The Good Healer (4)
I had just run into Ayla in the hallway a moment ago.
If I’d had my way, I would have given her a tour of the clinic since it was her first day. But the situation didn't allow for it.
“Report on the patient, please.”
“Male, 40s, fall at a construction site. Decreased level of consciousness, and the left pupil has started to dilate.”
The healer, who had spent the last few months training exclusively in stroke care at this clinic, gave the report. Of course, by 21st-century standards, it was still lacking, but for this era, it was a remarkably excellent briefing.
“What is the size of the dilation?”
“8mm.”
“Understood.”
I checked the patient’s head with my own eyes. The shaving and disinfection of the surgical site had already been completed. The assistant healers had taken care of it before I even arrived. We had been working together for months now; we were at the point where we could read each other’s minds.
“How many minutes since the cocaine application?”
“Five minutes have passed.”
“Then we will begin the Craniotomy.”
I picked up a scalpel from the instrument tray. It was my custom-made blade, created after countless modifications to a silver-crafted razor. I touched the tip of the scalpel to the small protrusion in front of the patient’s ear canal. Starting there, I drew a question-mark-shaped incision, sweeping wide around the ear and up to the crown of the head. The thin, thread-like red line of the incision began to thicken. I spoke immediately to the assistant healer.
“Refresh.”
“Refresh.”
The assistant healer repeated my order and applied holy magic to the incision line. Refresh was a spell even lower in rank than a basic heal. It was a level of magic that simply bathed the area in holy power without any catalysts, symbols, or complex incantations. As simple as it was, it only had the effect of capillary-level hemostasis and slight fatigue recovery. But to stop the bleeding along the incision line, it was more than enough.
“Forceps.”
“Forceps.”
I clamped down on the incision and peeled back the scalp. The white skull was revealed.
“Hammer and nail, please.”
“Yes, sir.”
I aimed the nail at the skull. In my original world, there was a dedicated tool called a ‘craniotome,’ a specialized drill for the head. I hadn't been able to make one in this world yet. So, I used a nail and hammer instead. Tap, tap! I made a groove in the skull, and then—
“Trephine.”
I drilled a hole with a tool that looked like a wine opener. One might worry, “What if you lose control of your strength and go too deep?” It was a question other healers asked often. My answer was always the same:
— “Then it’s just unfortunate.”
In the world I used to live in, this was how we opened up the top of the head. Surgical drills had a safety feature that stopped automatically upon touching the brain, but that was 21st-century technology. In the 20th century, where romance and grit still breathed, we performed brain surgery with nails, hammers, and wine openers. And if you made a mistake? You just had to consider it a contribution to the advancement of medicine.
Anyway. Five holes were completed along the edge of the skull.
“Gigli saw.”
I received the thin, tough wire saw. It was a staple of our fantasy world: an expensive wire saw plated with Mithril. I pushed the wire saw into the first hole and pulled it out through the second. I gripped it with both hands and sawed back and forth. Swoosh, swoosh. Repeating this several times created a solid line through the skull.
“Elevator.”
I inserted the elevator into the edge of the bone flap I had cut along the dotted line. I applied pressure using the principle of a lever—
Pop.
Lid removal successful.
“Please put the bone in saline.”
The removed lid was placed into a saline solution. Now, it was time to examine the brain.
“The hematoma is severe.”
A dark, reddish-black clot of blood had accumulated in the meninges, pressing down on the brain. As I was inspecting the hematoma, I felt a presence behind me. It was Ayla. She was standing with her back against the wall, staring blankly at the surgery from a distance. Her complexion looked pale. It was a common reaction for medical students witnessing their first surgery or anatomy lab.
“Student Ayla.”
Ayla flinched at my call.
“Other theology students usually faint at this point. You seem to be doing fine, Student Ayla.”
Sometimes, other healers would bring their acquaintances or children to the clinic. Most of them were theology students aspiring to become healers. Most of them would collapse on the spot when they saw scenes like this. But Ayla wasn't fainting.
“Do you think you can’t handle it at all?”
Ayla shook her head vigorously.
“That’s a good thing. Tell me if it gets too hard.”
I knew it was harsh for a child who had only just awakened her holy power. But it was a reality she would have to face eventually. Even if it weren't in my operating room, it was a rite of passage she would have had to endure regardless. According to what I’d heard from other healers, novice healers basically went through this rite of passage. They would show the new recruits the most gruesome pictures, traces, or actual scenes to help them steel their resolve. If they didn't mentally prepare themselves like this, they would crumble at the most critical moment.
