A Little Oil for the Gears
What keeps a person alive? Money? Food? Honor? No. "What are you talking about? You have to breathe to live." You have to be breathing before you can even begin to discuss body temperature, infection, or nutrition, don't you?
A newborn is no different. For a 34-week-old infant born prematurely into the world, the most important thing is spontaneous respiration. A baby born too early may have underdeveloped lungs, which can lead to respiratory distress. That is why I came to the annex—to prepare for potential breathing difficulties in advance.
Well, at 34 weeks, the lungs might just barely be mature enough. Perhaps this preparation wouldn't even be necessary. If so, that would be the best-case scenario. Everyone would be happy if it just turned out to be me being overly anxious.
#. If you're going to live, you've got to grease the gears
I returned to the main building carrying a mountain of medicines and instruments that the baby might need. The first thing I did upon arrival was a hygiene inspection of the maids. Please, just be washing properly. There’s always one or two who slack off the moment you aren't looking. Honestly, it’s hard to blame the people of this world for their ignorance. In an era where the very concept of bacteria doesn't exist, how absurd must it sound to be told to wash your hands?
Moreover, the lime water is truly caustic. It’s no exaggeration to compare it to bleach. My own hands are a mess, so imagine how the midwives and maids feel. As women, they would be much more sensitive to their skin, so it’s understandable that resentment would build up when they are forced to endure that to wash. I understand. I genuinely understand.
Still, this isn't right. But a midwife who was just touching cow dung in the barn coming to deliver a baby without washing her hands? That’s too much. Even if they don't know about bacteria, isn't it common sense that you shouldn't touch a baby with poop-stained hands? The problem is that the midwives of this era don't see it as a problem. After experiencing several similar incidents, I decided not to discuss common sense in this world anymore.
So, if they didn't wash their hands because they were worried about their skin, I’ll have to turn their world upside down. I don't think the people of this era are uncivilized, but I have no intention of compromising. Respecting the era doesn't mean I can compromise the lives of the mother and child.
"I'm back. Everyone washed their hands, right?"
The method for checking if they washed their hands is easy. Lime water has a pungent smell. So, if they washed, the smell would be blatantly obvious on their hands. *Sniff, sniff.* Fortunately, none of the maids tried to pull a fast one. Even though I am an adopted son and not a biological one, I am still the young master, so they seemed to follow my orders thoroughly. This is why authority is the best.
"What about the towels?"
"As you ordered, we have prepared only those that have been boiled."
Everything had been replaced with towels and blankets that had been boiled until they were pristine. Good. They followed instructions well.
"Then, everyone except the butler and the head of the family, please leave."
"???"
At my order to clear the room, question marks appeared over the maids' heads. I spoke to them as if issuing a stern warning.
"Starting today, I will be taking care of the mother and the baby. Does anyone have any objections?"
"By you, young master?"
"I am a doctor, and the patient is my family, so naturally, I should be the one to see them. If not me, who else? Now, everyone out."
Immediately after a baby is born, it is better to have as few people entering and exiting as possible. In an era where disinfection and infection prevention are difficult, it would be much more helpful for survival rates if only the midwife and the mother remained in the room.
I chased out all the maids who kept trying to argue. The butler and my godfather were no exception. After stubbornly chasing everyone out, I called my godfather to a stop at the entrance. Then, I explained the prognosis for the mother and the baby.
"Godfather. You can rest easy now regarding the mother. She will recover her strength to some extent in two days."
When I examined her while handling the afterbirth, there were no signs of hemorrhage, and there was nothing noteworthy about the amniotic fluid. There were no events that would raise concerns about infection. Therefore, the mother would likely have no major problems. She would probably sleep all day for the next two days, but that wasn't an illness; childbirth is just that exhausting, so it couldn't be helped.
"The problem is our young master... Ah, have you decided on a name for the child?"
"... It is Freed."
"Is it a 'Fre-' alliteration with Freya?"
I cracked a joke, thinking of my godfather's only daughter. I didn't know they used alliterative names in the West, too. Well, that wasn't the important thing right now.
"Godfather. You may need to prepare yourself. Tonight will likely be the critical moment for our Freed."
"What? What are you talking about!?"
"Freed must have wanted to see his father quickly, as he came into the world too early. His lungs are too weak to breathe."
A common cause of death for premature infants is 'Neonatal Respiratory Distress Syndrome.' To explain it simply, it is a phenomenon where the baby cannot breathe because the lungs are immature due to being born early.
"Let me explain in more detail. Originally, a person's lungs are coated with a thin film of oil."
