Chapter 10
Chapter 10
-----------------------------------------------------------------
Translator: penny
Chapter: 10
Chapter Title: Graduate Student Estina
-----------------------------------------------------------------
The surgery had gone off without a hitch. Now that I'd examined the patient, it was time to document what treatments I'd performed.
In the homeless clinic from my previous life, where there was no computer system, medical records were kept like this. They'd make a brown envelope for each patient and stuff all the relevant paperwork inside.
Wouldn't a similar approach work here?
Estina tilted her head at me curiously.
"How do you handle patient records, Professor?"
"Well... Isn't there any other way? You prepare envelopes, write the date on them, and jot down everything that happened with the patient that day."
It would be a hassle, but that's how I planned to do it here too. I started on the medical record. First, I wrote the date at the top.
- Performed surgery to fix a titanium plate to the humerus. Surgery completed successfully.
- General anesthesia not possible, so administered sedatives, painkillers, and local anesthetics in combination. Need to monitor for liver and kidney toxicity, but expect no issues.
Truth be told, if problems arose in that area, I'd have no countermeasures. Not being able to run blood tests was a real issue. If I ended up treating kidney failure based solely on symptoms...
Terrifying.
- No allergic reactions or side effects observed from the anesthetics used: Propofol (IV), Fentanyl (patch), Lidocaine (subcutaneous injection).
- Patient's condition stable.
Did Estina have anything to add?
"How's the patient doing? Give me a status report."
"Understood."
The apprentice healer nodded.
"Uh, how should I report it?"
"Report in this order: patient's identity, reason for admission, treatments performed, current status. Then we discuss what needs to be done next and any concerns regarding patient management."
Estina nodded and pulled out her notebook.
I'd done patient handoffs in my previous life too, and the biggest issue with them was this.
If I didn't know the patient's status well, I couldn't report it to anyone else.
So you had to memorize all the details to report properly, but that was easier said than done. Mess it up even a little, and you'd get chewed out.
"Patient Benjamin. Identified as an Academy student, admitted after falling from a horse resulting in arm fracture and compartment syndrome. Fasciotomy and bone fixation performed; current status stable."
Spot on. I picked up my pen and continued jotting down notes in the medical record. Estina peered over my shoulder at it.
- Suspected compartment syndrome. Confirmed and resolved after fasciotomy; under observation.
- Suspected comminuted fracture. Confirmed via exploratory surgery, then fixed with titanium plate. All fingers now move normally.
"Good. What's next?"
"Discharge?"
If only patients could be discharged a day after surgery. Unfortunately, no.
"Too soon for discharge. Once the bone starts knitting, we'll need rehab therapy. There'll be damaged bone and tendons, so returning to full function will take time and effort."
This patient wasn't ready for discharge yet either.
We had to check if the surgical wounds healed properly, if the bone was setting, if he could move his arm.
A week at least?
Depending on how powerful healing magic was here. Wounds might close in a few days, but functional recovery? Hard to say.
"Let's plan for a week. It's our first patient, after all."
"Understood."
Estina nodded but didn't leave. She looked like she had more to say. She was fidgeting, clearly wanting to ask something else.
"If you have more questions, pull up a chair and fire away."
Estina sat right in front of my desk.
As if she'd been waiting for the invitation.
"Professor, I've been wondering about this too. Bones are hard like stones, right? So how do they grow and knit back together?"
"Trees have growth rings. It's similar."
"But bones don't have rings."
Wow... sharp kid.
The precise mechanism of bone growth and repair is this: Bones are mostly made of fibers produced by cells and calcium phosphate crystals.
Bones have various cell types. Osteoclasts break down bone, osteoblasts build it. The processes happen simultaneously, maintaining a dynamic equilibrium.
When bone cracks or shatters, osteoblasts work harder. If there's a protrusion, osteoclasts kick in.
As we age, osteoclasts dominate, leading to osteoporosis sometimes.
That's the gist. But how do I explain it?
I pondered word choice for a moment. What would make sense to Estina?
"Estina, how much do you know about the microscopic structure of human tissue? Ever heard the word 'cell'?"
"Not really."
Cell theory is common knowledge to modern people, but even in original history, before Hooke saw cells under a microscope, most folks didn't believe in it.
They thought tissues were continuous masses, not made of brick-like components. The latter's correct, though.
Skip the cell talk for now.
"Bones melt. The components dissolve the bone, then rebuild it in a constant cycle. That's how bones grow and heal."
"So that's why there are no growth rings."
I nodded. Bones dissolve and reform, so they had no rings like in trees. Except in kids, bone size doesn't change much anyway.
Estina jotted down my words in her notebook.
"So bones are living parts of the body? Not just some stone-like thing."
"Bones are alive. We just saw blood vessels running through it. Haven't you done dissections?"
Estina nodded.
"Not in undergrad. Grad students usually do, but as you know..."
She'd been kicked out of grad school.
Estina looked a bit downcast.
"Don't worry about it."
"About what?"
"Learn under me, do research with me, and we'll crush anyone judging us by those ridiculous standards—with real skill."
"Thank you."
That said, I'd look into dissection classes later. Having a doctor who hadn't properly dissected working under me? Unacceptable.
The research I thought needed priority was this: four papers from real-world history.
First.
Robert Hooke's Micrographia, the foundational text of microscopy. Side note: Hooke didn't discover bacteria because he didn't know how to stain them for viewing.
This would lay the groundwork for observing bacteria.
Of course, spotting bacteria with a basic optical microscope is tough. You need staining or colony formation.
Second.
Pasteur's report to the French Academy of Sciences: On Microorganisms Existing in the Air.
The famous swan-neck flask experiment, disproving spontaneous generation for decay and disease causes.
This proves bacteria cause decay and disease, and that heat kills them.
Third.
Hans Christian Gram's On the Differential Staining of Dried or Sectioned Fission Bacteria.
I don't remember the exact title of Gram's report, but that's where Gram staining began.
With Gram staining and a microscope, we can observe bacteria directly and classify by traits. Maybe even tailor antibiotics later.
Fourth.
Joseph Lister's On the Antiseptic Principle in the Practice of Surgery. Lister developed disinfection for wounds and operating rooms to prevent post-op infections.
Yes, the Listerine guy. This would teach hospitals how to prevent infections in practice.
That's the structure of my plan to convince academia. My current direction builds on that.
Replicate those four papers with experiments in this world and submit to academia.
This world would leap centuries ahead, recognizing bacteria and developing aseptic surgery. Seemed feasible.
If I wrote the papers properly, that is.
Estina, who'd been listening quietly, scratched her head after some thought.
"So we have to write four papers?"
"That's the plan."
"Isn't that overdoing it?"
"We're overdoing it together, Miss Yi. You and me—we're in this as a team, right?"
Don't try to weasel out. We suffer together.
It's like a puzzle.
Publish one study quickly, and treatments plus follow-up research get easier.
Let's grind for a few years, Estina.
We can change the history of imperial medicine.
Estina already looked exhausted at the thought.