Chapter 76
***
I had just run into Ayla in the hallway.
I wanted to show her around the clinic, since it was her first day.
But the situation wasn't exactly conducive.
“Patient report, please.”
“Male in his forties, fell at a construction site. Consciousness is declining, and the left pupil has started to dilate.”
Over the past few months,
a healer at this clinic who had trained exclusively in strokes gave the report.
Of course, by 21st-century standards, it was still lacking.
Still, by the standards of this age, it was a very solid briefing.
“How dilated is it?”
“Eight millimeters.”
“Understood.”
I visually checked the patient’s head.
The planned surgical site had already been shaved and disinfected.
The assistant healers had taken care of it before I arrived.
A few months had passed since we started working together.
Now, we understood each other perfectly.
“How long has it been since the cocaine was applied?”
“Five minutes.”
“Then let’s begin the craniotomy.”
I picked up a scalpel from the instrument table.
It was my custom scalpel, made by repeatedly modifying a silversmith’s razor blade.
The tip of the scalpel touched the small protrusion in front of the patient’s ear canal.
Starting there, it swept widely around the ear and up to the crown.
I drew an incision line shaped like a question mark.
The thin red line grew thicker and thicker.
I immediately told the assistant healer.
“Refresh.”
“Refresh.”
The assistant healer repeated my words back and used holy magic on the incision line.
Refresh was a spell even lower-tier than Lesser Heal.
At its simplest, it was just bathing the area in divine power, with no catalyst, symbol, or formula.
Because it was so simple, its effects were limited to capillary-level hemostasis and a slight recovery from fatigue.
But that was enough to stop the incision from bleeding.
“Forceps.”
“Forceps.”
I pinched the incision tightly and peeled the scalp back.
The white skull was exposed.
“Hand me the hammer and nail.”
“Yep.”
I lined the nail up against the skull.
Normally, there is a separate head drill called a trephine.
They hadn’t made one in this world.
So I used a nail and hammer instead.
Tap, tap!
First, I make a notch in the skull,
“Trephine.”
I bore a hole with a tool that looks like a wine opener.
You might worry about what happens if I misjudge the force and go in too deep.
That’s actually a question other healers often ask.
— “That’s unfortunate.”
Back in the world I used to live in, this was how we opened someone’s head like a lid.
Surgical trephines have a function that automatically stops when they touch the brain, but that’s 21st-century technology.
In the romance-filled 20th century, brain surgery was done with nails, hammers, and wine openers.
What if you messed up?
You’d just have to count it as contributing to the advancement of medicine.
Well, anyway.
Five holes had been completed along the edge of the skull.
“Gigli saw.”
I took the thin, tough wire saw.
It was the expensive wire saw plated with mithril, one of fantasy’s staple materials.
I threaded the wire saw through the first hole and out through the second.
Gripping it with both hands, I saw back and forth.
Repeating that several times creates a cut line in the skull.
“Elevator.”
I wedged the elevator under the edge of the bone flap cut along the dotted line.
Apply force using leverage, and ─
Pop.
Lid off successfully.
“Please put the bone in saline.”
The opened lid was left soaking in saline.
Now it’s time to examine the brain.
“The hematoma is severe.”
A dark-red mass of blood had gathered on the meninges, pressing down on the brain.
As I examined the hematoma, I sensed someone behind me.
It was Ayla.
She stood with her back against the wall, staring blankly at the surgery from a distance she couldn’t reach.
She looked pale.
It was the common reaction of med students seeing an operating room or dissection lab for the first time.
“Student Ayla.”
Ayla flinched at my call.
“Other seminary students usually faint at this point. But you seem fine, Ayla.”
Other healers sometimes brought acquaintances or their own children to the clinic.
Most of them were theology students aspiring to become healers.
Most of them would faint on the spot when they saw scenes like this.
But Ayla wasn’t fainting.
“Do you think you absolutely can’t handle it?”
Ayla shook her head vigorously.
“Good. Tell me if it gets hard.”
I knew this was harsh on a child who had only just awakened divine power.
But it was a reality she would have to face someday.
Even if it weren’t my operating room, this was an ordeal she would have had to go through eventually.
According to the healers I’d heard from, novice healers basically go through this rite of passage.
They show them pictures or traces of the most horrific sights, or even the real thing, to steel the newcomer’s resolve.
