Chapter 63

63. The Monster Hunting Festival (3)

***

Alein, a healer affiliated with the Academy.

The eldest graduate student under Professor Fisher, Dean and healer of the Department of Healing, who was one of the event supervisors this time around. Though he worried endlessly…

“But we’ve got that professor, right?”

The professor who healed all the boors trying to kill each other during the swordsmanship tournament without a single casualty—none were injured beyond recovery.

“I heard he was recently transferred from the Imperial Palace as chief physician. Guess his skills are legit.”

Instructions came down from the Dean’s office:

“Send any patients showing even the slightest issue to Professor Asterix. Even those who seem fine should go to him.”

And so Alein followed orders on-site.

“I just hope this goes smoothly without anyone getting hurt… though the last case I sent over seemed kinda serious…”

“Let’s trust him. There’s nothing else we can do.” Alein nervously tapped his foot outside Professor Asterix’s ward.

“Will this student make it?”

***

“This patient is gonna die if we don’t act fast.”

“Ugh, headache. If we leave it alone, blood won’t circulate properly to the brain, but if we boost the blood pressure using epinephrine, their extremities might die off!”

No matter how I think about it, this seems like the only option. With a sigh, I picked up the scalpel again.

“We don’t have time! Hold them tight!”

“Hold on a sec, Doctor!”

The patient looked shocked, muttering something while Istina waved her hand in my peripheral vision. What now?

“Professor, you really aren’t going to use anesthesia?”

“Hey, no time for that. Just bite down on this cloth. It won’t hurt too much.”

Well, guess they can’t handle it without anesthesia…

As I spoke, my hands didn’t stop moving.

Lidocaine could constrict blood vessels, but administering more isn’t ideal…

“The heart’s being opened? There’s no way it won’t hurt-”

“Istina, shut up.”

Istina closed her mouth. I want to explain everything clearly, but there’s simply no time.

Carefully, I positioned the scalpel between the fourth rib space on the patient’s left side.

We don’t need a large incision here.

Two centimeters will be plenty.

The muscles between the ribs are thin—just a few millimeters layered in three sections…

A moment later.

Through the small cut, the pericardium revealed itself. The patient flinched slightly but didn’t scream in pain. Now I can see the pericardium clearly.

There’s no risk of damaging other structures.

Just slowly drain the fluid.

“Almost done. Please bear with it a little longer.”

“Urgh…”

The patient furrowed their brows but didn’t move or scream. Pericardial centesis may be dangerous, but it doesn’t cause much pain.

With forceps, I grasped part of the pericardium and inserted a needle inside. Blood-mixed brownish liquid began filling the syringe…

The effects will be immediate.

Compared to all the fuss, the actual procedure to treat cardiac tamponade wasn’t complicated. All we had to do was remove the fluid with a needle.

The incision between the ribs is nail-sized.

The puncture in the pericardium is needle-sized. It’s considered tricky mainly because messing around near the heart is inherently risky.

“All done. Let me stitch it up now.”

A few minutes later.

Lady Eleanor sat upright on the bed, looking somewhat nauseous. She gagged and coughed a couple of times, but…

She’s alive.

“Oof…”

“How does the patient feel?”

Her pale complexion improved. Her breathing seems steady too.

“Urgh… still feels like my heart’s pounding…”

“It touched your pericardium.”

“Am I okay now?”

“The procedure went well. You should recover within a day or two.”

If the blood pressure stabilizes, she’ll survive. If not… well, then there’s no solution.

We’d have to repeatedly drain the fluid from the pericardium to keep the heart beating. Either she gets better or… dies.

“Do I have to stay seated?”

“Yes. Water accumulating in the lungs would be bad.”

Because water previously pooled in her lungs, lying down isn’t allowed. Doing so might cause respiratory distress due to fluid redistribution.

It’s complicated, but when lying down, the fluid spreads across a larger surface area in the lungs.

The height of the lungs creates hydrostatic pressure that helps prevent further fluid leakage, among other things.

Puncturing the pericardium and draining the fluid was nerve-wracking…

But the procedure succeeded, and the patient survived.

I handed Eleanor a blanket. The knight still looked uneasy as she sat there.

