Chapter 176: Establishing Hierarchy (3)

After receiving Contact from the students on my way to Leaving Work.

I packed the Medication from the Mansion and returned to the Infirmary.

It was Going to work again just two hours after Leaving Work.

'If it wasn't for this Case, I would have just finished Leaving Work.'

If it had been another Disease, the Emergency Ward's Night Duty Healer would have handled it.

But listening through the Crystal Orb, this Case was not a Disease that other Healers could handle.

It's not because it's difficult, but because it's an unfamiliar illness.

'At least it's a Student, so it feels less unfair.'

I am also human and an office worker.

There is no way I wouldn't have any Complaint about my Leaving Work being delayed.

If my Leaving Work was delayed because of an ordinary Patient, I wouldn't be able to blame the Patient, so I would have just let out a Lament.

However, this Patient is a Student from the Department of Healing Arts.

'Then it's a different story.'

Traditionally, when working in a University Hospital, a Patient more welcome than a VIP Patient is precisely a Medical Student Patient.

As for the reason......

No matter what profession you go into, if there's a chance to legally make fun of your Junior or Disciple, is there anyone who would refuse?

Thanks to that, I was able to head to the Emergency Ward with a light step.

As soon as I entered the Emergency Ward, I could tell where that Student was without anyone telling me.

It was because First year freshmen were buzzing around one bed.

When I appeared, that group naturally parted.

"Have you arrived, Lord Saint!"

"How is his condition?"

"As per your Words, we only hooked him up with IV Fluid."

The Healer in charge was Vine.

He was a reliable Intermediate Healer who also substituted for Ward Rounds during my absence.

Receiving Vine's Handover, I examined the Student's condition.

On the bed, a Dwarf Student was tightly curled up like a shrimp.

Drenched in cold sweat, his Hair stuck to his Forehead.

The Dwarf Student gritted his teeth, unable to even let out a proper groan.

His Peers were looking at such a Student with eyes full of Worry.

"Student. Could you lie straight down?"

Nodding with difficulty, the Student changed his posture.

I sat by the bed and lightly pressed down on that Student's Abdomen.

"Ugh!"

A reaction came from around his Solar Plexus.

"What year are you in?"

"......F-First year...... sir."

"Your name?"

"T-Torvan, sir."

It was a common Dwarf-style name.

I nodded and made a Record of a few points on the Symptom list.

Consciousness is clear.

No problems on the liver side, and neither Murphy Sign (Diagnostic sign for Cholecystitis) nor Obturator Sign (Diagnostic for Appendicitis) are present.

'Well, I figured as much.'

It was unnecessary, but I just checked it as a procedural formality.

Next, I drew Torvan Student's Blood.

At that Time, Vine, who had been standing quietly, approached me.

"Lord Saint. Is it perhaps AP?"

Vine getting a confirmation from me, going so far as to use a non-existent abbreviation.

I realized the meaning of that abbreviation and nodded.

It seemed Vine had already roughly guessed Torvan's illness.

Just as a schoolhouse dog recites poetry after three years, a Second-year Resident learns how to write a Prescription.

Considering how much Time he had worked with me, it was natural in a way.

"If so, Lord Saint. May I take this Opportunity to make this friend study a bit?"

"It will certainly be a good experience. Go ahead."

It would be one thing if it was a Super-emergency, but putting the situations together, it wasn't a Super-emergency.

It meant it hurt to death, but it wasn't a fatal Disease.

As soon as he realized that, Vine seemed fully intent on making the Student study first and foremost.

'I guess I don't have to be the one to tease him.'

I just so happened to want to play a Prank on this Student too.

Since Vine would do it instead of me, I didn't go out of my way to forbid it.

Having received Permission, Vine beamed and said to the Student.

"Now, Student. Let me ask a Question. Does your stomach really feel like it hurts?"

"......Pardon?"

"Does your chest hurt? Or does your stomach hurt?"

"Uh...... M-My stomach seems to hurt."

"Are you sure? A Myocardial Infarction is sometimes mistaken for Abdominal pain, you know?"

The Student becoming confused.

Whether he was or not, Vine beamed and prepared the examination.

It seemed I wasn't the only one who found playing a Prank on their Junior fun.

"Now, then, next Question. What examination would the Student like to proceed with?"

"Uh...... C-Clairvoyance examination, ah, no. First, o-other examinations......"

"Don't you know No take-backs? Student?"

At Vine's brazenness, the Dwarf Student's Pupils vibrated as if there was an Earthquake.

