Chapter 50
"Never be so busy as not to think of others." ― Mother Teresa, The Joy in Loving: A Guide to Daily Living
Chizuru-chan looked down at the sheet of paper I had laid on her desk. The diagram of Oshiro Akio's broken leg was drawn in a slightly cartoonish manner, but in my defense, I didn't have an x-ray to refer to and I was never the "artist" type in this life or in my past life to begin with. However, I was at least beyond drawing stick figures. One would think I would have gotten better at drawing due to all the medical diagrams I was constantly drawing, but the only thing I really improved in was not dripping ink everywhere. And despite how cartoony the diagram looked, it was accurate, which was the most important thing.
But I couldn't stop my ego from swelling when Chizuru-chan looked impressed with my drawing skills.
I placed the calligraphy brush back down. "So, you remember how Oshiro-san's leg looked before amputation yesterday?" I asked, pausing briefly as Chizuru-chan nodded. "One look at the leg and you knew it likely had to be amputated. Can you tell me your reasoning?"
"It was the way the bone was broken," Chizuru-chan answered, blinking a few times. She pointed to the diagram where the break depicted in the broken jagged bone piercing the skin. "And there would be an infection because the bone was exposed. An infection would kill Oshiro-san."
I nodded before I began drawing another diagram of the same leg. This diagram, to my dismay, was slightly lopsided. I quickly stuffed down the urge to crumple the paper up and restart the drawing.
"Right. But did you know that these types of breaks don't always have to end in amputation?" I could see Chizuru-chan's eyes widen slightly out of the corner of my eye. "There are methods to prevent the bone from becoming septic and ways to piece the bone back together. The ultimate goal of repairing a compound fracture is the restoration of function. However, if function cannot be regained or if an infection does set in and cannot be eradicated, then amputation becomes the only option."
"But how would you piece the bone back together?" she asked before tilting her head at the new diagram. She pointed at the first diagram. "Oshiro-san's leg was crushed. If it was just one break, we could just set and splint the bone to keep it from moving while it heals. But Oshiro-san's bone was shattered into multiple pieces with the largest piece piercing his skin. The leg can't be splint normally."
"That's correct." I finished up the second diagram and moved on to a third one. "The leg can't be splint 'normally'. Instead, the bone needs to be pieced back together, then anchored in place with metal screws, plates, and rods so the bone can heal properly." Pausing work on the third diagram, I placed the brush back down and pointed to the extra lines in the second diagram. "When the leg is opened up in surgery, a metal rod can be inserted into the bone to act as a splint while the bone fragments are secured back into their proper place using screws and plates. The leg is then sutured up and bandaged. This is called internal fixation.[1]"
"But won't the metal rust and create poison within the body?"
"This is why only certain metals can be used. The preferred metal used for bone reconstruction is titanium, though, stainless steel can be used. Titanium is non-toxic and biocompatible, meaning the body won't reject it and the bone can grow into and on the titanium. Plus, the flexibility and elasticity of rivals that of human bone."
I picked the brush up and resumed the third diagram while Chizuru-chan sat in silence, watching me draw and evaluating what I just told her. She sucked on her lower lip before nibbling on it.
"Another method used to stabilize the bone is external fixation[2]," I said, breaking the silence just as I finished the final diagram. I pointed to the boxy lines of the third diagram. "In this method, metal pins are inserted into the bone above and below the fracture site. The metal pins protrude out of the skin where they are attached to metal bars. However, this method is usually used to stabilize the bone while the open wound is being taken care of and only used until it's safe to perform internal fixation."
Chizuru-chan nodded at my explanation, her eyes sweeping back up to look at all the previous diagrams as her hand lightly brushed the paper. She then frowned to herself before looking back at me.
"If it was possible to save Oshiro-san's leg, then why did we amputate yesterday?" she asked. The million-dollar question.
I picked up the worn journal I had brought with me and flipped to a dog-eared page before placing it on the desk. A chart was drawn in the center of the page.
Mangled Extremity Severity Scale
Skeletal and soft-tissue injury
Low energy (stab; simple fracture civilian gunshot wound: 1 point(s)
Medium energy (Open or multiple fractures, dislocation): 2 point(s)
High energy (close-range gunshot or military gunshot wounds, crush injury): 3 point(s)
Very high energy (all of the above plus gross contamination, soft tissue avulsion): 4 point(s)
Limb ischemia (Score is doubled for ischemia 6 hr.)
