Chapter 107
IO (intraosseous access)
Administration of fluids or drugs through the bone instead of a vein.
The principle is simple.
Bones, unlike how they look, are hollow inside and directly connected to veins.
So if you inject fluid into the inside of a bone, the medicine flows through the bone into the veins.
Any drug used in a vein can usually also be used through IO, and unlike those paper-thin veins, bones are large, so it’s also a method with a very low failure rate.
But if you only hear that much, one natural question will come to mind.
— “If it’s easier to access than a vein and has no drug side effects, then can’t we just use the bone for everything?”
It sounds like a method with no drawbacks at all, so why are the people who’ve ever received this treatment so incredibly rare?
The reason is simple.
“Ugh...! Aaaah...!”
“Gregor! Hold her down tight!”
“Aaaah!”
“Hold on! You have to endure it!”
Because it hurts like hell.
From the moment the needle goes in, and for as long as the medicine keeps flowing in.
Enough to make a mother dying of puerperal fever snap right back to her senses.
A needle is going into the bone from the start, so of course it hurts.
“Saint... is this really going to be okay?”
Gregor, pressing worriedly on the mother’s shin, asked.
He was skillfully restraining the thrashing patient so she wouldn’t get hurt.
“Yes. You’re doing well.”
Saying that, I connected the needle in the bone to the IV line.
Then I looked at Erpen.
“Erpen-nim. Could you keep pumping the IV?”
“Wouldn’t that make it go in too fast and burst a vessel?”
“If it were in a vein, yes. But the place we’re putting the fluid now is bone.”
The inside of a bone is hollow, but it’s filled with marrow.
Unlike veins, marrow doesn’t flow, and its pressure is fairly high.
Simply raising the IV bottle won’t get the medicine into the bone.
So IO had to be pumped by hand.
“How many times do I have to keep doing this?”
“Prontosil is a drug that needs to maintain a certain blood concentration for a certain length of time to have an antibacterial effect. So we need to keep infusing it until the patient gets back on her feet.”
Then I remembered Erpen’s position and corrected myself.
“You can have another junior healer do it.”
“No. It feels like I’ve gone back to my roots, and I like that.”
The hospital director smiled as he pumped the IV.
Beside him, a junior healer fidgeted anxiously.
“It’s been ages since I last felt the excitement of learning.”
Probably about three hundred years.
I swallowed the words that had risen to my throat and focused on the patient again.
The mother was thrashing in Gregor’s grip.
Erpen looked down at her worriedly and made a suggestion.
“Isn’t the injection too painful? Maybe giving her a little anesthetic would help...”
“It’s meaningless.”
I dismissed it firmly.
The pain of an intraosseous injection comes less from the needle prick than from the fluid filling the inside of the bone.
You’re filling the inside of a bone, which should be empty, with another liquid, so the patient is tormented by the pain of pressure squeezing from within.
Local anesthetics don’t work very well on pain like this.
And as for general anesthesia, it can’t be used in septic patients because of the risk of respiratory depression.
In the end, this patient’s pain was entirely hers to bear.
“That much pain won’t kill you.”
“Ugh...!”
“Gregor. Gag her.”
“Understood.”
“Uuuugh...!”
The marchioness’s dignity was a wreck, but there was nothing we could do about it.
After all, you have to stay alive before you can worry about dignity.
A few minutes passed as we wrestled with the patient.
“Time’s up. The antibiotics should have spread throughout her whole body by now.”
“Understood, I’ll cast Heal right away.”
Erpen, who had been pumping the IV, activated a spell.
However,
Clang!
“It failed. I must have miscalculated the concentration in her bodily fluids.”
Not used to sensing the levels of antibiotics and bacteria in the blood, the spell had failed once.
“I’ll cast it again. It seems putting it into bone needs a little adjustment, unlike a vein.”
Heal once more.
This time, warm light successfully seeped into the mother.
‘So healers really are mages after all. They can calculate something like this on the spot.’
That was something I couldn’t do.
They say they calculate the ratio of bad energy and good energy flowing through the human body and reflect it in the spell.
There was no way a normal person like me could do that.
‘The clinical concentration of antibiotics will have to be left to the healers.’
My role ended here.
After developing the medicine and confirming that it works, the rest is the healers’ job.
That was also the limit of a healer in this world who couldn’t use divine magic and stood apart from everyone else.
As I thought that, before long the patient’s fever began to drop rapidly.
“Hah... Hah...”
I brought a stethoscope to the gasping mother’s chest.
Crackling sounds from her lungs.
‘Pulmonary edema.’
A complication that can certainly appear in puerperal fever that has worsened into sepsis.
Fortunately, there was someone here who could deal with pulmonary edema.
“Erpen.”
“Speak.”
“Please do bloodletting one last time.”
“Didn’t we say bloodletting is meaningless for sepsis?”
“It would be meaningless if the bacteria were still multiplying.”
Saying that, I gestured to the old elf and brought the stethoscope over.
Erpen focused on the mother’s breathing.
“This sound...”
“There’s fluid in her lungs.”
Because the bacteria have ruined the body’s osmotic balance, the fluid in her blood has filled her lungs.
