The first patient was a pregnant young woman. Diera met with all of the complex’s medicants, the abbot, and Yozef. She started off summarizing the situation.
“The child is in breech position. The mother has been in labor for over a day, and we haven’t been able to turn the baby head down for normal birth. Prospects for both the mother and the child are grim. We don’t see any option, except to remove the baby surgically. Normally, we would use opiates to put the mother to sleep, even though it involves danger to the baby’s breathing. We lose about a third of the babies with such a procedure. In this case, we have no opiates and the only option would be to tie the mother to the operating table and remove the child as quickly as possible and sew the mother closed. We expect to lose at least half of the mothers.”
Diera paused, reached out, and picked up a small dark glass bottle containing ether. “After extensive discussion among the medicant staff and in consultation with Abbot Sistian, we have offered the option to the woman and her husband to try the ether produced by Yozef. We have warned the family of the risk of an untried procedure, and the husband and the wife have both agreed to try the ether to avoid the alternative.”
She looked around the room and continued. “In spite of our discussing this at great length, are there any final comments or thoughts?”
There were none.
“Then let us begin. The patient is in the surgical room next door.”
Yozef followed the abbey staff next door to a moaning woman lying with arms and legs strapped to an operating platform. Two female medicants held her hands and wiped sweat and tears from her face. Pain and fear chased each other across her face. The husband waited outside, as was the custom on Caedellium.
Brother Dyllis was to be the lead surgeon, and he and his assistants moved quickly. Everything had been planned, and they didn’t delay. Two sections of raised steps had been put together and placed on both sides of the table to allow staff to see the details of the operation. Yozef cringed at the lack of masks and the larger-than-necessary room but didn’t see it as the time to bring up aseptic conditions.
He stood on a top step, looking over people’s heads and down at the woman. Though the room seemed chill to him, his shirt armpits were soaked, and a cold sweat ran down his neck and back. While all of the tests checked out, this was for real. The assurances from Diera that this was the woman’s and the child’s best option had not assuaged the voice nagging him that he had facilitated something based on so little experience, and something that could kill one or both of the patients. His breathing was deep and harsh, just short of gasps, as his lungs hyperventilated.
Dyllis removed the cloths covering the woman’s swollen abdomen. Another sister swabbed the abdomen with what appeared to be concentrated soapy water. Yozef later learned the cloths and the instruments had been boiled in acidified water. While the woman was being prepped, Dyllis, another brother, and a sister washed their hands and forearms with soap and a basin of evidently water hot enough to give off steam but tolerable to the three medicants.
Sister Varnia held a leather sack serving to deliver the ether, while Brother Bolwyn unstoppered the brown bottle. He shook ether drops into the bag, Varnia closed the opening, rotated the bag several times, then opened it again and placed the opening over the mouth and the nose of the suffering woman. Her eyes widened, as the bag covered much of her face. She took several shallow breaths, gasped as the ether hit her, then closed her eyes. Varnia bent to put one ear to the woman’s chest and the other ear to hear the woman’s breathing, keeping the bag over the patient’s mouth and nose. Dyllis kept a hand on the woman’s chest to follow her breathing and motioned for Varnia to remove the bag. Everyone in the room held their collective breaths while they watched the woman. Her chest rose and fell in normal rhythm.
Dyllis continued checking her pulse and breathing. “Everything seems normal at this point. Now we’ll check for responses.” The classic knee-jerk response was positive, as were iris responses to a light held close. “Now for pain.” He took a large needle and did a minor stab to her forearm. No response. Dyllis looked up at the observers and nodded, then repeated the test at several other parts of her anatomy with increasing force.
“No response to the pricks and breathing still normal. We’re ready to proceed.” He looked at Diera, who nodded assent to continue. Varnia swabbed the woman’s abdomen again. Dyllis picked up a scalpel-like instrument and made a quick, shallow, vertical cut in the abdomen. He pulled back to observe whether there was any response. “No response,” said Dyllis with more than a little wonder in his voice. “I’ll proceed with removing the baby.”
