Chapter 206: Teaching Rounds

A soul already marked by the Grim Reaper was temporarily permitted to remain within the body, which lay upon a wooden board in the clinic.

The bedding was wrinkled; the previous occupant had not tidied it before leaving. The twisted fabric folds pressed uncomfortably against his back, and beneath those deep creases seemed to lurk epidemic miasma and unwashed, faint rust-colored spots, yet it was far better than a hard board.

He tried to lift himself slightly to smooth the blanket, but a violent coughing fit interrupted the motion. A pain like a wound being forcibly stretched surged through his chest. His hand clenched the nearest thing he could grab and pull, making the blanket even more wrinkled.

Something thicker and heavier than saliva sprayed out with the cough. His hand instinctively wiped it, sensing the familiar damp stickiness; a conspicuous streak of red appeared on his palm, catalyzing a steaming sensation of dry heat and anxiety.

Occasionally, shadowy figures carrying bottles and jars passed behind the white curtains, sparking a flicker of instinctive hope, only for it to cool quickly.

By now, expectations for herbal decoctions had been utterly worn away after the illness repeatedly worsened. The physician had plainly stated that improvement was unlikely; rather than calling it treatment, it was more apt to describe it as the survival instinct, a willingness to believe one could still struggle on.

Amidst the discomfort in his lungs, he could neither sleep nor stay awake, so he simply closed his eyes, trying to ignore the similar coughing rising and falling next door, letting his consciousness drift temporarily further from reality.

But this only made his hearing more acute. Within the coughing, there was a suppressed sound like footsteps of varying depth and resonance, pacing among the indoor curtains. Occasionally, it would stop, high-pitched and urgent, to knock on the door, urging and summoning; each sound caused a startle.

And amidst this sound, a series of footsteps on solid ground descended the wooden stairs, approaching this side. The direction indicated they were coming here.

A corner of the white curtain was lifted. It was not the usual apprentice delivering medicine, nor was it Dr. Dai Wei, seen only during consultations and when delivering verdicts. Instead, a tall stranger he had never met before walked naturally to the bedside and stood there.

A black robe similar to Dai Wei's but newer, youthful features visible behind a face-covering cloth, and a thick, receding hairline all arbitrarily lowered his credibility a few points.

However, he soon realized that impression points did not necessarily have to be reflected in appearance.

Behind the young, tall doctor, a middle-aged physician in a black robe trimmed with red thread followed, squeezing in and automatically taking a position half a body length to the side, hands clasped before him.

The only one he recognized, Dr. Dai Wei, walked last. He pulled back the curtain for a servant carrying a tray of instruments with both hands, then followed behind that middle-aged physician whose black robe was of a special cut, actively marginalizing himself to reduce his presence.

Several assistants and apprentices silently followed in small steps, occupying positions around the bed. The small partition was suddenly stuffed with nearly ten people, completely surrounding the sickbed. A pair of eyes, not tall enough to reach shoulder height, hid outside the crowd, trying to see into the inner circle.

"Hello, I am Viren, a surgical lecturer at Dunling University's Medical School. This is Professor Kraft from Rivers University." The doctor in the red-trimmed black robe stepped forward, throwing out an introduction containing several unfamiliar terms, presumably indicating great stature.

"We have come this time to provide a newer, more effective treatment for tuberculosis patients, especially one that is very effective against hemoptysis."

"Ah?" The patient on the bed stared for a moment, looking as if he hadn't quite understood, still considering whether he should sit up.

Dai Wei leaned in to translate, "These two are my teachers, here specifically to treat your white plague."

"May the Heavenly Father bless you."

"This does not refer to a complete cure, but perhaps to slowing the disease's progression and alleviating symptoms." Kraft pressed down on the patient who was trying to sit up and smoothed the sheets. "Before that, we must first understand whether your condition is suitable for initiating treatment."

Scanning the surroundings, intuition told him something important was missing here.

"Dr. Dai Wei?"

"I am here. Is there anything I can do for you?" The clinic doctor felt that the next step should be a simple inquiry of the patient followed by treatment; he only needed to sit quietly on the side and learn, seizing the learning opportunity that had fallen into his lap.

"Come, report the medical history."

That was the right tone. Kraft had finally found the correct way to open this. Lecturer Viren stepped aside, exposing Dai Wei, who was three parts startled, seven parts surprised, and ninety percent bewildered.

The gaze previously concentrated on Kraft, including that of the patient, shifted uniformly to the clinic's main figure, giving him a long-overdue sense of déjà vu, returning him to his not-so-pleasant student days.

"The patient came for consultation due to 'coughing and hemoptysis,' using..." Through a layer of cloth, Dai Wei took a deep breath through his nose, catching the herbal scent drifting from the jar in the apprentice's hand, "the same as now, an elderberry water decoction. Considering the patient suffers from loss of appetite and occasional abdominal pain, agrimony was added to stimulate appetite, and dill to relieve intestinal colic and strengthen the spleen and open the stomach."

Dai Wei felt cold sweat slide down his back, a delusion of being precisely pinpointed by a familiar teacher in a large lecture. Today, those present were not classmates; the damage to social status from answering nothing correctly was far greater than in a classroom.

