Case 2: Acute Appendicitis (Part 2)
Mages had the ability to read the flow of magic. Most of them could vaguely see magic flow, such as during activation of spells and magic tools, but few could see the magical flow in the human body. This was a world where diagnostic tools did not exist. However, I had trained my eyes enough to replace ultrasounds and CT scans, and could be used to diagnose diseases.
「The adventurer earlier had a part of his intestine become rotten and suppurated. If you do not open his abdomen quickly and remove the rotten part, he may not survive.」
「Huh? Wait, what do you mean?」
「Reina, I’m going to save the adventurer now. That’s what I’m trying to do. And I need your help. Will you help me?」
I took out a magic recovery potion from my bag and gave it to Reina. She’d used up her mana teleporting here. I needed her magic for what I was about to do, and it was better to replenish her mana as a precaution. We left the food we couldn’t finish, paid, and left the bar. It was a bit of a waste, but there wasn’t much left anway.
「The healer’s clinic is this way, right?」
Most healers who weren’t adventurers opened clinics in town for the sake of convenience. These healers opted to set up shops to conduct treatment safely in town instead of risking themselves as an adventurer.
In the clinic the adventurer was carried to, a healer was already casting healing magic. The adventurer’s symptoms lessened but did not resolve completely, no matter how much healing was cast.
「I knew it, it’s a curse…」
The healer ran out of mana and hung his head in disappointment. Healers were helpless against curses, and anything a healer couldn’t heal was called a curse. However, I had to prove that it was not a curse. Perhaps, this was the reason I was transferred to this world.
「I’m going to take over.」
I waited for the healer to finish before calling out to him. Among the healers present, there were some who could sense magical flow, even if they weren’t up to my level. The healer showed his ability through his attitude after looking at me.
「No matter how good a healer you are, you can’t cure curses.」
The healer, drenched in sweat, gave me his place while speaking to me. His tone was rough with frustration. I understood his feelings as a healer.
「Shuji, will you be alright?」
「Yeah, and you’re gonna help me, Reina.」
「Of, of course.」
Neumann, the adventurer, was crouching while holding his sides. This was his body’s defence mechanism, where the abdominal muscles spasmed in response to extreme pain.
「Sorry, but please face up… yes, try to relax. Endure the pain for a bit…does it hurt more when I press down, or when I release like this?」
「When, when you release it…」
「I see. Okay, listen carefully.」
When I pressed Neumann’s lower right abdomen, there seemed to be considerable pain. And the pain was aggravated more when I released the pressure from my hand. It was a reaction to pain called rebound tenderness, which indicated peritoneal irritation, meaning that the inflammation had spread to the peritoneum. Therefore, the contents of the appendix may have leaked out since the inflammation had already spread around it. If left alone, acute peritonitis could be fatal.
(Note: More info on the pereitoneum and more below)
「This is not a curse. A part of the intestine has rotted. But rest assured, I can treat this.」
His adventurer partner exclaimed. It was the warrior-like guy who had gathered the healers at the bar entrance just now.
「Yeah, but I can’t treat it unless you trust me completely. In order for me to treat you, I have to cut open your abdomen and remove the rotten intestines.」
This was a world where surgery was unheard of. Most wounds were healed by healing magic, so there was never a need to perform an operation. Moreover, most people could not understand why we would need to operate as a treatment, because there was inadequate knowledge about this disease.
「…Please do it,」said Neumann. 「I…cannot die yet.」
「I understand, I will do my best. I need the other people here to fetch me some things.」
A fellow healer answered. I think her name was Miria. I told Miria to go to the market to buy the necessary herbs.
「Now then, Reina. Please make this person sleep.」
All the metal instruments and needles were heated in a boiling water bath, so holding them was a problem. I thought I’d scalded my hand when I held it after it cooled down a little. When the temperature was just barely hot, I grasped them again to familiarize myself with them. I should reflect on this and put in more effort into preparation if I were going to do this next time.
I now had instruments which had been sterilized in boiling water. The instruments weren’t specialized surgical instruments either; they were just instruments that I brought because I thought I could make them work. There was a small knife instead of a scalpel, a pair of scissors, various tweezers as forceps, and a sewing needle and thread. There were a lot of other things such as cups of saline solution, trays, and other metal things, but when I thought about the fact that I was going to perform a full-blown surgery, I became nervous.
In truth, I did not realize how much harder it would be without the proper instruments. In short, I had my work cut out for me.
「Reina, will he really not wake up?」
「It’s fine. He won’t wake up even if his arms and legs are chopped off. Probably.」
I’d thought black mages were a troublesome group. I couldn’t help thinking that I did not want to get close to them because they could cast magic that could cut people’s consciousness by that much. Reina had used the coma spell, which was even stronger than the sleep spell.
The mask that I had hastily made stuck onto my face uncomfortably, but I thought it was better than nothing. It was not the time to think about this now.
