I Became a Plague Doctor in a Romance Fantasy Novel - Chapter 98



Episode 98. Curing Illnesses, Uncuring Illnesses (1)

Episode 98. Curing Illnesses, Uncuring Illnesses (1)

Another joyful outpatient clinic time.

No, it’s a bit weird to call it a joyful outpatient clinic time when people are coming because they’re sick. Still, wouldn’t it be joyful if their illnesses got better?

Knock, knock, knock.

“Come in.”

Anyway. The patient, hearing my voice, slowly walked into the consultation room.

Let’s see. An older patient who doesn’t look like a noble or a student. From her slightly limping gait, I could tell that she had difficulty moving. Diabetic foot, maybe?

I carefully watched the patient as she sat down. There were no visible deformities or muscle atrophy on her legs. They looked symmetrical.

What’s the problem, I wonder?

Could just be a foot injury.

“Oh my, Doctor. Hello. I heard you’re the Empire’s best physician. You’d treat someone ordinary like me?”

I nodded. Thought about playing it humble, you know, saying ‘not at all’, but. Couldn’t find a real reason to.

“Anyway, your name and age, please. And what’s troubling you?”

“Ryerd, 41 years old. My foot hurts.”

Younger than I’d thought.

“How does it hurt?”

“My feet keep blistering, bruising, getting cut up, I’m just about dying from it.”

“When did this start?”

“About 10 years ago.”

“Oh, dear. Let’s have a look.”

The patient took off his shoes and socks.

I looked at his feet.

Classic hallux valgus.

Big toe angled outwards, towards the other toes. It’ll probably just get worse over time.

“Is there no medicine for foot pain?”

“There’s no medicine for *this*.”

I vaguely remember hearing something about hallux valgus. I wracked my brain for a bit.

Was there a treatment for hallux valgus? Best not mess with the foot joints. The patient eyed me, then looked around nervously.

It was the same expression as always.

“Oh dear, there’s no cure, right? Other healers said the same thing. Still, thank you for seeing me…”

Ah, I remembered.

I interrupted the patient.

“It’s not over yet. There’s still something we can do… How uncomfortable is your foot?”

The man shook his head as if to say it was beyond words. I gestured for him to explain more.

“How much?”

“Yes.”

“Ah. It gets worse every year. Now, even walking is difficult. It’s a big problem, I need to work in the fields, but standing and walking is hard.”

“Your big toe overlaps with the second toe, or vice versa, right? So it’s hard to fit your foot into shoes, and you get blisters everywhere.”

“How did you know?”

The patient looked surprised. His eyes asked how I knew without him telling me. Well, I’ve seen a few people with similar conditions.

If it gets worse, you might not be able to walk.

“Yes. My toes rub and twist, and I get blisters after just a few minutes of walking. It’s killing me.”

I thought about how to bring this up. But no matter how much I thought about it, I couldn’t find a way to say it gently. I just had to say it.

“Um. Do you need all your toes?”

There is a simple treatment for hallux valgus. It’s not commonly used nowadays, but it’s definitely not ineffective.

Most symptoms of hallux valgus occur when the big toe bends outward and encroaches on the second toe’s space.

Without overthinking it, you can just cut off the second toe. A hospital can safely remove one toe.

“Toes? Aren’t they necessary?”

“Besides the big toe, there aren’t any toes that are truly necessary.”

“Ah…?”

“There aren’t any other treatments possible here right now. But, I can safely remove your second toe at the hospital. Painlessly.”

Foot correction, toe angle surgery – realistically, that’s impossible. We don’t even have an X-ray machine. But, cutting off a toe, I can do.

“Choose.”

“Just a moment.”

The patient stared at their foot.

Glaring at the problematic second toe. It’s not like this is some completely bogus treatment, I’ve actually seen it done at hospitals in the real world.

Back then I just thought, ‘Man, that patient’s tough,’ but right now I don’t see any other solutions.

“Take your time to think. Consider if your symptoms are bothersome enough to cut off a toe, how much you need that toe.”

“Hmm, it’s a dilemma.”

“You can take your time to think it over. It’s not a condition that changes daily. You can come back in a few hours, or even a few months.”

“What does the doctor think?”

“About what?”

The patient hesitated.

“If you, doctor, or your family, had this condition, how would you explain it? What would you choose?”

Even if it was me, I would have hesitated, but ultimately I would have chosen to just cut it off. If it was family, I would have recommended they just get the toe cut off as well.

