A note from Selkie

Merry Christmas one and all!

As the end of last chapter hinted, this chapter is going to be a fairly deep dive into some of the harsher aspects of medical ethics.

I was familiar with the concept of triage. Badly injured, injured, and weakly injured. Ignore the weakly injured, they’d be fine. The badly injured would take up huge amounts of resources to fix, while the injured were prime targets for healing.

From the sound of it though, what was being advocated was to just hit the weakly injured, the mildly sick, maybe treat the injured, and damn the badly injured, and the terribly sick entirely.

There was knowing the concept as a vague thing from back when I was on Earth, and now being the healer, being the person performing triage, the one who says “I’m sorry. You die, so that person can live.”

I was strongly tempted to develop a drinking habit to forget. Living with the choice I’d need to make would mark me.

I spent the rest of the evening healing as I thought on the new apprentice’s words, his thoughts echoing through my head with every patient, sending a stabbing knife of guilt through me.

Did I just damn more people healing that girl? Was the old man’s life worth saving, at the expense of someone else’s?

Should I weigh the two lives against each other, and only heal the ones I don’t find wanting?

How many old people were worth a young boy’s life? Two? Ten? Did I need to calculate how many expected years of life were left, and only when the old-people years outweighed the young boy’s expected life-years, should I heal the elderly?

What about quality of life? The young boy would enjoy life more than any single elderly individual, but then again, I had to look at their aggregate quality of life, not just any one of theirs.

Should I ask them if they were willing to sacrifice their lives for the young boy’s? Was it fair of me to push the burden onto someone else, to force them to collectively decide? Didn’t that pressure the one or two people who felt like they wanted to live, but didn’t want to speak out, to go against the crowd?

No, I’d have to be the one making the decision. I was the healer. The responsibility was mine.

It had never felt so heavy. Being at the bottom of the ocean, crushed by pressure. Atlas, holding up the world. It weighed on me, chaining down my limbs, slowing me down, making it hard to breathe. Making me hesitate.

Damning even more people with my indecision.

“Origen, can you grab four people next time?” I asked, coming to a decision. He nodded at me, leaving me with the most recent patient, a mother and daughter, both sick.

“Hey you,” I said to the still-nameless apprentice. “can you grab Markus? I’d like to talk with him about this more.”

He opened his mouth to protest, and Artemis stepped in to quash any objections before they started.

“She’s the lead healer here. You listen to her orders. Heck, I even listen to her orders in this room. She’s the goddess here, you’re just her minion.”

I shot Artemis an appreciative look, as Nameless Apprentice muttered something under his breath and shot off. Origen showed up with four people, who I healed in rapid succession, throwing up a quick [Veil] around each one for privacy, getting my mana low enough for a moderate conversation to not reduce the total number of people I could heal.

A brief moment of rest, which was rudely interrupted by Artemis physically shoving some food into my mouth.

“Eat.” She said sternly, angrily, crossing her arms.

“I thought she was the goddess.” Herodotos said sassily.

Artemis casually sparked him, causing him to jump and yelp in pain.

“Tormenting my apprentices?” Markus asked jokingly as he entered the room.

“Yup! Going to do something about it?” Artemis asked, challenging him.

Markus just laughed it off. “Nah, they’re under your supervision, how you choose to run things is up to you. They know they’re free to strike off on their own whenever, and will probably be ready to once this plague’s over. Interesting map.” He said, nodding to the heavily-pinned map.

He turned to me, getting serious.

“Elaine, I heard you needed help and advice. What’s going on?”

I explained to him the concept his apprentice had taught me, and explained the turmoil I was now going through.

He sucked in air through his teeth, looking at me with sympathy.

“Interesting. A lot of theoretical knowledge, but not a ton of practical knowledge. I assume Lady Ranger over there will give me problems if I ask too many questions on your classified background, but I’m dead curious who your master was, at the very least.”

I shook my head. “Never had one. Learned a bit from my mom, like most town healers. But I was never an apprentice.”

That got me a strange look, and a cough from Artemis, reminding me that it was best to keep my background under wraps, and probably pulling double-duty as a subtle threat to Markus. Solid work for a single cough.

“Well, some basics on the concept. You’re right that it’s a tricky and difficult thing. I call it ‘Justice’. Who is worthy? Who isn’t? More importantly, when we can only save some people, not everyone, who do you save? How do you fairly, and equally, distribute scarce medical resources to people?”

He stood up straight, assuming a lecturing posture. Herodotos immediately snapped into a ‘learning’ pose, with a speed that could only come from hours of drilling and practice. I figured it’d be polite to try and mimic him, and I did.

