagic fever with renal syndrome and severe fever with thrombocytopenia syndrome can leave complications, so we do need to be a bit careful, though?

“It’s a disease from a killer tick.”

“Killer? Am I going to die?”

It’s true the disease is treatable, but the reputation of “killer tick” didn’t just spring up out of nowhere. So many people died from it, that’s why it’s called that.

My thinking was too short-sighted. No, who came up with that nickname anyway? It’s going to freak the patients out.

“Ah. That’s what it’s generally called.”

“So, am I going to die?”

“No. You’ll get better if you take medication.”

I shook my head, and Mr. Josef looked at me with deeply suspicious eyes. Well, of course he would, after hearing the word “killer.”

“We believe your condition is an insect-borne infectious disease caused by a tick bite. In these cases, the pathogen is directly injected into the bloodstream, and non-specific systemic symptoms can appear without a vector organ.”

“Ah, is that so…?”

“It means symptoms can appear all over your body.”

The patient, who was lying down, looked a little confused, but nodded at my words.

“Yes. The disease seems to be from a tick, and you’ll get better in a few days with medication. Because it’s dangerous, you’ll have to be hospitalized for two days. It might take about a week for the disease to disappear completely.”

If this was a modern hospital, I’d confirm it with a blood antibody test, but that’s not possible here.

“Ah, I understand.”

“But it is a treatable illness.”

“Before I give you the medication, to make a definite diagnosis, I need to find the bite wound, you know?”

“Yes?”

“The tick might still be attached to your body, or there might be a scab where the tick bit you. I need to find that.”

We usually call it an eschar. A scab in the center of a target-like red rash, or a tick still attached. The patient scrunched his face.

“How do I do that?”

“I’ll come by this evening with the medication, so until then, you either look for the tick itself, or the bite mark. One of those two.”

Tick bites are a bit different from mosquito bites.

Usually, they don’t itch, and you often don’t even know you’ve been bitten. Ticks usually bite in places out of sight, like skin folds. If you don’t look carefully, you usually won’t find them.

I hope you succeed in finding the tick. If you can’t, the medical staff will have to look, and if even they can’t find it… we’ll have to consider other diagnoses.

“Oh, that’s right, just one more thing, patient. If you happen to get any unusual bruising, or if your urine changes color, you have to let us know immediately. Has there been anything like that?”

“No.”

“Thank you for your cooperation. So, look carefully for a tick, and I’ll see you later.”

I took Amy and we moved away.

Amy, leaning the medical record against the wall, was writing something, then glanced back over her shoulder at the patient’s expression.

– Patient’s level of consciousness: Alert.

“Is it a disease caused by a tick?”

“Yeah.”

“Will he be okay?”

“He’ll be fine if he takes his meds properly.”

As long as it’s not hemorrhagic fever with renal syndrome, or that disease that causes low platelets. Here, if your kidneys fail, dialysis is difficult, and platelet transfusions are hard to come by too.

We have to manage him well so that doesn’t happen.

“Keep an eye on his complexion and whether his hands swell. Ask how many times he’s peed, too.”

“Ah. Is it that serious?”

I nodded. Knowing what bacteria caused the illness would be great, but since I don’t know the specific species, I have to be careful.

Amy finished up what she was writing.

“Finished the medical record?”

“Yes.”

“How about the second patient?”

“They said they got bit by a dog.”

“That must’ve hurt.”

“I put a bandage on it earlier though.”

I need to see this myself. If there’s an infection in the wound, it could develop into a life-threatening illness. Other problems could be layered on top of it, too.

The patient was lying on the bed with a bandage wrapped around their calf. How long had it been since they put the bandage on? Should I re-wrap it?

“Hello, there.”

“Ah, hello…”

“What is your name?”

“Amanda.”

Amanda. She looked about the age of a student, but not like an Academy student. Well, would there even be a chance of getting bitten by a dog at the Academy?

“When did you put the bandage on?”

“Yesterday.”

“I’m going to take a look.”

I sanitized my hands and then carefully unwrapped the bandage from the patient’s leg. It looked a little compressed, but it was in better condition than I had expected. There was some redness though.

“Amy. Bring me some distilled water.”

“Yeah.”

“It looks like it’ll heal okay. There’s no real problem, but we’ll clean the wound again and give you preventative meds to stop gangrene.”

“Ah, okay.”

“Extend your leg out of the bed, please.”

Must’ve been a pretty big dog. It wasn’t just teeth marks, there were tears too.

“Amy. Look.”

“Yeah.”

“If the wound gets hot or red, there’s a risk of gangrene.”

“Yeah.”

“Don’t disinfect the inside of the wound directly, use distilled water to clean it, if you can. So you can see if there’s anything left inside.”

“Yeah, I understand.”

“Do you think this needs stitches, though?”

“Yeah.”

Well, it’d be better than not. Could leave it to heal on its own, but might not work out. I grabbed the needle and thread from beside me.

“Yeah. We’re gonna need to stitch the wound up. It’s bigger than I thought.”

“Ah… is it going to hurt?”

“We’ll use anesthetic.”

Anyways. Let’s just get it done. We cleaned the inside of the wound with distilled water, then disinfected the surrounding area with red antiseptic, and injected a local anesthetic.

Okay, got that done. I pinched the area around the wound with the tweezers to check the anesthetic was working properly. Seems good enough, at least.

“Needle.”

Amy handed me the needle.

“Amy… look closely. If the wound goes in one centimeter deep, you gotta push the needle in deeper to stitch it. That way, no space forms under the wound.”

“Ah, got it.”

“If you tie the knot too tight, it’ll cut off the blood flow and the flesh can die. Tie it just right. But if it’s not tight enough, it won’t close and heal.”

“Okay.”

Done. The wound was bigger than I thought, I had to put in six knots.

“Cover the wound with a band-aid or bandage, and if it’s a bandage, check it every day if possible.”

“Yes.”

Luckily, it’s nothing serious. I set the suturing tools down next to me, and stepped back over to Amy.

“I’ll give you two pills, take them now.”

“Okay. Just one day?”

It’s a preventative antibiotic, once is enough.

The prophylactic dose of amoxicillin before surgery is two grams. If the wound gets infected, then that’s a whole different story. In that case, you have to take antibiotics until the infection is gone.

Right, something else I need to check.

“Why did you get bitten? If the dog bit for no reason, it could be rabies.”

“It was a dog guarding someone else’s house. I don’t think it was a mad dog though.”

Thinking about it, one more thing I have to do for the patient came to mind. It’s a contaminated wound, so I should probably take preventative measures for tetanus.

Gotta administer tetanus antitoxin too.

Finally, I gave the patient one last injection. Then stepped away from the bedside.

“If you notice any change in your condition, tell me right away. Symptoms of rabies or tetanus can suddenly appear….”

“Ah, okay.”

Amanda nodded.

I agonized for a while.

It’s so frustrating when molecular testing isn’t an option at times like this. The odds of tetanus or rabies are low, but those two diseases are incredibly dangerous, and there’s no way to treat them after symptoms appear.

No, I can’t go because I’m worried. It’d be better to get all the rabies antibodies injected before leaving…