All right, here’s the question.
If there’s fluid in the lungs, what’s the fastest way to get it out?
“Looks like it’s time for bloodletting.”
“Correct.”
Strictly speaking, what she needs is emergency dialysis, not bloodletting.
To explain in a little more detail, pulmonary edema accompanying sepsis is treated with diuretics first.
That means getting the water out through urine.
If the diuretic doesn’t seem to work, then we move on to emergency dialysis.
But since we don’t have any diuretics here, we’ll leave it to our high-performance bloodletting machine, Erpen.
“Then if we see this kind of breathing trouble in a sepsis patient, we should do bloodletting?”
“Hmm... I’ll explain the details later.”
“Got it!”
Cheerfully, Erpen immediately began preparing the mother’s bloodletting.
Watching him skillfully make an incision on the inside of her thigh, I admired him inwardly.
‘Oh, so he’s using the femoral vein? Guess he really is a bloodletting authority.’
There is an order to the veins used for bloodletting, no, for dialysis.
1st is the jugular vein.
2nd is the femoral vein.
In this case, the patient’s veins are hard to see, so we go in through the relatively lower-failure femoral vein.
After that, Erpen inserted a catheter into the vein and, while casting Heal, swapped her blood out for fresh blood.
The elven healer watched the bucket filling with blood, eyes sparkling.
“We’ve found a new bloodletting method. Thank you, Saint.”
“....”
What on earth was his obsession with bloodletting?
I wanted to ask, but held back.
I didn’t want to go back three hundred years and listen to the long, drawn-out bloodletting epic that had continued ever since.
Leaving the patient in Erpen’s hands, a healer came up to me and whispered in my ear.
Whisper whisper.
As soon as I heard what she said, I turned away from the hospital room.
As I left the hospital room, Gregor followed after me.
“Saint, where are you rushing off to?”
“I’m going to the Rapabri Sect treatment center.”
“For what reason are you going there...?”
“Because I just heard about how the Rapabri Sect would be handled.”
“Handled...?”
“Yes.”
A few days ago.
Right after I said the Rapabri Sect did not support germ theory, I started thinking about what to do with them.
No matter how precious their own lives were to them, denying germ theory was no different from shirking responsibility.
So, while I was thinking about how to deal with them,
“After seeing today’s events, I was convinced. At the very least, those people were the kind who did their best in their own place.”
The moment they decided they couldn’t save the patient, they sent her this way.
At the very least, I thought they deserved a chance.
“I’ve finished speaking with the Inspectorate. The Rapabri Sect will not be held responsible for any of its mistakes so far.”
“The... Inspectorate?”
Gregor looked at me with wide eyes.
A pardon from the Inspectorate was no different from an imperial pardon.
If anyone ignored that and punished them anyway, it would be the same as disregarding the authority of the imperial family.
So it was only natural he’d be surprised to hear the Rapabri Sect was being pardoned by such a place.
“May I ask what reason allowed them to receive a pardon?”
“Ah, well...”
He let out a dry laugh beneath the crow mask.
“This is going to be a long story. I’ll explain it in the car on the way.”
*
A few days after Prontosil began being used in earnest at the Adamberta Infirmary.
The Rapabri Sect suddenly reversed its stance on germ theory.
— [Our sect also actively supports germ theory, and as of this moment we hereby announce that all midwives will be employed as honorary healers of the Rapabri Sect.]
The biggest reason they suddenly changed their attitude was the Inspectorate’s pardon.
— [The Inspectorate hereby states that, from this moment onward, imperial law shall not hold the Rapabri Sect accountable for any of the ‘mistakes’ it has committed so far, and shall not permit any disadvantage to befall them in this regard.]
The Inspectorate’s sudden backing of the Rapabri Sect.
Three major factors lay behind that backing.
And the visitation room at Eshenvalt Academy.
The Black Saint’s paladin, Gregor, and the woman seated opposite him were discussing it.
“What are the three, brother?”
“One is Viagra.”
Viagra.
Spinal injuries, drug addiction, heavy-metal poisoning, side effects from magical experiments, the passage of time, and so on.
A last line of defense for the men of this age who had lost their manhood for all kinds of reasons.
It wouldn’t be an exaggeration to say that since this miracle drug appeared, the Empire’s reproductive-age population had surged dramatically.
“I heard that even the head of Count Horn’s house, who took a concubine late in life, recently had a child.”
“...Wasn’t he in his fifties?”
“I couldn’t believe it when I heard it either.”
Gregor laughed in disbelief, his beard twitching.
“It’s not just the count’s house either. Similar news keeps coming in among other mixed-race couples too. So these days the number of babies being born keeps increasing more and more.”
“The Rapabri Sect must be busy.”
“Yes.”
About three years since Viagra came out.
During that time, births had increased by nearly twenty percent.
“And the second thing to pay attention to is vaccines.”
Vaccines.
The thing that protects against the plague that has claimed the lives of the most children in this world.
“Since vaccines appeared, child mortality has been dropping like a stone.”
At first it was the pus disease (smallpox) vaccine, but recently other vaccines have also begun to appear.
There are still only three kinds, though.