“Since you’ve already sanitized your hands and come in, don’t touch anything, just stand there. You’ll be participating in the surgery in a little while.”
“Yes….”
I left Ayla, who answered weakly, and moved to the next step.
“Dural incision. Prepare for suction.”
“Suction prepared.”
I placed the scalpel against the dura mater and made a cross-shaped incision. Gurgle. The moment the membrane split, the trapped blood—the subdural hematoma—gushed out. The blood clot that had been pooling between the brain and the dura mater had burst forth all at once.
“Suction.”
“Suction.”
The assistant healer, repeating the command, brought the manual suction device to the blood pooling on the brain. With a hissing sound, it began to pump the blood out. During that time, I turned my head back to Ayla.
“Student Ayla.”
“Yes!”
“Do you happen to know why Heal cannot treat someone who has suffered a head injury?”
“I don’t know!”
Well, of course she wouldn’t. She was a seminary student before she was even a student of healing arts. To explain it to Ayla and to review it for the other healers in the operating room, I spoke in a loud, clear voice.
“Heal is a spell that mends wounds. It’s excellent for sticking torn blood vessels back together or connecting broken bones.”
While the assistant continued pumping, the extracted blood clots were being collected in a bucket.
“However, Heal cannot remove blood that has already pooled. It cannot draw out rotten toxins, either.”
Heal is regeneration. Not removal.
“The reason this patient lost consciousness is that the blood pooled in the head is pressing down on the brain. So, even if you regenerate the torn blood vessels with Heal, the blood that has already escaped will still be pressing on the brain.”
I pointed to the hematoma that had been sucked out.
“That is why we open it up directly like this to remove the blood.”
“Ah….”
“Before I explained this surgical method, it was misunderstood as black magic. Isn’t that right, Assistant?”
“Haha….”
The assistant healer let out a dry laugh. When he first heard that I was going to ‘take the lid off a head,’ he had argued with me, asking if I intended to use black magic. Once I explained the principles, he was able to clear up the misunderstanding quickly.
“At the time, the Director just suddenly said we had to open the head of someone who had collapsed and touch their brain without even explaining the principle….”
“Did I use that kind of phrasing?”
I don’t really remember. Anyway.
“You’re feeling a bit better now, right?”
I asked, checking Ayla’s complexion. Ayla nodded. Her complexion was much better than before.
“It’s only for a moment that it’s difficult when you first enter an operating room.”
I continued speaking while examining the surface of the brain to find the source of the bleeding.
“The reason people can’t bear to look at cruel things is that what lies at the bottom of those acts is malice. But even if it’s the same scene, once you know that it is an act to save a person, it begins to feel different.”
I glanced at Ayla and said,
“How about it? Now that you know why we open the head? Does this surgery still feel as scary as it did at first?”
Ayla shook her head.
“No…. I think I feel much better than before.”
“Isn’t it fascinating? That is how nobility makes humans strong. Just by harboring goodwill and faith, we can gain this kind of courage.”
Ayla nodded. As if agreeing with my words, the assistant healers nodded silently as well. Usually, a doctor’s stomach for gore is proportional to their knowledge. Why this surgery is necessary. Why this person is dying. What I can do for them. The better one understands these things, the stronger their stomach becomes. Of course, there are some peers who can’t enter the operating room until the very end even if they know all that, but that’s just their nature, so it can’t be helped.
“Good. Then, Student, come closer.”
While we were chatting, the pumping had finished. I had also confirmed the blood vessel where the bleeding had occurred. The upper left parietal lobe. A Bridging vein had been severed. I immediately ligated the vein in several places with thread and called Ayla closer.
“Student Ayla. You said you knew how to use Refresh, right?”
“Yes? Yes….”
“Now, were you taught that Refresh could stop bleeding?”
Ayla shook her head.
“I heard that at least a basic Heal is needed for hemostasis. I was told Refresh should only be used for fatigue and stamina recovery.”
“Correct. You studied well. Textbook-wise, that is the right answer.”
I pointed to the bridging vein I had finished ligating. The bleeding had stopped because I had tied it off with thread. However, the blood vessel itself hadn't regenerated. It was in a state where it would bleed again if the thread came loose.
“Now, try casting Refresh here.”
