Chapter 175
What’s the girl’s illness?
The old mage lay in bed, the girl’s eyes were filled with anticipation as she looked at Elder Wood. On the side, the female knight, Seraina, stood with her sword drawn, her emerald eyes flickering slightly as she glanced between Elder Wood and Garrett. Eventually, her gaze lingered more on Garrett.
Garrett glanced at her, and Seraina nodded slightly to him, her eyes twinkling with amusement. Then, she gestured towards the girl on the bed, silently mouthing a question. Her eyes seemed to plead: What’s her illness? Do you know?
Garrett hesitated for a moment, then looked at Elder Wood and discreetly moved a step closer to the female knight with his right foot. Before his left foot could catch up, Elder Wood turned back with a smile, looking at Garrett.
"Garrett, what do you think?"
"I..." Garrett began, about to give an answer. But as the words reached his lips, he paused. "I have some guesses, but I need to examine her to be sure."
"In that case, go ahead," Elder Wood said with a smile, raising his hand. Garrett immediately jumped up.
"Just wait, I’ll go get pen and paper!"
Medical history!
Physical examination!
Documenting symptoms!
He sat down in front of the girl with a thick notebook, flipping it open. The pages were densely filled with notes up to halfway through. He flipped to the latest page and smiled at the girl on the bed.
"Miss, may I ask for your surname?"
"Meinlan," the girl replied, her face lowered, pulling the blanket tighter around her, her ears turning red. Garrett coughed and continued writing, asking further:
"Your age?"
"17."
"What seems to be the problem?"
"My... my stomach is getting bigger..."
"For how long?"
"..."
"How long has your stomach been growing?"
"About three, three to four months..."
"Was it this big from the beginning?"
"Of course not!"
"Does your stomach hurt?"
"A little..."
"Is it constant pain or does it come and go?"
"It comes and goes..."
"Have you experienced bloating?"
"A bit..."
"Do you feel nauseous? How’s your bowel movement? Is it daily? How much? Any flatulence?"
"Why... why are you asking everything!"
The girl’s ears turned red as she turned away, ignoring him. Garrett sighed and raised his head, gesturing towards Elder Wood, continuing to write swiftly:
"03.12
Iris Meinlan, female, 17 years old.
Abdominal distension, progressively worsening for 3-4 months, equivalent to six months of pregnancy.
Intermittent abdominal pain, bloating, occasional nausea."
He couldn’t continue. He grabbed another piece of paper and quickly wrote down a bunch of questions, glancing around before calling the female knight over. Seraina took the paper from him, scanned it, and was immediately stunned.
"Do we really have to ask all these?"
"We do."
"Do we really have to ask all of them?" Seraina’s slender fingers pointed at the paper, her cheeks turning red. "What she’s eaten? What medicines she’s taken in the past few months? Whether she’s...” Her cheeks reddened further. "Do we really need to ask everything?"
"We do!" Garrett put down his pen, clasping his hands together and pleading, "Sister, please help me out! These questions are awkward for me to ask, you’re a girl, she might be more comfortable talking to you... really, the more accurate and detailed the answers, the better I can assess the condition..."
"...Alright." Seraina took the paper and smirked, pointing outside. Garrett quickly grabbed a stool and rolled it over, stepping outside while gesturing for the two elders to join them. He sat against the curtain, ears perked, diligently recording the conversation between the two girls:
"Loss of appetite, weight loss, constipation, passing gas. Treated with divine magic five days ago, no improvement—what kind of ridiculous medical history is this? People will laugh if it’s sent back!"
Complaints aside, recording had to continue. Thank goodness this was considered outpatient—Garrett had taken the liberty to classify the patient as such—so he didn’t need to format the medical records like an inpatient. Otherwise, just the admission records would require two or three sheets of paper.
And after the admission records, there would be progress notes, consent forms, various records, and reports, each thick as his notebook stacked together, totaling about this thick...
After murmuring inside the curtain for a while, the female knight finally emerged, cheeks slightly flushed as she handed him the paper. Garrett quickly scanned it, finding it similar to his dictation, adding a couple of sentences before closing the notebook and walking over to the old mage:
"I’ve asked all the necessary questions about the young lady’s condition. Next, I need to perform some examinations on her—is it alright if I touch her body?"
"Is that necessary?" Elder Wood interrupted eagerly. Garrett nodded helplessly.
"It’s necessary. I need to verify some things—not through sight, hearing, divine magic, or magical investigation, but by touching, by pressing."
