Chapter 182: Devil's Snot (6)

'What the heck, damn it.'

I ended up hearing a sound I shouldn't have heard.

The soldier's pronunciation was slurring.

It was a signal that his tongue wasn't rolling properly.

'He couldn't be drunk.'

I ruled out the possibility of intoxication.

The moment my thoughts reached that point, a chill went down my spine.

It seemed I wasn't the only one who thought this.

"Professor. That person..."

"Yulian. That soldier doesn't look like he's in a good condition."

Jenny and Shallot's facial expressions also turned serious.

Jenny would have noticed as a student in the Department of Healing Arts,

and Shallot also had her own medical knowledge.

"Let's all go."

Feigning composure, I approached the soldier.

The banquet was currently in full swing.

I couldn't ruin the ripe atmosphere with an unconfirmed diagnosis.

I approached him, lightly offering the chalice in my hand.

"Your speech was truly impressive. Since you can't have alcohol, I'd like to offer you a beverage. Is that alright?"

"Ah! Lord Saint! Th-Thak you."

He bowed his head, overwhelmed with gratitude.

All while heavily slurring his pronunciation.

Just as I thought, it seemed I hadn't heard wrong.

I handed him the chalice.

While he received the chalice, I scanned the necessary parts.

'His smile isn't awkward, and there's no problem with his limb movements.'

When pronunciation becomes slurred, one must first differentiate between cerebral hemorrhage and cerebral infarction.

The criteria to differentiate them are as follows.

Is the facial expression awkward?

Is there a loss of strength in the limbs?

Can they not construct sentences well, or is their pronunciation slurred?

However, the soldier in front of me only met one of these.

That meant the possibility of a brain issue was low.

'For now, it doesn't seem to be a problem with tongue movement.'

The way his pronunciation was slurred was also far from a cerebral hemorrhage.

Usually, dysarthria caused by a cerebral hemorrhage appears in the form of slow speech and slurred labial sounds.

Roughly like this.

— My leg...... is nah...... ahs uncooh......ftable ahs I thooght......

It's not necessarily always like that, though.

But you can consider it to be roughly this kind of feeling.

In contrast, while the soldier's pronunciation was slurred, it wasn't like this.

If I had to describe it......

'It's closer to a pronunciation problem caused by trismus.'

Pronunciation like he's holding a hot potato in his mouth?

It was roughly that kind of feeling.

I quickly readjusted the direction of my diagnosis.

If it wasn't a brain problem, where did that pronunciation problem come from?

While talking with him, I found a few additional clues.

'It seems he has pain when swallowing saliva. The size his mouth opens is also small.'

Above all, his posture was strange.

His shoulders kept curling forward.

Just like how a pancreatitis patient arches their back like a shrimp.

What that posture meant was clear.

'It's an otolaryngology problem.'

It was a problem with the neck, not the brain.

It seemed some problem had occurred in the reconstructed area of his jaw.

Since there was a problem in the front of his neck, he kept leaning his neck forward to breathe easier.

His slurred pronunciation was likely due to that front neck problem as well.

"Sir. Could I possibly touch your neck?"

"Wha...... whas the mather?"

"Excuse me."

There was no time to explain.

I roughly asked for a perfunctory understanding and palpated the area below his neck.

A hard sensation felt along with a slight heat.

I felt like I knew what the problem was.

'So an infection was the problem. To think it's Ludwig's Angina.'

Of all places, for that disease to break out here.

I had no choice but to click my tongue internally.

Ludwig's Angina.

It is a disease where an infection originating from the floor of the mouth, meaning the bottom of the mouth, spreads deep into the neck.

It's a rare disease to see in modern times of the 21st century.

Usually, this disease occurs when one doesn't take antibiotics after pulling a tooth.

Naturally, there would be no reason to see it in modern society, where antibiotics flow in blood vessels instead of red blood cells.

'It shouldn't be that he forgot to take his antibiotics.'

There was no problem even up until a week ago.

I had checked it properly when I treated him last week.

He had been taking his penicillin well too.

If so, I had to assume the infection broke through the antibiotics.

It was something that could easily happen to a patient whose immunity level was weakened due to surgery.

'The progression speed is...... I should hurry a bit.'

Ludwig's Angina has a very fast progression speed.

