WeTried Translations
Translator/Editor: Haruto
Discord: https://dsc.gg/wetried
◈ The Dark Fantasy Doctor Was Mistaken for a Saint ◈
Chapter 92: The Intent Was Good (3)
──────
* * *
Immediately after we pulled the patient free from beneath the rebar,
I examined the thigh that had been trapped under it.
It was severely swollen and glossy.
The moment I saw it, I began preparing for surgery.
The patient could not afford to wait for a healer capable of using detoxification magic.
But Gregor’s lieutenant, who did not understand the situation, cried out in shock.
“Saint!? Didn’t you say you wouldn’t cut it off?”
“I’m not going to cut it off. I’m only going to open it.”
“May I ask why?”
“They have compartment syndrome.”
Compartment syndrome.
It was a condition in which muscles swelled severely within the fascia after a fracture, bruise, or similar injury, compressing the blood vessels and nerves.
If it continued for too long, the patient’s leg could become necrotic.
There was only one way to prevent that.
Open the leg to lower the pressure.
It worked on the same principle as a craniotomy.
Open it and relieve the pressure.
“Could you lend me a hand?”
“I don’t know how to perform surgery!”
“That’s fine. You only need to hold things.”
With Gregor’s lieutenant acting as my assistant, I began the operation inside the car, which served as a temporary operating room.
I roughly disinfected the surgical instruments and the affected area.
Then I held out my hand toward the lieutenant.
“No. 10 blade.”
“What?!”
“Ah, never mind.”
Out of habit, I had treated the lieutenant like one of the healers from the Merkuer clinics.
Of course, there was no way the lieutenant would understand that.
‘It’s been a while since I had to do everything myself.’
I had forgotten the feeling.
Surgery had become much easier after I trained the clinic healers to assist nearly as well as twenty-first-century surgical assistants.
This was my first time operating alone in a while.
“Can you use Refresh?”
“Yes. Even holy knights can use that much.”
“Then cast it every time I say Refresh.”
Tap, tap, tap.
As I spoke, I palpated downward from the patient’s side.
First, I marked the hard bone at the side of the hip, the greater trochanter.
Then I marked the lateral femoral epicondyle, the outer edge of the knee.
Connecting the two points in a straight line, I drew the dwarf-made modified No. 10 blade down in one long stroke.
Blood beaded up.
“Refresh.”
“Yes.”
The lieutenant used Refresh to stop the bleeding.
Once the blood stopped, the opened side of the thigh came into view.
“Metzenbaum... no, the scissors, please.”
“Yes, yes.”
The lieutenant handed me the scissors with the blades pointed toward me.
It was a mistake that would have earned a proper healer a severe scolding.
I took the scissors and brought them to the long white band over the muscle.
I cut the iliotibial band of the fascia lata along the grain of the fascia.
The muscle beneath it was released and bulged outward.
“Something like a hook, please. No, that’s a curette. Yes, the large hook.”
The lieutenant handed me a retractor, which I inserted between the muscles.
“Pull steadily in this direction.”
I had the lieutenant lift the vastus lateralis, then cut the lateral intermuscular septum with the scissors, just as before.
Once again, the muscles trapped beneath the fascia bulged out.
That released the muscles at the outer and front portions of the thigh.
The remaining process was simply a repetition of the same action.
The lieutenant pulled the vastus lateralis while I cut the fascia at the back and released it.
Just as I had released the thigh muscles in three directions,
“We’re here, Saint!”
Gregor arrived with a healer slung over one shoulder.
“I’m here, Director Schun... Ugh...”
The healer approached the patient while barely enduring his motion sickness.
After examining the thigh, he spoke.
“You completed the fasciotomy in that short time?”
“It had to be done before you used detoxification magic.”
Detoxification magic was meant to deal with the toxins that had pooled in the leg.
But if it were used without resolving the compartment syndrome, the trapped muscles could produce toxins again.
That would be no different from pouring water into a bottomless bucket.
That was why I had dealt with the compartment syndrome before the healer arrived.