If they don’t mentally armor themselves like this, they’ll break at the most critical moment.
“You already sanitized your hands before coming in, so don’t grab anything with them and just stand there. You’ll be taking part in the surgery a little later.”
“Yes….”
I left the feebly answering Ayla alone.
I moved straight to the next step.
“Incising the dura. Prepare suction.”
“Suction is ready.”
I set the scalpel against the dura and made a cross-shaped incision.
Gurgle.
The moment the membrane split,
the trapped blood—a subdural hematoma—spilled out.
The blood clot that had pooled between the brain and the dura burst out all at once.
“Suction.”
“Suction.”
The assistant healer, repeating my words, brought the manual suction device to the blood pooled around the brain.
With a hissing sound, it began pumping out the blood.
In the meantime, I turned back to Ayla.
“Student Ayla.”
“Yes!”
“Do you know why Heal can’t treat someone with a head injury?”
“I’m not sure!”
Well, of course she wouldn’t.
She was a seminary student before she was a healing student.
I explained in a loud voice, both to explain to Ayla and to review for the other healers in the operating room.
“Heal is magic that heals wounds. It’s excellent for stitching torn blood vessels together or joining broken bones.”
While the assistant kept pumping, the extracted clots were being collected in a bucket.
“But Heal can’t remove blood that’s already pooled. It can’t draw out rotten toxins either.”
Heal is regeneration.
Not removal.
“The reason this patient lost consciousness is because blood pooled in the head is pressing on the brain. So even if you regenerate the torn blood vessels with Heal, the blood that has already leaked out will still be pressing on the brain.”
I pointed at the hematoma that had been sucked out by the suction device.
“That’s why we open it directly like this and drain the blood.”
“Ah….”
“Before I explained this procedure, people thought it was black magic. Right, assistant?”
“Haha….”
The assistant healer gave a dry laugh.
When this person first heard me say I was going to open the head lid, they accused me of planning to use black magic or something.
But once I explained the principle, the misunderstanding was quickly cleared up.
“Back then, Director, you suddenly said we had to open up a collapsed person’s head and touch the brain without even explaining the principle…”
“Did I really say it like that?”
I don’t really remember.
Anyway.
“Feeling a bit better now?”
I asked while checking Ayla’s complexion.
Ayla nodded.
Her face looked much better than before.
“It’s only for a moment that it’s hard the first time you enter an operating room.”
I continued speaking while examining the brain’s surface to find the source of bleeding.
“The reason people can’t bear to watch cruel things is that malice lies at the bottom of those acts. But even the same scene feels different once you realize it’s an act meant to save someone’s life.”
I said, glancing sideways at Ayla.
“Well? Now that you know why we’re opening the head, does the surgery still feel as scary as it did at first?”
Ayla shook her head.
“No… I think it’s much better than before.”
“Amazing, isn’t it? Nobility has a way of making people this resilient. Simply by holding goodness and faith in our hearts, we can gain courage like this.”
Ayla nodded.
As if agreeing with me, the assistant healers also nodded silently.
A doctor’s ability to stomach things is proportional to their knowledge.
Why this surgery is necessary.
Why this person is dying.
What I can do for them.
The better you understand those things, the stronger your stomach becomes.
Of course, there are still some peers who can’t make it all the way into the operating room even after understanding that, but that’s just their nature, so there’s nothing to be done.
“Good. Then come closer, student.”
By the time we finished chatting, the pumping was over.
I also identified the vessel where the bleeding had occurred.
Upper left parietal lobe.
A bridging vein had torn.
I immediately ligated the vein in several places with thread, then called Ayla over.
“Ayla. You said you know how to use Refresh, right?”
“Huh? Yes….”
“Now then, did you learn that Refresh can normally stop bleeding?”
Ayla shook her head.
“I was taught that hemostasis requires at least Lesser Heal. Refresh should only be used for recovering fatigue and stamina.”
“Exactly. Good job studying. That’s the textbook answer.”
I pointed at the ligated bridging vein.
It had been tied off, so the bleeding had stopped.
But the vessel itself had not regenerated.
If the thread came loose, it would bleed again.
“Now then, try casting Refresh on this.”
Right next to the torn vessel,
I pointed to the torn vessel.
“… Here?”
