Sometimes You Have to Grease the Wheels (1)

What do people live by? Money? Food? Honor? No. 'What else? You have to breathe to live.' You have to be breathing first before you can even begin to discuss body temperature, infection, or nutrition.

It was no different for newborns. For a premature baby born at thirty-four weeks, the absolute most critical thing was spontaneous respiration. A baby born too early has underdeveloped lungs, which can easily lead to respiratory distress. That was why I had come to the annex—to prepare for that very emergency.

'Well, thirty-four weeks is right on the borderline where the lungs might have just barely matured.' Perhaps these preparations would prove unnecessary. 'That would be the best-case scenario.' If this all turned out to be nothing but my own overreaction, everyone would be happy.

I returned to the main estate laden with medicine and instruments that the baby might need. The very first thing I did upon my return was inspect the maids' hygiene. 'Please tell me you washed up properly.' If you don't keep an eye on them, there's always one or two who try to cut corners.

Frankly, it was hard to blame the people of this world for their ignorance. In an era where the very concept of bacteria didn't exist, telling them ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠to wash their hands must have sounded utterly absurd. Besides, the chlorinated lime water was incredibly harsh. To exaggerate slightly, it was practically equivalent to bleach. My own hands were already a ruined, chapped mess, so I could only imagine how the midwives and maids felt. As women, they were likely far more sensitive about their skin, so forcing them to wash with such harsh chemicals was bound to breed resentment. I understood. I truly did.

'But still, there are limits.' A midwife coming straight from shoveling cow dung at the pasture to deliver a baby without washing her hands was just too much. Even if they didn't know about germs, wasn't it basic common sense not to touch a newborn with manure-stained hands? The problem was that the midwives of this era saw absolutely nothing wrong with it. After witnessing several similar incidents, I had resolved never to argue common sense in this world.

'So, if any of them skipped washing their hands just to save their skin, I'm going to flip the table.' I didn't think the people of this era were inherently savage, but I had no intention of compromising either. Respecting the historical period shouldn't mean compromising the lives of the mother and child.

"I'm back. Has everyone washed their hands?" Checking was simple. Chlorinated lime water had a pungent, unmistakable odor. If they had washed, their hands would reek of it. Sniff, sniff. Fortunately, none of the maids had tried to cheat. Though I was only a godson and not a biological son, I was still a young master of the ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠house, so they seemed to have followed my orders to the letter. This was why authority was the best.

"What about the towels?"

"We have prepared them exactly as you ordered, young master. Every single one has been boiled."

The towels and blankets had all been replaced with freshly boiled, pristine white ones. Good. They had followed instructions.

"Now, everyone except the head butler and the Lord Baron, please step outside."

"???"

Question marks practically materialized over the maids' heads at my sudden dismissal. I spoke to them in a stern, commanding tone to head off any arguments.

"Starting today, I will be personally caring for my godmother and the baby. Does anyone ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠have any objections?"

"You, young master?"

"I am a doctor, and the patients are my family. Of course I should be the one to look after them. If not me, then who? Now, please, everyone out."

Immediately after birth, the fewer people entering and leaving the room, the better. In an era where proper disinfection and infection prevention were nearly impossible, keeping only myself and the mother in the room—crude as it was—would drastically improve survival rates. I ushered out the maids, who kept trying to protest. The head butler and my godfather were no exception. After stubbornly clearing the room, I stopped my godfather at the doorway to explain the prognosis for my godmother and the baby.

"Father. You can put your mind at ease regarding Mother. She should recover a good portion of her strength in about two days."

When I had delivered the placenta and examined her, there were no signs of concerning hemorrhaging, nor was there anything unusual about the amniotic fluid. There were no events that raised concerns about infection either. Thus, the Baroness would likely be fine. She would probably do nothing but sleep for the next two days, but that wasn't an illness—childbirth was simply that exhausting.

"The issue is our young master... Ah, have you decided on a name for the baby?"

"...Freed."

"Ah, sharing the 'Fre' prefix with Freya?" I joked, thinking of my godfather's eldest daughter. I hadn't expected them to use matching naming conventions in a Western-style fantasy world. Well, that wasn't what was important right now.

"Father. You may need to prepare yourself. Tonight will likely be the critical juncture for Freed."

"What? What do you mean by that?!"

"It seems Freed was too eager to see his father and came into the world a bit too early. His lungs are too weak for him to breathe properly."

The most common cause of death in premature infants is Neonatal Respiratory Distress Syndrome. To put it simply, because the baby is born too early, their lungs are underdeveloped, leaving them unable to breathe.

"Let me explain in more detail. Normally, a human's lungs are coated with a thin, oily film."

