Chapter 140
***
Is there any phrase as hollow as saying that all human lives are equal?
If you said the lives of noble heroes—like firefighters who would sacrifice their own lives right then and there to save someone—
and Nazi-like human trash whose only contributions to the world are shit and carbon dioxide were equal, who would agree?
Even in modern 21st-century society, where the concept of natural human rights has developed, that was not an idea people could easily accept.
I’m no different.
If Hitler and Gandhi arrived at my ER at the same time, my internal compass would point straight to saving Gandhi.
It seemed I wasn’t the only one who thought that.
“Um... Teacher.”
As I was preparing to operate on the black mage, Aila cautiously approached and said,
“I... hate black magic. And I hate even more the people who abuse it to torment others.”
“...”
“Honestly, I don’t even understand why you’re trying to save people like this...”
I flinched.
Because there was a professor under that crow mask who made his living with black magic.
Of course, I knew she hadn’t meant it that way.
Even so, I couldn’t help feeling a little stung.
“Student Aila.”
“I’m sorry to say this right before surgery...”
“You don’t want to come into the operation?”
“...To be honest, no.”
I understand.
I really do.
Right now, I don’t want to perform the surgery either.
I don’t like that damn chimera sorcerer to begin with.
Just how many people had he harmed to get that ability?
As someone who knew what kind of conditions chimera-type magic needed to reach completion, I couldn’t help being even more reluctant.
But what could I do?
Twenty-first-century doctors, especially trauma surgeons, are trained not to be able to do that.
“I feel the same way, Aila. Student Jenny will probably feel the same too.”
“Then why...?”
“Because there’s a patient there.”
A doctor must set aside value judgments once a patient comes in.
Whether that person is Hitler, a pig-demon from the North, or even someone trying to summon Cthulhu.
If there is a patient, you treat them first.
I had a situation like this in my previous life too.
— “A patient from prison. They said he was beaten into this state by fellow inmates.”
When you work in a university hospital, people like that come in as patients and make you wonder whether you really should save them.
Some of them are literal trash you’d only ever know from the news.
Honestly, it often made me wonder whether we really should be treating people like this with tax money.
Every time, my teacher taught me this:
— “I’m pissed too, but we still have to save them first. You should’ve taken the Geneva Declaration when you graduated, right?”
— “I deliberately didn’t recite it then.”
— “The moment you get your license, you automatically declare it.”
— “Tch.”
Jokingly speaking, once they’re a patient, whether they’re the Northern Pig Demon or Hitler, a doctor has to save them.
That was something my teacher often said.
And at some point, I too had been brainwashed by that belief and would save the person on the operating table first.
Whether it was some scum who committed domestic violence, a bastard hauled in after getting stabbed during a voice-phishing scam, or that goddamn bastard who sold drugs to kids.
I saved them first without judging them.
From my previous life, through Limbus Pit, and up to now.
There was only one reason.
“Student Aila, what do you think would happen if healers had the authority to pick and choose who gets to survive after being treated by them?”
“That’s ridiculous! Only the gods could decide something like that!”
“Exactly. That’s why I don’t judge good and evil.”
“Ah...”
The moment a doctor judges a patient’s good and evil, medicine turns into a tool of judgment and punishment.
Of course, someone will say otherwise.
That you just need to treat the irredeemable trash and nothing else.
But compromise is like inertia.
Once you start compromising, from that point on you keep compromising one thing after another.
At first, let’s not treat murderers.
Next, let’s not treat criminals.
Next, let’s not treat repeat offenders.
Someday, we might stop treating people simply because we don’t like them or because they crossed someone in power.
So I don’t judge, to make sure that doesn’t happen.
Because that could become irreversible arrogance.
— “That’s pretty irrational.”
— “Exactly. What are we supposed to do if this irrational altruism is the foundation of the 21st-century medicine you’re training in?”
If you’re going to pursue a conviction, don’t leave room for any exceptions, however extreme it may seem.
To the point that it looks stupid, foolish, irrational, and contradictory to others.
And if you still have a hard time accepting that...
— “Then let’s change the logic. We save these people because we hate them. We save them so these cowards can’t flee into death and can pay for their sins while still alive.”
— “Do you really think that makes sense?”
— “Then do you have a better one?”