「Are you sure this will be fine?」
「There’s no such thing as 100 percent. However, I have confidence that the odds are in my favour. Please relax.」
I was irritated by the boorish mannerisms of the clinic’s healer. He probably doubted my success, especially with the shabby instruments I was working with. However, it was useless to try to explain anything to him.
I soaked both my hands in liquor with extremely high alcohol content. Because it was a simple sterilization method, I didn’t consider this much protection at all. I realized how dangerous it was without using rubber gloves as a barrier against unknown infectious diseases, but I was unable to do anything about it even after thoroughly racking my brains. There was no option to not do this.
「I’m started…starting the surgery.」
As I conspicuously fumbled my words, I held the knife in my hand.
I incised the skin of the lower right abdomen while stretching the skin with my left hand. I confirmed the appendix’s location by watching the flow of magic. Once the skin was cut, I held the tweezers in my left hand and scissors with my dominant right hand. After separating the tissues under the skin, some muscles came into view. It was a muscle called the internal oblique, but blood began to flow because I’d nicked a small blood vessel when I parted the muscle. Hemostasis was achieved by using a hot iron to cauterize a part of the bleeding vessel. The handle of the hot iron was disinfected with boiling water and further sterilized with alcohol. One of the basics of surgery was to pay attention to sterilization thoroughly, and was even the first lesson taught.
The smell of burning meat drifted through the clinic. When I first smelled this as a student, I was shocked. Although that time, the surgeon used an electric scalpel instead of a hot iron.
Soon, I reached the peritoneum. Once I cut it open, I would reach the abdominal cavity, the bag in the abdomen containing organs like the intestine. Few people ever saw the inside of a person, be it someone from Japan or another world. Additionally, it was rare that one could casually observe a surgery like this.
I spread the incision to allow my hand to fit through. I inserted my hand into the abdominal cavity, and grabbed the large intestine. If I traced it, I could find the caecum, where the small intestine ended, and at the tip of the caecum was the appendix. It was normally cord-like, but in cases of appendicitis, it may adhere to the intestines around it.
The only people near Neumann were the clinic healer and Reina. However, some people might have felt nauseated when they watched the human intestine coming out from afar. I heard someone rush out.
「I knew it. It was critical.」
The appendix had festered and swelled, and the contents were about to burst. Its contents were, essentially, faeces containing a mass of bacteria. If something like that were to burst and spread into the abdominal cavity, it would become a serious problem.
I ligated the blood vessel supplying the appendix. In modern Japan, we used sterile silk thread. However, in this world, I used threads refined by spider monsters. All of them were sterilized once in boiling water. I then used a needle used for sewing to ligate the blood vessel. Sooner or later, I had to make proper instruments for surgery.
Finally, once the appendix itself was ligated with thread, it was excised and the stump was inverted into the intestine and left embedded in it.
I also cast a healing spell. I was in a fantasy world, after all.
The healing spell, which was cast directly in the abdomen, completely healed the intestinal wound. After sterilizing the abdominal cavity, I rinsed it using the saline solution whose concentration I had adjusted. The divided muscles and skin were easily stitched up, and then healed with another healing spell. This was a surgery that could never be done in modern Japan where magic did not exist. I didn’t understand it at all, but the wound healed perfectly, thanks to magic. And it did not have any imperfect suturing of the intestines, as it would with traditional surgery.
After I came to this world, I realized it the first time I healed wounds with magic. This could be applied to surgery too. I’d never done it, but it actually worked. The scary thing about surgery was fear that the surgeon was inexperienced, or that the patient’s ability to recover was weak, leading to suture failure, which prevented wounds from healing.
Although suture defects on the skin were annoying, defects in the intestinal sutures could cause leakage of the intestinal contents and could be life threatening. I could confirm such defects immediately here. If we were in modern Japan, I wouldn’t notice the defect for several days, and I would then require large-scale diagnostics such as imaging procedures. The wound would also take a few days to heal. This could be called a cheat, I suppose. It might not have been understood by anyone, but the fact that one of the most worrisome parts of surgery could be eliminated completely definitely reduced the burden on the surgeon’s mind.
I grinned broadly under the mask.
「The surgery is over.」
When I said that, the clinic burst into cheers.
「W-what a healer! He cured a curse!」the warrior from Neumann’s party exclaimed.
「Healer? No, I’m not a healer.」
I had never called myself this ever since I came to this world, but from now on, I would refer to myself in this manner.
「I am Shuji Miyagi, a doctor.」
The rest depended on Neumann’s resilience, but it would be okay now. Honestly, I needed to give him medications with antibacterial properties after this. The surgery was completed perfectly, and there was healing magic, so infection shouldn’t be an issue, but I still had to be careful as a surgeon.
This was very annoying. Reina seemed to have noticed it while putting away the tools.