This was how medical examinations went for female patients... Palpation and the like, perfectly normal medical procedures, still required parental and patient consent. Garrett sighed inwardly, wishing to avoid this hassle if possible—but the patient was right in front of him, and abandoning treatment wasn’t an option.
"Can you cure her?" Master Tolga pondered for a moment, not answering directly but instead asking Elder Wood. The elder lowered his head, considering:
"I’m not very confident. I’ve treated someone with a smaller stomach than hers, thought it was healed, but they suddenly died from severe abdominal pain. Plus," he glanced at Garrett, "this child’s treatment approach and methods are different from my divine magic. To be honest, I’m quite curious about his methods."
Master Tolga glanced at the still curtain and then back at Elder Wood, pondering. Elder Wood avoided his gaze, muttering to himself:
"We’ve just touched her earlier..."
"That settles it!" The old mage immediately made up his mind. He pulled back the curtain, nudging Garrett inside and personally led him to the girl’s side:
"Iris, don’t be afraid, let this priest take another look! Just a few touches, a little pressing, it’s okay, it won’t hurt!"
"I..." The girl’s snow-white cheeks flushed crimson, even her ears turning red. She kept her head down, clutching the blanket tightly around her until her father nudged her a few times, and she murmured softly, "Um."
Garrett: "..."
This won’t do! Shy as you may be, I have to see for a proper diagnosis!
"Miss, could you lift your head a little so I can see your face... um, I just need to look at your eyes..." Oh no, with her face so red, I can’t even tell if she’s blushing or pale! Thank goodness her eyes aren’t red too...
Garrett made an effort to recall the condition of the skin he had seen earlier and briskly noted down: "Skin and sclera free from jaundice." Excellent, that roughly eliminates any liver pathology, reducing the treatment pressure by a large margin. Next, onto palpation!
He waved for the female knight to come over, lowered his voice, and whispered, "Could you accompany her to the restroom first?"
After ushering the female knight in to accompany and provide testimony, Garrett gently and patiently explained the procedures to the young girl. Then, rubbing his hands together for warmth, he lifted the fleece blanket—
Physical examination, commence!
Garrett exerted effort to manage his expression, keeping his demeanor serious yet gentle and approachable. He lifted the fleece blanket covering the girl’s abdomen, carefully observing and measuring her waist circumference before instructing, "Miss, sit up slowly for me to take a look. Slowly, sit up straight. Good—now lie down."
"Why are you making her sit and lie down?" Elder Wood asked from behind. Garrett simply handed him the paper and pen, saying, "Elder, could you please help me record this? Note: Abdomen is uniformly distended, presenting a globular shape, with no significant changes in shape observed with changes in body position."
Elder Wood furrowed his brows as he wrote slowly. With just a brief sentence, there were two words he wasn’t quite familiar with, so he had to carefully consider how to write them. Garrett’s explanation quickly followed, "By sitting up and lying down, if the bulging in the abdomen doesn’t change shape significantly, it indicates that the bulge is hard, not soft, and especially not fluid—if it were fluid, it would flow to the sides when lying down, forming a puddle. Now, exhale, inhale, exhale again, inhale again—note that the distension doesn’t shift with respiration. This indicates that it’s not due to organs or masses beneath the diaphragm."
With each action he instructed the patient to perform, he provided an explanation, causing Iris’s face to alternate between pale and flushed. The female knight stood by, gently patting her friend’s shoulder, whispering, "So much to consider—"
"Indeed, there’s a lot to consider," Garrett replied with a faint smile.
Abdominal distension, medically termed as abdominal bloating, can be classified into generalized and localized distension. Just with generalized distension, there are three possible causes: ascites (fluid in the abdomen), abdominal distension due to gas, and large masses. And among ascites alone, there are three major categories and fifteen subcategories, totaling at least seventy to eighty etiologies.
Even after determining the most likely cause, it would require a plethora of ancillary examinations. Before ordering these tests, a physician’s physical examination must provide the initial direction.
"Abdominal wall veins not dilated, skin over the abdomen normal." Excellent, the possibility of intestinal obstruction just decreased a bit more! Likelihood of surgery↓↓
"Are you done with the examination?"
