Chapter 105

105. Death Rate Halved (1)

****

Mint stared at me intently.

“Hey.”

“Yes?”

“Lately, I’ve been getting quite a few letters too. People saying they’re sick, or someone they know is sick, and they’ve heard you’re the best doctor in the empire. They want an introduction. But I’ve mostly been ignoring them.”

“They’re mistaken about you.”

“About what?”

“You know… busy seeing patients to gain experience, that’s how one gets good at this. Sitting in some ivory tower only treating rich patients won’t build skill. Right?”

“Guess so.”

“Not saying making money is bad, but expecting someone who only does easy cases to suddenly become amazing is silly.”

There’s no shortcut. Skill comes from… hard work… no, experience. Mint thought it over and nodded slowly.

“That wasn’t actually what I wanted to talk about.”

“Yes?”

“I’m worried about all these people trying to poach you. Last time, Lord Lapis Acting himself seemed to be scheming to take you away.”

“I’m not going anywhere. Stop worrying.”

“Hmm… yeah…”

Mint still looked a bit uneasy.

“Oh right! I picked out two suits for you to wear. Come check them out later.”

I nodded.

“Gotta go now, I have a lecture… see you later!”

“Alright.”

With the sound of gathering her bag, Mint waved goodbye and left the research lab.

****

“Professor! Emergency!”

BAM BAM BAM. Teacher Istina burst into the room. There must be a reason for this—probably a severely injured patient arrived.

Judging by her agitated reaction, this could be worse than any patient we’ve seen so far… or maybe she’s just a bit squeamish.

“What is it?”

“A young male patient with a broken leg. His thigh bone is completely bent. We couldn’t even attempt to set the bones because he’s in too much pain.”

I was already moving quickly toward the ward with Teacher Istina, who kept muttering anxiously almost on the verge of tears.

“The swelling was so bad I couldn’t even wrap bandages around his leg. All I could do was lay him down on the bed before coming to find you…”

“Hmm. Is he conscious?”

“No. He’s just screaming in pain. Couldn’t get any history yet, though he appears to be a man in his 30s or 40s.”

We see such cases often enough.

When in extreme pain, speech is usually impossible. Anesthesia would help us communicate better. At least his ability to scream indicates he isn’t near death.

The broken thigh bone likely refers to a femur fracture. The bending suggests it didn’t just crack—it shattered into two pieces.

This is a dangerous condition, especially for elderly patients where it can feel like a death sentence.

During World War I in 1916, the mortality rate for soldiers with femur fractures was as high as 80%. After Thomas Splint was introduced, it dropped to 20%. Thank goodness we have that tool.

Thomas Splint is deceptively simple—a basic device whose impact seems disproportionately large.

“It’s a femur fracture.”

“Oh. I tried doing something, but he kept screaming, so I had to put a gag on him first. To prevent him biting his tongue or choking.”

“Good call.”

Femur fractures differ from other bone breaks due to the muscles involved. Strong muscles are attached to the femur.

Once fractured, those muscles start pulling on the bone fragments.

Unlike ribs which naturally fuse, the powerful muscles connected to the femur actually prevent the bone from rejoining properly.

The muscles responsible for leg movement pull the upper and lower parts of the femur in opposite directions, preventing alignment. While there is a solution, it’s extremely painful.

“How do we fix it?”

“We pull the leg.”

“Pull the freshly broken leg?”

“Yeah.”

“For how long?”

“Until we can apply the splint.”

To counteract the thigh muscles’ force, we need to pull the leg until the bones align enough for the splint.

“But won’t the pain make him pass out…?”

“Better than dying.”

Of course, this isn’t easy. Such intense pain could induce shock.

****

Upon reaching the ward, two nurses were applying cold towels to the patient’s leg. While it might slightly reduce heat, it doesn’t seem particularly effective.

“Go fetch that thing.”

“What thing?”

“That one—the full-length leg splint.”

“Ah, yes!”

Thomas Splint is remarkably simple.