「Shuji, what’s wrong?」
Neumann’s partners were delighted with the success of the surgery, but Reina saw me pondering about something. Reina had also watched the first surgery, and it seemed she was a little excited, as her ears were a little red.
「Well, there’s actually a medicine I really need.」
「Eh? What do you need?」
This was the reason why I moved to Yggdrasil. It was not included in the list I entrusted Miria with earlier, because I knew it wasn’t easy to obtain.
「Erm, the drop of the World Tree.」
「Do you mean… the sap of the World Tree which would not drop till the seventh layer and above?」
「Oh, right. That’s what we came to get last time.」
「We came to fetch it due to a noble’s request. It had a really high request fee.」
「That’s right. The reward was so high that I could spend weeks doing nothing.」
I had been really lucky to find antibiotics mixed in the drop of the World Tree. However, it was also unfortunate that it had been discovered in the drop of the World Tree, because it was a very valuable and rare item.
「Oh well. It may be fine without it.」
It was unlikely for bacteria to get into the wound. Healing magic was amazing, but it wasn’t perfect. There were things that could not be cured, and they were called curses.
One day, I may need the drop of the World Tree. I also need other medicines. That was why I decided to build a hospital here in Yggdrasil. The drop of the World Tree couldn’t be obtained in other towns. To refine it into a potion, I needed a high level refinement magic. If I put up a request for adventurers, the request fees, including transportation costs, would be enormous.
After casting the wakening spell on Neumann, he woke up.
「E-eh? It…doesn’t hurt.」
Neumann got up and used his hand to check his abdomen, confirming there wasn’t even a scar on it. Then Miria hugged Neumann.
「Thank goodness! I was really worried!」
「Sorry…for worrying you.」
I spoke to the clinic healer.
「Let him only drink a small amount of water for half a day. Tomorrow morning, if he wants to eat and doesn’t have any abdominal pain, he can go ahead and have some porridge, which is also good for digestion. Gradually switch from the soft diet to a normal diet, and he should recover completely after a few days.」
「Oh, I see. Leave it to me.」
Reina and I left the clinic after being thanked by Neumann, Miria, and their companions. It was probably fine if I left him to the healer. I told him where I stayed and to contact me if something came up.
「Reina, you were in the middle of your meal. Would you like to go back to the bar again?」
What happened? Reina’s face had been slightly flushed for a while, and it was not very energetic either.
「A-are you alright? Did you become ill during the surgery?」
「That’s not it…」
So weird. The usually talkative and full of energy Reina was not doing well. Was it some kind of infection, or…
「That surgery… was amazing. Shuji, I will say it again.」
「I want to follow Shuji.」
Eh? What? Why did she suddenly become grumpy? Was she hungry?
「Idiot! Shuji is an idiot!」
I was kicked in the back. Ouch! This was unreasonable! I didn’t understand!
And thus, my first surgery was a success. I didn’t know how much I could achieve in Yggdrasil. Nor did I think I could change the world if I worked hard. However, the feeling I had when I first thought of aiming to become a doctor, wanting to save the sick and dying in front of me, had resurfaced.
「Starting tomorrow, I have to find a place to build a hospital, make surgical instruments, make medicines… there’s so much to do.」
The ale was delicious when I went back to the bar to drink. That reminded me that the beer I drank after surgery in Japan was delicious too.
From then on, I was going to build a hospital here. And I hoped I could help those who were not suffering from “curses”, but “illnesses”. Reina and I parted outside our rooms, and I crawled into bed alone while staring at the ceiling of the inn. I reached out with my hand. I might not be able to grasp everything, but I would have to work hard from tomorrow on.
I murmured to myself.
「Since I was transferred to another world, I will build a hospital to perform surgery with magic.」
I slept well that night.
TL Doctor’s Corner: Acute appendicitis is an acute inflammation of the appendix. The incidence of this is about 1.1 cases in 1000 people. The most common cause of appendicitis is intestinal obstruction or infection. It presents with the classical triad of symptoms: abdominal pain on the lower right abdomen, or around the belly button if <48 hours, fever, and vomiting. Although, this triad happens only in about 50% of cases. If you present with symptoms like these, it is advised to visit your nearest local hospital immediately. Appendectomy is the only curative treatment for this, but management of this disease varies depending on the severity of the appendicitis. With modern technologies nowadays, like laparoscopic appendectomy, scarring will be minimal and the hospitalization period will be reduced too.
Editor Doctor’s Corner: The peritoneum mentioned in this chapter is basically the sac that surrounds the abdominal cavity and prevents your guts from poking out between your muscles. Also, when the wound splits apart at the suture lines, it’s called dehiscence, and it’s one of the most annoying-as-hell things to fix in surgery, because you just know, if it failed once, it will probably fail again, and it never heals well without a scar. This might be addressed again in a later chapter, so we’ll see what happens! Side note: I’m really jealous that he can have instant imaging with magic. Saves so much time!