Chapter 30

30th Episode: Severe Trauma Patient (2)

****

The patient’s suspected condition is a ruptured spleen.

Normally, internal bleeding from trauma typically results from organ damage. In most cases of trauma, either the liver or spleen tends to rupture.

If it were a liver rupture, we’d have to perform a procedure called hepatectomy, but that’s impossible for me. Thankfully, based on the location of the trauma, the damaged organ appears to be the spleen.

This makes things much simpler. I just need to remove the entire spleen since you can live without it.

The surgery I’m about to perform is called a splenectomy.

It’s not an impossible surgery, nor is it delicate. It’s risky, but leaving it untreated will likely result in the patient’s death.

I have no choice but to pick up the scalpel.

****

“Hippocrates’ first principle. Istina, do you know what it is?”

“Hippo…what? What’s that?”

“Do no harm.”

“Aha. Yeah, that’s definitely the most important thing. We can’t make the patient worse off because of us.”

Indeed, nothing else matters right now. This is something we must keep in mind as we proceed with this operation.

Given the limited equipment, I can’t confirm the diagnosis with certainty, nor can I guarantee the success of the surgery or its aftermath. That’s the reality here.

But one thing is clear:

Despite all our efforts so far, the patient’s blood pressure continues to drop, and their level of consciousness keeps declining.

The current heart rate has risen to around 120 beats per minute, and the respiratory rate is at 30 breaths per minute. If left untreated, the patient will fall into hypovolemic shock within a few hours.

Whether it’s due to medication, healing magic, or some other reason, the patient has managed to hang on until now—but they won’t last much longer.

There’s no option but to operate.

What I’ll need for the surgery:

A sterilized mask. Since we don’t have one, I’ll use a plague doctor mask—it covers my mouth and prevents hair from falling into the wound. Sterilized gloves. Clean hands. Purification magic.

A heated cautery tool. Still being prepared.

[Sanitize.]

[Sanitize.]

Istina stands by, ready.

Two ward nurses have also been pulled in and sterilized accordingly.

However, even with these precautions, this setup is merely a mimicry of a modern operating room. We can’t stop dust from entering this space.

For anesthesia, we’re using the same method as before.

General anesthesia isn’t just about drugs; it requires machines—gaseous sleep agents administered by anesthesiologists, and in large surgeries, ventilators too. That’s beyond my capability.

Even if I could induce general anesthesia, waking the patient afterward might be questionable.

We’ll go with a sedative dose of propofol, a fentanyl patch for pain relief, and lidocaine for local anesthesia at the surgical site. Anything more would be unrealistic.

“Nurse, please cover the patient so they can’t see the surgical area.”

Anesthesia administered—three types.

“Will this work?”

“It should.”

It *should*. Can I actually pull this off?

That’s a completely different question.

Oh man, this is horrifying.

Every step of the surgery is problematic. A splenectomy usually involves diagnosing through laparoscopy.

“Is everything going well?”

“Just try to relax as much as possible.”

“Why are you pressing on my limbs?”

Because any movement while the scalpel is inside could be catastrophic.

Typically, specialized equipment is used to inject carbon dioxide into the abdomen, and saline solution is applied to clean the organs during the process.

But none of that is available to me.

There’s only one way forward:

Cut open, then enter.

Skin incision. Subcutaneous fat incision. Muscle incision. Now, the abdominal cavity’s connective tissue is exposed. I’ll carefully cut through it, avoiding unknown blood vessels.

The internal organs are now visible—or rather, not visible.

Damn.

How could I forget this? When examining patients, students and novice doctors (like me) often overlook one crucial fact: we’re not dealing with normal human anatomy.

We’re dealing with diseased bodies.

In this case, the spleen has ruptured, causing massive blood loss—around a liter, probably.

Where did all that blood go?

The patient’s abdominal cavity looks like someone painted it red.

The mesentery, those thin membranes between the intestines, is completely soaked in blood, obscuring everything. What should I do?

Should I give up and sew them back up?

Nah…if there’s a will, there’s a way.

There’s only one viable option.

I’ll insert my hand, gently feeling around for the spleen while avoiding damaging any blood vessels or nerves.

