On the road to the convenience store, a pale red screen of light flashed before Kiryu Kazusuke’s eyes. A warm current rose from the base of his spine and swiftly spread through his limbs and bones.
[Saionji Mina’s world line has been converged]
[Reward: Physical fitness improved—slightly]
He rolled his neck. His trapezius muscles, stiff and aching after twenty-four hours of nonstop work, seemed to have loosened up quite a bit.
Then he tried clenching his fist.
A sense of strength?
There seemed to be a little, but not much.
His muscles hadn’t bulged like in a manga, nor did he have the illusion that he could kill an ox with one punch.
It felt more like being fully charged after sleeping in for an entire week.
So this was a “slight” improvement?
Well, fine.
For a medical intern who spent all year testing the limits of death by overwork, nothing could be more practical.
Kiryu Kazusuke walked into a Lawson convenience store, picked up a discounted tonkatsu bento, wolfed down his dinner at the counter in a few bites, tossed the empty box into the trash, and hurried toward the hospital.
……
Japan’s emergency medical system in 1994 was still in an age of chaos and unchecked growth.
Although a three-tier emergency system had been established as early as 1977, dividing cases into primary care for mild cases, secondary care for severe cases requiring hospitalization, and tertiary care for critical cases.
Primary emergency care was usually handled by holiday and nighttime acute care centers.
Secondary emergency care was undertaken by public or private hospitals on rotation.
Tertiary emergency care was handled by specialized lifesaving emergency centers.
As a national university hospital, Gunma University Hospital theoretically belonged to the category of “tertiary emergency care,” mainly receiving critically ill patients transferred from other hospitals or dying patients brought in by ambulance.
Gunma University Hospital bore the sign of an “Advanced Lifesaving Emergency Center,” making it a tertiary emergency medical facility.
But in reality?
As long as a place had an emergency sign hanging on it, anyone and everyone got shoved inside.
Whether it was a drunk who had fallen and split his head open, an auntie who had been having stomach pain for two days and didn’t want to wait in line at an outpatient clinic, or even an old man who felt lonely in the middle of the night and wanted someone to talk to.
As long as an ambulance picked them up, they were all sent here.
After all, ambulances in Japan were free.
This led to an enormous waste of emergency medical resources.
And in this era, before a complete system of “ER-style emergency specialists” had been established,
the ones standing on the front line of the emergency department were not emergency physicians who had received specialized emergency training.
They were “on-call doctors” dispatched in rotation from various departments, like Kiryu Kazusuke.
More accurately, they were medical interns.
Senior doctors usually slept in the second-line duty room, and unless something major happened that the interns couldn’t handle, they absolutely would not show their faces.
Interns were the consumables of the emergency room, used to fill this enormous black hole in the medical system.
“Doctor Kiryu, an ambulance is about to arrive. Head trauma, conscious.”
Head Nurse Takahashi was a veteran nurse in her forties. Brisk and decisive, she held a clipboard and spoke without even raising her head.
“Got it.”
Kiryu Kazusuke put on sterile gloves and stood at the entrance to the treatment room.
The sound of sirens came from the distance.
This, too, was the daily life of an emergency doctor: either saving people, or waiting on the road to save people.
Soon, the stretcher was pushed in.
A strong stench of alcohol hit them head-on, making people frown.
Lying on the stretcher was a man in his fifties, wearing a wrinkled suit. His face was flushed red, and there was a gash on his forehead, blood seeping out and dyeing half his face crimson.
“One… one more drink…”
Even in this state, he was still mumbling incoherently.
“He drank too much and fell on the steps outside an izakaya.”
As the emergency crew handed over the patient, they explained helplessly.
This again.
In Japan after the collapse of the bubble economy, there were simply too many people who drank themselves into the hospital to drown their sorrows.
“Hold him down.”
Kiryu Kazusuke instructed the male nurse beside him.
“Let go of me! I can still drink!”
The drunk twisted around on the bed, flailing his arms and legs, completely uncooperative.