Pulse reduced or absent but perfusion normal: 1 point(s)
Pulselessness; paresthesias, diminished capillary refill: 2 point(s)
Cool, paralyzed, insensitive, numb: 3 point(s)
Shock
Systolic blood pressure always 90 mm Hg: 0 point(s)
Hypotensive transiently: 1 point(s)
Persistent hypertension: 2 point(s)
Years
less than 30: 0 point(s)
30-50: 1 point(s)
greater than 50: 2 point(s)
"See this?" I pointed to the journal. "It's called the mangled extremity severity scale[3]. It's called MESS if you abbreviate it in English, in case you're curious." Chizuru-chan looked impressed at the mention of English. "If you get a score equal to or greater than seven when you assess the severity of the limb trauma, then it is best to amputate. Oshiro-san's wound had a score of nine. Plus, even if the score was less than seven, I still would have had to amputate. I'm completely out of surgical screws and rods, at the moment, and it would have taken too long to wait for a new supply to come in. It was best to amputate."
"Oh," Chizuru-chan said, becoming glum before falling silent. Her eyes then glazed over for a few seconds.
She hummed to herself before she started sucking on her lower lip. She looked at the open door of her room when a cold breeze rolled into the room. Outside was no longer a gleaming white wonderland with the exception of a few patches where the snow refused to melt, but it was still fairly chilly. I wrapped my hanten around myself a little tighter before a tiny shiver ran up my spine, causing me to sneeze.
"What is it?" I asked just as I rubbed my nose. She seemed interested enough in learning about medicine earlier, but now she just seemed distracted.
"All of this is interesting, and I am thankful that you're taking the time to teach me, but… I was just wondering…" Chizuru-chan twiddled her fingers as she looked down uncomfortably to stare at her lap. "When will I be able to go out and look for Otou-san? I've already been here a few weeks and all I've really done is sit in this room…"
I offered her a sympathetic smile. "Since you are Hijikata-san's 'page', it would technically be up to him to decide," if Hijikata-san did plan to let her out at all, "and it really can't be helped that he's up in Osaka right now with Sannan-san. You can try asking the others if you can go outside, though."
She instantly perked up with a small gasp. Excitement sparkled in her eyes as a smile bloomed on her face. All her reservation along with the look of discomfort she tended to wear around me was forgotten instantly as she practically bounced closer to me. She grasped my hands and held them up near her chest.
"Really?" Chizuru-chan chirped.
"Uh-huh." I nodded. "There's no guarantee that they will let you out, but there's no harm in trying. And if they're going to refer to Hijikata-san's judgment on whether to let you out or not, there's no harm in trying to convince them to support you so you'll have a high chance of going out when Hijikata-san returns. Referrals are very powerful, after all."
"Then I can leave this room?" Chizuru-chan asked. "Right now?"
She jumped to her feet without waiting for an answer and went to go stand at the threshold of the door. She shot the world outside a wistful look before looking back at me for permission. Not getting a "no" or a shake of my head, she hopped outside, giggling gleefully the moment her toes touched the hallway outside her room. Then, as if to savor the small freedom, she spun around with small bunny hops to enjoy the fresh outside air.
The whole display adorable was almost enough to make me forget the struggles of standing back up from a sitting position when heavily pregnant. Almost. It's kind of hard to forget when you can't see your feet.
Chizuru-chan waited patiently, almost thumping her feet in joy against the wooden floor as she waited for me roll onto my feet and catch up. When I was at her side again, her grin grew in size while she vibrated on the spot.
"So, where to?" she asked as she bounced on her heels.
I hadn't seen her smile so much a so freely since she arrived. It was refreshing and reminded me a little of Tamako-chan. Ah, I missed little Tamako-chan.
"We could go to the main hall." I pointed to the right.
Because that's where the friendlier people were, or should be now. The Idiot Trio were practically engineered to make people laugh, and they were nicer to women. Besides, it was kind of hard to imagine Chizuru-chan still smiling this much around Souji and Saito-san. Souji was just mean sometimes and Saito-san too quiet. I suppose we could have gone to talk to Otou-san, but he was probably busy right now and I didn't want to bother him too much, though he would suggest otherwise.
However, just as we approached the main hall, which was strangely quiet, Inoue-san emerged. He looked quite befuddled with his scrunched brow and pursed lips. He greeted us with a kind smile before peering at Chizuru-chan with hidden curiosity.
"Ah," Inoue-san said, pausing in front of us. "Good afternoon. Are you showing Yukimura-kun around, Shizuka-chan?"
"Not exactly." I glanced at Chizuru-chan as fidgeted nervously before bowing politely to Inoue-san. "I'm looking for Heisuke and the others. They're supposed to be in the main hall, but I'm guessing they aren't. It's too quiet."
Inoue-san shook his head with a chuckle. "No, they're not. I'm looking for them too. Do you have any idea where they went…? I can't find them anywhere and they didn't tell anyone if they were going to go somewhere this afternoon."
Really, the deduction wasn't all that difficult to make. They weren't in their usual spot. They weren't on patrol. They weren't doing any chores, and they didn't let anyone know if they were going out or not. And, in addition to all of that, Hijikata-san and Sannan-san weren't present at headquarters. It was every man's dream to go drinking in the afternoon, was it not? Well, it was at least those three's dream.