“Yes. Why don’t you try Refresh on this part I’ve tied off with thread?”
Ayla cautiously reached out her hand.
A faint light bloomed from her trembling fingertips.
And the moment Ayla’s divine power touched the ligated area, the torn vein twitched.
Soon, the hole in the vessel was sealed.
Ayla didn’t seem to notice the change yet.
So I loosened the thread to show her.
“See? Refresh stopped the bleeding, right?”
“Huh? Uh… how?”
“Because the necessary conditions were in place.”
Holy magic is ultimately just one branch of magic.
Only the energy source is divine power; from catalyst to symbolism to conditions, the principles are all the same as regular magic.
“Now then, Ayla. When using magic to light wet wood and dry wood, which is easier to ignite?”
“Dry wood, I guess?”
“Right? Dry wood can be lit even with a Lesser Fire spell, but wet wood would require more mana and a more complex formula.”
A prime example is the plague curses that are now all but dying out.
Because of the immunity formed through vaccinations, the amount of mana needed to cast the curses has increased exponentially.
That’s why the plague sorcerers are so desperate to kill me.
This surgery is an extension of that principle.
“Holy magic is the same. If the proper conditions are met, you can produce the same miracle with less divine power and a lower-tier holy spell.”
If you have a container of oil, a Lesser Fire spell can produce the heat of an Intermediate Fire spell.
In the cold northern regions, you can use stronger ice magic with less mana.
And a patient who has received proper emergency treatment can produce a miracle with less divine power.
In some cases, Lesser Heal alone can save a patient with a cerebral hemorrhage.
“Healing magic has developed in that direction all this time. This vein ligation is the same technique.”
A vessel gushing blood can only barely be stopped with Greater Heal.
But a vessel whose torn section has been stitched with thread can be closed with Refresh.
Of course, that was only possible because it was torn, not completely severed.
“Now then, shall we finish up?”
After that, I regenerated the severed vessels with Lesser Heal.
The rest were vessels Ayla still couldn’t handle yet.
The reason Refresh could regenerate them was that they were only slightly torn vessels.
The rest could only be regenerated with Lesser Heal.
After regenerating the vessels and stopping the bleeding,
“Once the brain swelling goes down, I’ll cover it with the bone in a few days.”
Since the brain was swollen tight, I decided not to cover it with the skull and to close only the scalp.
Of course, I could cast Heal to reduce the swelling.
But if I did, I’d have no divine power left for the next patients.
Prioritize and focus.
It was an unavoidable choice in a world with limited resources.
“The pupil has returned to 4 mm.”
Decompression was successful.
“Shall we close the scalp now?”
Time to put the peeled-back scalp back in place and suture it.
“Ayla, are you good at sewing?”
“I sometimes help my mother mend her priestly robes.”
“Good. Healers should be good with thread. Watch carefully how I do it.”
I handed the suture and needle to the assistant healer and said,
“Ty (assistant), please suture from the left. I’ll take the right.”
“Yes, Director.”
The assistant healer took up the needle and began stitching the head one stitch at a time.
Meanwhile, I sewed up the right-side wounds with my usual quick motions.
By the time the assistant healer had managed to close just one incision, I had already sutured all the rest.
After checking the tension of the thread one last time,
“We’re done. I’ll check the surgical instruments.”
While the other healers checked the used gauze and instruments,
I covered the sutured scalp with disinfected gauze.
Then Ayla asked cautiously,
“Director… I think this is going to leave a lot of scars later… Can’t you finish it neatly with Heal?”
“Good question, Miss Ayla.”
Cosmetic concerns are also something a surgeon must consider.
Especially for head surgeries, techniques that leave fewer scars are studied separately.
Treatment isn’t just removing the disease; it’s the process of getting the patient back to daily life.
So appearance can never be ignored.
“Aesthetics are important. But not right now.”
“Why not?”
“Because we’ll have to open it again in a month and cover the skull.”
I pointed to the skull soaking in saline.
“And there needs to be a scar left behind so we won’t get confused when we put the skull back in later. I’ll Heal everything then.”
Ayla looked taken aback.
“I didn’t know that.”
“That was a good question, Ayla. I hope you’ll keep putting the patient first like that in the future.”
I took off my gloves and left the operating room.
“Well then, it’s late, but now I’ll show you around the clinic.”