Two weeks after arriving in this medieval isekai world, I would have liked to say that I had gotten better at identifying wild carrots and mushrooms, but I was still plucking poisonous pnts one out of every ten tries.

  Despite my innumerable mistakes, I was fairly content with my final haul for the day. It was close to sunset, and I was carrying a woven basket filled to the brim with foraged goodies that I had collected close to the old witch’s hut outside of the city’s northern wall. Compared to other popur foraging spots which had already been picked clean by the locals, the forest around the witch’s residence was bountiful and untouched.

  Multiple people had already told me that it wasn’t safe to loiter around the Old Grass Witch.

  The inhabitants of this old-fashioned kingdom were extremely superstitious.

  They believed that the ugly Witch would transform people into pigs, even though no one had witnessed the old hag do anything of the sort. As a matter of fact, nearly all of the city residents relied on the witch’s medicines and natural remedies. It was usually too expensive to hire a priest from the Holy Church who could use healing magic, especially since this frontier city was located so far away from the capital. Most of the area’s inhabitants still worshipped pagan gods, and the locals were begrudgingly accepting of the neighborhood witch’s suspicious practices.

  In my past life, I had been a young 28-year-old doctor who had just been promoted to an academic research position. However, I had been killed by a stray bullet in a mass-shooting at my hospital’s emergency department that had happened suddenly out of the blue.

  My past experiences gave me a certain affinity for ‘pagan’ herbalism over ‘holy’ religion grounded in pure faith.

  In my opinion, the old spindly witch really wasn’t as bad as the rumors made her out to be. As a matter of fact, she was extremely nice. Even today, she had whacked me on the head with her broomstick, shrieked at me in an incomprehensible foreign nguage, and then removed the poisonous herbs and mushrooms that I had foraged in her backyard from my basket.

  My boyfriend and I would have really struggled in this isekai universe if it hadn’t been for her strict, terrible, and wickedly evil kindness.

  Needless to say, I felt indebted to the Old Grass Witch a whole lot.

  + + +

  The main gates to the frontier city of Rupelweld closed every day at sunset, which was roughly around the time that the st adventurer parties returned from their daily quests.

  I hurried to the Adventurer’s Guild, thinking that I’d be able to walk home with my ‘husband’ — Canaan.

  We had actually never been married.

  On our first day in this isekai universe, we were promptly informed that it was improper for a unmarried man and woman to cohabitate according to the social norms of this country. I simply couldn’t accept this old-fashioned nonsense since I ftly refused to live apart from my boyfriend, so I implicitly became his ‘wife’ by default.

  Canaan never told me how he felt about the sudden change in our retionship status, especially since I had been the one to unreasonably drag him away from his life to another universe without any warning… but he never uttered a single compint about our impoverished situation.

  Other than the ability to communicate in the local tongue, neither us had received any special powers and cheats from God. Apparently, I had used up my one wish after I had summoned my boyfriend to accompany me in this isekai universe.

  Canaan had registered at the local Adventurer’s Guild since it was the easiest job for a random man with no background to acquire, but his starting abilities were appraised at level 1.

  ‘Adventuring’ (monster-sying) was an incredibly dangerous job that involved high risk and high reward, so I’d always get nervous whenever he talked about his ambitious goal to earn enough gold to support the two of us.

  He was very fit — he had been a collegiate decathlon star who competed in the NCAA championships back when we were in school — but fighting monsters in an isekai universe when you were just an ordinary powerless human was absolutely no joke.

  There were constantly adventurers dying out on the field, and nearly all elderly ex-adventurers who survived into old age were permanently disabled. However, there was a never-ending demand for desperate people willing to risk their lives for the valuable magical cores that grew inside of monsters. Those fragile crystals were the entire basis of the magic system utilized by the Holy Church, and wealthy echelons of Adelgracian high society guzzled away at mana crystals like they were gasoline.

  I had already started to wonder exactly how many adventurers needed to die for each crate full of magic crystals that were shipped to the Royal Capital every week.

  But Canaan didn’t even hesitate when he picked up an improvised spear on our second day of our isekai saga. He simply told me that he’d try to level up his abilities while killing horned rabbits, and that he’d be back in time for dinner.

  + + +

  The receptionist of the Adventurer’s Guild gave me a polite bow as I walked inside the main entrance. Meanwhile, there were a few whistles and cat calls from drunken older adventurers who were seated at circur tables inside the rowdy establishment, which I completely ignored.

  It really wasn’t a very pleasant atmosphere.

  Adventurers were a poor and crude bunch, and most of them could not even read. To be fair, Canaan and I were also illiterate, but both of us had grown up in an entirely different social environment back on Earth. There was a certain degree of culture shock associated with plunging into a medieval society where a majority of our peers had misshapen teeth, rickets from malnutrition, eyepatches from blindness, and dozens of scars from old wounds.

