How to Fit a Brown Bear into a Jewelry Box

"That's the situation. We need to make a small incision in her abdomen so we can put her intestines back in place. But don't worry, she won't feel a thing during the procedure. My family's secret medicine will keep her asleep for a whole day, or even longer."

Kraft drew a rough diagram of the intestines inside the abdominal cavity, then circled the section that needed to be put back in place for Gris.

The father twisted his hands together. This was all completely unfamiliar to him, and he had no experience or common sense to rely on when judging it.

"The procedure is actually just three simple steps. We make a small incision, about this long." Kraft demonstrated with his hand. "Then we can reach that section of intestine and put it back in place. Finally, we quickly stitch up the incision."

"We'll be done soon. Afterward, she might develop a fever or have the wound fester, but at least she won't die anytime soon because of her intestines."

"Of course, of course. Thank you." Gris was persuaded by the explanation. Perhaps it was because it sounded simple, or perhaps the honest mention of both good and bad outcomes made it seem more trustworthy than the Priest and the clinic doctors, who'd guaranteed success with holy water or herbs. "She's my only family. Even if I have to sell the tavern..."

"I'll do everything I can." Kraft shook his hand. "Don't worry about the fee. We can discuss it once Lis has recovered."

He turned and entered the Observation Classroom, the place where he'd first reset someone's shoulder. Lucius and Liston were already waiting inside. Lis lay curled up on her side on the carefully cleaned stone table.

It wasn't that he didn't want to find another place. The classroom had been designed to demonstrate treatments and anatomy, and its layout made it naturally suited to surgery.

With all the windows open, the classroom was bright. There was plenty of space around the stone table, and its height was convenient for working. Liston had already cleaned it thoroughly with lime, then rinsed it with boiled water.

"Ready." Kraft nodded to Lucius, who helped Lis sit up so Kraft could give her the diluted Black Fluid.

This was the first time Kraft had seen the effects of the diluted liquid firsthand.

Lis's face had been contorted with pain, but less than five seconds after she drank it, her expression vanished as if a computer had shut down. It was as though some invisible force had descended, smoothing the tension from her face and drawing all emotion and sensation from her body, leaving only a calm shell.

Her limbs relaxed at once. The hand clutching her stomach fell away, and her spine bent back limply. She settled into Lucius's arms, then lay flat against the table without the slightest resistance.

Kraft had never seen an oral medication absorbed through the digestive tract work so quickly or so dramatically.

Across from him, Liston reached out in surprise to check Lis's breathing, then felt her pulse. Both were steady and regular, just a little slower than before.

"Your family's secret medicine?"

"Yes, the Family Secret Medicine. It's the last dose. Never mind that now. Wash your hands."

It was the classic surgical handwashing method, but they had limited supplies here, so Lucius had to serve as a human faucet, slowly pouring water from a pitcher. First came limewater, then cooled boiled water to rinse it clean.

"Like this. Palms, backs of your hands, between the fingers. Then cup your hands and rub them together. Finish with your fingertips and thumbs. Wash your wrists and your entire forearms, too."

Kraft tossed his black robe and sword aside, rolled up his sleeves, and demonstrated the less-than-perfect procedure for Liston. In theory, they should have scrubbed and soaked their hands, too, but they simply didn't have the supplies.

"Lucius, could you wipe down her entire stomach? Not just the area where we'll be operating—the whole thing, including both sides of her body. Wipe from the inside out."

"Also, don't touch the instrument table. I mean the one where I put the knife and sutures. Otherwise I'll have to throw everything back into boiling water and fish it out again..."

"One last check. Does everyone know what they're supposed to do? Lucius, you're in charge of everything outside this table. Hold the mirror and direct the light over here. Just don't touch anything."

"Liston, we'll be the ones touching the wound. Don't let your hands touch anything except her abdomen or the instruments. Don't lower them below your waist, or raise them above your shoulders. We need to keep things as 'clean' as possible. I can't explain it now, but we'll have a chance later."

