I Became a Plague Doctor in a Romance Fantasy

31. Critical Trauma Patient (3)

****

I almost forgot about one patient because of the spleen removal surgery. The patient wasn’t near death, nor did they require immediate attention, but still…

“Uh, Professor… When you pulled out the organ just now, did you stick your finger into it…?”

There was no helping it.

The broken spleen kept bleeding, and we had to remove it as fast as possible. There wasn’t enough time to delicately handle it.

Fortunately, this patient seems fine overall.

Relatively speaking, that is. A torn Achilles tendon is still a serious issue. Though less critical compared to a ruptured spleen.

Most importantly, no surgery is needed here.

“Hmm… Another case from sword dueling?”

“Probably.”

While we shouldn’t emotionally judge a patient’s situation, seriously… what is going on?

“How intense are these sword duels? Turning two people into cripples in a day? We’ll run out of knights at this rate.”

“Oh, there are still some left.”

“Are there?”

“One noble family usually only lets one child become an aristocrat. Competition to become a knight is fierce. There must be reasons behind it.”

Istina said this quietly, and I scratched my head. Maybe that makes sense…?

If someone else were guarding the ward today or if my section wasn’t full, these guys would’ve either died or become disabled for sure.

“It’s not right to kill each other during training.”

“A bit… different from usual, though.”

“Is there some kind of tournament today?”

“It seems so. Let me explain—”

“Hey, the patient woke up! Quick, come over!”

I stood up, and Istina followed. Looks like the event is big. But worrying about someone else’s event isn’t the priority right now.

We have a critical patient in front of us.

While we were dealing with the spleen patient for three hours, this one only received emergency care and nursing.

From the patient’s perspective, they might feel neglected, but tearing an ankle ligament won’t kill them. Still, I do feel sorry. Fact is, life-threatening conditions take precedence.

Anyway, let’s check this one quickly.

“The injury appears to be a torn ankle ligament. Considering the loud ‘bang’ sound, it’s likely the Achilles tendon. Istina, what’s the best treatment for an Achilles tendon rupture?”

Istina thought for a moment.

“Achilles tendon… the heel cord, right?”

“Yeah.”

“Wait… Are you planning surgery?”

Since Benjamin also underwent surgery, within Istina’s knowledge, surgery would be appropriate.

Surgery is indeed something to consider, but for patients with Achilles tendon ruptures, there’s no significant difference in prognosis between surgical and non-surgical treatments.

Our orthopedics professor mentioned this in class.

If I were in this situation, I wouldn’t opt for surgery.

Every surgery carries the risk of infection.

If bacterial Achilles tendonitis occurs post-surgery, even modern medicine struggles to treat it effectively.

Even with antibiotics… blood doesn’t flow through tendons, so antibiotics can’t make a meaningful difference in prognosis.

Of course, there’s no guarantee of zero infection in this makeshift operating room.

Non-surgical recovery periods could potentially shorten due to healing magic or superhuman recovery abilities.

In conclusion, there’s no real merit to surgery.

Though surgery allows quicker foot usage by weeks, crucially, I have no confidence in repairing the tendon properly.

With the spleen, I just removed it entirely, and for the fractured arm, I nailed it together, but…

Tendons are a completely different matter.

It’s much more intricate than anything I’ve done before, and I don’t know how to reattach it.

In short, there’s no reason to perform surgery. Other methods can sufficiently treat the condition.

“No surgery.”

“What will happen then?”

“The Achilles tendon will heal on its own without surgery. However, we need to apply a splint or cast. It’ll stay like that for several weeks.”

“Is that the best option?”

“If I were you, I wouldn’t choose surgery.”

Istina nodded.

Plan decided, method chosen. Now let’s start treatment. I pulled back the curtain beside the bed and made eye contact with the patient.

“May I ask your name, sir?”

“Oh, Iraes.”

Iraes. He looked a bit older, but he’s still a young man. Thinking about it, he’s an Academy student from the Knight Division, which explains his rough appearance.

Thinking further, the earlier patient with the ruptured spleen might also be from the same swordsmanship competition and division. They’re probably around the same age.

Sorry, I assumed you were an uncle-type person.

“Does your leg hurt now?”

“It was extremely painful when it happened, with a loud bang. But it doesn’t hurt much now.”

