Kiryu Kazusuke had just finished washing his hands and hadn't even had time for a sip of water.
"Doctor, the ambulance is here again."
"What is it this time?"
"Traffic accident. Apparently crashed a motorcycle into a utility pole. Open fracture of the left lower leg."
Kiryu Kazusuke's spirits lifted.
Orthopedic work.
As long as it wasn't one of those vague, hard-to-pin-down internal medicine cases, these straightforward surgical injuries were exactly what he preferred right now.
When the gurney was wheeled in, the scene was a bit bloody.
A young man wearing the tokko-fuku of a bosozoku biker gang, the pants on his leg already cut open.
The mid-shaft of his left tibia was cleanly snapped, the stark white, jagged bone end piercing through the skin and exposed, bleeding profusely.
"Give me a shot of Dolantin! I'm dying here!"
The young man was screaming in pain.
In Japan at this time, even for ordinary fractures that didn't require surgery, the use of Dolantin was extremely common in the emergency room and during reduction procedures.
It wasn't until the latter half of the 1990s that Dolantin would gradually be restricted by the Ministry of Health and the Anesthesiology Society.
"Stop yelling. Save your strength."
Kiryu Kazusuke stepped forward to examine him. The dorsalis pedis pulse was still present, and nerve sensation was still intact.
Good. No major blood vessels or nerves were injured—just a simple fracture.
Although it looked frightening, to an orthopedic doctor, this was far simpler and more straightforward than that appendicitis case from earlier.
"X-ray, prepare a plaster splint, notify the OR."
This was a mandatory emergency surgery: debridement, reduction, external fixation or internal fixation.
According to emergency protocols, such operations were usually led by the senior doctor, with the resident assisting.
Kiryu Kazusuke picked up the phone and dialed the First Surgery Department on-call room.
"This is Kiryu from the ER. I've admitted an open tibial fracture..."
"Yes, it needs surgery..."
"Understood."
After hanging up, the senior doctor told him to perform debridement and temporary fixation first, and to schedule the formal operation for tomorrow morning.
This was the normal state of the night-shift emergency department.
Unless it was life-threatening massive hemorrhage or organ rupture, any surgery that could be delayed until daytime would absolutely not warrant waking someone up in the middle of the night.
Especially for a fracture like this—as long as blood circulation was fine, a few hours' delay wouldn't kill the patient.
Kiryu Kazusuke returned to the treatment room.
"Debridement first."
The wound was irrigated with large amounts of saline to clear away dirt and foreign matter, then covered with sterile gauze and temporarily immobilized with a long-leg plaster splint.
The young man was still wailing, "Doctor, can you set the bone back in place first?"
"Can't do it now. The professor will arrange your surgery tomorrow morning." Kiryu Kazusuke applied the plaster while casually brushing him off.
His movements were extremely fast.
The plaster bandages were soaked in water, wrung out, then wrapped in circles around the lower leg.
The pressure was even, the tightness just right.
This was also basic skill.
If wrapped too tightly, it would compress the limb and cause ischemic necrosis (compartment syndrome).
If too loose, it wouldn't serve any immobilizing effect.
"All right. Send him to the ward."
After wrapping things up in a few minutes, Kiryu Kazusuke patted the not-yet-fully-dry plaster.
For the next several hours, it was an endless cycle of repetition.
A child with a fever, crying non-stop, given medicine, physical cooling; a college student with food poisoning, vomiting and diarrhea, put on an IV; a housewife who'd cut her hand while chopping vegetables, bandaged up and given a tetanus shot...
There were no heart-stopping major resuscitations, nor any miraculous recoveries from the brink of death.
This was the true face of the emergency room.
Assembly-line work.
Sorting people into categories. Treat what can be treated, transfer what can't. Admit who needs admitting, send home who can go home.
Kiryu Kazusuke was like a tireless machine, shuttling between beds.
If this were before, by now he would have been so exhausted his back ached, just wanting to find a corner to doze off.
But today...
It was strange.
Clearly, he had already been working continuously for four or five hours, the soles of his feet hot from walking, yet his mind was still hyper.
His thoughts were clear, his reactions sharp.
He didn't even have the hypoglycemic heart palpitations that usually came in the late-night hours.
He glanced at the wall clock.
Three in the morning.
The ER had finally quieted down a little.
Head Nurse Takahashi sat at the nurse's station, organizing medical records while rubbing her shoulders.
"Dr. Kiryu, aren't you tired?"
She glanced at Kiryu Kazusuke, who was still flipping through a medical journal, as if she'd seen a ghost.
The patient volume tonight actually wasn't small; one could even say it was packed.
Any other resident would have been slumped over the table playing dead by now, but this guy actually looked more energetic than when he'd first clocked in.
"I'm fine."
Kiryu Kazusuke turned a page.
However, he was entirely relying on "Improved Physical Fitness: Slight" to keep him going.
Now he finally understood.
This reward hadn't turned him into a superman, but it had greatly boosted his "endurance" and "recovery speed."
For the profession of a doctor, this was practically too good to be true.
Head Nurse Takahashi truly couldn't stand it anymore and proactively said, "Dr. Kiryu, you should go to the lounge and catch a nap too. I'll call you if anything happens."
Although residents were disposable resources, if this resource was pushed too hard and burned out, the nurses would be the ones left to deal with the trouble.
"Sure, thanks, Head Nurse."
Kiryu Kazusuke didn't put on airs. Although he didn't feel tired, there was no need to act too freakishly abnormal.
If you can slack off, you should slack off.
He closed the magazine and walked into the on-call room.
Inside were two sets of bunk beds. An internal medicine resident was already lying there, snoring thunderously.
Kiryu Kazusuke climbed onto the empty top bunk and lay down fully clothed.
He closed his eyes.
But he couldn't help but picture the scene in Apartment 301—smashing the security alarm with a metal folding chair.
Breaking things was indeed quite decompressing...
That went for him too.
Next time some drunk, doctor-beating bastard showed up in the ER, could he also...
Forget it. That's illegal.
Kiryu Kazusuke rolled over. A few seconds later, his breathing became steady and drawn-out.
However, he had only just closed his eyes when someone shook his shoulder violently, jolting him awake.
"Dr. Kiryu! Wake up! Hurry!"
"Critical patient! Code red! Arriving immediately!"
Head Nurse Takahashi's signature booming voice, accompanied by urgent knocking, pierced straight through the door.
Kiryu Kazusuke's eyes snapped open.
Code red!
This meant a patient in mortal danger had been brought in; if resuscitated immediately, there was a high chance of survival, and every second counted.
Therefore, there was absolutely no room for Kiryu Kazusuke to linger in bed.
He immediately rolled out of bed, grabbed the stethoscope hanging on the back of the chair, slung it around his neck, and rushed out of the on-call room.
At that moment, the ER doors were violently thrown open.
"Out of the way! Move!"
The paramedics pushed a stretcher in. On the gurney lay a man in his thirties, covered in blood, his clothes already cut to shreds.
"Fall from height, fourth floor!"
"Blood pressure 60/40, heart rate 140, respiration 35, altered consciousness!"
"Left chest wall collapsed, unstable pelvis, abdominal distension, bilateral open leg fractures!"
The paramedic shouted out the vital signs and injuries.
Severe polytrauma—that is, serious injuries to two or more parts of the body, at least one of which is life-threatening.
This was an invitation sent by the Grim Reaper.
"Push him into the resuscitation room!"
Kiryu Kazusuke wasted no words. One hand pressed on the patient's carotid artery as he sprinted alongside the speeding gurney, calling out directions.
At a time like this, there was no time to consult a senior physician.