Surgery is the skill associated with treating illnesses, deformities, or wounds by utilizing different surgical methods. These methods can range from carefully administered stitches to the amputation of a major limb. Often these methods involve the use of tools and specialized instruments such as scalpels, forceps, or saws. Skilled surgeons are a rarity within Idalos as it requires access to resources and knowledge in order to be successful in this field. A clean workplace and sterilized tools are a must if the surgeon is to avoid killing the majority of their patients. Although the source of infection is not well understood in Idalos, it is known that patients can become incredibly ill after surgery if the incisions or the surrounding environment are not kept hygienic.
Technique, knowledge and cleanliness are the three pillars of an effective surgeon.
Minimally Invasive Surgery
*Available at Novice
This type of surgery rarely involves endangering the patient as there is less pain and a lower risk of infection associated with it. Administering stitches or making small incisions to treat illness or wounds is covered under this type of surgery. Examples of Minimally Invasive Surgery would include removal of potentially hazardous growths from the skin, lancing boils, or stitching a laceration.
* Avaliable at Competent
Amputation consists of the surgical removal of digits or limbs from the body of a patient. Amputation is sometimes the only way to save the life of a patient; either due to gangrene or extreme damage to the limb. With amputation the surgeon should always anticipate the possibility of the patient dying from blood loss during the procedure. Preparations must be made in order to prevent loss of blood.
*Avaliable at Expert
Invasive surgery involves any type of surgery that requires highly invasive means in order to treat the patient or diagnose a condition. The chance of infection is very high with this type of surgery so the surgeon must be meticulous in sanitizing the surgical space along with the incision site. Blood loss is also common with invasive procedures. A more common example of Invasive Surgery might include the removal of a tumor or locating sites of internal bleeding that require cauterization or suturing.
*Available at Master
As surgical techniques improve over time the master surgeon can begin experimenting with new methods of surgery that have never been attempted before. As the surgeon is breaking new ground they will be faced with a mixture of failures and successes. However, successfully created surgical techniques will enhance the field in far reaching ways. As surgical technology is still in it's infancy in Idalos, new methods and development to existing methods are being discovered every trial. Innovative masters in the medical field along with those blessed with divine inspiration are working tirelessly to solve health issues that have baffled healers for arcs.
*The development of new surgical skills is always ongoing. New skills can be added as the field advances.
*Avaliable at Novice
Sometimes known as stitching, suturing is the simple act of sewing wounds and incisions closed once they have been disinfected and treated. Suturing greatly minimalizes the chance of a wound becoming infected and helps accelerate healing. A well administered set of stitches will also help prevent potential scaring.
*Note on Suturing: The Raft (Credit to Faith & Padraig) : The Raft is a type of waterproof bandage that was recently developed in Rharne during Zi'da 716. It is made of a gel-like substance that promotes healing and staves off infection when applied. It can be used as a superior replacement for stitches where it is available. Availability for this item will be increasing over time as the formula becomes more well known.
Preventing/Stopping Blood Loss
* Avaliable at Novice
There are many methods for preventing blood loss but the most common way is to simply apply pressure to the wound or incision site. This can be achieved with hands or a tourniquet of some kind. Additionally substances with styptic (anti-hemorrhagic) properties can be used to slow or stop bleeding. An example of a simple styptic agent would be cornstarch. In rare cases where hemorrhaging must be stopped quickly and there is no time to use gentler methods, cauterizing can be used to stop excessive bleeding. This method is not always advised since it is often very painful for the patient.
Sanitizing a Wound/Incision Site
*Avaliable at Novice
Methods for sanitizing a wound can be incredibly varied depending on the skills of the surgeon. The simplest way to sanitize a wound or incision site is to thoroughly wash the area with clean warm water and a freshly laundered cloth. This method does not guarantee protection from infection but it does remove some of the risk. Other methods can involve the use of herbs with sanitizing properties or other chemical compounds.
Treating Broken Bones
*Available at Competent
The setting of bones typically involves the surgeon manually manipulating the fractured bone in order to align the pieces that have been damaged and dislodged. This skill can take both a fair amount of strength and a delicate touch to accomplish successfully. Once the bone has been set it can then be set into place for healing by either a brace or a cast. Immobilizing the bone after being set is of utmost importance if the limb is to heal correctly. If treated by an unskilled surgeon, sometimes the bone can grow back incorrectly and become malformed. In this case another more capable surgeon should be tasked with re-breaking the bone in order to set it correctly.
*Avaliable at Expert
Sedation involves the use of chemicals to induce unconsciousness in patients. Sedation is typically used to render the patient unconscious so surgery can be performed painlessly. Use of sedative chemicals or compounds must be done with extreme care since these substances can very easily kill a patient if given in excess. Additionally the surgeon must take into account that their patient may wake up during surgery if they do not give them enough of the sedative to begin with.
