Chapter 298: The Second Time

The church members saw off Kraft, who was taking the patient away, proactively offered a carriage to facilitate transport, and assured that they would patiently wait for the patient's family to arrive and inform them of the destination.

They weren't truly concerned with what came next; the key point was that the church had entrusted the injured man's treatment to a doctor of considerable reputation.

As for the specific treatment the patient would receive, that was the doctor's business—not the church's.

Symbolically, they still sent one monk to ensure their involvement.

Brother Vatin volunteered for this role; he was somewhat worried—or rather, quite certain—that others, upon learning the upcoming treatment method, would refuse to let the patient be taken away.

Even the monk who had Buxing fallen from his horse during the rainstorm attack and was saved by Kraft would later feel a pang of unease when touching the small triangular depression on his scalp.

That piece of bone had been preserved, carved into a winged amulet, as a memento of his narrow escape and proof of divine favor, hoping this divine blessing would continue to accompany his life.

Kraft did not object to the patient's family attributing part of the credit to the Heavenly Father, nor did he feel it was a slight to his own work.

To some extent, he even agreed with this view.

Under current instruments and sterile conditions, successfully completing a craniotomy without infection or excessive bleeding or fluid leakage was, by any measure, conservative enough to warrant saying "the Heavenly Father protected him"—it could even qualify him for the Heavenly Father's Chosen, at least for the preliminary screening.

So unless absolutely necessary, Kraft generally avoided such surgeries.

After special examination, he ruled out patients whose compression was mild, active bleeding had stopped, and vital signs remained stable.

These patients could be kept under observation. If all went well, small hematomas would slowly absorb over the coming long period, possibly leaving some aftereffects—but still better than risking their lives on the operating table.

The rest were patients who had to be treated.

While preparing for surgery, a pre-drafted informed consent form had already been completed, awaiting the family's arrival to explain the condition and obtain their consent before proceeding.

Fortunately, the family of the patient with Cheyne-Stokes breathing arrived first.

Unfortunately, the patient's brother, of similar age, had little understanding of the doctor's meaning.

Despite Kraft's use of vivid analogies to describe the patient's current condition, its danger, and why surgery was the best option, the family kept asking when his brother would wake up.

"He may never wake up," the doctor had to speak more bluntly. "Even with my method, he will most likely die within days—or outright during treatment. The chance is extremely slim."

"You can choose to let him suffer less and depart more decently; or gamble on a one or two percent survival chance."

"You say you're going to open his skull… but isn't that just death?" This small-businessman understood no medicine at all; he could tell his brother's condition was bad, but if some random stranger on the street told him that, he'd beat them senseless.

"As long as we don't damage the internal structures, he's just missing a piece of skull—we need an opening to remove the blood clot," Kraft repeated the surgical principle, even invoking bloodletting.

"Just like doctors sometimes drain stagnant blood to treat illness—except this time, we're draining it from inside the brain."

"Is this the only way?" The brother still clung to hope.

"You could wait for a miracle." Honestly, Kraft's mind was already whispering, "Maybe we should just let it be."

This procedure was currently extremely difficult, offered limited benefits, easily caused misunderstandings and a cascade of troubles—a pure loss-making endeavor—but offering the most theoretically beneficial option was his duty.

"Think it over—quickly," he said, then left. The family could deliberate further, but he needed to prepare behind the scenes; once they signed, he could start immediately.

When Kraft finished washing his hands and arranged the final instrument, and while waiting, began to think he might not need to operate at all, Kup came to inform him that the family had agreed to sign.

Now things were much simpler—the only concern left was the operation itself.

The patient was carried onto the table by Dai Wei and his assistant; the hematoma's extent had already been marked.

Compared to the first craniotomy patient, this one's condition was clearly worse; the instability of vital signs stemmed from a more severe brain herniation.

Herniation could be simply understood as tissue being squeezed through gaps into places it shouldn't be.

This wasn't caused by direct trauma, but by a large hematoma disrupting intracranial pressure balance, forcing brain tissue to shift and compress. If the pressure were evenly distributed, it would be manageable.

But the problem was, the brain isn't a homogeneous blob of slime—it's divided into interconnected chambers by the tentorium cerebelli and falx cerebri, like a room partitioned into several small compartments.

Under pressure, contents from one compartment are forced into another; because the exit is narrow, only part of the tissue squeezes through, causing a small protrusion that presses against other parts.

In the worst case, this protruding part is the medulla oblongata, controlling vital functions—manifesting as Cheyne-Stokes breathing.

To achieve better decompression, besides removing the hematoma, this surgery required a larger bone flap removal—meaning a higher risk of infection.

Fortunately, the clinic, though rarely using large quantities, maintained regular ether reserves sufficient to support the surgery under general anesthesia.

Kup watched the blade carve an elliptical arc across the smooth scalp, like cutting through a tough pelt stretched over a bowl—this tissue must have been very resilient, as Kraft's knuckles stood out clearly from the force he applied.

Then came the literal act of lifting away this skin flap along with the thin muscle beneath.

Thanks to the Xi Guo family's instrument improvements, they could now use small flat clamps to hold the scalp edges and compress the superficial temporal artery to stop bleeding, instead of crudely cauterizing bleeding points with heated needles.

Dai Wei provided the hand to apply pressure for hemostasis; Kup held the scalp clamps with one hand and raised the reflector with the other to illuminate the field.

Next came a sterile version of carpentry work: without a surgical drill, chiseling out a large bone segment with small chisels was too time-consuming, demanding boldness, precision, speed, and steadiness.

Practice makes perfect. With his prior experience, Kraft felt he was adapting well to this procedure, finding rhythm in the rhythmic thudding.

Of course, if some genius could invent a drill in a world without electricity, that would be ideal. Early dentistry had foot-powered dental drills; sacrificing a craftsman's brain cells might not be an insurmountable technical barrier.

After about half an hour, he had already chiseled two-thirds of the planned opening perimeter; barring mishaps, he should reach decompression and clot removal within ten minutes and close the wound as soon as possible.

Dai Wei seemed numb; for over thirty years, the most blood he'd seen was the oozing from a thoracentesis needle puncture. Now he hesitated whether to turn away—such a rare sight was too hard to pass up.

Despite pressure hemostasis, small amounts of red still seeped toward the exposed, stark white bone surface, requiring repeated wiping with cotton balls. The shocking sight made him begin to tremble unconsciously.

Kraft hadn't noticed this at first, until he realized the surgical field suddenly began to shake; he slightly lifted his head, intending to ask the stronger-armed Kup and Dai Wei to switch hands.

But before he could speak, he realized the shaking wasn't confined to just this small area.

Objects lying flat weren't obvious, but taller glass bottles were swaying slightly side to side. Kup tightened his grip on his arm—he too felt the movement, but assumed he'd simply lost his hold.

"Don't move!" Kraft suddenly stopped his work and quickly pulled a disinfectant cloth over the surgical area. "Don't panic—we're only on the second floor; it won't collapse!"

The two were still bewildered when a clear sensation of dizziness and swaying vision struck them.

Long bottles, elevated shelves, even wooden pillars swayed; sounds of shattering vessels and delayed screams came from outside, followed by chaotic footsteps and more screams from the crowd.

"Don't move!" Kraft's roar drowned out the noise, snapping their startled minds back to the table.

He kept both hands raised, holding the cloth over the surgical field to block the faint dust drifting down from above, until the tremor from beneath subsided.

"Send someone else in to hold this cloth—we continue."