  I would compare my experience to walking into a den of pirates.

  Inside of the walls of Rupelweld, I was protected by city w, but I wouldn’t have been surprised if these so-called ‘adventurers’ had secret part-time jobs as highway bandits or outws.

  “Ya’ looking for your hubby, Darky?” One of the adventurers called out to me with a ugh.

  He was referring to the color of my skin tone.

  It honestly wasn’t even that dark — in fact, it was simply tan-colored — but nearly everyone in the Kingdom of Adelgracia was pale-skinned with brown or straw-colored hair. Like many medieval societies, it wasn’t particurly easy to travel, and most people lived their entire lives in the same vilge where they were born.

  Anyone could immediately see that Canaan and I were foreigners.

  However, to the credit of Rupelweld’s reputation as a frontier city, people were retively open-minded, and we weren’t particurly mistreated apart from a stray remark or two.

  “The Big Guy’s out back,” a different adventurer chimed in with a drunk slur. “Seems like their party had a pretty rough day.”

  —A ‘rough day’.

  Did that mean someone was injured?

  My stomach immediately tightened, and I quickened the pace of my footsteps.

  + + +

  Spotting Canaan inside of the guild building was extremely easy.

  He was by far the tallest person around.

  The average man in the Kingdom of Adelgracia was quite short (by modern standards on Earth). In my past life, I was nearly always a full head shorter than everyone else, but somehow my 150 cm (4’11”) height had become a totally average height in this isekai universe.

  “Canaan!” I called out to my boyfriend.

  He turned around.

  Before he could react, I tackled him with a running hug.

  Even though I charged at him with my full strength, Canaan didn’t even need to brace for impact. He might as well have been a solid pilr, because his legs didn’t even budge when I threw myself at him… a beautiful demonstration of Newton’s three ws of motion in practice.

  I was instantly relieved to see that there wasn’t any sign of injury.

  “Skyr?”

  I wished I had been tall enough to kiss him on his lips, but there really wasn’t any way for me to reach him unless he bent down to my level.

  Even though we had been making love non-stop almost every night ever since we arrived in this isekai world, I still hadn’t gotten over the honeymoon phase in my retionship with Canaan. We had been in a long-distance retionship ever since we graduated from college, and it had been seven whole years since we properly got to spend quality time with each other in person.

  Medical school and residency had taken me to random corners all across the United States, and Canaan’s job with in the federal government never gave him the opportunity to move with me. In many ways, it felt like a miracle that we were still dating. We only got to spend a few days together every year, and I was always so thirsty for his touch that it made literally made me depressed whenever we inevitably had to say goodbye.

  Being together with Canaan was the one thing that made living in this isekai universe tolerable.

  I really would have loved to continue having sex with him during the daytime too, but we didn’t have any money. Obviously, we wouldn’t have any food to eat unless we went to work, and we wouldn’t even have a bed to use during the night if we didn’t live responsibly.

  “Did you have a close call in the wilderness?” I asked while hugging his midsection tightly.

  “Yes and no,” Canaan replied quietly. “I’m completely fine, but our party’s scout doesn’t look good. He was ambushed and was struck in the chest by an ogre’s club before the rest of us caught up to him.”

  Ogres were a type of humanoid monster that were approximately twice the size of a typical human. They were some of the most dangerous creatures that lurked in the forests around Rupelweld, and they were considered well beyond the level of any novice adventurer.

  Needless to say, there was no way that my boyfriend’s F-rank party could have handled that kind of elite monster on their own. The best they could have done was run away. Even then, it was a complete coin toss to say that they’d escape without any casualties.

  They were probably incredibly lucky to return with just one major injury.

  “We carried him to the supply closet in the next room,” he told me. “Our party leader ran to beg the Church if they could spare a healer’s services for free… but we’re not optimistic. I don’t think our party could afford to pay the regur price for a priest.”

  Unlike on Earth, the Holy Church in this isekai universe did not regurly engage in phinthropy or charity. It was not a fundamental tenant of Solestianism (the dominant monotheistic religion in the Kingdom of Adelgracia), and you could never count on a priest from the Church to provide any healing services to a critically ill patient unless you paid a hefty fee.

  In the absence of a healer, the next best option was to go to the neighborhood butcher, who frequently doubled as a veterinarian whenever a local farmer’s livestock was sick. The rationale behind this was that butchers owned very sharp knives and were knowledgeable about mammalian anatomy, so they offered the most experience with cutting people open.