—- “...Nope.”
Then think of it as going to the trouble of treating them so they can be punished properly.
“We can think about what to do with this black mage after that.”
“Whether that means torturing him or carrying out the death sentence...”
That was something we’d leave to the Public Security Bureau after saving him.
I knew how contradictory it sounded, but this was a doctor’s creed, so there was nothing to be done.
“That’s what Student Jenny was thinking too, right?”
I stood blankly at the entrance to the operating room and said as I looked at Jenny, who was fidgeting.
She seemed to still be unsure whether her choice had been the right one.
I said to Jenny like this:
“Student Jenny. Your choice was right.”
“...Saint, aren’t you going to laugh at me?”
“Of course not.”
“But...”
“Student Jenny. Sorry to cut you off, but it looks like the anesthesia has kicked in.”
While we were chatting, the preparations for surgery were finished.
Jenny looked like she wanted to say something else, but I set that aside for later.
I nodded to Jenny and Aila and said,
“If you don’t want to come in, you don’t have to.”
If this had been a proper healer, they would have dragged me in for a counseling session, but
Jenny and Aila aren’t healers; they’re students in the Healing Department.
Strictly speaking, they had no obligation to participate in the surgery—only the right to observe it.
I wasn’t such a narrow-minded person that I’d force them into surgery.
“The choice is up to you students.”
“I...”
“I’ll go in.”
Rather than the hesitant Aila, Jenny spoke first.
“I want to go in.”
“Good, come on in.”
“I-I’ll go too!”
Aila raised her hand late.
And so, I began the surgery with the two students in tow.
***
“Timeout...”
“We don’t have time, so I’ll skip the time-out.”
I cut back heavily on procedures that weren’t directly related to keeping the patient alive.
“No imaging exam?”
“It’s a gunshot wound to the right upper abdomen. Skip all tests and start the laparotomy. Anesthesiology, please initiate the massive transfusion protocol.”
“Yes, sir.”
Normally, the standard procedure would be to assess the extent of the damage through imaging.
But this patient didn’t have that luxury.
Right upper abdomen.
Because, of all places, he’d been shot where the liver sits—the organ that doesn’t stop bleeding easily.
‘Of all places, why here?’
There wasn’t a single organ in the torso that wasn’t vital, but
the liver is an extremely important organ, no less important than the heart.
Because just as all blood gathers to the heart, most blood vessels are connected to the liver.
For that reason, once the liver starts bleeding, even if it doesn’t kill you instantly like a heart wound, you die quickly.
That’s why people who’ve lived by the knife stab upward from the right side of the abdomen when they want to kill someone.
Inside the clean, orderly operating room,
I said to the assistant healer,
“Can it be restored with Heal?”
“Saint. Are you really saying we should use divine power on someone like this?”
“...You don’t want to?”
“I’m sorry.”
The healer bowed his head.
“I want to... but I don’t think I can. No, more accurately, maybe I just don’t want to.”
“...”
I thought I understood what he meant.
One of the most important elements in healing magic is the caster’s emotions.
Just as magic needs the image of flames and murderous intent to burn its target,
to heal someone with divine magic, you have to genuinely want them to recover.
That’s why the assistant healer is saying this:
— “I truly can’t wish for this black mage to recover.”
“I’m sorry, Saint. I still have a lot of shortcomings.”
“It’s fine.”
The high-level healers who could restore a liver on the spot all gave the same answer.
They couldn’t feel mercy toward the black mage.
“It’s because our devotion isn’t enough. We’re sorry.”
Not enough devotion?
No.
Because they were devoted, they hated him even more.
And that was why they couldn’t cast Regeneration for him.
But I couldn’t bring myself to blame those healers.
Because I, too, was moving by conviction, not because I truly cared about the black mage.
I wasn’t in any position to criticize them.
That was when it happened.
“I-I think I can do it.”
Aila cautiously raised her hand.
“If it’s just a low-level Heal... I think I can do it.”
“Student Aila. Are you really able to? You’re not pushing yourself, are you?”
“After hearing what you said, Teacher, I started thinking that I really do want that person to recover. I think I can do it.”
Aila looked at me with trembling eyes.
As expected.
Unlike me, who had been mistaken for a saint, the genuine saint seemed able to feel pity even for someone like this.