"Check the front gates," I answered, holding back a snort. If Inoue-san caught them right as they were about to sneak out, then…
"Oh? If you say so," Inoue-san said before nodding at Chizuru-chan, "Enjoy your stroll with Shizuka-chan."
"Ah, thank you, Inoue-san!" Chizuru-chan chirped, hastily bowing again. She turned to me, looking far less peppy than she was before, once Inoue-san was out of sight. "You said we were looking for Toudou-san and the others, but they aren't here. Now what do we do?"
I spun around, dramatically pointing down the hall we just came from. "That way! To the inner courtyard!" I bellowed, hoping I could act silly enough to make her laugh. No choice but to go look for Souji and Saito-san.
However, instead of laughing, Chizuru-chan looked at me strangely with her large eyes. I felt my face grow hot as I reprimanded myself internally for such silly and familiar behavior with someone I yet to have a solid friendship with. Rapidly shaking my embarrassment off the best I could, I scratched the back of my head before quickly marching off in the direction I pointed in. Chizuru-chan shuffled after me, keeping a fair distance between herself and me.
How long had it been since I had been this awkward? Chizuru-chan was such a sweet person and I really wanted her to like me, but I felt like such a klutz every time I tried to make her laugh. Whenever I was being serious, everything turned out fine. She knew how to deal with that. However, every time I did something silly to try to make her laugh, she just stared at me blankly. Even though she was the one in an unfamiliar place, she was the one making me nervous. I felt like I was constantly doing something wrong around her whenever I cracked a joke. Was there something about me she didn't like?
That thought hurt more than I would have liked it to.
Scratching my forearms in discomfort, I nearly scrambled off in a disorganized rush when I heard the whoosh of air that signified the swinging of swords. My escape was close!
Out in the inner courtyard, I could see Saito-san swinging his sword. To the untrained eye, it would look as if Saito-san was just swinging his sword with no great skill. But, with closer observation, each movement was precise. Not a drop of energy wasted. Perfect control in every way.
Slightly to the right of Saito-san, Souji was hanging the recently washed laundry. He exchanged a few short words with Saito-san before he loosened his tasuki and tucked it back in his sleeves. Abandoning the remainder of the laundry, he went to go sit on the roka before he grinned and waved me over. Saito-san paused his katas to watch Chizuru-chan and I approach.
To escape the atmosphere of awkwardness I inadvertently created, I practically bolted to where Souji was. Pretending that it was done to escape the cold, I snuggled up to Souji's side, almost sighing in relief as I wrapped Souji's arm around me. Hearing an amused snort, I looked up only to see Souji's bemused grin and an arched eyebrow as he shot me a knowing look. I ignored his laughter as I grumbled nonsensical words under my breath.
"Okita-san! Saito-san! Good afternoon!" Chizuru-chan chirped, once again looking cheerful now that we actually found some of the guys. She bounced a little closer as she rocked back and forth on her the balls of her heels.
Souji greeted her with a lazy wave while Saito-san sheathed his sword and nodded at her silently.
"Afternoon, Chizuru-chan," Souji said, putting his weight on one arm as he leaned back in his seat. "Thinking hard on something, are we?"
Chizuru-chan jumped, looking like she had just been struck by lightning. "H-How did you guess…?"
"We did not have to," Saito-san answered, closing his eyes as he enjoyed a passing breeze. I only shivered and pressed myself further into Souji's side. "You just told us. At any rate, if you have something to say, then out with it."
She looked to me shortly for support despite the awkwardness we shared earlier.
"Well…," she said before taking a big breath. "I was hoping I could go look for my chichi-ue soon."
Saito-san's posture remained the same. "That's not possible." There was no room for argument. "We don't have enough men to spare to keep an eye on you."
Chizuru-chan frowned, puffing up her lower lip slightly in the most adorable way. She looked to Souji, probably hoping that he would have a different answer.
"Is there really nothing you can do?" The amount of disappointment in her voice made it sound like we purposely kicked a puppy. I even felt guilty for not taking her along whenever I headed out myself to take care of some simple chores I was still allowed to do. "It's not like I want to go very far. Just walking around the city is enough…"
"Hmm…" Souji hummed as she stole a glance down at me before pecking the top of my head in a comforting manner. "Well, I suppose we might be able to let you tag along when we go on our rounds"
Chizuru-chan blinked. "Your rounds?"
"This isn't just a stroll," Souji warned, narrowing his eyes at her almost dangerously, as if he were trying to intimidate her away. "While you're with us, you're in danger. If we make mistakes, our men die. If you don't want to get cut open by some angry ronin, you need to be ready to fight back."
"Well," Chizuru-chan said, stomping one foot as she steeled her expression, "I do know a little of swordsmanship. I should be able to protect myself a little…"
Despite the look of determination, there was still fear lurking behind her eyes. She reached down to touch the hilt of her kodachi for reassurance. Her nerves seemed to regather themselves after whatever internal debate she had died down. Saito-san watched her silently, but I could see he had some growing respect for her.