“Every time I watch your surgeries, Director, I’m astonished.”
The healer muttered this while casting detoxification magic on the patient’s leg.
The moment I confirmed that the magic had worked properly, I removed the tourniquet.
“We’ll dilute the remaining toxins with IV fluids.”
Detoxification magic was not perfect.
It could only neutralize enough of the toxins trapped in the leg to keep them from stopping the patient’s heart.
That was why I had tied the tourniquet, unlike in my previous life.
First, we weakened the toxins as much as possible. Then we released the tourniquet and diluted what remained with IV fluids.
In a sense, it was emergency dialysis from another world.
“Then, Director, since I still have divine power remaining, I’ll immediately use Heal on this patient...”
“No. Don’t.”
I stopped the healer.
“I checked while performing the fasciotomy. Internal fractures and vascular injuries are suspected.”
When I opened the back of the thigh, I had caught a slight glimpse behind the knee.
Blood had been surging up from there like mad.
The external wound did not look severe, but it meant everything below the knee was ruined inside.
‘Of course a crush syndrome patient wouldn’t be simple.’
That was the biggest problem with crush syndrome patients.
Right after rescue, there was no obvious external trauma.
But once you opened them up, the inside could be a complete disaster.
Compartment syndrome, complex fractures, severed blood vessels...
A complete disaster package.
‘I wish I could have gotten away with just IV fluids...’
Unfortunately, trauma patients never took the easy route.
The moment I confirmed that, I had no choice but to plan the next operation.
“Multiple fractures are also suspected. If we use Heal now, heterotopic ossification could occur.”
Heterotopic ossification.
A condition where broken bone fragments grow inside the muscle and tear through surrounding tissues.
It troubled trauma patients even in a world without divine power.
But its reputation in this world was incomparably worse than it had been in my previous life.
‘Anyone would be horrified if they cast divine magic and bones tore through the flesh from inside.’
There was a reason treatment in this world had developed toward amputation.
Cast Heal, leave bacteria behind, and the patient dies of sepsis.
Cast Heal, leave blood pooled inside, and the patient dies.
Cast Heal, have bones burst through flesh from inside, and the patient dies.
After seeing that enough times, people had no choice but to cut cleanly and use high-grade divine magic.
In any case.
“We’ve dealt with the urgent issue. We’ll perform debridement at the clinic.”
“Understood.”
The healer seemed to understand what I meant.
“Which sector is your clinic in?”
“The Civitas Sector 3 Clinic.”
“Can that clinic perform surgery?”
“It lacks some facilities for trauma patients, so... it would be difficult.”
“Understood. We’ll move the patient to the D-1 Clinic.”
We immediately loaded the patient into the car and headed for the D-1 Clinic.
‘Ugh. Cold.’
A cold wind came through the door Gregor had torn off.
* * *
The moment we arrived at the clinic, I summoned the trauma specialist healers.
“Male patient in his thirties. His right thigh was trapped in an overpass collapse three hours ago before rescue. We administered a full load of 0.9% saline and emergency detoxification magic for crush syndrome. Suspecting crush syndrome with compartment syndrome, we immediately performed a fasciotomy on site.”
As we wheeled the patient toward the operating room, I explained the situation to the healers following us.
“Decompression of the anterior, posterior, and medial compartments is complete. The muscles bulged out, and the swelling has partially decreased, but distal perfusion below the knee is extremely poor. During the fasciotomy, severe soft-tissue damage and fractures below the knee were suspected.”
The head healer of the D-1 Clinic trauma team answered immediately.
“We’ll prepare for radical debridement and an external fixator.”
Yes. This was the feeling.
Perhaps because we had worked together so often, as soon as I input the values, the answer I wanted was output immediately.
This was why it mattered to work with medical staff who understood one another.
The pace was completely different.
I gave the team leader an additional order.
“Prepare silver cannulas and vulcanized rubber tubing.”
“What do you intend to use them for?”
“It’s a surgical technique I’ll be showing you for the first time today. I’ll explain during the operation.”
“Understood.”