This is because infection is also influenced by anatomical structure.

To explain it simply, it's good to think of a subway.

Between a packed subway train and a quiet one, which is easier to cross into the next car?

Naturally, the quiet one would be easier.

Infection is the same.

The neck surprisingly has many empty spaces between muscles.

So once an infection occurs in the neck muscles, germs could spread very quickly through those spaces.

"Is it okay for you to breathe?"

"Now thaf you mension it, it feels a little...... schtuffy."

I checked his complexion and fingertips.

Fortunately, he hadn't reached the worst-case scenario like cyanosis or decreased consciousness.

It meant it wasn't a super-emergency where every minute and second was urgent.

However, we didn't have leeway either.

That infection could suddenly become severe at any moment.

He could be talking perfectly fine and suddenly die an hour later.

Therefore, I immediately gave instructions to Jenny.

"Jenny. Where is the nearest infirmary with a sect capable of neck surgery residing?"

"As it happens, based on the banquet hall, there is a Paresto Sect infirmary three blocks away."

Paresto Sect.

It was a sect equivalent to otolaryngology in modern times.

To be exact, it was a sect that looked at everything above the neck, so they even doubled in the neurosurgery area.

"Good. Let's move to the Paresto Sect right away."

"Could it be a Stroke?"

"No."

There was no time to explain to Jenny and the patient one by one.

"Let's go get some fresh air. It's stuffy with so many people, right?"

It was a remark thrown out for the surroundings to hear.

It was a natural excuse to avoid breaking the party's mood as much as possible.

However, the patient couldn't play along.

The soldier thumped his chest, as if he was having a bit of trouble breathing.

At his unnatural gait, the nobles quickly caught on.

— "Why is the Saint doing that?"

— "Did something happen to that soldier?"

— "Are withdrawal symptoms showing?"

I felt the unnecessary misunderstandings typical of the Misunderstanding Genre creeping up.

I usually tend to leave misunderstandings alone.

But I absolutely decline bad misunderstandings like this one.

I quickly corrected the misconception so that no misunderstanding would occur.

"It has nothing to do with morphine. An urgent matter to reinforce his jaw surgery has come up, so excuse me, but I will be stepping away."

I gave a glance to Shallot.

It meant I was leaving the banquet in her care while I was gone.

Still, she was a Marquis family's Young Lady and must have received bridal training, so it shouldn't be difficult for her.

Shallot also nodded, seemingly understanding the meaning.

"Silently helping one's husband from behind is also a wife's role, after all. Have a safe trip. I'll wrap up the banquet well."

After passing the baton of event organizer to Shallot like that.

I quickly headed for the exit, taking Jenny and the patient with me.

While Perisia was taking the car out of the parking lot.

Standing at the exit, I heard murmuring voices.

— "Hm. Just when the mood was about to rise, he breaks the atmosphere."

— "If he's sick, he should have quietly withdrawn and gone to an infirmary, is there a need to make such a fuss?"

— "No one would have known if he had quietly slipped out the back door. To purposely do it in the middle of the hall......"

— "For someone calling himself a soldier, to not even be able to take care of his own body."

They were remarks reprimanding the soldier.

They were words that seemed to say their enjoyment as nobles or Guild Masters was more important than a soldier's life.

It wasn't surprising.

Because this was the level of human rights awareness in this world.

Not all lives were equal.

To begin with, they hadn't come to this foundation because they suddenly awakened a spirit of love for the people.

The majority were those who gathered to form connections with The Black Saint or other Great Nobles.

That's why they were reacting like this.

Because the mood of high-ranking people was more important than the life of a mere soldier.

They were reacting that way as if representing the feelings of those high-ranking figures.

That was the art of getting by for nobles.

And that was the way the world worked.

'Why be surprised now.'

I made the foundation knowing this anyway.

I didn't even have any expectations.

Just as I was confirming the human rights awareness of this world for the first time in a while and was about to ignore it and leave.

— "Guild Master, aren't your words a bit excessive? A party like this couldn't possibly be more precious than a person's life."

— "I'm curious as to how you can make such thoughtless remarks at a banquet gathered to help soldiers. Are you indifferent, or just incompetent?"

— "Tsk tsk. Learning dignity as a pretense is why such words come out at a time like this. I can guess the level of your family."

