Chapter 77
*
It was delayed slightly because of an unexpected emergency patient.
Ayla's clinical field training began.
“Student Ayla. Today, I’ll explain in detail what healers do.”
There is one thing to keep in mind here.
Namely, not expecting her to know medical concepts.
Let’s think carefully.
Ayla has been a high school seminary student for less than two days since awakening her divine power.
And she won’t begin seriously studying medical knowledge until she enters the healing department of the academic division.
Right now, all she has is the religious knowledge she learned at seminary.
Would knowledge about blood vessels and nerves really stick in a child’s head?
‘Of course not.’
You can only see as much as you already know.
Even if I taught her serious medical knowledge here, none of it would remain in her head.
So for the time being, I’ll teach her only the most basic fundamentals.
“This clinic also has disciples of other healers. Some of them have already entered the healing department. They may become your seniors or classmates, so you should greet them when you meet.”
“Yes!”
On the way to another part of the clinic with Ayla,
I confirmed one thing.
“I’ll begin the proper tour now. Student Ayla, do you happen to know how other treatment centers are run?”
“I know because I sometimes go to my mother’s treatment center to deliver her lunch.”
“I see.”
That would make the explanation much easier.
“Good. Then I’ll start by explaining the purpose of this clinic.”
I took her toward the entrance.
“There are several types of clinics in each sector. The work done at each clinic isn’t radically different, but every clinic still has its own specialized function.”
In the past, this one clinic had to handle every kind of patient.
Mothers, children, trauma cases, internal medicine, surgery, and so on.
A small boarding house had to serve as a general hospital.
As a result, unavoidable inefficiencies arose.
So when I built clinics throughout the capital, I paid particular attention to dividing up their roles.
“D-1 Clinic in D Sector mainly handles emergencies, trauma, and complex cases.”
D-2 Clinic specialized in obstetrics and pediatrics.
D-3 Clinic specialized in chronic diseases.
D-4 Clinic specialized in infectious diseases.
I also made sure that every sector had at least one clinic with its own specialty.
“We’ll go over the details one by one over the course of a year.”
In any case, I planned to visit all of those clinics over the course of a year.
I turned right at the entrance.
A sign hung on the door leading to a small room.
Emergency Room.
“Student Ayla, have you ever heard of an emergency room?”
“No. I don’t know much about it.”
“Good. Then I’ll start by explaining what an emergency room is.”
There were no emergency rooms in this era.
When an emergency patient appeared, they simply laid them down beside the inpatients.
Perhaps because of that,
healers and aspiring healers always reacted the same way when I first introduced them to the emergency room.
Just like Ayla was now.
“This... is?”
Ayla tilted her head.
When a patient arrived at a treatment center, there were only two possible outcomes.
They were cured.
Or they had an incurable disease.
Because divine magic existed, this was a world where emergency patients could often walk out on their own two feet just seconds after arriving.
That was why the existence of an emergency room inevitably felt unfamiliar.
“Is this different from an inpatient ward?”
“Yes. Some patients have less time than others. This is where we assess such patients and provide initial treatment so they can be transferred to another clinic.”
The emergency room occupied half of the first floor of D-1 Clinic and contained ten beds in total.
Each bed had an instrument stand, and a board recording the patient’s condition hung above the head of the bed.
Three beds were occupied at the moment.
A laborer with a broken arm.
An elderly man brought in with abdominal pain.
And the fall-injury patient I had operated on earlier.
The fall-injury patient would be moved up to the inpatient ward on the second floor shortly.
“Divine power is a limited resource. Someone may die today without divine magic, while someone else can afford to wait two days. Here, we buy them time.”
The surgery we had just performed was a representative example.
If an emergency patient like the one from earlier arrived at an ordinary treatment center, they would pour divine power into that one patient.
Whether the treatment was effective or not was beside the point.
The problem came after the treatment was over.
The healer often had no divine power left to care for the next patient.
In the end, all they could do was watch helplessly as patients died, wringing their hands.
That was the result of healers clinging to the miracle of divine magic and obsessing over a complete cure.
“If we use only enough divine power on the patient we just treated to keep them alive, we can preserve the lives of three more patients like that today.”
