Chapter 31
Chapter 31
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Translator: penny
Chapter: 31
Chapter Title: Severe Trauma Patient (3)
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I almost forgot about one patient because of the splenectomy. He wasn't on the verge of death, nor was he urgently in need of attention.
"But, Professor... when you were removing the organ just now, did you stick your finger into it...?"
There was no choice.
Blood was still pouring from the ruptured spleen, and I had to remove it as quickly as possible. There wasn't time to extract it delicately.
Thank goodness this patient seemed fine.
Relatively speaking, that is. A torn Achilles tendon was still a serious issue. Less critical than a ruptured spleen, sure.
Above all, no surgery was needed.
"Hmm. This patient from a swordsmanship duel too?"
"Probably."
It's best not to make emotional judgments about a patient's situation. But what the hell?
"How intense are these swordsmanship duels? Turning two people into cripples in one day. Knights aren't exactly growing on trees."
"Well, there are quite a few."
"Really?"
"Even in prestigious families, only one son inherits the title. The competition to become a knight is fierce. There must be some reason for it."
Estina spoke softly, and I scratched my head. Could be...
If I hadn't been on duty today, or if my ward was full, these guys would've died or been crippled for life without question.
"Still, trying to kill each other in sparring is a bit much."
"A bit... Yeah, it's different from usual."
"Is there some tournament today?"
"Seems like it. Here's what happened—"
"Hey, the patient's waking up. Hurry over."
I stood up, and Estina followed. Must be a big event. No time to worry about someone else's program.
A pretty critical patient was right in front of me.
While we spent about three hours on the spleen patient, this one had only received emergency care and basic nursing.
From the patient's perspective, it'd be frustrating, but a torn ankle ligament wouldn't kill you. I felt a little sorry, but life-threatening conditions took priority.
Anyway, time to check him now.
"Looks like an ankle ligament tear from the injury. Given the popping sound, probably the Achilles tendon. Estina, what's the best treatment for an Achilles tendon rupture?"
Estina pondered for a moment.
"Achilles tendon. The one at the heel, right?"
"Yeah."
"Uh, are you going to do surgery?"
Since we'd operated on Benjamin Brisbane, surgery was within Estina's knowledge.
Surgery was worth considering, but for Achilles tendon ruptures, there's no significant difference in outcomes between surgery and conservative treatment.
The orthopedics professor had said so in class.
I wouldn't opt for surgery myself.
Every surgery carries infection risk.
If bacterial Achilles tendonitis develops post-op, even modern medicine struggles to treat it.
Antibiotics? Ligaments don't have blood vessels running through them for meaningful delivery. They won't make a real difference.
Obviously, no guarantees against infection in this makeshift OR.
Hard to quantify, but healing magic or superhuman recovery could shorten non-surgical healing time.
No real merit to surgery.
You might walk a few weeks sooner, but crucially, I had zero confidence in properly reattaching the ligament.
The spleen? Ripped the whole thing out. Arm bone? Nailed it back together.
Ligaments were a whole different beast.
Far more delicate than anything I'd done, and I didn't even know how to suture it.
Bottom line: No reason for surgery. Other methods would suffice.
"No surgery."
"Then what happens?"
"Achilles tendons heal on their own without surgery. We'll need a splint or plaster cast, though. It'll be like that for a few weeks."
"Is that the best option?"
"I wouldn't get surgery myself."
Estina nodded.
Treatment plan set, method decided. Time to start. I pulled back the bed curtain and met the patient's eyes.
"Patient, what's your name?"
"Uh, Aires."
Aires. He looked a bit older, but still a young man. Come to think of it, Academy student from the knight faculty—maybe that's why he seemed rough around the edges.
The spleen patient from earlier might've been from the same swordsmanship tournament, same knight faculty. Similar age too, probably.
Sorry for thinking you were some old guy.
"Does your leg hurt now?"
"It was excruciating with a pop at the time of injury. Not so much now."
Everyone here has iron willpower.
"I see."
"What's wrong with it?"
I chose my words carefully.
"Your ligament connecting the calf muscle to the heel has torn. It's called the Achilles tendon."
"What happens now?"
Walking will suck.
"Until it heals, you won't be able to plantarflex—stand on tiptoes. But with proper treatment, it'll return to normal."
"What does the treatment involve?"
"We'll splint it. No using that heel ligament for at least a month."
"A month? That's long."
"Better than never running again."
The patient fell silent at that.
Surprisingly, you can still walk with a torn Achilles. That's why some skip the hospital or delay treatment.
Good thing he came right away.
"No other options?"
"None."
The patient sighed.
"Ah, this isn't easy."
No other viable choices. The only treatment here: plaster cast for a few weeks.
"Alright, do it your way, Doctor."
"Patient, we need to confirm the diagnosis. Mind if we take a quick look at your leg?"
Aires nodded and sat up on the bed, extending both legs.
Estina and I leaned in to examine. Where's the injury?
How to confirm an Achilles tear? In a modern hospital, X-ray for sure.
No X-rays here.
So what then?
"Estina. We're assuming an Achilles tear here. How do we prove it?"
"Uh, press the wound... You shouldn't feel the torn part, right?"
The patient freaked out.
"H-Hey, don't poke the injured spot."
Fair enough—it'd hurt. The injured leg was already badly swollen.
"Hmm. Best way is comparison. Not just legs. See how one heel has posterior tension, but the other doesn't?"
"Ah!"
Asymmetry. Always check it.
"Excuse me. Need to run my finger along that Achilles to check if it's twisted and won't reattach properly."
Estina tilted her head.
"But how does a torn one reattach?"
"It's complicated. Muscles are wrapped in fascia. Even if torn, same fascial sheath means it can heal if positioned right."
Full functional recovery? Unrealistic. Oh, feel the gap. Align top and bottom—
"Point your toes down."
Toes down pulls the tendon up. Brings pieces closer, better healing odds. Let's see.
"Yes. We'll fix it in plaster like this."
Wonder if we have plaster casts.
"When can I go back?"
"Splint or plaster—needs thorough immobilization. Probably takes a few days."
The patient nodded slowly, as if understanding. Felt a bit sorry. No guarantees on full recovery.
"We'll make you crutches too."
Should be fine overall.
"Swelling's too bad now. Once it goes down, then plaster."
Anti-swelling meds? NSAIDs possible, but bad for ligament healing.
Better to let it be.
We stepped out of the ward for a bit.
With new patients, it'd be busy awhile. Rest when you can.
I only pieced together the full story after a few minutes of downtime.
Academy Knight Faculty Swordsmanship Tournament.
Every spring, knights and sword-wielders from across the nation gather to compete.
A few injuries every year.
Because I'd treated Benjamin Brisbane so well before, they brought all the tournament patients—mostly from great noble houses—to me.
"That's what happened."
"Ah. Should've said so earlier."
Estina hesitated.
"I was going to, but you were yelling and rushing off for a bucket of water. Missed the timing."
Did I? Sounds like me.
"Anyway, glad it worked out."
Kailas—the spleen patient. Aires—the recent one. Splinted until plaster's ready.
Plaster possible, but prep takes a day.
"Usually a few injuries yearly. But no problems this time? Everyone'll be thrilled."
I guess so.
I leaned against the wall, Estina slumped on the floor. Exhausted. Once these two are done, time to lie down.