As if covering up those small voices, voices overwhelmingly defending the soldier burst out like a floodgate opening.

Those voices were so loud that those who had voiced complaints earlier shrank back and couldn't say a word.

Looking closely, the ones reprimanding the soldier were actually the minority.

The majority were in an atmosphere of supporting my breaking the party's mood and leaving.

Right then, someone tapped my shoulder.

I turned my head.

Imperial Prince Edmund was smiling.

"Don't pay attention to folks like that. Dignity is revealed not in action, but in consideration. They aren't even worth you dedicating your attention to them one by one."

Edmund gently raised his chalice and spoke.

"The car is arriving just in time. Hurry and go."

"......I'm sorry for ruining the mood."

"There's no need to apologize. What does such trivial noble dignity matter? After all, dignity must embrace humanity within it to mean anything."

Chuckling, the Imperial Prince said.

"If you had just spouted empty flattery like the others that day, I wouldn't have been saved. I believe this conviction of yours is the most aristocratic dignity. And most of the people here are, consciously or not, indebted to your conviction. Most of them likely think the same as I do."

Saying so, Edmund pushed my back.

"So don't mind them, and save that soldier friend just like you did me. It wouldn't do for a strange rumor to spread that a soldier died at a banquet for soldiers, would it?"

The Imperial Prince didn't seem to think I would fail.

To live up to that expectation, I bowed my head and headed for the exit.

"Thank you."

Like that, I left the banquet hall behind and headed for the infirmary.

*

The car drove through the night streets.

I wondered if Perisia would get a warning from the guards again for reckless driving.

Before I even had time to worry about that, the car had already arrived at the infirmary.

I spoke to the soldier, who was leaning his body forward to make breathing even slightly easier.

"Please bear with it just a little longer."

He blinked wordlessly.

It seemed his voice wouldn't come out because his neck was too swollen.

Taking comfort in the fact that his breathing wasn't completely blocked, I got out of the car.

The infirmary was a partner facility of the Meyer Trading Company.

It meant they at least had the system in place to treat this patient.

As we headed to the entrance of the infirmary, the night duty healer who had been contacted was waiting to greet us at the entrance.

Looking at his name tag, he was an Intermediate Healer.

He was a man in his mid-thirties who looked quite experienced.

I spoke as I handed the patient over to him.

"I will do the handover for this patient."

The moment my lips parted, his body noticeably stiffened.

"Uhh...... uh? Lord Saint? I only heard it was an emergency patient?"

"I will explain later. I will do the handover for the patient."

I felt I knew why he was so nervous.

It was natural for him to be that nervous when The Black Saint showed up out of nowhere at his infirmary without any prior warning.

As if recalling his days as an apprentice healer, the Intermediate Healer was standing at stiff attention.

Without even the leeway to soothe him, I handed the patient over and immediately recited his condition.

"Please take the handover."

"23-year-old male patient. A patient who underwent mandible reconstruction using a fibular graft a month ago. He has an indurated edema in the floor of the mouth and the submandibular (under the jaw) space that started a few days ago. Currently showing symptoms of a hot potato voice, trismus, and dysphagia."

"It's Ludwig's Angina."

It seemed he had quite a bit of skill.

He must have studied hard with the book I wrote, seeing as the diagnosis popped right out.

However, separate from his skill, it seemed his nervousness still hadn't faded.

Swallowing his saliva, he reported in a trembling voice.

"......Suspecting a bacterial infection originating from the reconstructive surgery site, I will perform an incision and drainage. Considering the source of the infection, I plan to approach from the submandibular area to perform the drainage and aim for decompression."

"?"

"Would that be alright?"

If you know, why are you asking me that?

He's your patient to begin with.

And this is your turf.

At an attitude that seemed like a resident doctor getting confirmation from a professor, I was also a bit perplexed.

Even more so considering the person in front of me was a fully-fledged professional.

But I didn't show it and naturally checked the surgical assessment as if confirming.

"He is a patient with a vulnerable neck area. Wouldn't non-invasive internal medicine treatment using antibiotics followed by Heal be sufficient?"

At this, the healer's answer was firm.