So I changed the order of things.
Instead of pouring 40 units of divine power into one person every day,
we pour 10 units into each of four people over four days.
The former saves one person, but gives up on the three who come after.
The latter can save all four people over the course of four days.
All I did was change the order.
With the same resources, the survival rate becomes four times higher.
“It’s nothing so grand. It’s simply a change in perspective.”
Ayla stared at me as if she had been struck by a hammer.
It was a familiar reaction.
The healers who visited this place for the first time,
as well as their disciples and seminary students,
often reacted this way when they heard about the emergency room.
I sometimes wondered whether it was really worth reacting so strongly.
Still, whenever I saw that reaction, I couldn’t help feeling proud.
“Next, let’s go to the operating room.”
The operating room was connected not only to the entrance but also to the emergency room.
When we entered the operating room, we saw a healer in the middle of an operation.
“A fracture patient.”
It was a patient whose leg had been run over by a wagon and brought to the emergency room.
The healer was preparing the instruments for the operation one by one.
Taking care not to touch the surgical instruments, I explained each one from a distance.
“Every operating room and treatment room has holy water and religious symbols placed inside.”
It was a measure designed to conserve even the smallest amount of divine power.
A dazzlingly white statue was mounted on the wall of the operating room.
It was a statue of the Saint of Mercy, the same kind seen in the cathedral’s treatment rooms.
Holy water flowing from the statue’s feet ran beneath the floor of the operating room.
Inside the spotless white room, two healers placed the fracture patient on the bed.
“Watch carefully, Student Ayla.”
The condition of the patient’s leg was severe.
The wound was contaminated with dirt, and the bone was protruding through the skin.
It was an open fracture.
“Student Ayla, what kind of treatment do you think this patient needs?”
“Since it’s a wound beneath the skin, I think they’ll need Advanced Heal.”
“I’m not sure. Shall we take a look?”
The healer anesthetized the patient’s wound.
Then they washed away the mud covering the wound with diluted holy water.
The dark-red blood and brown mud clinging between the torn pieces of flesh were washed away.
Before long, crushed muscle tissue was revealed, dangling loosely.
“Ugh.”
Ayla flinched for a moment.
But perhaps because she had already overcome the brain surgery, she soon regained her composure.
The healer then disinfected the patient’s wound.
And instead of reaching for a brass cross, they reached for a scalpel.
“Student Ayla. Do you know what normally happens if you cast Heal on a wound in that condition?”
“I’m sorry. I don’t know.”
“If you regenerate a wound while contaminated or necrotic tissue remains, that tissue interferes with the wound’s regeneration.”
Of course, the miracle of divine magic could ignore such a minor problem and heal the wound anyway.
It would simply consume more divine power.
“As I explained with the brain surgery patient today, divine magic is regeneration, not removal.”
That was why they scraped away rotten tissue, pus, and every other contaminant before casting Heal.
Debridement.
A technique in modern medicine for preventing infection and promoting wound healing.
Treating a wound this way allowed them to conserve divine power.
“I had quite a time teaching the healers which parts to cut away.”
Debridement was not a procedure that simply left the prettiest-colored tissue and cut away the rest.
Would this tissue survive?
Would this tissue die soon?
They had to remove it carefully while considering the locations of blood vessels, the distribution of blood flow, and even the nerves.
The hardest part was removing tiny bone fragments and bone marrow that were barely visible.
Well, the difficulty was lower than in my previous life, since in this world, even if you cut away a little too much, Heal could somehow fix it.
“Once you clean the wound like that and then cast divine magic, it consumes less divine power and requires less skill.”
As I explained, I noticed an area that looked a little dangerous.
“Doctor. Isn’t that a nerve rather than a tendon?”
“Oh! I’m sorry!”
“Hold on a moment.”
I washed my hands and joined the operation for a while.
It looked somewhat difficult, so I stepped in to help.
“This person has an anatomical variation in their nerves and blood vessels. A nerve shouldn’t be running here. You should record it and perhaps write a paper about it for the academic community later.”
Scrape, scrape, scrape.
They scraped away the rotten tissue with a curette.
“Let’s cut the living flesh into the shape I marked as well. When we graft it, the blood vessels will distribute better if we use this shape.”