"In that case," Saito-san said, finally speaking, "allow me to test you. Let me see if that blade of yours is merely for show."
Chizuru-chan jumped, her eyes shooting between Saito-san and his katana. "What?"
Saito-san ignored the look of shock on her face. "I will hold back, but you need not. Come at me with your most powerful strike."
"B-But…!"
All that determination from before seemed to vaporize in an instant. Chizuru-chan took a hesitant step back as she watched Saito-san and Souji with a rare fearful innocence. It became clear at that moment that she had never swung a real sword a person before or even needed to.
"Is there something wrong, Yukimura?" Saito-san asked, his voice the same cool picture of poise. "Draw your blade, unless it is merely a decoration."
"No, of course it's not…," she assured weakly. "And I have taken lessons. I'm not lying. But…" She exploded in a loud cloud of emotion. "I can't! I can't attack you! If my hand were to slip and I cut or stab you, not only would you be injured, but you could die!"
Souji suddenly burst out laughing as he stole his arm back from me. He was laughing so hard that his entire body shook. Saito-san, on the other hand, looked like he just swallowed ink.
Chizuru-chan puffed her cheeks up in offense, like an overly fluffy kitten. "Excuse me… You don't have to laugh…," she muttered, crossing her arms.
"Oh, that you could kill Hajime-kun?" Souji slapped his knee as he sniggered some more. "That's not funny? Ha! Oh man! This is too good…"
"But I can't just draw my sword on someone if there's even a small chance it could hurt them!"
Saito-san smiled, nodding in understanding while Souji just rolled around in laughter some more. Sometimes these two got along so well that it was easy to forget that they were as different as they were similar. I irately whacked Souji's arm to get him to settle down. That only made him snicker some more before he smiled somewhat coldly at Chizuru-chan.
Contrary to popular belief of the local civilians, Souji believed fighting not to be all about scoring the kill but about self-defense. For Chizuru-chan to refuse to fight back, even if was to defend herself… Well, for Souji, who had always had to fight tooth and nail just to survive, Chizuru-chan's naivety tasted like ash in his mouth. And quite frankly, it did in my mouth too, and quite possibly even more so. I did want to help her find her father, but if she was going to act this naïve when she went out on patrols with the guys, there was a good chance she was going to make them stick out their necks just to her protect her. Patrol was already dangerous enough as it was.
Innocence was a sweet characteristic for Chizuru-chan to have, but things that were too sweet often gave people tooth decay.
"I understand where you are coming from, but if you prove your worth to me, it will help you," Saito-san said. "If you can prove to not be a hindrance, we will try and take you out, which will help your search."
Chizuru-chan said nothing as she looked down at her sword.
"If you are so concerned for my safety, then use your scabbard or the back of your blade." Saito-san continued to coax her.
Then finally making her decision, she straightened up and looked straight into Saito-san's calm eyes. "Let's go!" she said, drawing her short blade at last, the sword making a sharp hissing sound as it left the scabbard. She flipped the dull side of her blade towards her opponent and settled into a fighting stance.
The stance was very basic. There was no hint of personal style or experience. It was a blank slate and very dangerous. Even a mediocre swordsman would be able to predict her every move. It was a very sturdy basic form by dojo standards, but that was about it. She wasn't even going to last ten seconds against Saito-san. Matches in a dojo always paled in comparison to a real fight to the death.
However, Saito-san merely cocked his head slightly to one side and let out a small laugh. To him, her spirit, her determination, was enough. As Chizuru-chan shifted her weight on her feet, Saito-san remained completely lax with one hand on the hilt of his sword. Chizuru-chan tilted her head, puzzled by the lack of an attack stance before her foot inched forward.
"Here I come!" she announced, springing towards Saito-san with a short yell and with her kodachi raised over her head.
In an instant, Saito-san drew his sword, the gleaming light blinding me momentarily as the blade reflected the potent sunlight. There was the ungodly sound of metal screeching before Chizuru-chan's kodachi was sent flying in the air. Her short sword landed with a sharp thud, the blade sinking into the soil just a few inches away from Souji's feet. Souji's languidly glanced at the kodachi with near disinterest despite almost getting speared through the foot.
Saito-san's face was just inches from Chizuru-chan's face, the sharpened edge of his blade touching the delicate pale skin of her neck. If she moved just a little, she would cut herself on his blade. She froze, holding her breath with cold sweat dotting her forehead while she stared into Saito-san's eyes. Her arms hung limply at her side while her hands were still tight like she hadn't realized she was no longer holding her sword.
Chizuru-chan gasped airily at the blue orbs staring back at her.
"Your master should be proud. Your blade was not clouded."
"Umm…?" she said, taking shallow breaths once her senses returned.
"You can see into the heart of one's swordsmanship. You were blessed with a good teacher," Saito-san clarified. He turned without another word, sheathing his sword as he walked away.