He looked at Kraft, searching the other's reaction for an attitude toward this answer, only to find the latter was also looking at him. That look clearly said, "Keep going, why did you stop?"

What should I say? The cold sweat that had just stopped began to break out again. In his understanding, he had already said almost everything that needed to be said; everyone knew this was a tuberculosis patient, but judging by the look, it was far from over.

However, the professor was obviously an understanding person, quickly sensing his difficulty and deciding to offer a hint: "When did the patient start coughing, and what did he come into contact with? Was the coughing severe? Is there a difference between day and night? Is it a dry cough or with phlegm, and is there blood in the phlegm? Over such a long time, has it worsened or alleviated? When did the hemoptysis start, and is there chest pain..."

Dai Wei looked helplessly at Viren, and Viren naturally retorted with his eyes—You're asking me, a surgeon?

The atmosphere at the scene was not good, but fortunately, the patient had autonomous consciousness, and there were no communication barriers between the two parties.

"Doctor, I had a bit of coughing last winter; I drank some of that flower tea myself, and it was gone in a few days. Then the coughing came again this spring, getting more and more frequent." The patient propped himself up to sit on the bed, triggering another bout of coughing. Visible on his hands and the front of his clothes were old and new dark red stains, half dried and half fresh.

He struggled to cover his mouth to stifle the cough, speaking tightly as if fearing the doctor would turn and leave, "When the weather started getting hot, I discovered blood in my phlegm and generally felt too weak to exert myself, so I came to see you."

"Good, good, I understand." Kraft tore a piece of absorbent linen from the tray and handed it to him. "Regarding these specific times, do you have any impression of which months? Especially when did this coughing and hemoptysis begin?"

"I can't remember clearly. Does that matter?"

"It's fine, lie down first and rest a bit, let me take a look." From this angle, it was not unreasonable that current medical histories were generally incomplete. Under the current situation of vague concepts of time and patients lacking any health awareness, information collection for mobile patients was absolutely a mess.

Kraft unbuttoned the patient's clothes. Unlike the duke, who maintained sufficient nutritional supply and possessed an excellent constitution, the symptom of emaciation was very obvious here; when the chest heaved, the ribs could be faintly seen beneath the skin.

Almost no search for bony landmarks was needed; the location could be seen intuitively by sight alone.

【Highly suitable for teaching】

"Come, Kupp, put the things aside, come and press." Kraft called Kupp over, grabbed his hand, and pressed it onto the center of the patient's chest. "What bone is this?"

"The sternum."

"Very good. Now, what sensation do you feel in this area you are touching?"

"Uh... it seems uneven, a bit protruding?" Kupp answered uncertainly.

"Correct, this is the sternal angle, level with the second pair of ribs on both sides. We can use this to count the ribs up and down."

【Seems a bit troublesome】

Guiding Kupp's hand to touch both sides to locate the ribs, Kraft felt such a thought forming. He should have a simpler method, one that did not require distinguishing based on these rigid rules.

After a quick search within the diagnostics, logic vetoed the newly formed thought. This was indeed already a quite convenient method; to be faster, one would have to see directly, but not all patients were this emaciated.

Yet intuition still hinted that he should not be trapped in inefficient methods, guiding his consciousness to follow instinct and use that method, skipping the tedious inspection, palpation, percussion, and auscultation, to make a diagnosis for the patient from an absolutely accurate perspective.

【Is this not being responsible to the patient?】

Kraft pondered for a moment and grasped the source of the thought: it was the daily stirrings of the spiritual senses, like the mouth reflexively secreting saliva upon seeing delicious food.

He rejected the suggestion proposed by a part of himself. This was certainly not irresponsible. What was needed at present was a method that anyone with systematic education could perform, simple and easy to execute, not a human CT machine cheating with an extraordinary ability that was difficult to replicate.

If, as an initiator, one could not complete the full set of operations under ordinary human conditions yet still sought to promote the treatment method, that would be truly irresponsible.

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Suppressing the spiritual senses, Kraft followed the normal order to palpate for pleural friction rub and rule out contraindications of pleural adhesions. He then tapped sequentially between the ribs to locate the cavity. Next, he took a cylindrical object from the tray Kupp had brought; both ends were tightly sealed with thin membranes, looking like an elongated small drum.

This was also one of the Artisan's works from Westmin, the most primitive version of a stethoscope, or perhaps more appropriately called a "listening tube."

One end was placed on the area needing auscultation, and the ear was pressed against the other end. The benefit was that it saved the inconvenience of having to press one's head against the patient's chest to listen. It was still somewhat inconvenient, requiring bending over, stooping, and twisting the neck to adjust the position.

Kraft carefully positioned and moved the listening tube, missing the radiology department he had been away from for so long. Corresponding to the cavity location he had percussed, he distinguished the whistling sound of air passing through the cavity. After confirming repeatedly, he fixed the listening tube with both hands and offered the earpiece.

"Come listen, everyone. This is what the voice sounds like coming from the hollow lungs of a tubercular patient."