The Good Healer (5)
It had been delayed slightly due to an unexpected emergency patient, but Ayla’s field experience at the clinic had finally begun.
“Student Ayla. Today, I’m going to explain to you specifically what healers do.”
There was one thing to be careful about here: not to demand medical knowledge from her. Let’s think about it. Ayla was a high school student at the seminary who hadn’t even been awakened to holy power for two days yet. The time to study medical knowledge in earnest would come only after she entered the Department of Healing in the academic division. Right now, she had nothing but the religious knowledge she’d learned at the seminary. Would knowledge about blood vessels and nerves even stick in her head?
‘Not a chance.’
One only sees as much as one knows. Teaching her full-fledged medical theory now would be a waste of time. So, for the time being, I planned to teach her only the basics of the basics.
“This clinic also has apprentices from other healers. Some of them are already enrolled in the Department of Healing. They could be your seniors or peers, so it would be good to greet them if you run into them.”
“Yes, sir!”
On the way to another location with Ayla, I confirmed one fact.
“Now, I’ll begin the orientation in earnest, but do you happen to know how other treatment centers are operated, Student Ayla?”
“I know a little because I sometimes go to deliver lunchboxes to my mother’s treatment center.”
“I see.”
That would make the explanation much easier.
“Good. Then let’s start with the purpose of this clinic.”
I led her toward the entrance.
“There are various types of clinics in each sector. The work of each clinic isn’t vastly different, but each one still has its own specialization.”
In the past, this single clinic had to handle every kind of patient. From pregnant women to children, trauma, internal medicine, surgery, and so on. A small boarding house had to act as a general hospital. As a result, unavoidable inefficiencies occurred. That was why, when I was building clinics throughout the system, I put my heart and soul into the division of roles above all else.
“The D-1 clinic in D-Sector mainly handles emergencies, trauma, and high-difficulty patients.”
D-2 clinic specialized in obstetrics and pediatrics. D-3 clinic specialized in chronic diseases. D-4 clinic specialized in infectious diseases. I had taken care to ensure that at least one specialized clinic existed in every sector besides those.
“We’ll check them out one by one over the course of a year.”
I planned to visit all those clinics within the year anyway. I turned right at the entrance. A sign hung on the door leading to a small room: Emergency Room.
“Have you ever heard of a place called an emergency room, Student Ayla?”
“No. I’m not sure.”
“Good. Then I’ll explain what an emergency room is.”
In this era, there were no emergency rooms. It was a world where, if an emergency patient occurred, they were simply laid down next to an inpatient. Perhaps that was why. Whenever I introduced the emergency room for the first time, healers or aspirants always showed the same reaction. Just like Ayla was doing right now.
“This… is?”
Ayla tilted her head. When a patient arrived at a treatment center, the result they faced was one of two things: they were either cured, or it was an incurable disease. Because of the existence of holy magic, this was a world where one could often see emergency patients walking out on their own two feet in a matter of seconds. Naturally, the existence of an emergency room felt unfamiliar to them.
“Is this place different from the inpatient ward?”
“Yes. Some patients have less time than others. This place is where we triage such patients and perform initial treatment so they can be moved to other clinics.”
The emergency room, which occupied half of the first floor of the D-1 clinic, had a total of 10 beds. Each bed had a tray of instruments, and a chart recording the patient’s condition hung at the head of the bed. Three beds were currently occupied: a laborer with a broken arm, an elderly person brought in with abdominal pain, and the fall patient I had operated on earlier. The fall patient was now scheduled to be moved to the second-floor inpatient ward.
“Holy power is a limited resource. Someone might die if they don’t receive holy magic today, while someone else might have the luxury of waiting two days. Here, we are buying time for that person.”
The surgery I just performed was a prime example. If an emergency patient like the one I just had arrived at a typical treatment center, they would pour all their holy power into that patient. Setting aside whether that treatment was effective, the problem was what happened after the treatment ended. The healer would often have no holy power left to care for the next patient. In the end, they would have no choice but to suck their thumbs and watch the next patient die. This was the result of healers clinging to the miracle of holy magic and obsessing over a complete cure.
