***
A patellar fracture is one of the most demanding orthopedic surgeries in Modern Medicine.
There are various reasons for this.
First of all, the bone is small.
Bones like the shin, calf, or femur are quite large, so even if they break, finding the fragments is easy.
However, the patella is small, making it even more difficult to find the pieces if it shatters.
Furthermore, it is not a long bone with limited movement, but a joint bone, which makes recovery slower.
Besides that, if the bone fragments spread apart, the quadriceps and patellar tendon pull like rubber bands, making reduction difficult, and the soft tissue is thin, leading to a high risk of infection...
For these reasons, patellar surgery, along with foot bone surgery, is often considered an exceptionally difficult procedure in Orthopedics.
However, in this fantasy world, there is absolutely no need to worry about such things.
"Time Out. Patient name, Erika Nihilrit. 5:24 PM. Left patellar fracture, Open reduction."
Letting the operating room Healer's Time Out go in one ear and out the other, I began Eri's anesthesia.
Lying on the bed, Eri spoke to me.
"Come to think of it, this is my first time getting surgery. I always wanted to try counting down and holding out before falling asleep."
"Then give it a try."
"Ten, ni..."
She fell asleep immediately.
Even Eri, who preached the theory of willpower, was powerless before an anesthetic.
Seeing that the anesthesia was successful, I looked at the students and spoke.
"Ayla, Gwen, Student Jenny. I will explain before the surgery. Erika has been my patient since she was young. She has a chronic illness, so she regularly uses Heparin."
Jenny raised her hand the moment she heard that.
A feeling close to a competitive spirit surfaced in her eyes as she looked at my Crow Mask.
It was a gaze similar to the one Ayla showed when she entered Yulian's black magic class.
I pointed at Jenny and said.
"Go ahead and speak, Student Jenny."
"I understand that surgery is a taboo if the patient is using Heparin. Why aren't you performing a closed reduction using a Greater Heal?"
"That was a very good question."
Jenny's pointing out was reasonable.
Heparin is a medicine that prevents blood from clotting.
Therefore, surgery is generally not recommended while taking this medication, and if a patient is taking it, the correct course of action is to stop the medication and safely perform the surgery a week later.
"The first-year students probably haven't learned this yet, but if a patient is taking an anticoagulant like Heparin or Aspirin, it's best to avoid situations that could cause bleeding if possible."
Hearing only up to this point, one might think I had made a mistake.
Because I didn't stop the Heparin before going into surgery.
However, this was no mistake.
"However, Heparin is not stopped for all surgeries. For patients with a high risk of pulmonary embolism or in emergency surgery situations, the surgery proceeds without stopping the Heparin."
It would be best if all surgeries could be performed in the most ideal environment.
That is, with the patient having properly stopped their medication, having fasted, and having stable vital signs.
But patients in Trauma Surgery are for the most part far from optimal.
A traffic accident patient who regularly takes an anticoagulant.
A patient with a ruptured bowel right after eating a meal.
Eri was the same.
"A knee fracture like this must be treated with emergency surgery. Which means there's no time to stop the Heparin. That was a good question, Student Jenny."
"Umm... Yes."
Was my answer somehow unsatisfactory?
Jenny nodded reluctantly.
For some reason, Ayla had a triumphant facial expression beside her, but I decided not to pay it any mind.
"Then, I will now begin the surgery."
As always, I washed my hands with carbolic acid, changed into my scrubs, and began the surgery in earnest.
"No. 10 Blade."
"Blade."
Grabbing the scalpel handed to me by the assistant healer, I made a vertical incision down the center of the knee.
The moment beads of blood began to form, Ayla's Refresh came in immediately.
Thanks to that, I could keep the field clean while opening up the knee.
Inside the vertically opened space of the knee, shattered bone fragments and mangled ligaments were visible.
I pointed at each bone fragment and explained them to the students.
"This here is the patellar tendon, and the parts torn on both sides are the medial and lateral retinaculum. The cruciate ligament isn't properly visible from this incision site, but it should be around here."