Thanks to this oil film, the small air sacs in the lungs do not stick to each other even when they repeatedly contract and expand. However, premature infants are born before that oil coating is complete. Air sacs without the oil coating can stick together like wet balloons and fail to open again. As time passes, more and more air sacs fail to open, and the child becomes unable to breathe.
"You understand up to this point, right?"
"... How do you know such things?"
"I've butchered at least a hundred pigs at the slaughterhouse in the red-light district. That's where I learned it."
Of course, it was knowledge from my past life that I had known even before I cut open a pig's belly, but since I did know the knowledge and I had indeed cut open pigs, I was telling the truth according to the syllogism.
"So, if by any chance Freed cannot breathe, I will put that oil in from the outside so he can breathe."
"Then what are you doing! Why didn't you put it in instead of explaining!"
"No, I was just informing you in advance that such measures might be necessary if he cannot breathe; it doesn't mean it's necessary right now. I am asking for your understanding in advance because the treatment process might look a bit rough."
"Julian, I trust you completely. So, you can do anything; just save Freed and Linier, just like you saved me."
My godfather clung to me desperately. No, looking at his reaction, it’s as if I saved him miraculously while breaking some taboo. I just saved him with a click of quinine. Regardless, I had received my godfather's permission. I approached the mother, who was holding the baby while drenched in sweat.
"I will stay by your side and watch over you for the next week, Mother."
The mother looked at me with somewhat suspicious eyes. Unlike my godfather, the mother didn't like me very much. I knew the reason. 'They say my mother was my godfather's former fiancée.' She was uncomfortable with the fact that I was the 'son of her husband's ex-girlfriend.' Perhaps because of that, she used her position as the lady of the house to create an atmosphere of subtly ostracizing me within the mansion.
But that had nothing to do with me. A protagonist should be able to embrace such petty grudges with a broad heart. And it would be ridiculous for someone who is going to be the greatest doctor in the empire to react narrow-mindedly to something like this.
"Mother. First, you should get some sleep."
The mother looked at me with hazy eyes, then eventually nodded reluctantly and closed her eyes.
Linier Nihilit, the Baroness of the Nihilit family, had one worry. It was her adopted son.
'What kind of child did that woman leave behind?'
Julian Schnabel. The child left behind by her husband's former fiancée and first love. Baroness Nihilit was uncomfortable with this child. It was because she felt she could see that woman's image in Julian. Of course, her husband always whispered that she was his final love and showed it through his actions, so that discomfort never turned into jealousy. However, she could not erase the anxiety in a corner of her heart. She began to worry that perhaps he might pass the family down to Julian, who was not his biological son.
Then one day, Linier heard something unexpected from Julian's tutor.
The moment she heard that, a sense of relief welled up in a corner of Linier's heart. His learning speed is slow. He cannot accept knowledge. That meant that while he might be fine as a scholar or a mage, it would be difficult for him to rise high in noble society. It also meant he wouldn't threaten the position of Freya and the children to be born in the future.
'... Thank goodness.'
The moment that thought crossed her mind, Linier felt infinitely despicable. Feeling relieved at the shortcomings of a mere ten-year-old child. And that child was the posthumous son of her husband's cherished dead friend. However, that guilt did not last long. Instead, she began to justify that relief.
'If he is a child who is slow to learn anyway... wouldn't it be for his own good to give up his greed?'
Perhaps that was why. She pushed the child out of the family little by little.
* A year passed. She was saved by that child.
'What have I done...'
Late at night. Feeling thirsty, she woke up from a dream that might have been a memory. When she turned her head to the side, she saw a boy reading a book. The boy, who had been engrossed in studying late into the night, looked up and made eye contact with her.
"Mother? Are you cold by any chance? Should I turn up the heating?"
"... I am thirsty."
"Ah, water. Here it is. Drink carefully so you don't choke."
While Julian was away at the annex, the head of the family told her about Julian's actions. That he was going to the red-light district to treat people. Just as Julian's parents had done. The moment she heard that, Linier felt infinitely small. Until yesterday, she had been badmouthing Julian to the maids, calling him a 'brazen brat who frequents the red-light district.'
'What have I done...'
Doesn't this child know that fact? No way. If he is this brilliant, he would have noticed it more than enough. Nevertheless, Julian was doing his best for her and the baby.
"... I am sorry for causing you trouble."
The guilt seemed to crush her heart. Whether he knew that fact or not, Julian smiled brightly and handed her the water glass.
"It is nothing compared to the love you have given me, Mother."
She wanted to answer that it wasn't true, but cowardly, her lips wouldn't move. Linier couldn't say anything and just quenched her thirst. That was when it happened.