Rather than looking flustered, the team leader headed for the operating room with shining eyes.
That was not an ideal reaction when a patient was dying,
but doctors were creatures whose hearts raced whenever they heard about a new surgical technique.
“Ayla.”
“Yes! I’ll observe!”
I also called our Saintess of the Lantern, my personal healer with unlimited Refreshes.
After sending the patient into the operating room,
while the anesthesia healer diligently anesthetized the patient with ether,
I put on my gown, tied my mask, and washed my hands.
I was just about to cross the operating room threshold when I heard it.
“...Saint.”
Gregor called to me quietly from behind.
It was completely unlike his usual booming voice.
So unlike it that it took me a moment to realize it was Gregor speaking.
When I turned around, Gregor was standing a step before the operating room entrance.
He was not standing proudly with his chest out or showing off his muscles as usual.
With his shoulders slumped and both hands respectfully folded before his chest, Gregor spoke to me.
“Saint. May I make one request?”
“Go ahead.”
“Could I... watch that surgery from nearby?”
A question mark appeared over my head.
Why would a holy knight want to?
Unlike healer priests, holy knights could not use divine magic to heal others.
Watching surgery would not help them.
The lieutenant was also startled and tried to stop Gregor.
“Sir Gregor! What strange thing are you suddenly trying to do now...”
“I want to see that patient survive with my own eyes.”
The large man interrupted the lieutenant, speaking in a deeply subdued voice.
“There is a reason I must see the person I rescued survive with my own eyes.”
His voice was far more serious than usual.
Perhaps because of that,
even the lieutenant who had tried to stop him fell silent.
“...All right.”
I allowed Gregor into the operating room.
I did not ask why.
I thought I understood.
“Be careful not to touch the patient or the other healers.”
“Thank you, Saint.”
Gregor bowed to me, then carefully entered the operating room.
Like a sack of barley left in a corner, Gregor shrank into the far end of the room.
I left him there and began the surgery.
“DeBakey forceps.”
“Forceps.”
“Clamp.”
“Vascular clamp.”
As I called for them, surgical instruments were placed correctly into my hands alongside the repeated orders.
We understood each other perfectly.
As I searched for the patient’s arteries among the pulverized muscles, I began explaining things to the healer.
“Team Leader, can you tell what arteries these are?”
“The femoral artery and the popliteal artery trifurcation. They are almost severed.”
“Correct. What procedure have we usually performed in cases like this?”
“We performed TIVS, Temporary Intravascular Shunting.”
The trauma team leader answered in the manner of a trainee receiving instruction.
It was so satisfying to hear the answer I wanted immediately.
This was why I had made this person the team leader.
Once I left for the Imperial Academy, this person would have to run the clinic.
“That’s right. When blood vessels were severed, we performed TIVS, then slowly carried out reconstruction.”
TIVS, Temporary Intravascular Shunting.
It was an operation that temporarily connected the severed ends of a blood vessel with an artificial vessel.
High-grade Heal was desperately scarce compared to demand, and high-grade healers could not always remain at the clinic.
We performed this surgery to buy time for the leg while we found a high-grade healer or prepared to reconstruct the blood vessel.
“Do you think we can perform TIVS on this patient?”
“I thought it might be possible, but...”
“Unfortunately, it isn’t.”
This procedure could not be used on this patient.
“First, the injured area is a special location.”
The damaged blood vessel was behind the knee.
One of the most mobile areas in the body.
It moved even if the patient merely shifted in bed without walking.
What would happen if we connected an artificial blood vessel in such a mobile location?
“TIVS can come loose in an area that moves this much.”
The temporary vessel would simply pop right out.
That would be a major disaster.
There was another reason.
“The inside is too badly damaged. I can’t see any soft tissue to support the vessel.”
The tissues around the knee blood vessels had been damaged too severely.
Normally, an artificial vessel needed surrounding muscle or other tissue to support it.
But this patient’s insides had been pulverized.
Considering that the injury was at the knee, TIVS would almost certainly come loose.
