Chapter 30
Chapter 30
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Translator: penny
Chapter: 30
Chapter Title: Severe Trauma Patient (2)
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The patient's suspected condition: ruptured spleen.
Internal bleeding from trauma usually stems from organ damage. Typically, the liver or spleen ruptures in such cases.
A liver rupture would require a hepatectomy, which is beyond my capabilities. Fortunately, judging by the location of the trauma, the damaged organ seems to be the spleen.
This one's much simpler. I just need to remove the entire spleen. You can live without it, after all.
The surgery I'm about to perform is a splenectomy.
It's not impossible, nor is it particularly delicate. But the risks are high—and if I leave things as they are, the patient will die.
No choice but to pick up the scalpel.
"Hippocrates' first principle, Estina. Do you know what it is?"
"Hippo... what? What's that?"
"First, do no harm."
"Ah. Yeah, that has to be the most important one. There's nothing worse than a patient getting hurt because of us."
Nothing else matters. It's something we absolutely need to keep in mind right now, as we prepare for surgery.
I can't confirm the diagnosis with the tools at hand. I can't guarantee the surgery's success, nor the outcome afterward. That's just the reality.
One thing is certain.
Despite all our efforts before surgery, the patient's blood pressure keeps dropping, and their consciousness is steadily declining.
Heart rate's up to around 120, respiratory rate at 30 breaths per minute. At this rate, hypovolemic shock will set in within hours.
I don't know if it's the meds, the healing magic, or something else that's kept them alive this long. But they're on the verge of death.
No choice but to operate.
Let's review what's needed for the surgery.
Disinfected mask—none available, so plague doctor mask. Covers the mouth and keeps hair from falling out. Disinfected gloves. Hands. Purification magic.
Caustic iron—probably still heating up.
Estina was standing by at my side.
Two ward nurses had been pulled in as well, having gone through the same disinfection process.
But this is just a crude imitation of a modern operating room. We can't even keep dust from flying around in here.
Anesthesia is the same as last time.
General anesthesia isn't about the drugs—it's the machines. Gaseous sedatives, an anesthesiologist, and for major surgeries, a ventilator. Nothing I can replicate.
Even if I could induce it, waking the patient might be impossible.
Sedative dose of propofol. Fentanyl patch for pain control. Lidocaine local anesthetic at the incision site. Anything more is unrealistic.
"Nurse, please drape them with a sheet or something to block the patient's view of the surgical site."
Anesthetics administered—three types, complete.
"Will this even work?"
"It'll work."
It will. Can I pull it off here?
That's a completely different question.
Ah, this is truly horrific.
Every step of the surgery is a problem. A splenectomy is usually diagnostic via laparoscopy.
"I-is it going well?"
"Try to stay as still as possible."
"Why are you holding down my limbs?"
Why? Because if you move while there's a knife inside you, who knows what could happen.
Special equipment, carbon dioxide insufflation into the abdomen, washing away fluid with saline while clearing the organs. That's the standard procedure.
......None of which I have.
One option.
Open them up and go in.
Skin incision. Subcutaneous fat incision. Muscle incision. Finally, the connective tissue inside the abdomen comes into view. No idea where the blood vessels are, so carefully incise the connective tissue.
The abdominal organs should be visible.
No, they're not.
Damn it.
I forgot about that. Something students and novice doctors (like me) easily overlook when examining patients: we're not dealing with a normal human body.
We're dealing with a diseased one.
In this case, the spleen has ruptured, leading to massive blood loss. Probably around a liter gone.
And where did it all go?
The patient's abdominal cavity looked like someone had slathered it with red paint.
Thin membranes called mesenteries line the abdomen, and they're all soaked in blood—nothing's visible. What now?
Should I just sew it up and call it quits?
Well...... if you don't have teeth, use your gums.
One way forward.
Reach in with my hand, feel around for the organs, and locate the spleen. Gently, so I don't damage any vessels or nerves along the way.