“If you use just enough holy power to keep the patient alive, you can save three more lives like that today.”
So, I changed the order. Instead of pouring 40 units of holy power into one person every day, I split 10 units of holy power among four people over four days. The former saves one person and forces you to abandon the three who come after. The latter saves all four over four days. I only changed the order, but the survival rate became four times higher with the same resources.
“It’s not such a big deal. It’s just a simple shift in perspective.”
Ayla looked at me with a face that looked like she’d been hit by a hammer. It was a familiar reaction. Healers who visited this place for the first time, their apprentices, and seminary students all reacted like this when they heard about the existence of an emergency room. I wondered if it was really worth reacting that much, but I still felt a sense of pride whenever I saw such a reaction.
“Let’s go to the operating room next.”
The operating room was connected not only to the entrance but also to the emergency room. As we entered the operating room, I saw a healer in the middle of a surgery.
“A fracture patient, I see.”
It was a patient who had come to the emergency room after their leg was crushed by a carriage. The healer was preparing the tools for the patient’s surgery one by one. I explained from a distance, being careful not to touch any of the surgical instruments.
“Every operating room and treatment room is equipped with holy water and symbols.”
It was a measure to save even a little bit of holy power. A pure white statue hung on the wall of the operating room. It was the statue of the Saint of Mercy that could be seen in the cathedral’s treatment room. Holy water flowing from the feet of the saint’s statue was running under the floor of the operating room. In that stark white room, two healers lifted the fracture patient onto the bed.
“Watch closely, Student Ayla.”
The condition of the patient’s leg lying on the bed was serious. The wound was contaminated with dirt, and the bone had pierced through the skin. It was an open fracture.
“What do you think is the necessary treatment for that patient, Student Ayla?”
“Since it’s a wound under the skin, I think a high-level Heal is necessary.”
“Well, shall we see?”
The healer anesthetized the patient’s wound. Then, they washed away the mud on the wound with a diluted holy water solution. The dark red blood and brown mud tangled between the torn flesh were washed away. Soon, the mangled muscle tissue appeared, hanging loosely.
“Ugh.”
Ayla flinched slightly. However, perhaps because she had already overcome the brain surgery, she quickly regained her composure. The healer proceeded to disinfect the patient’s wound. And instead of a brass cross, they reached for a scalpel.
“Student Ayla. Do you know what usually happens if you cast Heal on that state as it is?”
“I’m sorry. I don’t know.”
“If you regenerate a wound while contaminated or necrotic tissue is still present, those tissues hinder the regeneration of the wound.”
Of course, the miracle of holy magic could ignore such trivial problems and heal the wound. It just consumed more holy power.
“As I said in the case of the patient who had brain surgery today, holy magic is regeneration, not removal.”
That was why we scraped away rotten tissue, pus, and all kinds of contaminants before casting Heal. Debridement. It was a technique in modern medicine to prevent infection and promote wound regeneration. Performing this procedure once allowed us to save holy power.
“I had a hard time teaching the healers where to cut.”
Debridement wasn’t a surgery where you just cut away everything except the pretty-colored tissue. Will this tissue survive? Will this tissue die soon? You had to scrape it away carefully, considering the location of blood vessels, blood flow distribution, and even nerves. Removing the tiny bone fragments and bone marrow that weren’t even visible was the biggest task. Well, since this world could somehow manage with Heal even if you cut a bit too much, the difficulty was lower than in my previous life.
“If you cast holy magic after making the wound clean like that, it consumes less holy power and the required level of proficiency is lower.”
As I was explaining, I saw a slightly dangerous area.
“Healer. That’s not a tendon, it’s a nerve.”
“Ah! I’m sorry!”
“Wait a moment.”
I washed my hands and participated in the surgery for a moment. It looked a bit difficult, so it seemed they needed help.
“This person has a variation in their nerves and blood vessels. A nerve shouldn’t be passing through here. You should record this and write a paper for the academic community later.”
Scrape, scrape, scrape. I scraped away the rotten tissue with a curette.
“Let’s cut the raw flesh into the shape I marked, too. You need to cut it in this shape for the blood vessels to be well-distributed when you graft it.”