Chizuru-chan remained frozen on spot, now loudly gasping for air once Saito-san's blade was removed from her neck. She brought a hand to her chest as her knees shook.
"What was that…?" she asked, her knees finally giving way as she slowly sunk to the ground.
Right beside me, Souji grinned at what he just witnessed. He lazily rose to his feet as he wrapped one hand around the hilt of Chizuru-chan's kodachi. He pulled it from the ground with a curious eye before giving it a little twirl to test its balance.
"This is a pretty nice little blade… Looks old though," Souji said lackadaisically as he held the sword out to Chizuru-chan.
"Huh?" she said weakly, looking over to Souji.
As if she suddenly realized her hands were empty, she looked down at her empty hands before scrambling back onto her feet as she glanced back at Souji's hands. Her eyes enlarged as she quickly pulled her back straight to bow.
"I-I'm sorry! Thank you for picking up my sword!"
Souji nodded, tossing the sword to Chizuru-chan. She caught the sword by the hilt with butter fingers, fumbling with it clumsily and almost dropping it several times. When her fingers finally stabilized, she rushed to sheath the blade like she was afraid she would still drop it.
Souji chuckled quietly as he sat back down indolently. "You alright? Gave you a bit of a start, didn't he? Not surprising. Hajime-kun's a real iai master."
"Y-Yes, I suppose I'm okay." Chizuru-chan rubbed her wrist with one hand before flushing slightly. "But… what's iai?"
"A technique where on draws the sword from its scabbard and strikes the enemy all at once. Since the technique uses incredible speed, it can be used as a counterattack or to aggressively attack an unsuspecting enemy," I explained before pointing at the way Saito-san wore his sword. "See how the blade is pointing upward?"
"Yes," Chizuru-chan answered before briefly looking down at her own blade, then back at Saito-san. "You wear your katana just like my kodachi, then?"
"That is correct," Saito-san replied with a short nod. "Older katana were once hung facing blade-down, but modern blades are worn at the waist, blade-up. Normally, one waits until the blade is drawn, then flips the blade over and faces their opponent."
"In iai, the sword is drawn with one hand," Souji added matter-of-factly. "Some think it diminishes the power of your swing."
"But that's not a problem Saito-san has…," Chizuru-chan finished as she watched Saito-san in silent awe. Her hands still shook. "It seems like he could easily finish an opponent with a single blow."
"Yup, Hajime-kun's a real blood sport…," Souji said before glancing at me with a nostalgic grin. "You jumped just like Shizuka did when Hajime-kun used iai on her the first time. At any rate, Hajime-kun would have finished you off right after he knocked the sword out of your hand if he were going for the kill."
"Wait, Saito-san used iai on Shizuka-san…?"
"Hmm, Shizuka knows how to use the naginata, but that's not the point of the conversation," Souji said with a shrug of his shoulders.
A shiver ran down her spine as she paled slightly when her thoughts wandered back to her own predicament. "That's iai, then…"
"Do not berate yourself." Saito-san rested his hand on top his katana's hilt as he looked at her with warm eyes. "You have room to improve, but you have enough that we might take you along."
All color returned to Chizuru-chan's cheeks in a matter of seconds as she jumped in excitement. She clasped her hands in front of her chest as if that would steady her fluttering heart.
"Really?" she exclaimed, her eyes moving between all of us.
Souji brought his hands together in a sarcastic yet polite applause. "Well, look at that! Hajime-kun himself gave you a pass! That's pretty amazing, you know."
"Then… that means…" Chizuru-chan's hopeful eyes shot back to me. "I can go outside on patrols?"
"Well," Souji said, drawing her attention once more, "if the man who told you to stay here approves it, then yeah, you're good to go with us."
"Right…" Chizuru-chan nodded, looking a little disappointed at the answer, but she looked more hopeful than before.
"You are going to have to wait until the Vice Commander returns from Osaka," Saito-san said, looking at Chizuru-chan briefly before looking away out of pity. "I am sorry. We will ask the Vice Commander for permission to take you on patrol."
"So, you think you can wait just a little bit longer?" Souji leaned back on his hands once more before smirking at Chizuru-chan. "If you want, we'll keep you company."
"Really…?" she asked, undoubtfully growing nervous at the sight of Souji's smirk.
"Yup. I wanted to ask you something anyways." Souji peered at me through the corner of his eye, causing me to tilt my head at him questioningly. His eyes grew cold as he looked at Chizuru-chan again. "Why do you always act like Shizuka's gonna eat you or something? It's like you want to be around her but then…"
My heart stopped. How did he know? And he was being way too direct!
"W-What…? I-I… Umm…," Chizuru-chan stuttered, looking around nervously like she wanted to run. Before she could answer, a yell interrupted her.
"CHIZURU!"