But before he could say anything, Vine proceeded with the examination.

The Imaging Test Result came out immediately.

"This is the Clairvoyance Result from below the Solar Plexus, behind the Stomach, Lord Saint."

I accepted the Result sheet Vine handed over.

The picture printed on the Black Board showed the appearance of the Student's internal organs.

The elongated organ situated behind the Stomach was faintly swollen. Signs of cloudy fluid pooling around it were also visible.

While I was checking the Clairvoyance Result like that, the Blood test Result also came out.

'As expected.'

The Enzyme levels were elevated.

These levels alongside Abdominal pain, and even the Imaging Test Result.

It was already a Confirmed diagnosis.

I shared the Blood test sheet with Vine.

Vine used that test sheet to play a Prank on the Student, no, give him Teachings.

"Amylase came out to 314 U/L, and Lipase 408 U/L. If you're a First year, you should have learned about these Enzymes, what do you think this means?"

"......It seems to be...... on the Pancreas side."

"Really?"

"......."

While Vine was doing his Best effort to play a Prank on the Student.

I prepared to administer the Medication I brought into the IV Fluid line.

"Height and Body Weight?"

"136 centimeters and...... 62 kilograms......"

Checked.

"I will set the initial dose to 2mg. If the Pain doesn't subside afterwards or the Effect is insufficient, administer an additional 1mg."

"Understood."

When I passed the Medicine Bottle, Vine respectfully took it.

I said to him as if requesting.

"However, since it's a Medication with a risk of Addiction like Cocaine, you must absolutely leave a gap of at least 10 minutes between the single dose and the next administration. Please make sure to keep that in mind."

Anyone working at this Infirmary cannot help but know well how to use Cocaine.

Because the Medication I use when opening a head Lid, which I often show off like a spectacle, is Cocaine.

Vine also knows well the dangers of Drug Addiction, so he will follow my instructions well.

Having finished the instructions, I looked at the Student on the bed again.

A few minutes after the Medicine started going in.

The Student's complexion began to look comfortable.

Only then did I look around.

Students had densely gathered around the bed before I knew it.

There were those watching their Peer with worried faces, mixed with gazes curious about what this unfamiliar illness was.

At that Time, Vine said in a Voice loud enough for everyone to hear.

"Now, then, since the Treatment is all done, what Disease does the Student think they have?"

"Yes?"

"You seem to be okay now, so you should try making a Diagnosis once."

"Uh......"

Soft sounds of laughter could be heard from the surroundings.

Seeing Vine acting so brazen, they guessed from the atmosphere that it wasn't an emergency.

I also turned my head from Vine's side as if to pitch in, and asked the surrounding Students.

"If the Patient doesn't know, I will ask all of you. What Disease do you think this Student has, and what First Aid did you perform specifically?"

For a while, no one could open their mouths.

Then, the girl wearing a Veil carefully raised her hand.

"......Is there no possibility it's an Aortic dissection?"

It was Ayla.

"Why did you think that, Ayla?"

"The form of the Pain in the Solar Plexus shooting out toward the back, seemed exactly like an Aortic dissection. So to perform First Aid for this, we were going to cast Greater Heal, but......"

"Heal didn't work, did it?"

"Yes."

Rather, it would have gotten more severe.

Because this Disease wasn't an Aortic dissection.

"It's good that you thought of the most critical illness first. The First Aid you performed by cautiously increasing the intensity of Heal step by step, being wary of Demon Disease, was also excellent."

This was good enough.

For First years.

Had graduates handled it like this, they would have been scolded though.

"Then did you check the Pulse on both wrists?"

"I only checked one side."

"If you suspected an Aortic dissection, why didn't you check the other side?"

"......I didn't know the diagnostic method well."

"An Aortic dissection often results in different Pulses in both wrists. The Aorta curves to the left, and if that tears, the Pulse felt in the left arm becomes weak. Then, shall we check it once right now?"

Ayla nodded and checked both of Torvan's wrists.

And then she nodded.

"......They are the same on both sides."

"Right. Just with that alone, the possibility of an Aortic dissection drops significantly."

This is the reason why one cannot make a Diagnosis merely by knowing a Disease.

Ayla had seen the methods of Observation and Treatment for numerous Diseases by my side.

However, her training to make a Diagnosis for those illnesses was still at a heavily lacking level.

She had not completely mastered the diagnostic methods, and going further, she hadn't mastered the Diagnosis algorithm either.