Kiryu Kazusuke ignored his nonsense and shone a penlight into his pupils.
The light reflex was brisk. Both pupils were equal and round. No cerebral herniation.
He checked the movement of the man’s limbs as well. No paralysis. Most likely, it was just a superficial wound plus a concussion.
“Send him for a head CT. Rule out intracranial bleeding.”
Kiryu Kazusuke wrote the order.
Even though he had already made a judgment in his heart, this procedure could not be skipped.
If this drunk really had a subdural hematoma and he failed to detect it before sending him home, then the next day he could just wait to make the headlines.
This was also the first law of survival in the emergency department: you didn’t have to be a miracle doctor, but you absolutely could not miss a diagnosis.
While waiting for the CT results, the nurses did not let him stay idle.
“Doctor Kiryu, bed three has abdominal pain.”
“Coming.”
Bed three was a young woman in her twenties, curled up on the bed, her face deathly pale.
“Where does it hurt?”
Kiryu Kazusuke pressed on her abdomen.
“Here… the lower right abdomen…”
Obvious tenderness at McBurney’s point, positive rebound tenderness. Typical acute appendicitis.
“Order a CBC and an ultrasound.”
Kiryu Kazusuke skillfully wrote the orders, then called the on-call doctor from Second Surgery.
At that moment, the drunk’s CT results came back. No skull fracture was seen, and there were no abnormal high-density shadows in the brain parenchyma. It was purely a superficial injury.
“Debridement and suturing.”
Kiryu Kazusuke picked up the needle holder.
The drunk was still groaning and whining, but the male nurse held him down firmly, leaving him unable to move.
The wound on his forehead was about three centimeters long. The edges were irregular, and there was still some grit embedded inside.
Rinse with saline, disinfect with hydrogen peroxide, drape, administer local anesthesia.
After the lidocaine was injected, the drunk finally quieted down somewhat.
In the past, Kiryu Kazusuke had been extremely sick of jobs like suturing the faces of patients reeking of alcohol.
Just the smell alone made him want to vomit.
On top of that, he had to endure the patient’s agitation, and crooked stitches were common.
But today was different.
Holding the needle holder in his hand, a familiar sensation of having everything under control welled up within him.
Although it was only simple debridement and suturing, with no need for any complex intradermal suture technique—the most basic interrupted sutures were more than enough—
even so…
The feel was too good.
Needle in, needle out, knot, cut.
His movements were so fast that even Head Nurse Takahashi beside him froze for a moment.
Usually, the skin of a drunk like this was loose, and with the interference of bleeding, suturing was very troublesome.
But Kiryu Kazusuke’s hands seemed to have a consciousness of their own, avoiding blood vessels and accurately aligning the wound edges.
In less than three minutes,
five stitches were done.
The wound was neat as a red centipede, the spacing of each stitch accurate to the tiniest degree.
“Done.”
Kiryu Kazusuke tossed the needle holder into the kidney dish and took off his gloves.
“That’s it?”
Head Nurse Takahashi glanced at the wound, somewhat surprised.
In the past, this kid Kiryu would take at least ten minutes to sew up a scalp, and he would have to complain a few times about the patient moving around.
Why was he so efficient today?
And the quality of these sutures…
Why did it feel even better than those specialty residents who acted so arrogant all day?
“Mm. Nothing difficult.”
Kiryu Kazusuke replied blandly, then turned to wash his hands.
This kind of low-level round wasn’t worth showing off over.
It was merely practiced hands.
But that smooth, flowing sensation truly did feel pleasant, both physically and mentally.
His skill, “Advanced Surgical Incision Suturing,” actually did not include non-surgical incisions like this.
So this was thanks to the “Physical fitness improved—slightly” that Saionji Mina had given him, which included the stability and coordination of his hands.
But…
If every suturing job could save seven minutes, then over the course of one night, he could sleep an extra hour or so.
How was this slight? This was practically life-saving.