“Lastly, hypercoagulability, an excessive tendency to clot, is suspected because of the crush syndrome. That means the risk of thrombosis, a blood clot, is extremely high.”
I had drawn a small amount of blood from the right leg on the way here.
It had clotted far too quickly.
“If we connect the artery around the right knee to save the top of the right foot, the blood will clot and block the vessel.”
It would be frustrating to connect it only for it to become blocked.
That was why we did not use TIVS for patients like this.
Instead, another technique had been prepared for such patients.
“You remember that I told you not to cover the left leg with a drape.”
I pointed at the sleeping patient’s left thigh.
“We will use the relatively healthy left femoral artery to save the right ankle. The procedure is called Cross-Limb Vascular Shunting, CLS.”
After explaining,
I had the trauma team leader move to a position with a clear view of the operation.
Then I opened the left thigh and found the femoral artery.
“Give me the silver cannulas and vulcanized rubber tubing coated with heparin.”
I generously applied heparin and connected the silver cannulas to both ends of the vulcanized rubber tubing.
Then I secured the left femoral artery and the upper portion of the shredded right popliteal artery with sutures.
“Vessel loop.”
“Vessel loop.”
“Clamp.”
“Clamp.”
“Ah, that is too far in. A little farther out. Yes, there. Yes. We’ll use a side-biting clamp. Tighten the clamp when I tell you to. Not yet.”
The clamp stopped above the healthy femoral artery.
After making the team leader wait, I connected the silver cannula to the artery below the right knee.
Then.
“Clamp on my signal. One, two... now.”
“Clamping.”
While the team leader temporarily blocked the artery,
I punctured the femoral artery with the silver cannula.
“Release the clamp.”
“Releasing.”
The team leader released the clamp.
Part of the blood from the left artery passed between the patient’s legs and flowed down beneath the right knee.
With that, the operation was nearly complete.
Once I could finally breathe a little easier, I asked the healers,
“When can the high-grade healer arrive?”
“There are still many patients with appointments. They said it would be the day after tomorrow at the earliest.”
Just as I thought.
CLS had been necessary.
A leg began to decay rapidly after four hours without blood flow.
That was why this operation was needed.
Without it, the patient might have needed an amputation by the time a high-grade healer arrived.
“Good. Assign that healer to this patient when they arrive.”
“Yes.”
Whether in the twenty-first century or now,
medical resources were not equal for everyone.
Just like people waiting for organ donations or reconstructive surgery.
That was also why surgeries that bought time remained necessary, even in a world where divine miracles existed.
“Let’s confirm whether the blood flow has returned. Healer.”
“Yes.”
The bat-eared healer placed a stethoscope against the patient’s leg.
A Doppler ultrasound device would have been ideal,
but equipment like that was impossible to expect in this world.
So we used a stethoscope instead.
I had taught the technique to a beastfolk healer whose hearing was dozens of times sharper than mine.
‘It was a good thing I learned the stethoscope technique.’
For reference, it was not a technique normally used in twenty-first-century Korea.
Korea was so advanced in medical equipment that one could find Doppler ultrasound devices even on remote islands.
This was a technique generally used by doctors who frequently volunteered overseas.
People like me, sucker fellows who got taken in by a promise of pork cutlets.
“The blood flow has returned.”
“Now... next...”
With that, we had put out the immediate fire.
“Let’s begin debridement.”
* * *
After that came the barbaric work of suturing shredded muscles, removing bone fragments,
and assembling bones with nails and hammers.
“Whew...”
It had been a while since I last performed CLS, and I felt completely drained.
Still, I was somewhat proud.
It had been a while since I handled blood vessels, and the adrenaline was flowing.
I was exhausted, but not actually tired. It was a strange state.
“You worked hard too, Ayla.”
“You worked hard, Director.”
After receiving a light Refresh from Ayla,
I called for the sack of barley I had forgotten about.
“Mr. Gregor.”
“Yes, Saint.”
“Let’s go to my office.”
The muscular man bowed and followed me with his head lowered.
Gregor and I sat across from each other on the office sofa.
