Chapter 209: Final Resting Place

Recognizing the distinct sideward motion, Kraft immediately identified the patient. Two punctures ago, this man had been sitting in the consultation room, asking if recovery was possible.

He stammered, trying to squeeze out words between short, frantic breaths. Despite enduring the pain and exerting all his strength, his exhalations were as faint as a thread, barely capable of forming correct syllables.

Kraft hurried to his side, straining to hear what he was saying—but what reached his ears were not descriptions of illness, but words like "church" and "cemetery."

"I need you to tell me what happened and how you feel now!" the bewildered doctor shouted into his ear, trying to pull him back from this incoherent mental state.

"Not the cemetery..."

Now he finally understood what the man was saying. Kraft sighed, half-amused, half-frustrated, and asked the young man who had brought him to help reposition the patient onto the bed in a half-sitting posture, so this fool who was already worrying about his postmortem burial could calm down.

"Who are you?" The young man's earnest demeanor suggested more than mere bystander sympathy—he likely knew the patient.

"This is my father. He suddenly collapsed on the way here." The youth looked anxiously at the doctor, momentarily at a loss for words, pressing his own side to mimic what he'd seen: the patient had suffered sudden chest pain while walking, and hadn't gone far before being brought back.

【Damn it, I'm not an emergency doc.】

He mentally replayed the patient's posture upon arrival once more—the unconscious leaning to the right, consistent throughout. It resembled a worsening of some preexisting condition.

"Massive hemoptysis?" Dai Wei asked, lifting the patient's lips—no blood flooded the mouth.

Unlikely. Even if a vessel had ruptured just now, it wouldn't look like this. Kraft decisively pulled a small knife from his case, sliced open and tore away the shirt, yanked off the distracting pendant, and examined the entire upper body.

The two sides of the chest cavity were clearly asymmetrical: the right side, which should have been restricted in expansion, was now abnormally full; the trachea was no longer centered but slightly bent and shifted leftward; both jugular veins swelled visibly beneath the skin.

Under the stethoscope, most of the right lung field had lost all breath sounds entirely—just like after a puncture to release air, but on a far larger scale, so vast that the lung had no room left to expand.

"Tension pneumothorax."

"But we didn't perform artificial pneumothorax on him, did we?"

"Then tell me why it's called 'artificial' pneumothorax."

The chest cavity is a sealed space. Besides air entering from outside through chest wall puncture, there's another possibility—air leaking from within.

"His lung has ruptured." The lung, ravaged by tuberculosis, had formed multiple lesions and structural damage, and in this case, had even breached the pleura, like a worn-out leather sack.

When the patient exerted himself—say, walking a long distance—his deep breathing caused pressure to rise until the weakened area could no longer hold, rupturing suddenly. Air drawn into the lung poured through the tear into the chest cavity, compressing the lung from the outside.

This case, however, had progressed with alarming speed and severity: a massive volume of air had accumulated in the chest cavity within minutes, reaching a life-threatening level.

【Tension pneumothorax】

When the tear allows air in but doesn't fully open, a unique one-way valve structure can form.

Air enters the chest cavity during inhalation but cannot escape during exhalation, functioning like a check valve—only inflow, no outflow.

This process of inflating the chest cavity is uncontrollable. Everyone knows that without breathing, you die; yet every breath only worsens the condition, making respiration harder and raising chest pressure gradually.

The rising pressure doesn't just compress the lungs—it crushes everything else in the chest cavity, including the heart. Blood cannot return, pooling in the vessels and causing the visible distension of veins.

"Needle, tubing." Kraft took the last half-bottle of alcohol and poured it generously over the patient's right chest, then filled the empty bottle with clean water.

Dai Wei handed him the needle attached to the tubing, watching as he plunged the other end into the water-filled bottle. "Need anesthesia?"

"Hold him down!" The patient had just become the second person to challenge needle thoracocentesis without anesthesia. May he possess the Duke's willpower—there was no time to slowly administer ether.

Still, considering the family's emotional state, Kraft quickly added two explanations: "Your father's lung has filled with air, which is now pressing on his heart and lungs. I must insert a needle to release it—it will hurt a bit."

The young man, still stunned by the sudden illness, hadn't grasped what Kraft meant—he simply nodded in agreement.

The next second, Kraft's hand pressed firmly onto the target spot, stabilizing the skin, and the needle pierced through. "Don't tense up—it'll be over soon."

Clearly, not everyone can endure pain calmly, especially the agony of a thick needle piercing the chest wall. The patient reflexively thrashed—but fortunately, Kup lived up to expectations, holding him down without letting the needle shift.

This puncture could be bolder: the lung was already compressed to a tiny size, the chest wall beneath filled with air, and with skilled technique, the needle pierced through swiftly, accurately, and decisively.

Bubbles erupted from the tube like boiling water—the high pressure in the chest cavity found its outlet, and air rushed out through the catheter.

As rapidly as the onset, the patient's condition improved visibly within minutes.

His breathing shifted from labored and rapid to steady; his consciousness returned from the fog of hypoxia, and he began fumbling around his neck.

Kraft found the pendant beside the pillow—a clichéd double-winged ring—and slipped it into his hand. Clutching the talisman, the patient spoke his first complete sentence after regaining awareness.

"I don't want to be buried there."

"You won't be," Kraft said, sealing the puncture site with a damp cloth and handing it to Dai Wei to secure. "You're lucky—you're alive."

He truly was lucky. If a vessel had ruptured along the way, turning this into a hemopneumothorax, there'd be no one to cry to. Opening the chest to find and stop the bleeding—no one here had the skill. Kraft might have been able to cheat and locate the bleed, but he still couldn't fix it.

"Then... when can you take this out?" Watching his father return from the gates of heaven, with a metal needle sticking out of his chest, was unsettling.

"Not anytime soon. As long as air keeps leaking, this stays in. Remove it, and you'll be back to how he was before. I recommend hospitalization... yes, stay here for a few days for observation." Now the one who should've had artificial pneumothorax had given himself a real one.

Frankly, Kraft didn't believe this patient had a good prognosis. Within days, pleurisy or empyema would likely set in—trauma plus infection, and no one could stop it. All they could do was keep him under close watch, salvaging one day at a time.

"Dai Wei, give this man black elderberry juice—three times daily, diluted. Have the family feed him slowly so he doesn't choke."

Over this period, forced by necessity, he'd gained some understanding of "primitive internal medicine," and could now confidently prescribe a medieval version of Isatis root, perhaps with a touch of vitamin C.

With the situation stabilized, as he prepared to leave, Kraft grew curious about the patient's obsession with cemeteries: "Earlier, he kept saying 'church' and 'cemetery'—what did he mean?"

The young man explained: "My father was devout his whole life—he wanted to be closer to the Lord. But now, it seems... unlikely."

"Why does that matter?"

"Professor, you may not know," Dai Wei stepped closer, lowering his voice, "but tuberculosis patients are rarely buried in church graveyards or ordinary cemeteries."

"Why?"

Dai Wei avoided the crowd and whispered: "The Church's stance dates back to the Great Plague. They consider highly contagious diseases—tuberculosis, syphilis, and others—as unclean. Such patients are usually buried only in designated cemeteries, which are far inferior to church grounds."

"All contagious patients?"

"Most of them. Unless they have special status, exceptions can be made."

"I see... so that's how it is?"