  There were very few professional surgeons or medical doctors. The Physician’s Guild was small, elitist, and exclusive (there wasn’t even a branch in a frontier city like Rupelweld), and the wealthy relied overwhelmingly on priests and magical healers to address any significant injury. Meanwhile, the poor simply died if the neighborhood butcher failed at their st-ditch attempt.

  The situation was definitely grave.

  “Can you do something about it?” Canaan asked me softly.

  He grabbed my hand tightly.

  In his mind, his ex-doctor girlfriend offered a much better shot at saving his party member’s life than a medieval meat butcher.

  …Which probably wasn’t the wrong judgement call at all.

  I took a deep breath.

  Back on Earth, I had trained as a internal medicine physician, and I really wanted nothing to do with surgical emergencies. However, Canaan was asking me right now, and I didn’t want to let my boyfriend down without a single attempt.

  “…I can try.”

  + + +

  When I stepped into the next room, my brain immediately switched over to fight-or-flight mode.

  It was a type of high blood pressure state that used to paralyze me when I was a first-year medical resident. Years ago, I had this naive belief that the fear would completely go away once I finished my clinical training, but I had merely gotten slightly more accustomed to my own severe anxiety by the time I was practicing as a fully licensed hospitalist.

  I was just a little better at pretending that I was totally calm.

  Had this been in a hospital, my eyes would have immediately flown over to the vitals monitor, but obviously there was no technology like this in a medieval isekai. Instead, I knelt down next to an adventurer who was writhing in pain and gasping for air on an improvised bedroll.

  He looked to be about 25 years old, thin, diaphoretic, and struggling to breathe. Unlike other adventurers that I had seen, he didn’t have any significant tattoos or scars, and I would have stereotyped him as a typical farmer’s boy who had turned towards part-time adventuring as a side-hustle to earn a little extra cash when the crops were out of season.

  Intermittently, he would cough and spit up sputum containing small traces of blood.

  I could see that he was tachypneic (breathing fast).

  The adventurer did not respond to my attempts to speak with him, but he would moan, writhe, and curse deliriously about a random person I did not know.

  He had a palpable radial pulse, which indicated that he had a systolic blood pressure of at least 80 mmHg, but he was very tachycardic (fast heart rate).

  He had distended neck veins.

  There was no obvious sign of active bleeding on his clothing.

  I grabbed a knife from the table and began to cut off his clothes. Meanwhile, I asked one of the attendants from the guild to grab a fire source. I also wanted the strongest liquor avaible, a metal spoon, as well as several ceramic cups.

  I did not bother to percuss his lung fields, as I was already quite sure of the diagnosis.

  The young man was already starting to have some right-sided tracheal deviation, which was essentially pathognomonic for a tension pneumothorax — a medical emergency. Given the blunt mechanism of injury and mild hemoptysis (coughing up blood), it was likely that he had some type of left-sided rib fracture complicated by hemothorax (blood in the chest cavity). Cardiac tamponade secondary to blunt cardiac injury and pericardial effusion was also possible, but if he had that, there was nothing I could do and he was certainly dead because I definitely was not going to attempt a blind pericardiocentesis.

  I counted four ribs on his bare chest and found the appropriate anatomic ndmarks. Then, I closed my eyes in order to calm my rapidly beating heart down. I still needed to wait for the guild member to return with the items that I requested.

  + + +

  In the United States, thoracostomies (putting a hole into the chest wall) was typically done by an emergency physician or a general surgeon. Hospitalists were not trained in this type of procedure, but the principle was simple enough that even paramedics could perform it in an emergency.

  The issue is that I did not have a needle decompression device, and I wasn’t even sure if there were any tube-like medical instruments that I could use in this primitive medieval isekai world.

  This really wasn’t any kind of ideal circumstance for me to be trying any crazy stunts. However, if I did absolutely nothing, the young adventurer would surely die.

  Seconds ter, the errand boy came running back with a bottle of rum, a torch, a metal spoon, and a handful of cups.

  Without wasting any time, I poured the alcohol on the adventurer’s chest, then doused my hands as well as my kitchen utensils. Next, I heated the knife and the rear end of the spoon on the open fme until I felt that it was reasonably sterile.

  I identified my site of entry.

  —4th intercostal space, anterior axilry line, upper edge of the rib.

  There wasn’t any time to waste.

  The adventurer screamed in pain when I made my incision, but it was only a small cut. The spoon would definitely be worse, and I called for help — anyone who could hold the man down. The technique I intended to use was known as a ”finger thoracostomy”, traditionally performed with a surgeon’s finger (…as aptly named), but I didn’t have any sterile gloves… so I figured any kind of blunt rod-like object would suffice.

  I pushed the rear end of the spoon into the man’s body until there was a high-pitched hiss, the sound of air escaping… the telltale sign of a successful decompression.