Everyone here has strong mental fortitude.

“I see.”

“What kind of disease is this?”

“You’ve torn the tendon connecting your heel to your calf muscle, known as the Achilles tendon.”

“So what happens next?”

Walking becomes a bit inconvenient.

“Until you recover, you won’t be able to rise onto your toes. However, with proper treatment, you should return to normal.”

“What kind of treatment?”

“We’ll apply a splint. You must avoid using your heel tendon for at least a month.”

“A month? That’s quite long.”

“Better than never being able to walk again.”

The patient fell silent after hearing this.

Surprisingly, even with a torn Achilles tendon, walking is still possible. Many people miss their chance for treatment because of this.

Luckily, this patient came to the hospital immediately.

“Are there any other options?”

“No.”

The patient sighed.

“This is tough…”

I don’t see any other choices. In this situation, the only viable treatment is wearing a cast for several weeks.

“Well, let’s go with the doctor’s recommendation.”

“To confirm the diagnosis, may we examine your leg briefly?”

Iraes nodded, sat on the edge of the bed, and extended both legs.

Istina and I bent down in front of him to inspect his leg. Where’s the damage?

****

How do we confirm the Achilles tendon is torn? If this were a modern hospital, we’d naturally take an X-ray.

But there’s no X-ray here.

So what do we use instead?

“Istina. Assuming the patient’s Achilles tendon is torn, how do we prove it?”

“Well, pressing on the injured area… Can’t we feel where it’s torn?”

The patient panicked.

“Eh, please don’t touch the injured spot.”

True, touching it would hurt. Already, the injured leg looks significantly swollen.

“Hmm. The best method is comparison. Not limited to legs. Looking at this patient, one leg maintains tension in the heel while the other doesn’t?”

“Aha!”

Asymmetry. Always something to look out for.

“Excuse me, but I need to trace along the Achilles tendon with my fingers to check if there’s any misalignment preventing reattachment.”

Istina tilted her head.

“But how does a torn tendon reconnect?”

“Well, it’s complicated. Muscles are wrapped in something called fascia. Even if the Achilles tendon tears, it remains within the fascia. If maintained well, it might reconnect.”

Honestly, expecting full functional recovery is unrealistic. Ah, I can feel where the tendon tore. Aligning the ends—

“Please point your toes downward.”

Pointing the toes tightens the Achilles tendon. Bringing the two pieces closer increases the chances of successful reattachment. Let’s see.

“Yes. We’ll secure it with bandages like this.”

Not sure if we have plaster casts available.

“When can I go home?”

“Hmm, we need to thoroughly immobilize the leg with either a splint or plaster cast. It’ll take a few days, probably.”

The patient slowly nodded, understanding. I felt a bit sorry since there’s no guarantee of full recovery.

“We’ll also provide crutches.”

“But the swelling is too severe now. After it subsides, we’ll apply the plaster cast.”

What anti-swelling medication is available? Non-steroidal anti-inflammatory painkillers could work, but they might hinder tendon recovery.

Best to leave it alone.

****

We stepped out of the ward for a moment.

With new patients coming in, we’ll be busy for a while. Best to rest while we can.

Only after a few minutes of downtime did I fully understand the situation.

The Academy’s Knight Division Swordsmanship Tournament.

Every spring, swordsmen and knights from all over the country gather to compete in swordsmanship. Today is the event.

Every year, a few people get injured.

Apparently, because I successfully treated Benjamin last time, most of the tournament’s high-ranking knights brought their injured here.

“That’s the story.”

“Ah. You should’ve said that earlier.”

Istina hesitated a bit.

“I was trying to say it, but then the professor started shouting and ran off, telling someone to bring water. I missed my chance.”

Did I do that?

Seems like I did.

“Anyway, it’s good everything worked out.”

Kylas. This was the patient with the ruptured spleen. And Iraes, the recent patient. I attached a splint until the plaster cast is ready.

Plaster casts aren’t impossible, but preparing materials takes about a day.

“Normally, a few people get injured every year, but it seems no one had major issues this time. Everyone will be happy.”

Indeed.

I leaned against the wall, and Istina sat on the floor. Tired. Once we finish handling these two current patients, I need to rest.

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