Dyllis stepped forward and with a quick and steady hand cut through the abdominal muscles and then the uterus, exposing the placenta. More careful strokes and the baby was exposed, then pulled out from the mother. The umbilical cord was cut and the baby given to another medicant, who carried out the classic swat on the butt while holding the baby by its feet. The collective exhalation of breaths was matched in intensity by the wail of the single small source. While the baby was further stimulated and cleaned, Dyllis applied a gentle pull on the umbilical cord until the placenta came out through the incision, and the mother was sewn closed.
Dyllis again checked the mother’s vitals, then announced, “Procedure is complete, mother and baby survived to this point.”
Applause and exultations broke out from the audience, followed by multiple conversations and congratulations all around. Yozef was exhausted. He had never imagined how standing and watching something could be so draining.
The following minutes were still tense, as they waited for the mother to awaken, as well as to see whether either she or her new daughter showed any ill effects. The woman awoke less than twenty minutes after the operation. It took her ten minutes to go from first responsiveness to being awake enough to answer questions. She was in pain, though not exceptional, all things considering.
By the next day, she was eating, was talking freely, and had started nursing. Abbot Sistian held a special ceremony that evening in the cathedral. He had insisted Yozef attend and gave effusive thanks, first to God, of course, then to Yozef.
Patient Number 4
During the next two sixdays, two more surgeries were successful using ether anesthetic. One patient was a tree cutter whose forearm had to be amputated, and a second involved a badly infected wisdom tooth. Yozef didn’t see either patient but was called on for a third case. He was with his three full-time workers in a new ether shop, housed in a small building outside the Abersford, and was inspecting the latest changes in the procedure. They were about to start a reaction run with a new vessel setup when Brother Alber arrived.
“Yozef, Sister Diera asks you come to the abbey. She has a patient she wants to ask you about.”
“A patient? Why does the Abbess want me?”
“I’m just the messenger,” groused Alber. “I was doing an inventory of the hospital supply room when she came in and asked me to find you.”
“Okay, I’ll be right with you.” Yozef turned to Filtin Fuller, the youngest of his workers and the most innovative. Yozef and Carnigan’s sometime drinking companion at the Snarling Graeko was on long-term loan from the glass-blowing shop. “Go ahead with your tests, and I’ll be back as soon as I find out what the abbess wants.”
A small two-seat cart was outside the shop, its stocky brown work pony untied and waiting patiently. Alber hustled Yozef onto the narrow bench, and they were off as soon as Yozef’s rear hit the wood. The cart wasn’t intended for the quick pace Alber pressed, and Yozef and his rear were relieved the trip to the hospital was short. Within a treatment room, Abbess Beynom attended a teenage boy of about seventeen years. She looked up as Yozef came in.
“Yozef, thank you for coming so soon. Come look at this.” She indicated the patient lying on the table and covered with a cloth. Yozef approached as she pulled down the cloth to expose the lower abdomen. The boy sweated profusely, obviously in pain. The low
er right of the abdomen appeared distended and flushed. Diera put her hand lightly on the area, and the boy flinched and groaned even at her light touch. “The skin is hot. Experience indicates the origin of the problem is the . . . ,” and Diera used a new Caedelli word.
It must be appendicitis and a new word for my dictionary.
“Are you talking about the small extension of the intestines where it bends here?” He pointed to the boy’s lower right abdomen.
“Yes,” said a surprised Diera. “You know of this structure?” They exchanged words, and Yozef did his usual categorization and word substitution.
“Yes, it’s the appendix and caused by some obstruction that leads to the death of the tissue,” he confirmed.
