Chapter 62

Episode 62. Monster Hunting Festival (2)

****

Gastric lavage and administration of atropine.

“Ugh… Cough… Uuuuuurk…”

The mage who was lying down just moments ago sat up on the bed and heaved for quite a while. Istina had already cast a healing spell on the patient.

“Are you feeling any better?”

“Nope.”

This world is great. Thanks to healing magic, recovery is incredibly fast. Without the healing magic from the healer who accompanied this patient earlier, they might’ve already died from respiratory distress.

“Just out of curiosity… Why did you eat the mushroom?”

“Ugh… I usually eat them to replenish mana, but I must’ve overeaten or maybe it was a different kind. Anyway… thank you.”

“Does that mean you can just pick up any random mushroom off the street? If it weren’t for me, Teacher, you could’ve really died.”

“Yes…”

Ina bowed deeply. Working at the hospital teaches you something: never underestimate people.

There are all kinds of crazy folks out there. Eating mushrooms randomly because you’re bored while walking down the street is just the tip of the iceberg.

Like someone using cucumbers until they break inside and have no way to get them out, so they come to the ER looking awkward…

Don’t think too hard about it.

Never underestimate regular people. Just because I don’t eat strange mushrooms while wandering in the forest doesn’t mean everyone else has the same common sense.

****

Anyway, the mushroom-eating teacher went home alive. Hopefully, they learned the lesson not to eat nameless mushrooms from the woods.

“There aren’t as many patients as I expected?”

“Dunno. Maybe the monsters are fighting gently?”

I thought there would be more trauma patients…

With so many people going out monster hunting, there should be some injuries. But all we’ve seen are weird cases, and none from actual fights with monsters…

Ah. I see them now.

“Hey, right after I said that, here comes a stretcher!”

“Istina… Never say aloud that there are no patients. Just think it in your mind.”

“Got it.”

The goddess of fate doesn’t tolerate provocation. Patients can arrive anytime, so enjoy the quiet moments while they last.

Even though the first patient was just someone who ate mushrooms and collapsed, it was anticlimactic. But this one coming in now is a real trauma case.

I ran over with Istina.

“Patient information!”

“Academy student, Miss Elenore. She has impaired consciousness and bruising on the left thoracic cage! Broken ribs on the left side, weak pulse!”

“What happened?”

“Bear!”

No further explanation needed.

Wait… Does a bear count as a monster? Why would anyone fight wild animals instead of proper monsters? Not important right now though.

Let’s check. Lacerations on the side, bruises on the chest.

This looks serious. The pulse is faint. She’s breathing, but her complexion is pale.

I tried checking the pulse again. Nothing from the wrist… Then I checked the neck.

It’s there, but it’s rapid. Low blood pressure, slight tachycardia. This means-

I turned to Istina.

“The patient is hemodynamically unstable. Take her to the operating room and call a nurse! And bring the auscultation device!”

Cyanosis, low blood pressure, and tachycardia. While bleeding might be the cause, trauma can lead to various complications.

Punctured lungs from broken ribs? Internal bleeding in the chest cavity? There are multiple possible conditions, but few solutions.

Luckily, there’s one good thing:

Internal organs seem fine. No bruises on the abdomen this time.

First, let’s stabilize the blood pressure. I took out an epinephrine injection and administered it into the vein of the patient’s arm.

Epinephrine is a vasoconstrictor.

Injecting it intravenously causes the blood vessels throughout the body to constrict, raising blood pressure slightly. It may also reduce internal bleeding if present.

The pulse isn’t back yet, but the patient seems more alert. Perhaps the epinephrine redirected blood flow to the brain?

Still, the epinephrine seems effective. I connected an IV line to the patient’s arm. Let’s hope the blood pressure stabilizes.

Let’s wait a few minutes. Time to wake her up.

“Miss! Stay awake! I’m about to palpate the injury site, so respond if it hurts!”

“Uh… It hurts even when I’m still-“

“Palpating now.”

“Aaaah! It hurts!”

She seemed unconscious before, but she’s perfectly fine now.

As I mentioned earlier, if you suspect internal bleeding and fall asleep, you might cross the River Jordan. You need to keep them awake.

“Aaaaah!”