I performed additional excision with the graft in mind.
After completing a sufficient amount of debridement,
I stepped back from the operation and returned to Ayla.
“I’m sorry. Let me finish explaining.”
In the meantime, the healers put down their scalpels.
Next, the healers began nailing the bone together.
Clack! Clack!
They were fixing the broken bone in place with a metal plate.
“They’ll temporarily stabilize the bone like that. Lesser Heal can’t reconnect bones and nerves, so we have to rely on natural healing.”
After stabilizing the bone like that,
the healers put down their hammers and nails and picked up their brass crosses.
The two healers took turns casting Lesser Heal.
The blood vessels and some of the tissue regenerated.
As soon as they confirmed that the blood vessels had fully regenerated, they stopped casting Heal.
“As with the previous operation, we’ll stop the surgery here. There are still patients who need divine power.”
The wound would be left open.
Trying to force a large wound closed could cause it to tear instead.
So they planned to close it very slowly over the course of several days.
They would pull skin or muscle over from another part, attach it, and regenerate it.
By repeating that process, they could replace the miracle of Advanced Heal with Lesser Heal.
Of course, I didn’t explain the details to Ayla.
Grafting surgery was too advanced for her to understand yet.
Before long, the patient, whose open wound had been packed with a sponge soaked in holy water, was wheeled out of the operating room.
After finishing with Heal, the priests switched places with other priests and headed to the prayer room on the third floor.
Unlike mana, divine power was not a resource that recovered simply by eating well and getting plenty of rest.
Once it was depleted, they had to replenish it through prayer like that.
“Well, then...”
When I checked the clock, it was already time for lunch.
Before buying Ayla lunch,
I asked her a question.
“What do you think, Student Ayla? How did you find our clinic?”
“….”
Ayla remained dazed and silent for a long time.
***
Ayla’s tour of the clinics continued for some time after that day.
At D-2 Clinic, she watched them treat obstetric and pediatric conditions.
At D-4 Clinic, she observed methods of treating infectious diseases.
During the tour, Ayla sometimes came to wonder about certain things.
“But all these treatments must be expensive. Does the merchant guild cover all the costs?”
“It’s something like that, Student Ayla.”
Naturally, we did charge money.
The healers weren’t coming all the way down here to work for free, either.
It simply wasn’t an amount the poor could afford.
“We charge patients only the minimum possible cost. The Mercure Merchant Guild covers the rest.”
“Then... are the clinics operating at a loss?”
“Almost all of them are.”
There were a few that occasionally turned a profit.
But the losses at the other clinics were enough to make that meaningless.
The expenses the guild was shouldering because of the clinics were by no means small.
“Then why do you keep operating them?”
It was a good question.
In fact, even the executives of the Mercure Merchant Guild asked that question periodically.
People say that a person is different when entering the outhouse than when coming out of it.
The clinic-support program began as a lesson drawn from Viagra’s accidental discovery.
The idea was to conduct clinical trials through the clinics and reduce their cost.
But once they actually saw the clinics’ losses, their minds tended to change.
— “Director Shun. Do we really have to keep doing this?”
Whenever I received that question, I had an argument I used to persuade them.
“Student Ayla. Do you know what we need in order to develop medicine?”
“Knowledge...?”
“Yes. We need knowledge. But knowledge doesn’t appear out of thin air.”
Knowledge doesn’t come from digging it out of the ground.
It all comes from data.
And the clinic-support program was extremely important from a data standpoint.
“Patients can receive treatment cheaply because they allow us to use their information however we wish.”
The clinics weren’t providing these treatments to patients for no reason.
Their place of residence. Their family relationships.
What they ate, what work they did, and whom they met.
What they had done several years ago and what they planned to do several days later.
They received this treatment in exchange for providing all that personal information and allowing us to handle it however we wished.
For reference, even people who were reluctant to give their information to mages because of black mages
didn’t find it strange to tell priests everything from their small daily affairs to their deepest secrets.
Perhaps it was because the concept of confession had taken root in everyday life.
They had no qualms about giving their personal information to clinics staffed by healers.
Well, we would keep their secrets no less strictly than a confessor would, so perhaps it wasn’t entirely a misconception.