  The young adventured kicked and writhed like I was murdering him, which was probably fair given that everything had been done with zero anesthesia.

  I then asked for a ceramic cup and held the rim over the fme. After a few seconds, I immediately pced the cup upside down over the area of my incision and confirmed that it formed a tight seal.

  Quite some time ago, I had read about this primitive method in a medical history book.

  In the 15th Century, the Turkish surgeon Serefeddin Sabuncuoglu described a technique known as “mihceme” (aspiration by negative pressure). It utilized the principle of ”cupping therapy“ that was a cssical feature of East Asian traditional medicine. By utilizing a fme to burn the oxygen on the inside of a cup, this produced a vacuum that could suction the internal contents of a pneumothorax/hemothorax.

  I didn’t have access to a modern chest tube (specifically the water seal apparatus), so a vacuum seal was the best alternative that I could think of in this low-technology environment.

  I genuinely had no idea how well it would work, but I didn’t have the correct tools or even the right medical expertise. It was essentially a st-ditch Hail Mary that I had attempted out of pure desperation, and I was sure I would have been sued for medical malpractice if I tried anything like this back on Earth… since I definitely was not a licensed surgeon.

  + + +

  The adventurer’s condition had rgely stabilized by the time I completed my secondary survey.

  To be honest, I still felt like it was 50-50 whether he’d actually survive in the long run, especially given the incredibly high risk of infection, but I gave the aftercare instructions to the guild member who had essentially acted as my assistant during this process.

  Specifically, I told him to change the cups every hour with a simir vacuum technique. Even if the seal weakened, the cup should be held in pce to prevent air from entering the lung. The patient should exhale forcefully through his nose when the cups were changed, and the bloody discharge should be quickly wiped with alcohol. As a general rule, any item that touched the patient’s wound should be sterilized with boiling water for at least 20 minutes.

  I suspected it would take 3 to 4 days before the pneumothorax would spontaneously resolve, but it depended on the magnitude of the hemothorax that I hadn’t visualized. I told the guild attendant that he should find me again if there was too much bloody drainage, if it looked like the incision was leaking pus, if the man developed a fever, or if he had any difficulty breathing.

  Other than that, there wasn’t too much we could do besides simply waiting…

  + + +

  My voice gradually faltered.

  The adrenaline pumping through my bloodstream had died down, so a terrible sense of insecurity and imposter syndrome took hold of my heart. The attendant had been diligently taking notes on a sheet of parchment, and he looked confused when I suddenly excused myself at the first opportunity. I opened the door and escaped from the procedure room.

  I ran back to Canaan’s side and hugged him tightly.

  No matter how confident and self-assured I might have appeared to a third-party observer, all of this had actually been quite scary for me.

  I really didn’t want to do this kind of gruesome surgical work every day.

  During the case, I had gotten so self-absorbed in my own little internalized world that I hadn’t even considered exactly how people of this medieval society would react if they learned that a woman was performing surgery. Did I commit a taboo? Had a vioted the w? Would the city inhabitants look at me like I was a freak or a monster?

  The anxiety in my heart flooded my brain to the top of the sky.

  My boyfriend rubbed my head softly.

  He apparently knew me well enough to have a reasonable guess about the worries in my head.

  “I love you, Skyr,” he reassured me. “You did great. I’ll ask the the guild to keep quiet about this. I don’t think there shouldn’t be any issues, since our scout’s father is a cousin of the guild master. I think they’ll definitely want to thank you in person ter, but I can already guess that you don’t want any special attention from the higher ups…”

  He bent down to kiss me on the lips.

  It was just a single light touch, but the countless insecurities in my head instantly melted away.

  …They were repced by a throbbing sensation of raw hunger.

  Canaan always had such a strange effect on my body.

  “…Are you still going to be in the mood to do it again tonight?” Canaan astutely changed the topic to the issue that I cared the most about. “Or do you think you’ll need to take a break tonight after everything that happened?”

  —Skipping a night of sex?

  I simply couldn’t accept that idea.

  I knew Canaan was trying being considerate, since I used to cry on the phone to him every other night during the years I was a medical resident in New York City. However, the current situation was entirely different than before, and I wasn't the same kind of helpless and mentally fragile girl that I used to be in the past.

  “Let’s go home already…” I pleaded with him. “I had to wait all day for this…”

  If I needed any kind of medicine to cure my insecurities, my so-called ‘husband’ Canaan was the only drug that I ever needed. Even if the entire world was going through the nuclear apocalypse, there wasn't a single thing in the entire world that could bother me as long as I had my favorite person tangled with me in bed.

  ?

  AnnouncementDiscimer: The medical depictions in this story are intended for entertainment purposes only and should not be attempted or utilized as actual advice for real life.