How awful and complicated does a surgery have to be before dying seems preferable? But if everything turns out fine at the end, does it matter?

“Could someone hold the patient down?”

Let me recall the organ positions. From my perspective, the liver is on the left. Next comes the stomach. The spleen should be toward the upper-right, slightly behind.

I need to clamp two major blood vessels: the splenic artery and vein. Is that even possible?

“Heated scissors ready?”

“Uh…heated scissors?”

“Yes! They’re ready!”

“What ARE heated scissors!?”

You idiot! You’ve been given three sedatives and yet you’re still conscious. Why couldn’t you have a sleeping constitution?

“Press down firmly on the patient. This is going to hurt like hell, but moving will kill them.”

“Wha—?”

After making a squelching sound akin to plunging your hand into mud, my fingers entered the abdominal cavity. The stomach is the largest organ nearby. Blood vessels abound, and the mesentery tears wherever my fingers move.

“AHHHHHHH!”

The expected scream. Ugh.

At least the patient isn’t thrashing around. Probably thanks to the propofol.

From the viewer’s perspective, the spleen is located at the upper-right corner. I need to remove it—but cutting random blood vessels would cause uncontrollable bleeding. Not an option.

I’ll need the heated scissors.

Thankfully, despite all this, visceral pain isn’t directly felt. Internal organs don’t transmit sharp pain sensations.

“Splenetic artery. Vein. Needle.”

First, I severed the splenic artery and vein with the scissors, then sealed them with stitches just in case. What about the smaller blood vessels attached to the spleen?

Using the scissors, I cut the small vessels and cauterized the ends with the hot metal surface. Hopefully, this achieves hemostasis.

Not sure though.

Time to remove the spleen.

The spleen was firm but leaking blood everywhere like a bruised dotorimuk block. This won’t come out easily.

Also, inserting my hand again risks damaging blood vessels or nerves, or causing the patient to thrash and worsen their condition.

Hmm.

Since I’m removing the spleen anyway…

There’s no need to take unnecessary risks. I simply inserted my fingers into the spleen and carefully extracted it whole.

Let’s check. Is the patient still alive?

“Istina, check the pulse.”

“The patient still has a pulse in their neck.”

They’re alive!

“All done. Now we just need to close the wound. Great job, patient.”

It’d be wise to double-check for remaining bleeding, but I don’t have a good way to do that. Just visual inspection, maybe?

For now…

None of the blood vessels I cut are bleeding. That’s a good sign. Smaller vessels will likely clot on their own.

Now, time to close it up.

Though multiple layers were cut during entry, stitching them separately doesn’t significantly improve outcomes according to the academic community.

Still, I can’t rule out the possibility that it might help.

With that, suturing completes the surgery.

****

It took forever. So much sweat accumulated inside my mask it sloshed around, and my hands were soaked in sweat under the gloves.

The surgery is finally over.

Ideally, such a heavily bleeding patient would require a blood transfusion, but I don’t know their blood type, nor can I safely extract and transfuse blood from someone else.

Assuming the patient lost about a liter of blood, they should survive without transfusion. For now, I’ll connect intravenous fluids and oral hydration.

Then I woke the patient back up.

“Can I sleep now?”

“If you sleep, you die.”

“Ah, understood.”

“You absolutely cannot sleep until sunset.”

This patient shouldn’t be okay, but they seem relatively normal despite their pale complexion. Why?

Adrenaline, maybe?

Before the surgery, the patient was almost unconscious, on the verge of hypovolemic shock. Yet somehow, they’ve recovered quickly. How?

Blood doesn’t magically regenerate after surgery, so I can’t explain it.

Some people have unusual constitutions, or perhaps it’s due to healing magic. Either way, I can’t complain.

[Heal.]

As long as the patient is stable now, observing them in the hospital for a week should suffice. Though I can’t predict exactly when they’ll fully recover.

“Don’t sleep, but feel free to rest deeply.”

The patient’s name was Kailas, I think. They sat quietly on the bed, connected to a modern IV drip set.

Something feels like I’ve forgotten something…

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