Chapter 150

Episode 150: Appendicitis (2)

Early morning. But even in the early hours, the hospital wasn’t empty. People don’t schedule when they get sick, after all.

Istina rubbed her sleepy eyes as she headed to the ward. The hospital rooms needed round-the-clock monitoring, making shift changes a matter of survival.

Still, it was disappointing to have missed the surgery observation opportunity. Istina glanced at the medical record.

– Pressing on the abdomen revealed tenderness and rebound tenderness at the location of the appendix.

– Inflammation of the appendix suspected; appendix removed. Inflammation confirmed upon removal.

What exactly happened here?

So, they surgically removed part of the large intestine from this patient? Does that even make sense? It must be possible if they did it…

The more she thought about it, the more amazing it seemed.

– Antibiotics in use.

– Discharge planned once recovery is complete.

Professor Asterisk’s operation yesterday might have been the first-ever appendectomy performed on a living patient. Whether it was truly the first or not, it was the first reported in the empire’s academic community.

Moreover, this was a procedure other healers could replicate with effort—find the three-quarter point, cut, and there’s your appendix.

It probably went down like that.

Since Istina didn’t observe the surgery, all she could imagine was a mess of bloody organs. How do you know where to cut without killing someone?

Istina held the medical record reverently as she approached the patient. The patient lay still, clutching their stomach and staring at the ceiling.

“May I ask your name, patient?”

“Simon.”

“Hello. Are you feeling any better? Do you remember the surgery?”

The patient shook their head, confused. Istina tilted hers.

“It happened while you were asleep.”

“Oh. I don’t remember anything?”

Every case seems different.

Some scream in agony despite heavy medication, while others sleep through the entire thing like nothing happened.

“Yes.”

“Understood. Let me check your surgical site.”

Of course, they wouldn’t have operated with a clear mind. They likely used opium, alcohol, or some other drug to dull the senses.

Istina lifted the patient’s gown to inspect the wound. It was covered with gauze and bandages, but removing the gauze revealed the surgical incision line.

An incision about a handspan long.

No matter what else, the stitching job was eerily neat. Istina prodded around the wound with a disinfected stick.

“Does it hurt when I press?”

“A little.”

The patient’s responses were brief.

Istina paused to think. If the patient’s stomach hurts, speaking might be uncomfortable. If she had sharper instincts, she’d notice the patient lying curled toward the right side.

The surgical site is on the right. The pulling sensation causing pain leads to an asymmetrical posture due to asymmetrical pain.

Istina pressed again gently. The wound didn’t split open under pressure.

Opening here must lead straight to the appendix. So, they made the incision and finished the surgery quickly, no complications.

Thinking about it gave her chills. Quite a few people die from sudden severe abdominal pain, all likely due to this condition. Cutting into the abdomen and removing the appendix is the treatment?

Istina poked the surgical site again.

Complicated or simple—it depends. Slice open the spot Professor called McBurney’s Point, enter the peritoneal cavity, and that’s it.

“Looks good. Any other pain?”

“This spot hurts.”

“That’s normal.”

Istina noted the patient’s information on the medical record. Nothing special to document—surgical site pain, minimal talking.

Oh, right. Istina recalled the questionnaire Professor Asterisk had given her. What questions should she ask again?

“Have you passed urine?”

“Yes.”

“How many times?”

“Twice today.”

It was still morning, so twice wasn’t bad. Istina nodded. Everything necessary was recorded. Just wrap things up now.

“Alright, thank you for your time. Please let us know immediately if symptoms change or worsen.”

Istina left the room, holding the medical record, leaving the patient lying quietly behind her.

***

I sat quietly in the lab. Though a surgical patient had arrived, the young one would likely recover quickly.

Istina entered the lab.

A faint smell of bread wafted around her. As soon as she came in, she hung her surgical gown and placed a packet of cookies on my desk.

“Hi.”

“I heard you did a new surgery yesterday while I was gone. I visited the patient this morning out of curiosity.”

She wasn’t there then. I thought about showing her the appendectomy but couldn’t summon her mid-procedure.

“Good job. How was it?”

“Just fine.”

“What did you check?”

Istina bowed her head and looked at the medical record she’d written. I waited a moment.

“I asked if the patient urinated post-surgery, if there was inflammation around the surgical site, and if pressing caused pain.”

Well… pressing on a surgical site will obviously hurt. Still, good thinking to confirm there was no inflammation, no improper stitching, no pooling blood.

“The surgical area hurts when pressed.”

“Based on my checks, there doesn’t seem to be any issue near the surgical site.”

I nodded.

“Still, good work. This young patient should recover quickly. I’ll check on them later.”

“Yes.”

Istina placed the medical record on the lab table and started eating the cookies she’d brought.

“By the way, professor, is appendicitis common or rare? I’ve seen quite a few cases of sudden stomach pain leading to death.”

Not sure how common it is. It does come up occasionally, especially in emergency rooms.

“Common? There are a few other diagnoses with similar symptoms, though. If pressing McBurney’s Point causes the most pain, appendicitis becomes more likely.”

Istina eagerly scribbled down what I said, looking very serious.

“Is there no treatment besides surgery?”

“Hmm. Antibiotic treatment might be better than jumping straight into surgery. Quite a few people recover from appendicitis with antibiotics.”

“If that’s true, why perform surgery?”

Istina tilted her head at this question.

Good question.

“The large intestine is basically full of waste. No matter how much medicine you use, bacteria won’t completely disappear. Even with strong antibiotics.”

“Ah, now that you mention it, that makes sense.”

“No guarantee antibiotics will work. Bacteria will always be present in the large intestine. It might work, or it might not.”

The best treatment for appendicitis is surgery.

If the infected appendix bursts, the patient risks uncontrollable peritonitis. It’s best to operate as soon as possible.

Istina scratched her head.

“How did you even know this, professor? If it were me, I never would’ve thought to cut open the stomach and remove the appendix.”

Why did the idea to remove the appendix occur to someone? Can’t say exactly how the person thought, but it certainly seemed like something that wanted cutting off.

The appendix looks like a tail sticking out from the end of a long balloon. Its developmental origin isn’t much different from the large intestine.

“Hmm. It just looks like something you’d want to cut off, right?”

“Yeah.”

My graduate student put down the medical record she’d been reading, leaned back, and sipped her tea comfortably.

“Tricky. I never imagined you could live after removing part of an organ.”

“The gastrointestinal tract is less critical. The large intestine is much longer than an arm, so removing a bit shouldn’t be a problem.”

***

Istina crossed her legs. On the desk lay the academy’s daily newspaper.

“Oh yeah, professor. I read in the paper a few days ago that the medicine developed in our lab is finally being implemented?”

“Where?”

“In the paper. What was it… there’s an epidemic in the northern region right now. They sent medicine packages via dog sleds to each village. Thanks to that, thousands of lives were saved.”

“Ah.”

Violet mentioned something similar.

Late autumn, winter in the north. If it’s pneumonia spreading like an epidemic, it’s likely pneumococcus, requiring antibiotic treatment.

Aspirin probably helped with high fever and coughing too. Violet, give more details next time. This is bigger than expected.

“Thank goodness.”

***

Clang. The sword at the knight’s waist jingled every time the soldier moved. A priest blocked the knight’s path.

“You cannot bring weapons into the ward. Come back once the patient recovers.”

“There was a decapitated body found at this family’s home. Even if we’re not arresting anyone, surely we can ask questions?”

“Because of the possibility of an epidemic, contact is prohibited. I’ll check with higher-ups.”

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