Chapter 2230 - Principles and Expedience

"At the foot of Chengmai's walls, the wounded lay beyond counting—friend and foe alike. Those were the days when, as they said, 'the men rest but the tables never stop.' The Elders told us: do your best and leave the rest to fate. Save as many as you can. With what we knew then, even as assistants we were really just fumbling at the edges—sterilizing, draping, holding down limbs. But there was no time to be choosy. Cases that weren't too complicated got parceled out to us. Some procedures I'd only watched the Elders perform; others I'd only heard lectured about. With wounded flooding in like a tide, you had to do it whether you knew how or not. Back then, it wasn't just me—even the Elders themselves stood frozen at the table sometimes. As for patients we couldn't save? Too many to count. Which day didn't claim several?

"I won't go into all of it. Let me just tell you about one Ming soldier. An artillery shell had shattered his tibia; amputation meant debridement. I was operating with Elder Lin. Looking back, I don't know what possessed me—I was fixated on how useful the newly issued hydrogen peroxide was. I soaked gauze balls in it and actually stuffed them into the bone-marrow cavity to scrub..."

Chen Ruihe's eyes widened. Before he could speak, Xie Yao gave a bitter, self-mocking laugh. "Yes—you've been in the ER. You can guess immediately. Pour in hydrogen peroxide and it foams like mad. Plug the cavity with gauze, and the bubbles can't escape—they can only be forced deeper into the marrow. With pressure that high, what do you think happens?"

"...Air embolism?" Chen Ruihe asked cautiously.

Xie Yao nodded. "I'd heard air embolism was extremely dangerous, but I never imagined it could strike faster than any human could react. Before Elder Lin could turn to see what I had in my hand, the patient cried out, 'I can't breathe!'—and in an instant lost consciousness. Just like that. Gone in a flash. If you truly want to file a complaint, first tell me: one piece of gauze cost a man his life—what punishment do I deserve? Failing to supervise, allowing an assistant to kill a patient—what punishment does Elder Lin deserve?"

Chen Ruihe was taken aback. "That... how can these situations be compared? Doctor Xie, everyone knows your skill—who's qualified to judge you? Of course you shouldn't be punished. And the Elders... of course they can't be punished either. But I've heard that in Australia, this is called a 'medical accident'—doctors go to prison! Even if the government doesn't pursue it, the patient's family will demand the doctor's life!"

"No need to go to Australia—if this had happened at Bairen General Hospital, it would already count as a medical accident." Xie Yao smiled meaningfully. "But this happened at the front line. Demand my life? That soldier couldn't even give his name. In times like these, he probably had no family—who would come here demanding justice?"

"But that's not—" Chen Ruihe blurted out, but Xie Yao raised a hand to stop him.

"Hold on. Let me ask you: what is the level of Australian medicine, and what is the level in these newly liberated lands?"

"Well..." Chen Ruihe was stumped. No one had been to Australia; everyone knew only what the Elders showed them. But wasn't the Elders' level the Australian level? What did that have to do with whether something was a "medical accident"?

"I once heard Elder Lin mention that even in Australia, doctors in the capital and doctors in remote backwaters receive different punishments for the same mistake—the capital punishes more severely; country quacks get off lighter." Xie Yao continued. "If Wang Chuyi had lost that leg in Lingao, the medic would go straight to Fu Youdi for a year or two in the penal-battalion medical squad. But here at the front... heh heh heh..."

"But... that's not right..." Chen Ruihe sensed something was off but couldn't quite articulate it. "We're all naturalized subjects of the Council of Elders—why should the difference in treatment be so stark?"

"Today, as a senior, I'll give you a bit of life advice—a word to the wise. Just remember this: this incident happened on semi-pacified soil. If no one files a complaint, the officials won't pursue it. The medic's skills are low—you and I can see that plainly. Does Elder Song not see it? Does Elder Lin not see it? Does the Council of Elders not see it? Why don't they throw him in prison? Why do they still send him to the front? Have you thought about what's behind all this?" Xie Yao asked.

Chen Ruihe opened his mouth but said nothing. He remembered his training courses: several Elder doctors had remarked that the medic training was "far too crude." Supposedly, in Australia, training a doctor took over a decade before one could practice independently.

Here under the Council, the best naturalized doctors at Baipu General Hospital had only five years' experience—and most had started as nurses or medics with hardly any medical education, "growing through practice," built up by treating patients and attending short-term training courses. It was easy to imagine how many "hydrogen peroxide" accidents such crash-course doctors had caused.

