I Became a Plague Doctor in a Romance Fantasy

149. Appendicitis (1)

BOOM! With a frantic crash, Amy burst into the research lab door like it personally insulted her.

I glanced up from my work, already accustomed to such entrances. Amy was panting heavily before blurting out:

“Emergency patient just came in!”

“What’s wrong with them?”

“Severe lower abdominal pain, bloody diarrhea, and increased breathing rate and body temperature. Thought it might be cholera so I rushed over.”

“Did you palpate their abdomen yet?”

“No.”

“We need to figure out where exactly it hurts.”

With that, I grabbed my things and stood up, ready to leave the lab. Amy was pacing anxiously on the spot.

“Let’s go. Why did you suspect cholera?”

“The diarrhea and fever.”

“Any contact history with cholera patients?”

“Not that we know of… but there could’ve been unnoticed exposure.”

I nodded thoughtfully. It didn’t quite seem like cholera – while possible, severe abdominal pain and bloody stool aren’t typical early symptoms.

More likely, this could be diverticulitis or appendicitis given the nature of the pain and bleeding.

Let’s check it out anyway.

“How old is the patient?”

“33-year-old male farmer from near the capital. No clear cause for his symptoms yet. Notable detail: he’s been sweating profusely.”

I pondered this briefly.

Hopefully not diverticulitis – while appendectomy is relatively simple, I’m unsure about performing colonic surgery if needed. Might involve resection and anastomosis…

Not impossible at this age, but less common. Meanwhile, if it truly is cholera as Amy suggested, oral rehydration and antibiotics should suffice – much simpler treatment indeed.

“Did you check the patient’s pulse?”

“Yeah, 130 beats per minute. Quite fast. No signs of dehydration yet though.”

See? If it were cholera, dehydration symptoms would likely appear later rather than earlier.

I sighed deeply.

“So what measures have you taken?”

“I gave him salt water. Heard giving aspirin to someone with gastrointestinal bleeding could be dangerous, so I administered a small dose of opium instead.”

“Good call.”

Of course, in a modern hospital we wouldn’t prescribe opioids so casually, but options are limited here.

“We’re here.”

“Was really worried they might die, but seeing you Professor makes me feel better.”

The ward was chaotic due to our loudly suffering patient. As I entered the hospital room:

They must be in considerable pain.

I looked at the patient lying on the bed. First thing I noticed was how soaked the sheets were with cold sweat – he was still perspiring heavily.

Fever noted. Though pale, no apparent signs of dehydration judging by their eyes and mouth – looks like the nurses have been diligent about hydration.

“Patient, can you hear me?”

“Yes?”

“On a scale of 0 to 10, how bad does your stomach hurt right now?”

“Oh, about 5. Was closer to 7 earlier though.”

Makes sense considering the opium administration. Current pain level shouldn’t be too severe then.

“I’ll help you. Let me examine your abdomen first. Please bear with any discomfort…”

I lifted the patient’s shirt to expose the navel, motioning Amy over.

“Yes?”

“Tell me, do you know where the appendix is located?”

“Um… lower right side?”

Correct. By finding the midpoint between the umbilicus and anterior superior iliac spine – that bony protrusion on the hip – we can pinpoint the approximate location of the appendix. Should be roughly around here…

Medically known as McBurney’s point.

This is anatomically where the appendix lies within the abdomen. Pressing firmly here caused the patient to flinch noticeably.

“Does that hurt?”

“Yes.”

“And other areas?”

Based on reported diarrhea and bleeding, let’s assume some issue with the colon.

Following the large intestine’s path, I pressed various points along the patient’s abdomen. They emitted a soft groan.

“Where does it hurt most?”

“Where you pressed first.”

“Here?”

Pressing McBurney’s point again elicited another sharp cry. Seems appendicitis is indeed the diagnosis…

In modern hospitals, CT scans, ultrasounds, and blood tests typically confirm appendicitis. Here, we lack such luxuries.

While appendicitis seems likely…

Can we proceed directly to surgery based solely on this? There’s always a chance antibiotics alone might resolve it…

“Amy, should we operate on this patient?”

“Is surgery necessary?”

“While removing the appendix is ideal for appendicitis, sometimes antibiotics alone can treat it…”

Amy tilted her head curiously.

“Then wouldn’t surgery be safer?”

Patient’s temperature has reached 38 degrees Celsius. Prompt surgery might be best…

We moved the patient to the operating table. Appendectomy is relatively straightforward surgery.

Simply incise at McBurney’s point, enter the peritoneal cavity, and remove the appendix.

Of course, countless things could go wrong.

What if it isn’t appendicitis after opening? That’d be disastrous – unnecessary laparotomy plus unclear treatment plan.

“Pay close attention, Amy. We’ll make minimal incisions, focusing specifically on McBurney’s point.”

“Understood.”

As usual. Induced deep sedation via propofol injection, with a nurse standing by holding the简易ambu bag.

Looking at the patient:

“Shall we begin?”

Sedated patient couldn’t respond verbally, though they mumbled something unintelligible.

“Well, let’s start the surgery.”

Lifting the scalpel, I made an incision about hand-width long on the patient’s abdomen. Inserting the Richardson retractor to widen the cut-

“Ah!”

Patient screamed briefly but showed little other reaction. Anesthesia seems effective this time.

Rechecked gloves before inserting fingers into the incision to grasp the large intestine. Amy held her breath.

“Will this hurt them?”

Apparently not, given how well the anesthesia took. While not full general anesthesia, deep sedation effects vary person to person.

Grasping the ileum, I located the attached appendix. Though not yet ruptured, it was clearly enlarged – definitely appendicitis.

Rinsed the appendix with saline solution after pulling it above the abdomen. Amy observed closely before questioning:

“Is it okay to just cut this off?”

“Huh?”

“It might be useful, right?”

True, the appendix does have functions, but its absence doesn’t seem problematic. Removing it entirely is far better.

“It’s already damaged beyond repair.”

“Oh.”

“Go ahead and cut it.”

Amy snipped the appendix cleanly with surgical scissors. I sutured the cut area with stitches – quick process.

Appendix removal site was roughly thumbnail-sized. After checking proper suturing of the large intestine with water, I set it back down.

“Are we done?”

“Yeah, just need to stitch up the skin now.”

“But how do we clean up this mess?”

“Just put everything back inside.”

Since we pulled it out directly, putting it back follows same logic. Though we should monitor for potential bowel obstruction over next few days.

Intestines are long tubes without specific placement methods – letting them settle naturally is best approach.

Placed the large intestine back inside the patient. At least appendix removal went smoothly.

“Just need to finish stitching now.”

“Right.”

Amy nodded. Finished stitching up the patient and placed a towel over them.

Surgery completed successfully. Patient remains under deep sedation as we wait for it to wear off.

“What are we waiting for exactly?”

“Just waiting till patient regains consciousness from sedation. Need to ensure they wake up properly.”

“Ah.”

“Yep. In rare cases, deep sedation might prevent normal breathing.”

Amy looked at the removed appendix on the operating table – tiny lump of blood about finger size.

“Hard to believe such a small thing could endanger someone’s life like this.”

“Serious condition though. If appendicitis ruptures, bacteria and fecal matter spread throughout the abdomen causing much worse complications. Can become life-threatening quickly.”

Patient stirred slightly on the operating table. We turned our attention to see if they were waking up.

“Thank you…”

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