Thanks to this surfactant, the tiny air sacs in the lungs don't stick together when they expand and contract. However, premature babies are born before this oily coating is fully developed. Without it, the air sacs stick together like wet balloons and fail to reinflate. As time passes, more and more air sacs collapse, and eventually, the baby suffocates.

"Do you understand so far?"

"...How do you know such things?"

"I must have slaughtered over a hundred pigs at the slaughterhouse in the Red-Light District. That is where I learned it."

Of course, it was actually knowledge from my past life that I possessed long before I ever slit a pig's belly, but since I had the knowledge and I had dissected pigs, by syllogism, I was technically telling the truth.

"So, if Freed struggles to breathe, I will administer that oil from the outside to help him."

"Then what are you waiting for?! Don't waste time explaining, administer it at once!"

"No, Father. I am merely warning you that this measure might become necessary if he stops breathing. It is not needed this very second. I am simply asking for your understanding in advance, as the procedure might look a bit rough."

"Julian, I trust you completely. Do whatever you must. Just save Freed and Linier, just as you saved me."

My godfather clung to me desperately. Honestly, from his reaction, one would think I had miraculously saved him by breaking some forbidden taboo. I had literally just given him a dose of quinine. Regardless, I had obtained his permission. I approached my godmother, who was cradling the baby, drenched in sweat.

"I will be staying by your side to watch over him for the next week, Mother."

My godmother looked at me with a somewhat complicated expression. Unlike my godfather, she didn't particularly like me. I knew the reason. 'My mother was my godfather's former fiancée.' The fact that I was 'her husband's ex-fiancée's son' made her uncomfortable. Perhaps because of that, she had used her position as the mistress of the house to subtly foster an atmosphere of ostracization against me within the estate. But none of that mattered to me. As a protagonist, one must possess the magnanimity to overlook such petty grievances. Besides, it would be ridiculous for someone destined to become the greatest doctor in the Empire to react so pettily to something like this.

"Mother. Please, close your eyes and get some rest first."

She stared at me with hazy, exhausted eyes before reluctantly nodding and drifting off to sleep.

Linier Nihilite, the Baroness of the Nihilite family, harbored a single, persistent worry. It was her godson. 'What kind of child did that woman leave behind?' Julian Schnabel. The child left behind by her husband's former fiancée and first love. The Baroness found the boy deeply unsettling. It was as if she could see traces of that woman in Julian. Of course, her husband constantly whispered that she was his final love and proved it through his actions, so her discomfort never festered into jealousy. Yet, she could not shake the anxiety in a corner of her heart. She had begun to worry that her husband might pass the family succession to Julian, who was not even his biological child.

Then, one day, Linier heard something unexpected from Julian's tutor.

The moment she heard those words, a sense of relief blossomed in a corner of Linier's heart. A slow learner. Someone who couldn't absorb knowledge. That meant that while he might become a scholar or a Mage, he would struggle to rise ‍‍‌‌⁠​​⁠‌​​‍​​‍​‌​⁠‍‌‍⁠⁠‌⁠‌‍‌‍‌‌‌‍⁠​‌​‌​‌‍‌‌‌⁠‍​​‌‍⁠‌‌⁠⁠high in noble society. It meant he would never pose a threat to the positions of Freya and the children she would bear in the future.

'Thank goodness...' The instant that thought crossed her mind, Linier felt utterly despicable. To feel relieved by the shortcomings of a mere ten-year-old child. And a posthumous child of her husband's dearest deceased friend, whom he cherished so deeply, at that. But the guilt did not last long. Instead, she began to justify her relief. 'If he is a slow learner anyway... wouldn't it be better for the boy to abandon any grand ambitions?' Perhaps that was why she had gradually, subtly pushed the child to the periphery of the family.

One year later, she was saved by that very child.

'What have I done...?' In the dead of night, she woke from a dream that felt like a memory, her throat parched. Turning her head, she saw a boy sitting beside her, reading a book. The boy, who had been engrossed in his studies late into the night, raised his head and met her eyes.

"Mother? Are you cold? Shall I stoke the fire?"

"...I am thirsty."

"Ah, water. Here you go. Drink slowly so you don't choke."

While Julian had been away at the annex, the Baron had told her of Julian's recent activities. He explained that Julian had been going to the Red-Light District to treat the sick, just as his parents once had. Hearing those words made Linier feel incredibly small. Only yesterday, she had been gossiping with the maids, disparaging Julian as an 'insolent degenerate who frequents the red-light district.'

'What have I done...?' Did the boy not know? There was no way. A child as brilliant as him would have easily noticed. Yet, Julian was doing his absolute best for her and her baby.

"...I am sorry to have caused you such trouble."

Guilt weighed heavily on her heart, crushing it. Unaware of her inner turmoil—or perhaps choosing to ignore it—Julian offered her a gentle smile as he handed her the glass of water.

"It is nothing compared to the love you have given me, Mother."