“Would chamomile tea be all right?”
“Thank you, Saint.”
Gregor answered with his shoulders slumped.
A steaming teacup was placed before the muscular man.
Sip.
For a while, we drank tea without saying a word.
After several minutes,
Gregor broke the silence.
“...Saint. May I ask you something?”
“Please do.”
Beneath my crow mask, I slowly took a deep breath.
I had an idea what he wanted to ask.
After more than a decade in trauma surgery across both lives,
there was always only one question that came from this sort of atmosphere.
“...When rescuing someone trapped beneath something... should we always have been this careful?”
Gregor lowered his gaze.
“Giving them IV fluids, calling a healer who can use detoxification magic, opening their leg... Must it be so complicated for someone to survive?”
“...Yes.”
Saving lives was not easy.
How could you easily save someone trapped beneath such a massive structure?
Watch for crush syndrome, resolve compartment syndrome, deal with fractures, vascular injuries, DIC, internal bleeding, infections, bone marrow embolisms...
There had been too many problems to consider while operating on today’s patient.
“A human life... is originally this heavy.”
“Then...”
“...”
“Then how many people has someone like me, who only knew how to lift things, killed with good intentions...?”
Just as I thought.
After hearing the question, I closed my eyes.
It was a common worry.
One that I, my seniors, and my juniors had all faced at least once.
“How many people has my ignorance led to death?”
His voice came from beneath his bowed head.
I spoke toward the top of his exposed head.
“Probably too many to count.”
His voice trembled.
“Then... am I a sinner?”
“...Yes.”
Then I continued.
“You and I are both sinners.”
“?!”
Gregor raised his head with a sharp intake of breath.
“Saint?”
“Don’t look at me like that. I have had my shortcomings too.”
I had once been like Gregor.
The firefighter I lost because I did not understand blast lung injury.
The mothers in Limbus Pit I lost because I lacked obstetrics knowledge.
The patients under the black flag whose treatment had been delayed because my emergency triage was incomplete.
No, let me correct that.
Perhaps I was still in those days.
I had never once been perfect.
The misunderstanding genre buff had merely produced results beyond my abilities.
I was always just a flawed and ignorant human being.
“Have you ever considered why we cannot hold on to sand, Gregor?”
“...”
“Even a handful of sand slips through our fingers. How many lives do you think have slipped through hands like these?”
If I had been more capable, if I had worked harder,
there were many patients I could have returned to their families.
From my residency until now,
there had not been a day when I felt no regret.
Even so, I did not bury myself in regret.
I had learned many ways from my seniors.
Some relieved it with alcohol or cigarettes.
Some relieved it with games or movies.
Some turned to religion.
But this seemed to be the most effective method.
“Then how did you... overcome it, Saint?”
“I always think this in those moments.”
It was a method a senior from pediatrics had taught me.
“I’m sorry to those involved, but what can we do? We keep them in our hearts, promise to do better, and move forward. We endure this age so that the tragedy of those who passed through my hands does not continue into the next generation. And we hope that, someday far in the future, a junior much better than me will appear.”
My memory was a little hazy,
but I thought that senior had said something like this.
“Future generations will call us quacks, but what can we do? Being born too early is our sin. Someday, even this damned rare disease will have a treatment. Until then, we just have to endure if we don’t have the confidence to solve it.”
“Our sin is that we were born too early. So we can only endure this era and hope that this tragedy will someday be solved.”
* * *
While counseling Gregor,
I remembered something his godfather, the bishop, had told me before.
Apparently, Gregor had not originally been such a cheerful young man.
More precisely, he had once been cheerful, but he had lost that brightness shortly before meeting me.
“He was an ordinary child. A simple boy who became a holy knight because he admired heroes.”
But the tragedy had begun because he loved people too much.
He was a holy knight, yet he could not cut down people.
So he focused only on rescuing them.
But as could be inferred from the questions he had asked me,
his rescue efforts had not saved people.
He could not become an inquisitor because he could not cut people down.
He could not save people despite being a holy knight.