"... Mother. Could you entrust Freed to me for a moment?"
Julian, suddenly looking at the baby with serious eyes.
"What is the matter?"
"There won't be any problems, so please entrust him to me."
It was not a voice that sounded like there were no problems at all. Suddenly, the conversation Julian and her husband had earlier that day came to mind. The explanation that Freed might not be able to breathe. As she recalled that explanation, anxiety washed over her.
"Don't tell me Freed is..."
"It is no longer a problem that I am sufficiently anticipating and preparing for, Mother. Trust me."
But Julian reassured her with a voice full of conviction. It was the voice of a mere 10-year-old child, so how could she feel so reassured? Linier handed the baby to Julian with trembling hands.
"Thank you for trusting me."
Julian received the baby with his small body and laid him on a warm sheet he had warmed up in advance. His gaze was fixed on the child's chest.
'A sunken chest is proof that the child cannot breathe.'
His skin was a bit blue, and faint groans could be heard. The neonatal respiratory distress syndrome she had feared had occurred. Julian quickly diagnosed the baby's condition and took out the medicine and tools he had prepared. A long, thin tube-like object appeared from his bag. It was an object with a blunt end, something Linier was seeing for the first time.
"Julian, what is that?"
"It is a tube made by processing a goose quill. I will use this to pour in the oil."
Julian inserted his little finger deep into the baby's throat without hesitation. Warm, moist mucous membranes wrapped around his finger. He brushed the baby's palate, passed the root of the tongue, and pushed his fingertip behind the uvula. One knuckle, two knuckles. There was no gagging. It was the opposite. The baby's reflex to swallow tightened around his finger. Ignoring that resistance, he inserted it deeper. It was a technique called digital palpation, finding the entrance to the airway with a finger.
'Found it.'
He felt the soft cartilage—the epiglottis—at his fingertip. He pushed the quill in beside his finger. As an aside, the 'goose' that owned that quill was slang for a slightly large avian-type magic beast. Julian had never seen that magic beast in person, but since the feathers floating around the market looked useful, he had processed them into tubes and was using them regularly.
The quill entered the child's airway. Next was the oil's turn. Oil obtained by squeezing the lungs of pigs and working alchemists to the bone. The correct name for this oil was surfactant. The oil flowed into the baby's lungs through the tube. Immediately after, the baby's chest heaved slightly.
Julian pulled the quill out of the throat. The mucus and oil on the end were mixed and glistening. Julian looked down at Freed quietly. One breath. Two breaths. Three breaths. He counted something in his heart and looked down at Freed quietly. A few minutes later, the chest that had been sunken began to swell little by little. The baby's skin noticeably regained its pink hue. When the whimpering stopped and only even breathing sounds remained, Linier let out a sigh of relief. Julian also let out a sigh and wiped the sweat from his forehead. He, too, had been nervous inside.
When everything was over, Julian caught his breath and joked.
"Whew. Because of my youngest brother, I couldn't even sleep all night... what kind of hardship is this?"
Linier was dumbfounded by that old-man-like remark. Was he really 11 years old? But at the same time, she was relieved. Because that cheeky joke implied that Freed was safe.
"Julian... thank you so much."
Tears welled up in Linier's eyes. They were tears that contained both guilt and gratitude. At that, Julian briefly showed a triumphant expression. But that was only for a moment. He hardened his face and bowed politely.
"Sometimes God is away from his seat. I was just struggling to fill that vacancy for a moment as a doctor."
Julian showing humility instead of being purely happy. It was as if he had a kind of sense of duty that he shouldn't be happy about something like this. At that sight, Linier's heart ached. How much. How much was this child sacrificing to live at this age? How much was he sacrificing that he couldn't even accept such a thank-you properly?
Linier barely held back the tears that were about to flow and held Julian's two hands tightly. 'At least.' She wanted to fill what this child was lacking. It was an adult's duty, and an atonement for her actions of mistreating the child until now.
* At that moment, Julian thought.
'Wow. He lived.'
He did not forget his identity. He is a trauma surgeon. Not a pediatrician or an obstetrician. And he never mistook his own station. 'Cases involving mothers and newborns are always nerve-wracking.' Therefore, at least in this area, he considered his skills to be on a level similar to a resident in that field. No, he thought he was actually a step lower than that.
In his view, all the treatments and procedures he had succeeded in since he started working in the red-light district were entirely thanks to luck, not skill. This time was the same.
'Even when I commit malpractice with blind technique, there's no accident. As expected, the misunderstanding trope is the best.'
At least, that was what he thought.