How difficult, complicated, and agonizing does this surgery have to be before death seems preferable? But if everything's normal by the end, does it matter?
"Hold them down a bit."
Let's recall organ positions. From a downward view: liver on the left. Stomach next. Spleen is up and to the right, toward the back.
Two major vessels to clamp: splenic artery and splenic vein. Can I even manage this?
"Hot cautery shears. Are the hot cautery shears ready?"
"Pardon? Hot cautery shears?"
"Ah, they're ready!"
"What the hell are hot cautery shears!?"
This guy—what, poison-proof? Three layers of meds, and he's still hearing me. Couldn't he have a constitution that sleeps deeply?
"Hold the patient down tight. This is going to hurt like hell, and if they move from the pain, they'll die."
"What!?"
A gruesome, squelching sound like plunging a hand into mud, and my fingers entered the abdomen. First, a large organ above—stomach. Vessels everywhere, mesentery tearing with every finger movement.
"Argh! Aaaargh!"
The scream I'd expected. Ugh.
At least no thrashing. Or maybe the propofol prevents that.
From the viewer's perspective, the spleen is at the upper right end. Need to cut it out...... but severing vessels blindly would cause gushing blood. Can't have that.
Need shears heated over fire.
At least the spleen is visible now—thank goodness. I cleared away as much blood-soaked mesentery as possible.
"Spread the incision as wide as you can. Bringing in the shears now."
"W-what even are these hot cautery shears!?"
What else? Shears heated in fire.
Luckily, pain from visceral organs isn't directly felt. The organs themselves don't hurt like that.
"Splenic artery. Vein. Needle."
Severed the splenic artery and vein with the shears. Stitched them just in case. What about the smaller vessels attached to the spleen?
I cut those too, then cauterized the stumps with the flat of the shears. That should achieve hemostasis by electrocautery, right?
Who knows.
Time to extract the spleen.
It was firm but leaking blood from spots like a bruised mung bean jelly. Might not come out easily.
Thrusting my hand in and rummaging could damage vessels or nerves, or the patient might thrash and hurt themselves more.
Hmm.
We're discarding the spleen anyway.
No need to take risks. I just jammed my fingers into the spleen and carefully pulled the whole thing out.
Let's see. Is the patient still alive?
"Estina. Check the pulse."
"Patient still has a pulse in the neck."
Alive.
"All done. Just need to close up now. Good job, patient."
Should check for residual bleeding, but no good way to do that. Just eyeball it...?
For now.
No bleeding from the vessels I cut. That should be fine. Capillaries have no special fix—they'll clot on their own, probably.
Time to close up.
I cut through multiple layers, but studies show separating and suturing layers doesn't improve outcomes.
Not that it's never necessary.
Suture, and surgery's over.
It took forever. Sweat pooled inside my mask, sloshing around, and my gloves were soaked—hands felt like they were on fire.
But the surgery ended.
Such a heavy bleeder normally needs a transfusion. But I don't know the patient's blood type, and drawing blood from someone else to transfuse... nah.
Assuming about a liter lost, they can survive without one. Hook up IV fluids, oral rehydration for now.
I shook the patient awake again.
"Can I sleep now?"
"Sleep and you'll die, I said."
"Ah, got it."
"Absolutely not until sunset."
This patient shouldn't be fine. Face is still pale, of course, but they've been speaking relatively normally for a while. Why?
Adrenaline?
Can't figure out why they're so composed.
Pre-surgery, they were borderline hypovolemic shock, consciousness fuzzy. Anesthesia effects shouldn't have worn off yet, but they're fine. Surgery doesn't magically create blood.
Can't explain that.
Some people have weird constitutions. Or blame the healing magic. If that's skewing things, nothing I can do.
They look okay now—relief. Probably just observe in the hospital for a week? Hard to say if it'll stay fine.
"Don't fall asleep, but rest deeply."
This patient—Kylas, was it? The patient sat blankly on the bed. A modern IV set dripped steadily beside them.
Feels like I forgot something?