After listing every precaution he could think of, Kraft held his hands suspended in front of his chest and waited for Lucius and Liston to confirm they understood. But his long string of instructions seemed to have frightened them. They'd clearly tensed up, their faces saying, "That's not how you made it sound when you talked to us outside."

The sight brought back memories of Kraft's first time at the operating table. He'd already rehearsed the procedure several times in the simulation room and could fluently recite every step, from surgical handwashing to putting on a gown and laying out the sterile drapes.

But in practice, he'd started shaking as soon as he put his hands under the faucet. He'd pressed the pump on the soap dispenser several times, his mind completely blank, terrified he'd missed a spot.

Putting himself in their shoes, he realized Lucius and Liston had never been through anything like this. His sudden sternness had made them far too nervous. He thought he ought to tell an old joke to lighten the mood.

"Do you know how to fit a brown bear into a jewelry box?" There were no elephants or refrigerators here, so the joke needed a little local adaptation.

"Huh?"

"Open the jewelry box, put the brown bear inside, then close the jewelry box."

"..." The joke didn't land. Lucius and Liston exchanged glances, taking a few seconds to realize Kraft was joking.

Lucius managed an awkward but polite smile, while Liston grew even more nervous. The joke reminded him of Kraft's description of the surgery: "Make an incision, put the intestine back in place, then stitch it up." In reality, it couldn't possibly be that simple. They were attempting something this world had never seen before.

"Take a deep breath, my friend. You'll feel better. Then hand me that knife. It's a rare opportunity, so let's treat it as a special lesson, all right? We might even have the chance to explain everything in detail." Realizing his attempt to lighten the mood had failed, Kraft tried to salvage the situation. He hoped Liston would see it as a long-overdue practical lesson.

"We'll use a right paramedian incision. For an infant, we could also use an upper abdominal transverse incision..."

The blade cut through the skin, and blood seeped from the incision. The knife was the one Liston had provided. It was thin and long, and the material was good—no surprise, given that it had been custom-made for a lecturer specializing in anatomy.

It wasn't as sharp as a scalpel, but it felt decent in his hand, and was much less clumsy than he'd expected.

"Clean linen, Liston. Lucius, move to the other side so the light shines from across the table."

They had no proper gauze, so they had to make do with the linen cloth commonly used in this era. The piece in his hand was already finely made, but even so, Kraft didn't dare wipe the wound with it. He could only rely on its absorbency to soak up the blood and keep his view clear.

Lucius moved to the other side of the table and raised the metal mirror in his hand, directing a patch of light onto the incision. The mirror could barely reflect a person's outline, but thankfully, all they needed was to use it to direct the light.

A retractor was passed to Kraft. Thanks to the needs of anatomy classes, they could find a tool like this at the Academy rather than having to improvise with something else.

"I hope this one hasn't been used."

"Of course. Like the knife, it's new. I had a set made, but haven't had a chance to use it." Liston passed him another one. They would use the two curved metal strips to pull the incision wide enough to see inside.

"I can't see anything. Lucius, try adjusting the light again." The view inside the abdominal cavity was extremely limited. Moving shadows and pink intestines blurred together in the narrow field of vision.

Kraft was sure he'd made the incision in the right place. Now he had to find the intussusception as quickly as possible. This wasn't a sterile operating room; the longer the wound stayed open, the greater the risk of infection.

As the light shifted, a bulge of yellow fat appeared in the field of view. "Stop. Right there."

Kraft had spotted the landmark: the epiploic appendages distributed along the taeniae coli. Following a taenia down would lead to the appendix where the three bands converged, with the cecum above it. The ileocolic intussusception he was looking for lay beside them.

He put his fingers into the abdominal cavity and felt the problem. Gently tugging at the section of intestine, he said, "Light, over here."