*Available at Master
This skill is a rarity among surgeons in Idalos as it has only recently been discovered and successfully tested. The master surgeon is only able to successfully utilize this skill due to their ability to ensure completely sanitary conditions during surgery. Additionally the surgeon must have the skills to ensure that the blood type of the patient matches the blood type of the donor. It is now understood that not all blood is the same; if incompatible blood is used then the patient can become extremely ill or potentially die. Typically tools such as needles and tubes are required to accomplish a successful blood transfusion.
Endurance: Endurance will aid in keeping a tired surgeon on their feet.
Discipline: Allows the surgeon to stay focused; in the heat of a battlefield or during a delicate procedure.
Detection: The surgeon is better able to notice changes in vital signs and locate problems during surgery
Gardening: May provide the surgeon with knowledge associated with plants and their uses as sedatives or antibacterial cleaning agents.
Medicine: Assists with diagnosing problems that may require surgery.
Needlecraft: Suturing is made cleaner and more uniform; enables the surgeon to leave fewer scars.
: Useful in creating chemical agents for use in sterilizing tools and the surgical work space. Additionally, chemistry is key in creating sedatives and painkillers that can be used to reduce the physical stress of surgery.
: Much like chemistry, alchemy can be used to create a great variety of substances that can be used as sedatives or painkillers. Beyond that the alchemist can create equipment that may better serve the surgeon that normal surgical tools.
The Novice surgeon is capable of performing minimally invasive surgeries. Infections can be very common if the novice does not work ceaselessly to keep themselves and their tools clean. Due to inexperience, patients are more prone to bleeding excessively under the care of this surgeon. Some might consider it preferable to avoid treatment altogether rather than face the scalpel of the novice. Suturing is done with little concern for preventing scars, so stitches are often messy and lacking in uniformity. At this level the surgeon only understands the very basics of preventing blood loss. The use of tourniquets is sloppy and ends up failing half the time. The novice is only versed in sanitizing wounds and work areas with boiled water and freshly laundered cloth. The use of chemical agents for cleaning is typically beyond the knowledge of this surgeon.
At Competence the surgeon has become much better at keeping their workspace and tools sanitary. Now patients run a much lower risk of become ill from infection following their surgery. Now that the surgeon better understands the importance of a clean workplace they may now begin using antiseptic components and chemicals to further prevent the chance of infection. The risk of blood loss has lowered and the surgeon has become competent at stopping blood loss more easily should it occur. The competent surgeon can now successfully amputate fingers and toes to prevent conditions such as gangrene or frost bite from damaging the limbs. Keep in mind that amputations will be painful since the surgeon does not yet understand the delicate nature of using sedation on their patients. Attempts to amputate larger limbs will almost always result in death. Stitches will now be more uniform and straight, allowing wounds to heal cleanly and lessen the chance of scaring. Competent surgeons can now successfully set bones and prepare them for healing with the use of a cast or brace. Due to inexperience these surgeons may run the risk of incorrectly aligning bones from time to time.
The possibility of infection has reduced to the point that patients often survive surgery without any complications. The expert surgeon is absorbed with cleanliness. Blood loss and scarring from incisions or stitches are a rare occurrence. It is at this stage that the surgeon is capable of successfully amputating any limbs with little difficulty. Additionally the expert surgeon can begin experimenting with more invasive surgeries. Invasive procedures will be met with many difficulties as the surgeon learns techniques associated with such risky operations. At this level the surgeon can use sedation to make the surgery much less painful for their patients. From time to time the surgeon may administer the incorrect dose of sedative and run the risk of killing their patient or allowing them to wake mid-surgery. Setting bones has become commonplace for the expert surgeon. Only rarely does the surgeon mistakenly misalign a fractured bone.
Through careful preparation the master surgeon is capable of maintaining a pristine clinical environment that guarantees the complete prevention of all infections. The chance of blood loss is almost completely mitigated due to the sheer skill of the surgeon. If blood loss occurs the master surgeon can easily stop the blood flow with very little effort. With the perfected use of sedatives they have rendered surgery nearly completely painless. Patients rarely if ever run the risk of dying from sedation or waking up during surgery. The master surgeon never scars or maims their patients as they have an incredibly delicate touch and impressively nimble hands. The technique used in setting bones has become perfected as the master surgeon is always successful in setting a fracture. Blood transfusion can be accomplished at this stage, although this procedure will always carry the risk of the patient dying or become very ill the surgeon does not take every precaution. All forms of surgery come easily to this surgeon. As such, the master can begin developing new surgical techniques via experimentation. Experimental surgery will be fraught with trial and error but through careful study and experience the master surgeon is capable of pushing the field ever forward.
: Rose Greenwood