Chapter 296

Many who aspire to pursue medicine encounter at some point in their studies a question, often posed by their instructors, about prioritization and unavoidable choices.

Suppose one day you and your incompetent colleague find yourselves in a scenario with limited time and personnel, yet multiple patients arrive simultaneously, as follows:

Option one: A young female patient, accompanied by a male friend, complains of dizziness, headache, blurred vision, chest tightness, chest pain, shortness of breath, abdominal pain, nausea, and weakness in all limbs, with a history of congenital heart disease, immune dysregulation, wind-heat invading the lungs, spleen-stomach disharmony, and kidney yin deficiency; she sobs tearfully before you.

Option two: A work injury patient, brought by coworkers, sits idly on a corridor bench smoking silently, clutching a wad of tissue containing two fresh fingers.

Option three: A big brother who may have just bravely fought in some unregulated drinking spot, his scalp sliced open by broken bottles, flesh flayed, blood drenching his face and head, wailing louder than the public address system.

Option four: A young child, brought by elderly family members, silent and uncomplaining: "Everything was fine before—never had serious illness, just a few days of coughing without fever, came for a check-up." Now breathing slightly rapid, lips appearing somewhat darkened.

Option five: A middle-aged man, driven by his children, lies silently on a nearby bench, no visible external injuries, ignoring the surrounding chaos, enjoying infant-like sleep.

Option six: Everything is fine, but it's the dean's father.

Alright, the scenario and options are as above. No calling for consultations or seeking higher authority. Choose independently within ten seconds who to examine and treat first—you may select multiple and rank them.

Time's up. Every well-trained doctor has surely selected their preferred answer.

Most people, when asked, can hardly suppress a laugh—but their instructors typically do not interrupt the laughter.

Because they have no idea they might one day find themselves in such a situation—like Kraft does now.

The core logic of this absurd question is simple: prioritize those with compromised vital signs or altered consciousness.

"Hurry, hurry!" Kraft drags the injured man away from the wall, far from the building whose bricks or tiles might fall at any moment. "I'm a doctor—everyone, lend a hand!"

"Wait… no, don't move any patients yet."

The unlucky soul brushed by the gargoyle shards likely has only a fracture—his cries are strong and full of breath. Because he's at the epicenter, the crowd has scattered away from him, avoiding being trampled.

After a quick assessment confirming a closed fracture of the left humerus, Kraft leaves him in place and rushes toward those enjoying "infant-like sleep."

It was right not to let untrained people move patients immediately. The second patient lies in an odd posture, neck stiff and locked, emitting a faint gurgling sound as someone approaches.

He's still conscious, but neck restriction and pain prevent speech.

The force and direction of his trauma were unusually precise—seemingly forcing a cervical dislocation. If moved carelessly, allowing the cervical spine to shift freely, he might suffer a high spinal cord injury.

"Leave this one. Wait for a backboard to come!"

Skipping over those clutching injured limbs and still screaming, Kraft prioritizes time for those who've fallen silent—the critical cases—and quickly identifies those needing urgent intervention.

"Those with rib fractures, move back slightly. Wait—how come one's got multiple fractures? Flail chest? Let me stabilize it." Treatable, needs immediate control.

"So many petechiae—traumatic asphyxia. Heart still beating. Calm down. Next time, don't hold your breath when you're crushed." A specific injury caused by sudden intrathoracic pressure rise—luckily, no cardiac arrest.

"Unconscious, but heart rate and breathing stable, no visible trauma—observe." Could be mild or severe; no immediate lethal signs.

"Looks like a pneumothorax—closed. No dyspnea beyond pain—wait for the clinic's needle to arrive." Assess before deciding on intervention.

"Unconscious, head trauma, breathing irregular—fast then slow. Bad. Cheyne-Stokes respiration. Intracranial issue." Serious, but untreatable for now.

Wading observes in this man a confident professional demeanor, directing those still able to stand to follow orders, completely at ease.

His behavior is so natural that no one questions his identity; even those hesitant accept the situation, doubting but silent because others don't object—allowing a medical student to slip in unnoticed.

No need to explain where he came from—in the chaos, Kraft assumes command of the scene and sends Wading to the clinic for tools and reinforcements.

With no labels or pens available, he uses folded pant legs as triage markers. This method sometimes fails—some in robes have no pant legs to fold, so he uses folded sleeves instead.

Fortunately, few patients require immediate intervention; most have only soft tissue injuries.

Within moments, Kraft circles the entire area, sorting out fractures needing reduction or fixation, those suspected of internal issues requiring observation, and a few truly life-threatening cases.

By the time Brother Wading arrives with Kup and the tool kit, Kraft has already treated the first patient in a makeshift indoor shelter, using borrowed cloth to apply pressure dressing and stabilization to the flail chest patient—though still grimacing in pain, he now has the strength to grimace.

"Perfect timing—there's a pneumothorax patient over there with significant lung collapse." Kraft takes the kit and assigns Kup his first task. "You've done plenty of thoracentesis lately—go drain his chest."

"Me?"

"Yes, you do it. I need to attend to someone else." The professor wastes no second, opens the kit, lets Kup choose his tools, then walks toward the quietest section.

Earlier assessments were rough—now comes the detailed examination phase.

When patient volume is high, relying on spiritual perception to replace imaging diagnostics becomes inadequate.

Fortunately, in eras when imaging technology was underdeveloped, doctors still examined patients and developed systematic physical examination methods to indirectly assess the nature and extent of neurological damage.

Their names are long and awkward: Kernig's sign, Brudzinski's sign, Babinski's sign, Oppenheim's sign, Hoffmann's sign, Chaddock's sign—but all they require is lifting the head, raising the leg, or scraping the sole or instep with a sharp object, then observing reflexes.

For someone skilled, completing a full set takes barely a few minutes.

The patient previously judged as severe is indeed worse—beyond blurred consciousness, he now shows clear pathological signs: diminished response to sound, speech, and pain; deeply comatose.

Even with spiritual perception to locate and attempt to relieve hematoma pressure, the chance of pulling him back from death's grasp is slim.

Church helpers bring a light source. He lifts the patient's eyelids, preparing for a final check of pupillary response.

Under the lantern's glow, the patient's eyeballs repeat a subtle motion—slightly rolling upward, then snapping back to position.

The movement is faint, lasting only a few breaths, and the flickering firelight nearly obscures it—only careful observation catches it.

"Nystagmus?" Likely a sign of intracranial injury, combined with abnormal breathing, suggesting damage to the posterior cerebellum or brainstem.

But is intracranial injury nystagmus really like this? Honestly, he's not a neurologist and has doubts—but time is short. He moves on, seizing the brightest light to check every patient's pupillary light reflex.

"Huh?" As he lifts the eyelid of another deeply comatose patient with minimal pain response, Kraft lets out a surprised exclamation.

This patient's eyeballs, too, are repeating the slight upward roll and snap back.

【What are the odds?】

Another case of nystagmus—and both are vertical upward nystagmus. He begins to doubt himself: Is this some obscure clinical detail never taught in textbooks, or just coincidence?

It could be coincidence—but his knowledge tells him the probability of two deeply comatose patients both exhibiting such classic vertical nystagmus is extremely low.

Skeptical, Kraft lifts the eyelid of another comatose patient and waits, observing.

Just as he's about to laugh at his own absurd notion, the patient's rigidly staring eyeball faintly jerks upward a few times.