The old mage asked somewhat impatiently. Garrett took a deep breath. "Almost. Elder, come and see—around her belly button—are there elongated protuberances? It’s particularly clear when she bends over from the side. Okay, gently tap it—"
After the gentle taps, the elongated protrusions on the snow-white, prominently swollen belly kept wriggling up and down. Some moved forward, some backward, in different directions. Iris moaned softly, "It hurts—"
"It’ll be over soon, just bear with it," Garrett reassured her softly. The old mage exclaimed behind him, "What is this?!"
"This is her intestines—or rather, this is what’s blocking her intestines, causing her abdomen to swell like this."
Garrett explained confidently. He turned to Elder Wood and gestured with his hands, "Note, multi-layered trapezoidal intestinal shape and intestinal peristalsis—Elder, do you have a long hollow tube? I need to listen to bowel sounds!" Damn it, he forgot to bring the stethoscope again—
"I’ll have someone fetch it," Elder Wood put down his pen and got up to leave. Master Tolga grabbed his arm, "Why bother with all that trouble? I’ll do it!"
He extended his hands, and with a pull in the air, a straight, hollow, semi-transparent cylindrical tube appeared in the air. Garrett exclaimed, "Ah!" Magic trick! This was created using magic! How did he not think of this before! Sure, he couldn’t make a stethoscope, but he could create a tube! Magic tricks were apprentice-level magic, and he could perform dozens of them a day, with almost negligible consumption!
He thanked Tolga and took the stethoscope, pressing it against his ear. Placing one end on Iris’s abdomen, his expression immediately turned serious as he adjusted his breathing and listened intently. His left hand, free, curled and uncurled its fingers, counting silently: "Note, during abdominal pain, accompanied by high-pitched bowel sounds, resembling metallic sounds... Bowel sounds occur more than ten times per minute, and are louder, indicating hyperactive bowel sounds."
With the examination reaching this point, the symptoms were essentially confirmed. Garrett still didn’t dare to be careless. From the liver and spleen downwards, he carefully palpated again to ensure there were no other abnormalities before washing his hands. The old mage followed alongside, eagerly inquiring, "So, it’s an intestinal obstruction, right? Just give her some laxatives, and it should clear up, right?"
"It’s not that simple..."
Garrett looked at him wordlessly. Mechanical intestinal obstruction had been confirmed, but where was the obstruction? Was it a complete intestinal obstruction or a partial one? Simple or strangulated? Was there torsion? Intussusception? Perforation? Moreover, intestinal obstruction wasn’t necessarily caused by constipation; giving laxatives might not work... What if it’s a foreign body? Gallstones? Tumor? Laxatives wouldn’t help in those cases either!
He reached out to Elder Wood, "Elder, your oak staff, may I borrow it?"
"Going to use Detection Magic again?" Elder Wood handed over the oak staff with a smile, then moved behind Garrett, releasing the spell and entering a meditative state. Soon, he furrowed his brows, looking puzzled, "What are you looking at?"
The old mage frowned even harder than Elder Wood. Garrett shrugged: Surely they couldn’t understand, not knowing human anatomy, having not studied medical imaging. Even a novice doctor would need a year or two and to have seen hundreds or thousands of images to understand! He turned the pages, sketching what he saw in the meditative vision. Starting with a supine film, then having Iris stand up, activating Detection Magic again, and sketching an upright film. Leveraging the foundation accumulated from years of drawing diagrams to explain to patients, body contours, bones, organs, intestines, etc., quickly appeared on the paper.
The advantage of magic was that what you saw was what you got. A healer could handle everything from examination to treatment on their own, without having the patient queue up for an X-ray. The downside was that once the magic ended, the images in the meditative vision disappeared immediately, and aside from drawing
them on the spot, there was no way to preserve the images—
Ah, in the future, when conditions allowed, he would have to set up an X-ray machine!
After completing two X-ray films—let’s call them X-rays for now—and a ultrasound image, Garrett spread out the three images, explaining to the patient and her family:
"Look here, this is the supine film, showing the intestines—isn’t it thicker than the adjacent area? That’s where the intestines are blocked. Here, and here, areas with different brightness, are due to small bowel distension. Now, look at the upright film, rings arranged like a ladder, forming a fluid-gas interface..."
"Here, there are some clustered shadows, the clusters are quite large, exceeding..." Garrett gestured with his hand, "a diameter of 10 centimeters. Combined with what the elder mentioned earlier about sensing many chaotic life forces, I believe—"
The two elders looked at the images, puzzled. Elder Wood was still trying to discern, memorize, and recite, while Master Tolga had one hand on him and the other on Garrett, steam almost coming out of his head in agitation:
"How should we treat it then!"
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