"Because of the reconstructive surgery, there is a strong suspicion of pus. If the outer skin and oral cavity heal due to Heal, the pus will be trapped in the lumen and there is a high possibility it will compress the airway even more strongly. Therefore, we must prioritize drainage."

"Since he's already received reconstructive surgery, wouldn't the surgery be difficult?"

To this, the healer spoke cautiously.

"In the past, during the incident of The Spring of Those Who Could Not Return, I was present when you performed the mandible reconstruction, Lord Saint. Since I've studied this area since then, I am confident in the surgery."

"......Your name is?"

"Yes?"

"What is your name?"

The healer panicked at my question.

Soon, he said.

"It is...... Ludwig."

"Understood."

Ludwig. I memorized it.

Coincidentally, his name is Ludwig too.

I don't usually believe in destiny, but at this point, it's definitely destiny.

I had a peer like this too.

Cho Young-jae, a guy the Radiology Department coveted.

Though he betrayed the Radiology Department and went to Psychiatry.

Anyway, this guy Ludwig seemed to have found his aptitude well.

'Even his name is auspicious. Before I return to the Academy, I should talk to his sect and pack him up to take with me.'

As it happened, the Meyer Infirmary was short on otolaryngology healers.

It was because most of the Paresto Sect people had gone over to neurosurgery.

Was it because I showed them a performance of popping the lid of the head?

Everyone was intoxicated with the neurosurgery high, hoping to touch brains rather than eyes, noses, and mouths.

'It's the opposite of my previous life.'

After formulating a plan to kidnap the Paresto Sect's otolaryngologist, Ludwig.

I finished the handover to Ludwig.

"Now please handle leading the surgery, healer."

"Pardon? Wasn't it that you would be leading the surgery and I would assist, Lord Saint?"

"No, it wasn't."

From the start, I intended to leave leading the surgery to another doctor.

This patient.

I couldn't operate on him.

It wasn't that I didn't know how to do the surgery.

It was because I had a more important role than the surgery.

"He is a difficult patient to anesthetize. And I haven't taught any healers the method of anesthesia for a patient like this yet."

Anesthesia also requires its own skilled technique.

And this Ludwig's Angina patient was very difficult to anesthetize.

Even the specialized anesthesia healer at the Meyer Infirmary would probably find it difficult to anesthetize him.

So I had no choice but to do it.

"Just lend us the operating room. I will handle the anesthesia."

"Uh...... uh?"

"Healer Ludwig, you will be leading the surgery."

With that, I gave a glance to Jenny.

"Student Jenny."

"Yes."

"Someone else here will assist, so please be Assistant 2."

"Understood."

Ludwig, naturally accepting the role.

Soon, he mumbled, on the verge of tears.

"Do I really have to lead the surgery?"

"Didn't you say you were confident."

"I meant I'm confident in assisting."

"Then leading the surgery shouldn't be difficult either."

Ultimately unable to win against my coercion, Ludwig ended up leading the surgery.

*

The specialized anesthesia healer obediently stepped aside.

Rather, saying it was fine as long as he could observe, he volunteered for the unidentified role of anesthesia assistant. (Anesthesia does not require an assistant.)

After fair and square usurping the role of the anesthesia supervisor in this infirmary.

"P-Please anesthetize him, L-Lord Saint."

I immediately prepared the anesthesia according to the leading surgeon Ludwig's instructions.

Pat, pat.

The patient was patting and giving encouragement to the burdened leading surgeon.

Meanwhile, I prepared the medication.

It was an anesthetic other than morphine.

Watching quietly, the specialized anesthesia healer cautiously asked a question.

"Is there a reason you aren't using morphine? Is it perhaps because of his past history of morphine addiction?"

Morphine.

At the appearance of that word, the soldier's body shuddered.

I shook my head.

"The limited use of morphine during a surgical procedure does not cause an immediate recurrence of addiction."

People commonly misunderstand this.

Anesthesia with morphine for someone who quit morphine doesn't cause a relapse of addiction.

Of course, there is a possibility that the craving for the drug might be stimulated again.

But addiction doesn't resurrect like a flare-up from just a single medical administration.

Is addiction the issue to begin with?

It's all useless if he dies.

In that sense, not using morphine for this patient was for a different reason.

First, before explaining, I sat the patient up instead of laying him down on the operating table.