Diera listened to Yozef’s casual comment, raised a questioning eyebrow, nodded, and said, “Our only treatment is to make the patient as comfortable as possible and hope for his recovery. If the pain gets severe enough, we would normally give him small amounts of opiates to help, but since we have none left and since your ether is more a short-term solution to pain, there’s nothing more we can do. I asked you to come when it occurred to me your people might have a treatment we don’t have.”
“There’s only one treatment I know of, and that’s to remove the appendix.”
“Remove it?” said a surprised Abbess. “That carries as much risk as letting the body heal itself, due to the risk of shock from any surgery, from blood loss, and from corruption. I suppose your ether solves much of the first problem, but there are still the other two. And doesn’t the appendix perform some function? Many medicants think it has something to do with digestion.”
“I don’t think blood loss is a problem, Abbess. The loss is minimal when removing the appendix, since there are few blood vessels running directly to it from the larger parts of the intestine.” Thank you, Biology 101. “As for function, it can be removed without harm . . . as far as my people know.” Yozef remembered there was still uncertainty about whether the appendix was an unnecessary vestigial structure or had an immunological role. He didn’t want to delve into either possibility, especially since the vestigial option led to dangerous territory. He wasn’t ready to say anything about organism development, evolution, and who knew what else, until he understood more of their religion and origin myths.
“If it has no function, why does it exist?”
Yozef shrugged, but Diera’s reservations were evident.
“Then there’s corruption,” she went on.
“Corruption’s a problem but can be minimized by aseptic conditions.”
“Aseptic? Another of your words I don’t know the reference to.”
“Well, you know, to prevent bacteria from getting to the incision?”
She frowned, frustrated, “Another word. Bacteria? What’s bacteria?”
Whoops. He had to remember to think before speaking. Did they even know of the existence of microorganisms? If they washed their hands, bandages, and instruments before surgery, why wouldn’t they know about bacteria?
“Why do you wash or wipe everything involved in surgery?” Yozef asked.
“It started as a custom to signify purifying the body in preparation for asking God’s mercy, then came to be seen as helping to reduce corruption. How is not certain, but some believe it also wards off dangerous humors. Whatever the cause, it has a positive effect, and it’s standard procedure.”
Okay. No knowledge of bacteria. Another place he needed to start introducing new ideas. He wasn’t sure whether this was one of those times but plunged ahead, regardless.
Yozef took a deep breath. “Bacteria are tiny animals that are so small, you cannot see them, and they are everywhere. They get into a wound or an incision from surgery, and, once inside the body, they multiply and attack it. There are different kinds, and some cause disease and not just corruption. This process we call ‘infections’ and is due to the bacteria.”
Her demeanor reminded Yozef of parents listening to an outrageous story from a child, perhaps a story the child believed to be true.
“Now, Yozef,” she said in a gentle tone, “how can there be animals you can’t see?”
“Why not?” he returned. “Consider the Balmoth.” Yozef had seen pictures of the huge herbivore. Supposedly, there had once been many more of the giants on the island, but numbers had been reduced to small groups in the upland forests. They looked very much like the prehistoric mammal Paraceratheriums of Earth, extinct there for tens of millions of years. At that moment, the thought occurred to him that the Balmoth looked too much like the extinct Earth mammal. Could the transplantation from Earth to Anyar have been going on much longer than he thought? He had been assuming the Earth-like animals and plants were brought here only in the last five thousand years.
“Think of the Balmoth,” he repeated. “Now consider a smaller animal, maybe a large horse. Then one smaller and smaller. What is the smallest known animal?”
Humoring him for the moment, she said, “Well, I guess there are some very small insects. I’ve seen some so tiny, you only notice them when a dark one moves across a white surface, and only if you’re looking right at it at that moment. Brother Wallington knows more about such things. He’s made his life study the animals and the plants of Caedellium.”
I’ll have to talk with this Wallington.
“What if there are animals smaller than those insects? So small your eye can’t see them. Just because they’re smaller than your eye can detect doesn’t mean they aren’t there.”