Heisuke appeared, kicking up a cloud of dust as he came to a screeching halt. Sano-san appeared a little after Heisuke, though, Sano-san looked much calmer and refined.
So, it looks like they were caught trying to sneak out to drink, but where was Shinpachi-san…?
"There you are!" Heisuke exclaimed. He grabbed her hand and began dragging her off with Sano-san following. "I told Gen-san I'd give you a tour! C'mon! Let's go!"
"T-Toudou-san?!"
"It's Heisuke, Chizuru. We're around the same age, right?"
I waited for those three to be completely out of sight before I glowered at Souji. He grew a little sheepish under my intense gaze but remained unapologetic.
"That was too much!" I scolded. "You should have just left it alone."
"And continue to watch you look uncomfortable? No way," Souji replied, crossing his arms. "Now are you going to tell me what that is all about?"
Saito-san watched Souji and I argue before he huffed and went back to his katas from before. While it looked like he was disinterested in our conversation. There was no uncertainty he was still eavesdropping. Mine and Souji's debate ended with no real winner or answer. There was an unspoken agreement to let it drop when Heisuke came to fetch us for dinner hours later. The unfinished laundry was left forgotten.
"You kids are late," was the first thing Shinpachi-san said to us as soon as we stepped into the main hall. "Who's gonna answer to my crying stomach?"
All the food was already laid out, but Otou-san and Inoue-san were nowhere in sight. With Hijikata-san and Sannan-san still gone, I guess it made sense that they both were taking their meals in their rooms so they could work and eat at the same time. Saito-san wordlessly went to find his seat while Souji was less graceful.
"Well, no one said you had to wait," Souji snorted before escorting me to my seat, which was directly across from Chizuru-chan's seat. The moment we sat down, Souji picked up his small dish of takuan and placed it on my tray.
Shinpachi-san crossed his arms at Souji. "You guys oughta apologize to my stomach! He wanted to dig in, but I said, 'No, we've gotta wait for em.'"
Sano-san shook his head with a relaxed smile. "You're such a softie, Shinpachi… Alright guys, it's time to eat, and that means every man for himself."
At that, Shinpachi-san grinned wildly as he brazenly picked up his chopsticks and jabbed at Heisuke's food. Heisuke yelped in alarm and elbowed Shinpachi-san's stomach in a rush to rescue his food. Shinpachi-san didn't even flinch.
"Survival of the fittest! This food is mine!" Shinpachi-san declared in a boisterous yell just as he took a sizable chunk out of Heisuke's grilled sardine.
"Hey! Why do you always steal my food?!"
Shinpachi-san belted out a deep throated laugh. "It's 'cause of the difference of size, kid! I got a bigger body. That means I need more food!"
"Well, I'm still growing, old man, so I gotta eat more too!"
Chizuru-chan glanced at the commotion going on beside her with a large sweat drop growing on her forehead before inching closer to Sano-san and away from the chaos.
Sano-san chuckled before taking a sip of saké. "Sorry you had to see this, Chizuru. They're always like this."
"I've, um, gotten used to it," she answered far too politely, though, she quickly took a bite of rice shortly right after, like she was afraid someone was going to steal her food.
I snorted and dug into my food too, but I left my own grilled sardine untouched. I was sure it tasted fine since Inoue-san cooked today, but I couldn't help but feel a little sick when I got a whiff of it. It had to be my own imagination because the fish smelled like one-day old trash that had been sitting outside in the hot sun. Heisuke was quick to take note of my aversion to the fish and quickly plucked it from my plate in silent glee. He quickly wolfed it down before Shinpachi-san could snatch it. Once the offending fish was gone, Saito-san silently placed some of his tofu in my bowl while Souji placed his bowl of miso soup on my tray. I frowned at both of them reprovingly but was ignored.
It was then Inoue-san stepped into the room with an open letter hanging limply in his hand. I stopped myself from greeting him when I was met with a distressed expression. Seeming to sense the poor mood, everyone in the room quickly settled down as all warmth evaporated.
"Gentlemen, do you have a moment?" Inoue-san asked. His voice was still warm but the solemnity in his eyes matched his expression. "I've just received word from Osaka. Sannan-san has been gravely injured in battle."
My heart stopped as my hand shook. A melancholic silence echoed throughout the room, completely killing and crushing any cheer that may have been left in the room.
"What happened?" Souji asked just I dropped my chopsticks.
My hands had grown numb, and my mouth dry. Each breath ached.
"A dry goods store in Osaka was invaded by a group of ronin. Toshi-san and Sannan-san arrived in time to enter the fray and subdue the ronin, however… Sannan-san was stabbed in the encounter."
"Where?!" I blurted, unable to sit still any longer. I tightly grabbed the fabric of my kimono. "Where was he stabbed?"
Inoue-san closed his eyes and took a deep breath. "According to the letter, he was gravely hurt. The wound is on his left arm. It will be hard for him to wield a blade, but he will almost certainly survive."