To properly see the cruciate ligament, the bone has to be lifted entirely.
Naturally, I couldn't do that during the surgery, so I simply mentioned it and moved on.
I tried inserting my finger into the open space.
It was to evaluate the condition of the articular surface behind the patella.
This way, I could check the condition of the ligaments that couldn't be confirmed with an X-ray(?).
I spoke to the Healer who was preparing an Intermediate Heal with their eyes closed.
"Please take note. Posterior articular surface. It's a coronal split fracture running from the central ridge to the lateral articular surface. Approximately 2 millimeters of depression and a step-off deformity on the lateral articular surface. Medial articular surface is partially preserved, confirming one viable osteochondral fragment attached to the medial retinaculum. The inferior pole has multifragmentary comminution, and the continuity of the patellar tendon is maintained, but at the inferior pole attachment site..."
I conveyed the information to the Healer while feeling around with my finger.
Of course, strictly speaking, this information was not essential.
The fact that the bone was broken was all that mattered; what shape it was shattered into was not that important.
If it had been important, how could Heal have had any effect before I introduced surgery?
Fitting for a convenient God's Miracle, it seemed to find its proper place on its own even without knowing that much.
Even so, there was only one reason I was conveying this fact to the Healer.
"...Medial retinaculum ruptured, lateral retinaculum has a stretch injury, but continuity seems to be maintained."
Because knowing it reduces the consumption of divine power.
Magic is essentially coding.
The more detailed the spell is, the more only the result I desire appears, and the likelihood of undesired results decreases.
Divine Magic is no exception.
The more detailed the bone is described, the more we can reduce the waste of other blood vessels or muscles uselessly sucking up the divine power.
That is why I was giving such a detailed spell.
With the meaning that since the patella was broken like this, they should reflect that in the runic formula so divine power wouldn't be wasted in strange places.
"Confirmed."
"Then I will conclude the evaluation and begin the reduction."
Originally, for patellar fractures, a wire and suture thread are used to fix the fragmented bones and connect them with the ligaments.
But there is no need for that in this world.
Originally, the wire is a tool that exists to fix the bone in place until it naturally regenerates.
It is also a tool not strictly necessary in a world where Heal exists.
Therefore, the tool I would use in this surgery wasn't a wire, but thread.
However, there was a problem here.
Unlike suturing flesh with a needle and thread, bone is sturdy, making it not so easy.
However, a solution for this existed as well.
"Give me the 2-millimeter drill."
An awl-like hand drill was placed in my hand.
I bore two holes into each of the larger bone fragments among the shattered pieces.
Then, I passed the thread through those holes, making the bones connect to each other in a figure-eight shape.
The bones adhered nicely together on their own like magnets, even without putting much force into the knot.
The principle is simple.
It was designed to inversely utilize the force of the quadriceps trying to spread the bone fragments apart, making them press against the fractured surface on their own instead.
After dealing with the large fragments like that, I then grabbed the small bone fragments that were too ambiguous to sew with thread.
All that was needed for these was to weave the thread like a net to make them attach to the larger pieces.
Now, the final and most important step remained.
"Healer. Please examine it one more time."
Namely, the X-ray imaging.
Following my instruction, the Healer on standby placed a Black Board beneath the knee and proceeded with the examination.
The beautifully(?) aligned knee photograph drawn on the Black Board.
Only after carefully observing the photograph for a while did I nod my head and speak.
"You may Heal it now."
"I will cast Fracture Heal."
The Intermediate Heal settled into the shattered patella.
The bones instantly stuck together.
I watched that sight from a distance with my crossed arms.
All that was left now was suturing the open surface of the knee again, so my role was practically over.
At that time, Gwen, who had been quietly watching, asked a question.
"Umm... Lord Saint. Would it be alright if I asked a question..."
"You may ask, Student Gwen."
"Why is it that you don't Heal the bone and the flesh simultaneously all at once?"
"You have a good eye."
It was exactly as she had pointed out.
One might think that you could just close the flesh together while regenerating the bone.