To speak frankly, wouldn't she still be unable to perfectly distinguish between Reflux Esophagitis and a Heart Attack?

... Though I died because I couldn't distinguish them either.

Of course, just because of that, there was no reason to be disappointed in Ayla or to admonish her.

'She's a First year, after all.'

When I was a First year, I only knew that if a person collapsed, you had to perform a Heart Massage.

If there was a point where I was better than a Civilian, it was only that I knew a little about the human Anatomical structure?

I could only say I properly acquired my Diagnosis ability after becoming a Resident Doctor.

Vine explained as if cutting in.

"To add an additional explanation, an Aortic dissection doesn't happen suddenly while drinking alcohol, and it rarely accompanies Vomiting. Generally, clutching the chest once and passing out right then and there is common."

He said with a sly smile to the Students.

"From what I hear, you probably jumped to the conclusion that it was an Aortic dissection and performed First Aid suited for that, but you panicked when it didn't work, right?"

Everyone nodded.

Vine continued his explanation while looking at those Students.

"The ability to make a Diagnosis doesn't directly connect to simply how many illnesses you have memorized. A Diagnosis is the process of synthesizing the very small Clues a Patient leaves, sorting out what is meaningful and meaningless, and interpreting what those Clues truly mean."

Vine, who was giving a splendid explanation, glanced at me.

It was because those Words were something he had heard from me in the past.

"Just because you've seen it roughly in a Book doesn't mean you should forcefully piece together Clues into an already predetermined Result. You must interpret the meaning from every single action and Symptom of the Patient to gather them into a Result. That is a true Diagnosis, and it's also the reason why a Diagnosis is so difficult."

Saying that, Vine gave a brief Bitter smile.

It was likely because it reminded him of his past days of piecing together Clues to a pre-decided Disease.

However, no matter how good the Words were, it could be a difficult concept that hadn't quite resonated with the First years yet.

So I added to it as if throwing in a bonus.

"What you all must learn today is not the Name of a disease. Focus on the deductive process, on what the fragmented Clues mean."

The Students each nodded with serious faces.

Some of them were already taking out their Notebook to jot something down.

Seeing the sight of such Students, a smile naturally formed.

At that Time, The Saint of Radiance Lauren, who was at the back, carefully raised his hand.

"May I ask just one Question, The Black Saint?"

"Ask away."

"How did the Lord Saint deduce this Disease just by receiving Contact? And was this Disease Demon Disease?"

It was a good Question.

Because it was a Question asking not about the Disease but the Diagnosis process.

I immediately answered Lauren.

"First, the Name of a disease is Acute Pancreatitis."

"Acute...... Pancreatitis? You mean there is Inflammation in the Pancreas?"

"That's right."

"Then how did you make a Diagnosis of that from far away."

"It wasn't that difficult."

As soon as I received the Contact, I predicted the probability of the Student having Acute Pancreatitis to be 90 percent.

It was because Clues were scattered everywhere.

First.

The Abdominal pain started while drinking Alcohol at the Steakhouse.

That's a Clue to single out the illnesses that could undergo Worsening due to Alcohol and fat.

Second.

Heal didn't work.

It means it's a Disease that isn't a simple Gastritis or injury.

The illnesses are narrowed down once more here.

Lastly, third.

"You said the Patient was curling their back up like a shrimp, right?"

When a person hurts, they instinctively take a posture to not hurt.

A person with a hurting knee walks stealthily.

A person with a hurting Shoulder doesn't move their arm.

A person whose testicles hurt taps their back.

And a person whose Pancreas area hurts curls their body up like a shrimp.

"This is an instinctive act of deliberately bending the body to prevent the Pancreas from touching the abdominal wall (stomach)."

I was sure of it then.

That it was Acute Pancreatitis.

'That's why I came moderately hurrying.'

Acute Pancreatitis is indeed an emergency, but it's not a Super-emergency.

If I had to set a Golden time, it's about 12~24 hours?

Since it wasn't a Disease that was urgent by the 10-second mark, there was no need to hurry while driving a carriage.

Of course, the Patient would feel like dying during that time.

"There would be minor Clues as well. Judging by the Vomiting, the possibility of an issue on the heart side seems low."

The closest similar illness is Kidney Stone?

But that possibility was also low.

Because a Kidney Stone hurts the Lower abdomen and flanks, not the back.

So I was roughly sure of it.

"If so, Lord Saint."

This time, Ayla asked carefully.

"If Inflammation has occurred in the Pancreas, why wasn't it treated with Healing Magic? Is Pancreatitis also Demon Disease?"