I silently felt a little respect for Aila and immediately prepared for the surgery.
“Having Student Aila is reassuring.”
Back during the Spring Incident of the Unreturned,
I had saved patients even worse than this with just low-level Heal.
High-level Heal?
Unfortunately, there was nothing to be done.
As soon as the assistant healer who would be casting Heal had been decided, I immediately prepared for the operation.
“Blade No. 10.”
The scalpel was placed in my hand.
Right before I used that scalpel to open the skin, I took a moment to steady my breathing.
“Hoo...”
The important thing with a liver gunshot wound isn’t to dawdle.
If you’re going to open it, you have to open it fast.
But opening it unprepared leads to an even worse result than opening it late.
‘Once the abdomen is opened, it’ll be soaked in blood, so I need to picture the vascular layout in my head and find it quickly.’
Right before the abdomen is opened, the blood pooled inside acts like pressure, compressing the wound itself.
In that situation, what happens once you start opening the abdomen?
The clock that had been running slowly starts racing.
The compressed wound opens, blood spurts like a fountain, and the patient’s condition rapidly worsens.
That’s why you have to picture the blood vessels in your head before you cut the abdomen open.
Because if you look for them after opening, it’ll be too late.
‘The technique...’
Right. Let’s go with that.
As soon as I finished taking a breath and figuring out the surgical estimate, I brought the scalpel to the epigastrium.
Even though the bleeding site was on the right side of the abdomen, I still had to check the whole abdomen anyway to get at the vessels.
The scalpel, starting from the epigastrium, slid down to the navel.
At that moment,
Thwack!
Blood burst out of the abdomen like a fountain.
Once the pressure was released, the blood that had pooled inside burst out.
Even though she wasn’t new to trauma cases, Aila looked flustered.
“Huh? Huh??”
Because the blood gushing out looked anything but normal.
Aila looked at me as if asking whether this could really be saved.
I answered by immediately giving orders to the assistant healers.
“Start packing. Doctor, please suction out the hematoma.”
First, mindless four-quadrant packing.
Stuff gauze into all four directions, as if dividing east, west, south, and north.
Meanwhile, another assistant healer diligently scooped out the huge pool of blood inside the abdomen.
At times, even basins came out.
If we tried to pump it out with a refined, cute little instrument like a suction device, it would take forever.
In a situation like this, we had to scoop out all the blood first, even if we had to use basins, ladles, or buckets.
“...I can see a bit of it now.”
Only after most of the blood had been scooped out did the shape of the liver begin to show through the lenses of the crow mask.
“Give me the Bookwalter retractor.”
At my instruction, a massive, thick metal pillar was erected beside the operating table.
From that pillar, a long metal arm extended over the patient, with an oval ring hanging from it.
Each of the ring’s four sides had hook-like clasps attached to them.
Once those hooks were set into the abdomen, the belly was pulled wide open without anyone having to hold it.
I gently touched the blood-soaked surface of the liver with my finger and said,
“Record it.”
As the suction device drew out the blood, the path the bullet had torn open briefly came into view.
Tracing that direction with my fingertip, I described the condition of the liver.
“The trajectory starts in segment 5, passes deep through segment 8, and goes posterosuperiorly. Segment 7... damage suspected up to the margin. Segment 6 looks intact to the naked eye. No sign of damage to the left lobe.”
After a long time, I divided the liver into eight segments and pictured the bullet’s path in my head.
It pierced from below upward, from the center toward the right lateral side.
Then the damaged vessels must be...
“The surface side looks like parenchymal bleeding with inflow vessel damage... and the deep side looks like venous bleeding... hmm...”
I needed to determine which vessel was bleeding, but I couldn’t be sure.
The liver’s major vessels can be roughly divided into three types.
The hepatic artery, hepatic vein, and portal vein.
Which of those vessels ruptured was the key to the surgery.
“Let’s perform a hepatic sandwich to assess the vessels.”
“A... sandwich?”
Ah, right.
I remembered that the surgical team wasn’t yet accustomed to liver trauma surgery and corrected my wording.
“Place pads above and below the liver, then press from both sides.”
Ordinary hemostasis is done by stuffing gauze into the wound.
But the liver is controlled by compressing it from above and below.