"Oh, thank goodness…" I could hear Chizuru-chan breathe a sigh of relief in her naivety.
I almost wanted to laugh deprecatorily at her misunderstanding. True, Sannan-san would survive, but would he still be able to live with himself? Her relief was nothing but a useless sentiment. Being rendered unable to wield a sword was a fate worse than death for any warrior.
"He should be returning here soon enough, when he's fit enough to travel," Inoue-san continued. "Now please, excuse me. I must speak with Isami-san. Shizuka-chan, if you could come with me? Toshi-san addressed part of his letter to you."
Quickly excusing myself, I pushed the remainder of my food towards Heisuke and Shinpachi-san before I stood and followed Inoue-san out the room. Without wasting time, I took the letter from Inoue-san while we were on the way to Otou-san's room. Skimming through the contents of the letter, I located the portion of the letter addressed to me.
Shizuka,
Sannan-san took a severe stab wound to his left shoulder with the most severe damage being done to the underarm region. It was a clean cut, but deep enough for the sword to have nicked part of the bone. However, we managed to stop the bleeding before Sannan-san lost too much blood. Sannan-san suffered a high fever the day after the injury, but the fever faded on the second day so infection is not too much of a concern. After regaining consciousness, Sannan-san has had difficulty straightening his arm at the elbow, turning his arm outward, and cannot lift his wrist and fingers. Sannan-san also said that he has loss of feeling in the arm. Reply as soon as you possibly can.
My heart dropped to the same vicinity of ankles. I swallowed, my throat cracking painfully in its dryness. I was a trauma surgeon in my past life, but…
I did have some knowledge about neurosurgery and I had done some procedure on nerves during my internship, but neurosurgery wasn't my specialty. Going off Hijikata-san's descriptions, the radial nerve must had either been nicked or severed. If Sannan-san was lucky, the nerve was only nicked and could possibly regenerate. Any nerve that was part of the peripheral nervous system[4] and consisted of nerves and ganglia[5] outside of the brain and spinal cord had the ability to regenerate.
However, if the radial nerve[6] had been severed, then Sannan-san would need a nerve graft[7] to reconnect the two ends of the severed nerve. A nerve graft required microsurgery[8]. I didn't have any of the equipment. I could write to Kyoko-chan and Kenji-san to ask about manufacturing the equipment needed, but there was no guarantee that they could even create something viable even with their ingenuity.
I needed time to obtain the equipment needed and time to research the procedure. While it was possible to hold off on performing a nerve graft for many years after the occurrence of the injury… With the passage of time came the increased chance of a nerve graft's reduced performance, if it even took in the first place.
"Shizuka-chan?"
I looked up at Inoue-san. Some part of my hopeless must have appeared on my face.
"It's bad, isn't it?" Inoue-san asked just as we arrived right outside Otou-san's room.
My hands tightened around the letter, wrinkling the edges. I bit my lower lip and stared down at the floor.
"I don't know if this is something I can fix," I finally said.
"It's too early to give up," Inoue-san replied, his voice soft as he placed an encouraging hand on my shoulder. "You haven't even seen the injury yet, so don't say you can't do it yet."
Inoue-san's words brought a smile to my face.
He was right. I could do this. I had to. I couldn't waste time feeling depressed.
"Good," Inoue-san said as if he could read my thoughts. He turned back towards the closed door in front of us before clearing his throat. "Isami-san," he called through the door. "We just received a letter from Toshi-san with poor news."
"Poor news?" I heard Otou-san mutter. The door suddenly slid open to reveal Otou-san's concerned face. "What happened?"
"Sannan-san got hurt," I blurted before looking back down as I played with my fingers. "He's stable for now, but his arm needs surgery in order to function properly again.
Otou-san's eyes widened in shock. He placed a hand on his forehead before wandering back to his seat in a daze. There was a dull thump when Otou-san dropped back into his seat. He brought his hands together and crossed his fingers in front of his mouth, lost in thought. I passed the letter to him when he held his hand out.
"I see…," he said after reading the letter twice. "This is something you can fix, right Shizu-chan?"
"I need to see the wound first."
Otou-san nodded somewhat despondently. "Very well. When they return, I'll—"
"Who says I'll be waiting for them to return," I interrupted. I watched Inoue-san's and Otou-san's eyes grow wide in panic when they caught on to what I was suggesting. I wasn't going to give them time to reject my suggestion. "I know I'm not supposed to travel at thirty-two weeks pregnant, but Osaka is only a couple of hours away by ferry and I don't feel comfortable waiting for them to return to see Sannan-san wound. However, I'm not stupid enough to travel alone and I know Souji won't let me travel without him."
"Shizu-chan!" Otou-san slammed his palm on the floor. "What if something happens with the baby while you're away? I don't like how risky this sounds!"