"A side effect of morphine is respiratory center depression. It's far too dangerous for a patient whose airway is already narrowed. So, I will anesthetize him with cocaine."

It's true that morphine is an excellent painkiller.

But it wasn't a panacea that could be used anytime, anywhere.

Even in choosing a single painkiller, this level of detail difference was needed.

It means not just anyone can do the Anesthesiology Department's job.

Next, the intubation procedure also needed to be readjusted.

Normally, in general anesthesia, tracheal intubation is done after putting the patient to sleep.

At this time, proceeding with intubation while the patient is asleep is the standard.

But not this time.

"You're going to do an awake intubation?"

"Yes. It can't be helped. If we put the patient to sleep, the jaw tension will release, and the tongue will be pushed back."

Right now, the patient is consciously adjusting his tongue's position to breathe.

If we put him to sleep in the midst of that, what would happen?

"If the muscle tension is released, the airway could completely close due to the swollen tissues. If that happens, intubation would be impossible."

"......Would intubation even be possible?"

At this, the specialized anesthesia healer looked at the patient with worry.

"Since he can't lie down anyway, intubation will be difficult. Added to that, if it's Ludwig's Angina, his neck is so swollen that the field of view won't be secured, right?"

"I suppose so."

A normal intubation is impossible for a patient with a neck that severely swollen.

If we force the intubation like this, the tube will pass into the esophagus instead of the airway.

"There is a way."

First, I prepared the cocaine.

Gripping a cocaine-soaked cotton swab with long forceps, I rubbed it gently against the inside of his throat.

Next, I pierced exactly the area I needed to aim for with a syringe.

The nerve responsible for the gag reflex.

The Superior laryngeal nerve that controls the epiglottis and the upper vocal cords.

I injected the syringe into the pathway where these two nerves pass.

"Transtracheal local anesthesia is complete."

Up to this point, it was a technique even specialized anesthesia healers knew how to do.

However, the technique that would follow was one I hadn't remembered teaching anyone yet.

"I will intubate. Needle, please."

"Pardon? A needle?"

Leaving the panicking healers be, I received the needle Jenny handed over.

Raising that thick needle, I pierced the front of the patient's neck.

Pop!

The thin membrane located between the thyroid cartilage and the cricoid cartilage.

It felt like that membrane was successfully punctured.

I inserted a thin guidewire through that needle hole.

And I pushed the wire upwards through the throat, towards the mouth.

The wire went up against the airway, past the pharynx, and slightly revealed itself around the tonsil area.

I snagged the wire and pulled it up with the forceps.

And at the end of that guidewire, I attached an endotracheal tube.

As I pulled the wire, the tube slipped right down into the patient's throat.

"Without a laryngoscope...... how?"

I explained to the blankly muttering healer.

"It's retrograde intubation. By following the guidewire starting from the airway and pushing the tube downwards, you can accurately seat it inside the trachea."

It wasn't a frequently performed technique since a hole had to be pierced in the patient's neck.

However, out of the techniques that pierce a hole in the neck, it had the least side effects.

Techniques like Cricothyroidotomy() had the side effect of causing inflammation in the neck area later on.

For a patient suffering from swelling, this kind of retrograde intubation was much better.

"The airway is now secured. Please do the Time Out, Healer Ludwig."

Of course, this isn't the end.

If the patient's condition suddenly worsens, we might have to stab something like a ballpoint pen into his neck like in a drama.

Or we might have to go to great lengths with a drug cocktail.

That's why I wasn't leading the surgery this time.

Anesthesia is also a specialized domain, so it was necessary for me to take charge of it this time.

"......"

"......"

However, the reaction was strange.

"Um, Lord Saint."

With eyes that seemed to have lost confidence, Ludwig pleaded.

"Couldn't you just lead the surgery, Lord Saint?"

"Do it."

Ah, he's whining so much.

Why is someone calling himself an expert acting like that?

He said he studied and was confident.

But it seemed I was the only one here who thought like this.

The healer who took on the anesthesia assistant(?) role spoke as if to comfort Ludwig.

"You can do it...... probably."

"I'm jealous of you, sir."

"Sorry."

"......Haa. I'll do the Time Out."

Shrinking back, Ludwig declared the Time Out.

Soon, he brought the scalpel to the soldier's neck.