I performed additional resection, considering the graft. After finishing the debridement to some extent, I stepped back from the operating table and returned to Ayla.
“I’m sorry. I’ll finish the explanation.”
In the meantime, the healers had put down their scalpels. Next, they began nailing the bone. Clack! Clack! It was the stage of fixing the broken bone with a metal plate.
“They’re going to fix the bone temporarily like that. Since a low-level Heal can’t connect bone and nerve, they’re relying on natural healing.”
After fixing the bone like that, the healers put down the hammer and nails and picked up a brass cross. The two took turns casting low-level Heal. Then, the blood vessels and some tissues regenerated. As soon as they confirmed that the blood vessels had completely regenerated, they stopped the Heal.
“Like the previous surgery, they’re going to stop the surgery here. There are still patients who need holy power.”
They didn’t close the wound. If you try to force a large wound shut, it might tear instead. So, they planned to close it very slowly over several days. Pulling skin or muscle from other tissues, attaching it, regenerating it. If you repeat that, you can replace the miracle of high-level Heal with low-level Heal. Of course, I didn’t explain the specific details to Ayla. Graft surgery was still a high-difficulty area for her to understand.
Before long, the patient, whose open wound was filled with a sponge soaked in holy water, was moved out of the operating room. The priests who had finished casting Heal exchanged places with other priests and headed to the prayer room on the third floor. Unlike mana, holy power wasn’t a resource that recovered just by eating well and resting. Once depleted, it had to be replenished through prayer like that.
“Now then…”
Looking at the clock, it was already time for lunch. Before buying lunch for Ayla, I asked her a question.
“How was it, Student Ayla? What are your thoughts after seeing our clinic?”
“…”
Ayla remained speechless, completely dazed for a while.
From that day on, Ayla’s tour of the clinics continued for a while. She saw obstetrics and pediatric diseases at the D-2 clinic, and she watched how to treat infectious diseases at the D-4 clinic. During the tour, Ayla sometimes harbored a question.
“But all these treatments must be expensive. Is the merchant guild covering all the costs?”
“It’s similar, Student Ayla.”
Of course, we were receiving money. Healers didn’t come all the way down here to work for free, either. However, it wasn’t a level of cost that the poor could afford.
“We are receiving the minimum possible cost from the patients. The rest is a structure where the Merkur Merchant Guild compensates for it.”
“Then… is the clinic in the red?”
“Almost all of them are in the red.”
There were clinics that were in the black occasionally. But the deficits of the other clinics made that meaningless. The expenditures the merchant guild was enduring because of the clinics right now were by no means small.
“Then why do you keep operating them?”
A good question. In fact, this was a question that the executives of the Merkur Merchant Guild also threw out periodically. They say people are different when they enter the latrine and when they come out. Originally, the clinic support project was a project that started with the lesson of the accidental discovery of Viagra. It was to reduce clinical trial costs by conducting clinical trials on patients through the clinics. However, once they confirmed the deficits of the clinics, their thoughts often changed.
— “Director Shun. Do we really have to do this?”
Whenever such a question came up, there was a logic I used to persuade them.
“Student Ayla. Do you know what is needed to develop medicine?”
“Knowledge… isn’t it?”
“Yes. Knowledge is needed. But knowledge doesn’t appear out of thin air.”
Knowledge doesn’t come from digging the ground. It only appears when you have data. And the clinic support project occupied a very important position in terms of this data.
“The reason patients can see a doctor cheaply is that those people allow us to use their information however we want.”
The clinic doesn’t provide these treatments to patients for no reason. Their residence. Family relationships. What they eat, what kind of work they do, who they meet. What they did a few years ago, what they plan to do in a few days. They provide all that personal information, and they receive such treatment in exchange for us handling it however we want.
For reference, people who were reluctant to hand over their information to mages because of dark mages didn’t think it strange to tell priests everything from their trivial daily lives to their secrets. Perhaps it was because the concept of confession was rooted in daily life. They didn’t mind at all handing over personal information to clinics where healers resided. Well, since we would keep secrets just as well as confession, it might not be a misunderstanding at all.
