Chapter 80
*
I led the count I had met in front of the Green Flag camp into the tent.
The inside of the tent was cramped.
“Where is this…?”
“A space prepared for people whose treatment might be a bit embarrassing.”
You might think shame has no place in a disaster like this, but even in situations like this, privacy matters.
Especially for patients who need treatment below the waist.
And, though I don’t really want to say it explicitly,
there are sometimes trash like that who take advantage of the chaos to do sexually vile things.
Even in a disaster, setting up separate privacy rooms is standard practice.
“Please sit here.”
There was a bed inside the tent.
Though to call it a bed was a bit embarrassing, since it was really just a blanket spread over a wooden board.
The count sat on the makeshift cot.
Keeping his back ramrod straight.
“Does it hurt when you lean your back against something?”
“…I’ve been listening to you for a moment now, and that’s fascinating. How did you figure that out?”
“Simple observation.”
I said while setting my surgical tools on the wooden box beside the bed.
“You seemed to have trouble leaning against anything, there were pauses between your words, and you also looked like you were reflexively holding back a cough whenever you made a hard consonant.”
Swish, swish.
I sprayed disinfectant onto a wad of cotton.
I prepared the disinfectant cotton and set the needle and tube up in sterile fashion.
“I also saw signs of jugular vein distension on the right side of your neck. That’s evidence that the mediastinum has shifted to the right. When you breathe, the left side of your chest hardly moves at all, while the right side stands out. Your accessory breathing muscles were also overly tense.”
“…?”
He looked like he had no idea what I was talking about.
So I explained it in simpler terms.
“Pneumothorax. The lung inside your chest has torn. You’re a superhuman, so you’re holding on, but if you go home like this, you’ll quietly pass away tonight.”
….
I finished the rough explanation and stepped toward the count.
“Please take off your shirt. I’ll do a simple procedure… no, a treatment.”
“Why would treatment need a needle? Is this perhaps an excision surgery?”
The count said warily.
The excision procedures of healers are infamous.
They cut out the problematic area and then regenerate it.
The downside is that this only works on limbs.
There is no excision surgery for the torso.
That was why the count was wary of me.
He was probably wondering if I was trying to use this situation to assassinate him.
But the treatment I was going to do was not excision.
“It’s not excision. I’m just going to make a small hole in the space where the lung is.”
“What?”
“There normally shouldn’t be any air inside the chest cavity, but if the lung tears, air can enter that space. If that air presses on the lung, breathing becomes difficult.”
That wouldn’t mean much to him, of course.
But now wasn’t the time to make the count understand it the way I would a student.
“I’ve already saved plenty of people with this.”
I slightly lifted the tent flap.
The red-flag zone was visible outside.
There were people there with needles and tubes stuck into their chests.
Hemothorax or tension pneumothorax.
People whose lungs had been injured like the count’s.
“If this were an assassination, how would you explain the people receiving that treatment moving to the yellow zone?”
Pneumothorax is one of the kinder ultra-emergencies, because once you treat it, the patient can go straight from red to yellow.
You just stick a needle in front of the lung.
And if it takes 30 seconds at the shortest, 2 minutes at the longest, that’s enough.
There was absolutely no reason not to do it.
“My lord Count. So please take off your shirt. The longer you delay, the more dangerous it becomes for the people who still haven’t received treatment.”
….
The count reluctantly pulled his clothes up.
Before treating him, I checked a few things against his chest.
I tapped, listened, and checked for vibrations once more.
‘It’s a tension pneumothorax.’
I scrubbed the skin between the fifth and sixth ribs with an alcohol swab.
And then I poked in with a 14G needle.
It was that procedure you see in medical dramas all the time.
The one where patients who couldn’t breathe suddenly start breathing the moment you stick in a ballpoint pen refill.
I’d just done it a little more hygienically.
“Please try breathing.”
Whoosh.
Air hissed out of the needle.
The count’s expression relaxed considerably as well.
“…Amazing.”
“Good.”
I said while putting the tools away.