"Think it over. If you can't figure it out, at least you've taken political classes. The chapters on life under Ming rule are numerous—required reading. When you're on shift, don't carry such a chip on your shoulder." Xie Yao offered a helpless smile. "You can learn technique from me. Don't learn my temper."

This answer did not satisfy Chen Ruihe, but he seemed to grasp Xie Yao's subtext. The double standard's tolerance felt at odds with the oath he had sworn—but he didn't know how to refute it. Or perhaps he didn't truly want to.

Fortunately, the conversation did not continue. Just as they were talking, the orthopedic surgeon who had been on shift the previous day came in to eat. Seeing they seemed finished, he nodded and went to get his meal.

Xie Yao greeted him casually. "Off duty? How many yesterday?"

Chen Ruihe knew "how many" meant amputations.

For orthopedics, given the lack of internal-fixation materials and the transport constraints, amputation and bone-setting were virtually the entire job. In orthopedics slang, "surgery" simply meant amputation.

In this era, shortage of doctors and medicine was the norm. Even Elder doctors, facing many injuries and illnesses routine in the old timeline, were helpless. Especially for mechanical limb trauma that in the old timeline could have been repaired surgically and recovered—here, amputation had become a common treatment, mirroring the early days of surgical history.

"The literature says early surgeons were barbers and butchers. It was meant as a slur, but there was truth in it," Elder He had once remarked at a medical-sector meeting.

In the Elder physicians' expectations, soldiers who had endured unbearable transport, operated on by poorly trained surgeons, in filthy surgical environments, using often-backordered homemade anesthetics for improper procedures, would surely experience blood, terror, and despair—and record appalling complication and mortality rates. But to their surprise, the wounded often displayed uncomplaining tenacity and endurance. Of course, this surprised no one among the naturalized staff: an officer who would give his soldiers medicine was already considered a benevolent commander. That the Council of Elders would give equal medical care to derelicts, beggars, and enemy soldiers—that was sainthood. What did these grunts have to complain about?

Before the campaign, orthopedic Elders had foreseen that amputation would likely be overused—even in the best-equipped Lingao General Hospital, work-injury cases showed that tendency. So they drafted indication standards; Lin Motian repeatedly stressed the dangers and cruelty of amputation. But under primitive pharmaceuticals and difficult transport, amputations performed to save lives became ever more common.

"Don't get me started... damn it. Off duty? I wish. Just catching a breather. The scalpels are so dull they won't cut skin! 'Amputate'? Amputate my balls! That patient—supposedly the local county magistrate—what was his name? Right, Wang Chuyi! The pain, oh the pain—he screamed through the entire surgery! The anesthesia didn't even work." The orthopedic surgeon was in a foul mood but had a healthy appetite; his mess tin was heaped full. "The scalpels haven't been replaced in ages. When will supplies arrive? It's driving me mad. At this rate, even suture thread will run out!"

"His amputation was risky, wasn't it? Lots of blood vessels in the leg," Xie Yao said.

"Indeed." The orthopedic surgeon nodded. "It wasn't that long—about twenty minutes—but the patient's screaming made me afraid to cut. Slowed me down! Lucky for him he's got a strong constitution; he only took a few pellets. If there'd been more, hunting for iron shot and lead with this dull blade—there'd be no end to it!"

"How much of his left leg did you save?"

"Above the knee, barely. Whether it heals—who knows? The infection hurdle will be hard to clear." The orthopedic surgeon sat down next to them and began wolfing down his food. "What a day! My arms can't even lift anymore." His hands were shaking; he could barely hold his chopsticks.

Chen Ruihe sighed. There was nothing to be done.

"I hear you were up all night too. The other patient—couldn't save the spleen?"

Xie Yao shook his head. "He's lucky—lost a spleen, but his life is safe. The poor fellow before him, though—open abdominal wound from a cold weapon, deep penetration. You know those are even more dangerous than gunshot wounds, more prone to infection. By the time he got here, it was classic peritonitis. I sutured the bowel, but there's no medicine. Whether he survives infection is anyone's guess. And even if he's tough enough to make it, he'll probably end up with a fistula—carrying a colostomy bag on his hip for the rest of his life. One slip, and infection again. He probably won't live long."

(End of Chapter)