But there was a reason for this as well.
"It's to reduce the calculation burden."
"Calculation burden? ...Ah."
The reason for Healing the bone, flesh, and muscle separately.
She seemed to have realized its meaning.
"Certainly, doing it that way allows concentration solely on the bone, and it would reduce the instances of the Heal meaninglessly leaking out to other places."
This was the division of labor.
The existing Healers tried to treat everything at once.
But the way I saw it, this made the runic formula far too complex and the burden on the Caster also grew heavily.
So when I made them Heal the bone separately, the blood vessel separately, and the muscle, ligament, and flesh separately, what do you know.
A miracle that previously only a Healer with a high level of mastery could achieve could now be replicated by a Healer a step lower in their level of mastery.
Reducing the consumption of divine power that uselessly seeped into other body parts was a bonus on top of this.
As they say, many drops make a shower; when the aforementioned various details gathered and gathered, the consumption amount of divine power decreased significantly.
"Taking care of details like these allows us to save about 30 percent."
30 percent is a large figure.
Because it meant a Healer who used to treat 30 people a day would now be able to treat 40 people.
Other than this, the Meyer Clinic was overflowing with such details to reduce divine power consumption.
Even now, we are continuously making developments on those details.
While we were talking, Eri's knee returned to a pretty state.
It was a satisfying result.
I decided to have a Q&A time with the students until Eri woke up from the anesthesia.
"Now, are there any questions?"
"I have a question."
It was Jenny's question.
Seeing her continuously ask me questions since earlier, it seemed she had a lot of interest in treatment.
Perhaps the gaze she briefly showed during her first question wasn't a competitive spirit, but a passion for learning.
"What is the reason you examined it once more with Clairvoyance Magic at the end? It was already an open wound, so was there a need to verify it again?"
"Heterotopic Ossification. It is to prevent that."
"Heterotopic... Ossification?"
Jenny tilted her head.
Instead of explaining, I picked up Eri's bone fragment that had been left on the surgical table.
It was a bone fragment I had simply removed as I couldn't bring myself to tie it with the thread.
"Student Jenny. Will you cast a Minor Heal on this?"
"Understood."
Her Heal settled into the bone fragment.
Thereupon, the bone fragment that was barely 1mm grew closer to 2mm.
But Jenny still looked doubtful, as if she couldn't grasp the meaning of the bone fragment growing larger.
I explained it for her sake.
"The human eye is not accurate. Especially at an actual surgical scene, bone fragments aren't white like in an Anatomy book; they are covered in blood, making them difficult to spot like camouflage. What would happen if we closed it back up while leaving such a small fragment in a place like the muscle?"
"The bone fragment would remain between the muscles, right?"
"What would happen if that person received a Heal in that state?"
As I shook the enlarged bone fragment, Jenny let out an exclamation as if she understood.
"It would end up tearing the muscle."
"Yes. It is for that reason."
This is also the reason why Debridement (debridement) is important.
Because the remaining bone fragments shouldn't tear the flesh.
However, Jenny's reaction was somewhat strange.
She was full of admiration, but she also seemed somewhat frustrated.
Ayla was strange, too.
Every time Jenny asked a question, she triumphantly puffed out her chest, the corners of her mouth twitching.
While I was finding both of their reactions strange, Jenny, who had been mulling over my explanation, nodded her head as if she understood.
"Then I will ask one final question."
"Ask to your heart's content."
Jenny, asking her last question.
However, the gaze in her eyes as she asked this question was a bit different from before.
How should I put it.
It wasn't to figure something out, but she seemed genuinely curious.
"When you were explaining the joint evaluation to the Healer during the surgery..."
Jenny hesitated for a moment before finally speaking up.
"You explained the wound location in millimeters, but would it be alright to explain it in inches instead?"
"......"
"No, well... I'm just more comfortable with inches..."
The emotion I felt at that moment was a sense of relief.
Had I not been wearing my Crow Mask,
I was certain that I would have broken my facial expression in a way unbefitting my Persona, and hurled curses right in her face.