Miss Eleanor… What a powerful voice! Still, despite her clear reaction, her complexion keeps getting paler, and her pulse weaker.

“Auscultation device!”

Why is it taking so long? Impatiently, I snatched the auscultation device from Istina’s hand.

We need to check if the heart is beating abnormally due to trauma or if there’s blood pooling in the chest cavity or lungs. A cardiac monitor would’ve helped diagnose sooner.

“I’ll perform auscultation now.”

I furrowed my brow.

Think harder. If the lungs fill with blood, you’ll hear crackling sounds or bubbling noises. These are caused by fluid in the lungs.

If fluid accumulates outside the lungs but within the chest cavity, friction sounds occur as the lung moves against the pleura due to liquid.

The lungs don’t seem filled with fluid.

Normal breathing sounds. No signs of bleeding inside the chest cavity or fluid in the lung tissue.

Finally, the pièce de résistance of auscultation: the heart.

The heartbeat is audible but rapid and strained. More importantly… There’s a friction sound from the heart.

This indicates bleeding in the pericardium, which is compressing the heart and preventing it from functioning properly. Though auscultation alone isn’t definitive, this is my diagnosis.

“The problem is with the heart.”

Istina looked at me.

“Will you operate?”

“Let me think for a moment.”

Thoracic surgery is one of the most difficult procedures. Even if I open this patient’s chest and operate… The chances of survival afterward aren’t high…

Though the heart is problematic, it’s not something I can fix surgically. So what can I do?

There is a way to relieve cardiac tamponade. By opening the pericardium.

Cardiac tamponade occurs when the heart is compressed due to fluid accumulation in the pericardium. Naturally, this leads to various issues.

Pulmonary circulation fails, causing fluid to accumulate in the lungs, and arterial blood pressure drops.

The cause of the compression matters. If it’s damage to the coronary arteries or major blood vessels, there’s nothing we can do. But we can remove the fluid pressing on the pericardium.

If we had an ultrasound machine, we could use a needle alone. Since we don’t have one here, inserting a needle blindly isn’t an option. We’ll have to perform the procedure under direct vision. It won’t be easy, but…

“We can’t find the source of bleeding surgically. I’ll incise the patient’s pericardium to drain the fluid compressing the heart. Prepare for surgery.”

Istina nodded.

****

Hurry. Preparing for surgery took less than two minutes. We were already preparing beforehand anyway.

“Position ready.”

Pericardiocentesis.

Normally, this procedure only requires a needle. Insert a syringe into the pericardium and drain the accumulated blood.

The issue is that ultrasound is typically used during this process. Without ultrasound, you can’t safely insert the needle into the pericardium.

Inserting a needle without ultrasound guidance might puncture the heart instead of the pericardium.

Then… Instant death.

“I’ll make an incision between the ribs. Exposing the pericardium through the rib spaces and then cutting it open visually.”

“Will she survive?”

“Probably.”

Istina frowned.

The patient looked at me fearfully. It was pitiful.

“Can we avoid surgery? I feel fine now. If I just rest for a bit-“

“It’s due to the drug effects. You’ll die soon.”

“Die?”

“If we don’t operate.”

The patient’s hands are already turning blue.

One side effect of epinephrine is that it can cause peripheral blood vessels to contract, leading to poor circulation in the extremities when blood pressure is already low.

It’s better than no blood reaching the brain, but if it isn’t resolved within hours, fingers and toes will die. We can’t leave the pericardial fluid untreated.

The current feeling of normalcy is just an illusion created by the drugs.

“Can’t we use anesthesia?”

“No need for anesthesia.”

We don’t have time for anesthesia anyway. Who knows what could happen if we accidentally anesthetize near the heart.

“You’re opening the heart, right? Cough… Cough…”

That was a deep cough. You can tell the lungs are filling with fluid without using the auscultation device.

“This is the sound of fluid accumulating in the lungs… Starting the procedure immediately.”

The goal is not to touch the heart. We need to precisely open only the pericardium.

Did this patient injure their lungs during the fight, or is it fluid accumulating in the lungs due to worsening cardiac tamponade?

Either way, there’s no time to waste. I couldn’t tightly shut my eyes… So I opened them as wide as possible. The surgery will succeed.

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