“Though I’m only asking now, why did you hide the symptoms?”
“You may not understand it, but a count can’t show weakness.”
The count gave a bitter smile.
“If it becomes known that a third-tier superhuman was brought down by something as trivial as a troll’s club, people may start questioning my skill.”
Well, then.
So the count had his troubles too, in more ways than one.
To think he had to hide internal injuries just so he wouldn’t show weakness.
It was heartbreaking that he had to worry about such things when he should already have his hands full just dealing with monsters.
“Then let’s wrap it up.”
I inserted the tube into the spot where the needle had gone in.
And then I took a single surgical rubber glove out of my bag.
‘Tsk. As expected, it’s thick.’
I had asked them to make surgical gloves while they were making condoms as a side job.
Naturally, I had ordered the gloves to be thin enough to preserve fingertip sensation.
So they were also trying to make the condoms as thin as possible and, while they were at it, thin the gloves too.
But they still didn’t have the skill, so the gloves were thick.
Every time I saw that, I found myself missing the ultra-thin(?) latex surgical gloves from the 21st century.
‘Well, this will do for now.’
I cut off the index finger of the glove with scissors.
I slipped the cut rubber finger over the end of the tube stuck in the count’s chest and tied it tightly with thread.
Ta-da.
A one-way flutter valve, complete.
A technique I learned at a disaster scene in my previous life.
…I was told it was supposed to be safe and rewarding summer medical volunteer work.
But that crazy professor dragged me to an overseas explosion site.
Supposedly it was safe because it had already exploded once.
Finally, I pushed the tube inside his shirt and arranged his clothes so it couldn’t be seen from the outside.
From the outside, nothing looked different at all.
“Normally I prefer the water-seal drainage method, but since you didn’t want anyone to see it, I did it this way.”
“It’s seamless. Thank you.”
“Still, if you keep the tube under your clothes, you may have trouble breathing again, so it would be best if you rested somewhere like a carriage, alone.”
“Understood.”
The count got down from the cot.
Meanwhile, I said while tidying up the tools,
“Unfortunately, I’d like to cast Heal on you right here, but that won’t be possible.”
Patients I can treat with 21st-century procedures, including pneumothorax, don’t need holy magic.
That’s for the patients who can’t be saved without the miracle of holy magic.
“I know.”
The count’s answer was calm as well.
“At my rank, this level of treatment is enough. The miracle of God should go to those who are more desperate than I am. On the battlefield, divine miracles and potions were always in short supply.”
“Thank you for understanding.”
The count’s pneumothorax would probably improve in a few days.
The count briefly reached for his armor.
But I didn’t allow it.
“Please don’t put your armor on. The tube may get compressed and stop working properly.”
“I’ll keep that in mind.”
The count said while holding the breastplate in one hand.
“Shun Isa.”
He gave me a slight bow.
“I salute your devotion.”
I shook my head.
“On the contrary, I’m the one who should be more grateful.”
“For what?”
The count asked back with a puzzled expression.
I didn’t answer.
My gaze was fixed on the fingertip I had just cut off from the rubber glove.
— “I’m fine. Please see the other citizens first.”
In an old, faded memory.
The fellow who had been lured to the explosion site by the lying professor was talking to a firefighter.
— “I’m just a little out of breath from exercising hard.”
— “Indeed, the physical exam results are all normal.”
— “Right? So you can hurry on to someone else.”
The professor, the firefighter, and I.
We all diagnosed him as green.
And when everything was over.
What greeted us was the firefighter’s cold body.
The cause was Blast Lung Injury.
A disease in which blast pressure throws the inside of the lungs into chaos.
This disease has no symptoms or abnormalities immediately after the explosion, then twenty-four hours later the inside of the lungs suddenly starts filling with fluid and blood.
And then the patient quietly drowns in their own fluids.
At that accident scene, there were countless people who quietly passed away like that.
Still, that firefighter was the one I remembered most clearly.
He smiled at the end and said he was fine, and I truly believed that smile,
but that trust was what ultimately came back to us as tragedy.
After that day.