"No. It is not Demon Disease."

Demon Disease is an expression currently functioning as a General Term for Diseases that Healing Magic doesn't work on, such as a Tumor or an Autoimmune Disease.

However, Acute Pancreatitis was far from such a thing.

"Heal works well on Pancreatitis. A Complete Cure is also possible with Greater Heal."

"But when we cast it......"

"It hurt more, didn't it? This is due to the Principle of Pancreatitis."

Acute Pancreatitis is not a Disease where organs are simply damaged by external substances like a Germ.

"You all know that the Pancreas spews Digestive Fluid, right?"

Being the 2nd semester, they should know this from taking Anatomy Class.

I know they are learning the Pancreas side around now after finishing the Hand Region.

The Students nodded as per my Prediction.

I continued the explanation.

"Pancreatitis is a Disease where it spews an uncontrollable amount of Digestive Fluid due to being excessively subjected to a Stimulus from Alcohol or fat, ultimately melting itself down."

Now, here is a question.

"In this situation, what will happen if Heal is cast on the Pancreas?"

"The healthier Digestive Gland will spew more Digestive Fluid, and......"

"So that's why the Pain becomes severe."

As expected of smart children.

What they lacked in the first place was knowledge, not Intelligence.

Just explaining this much, they will easily understand the reason why Heal didn't work well.

"I understand. If I had used Greater Heal, it could have been treated."

"Although there would have been tremendous Pain commensurate with that."

That's right.

Acute Pancreatitis is a Disease that eventually does get treated if you keep smashing high-grade Greater Heal into it.

If the speed of Regeneration through Magic becomes faster than the speed of the organ being damaged by Digestive Fluid, the Pancreas would calm down and get better.

The problem is that recovery process.

From the Patient's Stance, it's equivalent to endlessly repeating the cycle of recovering after undergoing the torture of their organ melting away.

It would probably be hard to endure that with a sane mind.

This is the reason I don't recommend Healing Magic.

Because while it gets treated, the Trauma is no joke.

'Because severe Pancreatitis is Pain that can be compared to a Kidney Stone.'

Probably seven out of ten will beg to be killed if you treat it with Greater Heal?

"Then...... how do you perform the Treatment?"

"It's simple."

To Lauren's Question, I pointed at the IV Fluid pack.

"You hook up an IV Fluid to perform Dilution on the Inflammation, take a strong Painkiller, and hope Time solves it."

There is no Medication for Acute Pancreatitis.

There is no choice but to take a Painkiller, get an IV Fluid, and hope for a Natural recovery.

Unless there is a stone, a Surgery is not necessary either.

No, one should not perform a Surgery.

Unlike other organs, the Pancreas is not an organ that is okay to remove.

'For other organs, Daily life just becomes Uncomfortable if they're gone, but for the Pancreas, you could die.'

Since the Gallbladder is an organ that's okay to not have, you cut it out if Inflammation occurs.

The Large Intestine is long, so it's okay to cut a part of it out.

But the Pancreas is not.

'If the Pancreas is gone, Diabetes is a given and the Digestion ability completely disappears.'

Therefore, you typically don't perform a Surgery for Pancreatitis.

Because the cure is worse than the disease.

"He should just be hospitalized for Several days and take this Medication."

The fortunate point is that the Pancreas is an organ that sufficiently undergoes recovery.

It heals on its own if you rest while taking a Painkiller.

At this, Ayla stared intently at the Medicine Bottle connected to the IV Fluid and asked.

"Then, by any chance, what on earth is that Painkiller?"

It was a pretty sharp Question.

A Question she's probably asking because she knows that among existing Painkillers, there is almost no Painkiller that controls the Pain of the Abdomen's internal organs.

'Because most people would know Cocaine or Chloroform as Anesthesia Medications that can be used anywhere.'

The First year Students won't be able to understand the sharpness of that Question.

If it were up to me, I wanted to explain this Medication to Ayla right here.

But I couldn't.

Because I had finished consulting with the church and The Military to make a Disclosure of this Painkiller only a week later.

I lightly shrugged my Shoulders and turned around.

"I cannot answer that yet."

Because it's a Medication with such strong ripple effects that it would completely change the Board of the war.

Even within the Infirmary, it was to the extent that it was kept a Secret unless one was Cardinal Wendras or of the High-rank Healer level.

"I will tell you when the Time comes, Student Ayla."

Ayla nodding with a regretful look.

Like that, the commotion in the Middle of the night came to an end.