Chapter 98

98. Curing Diseases, Uncuring Diseases (1)

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Another day, another fun outpatient clinic time!

No, wait. Calling it “fun” when people come in because they’re sick feels kinda off. But isn’t getting better supposed to be fun?

Knock knock knock.

“Come in.”

Anyway, the patient heard me and slowly shuffled into the clinic.

Let’s see… An elderly patient who doesn’t look like nobility or a student. The slight limp suggests mobility issues. Could be diabetic foot?

I carefully observed as the patient sat down. No visible deformities or muscle atrophy on the legs. They appear symmetrical…

What could be wrong here? Maybe just a simple injury?

“Ah, Doctor! Hello there. I heard you’re the empire’s top physician, yet here you are treating common folk like me.”

I nodded. Thought about saying something humble but decided against it.

“Anyway, may I have your name and age? And what brings you here today?”

“Laiared, 41 years old. My feet hurt.”

Younger than I expected.

“How does it hurt?”

“My feet keep getting blisters, bruises, wounds… It’s driving me crazy!”

“How long has this been going on?”

“About ten years now.”

“Hmm, let me take a look.”

The patient removed their shoes and socks.

Classic hallux valgus.

The big toe bends outward, towards the other toes. This will likely get worse over time…

“Do we have any medicine for foot pain?”

“There’s no medicine for this condition.”

I tried to recall what I knew about hallux valgus treatment…

Was there a specific treatment method? Probably best not to mess with foot joints… The patient seemed to sense my hesitation.

Figures.

“Oh well, guess there’s no cure then. Other healers said similar things. Still, thank you for seeing me…”

Wait, something clicked in my mind.

“Not so fast. There’s still something we can do… How much is this affecting your daily life?”

The uncle waved his hand dismissively, but I gestured for him to explain further.

“How bad is it?”

“Yes…”

“It gets worse every year. Now even walking is difficult. This is a real problem since I need to work in the fields, but standing and walking has become almost impossible.”

“The big toe overlaps the second toe, right? That’s why your feet don’t fit properly in shoes, leading to constant blisters?”

“How did you know that?”

The patient looked surprised. Of course – I’ve seen enough similar cases.

If left untreated, you might lose the ability to walk entirely.

“Yes. The toes rub against each other, causing blisters after just a few minutes of walking. It’s truly unbearable.”

I thought about how to phrase this. Unfortunately, there was no gentle way to put it.

“Um… Do you really need all your toes?”

****

There’s actually a straightforward treatment method for hallux valgus. Not commonly used in modern medicine, but definitely effective.

Most symptoms arise because the big toe bends outward, encroaching on the second toe’s space.

Simple solution: Just remove the second toe. We can safely amputate one toe at the hospital.

“Do you really need all your toes?”

“No, not really besides the big toe…”

“Exactly.”

Currently, there’s no other viable treatment option here. However, we can safely remove the second toe at the hospital, completely pain-free.

Without X-ray machines, correcting the foot structure or adjusting toe angles isn’t feasible. But amputation is possible.

“Think about it.”

“Just a moment…”

The patient stared at their foot.

Specifically, the problematic second toe. Though unconventional, I had seen this procedure performed in real hospitals.

Back then, I thought the patient was pretty tough. Now, though, there seems to be no other solution.

“Take your time. Consider whether the symptoms are bothersome enough to warrant amputation, and how necessary that toe really is.”

“I see… Tough decision.”

“You can take as much time as you need. This isn’t an urgent condition. You can come back in a few hours, or even months if needed.”

“What would you do, Doctor?”

“What?”

The patient hesitated.

“If this happened to you or your family, how would you explain it? What choice would you make?”

Even if it were me, I’d probably choose amputation after some thought. For a family member, I’d recommend the same.

“I’d choose amputation.”

“Really?”

“Because the second toe isn’t really essential. Plus, hallux valgus tends to worsen over decades.”

The patient nodded resolutely. This won’t be a complicated surgery.

****

Since we have the time, let’s proceed with the surgery immediately.

The patient elevated their foot using a few pillows. I cleaned the area with alcohol and shaved all hair from the foot using a razor.

That completes most of the pre-op preparation.

“I’ll administer anesthesia now. You won’t feel much.”

The patient silently nodded. Istina stood behind me.

“Now, Istina, watch closely. Can you tell why we need to remove this toe just by looking?”

“Yes, walking would be difficult like this.”

“Good. So what complications could arise during toe amputation?”

“Bleeding, infection, gangrene.”

Correct as always.

“So, how do we prevent these?”

Istina thought for a moment.

“To prevent bleeding, we keep the leg elevated above heart level and monitor closely for immediate hemostasis if needed.”

“Excellent.”

“We sterilize the surgical tools, clean the patient’s foot, and remove all hair to prevent infection.”

“Well done. Anything else?”

“Not sure…”

Difficult to expect more than that. Still, she did pretty well.

“The foot goes inside shoes, which contain lots of anaerobic bacteria. When sweat builds up, it gets worse. For three days post-op, we need to actively monitor for infection and change bandages twice daily.”

“Understood.”

“We should also check for any unusual wounds on the patient’s foot in case of diabetic foot. None present, right?”

“Ah, good point.”

Checked earlier – no suspicious scars or ulcers on the patient’s foot. Doesn’t seem to be in the diabetic foot risk group. Though I’m not sure if we can measure blood sugar levels here.

“We could use a tourniquet to restrict blood flow before surgery.”

Istina nodded like a scolded child. She answered well, but didn’t cover everything possible.

Anyway, the surgical procedure remains standard. Sedation with propofol IV, followed by lidocaine local anesthesia.

Make incisions along the planned line…

“Saw.”

Istina handed me a small saw. Cutting off a toe isn’t technically difficult, though I’ve never used a saw on a patient before.

“This might hurt a bit.”

Anesthesia usually doesn’t fully reach the bone…

Though we did administer propofol. I started sawing, and the patient winced slightly. Can’t be helped. It’ll be over soon.

“All done. Scissors.”

I finished cutting off the toe with surgical scissors. Just need to close the wound now.

“Watch closely, Istina.”

“Yes.”

“Looks easy, but be careful. If the skin folds inward while suturing, sweat glands or hair could grow inside the tissue.”

“Ah, I see.”

“Must be done carefully. Come take a look.”

Despite the lengthy preparation, the actual procedure went quickly thanks to the small size of the toe. After stitching up the surrounding flesh, I removed my mask.

“All finished. No walking today. Change the bandage daily, and I recommend wearing sandals for a week.”

The patient didn’t respond this time.

Sedative effects haven’t worn off yet. Come to think of it, this was quite interesting…

Compared to academy knight students screaming despite receiving propofol, fentanyl patches, and local anesthesia…

Seems like regular people are different somehow. Not sure how to investigate further though.

I took a step back as Istina wrapped the wound with white bandages. Another successful operation without major issues.

****

Meanwhile, Istina scratched her head. I’m sure I carelessly tossed the stethoscope into my gown pocket earlier… Where did it go?

Good thing today’s patients didn’t have respiratory or cardiac conditions.

“Professor, have you seen my stethoscope?”

“Don’t know. You need to keep better track of your own things.”

“Yes…”

“Will buy you another next time.”

Professor Asterix didn’t seem to be listening. He was busy preparing glass bottles of medicine for the recently operated patient.

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