Because the liver tissue is so soft, stuffing gauze into it only makes the wound open wider.
It’s the same logic as being careful when cooking liver.
Of course, I had never cooked with human liver.
After pressing the torn liver with just the right amount of force for a few seconds,
once the gauze was removed, blood began spurting again from the torn liver.
Primary hemostasis failed.
At this point, a somewhat extreme technique was needed.
“The Pringle maneuver... no.”
I was about to order the Pringle maneuver when I stopped myself.
Because I remembered I hadn’t taught it yet.
“Clamp.”
Thinking I should teach them this sometime too, I took the clamp in my hand.
I found the blood-soaked red ligament under the liver leading toward the stomach.
I pinched the vessels gathered beneath that ligament with forceps.
It was to figure out which vessel had been torn.
More precisely, you clamp the place where the vessels beneath the liver converge to determine whether the tear is in the upper or lower vessels.
If pinching the lower side stops the bleeding, then the lower vessels are damaged,
and if the blood keeps flowing as if nothing happened, then the upper vessels are damaged.
Normally, the assistant doctor would evaluate all that and the lead surgeon would mentally work out the next step.
But my assistant doctor wasn’t seasoned yet, so I had to do everything myself.
“...The bleeding has decreased. It’s a mixed injury, with damage to the inflow vessels.”
Ta-da.
The correct answer was that both the upper and lower sides were torn.
Damn it.
I’m giving up on a right lobectomy.
This wasn’t bleeding I could control just by cutting off the right lobe.
I grumbled inwardly and carried out the treatments I could do right away.
I clipped and tied off the small arterial bleeds on the surface with Kelly clamps.
I tied off the shallow liver parenchymal lacerations with thick silk sutures.
The tiny microbleeds were handled with Refresh.
I administered low-level Heal only in areas where the blood had spread thinly.
Even then, there was nothing I could do about the deep bleeding.
But that was fine.
“Student Aila. Restoring internal organs is difficult with low-level Heal, right?”
“Yes, I think so...”
“Then please restore only the vessels.”
By the common sense of the old days, vessel regeneration required high-level Heal.
But once surgery came into existence, it was discovered that if you controlled the bleeding well and connected the vessels neatly with sutures, low-level Heal could still stop the bleeding.
Wouldn’t this amount of hemostasis be enough?
And my prediction was correct.
“Huh? Huh? The bl... the bleeding stopped!”
As expected.
Once the large vessels were tied off and the bleeding was controlled, the smaller vessel bleeding could also be handled with low-level Heal.
Of course, the torn liver itself didn’t come back.
And a torn liver was a danger in itself.
“I’ll wash it out once and check the bile ducts.”
Easy to forget, but the liver is the organ that produces bile, a digestive fluid.
In other words, if the liver parenchyma and bile ducts are left torn, bile can leak into the abdominal cavity.
What happens if a liver like that is left alone?
The digestive fluid starts dissolving the inside of the abdomen.
It isn’t as strong as stomach acid, but liver bile is pretty harsh in its own way, so if left alone it would turn the abdomen into a mess.
That’s why we check the bile ducts, to make sure that doesn’t happen.
“Gallbladder rupture confirmed. We’ll remove the gallbladder. The common bile duct and main ducts are... fortunately intact.”
Call it heaven-sent luck, I suppose.
Because the bullet had passed through cleanly, the biliary system didn’t seem badly damaged.
And then, after inserting the drain into the abdomen,
“I’ll close the abdomen now.”
I finished the chimera sorcerer’s surgery by closing the abdomen.
*
After the surgery was over.
By the time the other healers, including Aila, had collapsed from exhaustion in the operating room,
I headed to the recovery room to check on the patient’s condition.
When I arrived in the recovery room, I found an earlier visitor who had come to see the black mage before me.
It was Jenny.
“Student Jenny.”
“Saint, aren’t you tired?”
“I’m not tired today because I didn’t have many surgeries.”
“...Just how many surgeries do you usually do?”
Well.
About four on average?
I’ve even done a 36-hour stretch.
Compared to that, one surgery wasn’t that hard.
If anything, I was worried about the stamina of the other healers, who had only assisted in the operating room and were already exhausted.
‘Should I make them do morning calisthenics or something?’