She wanted to deny it, but her lips refused to part, paralyzed by her own cowardice. Linier could say nothing; she merely wet her parched throat. It was then.

"...Mother. Would you hand Freed to me for a moment?"

Julian was suddenly staring at the baby with an incredibly grave expression.

"What is wrong?"

"There is nothing to worry about, so please hand him to me."

His voice did not sound reassuring at all. In that instant, the conversation Julian had shared with her husband earlier that day flashed through her mind. The explanation that Freed might struggle to breathe. Recalling that warning, a wave of dread washed over her.

"Could it be that Freed..."

"An anticipated and prepared-for scenario is no longer a problem, Mother. Trust me."

Yet, Julian reassured her with absolute confidence in his voice. How could the voice of a young boy barely over ten years old bring such profound comfort? With trembling hands, Linier handed the baby over to Julian.

"Thank you for trusting me."

Julian took the baby into his small arms and laid him down on a pre-warmed, cozy sheet. His gaze fixed on the infant's chest. 'Chest retractions. That's proof the baby isn't breathing properly.' The skin was slightly cyanotic, and a faint, weak grunting sound could be heard. The feared Neonatal Respiratory Distress Syndrome had manifested. Julian rapidly assessed the baby's condition and pulled out the medicine and tools he had prepared. From his bag, he produced a long, thin tube. It was a blunt-tipped instrument that Linier had never seen before.

"Julian, what is that?"

"It is a tube crafted from a goose quill. I will use this to instill the oil."

Without hesitation, Julian slid his pinky finger deep into the baby's throat. The warm, moist mucous membrane enveloped his finger. He slid his fingertip past the baby's palate, over the base of the tongue, and behind the uvula. One knuckle deep, then two. There was no gag reflex. In fact, it was the opposite. The baby's swallowing reflex tightened around his finger. Ignoring the resistance, he pushed deeper. It was a digital intubation technique—a method of locating the airway entrance using only a finger.

'Found it.' He felt the soft cartilage of the epiglottis at his fingertip. He slid the quill tube down alongside his finger. As a side note, the 'goose' that owned this quill was actually a slang term for a rather large, avian-type magic beast. Julian had never seen the beast itself, but the feathers circulating in the market looked highly practical, so he had processed them into tubes for his own use. The quill successfully entered the baby's trachea. Next was the oil. The oil obtained by squeezing pig lungs and working his alchemists to the bone. The precise scientific name for this oil was surfactant. The surfactant flowed through the tube and into the baby's lungs. Immediately after, the baby's chest rose slightly. Julian withdrew the quill from the throat. The tip glistened with a mixture of mucus and oil.

Julian quietly looked down at Freed. One breath. Two. Three. He silently watched Freed, counting the seconds in his head. A few minutes later, the retracted chest began to expand properly. The baby's skin visibly regained its healthy pink hue. As the whimpering ceased and was replaced by steady, even breathing, Linier let out a long sigh of relief. Julian also exhaled deeply and wiped the sweat from his brow. He, too, had been anxious.

Once everything was over, Julian caught his breath and grumbled playfully. "Whew. Losing a whole night's sleep over my baby brother... What an ordeal."

Linier was dumbfounded by his precocious, old-man-like complaint. Was this child truly only eleven years old? Yet, she felt relieved. His playful banter was proof that Freed was now out of danger.

"Julian... thank you so much."

Tears welled in Linier's eyes—tears born of both guilt and profound gratitude. At her words, Julian briefly wore a triumphant expression. But it was only momentary. His face grew serious, and he bowed politely.

"Sometimes, God steps away from His post. As a doctor, I merely struggled to temporarily fill the void He left behind."

Instead of rejoicing purely, Julian showed deep humility. It was as if he possessed a sense of duty that dictated he shouldn't celebrate such a basic task. Seeing this, Linier's heart ached. Just how much... how much had this child sacrificed at such a young age? What kind of life had he lived to be unable to simply accept a word of gratitude? Barely holding back her tears, Linier tightly grasped Julian's hands. 'At the very least...' She wanted to fill whatever void remained in this child's life. It was her duty as an adult, and her atonement for how coldly she had treated him until now.

Meanwhile, Julian was thinking: 'Wow. He actually survived.' He had not forgotten his true identity. He was a trauma surgeon, not a pediatrician or an obstetrician. And he never overestimated his own capabilities. 'Maternal and neonatal cases are always nerve-wracking.' Therefore, at least in this field, he considered his skills to be on par with a resident in those specialties—or perhaps even a step below. In his eyes, every successful treatment and procedure he had performed since working in the Red-Light District was due to sheer luck, not skill. This time was no different. 'To think I pulled off a blind intubation without a single hitch. Misunderstandings really are the best.' At least, that was what he believed.