Diera hesitated as she considered this reasoning. “Yes, I can see what you say. I had never thought of it that way. It could be a Fallacy of Yodrill.”
“A what of who?”
“Yodrill was a scholastic long ago from Melosia. He described a method of logical thinking about any problem. Among his writings are descriptions of common errors in reasoning, still called the Fallacies of Yodrill. What you’re saying is that we’re making the fallacy of assuming something doesn’t exist if we don’t see it. This particular fallacy is warned against when one believes a technique is impossible because one hasn’t seen it work, or a place doesn’t exist because one hasn’t been there. The animals too small to see could be another example. That doesn’t prove they do exist, only that they could exist.
“Anyway,” Yozef said, “you already do procedures that help with destroying these bacteria, you just need to do even more. For example, the surgeries would best be done in closed rooms that have been vigorously cleaned, where the outside air is not free to bring in more bacteria. The same with too many people in the room. Only those medicants performing the surgery should be present, and all should wear clean clothing and masks, so you won’t breathe on any open incisions.”
Yozef stopped with his suggestions. Those were all he could remember from TV, movies, and books. He also thought it best not to hit Diera with too much at one time.
Chapter 17: Impact
Discomforting Hope
Later that evening, Sistian Beynom returned from visiting a nearby village and found his wife sitting on their porch, staring off into the twilight. He climbed the six steps and stood beside her. She continued her faraway gaze, oblivious to his presence.
“Diera?” he asked softly. No response. “Diera!” he said more urgently, now beginning to be concerned. She stirred, her eyes focusing, and noticed him standing next to her.
“Oh, Sistian. I didn’t see you come.”
“Is everything all right, Diera?”
“All right?” she echoed. “Is everything all right? I think it is. Maybe that’s the problem. I think everything is all right, though I’m not sure.”
Sistian sat next her and took one of her hands in his. “What’s the matter, Dear?”
She looked at him, saw his concern, and gave a small and what she hoped was reassuring smile. “It’s nothing to worry about. Not as if I’m ill or anything. It’s just that I have so many emotions right now, I’m not sure what I’m feeling.”
“What k
ind of emotions?”
She smiled wryly, “Confusion, wonder, caution, fear, surprise, hope, excitement.”
“About what?”
“About how we help people. How we practice medicine. Are we much better than the primitive tribal shamans in our histories and stories, treating patients with concoctions of herbs and whatnot because of superstitions?”
Sistian frowned. Diera was among the most conscientious medicants he knew, totally committed to helping her patients, and tireless in searching for new medicines and procedures. She fought endless skirmishes, especially with older medicants who resisted changing practices long established, whether or not they seemed efficacious.
“I assume something happened today to suddenly make you doubt your calling.”
“Oh, yes. Not only something happened, but someone. Yozef.”
“Yozef?” said a startled Sistian. “What happened today involving Yozef?”
Diera described to her husband the patient brought in with the abdominal pain and her calling in Yozef to see if his people knew of any treatment for the conditions.
“And did he know something?”
“Dearest, he not only knew what the problem was, he told me how to cure it, what caused it, and gave an explanation about the general causes of diseases.”
Sistian sat back in his chair. “Those are quite astounding assertions. I think you need to tell me more details.”
For the next half hour, the abbess did. She recounted Yozef’s knowing details of the “appendix,” as he called it, and giving a plausible explanation of the pain, of fever, of the consequences without treatment, of the surgical treatment, and of the tiny animals that cause many diseases.
“How do you know what he told you is accurate? He’s not a medicant himself.”
“Ah, Sistian,” his wife murmured, “as usual, you have cut right to the heart of the matter. You’re right. Yozef is not a trained medicant. In many ways, he’s ignorant of details of treating illness and injuries. That’s what is hitting me the most. What he considers common knowledge may be more than all we think we know. And how should that make me feel? Like one of those primitive tribal shamans?”
Cast Under an Alien Sun (Destiny's Crucible) Page 17