Thinking that, I said to Jenny,
“Before going into surgery, what were you trying to say?”
“Well...”
Jenny looked at the chimera sorcerer, who still hadn’t woken up, and said,
“Until now, I hadn’t really thought anything about black mages dying. Even when I went out to subdue black mages, I didn’t really think about it. But...”
Jenny let out a deep sigh.
“But right after my junior subdued this black mage, I heard him muttering.”
— “I... don’t... want to die...”
“Honestly, my heart was cold. But then I remembered the old doctrine...”
“So you asked Erica to save him?”
“...Yes. It was closer to a sense of duty than compassion, though.”
Jenny had a self-deprecating smile on her face.
“It was because of the conviction that made me a healer.”
She took a die out of her pocket.
The same die I had given her as Yulian.
“I have an older brother. At one time, he was someone who couldn’t live up to the world’s standards. When that brother shut himself away in his room, I was criticized for not shedding tears for him.”
She rolled the die in the palm of her hand.
“So I decided I wouldn’t judge someone I knew absolutely nothing about. That’s also why I liked dice. It’s not me deciding; luck decides.”
Drip, dribble…….
The die rolled at the patient’s bedside.
“That I want to save this person too...”
“Is that because of the rule you set for yourself, Jenny?”
“Yes. Separate from my feelings, I have a healer’s duty.”
But Jenny didn’t seem to like her own choice.
“Saint, doesn’t it seem contradictory to you? Me helping cause a situation like this and still trying to save him?”
“Not at all.”
Even American police don’t do it differently when arresting criminals, do they?
They open fire first, and if the person survives, they send them to the hospital first, don’t they?
On the surface, it’s contradiction itself.
You try to kill them right up until just before, and then once they’ve been neutralized and are lying there pitifully, you try to save them.
What’s more, this is a dark fantasy.
A half-baked mindset from my previous life won’t earn you any praise here.
But I liked that contradictory conviction.
After all, where in the world is there a belief that runs smoothly without contradiction?
If there were such a belief, there’d be no ideological conflict or religious conflict; everything would have been unified into one.
That’s why I liked Jenny’s contradictory conviction.
Because,
“I’ve had the same thing happen to me.”
“Huh? You too, Saint?”
“I’ve also treated someone who was trying to hurt me.”
Because that’s exactly how I’m living right now.
Back when I was at the clinic with Erica in my previous life,
there was a clown from Sector H who came to hurt me in the winter.
Once Erica had neutralized him, I gave him the best treatment I could.
It wasn’t because I felt sorry for him, or because I was some saintly paragon who loved even his enemies.
It was simply the doctor-like conviction ingrained in me that moved me.
For that reason, Jenny’s actions didn’t feel strange to me.
When I told Jenny that, she looked surprised and, at the same time, curious.
“Then what happened to that clown...?”
“Who knows?”
Right after that, I don’t know what became of him after the ringleader dragged him away.
And I don’t want to know.
And after hearing that, Jenny looked at me flustered.
“You let the patient you saved get dragged off?”
“I did my duty.”
There’s something you’re misunderstanding: a doctor’s duty ends with doing their best for the patient.
Whether that patient later goes to prison or gets executed isn’t my concern.
Unless you’re going to carry out the sentence on the spot inside a sacred hospital, who takes them away isn’t my business.
“...That sounds like a really convenient belief.”
“In a complicated world, it’s a necessary belief.”
Jenny mulled over that line for a moment.
Before long, she snorted a little laugh and said,
“Then could I try imitating that belief a little?”
“I’d be glad if you did.”
“Then...”
Jenny’s gaze moved to the recovery room exit.
Soldiers in uniform were waiting at the entrance, watching my reaction.
Jenny nodded toward them and said,
“I guess I don’t need to stop those people from taking the patient away, do I?”
“I have no intention of stopping them.”
Normally, people who came out of prison to undergo surgery would go straight back to prison once the surgery was over and they’d recovered.
This world’s human-rights awareness is a bit lower, so I guess they’d take him away before he even recovers.
“Are you going to stop them, Student Jenny?”
At my question, Jenny slowly shook her head.
Soon, the two of us, as if we had reached an understanding, spoke to the soldiers standing at the entrance.
“Sorry to keep you waiting.”