“If it were me, I’d cut it off.”

“Really?”

“Didn’t really see a need for the second toe, you know? And this bunion looks like it’s getting worse, it’s the kind of thing that deteriorates over decades anyway.”

The patient nodded, their face set with a determined look. It wouldn’t be a difficult surgery.

Since we had the time, we decided to do the surgery right away.

From noble mtl dot com

The patient propped up their foot with a few pillows. I wiped their foot down with alcohol, then used a razor to shave off every single hair, leaving it completely bare.

That pretty much finished the prep.

“I’m going to give you the anesthetic. It won’t hurt too much.”

The patient nodded without opening their mouth. Istina was standing behind me.

“Alright, Istina. Watch closely. You can see just by looking why this toe needs to go, right?”

“Yes. It’d be hard to walk like that.”

“Exactly. So, what are the possible complications when we cut off this toe like this?”

“Bleeding, infection, and gangrene.”

Right on the money.

“And what are the measures we need to take to prevent each of those?”

Istina thought for a long moment.

“To stop the bleeding, we need to keep the leg elevated above the heart like this, and watch closely so we can stop it immediately if it starts.”

“Good.”

“To prevent infection, we need to sterilize the surgical tools, sterilize the patient’s foot, and remove all the hair from the patient’s foot.”

“You answered well. Anything else?”

“I don’t know.”

It’d be hard to expect more than one answer right now. Still, this was decent enough.

“Feet go inside shoes, and shoes are full of anaerobic bacteria. It’s worse if there’s even a little sweat in there. For about three days after surgery, you need to actively monitor the infection site, and change the bandage twice a day.”

“Yes.”

“If there’s diabetic foot, the wound might not heal, so you have to check if the patient has any strange wounds on their feet. You don’t, do you?”

“Ah, right.”

I’d looked carefully earlier, and the patient didn’t have any strange scars or ulcers on their feet. I don’t think they’re in the high-risk group for diabetic foot. I’m not even sure if there’s a way to measure blood sugar in this world, though.

“Before the patient’s surgery, we can also restrict blood flow by tying off the leg with a tourniquet.”

Istina nodded like someone being scolded. She answered well, but the problem, if you could call it that, was that she hadn’t mentioned absolutely everything possible.

Anyway. The surgery procedure was the same as always. Sedate with a propofol IV, then local anesthesia with lidocaine.

Make an incision along the incision line with a scalpel, then…

“Saw.”

Istina handed me the small saw. Cutting off a toe isn’t a difficult task, but the truth is I don’t remember ever using a saw on a patient before.

“This is going to hurt a bit.”

Usually the anesthesia doesn’t reach all the way to the bone.

That’s why I gave the propofol, though. I started sawing, and the patient frowned a little, looking like they were in some pain. There’s no way around it. It’ll be over soon.

“All done. Scissors.”

I finished cutting off the toe with surgical scissors. Now, all that’s left is to finish the surgery.

“Look carefully, Istina.”

“Yes.”

“Even if it looks easy, this. If the skin folds inward when you suture, sweat glands, sebaceous glands, and hair can grow inside the tissue.”

“Ah, I see.”

“You have to cover it carefully. Come take a look.”

The preparation took a while. But since the toe was so small, the procedure finished quickly. I stitched the surrounding skin just enough, then took off my mask.

“It’s all done now. You shouldn’t walk today. Change the bandage every day, and I recommend wearing sandals for a week.”

The patient didn’t answer this time either.

The sedative hasn’t worn off yet, it seems. Thinking about it, it was kind of an interesting point.

Considering the Academy’s Knight Department students screaming and yelling even after getting propofol, fentanyl patches, and local anesthesia…

There must be something different about ordinary people. There’s no way to find out what, though.

I stepped back, and Istina began wrapping a white bandage around the patient’s wound. Well, it ended without any big problems.

Meanwhile. Istina scratched her head. She was sure she’d just shoved her stethoscope haphazardly into her gown pocket, but she had no idea where it went…

Good thing the patient who came in today didn’t have any respiratory or heart problems.

“Professor. Have you seen my stethoscope?”

“No idea. You should be responsible for your own things.”

“Okay…”

“I’ll buy you a new one next time.”

Professor Asterix didn’t seem to be listening to Istina. He was busy preparing a vial of medication for the patient who’d just had surgery.