Chapter 116

Chapter 116. Euthanasia (2)

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The temple’s Black Death ward was thick with the scent of strange flowers and incense, strong enough to detect even through the mask.

I scratched my head.

“Why…?”

There wasn’t much room for speculation—it could only mean one thing. These people likely believed it aided in patient treatment, in their own way. After re-sanitizing my hands and properly adjusting my plague doctor mask, I approached the bedside.

Diagnosis was straightforward.

Blackened limbs, skin lesions—thankfully no coughing sounds yet. That might mean pneumonic Black Death hasn’t spread, right?

Upon reflection, there was no guarantee this world’s Black Death perfectly mirrored the original. While it was indeed an insect-borne bacterial infection, predicting identical disease progression would be reckless.

“Are you the teacher who came to assist?”

“I’m Professor Asterix.”

An elderly gentleman with white hair stood before me, wearing priest robes with an apron-like covering, his mouth and nose concealed by cloth.

The ward was noisier than expected. The clergyman pulled me aside for conversation.

“Oh, thank goodness you’ve come! I’m Archbishop Karl, also a healer. We’re short on hands, so I’m on the front lines.”

The old man’s dedication was admirable.

“Yes. What’s with the floral scent?”

“We burn incense to combat the stench. It’s better than nothing, surely.”

Though I had much to say, I held my tongue. Arguing about flower scents or miasma theory wouldn’t help here. If it gave them peace of mind…

“I’ve heard you’re the empire’s finest healer. What treatment do you recommend?”

The archbishop looked at me with sorrowful eyes.

I hesitated—this wasn’t an easy question. To offer the most pragmatic and public-spirited answer…

“Euthanasia.”

****

It may sound extreme…

Black Death (黑死病).

Everything is in the name.

You turn black and die. More precisely, turning black means dying.

In cases of septicemic Black Death, administering antibiotics within a day of symptom onset is critical—if missed, improvement is unlikely. Here’s why:

Blackened limbs result from bacteria in the bloodstream triggering disseminated intravascular coagulation.

Microscopic blood clots spread, blocking vessels and causing tissue necrosis, which appears black.

Simply put, if limbs are visibly blackened…

There’s no cure. As necrotic tissue decomposes, hyperkalemia disrupts heart rhythm, and decaying matter floods the bloodstream with inflammatory substances.

Amputation might seem like a solution—but does cutting off limbs guarantee survival? Honestly, I don’t know.

If it were just a few patients, it’d be worth trying, but attempting surgery now poses significant risk of infecting medical staff through blood exposure. Expecting terminally ill patients to consent to surgery is unrealistic, and even perfect surgeries wouldn’t ensure survival.

“Once limbs turn black, patients have no chance of survival.”

“Hmm…”

“In my opinion, the best course is discussing with patients and administering opium for a peaceful passing.”

The archbishop shook his head.

“You haven’t even examined the patients yet—you seem awfully hasty.”

“Not at all, Archbishop. Tomorrow, the next day—we don’t know how many patients will flood in. For those without septicemic symptoms yet, I’ll do my utmost to treat them.”

“I appreciate your perspective, but we won’t give up so easily.”

“No, Archbishop…”

“We may have members who can make quick, harsh decisions—and they might be correct—but clerics cannot be such people.”

This isn’t that simple.

Look around the ward.

We’re using half the city’s medical resources on patients who’ll die within two days. Priorities need clarification.

“I understand the situation is regrettable, but we’re expending half the city’s healing personnel on patients who’ll die within two days. I’m not the one making cruel choices here.”

The archbishop firmly shook his head.

“I understand your stance, Professor, but let’s assess tomorrow’s situation. Even if we must surrender, we’ll fight until the very end.”

I sighed.

Of course, it’s difficult for someone claiming to heal to decide on euthanasia. Though disagreeing with the archbishop, I had no intention of being stubborn.

This isn’t about saving lives—it’s about taking them. There’s no room for conflict here. I sighed again.

****

Let’s at least examine the patients. I turned toward the beds, Istina following behind.

“Do you truly believe euthanasia is necessary? Isn’t it too extreme?”

“As long as we haven’t encountered pneumonic Black Death, euthanizing septicemic patients with no chance of survival is an option.”

Ultimately, it comes down to whether the ends justify the means. There’s no guarantee utilitarianism offers the right approach.

“There’s no need for complex diagnoses. Give seven pills to each Black Death patient, instructing them to take one daily. Document any other issues.”

“Yes.”

“Oh, right. Go prepare oral IV fluids with 0.9% salt water. 0.5% sugar works too.”

Istina left.

I surveyed the patients. Let’s set a goal: confirming whether any have pneumonic Black Death.

Transmission speeds differ. Bubonic or septicemic types spread via insect bites—not person-to-person.

Conversely, pneumonic Black Death spreads directly between people, far more rapidly.

What if we find a case?

My suggestion to the archbishop involved administering painkillers for a peaceful passing. But he rejected that.

The ward resembled hell itself.

Crying, shouting, groaning patients. Approaching the beds, every gaze fixated on me—what else could they do but wait for the healer?

The first patient appeared normal—an average-looking uncle. No blackened extremities, eyes partially open.

“Patient, are you conscious?”

“Yes…”

I poked the patient with a spoon resting nearby. As mentioned before, assuming a sleeping patient is fine—”Ah, they’re resting well”—is unacceptable.

They might be unconscious. Even if nine out of ten patients curse you, waking that one unconscious patient is crucial.

“Ahhh, what are you doing?”

“Checking if you’re dead.”

I set the spoon down.

The patient blinked then weakly reached toward me. I stepped back, unsure of the protective gear’s reliability.

“Listen carefully. I’ll give you seven pills—take one daily.”

“Yes.”

The patient nodded.

“Have you noticed any unusual bruising? Any bleeding from the mouth or nose? Any discoloration of fingers or toes?”

“Hmm, no, none of that.”

If any patient shows signs of disseminated intravascular coagulation, I’d consider prescribing anticoagulants—but fortunately, not this one.

“The city’s situation is dire. Stay alert, eat and drink well, and try your best.”

“Yes.”

“Lastly, cough for me.”

“Hack, hack.”

The forced cough sounded normal—no crackling phlegm, likely no pneumonia.

The patient took one pill in front of me. Antibiotic treatment should increase survival chances by about 10%. Hopefully?

On to the next patient.

****

Hack, hack, hack.

This young male patient was already coughing. Clenching my teeth…

This patient might already have pneumonic Black Death. Ironically, his youth suggests he survived long enough to develop this form.

Though euthanasia was my suggestion to the archbishop, let’s assume it’s unavailable. How should I treat this patient?

I sighed.

“Patient, look at me.”

“Yes?”

No time for beating around the bush. Complete honesty required—even if cruel.

“How badly do you want to live?”

“What do you mean by that…?”

No time for this. I shook my head.

“While you’re putting everyone in this city at risk, if you truly, genuinely wish to survive, I’ll do my utmost to treat you.”

“Otherwise?”

Otherwise…

“There are many ways to die peacefully.”

“Do I have a choice?”

“Yes.”

Tears immediately welled up in the patient’s eyes.

“I-I don’t know about that…but if there’s a chance to live, I really want to survive. I’m sorry…”

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