I pointed to the torn vessel next to the severed one. “… Here?”
“Yes. Shall we try casting Refresh on this part where I’ve tied it off with thread?”
Ayla reached out cautiously. A faint light bloomed from her trembling fingertips. And the moment Ayla’s holy power touched the ligation site, the torn vein twitched. Soon, the hole in the vessel was sealed. Ayla didn't seem to have noticed this change yet. So, I untied the thread to show her.
“There. The bleeding stopped with Refresh, didn’t it?”
“Oh? Oh… how?”
“Because the sufficient conditions have been met.”
Holy magic is, after all, a branch of magic. The resource is holy power, but the principles—from catalysts to symbolism and conditions—are exactly the same as magic.
“Now, Student Ayla. If you were to light a fire on wet wood and dry wood with magic, which one would be easier to ignite?”
“Dry wood, right?”
“Exactly. Dry wood can be ignited even with basic fire magic, but wet wood requires more magical power and more complex incantations.”
A representative example is the curses of the plague, which are now becoming extinct. Because of the immunity formed by vaccinations, the amount of magical power required to cast the curse has increased geometrically. That’s why the plague sorcerers are so desperate to kill me. This surgery is an extension of that principle.
“Holy magic is the same. If you meet the proper conditions, you can perform the same miracles with less holy power and lower-level holy magic.”
If you have a barrel of oil, you can produce the firepower of intermediate fire magic with basic fire magic. In the cold North, you can use more powerful ice magic with less magical power. And a patient who has received proper first aid can perform miracles with less holy power. In some cases, you can save a cerebral hemorrhage patient with just a basic Heal.
“Healing magic has been developing in that direction until now. This venous ligation is the same technique.”
A blood vessel gushing with blood can only barely be stopped with high-level Heal. But a blood vessel where the torn area has been sutured with thread can be closed even with Refresh. Of course, it was only possible because it was torn, not completely severed.
“Now, shall we finish up?”
After that, I regenerated the severed blood vessels with basic Heal. The rest were blood vessels that Ayla couldn't handle yet. Refresh could only regenerate slightly torn vessels; the rest required basic Heal. After regenerating the blood vessels and stopping the bleeding,
“Once the swelling in the brain goes down, we’ll cover the bone in a few days.”
Since the brain was swollen tight, I decided not to cover it with the skull, but only with skin. Of course, I could cast Heal to reduce the swelling. But if I did that, this priest wouldn't have any holy power left to use on the next patients. Selection and concentration. In a world with limited resources, it was an unavoidable choice.
“Pupils have returned to 4mm.”
The decompression was successful.
“Shall we cover the scalp now?”
I covered the peeled-back scalp back into its original place and it was time to suture.
“Student Ayla, are you good at sewing?”
“I occasionally help my mother mend her priest’s robes.”
“Good. It’s good for a healer to be good with thread. Watch closely how I do it.”
I handed the suture and needle to the assistant healer and said,
“Assistant, please suture from the left side. I’ll take the right.”
“Yes, Director.”
The assistant healer picked up the needle and began to stitch the head, one stitch at a time. Meanwhile, I sutured the wounds on the right side as I usually did, swish, swish. While the assistant healer was barely finishing one incision, I had already sutured all the remaining ones. After checking the tension of the thread one last time,
“We’re finished. Let’s check the surgical instruments.”
While the other healers checked the gauze and tools used, I covered the sutured scalp with disinfectant gauze. That was when Ayla asked cautiously,
“Director… I think this will leave a lot of scars later… can’t we finish it cleanly with Heal?”
“That’s a good question, Ayla.”
Aesthetic aspects are also something a surgeon must consider. Especially with head surgeries, there are even separate studies on surgical methods that leave fewer scars. Treatment isn't just about removing the disease; it’s a process of helping the patient return to their daily life. Therefore, aesthetics can never be ignored.
“Aesthetics are important. But we won’t do it now.”
“Why?”
“Because we have to open it again in a month to cover the skull.”
I pointed to the skull soaking in the saline solution.
“And if the scar remains, it helps us not get confused when we put the skull back in later. We’ll heal everything then.”
Ayla made an ‘ah’ expression.
“I didn’t know that.”
“It was a good question, Student Ayla. It would be good if you continue to think about the patient’s perspective first like that in the future.”
I took off my gloves and left the operating room.
“Now, it’s a bit late, but I’ll show you around the clinic.”