"And what about Sannan-san's arm?!" I cried. Otou-san fell silent. "Injuries are time sensitive! I don't want Sannan-san to lose all chances of being able to use his arm again just because the timing is inconvenient."
Otou-san curled his hand into a tight fist. He knew he lost this argument. I sighed, relaxing my tense shoulders before I grabbed his hand.
"Otou-san… If you're that worried about me…" Bringing Yamazaki-san was nonnegotiable because he was critical in spying on the Choshu. "Then I'll also take Chizuru-chan with me. You know I've started teaching her, and she does have some medical experience. Plus, I'm certain she won't run." It wasn't much experience, but I said that for his benefit and not mine.
Otou-san's hand tightened around mine before he gave me a weary smile. "Edo women are tough, aren't they?"
I wasn't sure about the word tough, but if he said that I cared too much, it would be another story.
[1] Cannada, Lisa K., and Robert P. Dunbar. "Open Fractures." OrthoInfo, edited by Lisa Chaudhry, American Academy of Othorpaedic Surgeons, Mar. 2017, . ?topic=a00582. Accessed 1 June 2017.
[2] Cannada, Lisa K., and Robert P. Dunbar. "Open Fractures." OrthoInfo, edited by Lisa Chaudhry, American Academy of Othorpaedic Surgeons, Mar. 2017, . ?topic=a00582. Accessed 1 June 2017.
[3] Cross, William W, and Marc F Swiontkowski. "Treatment Principles in the Management of Open Fractures." Indian Journal of Orthopaedics 42.4 (2008): 377–386. PMC. Web. 1 June 2017.
[4] The peripheral nervous system (PNS) is one of the two main parts of the nervous system, the other part is the central nervous system (CNS). The PNS consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the CNS to the limbs and organs, essentially serving as a relay between the brain and spinal cord and the rest of the body. Unlike the CNS, the PNS is not protected by the vertebral column and skull, or by the blood–brain barrier, which leaves it exposed to toxins and mechanical injuries. The peripheral nervous system is divided into the somatic nervous system and the autonomic nervous system. In the somatic nervous system, the cranial nerves are part of the PNS with the exception of the optic nerve (cranial nerve II), along with the retina. The second cranial nerve is not a true peripheral nerve but a tract of the diencephalon. Cranial nerve ganglia originate in the CNS. However, the remaining ten cranial nerve axons extend beyond the brain and are therefore considered part of the PNS. The autonomic nervous system is an involuntary control of smooth muscle and glands. The connection between CNS and organs allows the system to be in two different functional states: sympathetic and parasympathetic.
[5] In a neurological context, ganglia are composed mainly of somata and dendritic structures which are bundled or connected. Ganglia often interconnect with other ganglia to form a complex system of ganglia known as a plexus. Ganglia provide relay points and intermediary connections between different neurological structures in the body, such as the peripheral and central nervous systems.
Among vertebrates there are three major groups of ganglia:
1. Dorsal root ganglia (also known as the spinal ganglia) contain the cell bodies of sensory (afferent) neurons.
2. Cranial nerve ganglia, contain the cell bodies of cranial nerve neurons.
3. Autonomic ganglia contain the cell bodies of autonomic nerves.
In the autonomic nervous system, fibers from the central nervous system to the ganglia are known as preganglionic fibers, while those from the ganglia to the effector organ are called postganglionic fibers.
[6] The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.
It originates from the brachial plexus, carrying fibers from the ventral roots of spinal nerves C5, C6, C7, C8 & T1.
The radial nerve and its branches provide motor innervation to the dorsal arm muscles (the triceps brachii and the anconeus) and the extrinsic extensors of the wrists and hands; it also provides cutaneous sensory innervation to most of the back of the hand, except for the back of the little finger and adjacent half of the ring finger (which are innervated by the ulnar nerve).
The radial nerve divides into a deep branch, which becomes the posterior interosseous nerve, and a superficial branch, which goes on to innervate the dorsum (back) of the hand.
[7] Nerve grafts are used when a patient has a nerve injury resulting in complete loss of muscle function or sensation.
A nerve graft is a surgical technique in which a segment of unrelated nerve is used to replace or bridge an injured portion of nerve. The donor nerve serves as a "track" along which axons (appendages of neurons, which transmit impulses from the spinal cord to the muscle) can grow down to the target area.
Grafts are selected from nerves that are considered expendable, or much less important than the function being restored. Common examples of nerves that are used for grafts include the sural nerve in the leg, which provides sensation to the side of the foot, and the medial antebrachial cutaneous nerve, which provides sensation to the inner aspect of the arm. The sural nerve runs down the back of the leg from behind the knee to the outside of the foot. The procedure to take this nerve leaves a scar in the back of the patient's leg with numbness to the outside of the foot. The medial antebrachial cutaneous nerve is taken from the inner upper arm, and this procedure results in numbness to the inside portions of the arm, elbow and forearm.
[8] Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as: general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery and pediatric surgery.