I, too, and that professor stopped trusting patients’ words.
Strictly speaking, it wasn’t that we ignored them.
We simply stopped diagnosing based only on the patient’s words.
Things the patient doesn’t know about, and things everyone can overlook.
It was probably from that point on that I began obsessively focusing on those things.
“…Isa?”
My senses returned at the count’s voice.
“Aren’t you going to tell me what exactly you’re thankful for?”
“…I meant I was grateful that I was able to discover your condition, Lord Count.”
“Why would you be grateful for that?”
“Well… I guess when you do this kind of work, there are times when you’re grateful for everything.”
I was just grateful.
This time, for having found it.
The count stared at me for a long while, then quietly nodded.
***
After finishing the count’s private treatment,
I returned to the field and started triaging the patients again.
“This is an airway obstruction from tongue collapse caused by a shattered lower jaw. It’s urgent, so classify it as red. Keep the patient lying face-down until treatment.”
“There are fragments lodged in the eyes. Bandage both eyes, students. The patient won’t be able to see, but you’ll have to bear with it. To save one eye, you can’t move either eye. Let’s make the flag yellow.”
“This is a patellar fracture from a fall. The blood vessels and nerves are fine, so classify it as green.”
While handling the injured, I checked the time.
By feel, it wouldn’t have been strange if it were already lunchtime.
The hour hand had only moved by one number.
As the sun slowly rose, the other strike teams began returning as well.
Toot—toot-toooot!
“Injured over here!”
“Don’t distinguish between rescue teams and strike teams—everyone follow the orders!”
Every time the horn sounded, people poured into the gate.
The strike team that had gone out beyond the wall a few days earlier, and the rescue team that had gone to save them after they were stranded, were being carried in on stretchers.
At a glance, more than three times as many people as the dawn casualties were being pushed in.
Ayla’s face darkened at the sight.
“M-Mr. Isa… the injured keep…”
“Just as expected.”
At first, the strike team and the rescue team were split half and half.
Soon it became one subjugation team to two rescue teams, then in the next wave one to three, and then one to five.
As time passed, the exchange ratio reversed.
There were more people returning injured after going out to rescue others than there were people returning after being rescued.
The reason was simple.
It normally takes five people to save one person.
Even in that famous movie about rescuing Private Ryan, didn’t a whole bunch of people get chewed up just to save one private?
That’s how disastrous the exchange ratio of rescue operations tends to be.
Even so, the Guild continued sending rescue personnel to the stranded strike teams.
Because the stranded included A-rank adventurers, heroes, and people like nobles.
Of course, as a doctor, I didn’t really understand the strategic significance of this rescue effort.
Nor could I really feel how necessary it was to throw people into the grinder to save them.
But I knew that they trusted us and were continuing the rescue operation because of that.
So I only focused on treating the exponentially exploding number of wounded.
Still….
‘I’m getting tired.’
“Red. Get them to the surgical tent immediately. Next!”
“My arm… my arm’s been cut off!”
“Tighten the tourniquet more! You’re bleeding through! Yellow. Next!”
Toot—toot-toooot!
The horn sounded a beat longer.
I knew without even turning my head.
Another group was surely pouring in through the gate.
“Mr. Isa! We need to change the criteria! From now on, open fractures should be classified as black, not red!”
“Poisoning patients should be changed from yellow to red from now on!”
As the number of injured rises, the people who can be saved are gradually pushed further down the priority list.
Originally, triage is a classification method with a lot of variability depending on available resources.
If you had the manpower to handle dozens of brain hemorrhage patients, even someone with a split-open head could be classified as yellow.
But if manpower is lacking, even a poisoning patient who only needs one antidote can be pushed from yellow to red.
In the end, reality is always a matter of resources.
“Mr. Isa….”
Ayla, who had been following me, kept trying to say something before closing her mouth again.
Because just moments ago, I had classified the patient with the severed arm as black.
Normally, that would be red—a patient who could be saved with treatment.
But there simply weren’t enough people.
We couldn’t perform a surgery that would take more than an hour.
