Episode 117. Euthanasia (3)
I looked at the patient.
“You want to live, right?”
“Yes.”
“Let me see your arms and legs.”
The patient’s limbs weren’t black yet, but pinpoint bleeding was scattered across them. Red spots were appearing.
I had suggested euthanasia, though I still think it’s the easiest way for both of us… But it’s not an untreatable situation.
The bacterial toxins from the Black Death are circulating in the blood. Sepsis-induced Black Death has already begun, but since they’re not black yet, necrosis hasn’t started.
I closed my eyes.
What’s the treatment for Disseminated Intravascular Coagulation (DIC)?
Anticoagulants or antiplatelet drugs. Blood clots are blocking small vessels, causing red spots, and soon necrosis will begin.
Heparin.
Should I use Heparin now? It’ll make the bleeding worse. Bruising will get severe, but could it prevent necrosis?
I don’t know what’s best either.
“What is your name?”
“Chris.”
“Alright, Mr. Chris. I’m going to administer a drug that thins the blood. In the short term, bruising will worsen, but it might stop your limbs from rotting.”
Chris nodded resolutely.
“Then…”
<Heparin isn’t meant to be injected directly into veins. Using Heparin can cause severe bruising or prolonged bleeding where the needle enters because it prevents clot formation.>
In principle, it should go through an IV catheter or subcutaneous injection… But there’s nothing we can do about it.
Oral anticoagulants may take hours to work. Injecting directly into the bloodstream is the only option now.
I located the vein in the patient’s arm and injected Heparin into it.
“Alright, try to stay alert until sunset. If you feel anything unusual, let me know immediately.”
Chris nodded.
“Since this drug prevents blood clotting, the needle puncture site might not heal properly. Press on the spot where the needle went in for about an hour.”
“An hour?”
“Why? Are you busy today?”
Chris shook his head as if he found it absurd. Still need to give antibiotics…
“Take one pill per day.”
I was organizing the situation while constantly disinfecting my hands with alcohol. Even with protective measures, I couldn’t shake off the uneasy feeling.
There’s no such thing as perfect protection anyway.
I gave a week’s worth of medicine to patients with pneumonic plague in sputum form. Along with oral rehydration.
Chris, the sole patient suspected of having pneumonic plague, received special care.
Patients whose limbs had turned black—those with septicemic plague—I gave them one antibiotic pill each. We’ll see tomorrow if they survive.
This is a terrible disease.
The muscles controlling finger movement are actually in the arm, not the fingers themselves. Even if the fingers lose sensation and start decaying, they can still move.
“That’s how it is, Archbishop.”
“No patients have been euthanized, correct?”
“Yes.”
Most medical professionals I met in the modern world supported euthanasia or dignified death. There were many elderly patients suffering without hope of recovery… The atmosphere here is different.
Mostly young patients.
Giving a Do Not Resuscitate order to an 80-year-old dementia patient versus suggesting opium-induced euthanasia to a crying young adult… They carry different weights.
Anyway,
“I’ve prescribed all the medicine. Patients who can recover will start improving soon.”
“Are there many patients who cannot recover?”
“All patients with blackened limbs. Even if they survive, they’ll live with lifelong disabilities.”
There’s nothing we can do about it. Since the patient isn’t here, there’s no reason to sugarcoat things to another doctor. The Archbishop nodded solemnly.
I handed over a bottle of medicine to the Archbishop.
“This is an antibiotic for the plague bacteria. If more patients come, give them one pill daily.”
“Where are you going, Professor?”
“I need to make rounds.”
The Archbishop held onto me.
“It’s too dangerous.”
“Aren’t there many patients isolated at home? No one knows whether these quarantined individuals are still with patients or healthy people. I need to treat them.”
“Must you go? Wouldn’t it be better to stay in the temple and treat patients?”
“We need to find the source of the epidemic.”
The way to end an epidemic: when there’s not a single person left with the plague. That’s why I suggested euthanasia earlier…
“You seem worried.”
“I’ll leave the hospital in your hands.”
Euthanasia might be the only realistic solution. If we’re not using that method, then I have to treat everyone individually.
I rushed toward Vinia Castle.
Vinia’s Lord, whom I hadn’t seen earlier, was waiting for me. Upon seeing me, he sighed with half relief and half concern.
“You must be the dispatched professor.”
“Yeah, Lord. I disinfected again after leaving the temple, but please don’t come too close.”
Vinia’s Lord nodded.
Though the Lord looked like a corpse, under different circumstances, he might have appeared perfectly normal.
“How does the situation look to you, Professor?”
I carefully chose my words.
“I told the Archbishop the same thing. If the situation worsens further, we’ll need to consider euthanasia for critically ill patients with no hope of recovery.”
“That sounds brutal.”
“I apologize, but it’s the best course of action.”
The Lord slumped into a chair like someone exhausted. I stared at him behind my mask.
“Why do you think so?”
“Patients whose limbs have turned black have no chance of recovery and endanger those around them. My suggestion is to send these individuals peacefully with opium while we still have control over the situation.”
The Lord didn’t answer immediately.
“Did you do that?”
“There was strong opposition.”
“It makes sense…”
The Lord sighed again.
“Understood. When the temple beds are full, or when we lose control of the situation, start euthanasia with critically ill patients.”
I bowed deeply.
“Thank you for your decision.”
“Are there any other solutions?”
There’s one necessary task.
The main vector for the plague is fleas.
Even though rats aren’t visibly present on the streets, we need to consider which homes might harbor infected fleas and how to exterminate them.
“We need to eradicate fleas.”
The methods to catch fleas are…
Hedwig was waiting for me.
“Do you have a plan?”
I nodded.
“Prepare firewood, mats, vodka, paint, and wood polish. And mobilize soldiers. We’re heading to the scene now.”
“Possible, but why paint and polish?”
“For disinfection.”
Hedwig scratched her head.
“I’ll prepare everything so we can leave today. What’s the situation? Are we making royal inspections?”
“Yes.”
The most efficient way to catch fleas would probably be DDT, but I’ve also considered what methods might work in this world.
Currently, about ten households are quarantined.
The situation is still manageable.
Soldiers gathered in front of the first house. A bonfire was lit in front of the house, and the soldiers assigned by the Lord looked at me.
“Alright, let me explain the plan. I’ll treat plague patients, and you will repaint their houses, disinfect them, and burn any furniture that can be burned.”
“Question.”
“Yes.”
Rin, the captain.
A sharp-eyed female magician, one of the mages of Vinia Castle, they said.
“What’s the purpose of this task?”
“The plague spreads in two ways. Pneumonic plague spreads through coughing, and other types spread via insects.”
“So we’re catching insects?”
“Yes.”
“Understood.”
I continued speaking.
“Therefore, we need to eliminate all insects. Paint, salt, and vodka can help kill fleas. Bedbugs are harder to deal with, so let’s pray there aren’t any. And absolutely do not get bitten by insects.”
Rin nodded, and the operation began.
We knocked on the door of the quarantined house. A man with a haggard expression opened it.
“What is the matter?”
“I’m a healer. I’ve come to treat plague patients and disinfect your house.”
“They’ve already passed away.”
We arrived too late.
If I had come a day earlier, they might have survived. I sighed.
“Are there any other patients inside?”
“Yes.”
“I apologize. Let’s just disinfect the house then.”
It’s fortunate that there are no more patients in the quarantined house… Or maybe they’re just asymptomatic. It could also be a lie. Just because they were isolated with plague patients doesn’t mean they’ll definitely contract it.
There’s no surefire way to know.
Let’s proceed with the plan for now.