Hugh Owen Thomas, considered the father of orthopedics, was a British military doctor during WWI who invented this device.

In essence, it’s a mechanism that safely pulls and stabilizes the leg. Its simplicity makes it very practical.

Anyway, Teacher Istina rushed off to the hospital warehouse while I examined the new patient.

“Patient, can you hear me?”

The gagged patient shook his head weakly. Hmm… does he have something important to say?

I took out a fentanyl patch from my pocket, applied it to his bare chest, then removed the gag. The patient panted heavily.

Fentanyl patches take time to work. I considered propofol injection—since there’s no bleeding and the patient is hemodynamically stable, propofol should be fine.

Checking the patient’s wrist pulse, it felt strong despite the injury.

After disinfecting the inner elbow with alcohol swabs, I administered a small dose of propofol intravenously. No time to calculate exact amounts.

The medication started taking effect immediately.

“Are you alright, patient?”

“AAAHHH!”

“The gag is to prevent hyperventilation or tongue biting. Are you in a lot of pain?”

“Yes.”

Oh dear… things are about to get worse.

Continuously administering painkillers isn’t feasible. Teacher Istina returned with the splint.

Thanks to the propofol, the patient began speaking—apparently feeling less pain than before.

“Just bear with it, patient.”

“Uh… what IS that thing?”

It’s a Thomas Splint back in my previous life—a tool for straightening broken legs. Though it does resemble a medieval torture device at first glance.

“Wait…”

Seeing the splint, the patient attempted to escape. I pinned him down to prevent him falling off the bed, which could rupture blood vessels or nerves causing further complications.

“Patient, if we don’t act, your leg will be permanently damaged.”

“So you’re suggesting pulling with THAT thing?”

The Thomas Splint has a simple structure:

A thick hoop for the thigh, a smaller one for the calf, and two metal rods connecting them. It pulls the leg downward and stabilizes it, preventing rotation.

“Stay still—it’s dangerous to move.”

“Will it hurt a lot?”

“No. Nurse, please monitor the patient’s face for signs of shock.”

“But you said it wouldn’t hurt!”

“Well… obviously a broken leg hurts. I meant try to stay calm.”

Sorry to say, but concerns about pain should’ve been addressed BEFORE the leg shattered.

Fortunately, no other bones seem broken. If the spine was involved, that would be beyond my expertise—even for an orthopedic specialist without X-rays, spinal surgery is nearly impossible to perform accurately.

While the patient protested, fear likely clouded his judgment. With the propofol effect, restraining him proved manageable. Teacher Istina quickly positioned the splint. Next step…

“Gag. Nurse, please reapply the gag. Patient, raise your hand if you have anything to say instead of screaming.”

If this were a modern hospital, we’d perform general anesthesia and insert titanium nails into the femur. Here, we’re limited to propofol-induced endurance.

This will hurt more than last time when we removed the spleen. Regional anesthesia isn’t possible either.

Even with anesthesia, bones themselves can’t be numbed. Attempting caudal epidural anesthesia risks nerve damage with no recourse for treatment.

Given our limitations, this is the best option.

“Nurse, another pair of hands needed. Someone to hold the splint while pulling the patient’s calf. Teacher Istina, take a look.”

“Yes.”

“Observe closely. The patient’s left leg is about three centimeters shorter. This is due to misaligned bones causing the leg to bend. So…”

We need to pull.

“Patient, bite down hard. If you lose consciousness, it’s your own fault.”

“UUUUUGGGHHH!”

Stay calm.

“Nurses, keep the patient steady. If we don’t straighten the leg now, lifelong disability awaits. On the count of three, we’ll pull.”

It’s going to be excruciating.

Removing the spleen by poking fingers inside was relatively tolerable since internal organs lack many pain receptors.

Legs, however, are packed with pain receptors—about fifty times more than internal organs.

This isn’t just painful; we’re entering territory where true pain-induced shock becomes a concern. Likely fifty times worse than the spleen removal case…

“One. Two. Three.”

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