Medicine

From Mizahar Lore

Medicine can mean the difference between life and death.

Medicine is the art of caring for the body, maintaining its health and aiding it while it is recovering from disease and injury. This skill is closely related to the goddess-given gnosis of Healing, though there are several key differences. The gnosis heals instantaneously and is limited to those favored by Rak'keli. Medicine, however, is an art and science that can be learned by anyone and carries the individual flavors of the practitioner, his or her culture, and experiences. Medicine comes in numerous forms throughout Mizahar. The Akvatari for example use music and color in their practice of medicine. The Akalak believe in training the mind to deal with health and fitness before serious illness develops. The Konti take a hands-on holistic approach - dealing with diet, inner energies, and the creation of complex medicines made from wholesome ingredients. From almost any race or cultural group, one can find a wide array of approaches to aiding a body to feel better.

It is important to remember that Mizaharans have no knowledge of germs, and only basic ideas of how disease is transmitted. However, it is largely understood by even the most untutored medic that cleanliness is important. In the first mark stage of Rak'keli's gnosis the ability to purify a wound is included. Based on that and the assumption of trial and error knowledge base, sterilization is widely understood to be a necessity.

Related Skills

• Herbalism
• Philtering
• Poison

Learning Medicine

Medicine can be learned through books, although hands-on training and experience can offer a more stable base for aspiring physicians, as each patient and case will vary slightly from the textbook situation. Well known areas of medical learning include the Opal Temple of Mura, home to the Opal Order, the Medical Library and, on occasion, Rak’keli herself. In Avanthal the Whitevine Hold is the most strongly associated with medicine and a good place for potential physicians to begin their training. Physicians will rely heavily on knowledge from other fields. The skill medicine refers to a person’s ability to diagnose ailments, injuries and diseases, and to heal them through non magical means. Knowledge of the anatomy of the species being treated (which is not limited to the sentient races of Mizahar) is important for would-be doctors. The medicine skill can be used to treat animals as well. Knowledge of poisons, herbalism, and even philtering can be important skills for a well-rounded medic who wishes to create antidotes and prescriptions to deal with a patient’s complaints. It is important to note that someone with no knowledge of herbalism, though they may be a master in medicine, cannot create or prescribe any type of salve, tincture or other herbal remedy.

Common Techniques in Medicine

Medicine is a broad skill that exists in every culture and includes many different forms and techniques. Some examples of common medical techniques and practices are as follows.

Amputations

Loss of limb is common enough in a dangerous world like Mizahar, and can be a terrifying prospect if the doctor does not also have knowledge of herbalism to dull the pain. This skill can only be successfully performed without risk of massive complications by an expert level or higher who is familiar with the specific anatomy of the species. Though most humanoid species are similar enough to prevent serious complication there are always slight variations in the body a practitioner must be prepared for as amputation is one of the most dangerous procedures a patient can under go. A successful amputation must be performed as quickly as possible to eliminate extensive blood loss and shock. This is often done using a curved blade to cut through any flesh until the bone is reached, after which a bone saw must be used to completely separate the limb. Wounds are typically cauterized afterward using a heated blade or hot pitch, in rare cases reimancy has been rumored to be useful if well controlled. An expert in medicine would be able to complete an amputation in thirty seconds, with a less skilled doctor the procedure is much longer, and more painful.

Basic Health Checks

The basic check-up is dependent on a doctor’s knowledge of anatomy and the history of the patient. At a low skill level a doctor will be able to spot anything clearly out of the ordinary, but physical issues only beginning to develop or internal problems will be nearly invisible to anyone but an expert doctor without the help of a skill like auristics. This is an area of health care that is extremely dependent on the physician’s knowledge of the species. Without basic information about the creature being examined it is difficult to detect if something is out of the ordinary. While physician without extensive knowledge of their patient's species would not be incapable of determining anything that was not a blood spurting wound, it would certainly increase the level of difficulty. There are symptoms such as fever, fatigue, shakes, sweats, et cetera that often stretch past any barriers. Even a high numbered novice should be capable of seeing said issues and at least suspecting them for being possible signs of a deeper lying issue.

Bedside Manner/Care

After a physician has done all in their power, there is often little that will mend a patient except for time and rest. Bedside manner is tremendously important, especially when dealing with severely injured or ill people who have a long expected recovery time. This includes being able to monitor a patient’s wellbeing and ensure that their condition is not worsening. It also means checking for and preventing bedsores from forming. A good physician will know how to move patients to prevent further injury, to lessen pressure so bedsores do not form and perhaps even supply a recovering knight with in-bed stretches and exercises so their physical ability does not deteriorate too much. Bedside manner also proves important when dealing with traumatic situations. A calm, confident countenance will assist the physician in handling a patient whereas a uncertainty and panic will only detriment. High stress situations can mortally handicap a patient's likelihood of survival and it falls to the physician to defend them from it. The leadership skill is very useful for a physician to have. Often over looked are how doctors treat their healing patients, having a pleasant personality and calm demeanor can go a long way on the road to recovery, though this is not necessarily part of the medical skill set.