True, expecting someone whose heart was pierced by a needle to feel good would be absurd. Still, saving her life makes me feel somewhat accomplished.

“Let me check your pulse again.”

“I don’t want to. Thank you for saving me, though.”

“Come on…”

Eleanor wrapped herself in the blanket, folding her hands defensively on her knees. Fair enough…

She glanced at me, suspicion still lingering in her eyes.

“So, what exactly did you do?”

“There’s a sac called the pericardium surrounding the heart. We surgically removed excessive fluid from it since too much liquid can compress the heart.”

Eleanor tilted her head.

“Was it heart surgery?”

“No, I didn’t touch the heart itself.”

“I see. Why was there so much liquid?”

“Likely due to trauma. Could be damage to the coronary arteries or major blood vessels, or maybe smaller vessel injuries. Right now, we can’t tell.”

Still, I’m optimistic.

Given her returning pulse and color, the internal bleeding in the pericardium might’ve stopped. From here, medication alone should suffice.

Beyond this point, there’s no other course of action.

“In any case, the procedure went well. If your blood pressure and pulse stabilize, you’ll be fine. We’ll monitor for sepsis and administer preventive antibiotics since the pericardium was opened.”

Eleanor nodded slowly.

“What if things get unstable?”

“If that happens, there’s no remedy. We’ll try our best to manage symptoms and aid recovery.”

“Honest. Understood.”

Eleanor asked many questions.

Typically, after such procedures, people are too tired or sick to ask this much.

“You’ll need to stay in the ward for a few days and take medicine. Sit up to avoid respiratory distress; lung fluids may take time to clear.”

If the heart rate continues rising, beta-blockers could help. If pleural effusion persists, loop diuretics might be necessary.

These must be monitored closely.

For prophylactic antibiotics, I’ll use ampicillin.

However, if endocarditis or sepsis fully develops, ampicillin won’t suffice…

We’d need far stronger antibiotics then… but let’s deal with that if it comes to it. I placed a glass bottle of pills beside her bed.

“Take one pill every morning.”

“What kind of medicine is this?”

Thinking back, this person who couldn’t even have their pulse taken earlier sure talks a lot… But I shouldn’t complain. A few days ago, I treated a drug addict.

“This kills bacteria. Since you underwent pericardial opening, you’re at high risk for bacteremia, so we’ll give you antibiotics as prevention.”

Eleanor stared at the bottle before nodding. Hopefully, she’s convinced.

“When can I be discharged?”

“Wait three days. If there are no issues during that time, discharge is fine.”

“Thank you.”

“Rest well. And stay sitting up!”

I caught Eleanor as she tried to lie down.

Seriously, sit up! Lying down could trigger respiratory distress!

Let’s assume her disoriented state stems from shock. The knight’s treatment is complete.

I left the ward with Istina.

***

It was quite the ordeal.

The monster hunting festival must be wrapping up about now. We returned to the research lab and slumped into our chairs. What a long day.

“Did you document the patient records?”

“Yes.”

Istina nodded.

“More people got hurt for surprisingly dumb reasons than expected. Thought most injuries would come from fighting.”

“Yeah.”

Working in the ER desensitizes you to whatever patients do, but collapsing after eating mushrooms solo was genuinely surprising.

What’s wrong with that guy’s brain?

Istina appeared exhausted, leaning sideways on the couch and staring blankly at the distance.

Oh yeah, I forgot to mention that.

“Istina, remember the knight we treated earlier?”

“Ah, yes!”

“If her body temperature exceeds 38°C, heart rate goes above 90, or respiratory rate surpasses 20, let me know. She’s at high risk for sepsis, so we need to watch carefully.”

After a brief silence, Istina pondered, then tilted her head uncertainly.

“What exactly is sepsis?”

“Bacteria circulating in the bloodstream.”

The king of internal medicine diseases.

“Understood. So, fever over 38°C, heart rate above 90, and respiratory rate over 20 means sepsis?”

It’s a bit complex, but roughly yes. I nodded.

“Please explain further.”

Maybe because she’s tired, Istina sat cross-legged, deep in thought. After cleaning her glasses, she turned to me.

---