A woman in her forties.
Stout in figure, with a ruddy complexion and a loud voice.
Her hand was numb.
So, what kind of numbness was it? Tendonitis? Carpal tunnel syndrome? Or cervical spondylosis causing compression?
Garrett smiled and asked her to sit down, looking down attentively. His gaze fell on her hand, and his pupils instantly contracted:
The whole hand was swollen like a carrot, with all five fingers on her right hand stretched tight, shiny, and purple. The back of the hand showed a large patch of abnormal waxy pallor, covered with numerous blood-filled blisters, shimmering at a glance.
The edges were purplish-blue, extending from the back of the hand across the wrist, tracing out an equilateral triangle.
This handâŠ
Garrett instinctively felt something was wrong. He maintained a calm smile, his tone light:
"Aunt Rita, whatâs happened to your hand? When did it start feeling numb? How many days has it been? Anything else uncomfortable usually?"
"Hey!" The woman waved her hand nonchalantly. Sitting opposite Garrett, she smiled, but her smile betrayed a deep-seated anxiety:
"Iâm usually very healthy! I take care of everyone at home, inside and out, including several big men and two grandsons. Itâs just this hand, I pricked it while cutting fish the day before yesterday, and today itâs swollen like this! Look, look!"
A history of trauma. Garrett made a mental note and continued to inquire patiently:
"How many days has the hand been hurting?"
"Two days. It was a bit swollen and painful yesterday, and I applied some medicine myself, it seemed to get a bit better." The woman spoke incessantly:
"But it got really painful last night. I thought about it, and didnât want to bother anyone late at night, especially since the temple doesnât take appointments at nightâtoday, fortunately, it doesnât hurt muchâŠ"
Severe swelling from the fingers to the wrist.
Large areas of purplish-blue.
From severe pain to hardly hurtingâŠ
This was not a good sign. Garrett would rather her hand still be in painâpain meant the inflammatory response was still ongoing, that there was still vitality in the tissue. He pinched the womanâs fingertip:
"Does it hurt?"
"Not at all! I canât feel a thing!"
Aunt Ritaâs voice grew even louder. Garrett looked around; several priests at nearby consultation tables turned to look. Garrett smiled at them, then took out the smallest syringe and pointed at the veins on the back of the womanâs hand:
"Auntie, I need to draw a little blood from your hand to better understand whatâs going on. If you could place your hand flat here, and donât move. Donât worry, it wonât hurt much."
"Ha, you young man. Just draw, Auntie isnât afraid of pain."
The woman responded briskly. Garrett forced a smile and held her fingertip, gently inserting the needle into her dorsal vein. The needle went in, he pulled back, butâ
No blood!
Garrettâs scalp exploded. No blood in the dorsal veins meant that the tissue underneath was on the brink of, or even beginning to undergo, necrosis. Could these fingers, or even this entire hand, still be saved?
He immediately stood up. Holding the womanâs hand gently yet firmly, he ushered her towards the operating room:
"Auntie, your hand is a bit troublesome, we need to take a closer look inside. Come with meâby the way, is your family nearby? It would be better if your husband could come tooâŠ"
"My husband? He should be patrolling the city today, should I call him over?"
"No! Iâll have someone call him!"
The woman followed him somewhat bewilderedly. Garrett pulled her along and quickly summoned a nearby priest apprentice, speaking hurriedly:
"Get the teacher here! Call the bishop! And her family, hurry!"
After settling her into the operating room, he tossed a ăPain Delayă spell and strapped on a tourniquet, arranging surgical instruments at the side of the operating table. The tools shone silver, the cold air chilling, making the woman immediately tense up:
"Little⊠Nordmark mage, whatâs wrong? Whatâs wrong with this hand?"
"Aunt Rita, donât worry for now." Garrett soothed her gently. He touched her forehead, and sure enough, her temperature was quite high. Without a second thought, Garrett pulled out a thermometer:
"Keep this under your tongue, press it down with your tongue, thatâs right, just hold it with your lips, donât bite it. Hey, someone help me watch her, take it out after five minutes and check the reading, Iâll go scrub upâ"
Five minutes
later, the report came back: the patientâs temperature was a high 39.2 degrees, clearly infected. Garrett hurried back to begin the surgery:
He cut open the skin on the back of the hand, and a familiar foul smell assaulted his nostrils. Garrett took a deep breath, sensing trouble:
Damn! Not that smell again!
He peeled back the skin flap, revealing large amounts of necrotic fat; cutting deeper, at the superficial fascia level of the necrotic tissue, copious amounts of dishwater-like pus appeared; he opened the tendon sheath, and the dorsal artery barely responded when touched, almost no elasticity.
Garrettâs heart tightened further. He cut open the dorsal artery, a dark sludge accompanied by a trickle of fresh blood slowly flowed out. Even the artery was nearly blockedâŠ
It looked like necrotizing fasciitis. This disease starts suddenly and progresses quickly. Moreover, the patient had delayed for three days!
Pray she doesnât have diabetes, pray she doesnât have diabetes, pray she doesnât have diabetesâŠ
Garrett repeated the prayer in his heart. He drew a small tube of blood from the womanâs radial vein, sending a little snake to taste it. The snake dove in, and moments later, it reared its head:
"Itâs so sweet! This blood is so sweet!"
Done for. She really has diabetes, combined with necrotizing fasciitis. Garrettâs vision darkened:
Diabetes combined with necrotizing fasciitis is especially prone to occur, especially hard to heal, especially prone to recurrence. Diabetic foot has always been one of the most difficult challenges in surgical wound repair.
Moreover, the handâs structure, dense and complex, makes preserving function more difficult than in the footâŠ
Could this hand still be saved?
Just then, the operating room door opened, Elder Elwin and the bald bishop came in together. Both of their gazes landed on the hand, and they exchanged a look:
"This handâŠ"
"This hand is almost devoid of life!"
The bald bishop blurted out. The womanâs body shook:
"What?!"
"This hand may need to be amputated." Garrett said with a grave face:
"Bishop, please explain the situation to Aunt Ritaâs husband. I will do my best to save this hand, but if it canât be saved, for the sake of her life, amputation might be necessary. Of course, thatâs if they agreeâ"
"What? You want to... cut off this hand?" The womanâs face turned deathly pale. Her right hand instinctively retracted, her left hand covering over it as if to protect the soon-to-be-lost hand:
"Little Garrettâ"
"Put your hand down!"
Garrett shouted faster than she could. With a flick of his hand, two vines shot out, binding her left arm firmly to her side:
"Aunt Rita, I know losing a hand is painful and inconvenient, I will do my best to preserve itâbut if it canât be saved, a dead hand attached to the body will kill you!"
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