Bone Setting

The act of being able to splint bones and create casts is a tremendously important skill for medics in such a violent world. Physicians at a basic skill level will be able to splint simple compound breaks where the skin is not broken and prevent further damage from being done. This is typically done by preventing movement around the fracture by binding the limb with soft, thick layers of fabric or tying the injury to a flat, firm surface or another limb. In more advanced levels a physician will be able to reset bones and deal with fractures that have broken the skin. They will be able to realign broken bones so that they heal properly and create long lasting casts that will protect the break better than a temporary splint. Such sturdy splints are often made using the same basic technique; wooden slats to immobilize the break wrapped in cloth, but can be soaked in a variety of substances to make them stronger. Stiffeners can include wax, starch, egg whites, flour and animal fat.

Diagnosing and Treating Illness

The art of diagnosing an illness is one aspect of medicine most difficult to learn from books. Though books are helpful reference materials doctors must learn to see and identify subtle differences in the various symptoms that diseases present. This must then be combined with the ability to recall a variety of ailments. The body will only present a small array of symptoms and many will indicate several diseases, which is why most beginning to study medicine simply do not have the experience or knowledge to diagnose illnesses accurately. While someone with skills only in medicine can diagnose a disease with the proper knowledge they can create no herbal remedies or philters to alleviate symptoms; just as an herbalist with no medical background would be at a loss when trying to discover what ails the patient so they could prepare the proper mixtures. This is one reason these two skills are so reliant on one another and students studying medicine are often taught both disciplines. What a doctor can do without herbal skills is limited. Physicians can design diets to increase overall health, physical regimes that may strengthen the parts of the body that have become weak, or let blood to release contaminants from the body. Bloodletting is not something a novice is capable of, as it requires specific knowledge of vessels, their locations and what they are connected too, as each vessel carries blood from a different area and will serve a different purpose. With an unskilled person there is also the significant risk of simply bleeding out instead of healing.

Physical Therapy and Rehabilitation

Physical therapy can be used by doctors to help speed the healing process after a serious injury and rebuild the muscles and control of the body part. Common techniques include manual manipulation (either by the doctor or by patient following instructions depending on the severity of the disability), massage and exercises to rebuild strength. Simple techniques can be used by competent doctors and stretching is even well known by novices, but as a doctor progresses they may begin to create their own techniques and tailor them to the needs of the patient.

Surgery

Any type of surgery in Mizahar has the potential to become life-threatening. The risk of infection is tremendously high and a doctor must rely on not only a well-rounded base of knowledge but the proper tools and be able to act quickly to prevent further damage. The most common type of minor surgery in Mizahar typically involves the removal of small objects, like arrow heads from the body. Even a novice will be able to do this as long as the wound has not punctured any vital organs or major blood vessels, and the arrow head is not one specifically designed to cause more damage on the way out, like a barbed arrow. More complex surgeries may be undertaken by physicians with more skill. This is rare though, due to the risk involved for the patient and limitations in medical knowledge. Because of this emergency surgery is usually the only type of surgery undertaken, and skill progression means less damage is done in removing foreign object from the body and larger wounds can be dealt with safely. Anything involving the internal organs is extremely risky and rarely, if ever, attempted with success.

Suturing

Most sutures in Mizahar are made from organic materials. Cat-gut threads and silk are common materials for doctors to use, though this will vary from city to city. Animal materials will be absorbed by the body, however if a doctor uses silk threads or a similar material they must also know how to remove them. Sutures are typically tied off and the thread is cut after each stitch, though there are other methods. The suture is typically placed as far from the wound as they are from each other. The skin around the wound should stick slightly upward once closed with sutures, not tuck inward. Doctors learn special knots to secure the stitches in training, such as surgical or square knots. The finesse a doctor can apply sutures with is dependent on skill level. While a novice who has learned suturing will be able to close small surface wounds with clean cuts a competent level medic would be able to deal with ragged and torn edges. A doctor who is a master can be expected to limit scarring and will be able to stitch damaged blood vessels if they are large enough.

Wound Care

Though the causes of infections remain a mystery a good deal is known about how dangerous they can be. But Mizaharian doctors do know how to prevent infection from settling into a wound and how to help it heal. As the basic level a doctor in training will know to keep a wound dry and clean to prevent rot from setting in. They may be able to suture small wounds and properly change dressings, simple maintance tasks that prevent the injury from becoming more severe. At higher levels a medic will be able to speed the recovery of wounds by dressing them in particular ways and even removing dead tissues, often through the use of maggots. Items like vinegar, honey and lemon juice can be used to slow bleeding and in some cases also work as antiseptics.

Obstetrics

The massive destruction to life on Mizahar during the Valterrian resulted in a severely dwindled population. With nearly all of the sentient races at dangerously low numbers, a combination of banal biology and universal life cycles stresses the need to reproduce. Destruction breeds creation and obstetrics is a vital and important aspect of medicine for a physician to learn as well as of the most common. Aid in conception, detection of early pregnancy, the proper monitoring and treatment during gestation for woman and child, the safe delivery of the child and care of mother and child following are require special skill sets and knowledge. A physician with herbalism training may be able to provide a woman with potions both to increase fertility as well as to prevent conception. They will need to know how to monitor a pregnancy and take measures to alleviate potentially harmful symptoms. Standard midwifery is paramount. The ability to safely deliver a baby is widely sought, requiring steady hands and a quick mind to save two lives when problems arise. Due to the immense dangers of surgery, cesarean deliveries are incredibly rare and almost never successful by physicians not at least at expert level.

Skill progression

It is important to remember than no matter how skilled a doctor may be they often rely heavily on other skills. Even a Master Doctor cannot create an antidote without poison skill, though they may know enough about the body’s processes that an alternate route to healing can be considered.