A world where good intentions alone could not guarantee the best outcome.
Amid repeated failures, he was branded an incompetent man within the Church.
The people of the Church gradually began to turn away from him as well.
After one year, then two years of this,
Gregor had apparently become increasingly quiet.
The seat farthest in the corner of the dining hall.
The last row at Mass.
The most isolated patch of sand at the training ground.
Just as the edges of rooms were becoming his nest,
“You chose my son, Saint.”
Apparently, I had chosen him.
“He is hiding himself inside his muscles now. If he does not do that... he cannot endure.”
The Gregor who came out of his room because of me had been imposing from our very first meeting.
A confident young man who loved his muscles and proudly boasted of the history of his Ardenu Sect.
But in truth, he had merely put on muscle as armor and acted confident.
“I understand that he is burdensome. But... it will only be temporary. He is getting better. Please... please bear with him a little. I will speak to him properly.”
It was a kind of bravado.
To hide his own incompetence.
And to avoid disappointing me, the saint.
That was why I had never disliked Gregor’s bold manner.
Rather, I liked his way of doing things.
When things were hard for me, I also acted ridiculous and put on airs.
When that gave the people around me strength,
somehow, it became possible to overcome it.
That was why I respected Gregor’s method.
Playing the fool was also one of the ways I had endured the miserable reality of my previous life.
“Gregor.”
“...”
Returning to the present,
I called to the massive, muscular man who had completely lost heart.
“Good intentions alone cannot save people. You and I are both sinners. Perhaps enduring is all we can manage. But...”
Gregor had fallen apart.
The moment he witnessed that his good intentions had gone in the wrong direction.
I poured tea into the poor man’s empty cup and continued.
“Even so, we must continue onward. If we chose the wrong answer, we leave it in the records so those who come after us will not repeat it. It makes the heart a little lighter when you think that, in the end, we might only become a bridge of hope leading future generations to the answer.”
“Saint...”
“If you are afraid of making mistakes even then, stand proudly and shout as you always do. Someone will surely find hope in your confident manner.”
It was impossible not to make mistakes.
So.
It would be good to at least work toward giving people hope.
“Would it not help to take pride in being someone who reminds others not to forget hope and composure?”
Gregor’s shoulders trembled faintly.
“...Then... are you saying I am not merely an armored beetle?”
Armored beetle.
It was the slur used for Gregor.
A word mocking his hard muscles as something incapable of doing anything.
I had never liked that slur.
So I denied that he was a bug.
“If you only lift your head a little, you will see people who love you waiting for you to come out of the room. You should not demean yourself by calling yourself a bug.”
People hoped bugs would never appear before them.
In other words, if even one person was waiting outside the room,
the person inside was not a bug.
And among those waiting for him were the bishop,
the holy knights who followed him,
and the citizens he had rescued.
He was loved by far too many people to call himself a bug.
“Do you not think the gods gave you such immense talent because they love you as well? Is that not why you offered prayers of thanks each dawn?”
“...”
I smiled beneath my mask.
He could not see it, but still.
Gregor lowered his head without speaking.
Drip. Drip.
Drops fell into the teacup clutched in his hands.
Pretending not to notice, I lifted my mask slightly and took a sip of tea.
“A cup of tea after saving a life is especially meaningful. Wouldn’t you agree?”
Nod.
Gregor nodded without a word.
Author’s Note
Ttutai... Wuttya... I’m gonna become a medical-fiction pro...
I was late because I had to research the surgery parts.
Complex trauma sections are sooo hardy-hard.
With craniotomies, you just do the skull-openy thing... It’s hard in real life, but easy to describe.
Complex trauma, on the other hand, means there’s so much stuff to look up...
I didn’t even research that much, but I learned for the first time how hard it is to research just a few sentences...
And the reason this chapter is such a heaping-rice-bowl burst is...
Ending a chapter with only the surgery scene somehow felt a bit lacking...
In conclusion, I’m sorry for being late.
Footnotes:
Join our discord at https://dsc.gg/wetried