“…Black.”
This one was a brain hemorrhage casualty.
A patient I could treat within thirty minutes if I got my hands on them.
But the moment I spent thirty minutes in surgery, thirty patients outside would be left unattended.
So I had to classify this person as black.
‘It’s not even been two hours, and it’s already this bad.’
Two hours after we started handling the injured, the damage was already spiraling out of control.
314/42
The number of injured and dead recorded on the Guild’s board kept climbing.
My chest felt tight.
Not because I was despairing.
‘Damn it….’
Because it was heartbreaking.
I knew a way to break through this situation.
Originally, the triage we were doing now was far removed from the proper method.
A triage officer who classifies patients and performs simple treatment.
A treatment team leader who focuses only on advanced care for classified patients.
Emergency triage should divide these two roles between two groups.
But right now, the healers from the Mercure Trading Company and I had to perform both roles at the same time.
That was causing inefficiency.
I took a brief breath and turned my head.
“It’s okay. This should make things a little easier for you.”
Ayla was casting Refresh on the black and red patients.
Ayla’s friends had already exhausted their divine power or given up mentally.
Even so, Ayla kept casting Refresh.
Thanks to that, the patients’ time was being bought little by little.
“…Tsk.”
I clicked my tongue where no one could hear it inside the mask.
The student isn’t giving up, and I’m already thinking of compromise points in my head.
‘What kind of protagonist makes compromises?’
Since being possessed, I hadn’t compromised even once.
And here I am, thinking of that sort of thing just because it’s a little hard.
Looks like I’m still far from being a proper protagonist.
“I’m rearranging the shift order! Taking into account the prayer times of those whose divine power is depleted, I’ll reassign the personnel!”
That was when I had steeled myself and was shouting that at the healers from the clinic again.
There was a commotion near the guild entrance.
“Make way! Move!”
“This is the Church’s healing dispatch unit! Open the way!”
The voices rang out in layers, three deep, four deep.
I stopped the triage I was doing and looked up.
Several carriages were lined up on the road in front of the guild’s main gate.
White carriages emblazoned with a golden sun emblem.
It was the Church.
The carriage doors opened, and people in white vestments jumped out.
Priests in pure white vestments quickly joined the healers from the clinic.
“Sorry we’re late!”
And from the crowd pouring out, a priest wearing a different vestment that was not pure white sprinted into the guild building alone.
“Archbishop Lyelik has arrived! Guild Master!”
A man wearing the purple shoulder sash, the symbol of an archbishop, pushed his way through the people.
Raymond Lyelik.
Former imperial personal healer.
Current bishop of the imperial capital diocese.
In 21st-century terms, he was about like the head of a public health center.
As soon as he entered the guild, he looked around, spotted me, and strode over.
Then he gave me a slight bow.
“I’m Raymond Lyelik, Mr. Isa. I was late getting here because I had to deliver the mobilization order to every treatment center.”
I shook my head.
“No. You did very well.”
That wasn’t empty praise.
If he had come straight to the scene, it would have been easier at first.
But that would have been all.
After that, the situation would have gotten difficult again.
Because in situations like this, rear-line care is the most important thing.
In the end, no matter how well you triage on-site, if there are no hospitals backing you up from behind, it’s useless.
In that sense, the archbishop’s judgment was appropriate.
He had mobilized every treatment center in the empire as rear-line hospitals.
And this was an era when communications networks hadn’t really developed yet.
I could understand a hundred times over why he was late.
“On the way here, I heard the gist from the other healers. Triage classification… what a splendid system.”
The archbishop said as he looked over the scene.
“May I ask what I’m supposed to do here?”
Instead of asking me to hand over command, he immediately inserted himself into the chain of command.
He was a highly exemplary reinforcement.
So I could trust the archbishop and speak.
“Archbishop.”
“Yes?”
“Then from now on, would you take command of the field triage?”
“And you, Mr. Isa?”
I bobbed my raven beak up and down and said.
“Looks like I need to return to my main job.”
It was time to return to the operating tent.