A Surgery with Nothing

Wu Zhou followed the standard surgical hand-washing procedure. Using clean water and soap pods, he worked up a lather and washed from his fingertips to his upper arms. After one wash, he cupped strong liquor in his hands and scrubbed them carefully again.

As he scrubbed, he sighed inwardly. No running water, no antibacterial hand wash, no Povidone-Iodine, no Chlorhexidine. Three rounds of surgical scrubbing had been reduced to two. If this were the emergency department, even the operating room nurses would scold him until he fled with his head down.

He did not even know whether this strong liquor had enough alcohol content—judging by the smell, it probably did not!

Sterile gloves were out of the question too. Whether the wounded man got infected was basically up to fate...

Right, there were no antibiotics either!

No Sulfonamides, no Penicillin, no Cephalosporin of any kind...

He was about to handle intestines with these bare hands. Just thinking about the risk of infection after closing the abdomen made Wu Zhou shudder.

This was outright gambling with a life!

But if the intestines were damaged, that would be an even bigger problem. If intestinal contents leaked out, peritonitis, sepsis, and all kinds of complications could follow. Any one of them could kill. Clinically, closing the abdomen without properly repairing the intestines would count as malpractice. The gastrointestinal surgery department would get pelted with a whole basket of rotten eggs.

Of two evils, choose the lesser.

Holding his breath, Wu Zhou began at the duodenum and carefully ran through the intestines inch by inch. Bloody loops of intestine slipped through his fingers, and before long, frantic retching sounded beside him:

"Bleurgh—"

The Red-haired Archer was kneeling on the ground, folded over with his head tucked between his knees, his face nearly buried in his vomit. The Young Priest was pale, desperately keeping his gaze lowered to avoid the abdominal cavity. His lips were pressed tight, and his cheeks bulged and twitched. Behind them came a loud thump, like a bucket hitting the ground, followed by the sound of the water carrier vomiting too.

Go on, vomit. Vomit enough, and you'll get used to it. Wu Zhou grumbled inwardly. Then he looked up at the wounded man and nearly lost his soul.

"Why are you awake?! Hold him down! Hold him down now!"

Damn it, waking up during surgery!... No, there was no "during surgery" at all. There had been no anesthesia from start to finish. The wounded man had simply woken up!

I'm handling your intestines, brother!

Don't move!!!

Several warriors, vomit still hanging from their mouths, rushed over and pinned him down. The wounded man erupted with astonishing strength in his terror. Despite having lost at least 500 milliliters of blood, he struggled violently, and the three of them nearly failed to restrain him. Wu Zhou held a section of jejunum in his left hand and a section of ileum in his right, cold sweat covering his face.

"Don't move! Don't move—"

No anesthesia was terrifying... Did anyone have decent aim? Could they just knock him out with a club...

Just kidding. If they gave him an epidural hematoma, Wu Zhou would not even know how to treat it!

After explanations and reassurance, the wounded man finally calmed down. Wu Zhou steadied himself and inspected the intestines inch by inch. Nothing. Nothing. The jejunum was intact too. Wonderful! Next came the ileum. This was the section that had spilled out earlier, the most dangerous part...

A five-centimeter-long tear!

Good thing he had found it. If he had missed it and simply put the intestines back...

Wu Zhou was already imagining the chain of consequences: leaking intestinal contents, suppuration, peritonitis, sepsis, and finally death. Surgery was like that. Find it and stitch it up, and everything was fine. Miss even the tiniest thing during inspection... heh.

There were no conditions here to suture the intestines. Fortunately, he had another option.

Wu Zhou carefully turned the Minor Healing Potion bottle upside down and dripped the potion onto the wound. One drop, two drops...

Right before his eyes, the narrow tear began to close as though filmed in time-lapse. One centimeter, two centimeters...

Then it stopped.

Wu Zhou shoved the stopper back in, shook the bottle hard, and pulled it out again. He managed to shake out... another drop.

Spirits of heaven and earth, Amitabha, Infinite Heavenly Worthy—whatever god in this world supplied Healing Potions, please let this wound heal... No, please let this potion be enough!

It healed another centimeter.

Another drop...

It was healed! Perfectly!

Wu Zhou let out a breath and continued downward. Fortunately, the remaining ileum, as well as the cecum and colon below it, were undamaged. As for the rectum, it was probably too deep to have been affected, so there was no need to check it.

Irrigate!

Close the abdomen!

Right, there was no 37-degree-Celsius Saline Solution here. He would have to mix it himself...

"Has the water boiled yet?"

"Not yet..."

See? This was how dire it was.

What could he do?

Should he be grateful that they were beside a broken house, with enough means to boil water and even find some salt?

Wu Zhou took a deep breath, then another, then a third. Holding his hands level before his chest, he twisted his upper body around in an extremely awkward posture and waited eagerly for the water in the pot to boil. Then he began verbally directing his companions in mixing Saline Solution on the spot:

"Pour the boiling water into the cooled boiled water... Don't pour in too much! Taste it... No, don't drink straight from it. Pour some out before you drink it. It should feel the same temperature as your mouth—neither hot nor cold.

"Good. Now add salt! Not too much. A pile about the size of the first joint of your thumb. Crush it, toss it in, and shake it up!—Taste it again. It should taste very salty, but not so salty that it turns bitter. Is that right? Good. Come on, let me taste it too..."

"Why add salt?"

The Young Priest had finally recovered somewhat from vomiting. Even the freckles on his face seemed to have dimmed a little, though his eyes remained bright. Hearing him ask, Wu Zhou answered without thinking:

"Saline Solution doesn't hurt when you wash wounds with it."

"What kind of salt water?... Why doesn't it hurt?"

Wu Zhou said, "..."

Oh no, he had let it slip! The people of this world did not know what Saline Solution was!

And why did it not hurt? Was he supposed to teach a physiology class on the spot, starting with cellular osmotic pressure and ending with neural conduction?

"Ahem. Saline Solution is salt water that is as salty as blood... When your own blood runs over your own wound, doesn't it hurt much less?"

"But salt is expensive!"

No way. Salt was expensive too?

Wu Zhou broke out in a cold sweat. In clinical practice, Saline Solution was one of the most widely used supplies. It was used for debridement, for flushing all kinds of tubes, and for irrigation before closing the chest or abdomen. Everyone just picked it up and poured it liberally. For a major operation, having dozens of liters of Saline Solution listed on the bill was nothing unusual.

And now they were telling him salt was expensive...

Wu Zhou turned his head and looked at the rough stone walls, the thatched roof, and the pitch-dark house beside them. Fine. Salt really was expensive.

"Even if it's expensive, we have to use it! If we don't use salt water at this concentration, the wound will heal badly!"

With fresh water, the osmotic pressure would be too low. A whole mass of cells would die, and it might cause an electrolyte imbalance or something else...

These people probably had never even heard of cells or ions...

The Young Priest looked thoughtful. Then a loud cough rang out nearby. "Ahem... Little Grete, the salt water's here!"