“What? You replace the cost with something like that?”
However, Ayla tilted her head as if she couldn’t be convinced by this explanation alone. Perhaps it was because it was an era that didn’t know the importance of personal information. She didn’t seem to realize the value of this data. So, I told her the logic that the guild leader and other directors could decisively understand.
“Student Ayla. To make medicine, you have to know which patient has which symptoms, right?”
“Yes. That’s right.”
“But suppose most of those patients only visit our clinics. Then, do you think other merchant guilds could develop medicine?”
We had bought patient data at a cheap price. Of course, the data of each individual patient might not be very expensive. But what if that becomes dozens, hundreds, and most patients? Other merchant guilds couldn’t manufacture pharmaceuticals without the data our guild possessed. It wasn’t for nothing that pharmaceutical companies in the 21st century signed R&D cooperation contracts with large hospitals.
— “Research and development cannot be converted into simple numbers. But development often holds value beyond what is written in numbers. Do you still think this project is useless, Directors?”
When I persuaded them with this logic, the other directors and the guild leader were convinced at once. It was as if our company was grasping power that couldn’t be bought with money. Eventually, thanks to this support project, the guild and Director Shun were able to secure a kind image and profits at the same time.
‘I feel guilty because it feels like I abused the misunderstanding.’
I felt sorry for deceiving the patients a little, but I rationalized it by saying they were receiving appropriate, high-quality treatment at a cheap price.
“Do you understand now?”
“No… no matter how much I think about it, I don’t really know why this is a profit for Director Shun. It seems like you’re sacrificing too much…”
“It’s never a sacrifice. Rather, I am always in debt to the patients.”
It seemed Ayla was misunderstanding something firmly again, but since this wasn’t the first time for such a misunderstanding, I decided to leave it alone.
“Since the topic came up, I’ll show you a representative example.”
It was just when we were visiting a research-centered clinic. Since the topic of data had come up, it seemed like a good idea to explain it using that place as an example.
“Shall we go to the D-3 clinic today?”
*
The D-3 clinic was a clinic centered on chronic diseases. And when it came to chronic diseases, there were diseases that our company managed representatively. Gout. Diabetes. And erectile dysfunction. The D-3 clinic mainly cared for such patients and conducted research based on their data. Our merchant guild collected data from chronic disease clinics in each sector, including this one. And based on that data, we were continuously improving our drugs. As an aside, the data I was using for the black magic thesis I was writing as Julian was also being collected in this way.
“Let’s go in.”
The atmosphere of the D-3 clinic was different from the D-1. How should I put it? Instead of the unique tension of the emergency room, the cozy smell of daily life wafted through. In the waiting room, elderly people with blankets on their laps were sitting in a row. In one corner, a healer was lifting a patient’s foot to examine a wound.
“Oh, that beastman?”
“Ah, the one who guided Ayla? He’s a patient here, too.”
I saw Wangcho in the middle. He was being scolded severely by a gout specialist healer. I heard last time that he thought he could get medicine more easily if I wasn’t watching. No way. Instead, he was being handled by a healer with a rougher mouth than me.
— “Instead of being in pain like this every time, I think it would be a method to cut it once and regenerate it.”
— “Hiiik! I’m sorry! I’ll manage it well, so please, anything but that!”
It was a bit of a letdown that a back-alley giant who ruled D-Sector and E-Sector was acting like that, but I continued the conversation while passing the treatment room where Wangcho was being treated.
“Student Ayla, the patients here are not emergencies. They are people who will come here tomorrow, the day after tomorrow, and a month later.”
“Are the healers taking care of those people every time?”
“To be precise, they are managing them. What these people need is not a miracle once, but steady care.”
Diabetes or gout were diseases that couldn’t be helped even with Heal. So, they were being cared for steadily like this. And as they came steadily, the data was also collected steadily. Rare among the clinics, these were clinics that were in the black. Medicine was sold as medicine, and data was collected as data. Above all, Viagra was mainly sold here, too.
“Now, shall we look at diabetes patients today?”
I took Ayla and went inside the clinic.