“What? You’re using something like that to replace the cost?”
But Ayla didn’t seem convinced by that explanation alone and tilted her head.
Perhaps this was an era when people didn’t understand the importance of personal information.
She didn’t seem to grasp the value of that data.
So I told her the argument that had finally convinced the guild master and the other directors.
“Student Ayla. To make medicine, we need to know what symptoms different patients have, right?”
“Yes, that’s right.”
“Now imagine that most of those patients went only to our clinics. Would other merchant guilds be able to develop medicine at all?”
We had purchased patient data cheaply.
Of course, the data from any one patient might not be worth very much.
But what if that grew to dozens, then hundreds, then most of the patients?
Other guilds would be unable to develop pharmaceuticals without the data our guild possessed.
There’s a reason pharmaceutical companies in the twenty-first century sign R&D cooperation agreements with major hospitals.
— “Research and development cannot be reduced to a simple number. But development often carries a value greater than the numbers suggest. Do you still think this project is useless, directors?”
That argument convinced the other directors and the guild master immediately.
It meant our company had seized power that money couldn’t buy.
In the end, thanks to this support program, the guild and Director Shun gained both a good reputation and profits.
‘I do feel a little guilty about taking advantage of the misunderstanding premise.’
I felt sorry for misleading the patients a little, but I rationalized it by telling myself that they could receive suitable, high-quality treatment at a low price.
“Do you understand now?”
“No... No matter how I think about it, I still don’t understand how this benefits you, Director Shun. Aren’t you sacrificing far too much...?”
“It’s not a sacrifice at all. If anything, I’m always indebted to the patients.”
It seemed Ayla was misunderstanding something again.
But this wasn’t the first time she had misunderstood something like this, so I decided to leave it alone.
“Since we’re on the subject, I’ll show you a representative example.”
It happened to be time for a visit to a research-focused clinic.
Since we had started talking about data, it seemed like a good idea to use that clinic as an example.
“Shall we go to D-3 Clinic today?”
*
D-3 Clinic specialized in chronic diseases.
And when you talk about chronic diseases, there were several conditions our company handled in particular.
Gout. Diabetes.
And erectile dysfunction.
D-3 Clinic mainly cared for patients with those conditions and conducted research based on their data.
Our guild gathered data from the chronic-disease clinics in each sector, including this one.
And we were continuously improving our medicines based on that data.
As an aside, I was also gathering data this way for the black-magic paper I was writing as Yulian.
“Let’s go in.”
The atmosphere at D-3 Clinic was different from D-1’s from the outset.
How should I put it?
Instead of the distinctive tension of an emergency room, it was filled with the warm, homely air of everyday life.
Elderly people sat side by side in the waiting room, with blankets draped over their knees.
In one corner, a healer was lifting a patient’s foot to examine a wound.
“Oh, what about that beastman?”
“Ah, that’s the person who guided Miss Ayla, right? That person is a patient here too.”
Wangcho was there as well.
Wangcho was being roundly scolded by a healer specializing in gout.
I heard Wangcho had thought it would be easier to get medicine if I wasn’t watching.
Not a chance.
Wangcho had been assigned to a healer whose mouth was even rougher than mine.
— “Rather than suffering this pain every time, you might as well cut it off once and regenerate it.”
— “Eek! I’m sorry! I’ll take better care of it, so please don’t do that!”
It was a little jarring to see the underworld kingpin who ruled D and E Sectors acting like that.
We continued talking as we passed the examination room where Wangcho was being treated.
“Student Ayla, the patients here aren’t emergencies. They’ll come back tomorrow, the day after, and even a month from now.”
“Do the healers look after people like that every time they come?”
“More precisely, they manage them. What these people need isn’t a single miracle but continuous care.”
Diabetes and gout were diseases that even Heal couldn’t simply fix.
So we cared for them continuously like this.
And because they kept coming back, we were able to steadily collect their data as well.
The few clinics that turned a profit were generally like these.
The medicine sold, and the data accumulated.
Above all, this was where we mainly sold Viagra.
“Now then, shall we take a look at a diabetes patient today?”
I took Ayla farther inside the clinic.