Even so, the number of children who safely made it to adulthood had nearly doubled.
Including children who no longer ended up disabled, the number was even greater.
“More children are being born, and unlike in the past, the chance of those children catching a serious illness has also decreased. And with the recently developed... ”
Gregor stopped mid-sentence and looked around.
He glanced around and then whispered in a voice so low that only the woman opposite him could hear.
“Don’t tell anyone. The Saint recently developed a germ-killing medicine. It’s something that will be revealed in a few months, so don’t tell anyone until then.”
“I understand. But what does that have to do with the Rapabri Sect?”
“That medicine is a treatment for puerperal fever.”
“...?”
The woman murmured blankly.
“Puerperal fever...?”
Puerperal fever.
The number one cause of death for women in this era.
And the most common reason so many children end up losing their mothers.
Even top-tier senior healers couldn’t do anything about that disease.
And now there’s a medicine that could treat it?
“Then if only it had come a little sooner, my mother too...”
“...”
The two of them paused and lowered their heads for a moment.
Breaking that silence, the woman tried to lighten the mood with a joke.
“If a medicine that treats puerperal fever really exists, then the populations of the other races will increase a lot.”
“I think so too. The beastfolk in particular might double.”
She nodded at Gregor’s words.
“I understand what you mean, brother. But how is that related to the Rapabri Sect’s pardon?”
“Both the Church and the Empire are expecting the birthrate to increase by 1.5 times, or perhaps even 2 times, from here on out. And if the Rapabri Sect properly helps with deliveries, the population will explode in the future.”
“So that’s why they’re pardoning them.”
“Yes.”
Population is national strength.
Of course, overpopulation isn’t desirable.
But for humanity, which could be wiped out by demonic beasts at any moment, more people is better for now.
“That’s also why they hired midwives in droves.”
Delivering babies doesn’t especially require a healer.
So they probably set up a system where midwives handle the births and healers deal with any problems afterward.
“Then if even the Rapabri Sect acknowledged the existence of germs...”
“That leaves only the Mensia Sect.”
The woman nodded.
“No wonder. These days, even my friends in the Healing Department have been saying the Mensia Sect’s days are numbered. So that was it.”
“Yes.”
“Thank you, brother.”
The woman got to her feet.
“Thanks to you, I think I can decide which sect to join.”
“Good. I’m glad I could help. But I do have one question...”
“What is it?”
“Aren’t you a first-year in the Healing Department right now?”
“I’ll be a second-year in a few months.”
“Even so, you still have two years until graduation. And besides, you’ll train for four more years at the academy infirmary where the healers created by the Saint train, so that makes six years left, doesn’t it?”
The woman looked at Gregor with an incredulous expression.
“You’re supposed to decide on a sect early, while you’re still a student, and build your connections.”
“If you put it that way...”
Gregor reluctantly accepted that.
Then, suddenly remembering something, he said to the woman as if in warning.
“Right. Father told me to remind you as well—you know the academy infirmary opens next year, right?”
“I know very well, brother.”
“The Black Saint will be coming there too, so you absolutely mustn’t challenge him like you did the other healers, okay?”
“Okay.”
“And the Saintess of the Lamp too!”
“I know, I know.”
The black-haired woman half-listened to Gregor’s warning, letting it go in one ear and out the other.
“Honestly, I just hope you don’t strip inside the infirmary, brother.”
“What do you mean by that?”
Gregor, seated on the chair, struck a pose that emphasized his forearms.
“A healthy mind dwells in a healthy body. Showing this healthy body to the sick and instilling in them a longing for muscles—that’s the best treatment I can offer, isn’t it?”
“Haa... I clearly heard from Father that you’d gotten better...”
The woman put a hand to her head.
Just as the woman, after finishing her visit, was about to leave the visitation room.
Gregor said to the woman—Jenny Lyrik.
“Right. Jenny. Father wanted me to tell you something.”
“What is it, brother?”
“He says you should ease up on the gambling.”
Flinch.
“Just asking in case, but you’re not working as an infirmary assistant because you blew all your pocket money on gambling, are you?”
“I... haven’t been gambling lately...”
“Horse racing?”
“...”
Jenny fell silent.
Gregor’s gaze sharpened.
“Could it be that you’re borrowing money from a friend...”
“J-just a little from my roommate...”
“How much did you borrow?”
She held up three fingers.
“3 copper?”
She shook her head.
“3 silver?”
She shook her head.
“Don’t tell me... 3 gold?”
Grrr... nodded.
“...”
“...”
“Please tell Father gently.”
“I’ll say it exactly as it is.”
“No!”
Jenny clung to Gregor’s vestments and hung on.
Gregor shook his younger sister off and shouted.
“Let go! Visiting hours are over! We have to go back to the capital now!”
“I can’t let go! At least don’t tell him I borrowed money from Charlotte!”
“I know already!”
“What about the fact that you’re doing holy-power shuttle duty at the infirmary?”
“That one I’ll have to tell. We sent you there to study, and you’re out here making money for gambling.”
“Aaaagh! It’s practice! It’s like practice, I tell you!”
“Bah! Stop spewing nonsense!”
It was an hour later when Gregor finally left the visitation room.