Lucius had gradually gotten the hang of it. He tilted the mirror, moving the patch of light toward Kraft's fingertips and illuminating the section of intestine. This was the best-case scenario. From its color, the intestine hadn't become necrotic. Otherwise, Kraft would have had to consider how to remove the dead section and reconnect the two ends.

The next part involved a few operations that would look rather horrifying.

"Watch closely. This is the part that's telescoped in. Now I'm going to push it back." Kraft relaxed a little as he explained what he was doing to Liston, who was holding the retractor. "Don't lean in too close."

Once he'd partly reduced the intussusception, he pulled the section of intestine outward and gently pressed toward the proximal end with his thumb and forefinger. Even Lucius, holding the mirror a few steps away, could see the red lump in Kraft's hands.

Even Liston, who had performed dissections, found the sight unsettling. Calmly operating on a living person felt entirely different from working on a corpse. He glanced at Lis's face. The girl was still sleeping peacefully, completely unaware that someone had just run their fingers along a section of her intestine.

Precision and force worked in tandem. Years of sword practice had made Kraft's hands steady, while a mind from another world guided them as he slowly squeezed the telescoped ileum out of the colon.

"Don't shake. Just hold on a little longer."

The patch of light wavered. Lucius's arms were trembling, whether from fatigue or fear of the slick, pink strips of tissue in the surgeon's hands, Kraft couldn't tell. It was something that no amount of practice on the dead could help him overcome. He would only learn to tolerate it through real experience.

He tightened his grip on the mirror and readjusted the angle of the light. The operation in the illuminated area was nearly over.

The "fit the brown bear into the box" part was basically finished. Kraft had successfully reduced the ileum, and the exposed section looked normal. It hadn't ruptured, and the appendix wasn't congested or swollen.

Thank the gods. Gris had caught it in time, and the Priest hadn't delayed things by giving her another dose of holy water. If they'd come in the afternoon or evening, the outcome might not have been so good.

"Needle, thread."

Liston handed him a curved needle and thread.

The needle had been made by bending a sewing needle. The thread was the strongest fine thread Kraft could find. A student whose family sold textiles had provided it as a favor. It was supposedly made from some kind of spider silk and claimed to be able to replace the iron rings used to connect armor plates. Usually, it was sold by the strand. The student had given Kraft a whole bundle.

Once this was over, he ought to make time to visit and thank the student properly, and pay him back, so his mother wouldn't discover the sort of thing he'd done and give him a hard time.

A continuous full-thickness suture was the only choice with no absorbable thread available. There was no avoiding a scar on the little girl's stomach. Still, children grew quickly, so hopefully it would fade over time.

Fortunately, crop tops weren't popular in the northern climate of the Norse Kingdom. When the girl grew up, she wouldn't someday complain while picking out clothes that her doctor hadn't been skilled enough.

The suturing went very smoothly. It was Kraft's favorite part of the procedure. The evenly spaced in-and-out of the needle, pulling the incision back together, gave his mild obsessive-compulsive tendencies a subtle sense of satisfaction.

He finished the final stitch, deftly tied three surgical knots, wiped away the remaining blood, and covered the wound with four layers of fine linen.

"Tape." Kraft reached out instinctively, but didn't get what he wanted. He looked up and saw Liston's confused expression. "Uh, I mean, tear some linen into long strips. We need to wrap them around her waist twice to hold the dressing in place."

"Lucius, you can put the mirror down now. Go get some rest."

Liston and Lucius watched as Kraft wrapped the cloth around Lis's waist, tied it into a neat bow, straightened everything out, and covered her with her clothes again.

With the help of the "Family Secret Medicine," the operation that "only worked in Human Anatomy" had gone off without a hitch. The man who'd made history wiped the sweat from his brow, completely unaware of his achievement, then collapsed onto the floor and gasped for breath with no regard for appearances.

"So we really did fit a brown bear into a jewelry box?"