“First off, the choice is always yours to decide who to save, and who not to. Nobody can force you to make a different call, although many will pressure you to heal someone else. Feel free to tell them to stick it where the sun don’t shine. At the same time, it can be worth considering politics. Save the governor’s sick elderly father, or a baby. The baby is almost always right to heal. But if the governor will throw you out of town if his father isn’t healed, you lose access to everyone else in the town, and can’t help a single one of them.”

“I’ve been in that exact situation, about, oh six years ago. It’s ugly. There is no right call, both are wrong. You can only make your best call, and pray to the gods.”

I closed my eyes, bowing my head. This was making it both worse, and better, at the same time.

“Second off, there are more factors than just the patient themselves. A father, supporting a wife and four kids? Well, saving him saves more than just him, it saves his entire family. If you pick a kid over him, you’ve saved one kid, but damned three more to death.”

His tone turned sympathetic.

“Tell you what. I’ll tell you my order of healing. If you’re lost, if you’re struggling, maybe this will provide a foundation for you to work off of. Change it, evolve it, to fit your own criteria.”

“I’ll heal babies, kids, young men and women, pregnant women, and people whose entire family depend on them, who are only mildly ill first. I’ll heal anyone else who’s mildly ill next. Then I repeat the same group, for badly ill people, then anyone else who’s close to death after them. Lastly, I’ll heal orphans and slaves, mild to terrible.”

“Why are they last?” I said, wanting to burn with rage at his choice, at his casual dismissal of slaves and street urchins.

“They’re unlikely to survive anyways; likely to starve and die even with my best intervention. Why should I waste resources on someone who’s going to die anyways, when there are others who’ll live a long and healthy life?” Markus said, coldly dismissing them.

At the same time, if he wasn’t cold, practically cruel, about it, could he even live with himself? Would the guilt crush him, the remorse kill him?

Artemis put a steadying hand on my shoulder, squeezing.

“I wish you the best of luck Elaine. You’re doing amazingly, and if nothing else, you’ve given hope to the very sickest people who are waiting for help. Most of us are targeting the less-ill, trying to get on top of the disease. The ones you’re healing believe they’re too far gone, and you’re their last hope, their beacon so to speak.”

Every word was like a stab into my heart, causing pain. Did he know how much harder he was making this?

“I need to get going now. I hope I helped.” Markus said. I mutely nodded my head.

“Oh, something for you to know, since you never had a formal master.” Markus said. “Don’t worry too much if you get a kill notification on someone. It happens to all of us.”

[*ding!* Congratulations! [Learning] has reached level 122!]

He turned and left, and I threw up [Veil], ran to Artemis, and bawled in her arms. Knowing that would have saved me so many years of torment, nights of anguish, guilt over Lyra no longer fresh, but a constant sore, aching wound across my heart. Artemis didn’t know the full story, but she could guess, as she held me and rocked me.

After a few minutes, Artemis interrupted my pity-party.

“Alright healy-bug. Let’s get you back out there and fixing people. I don’t know what happened, but it’s too easy to guess. What’s done is done. You need to focus on the people in front of you, get to saving them. Here,” She said, taking some cloth out, wiping my face and nose. “let’s get your serious super-healer-ranger face on! You can do it! Yeeeaaaahhhh!”

I sniffed appreciatively, getting my super-healer-ranger face on, dropping [Veil].

“Origen.” I said, having him pop back in. “New priority ordering. Go in age, from youngest to oldest, grabbing the sickest. Also, if you see something, see someone, that you think should be brought to my attention, who should be healed, feel free to grab them instead.”

Origen nodded, showing his understanding, at getting a hint of my dilemma. My solution was far from perfect, might even be worse than Markus’s solution.

At the same time, Origen also knew the crushing burden I was placing on him. In many senses, I was abdicating my responsibility, easing myself into it slowly. By having Origen act as the filter, the decider, of who I saw, he was effectively running triage, being the arbiter of Justice, deciding who got medical attention, and who would have to wait. I’d given him guidelines, I was taking on some of the responsibility, but I wasn’t fooling myself – a non-zero portion of the responsibility was Origen’s.

Bless him. I’d tell whatever tales he wanted.

It sounded like I was the last bastion of hope for many though, and I didn’t want to snatch that away from them, to cruelly crush the last dream, the last hope, that people had.

I used to be the [Light of Hope] after all, and I was sticking to that root.

[*ding!* Congratulations! [Phases of the Moon] has reached level 114!]

[*ding!* Congratulations! [Medicine] has reached level 128!]

[*ding!* Congratulations! [Warmth of the Sun] has reached level 120!]

[*ding!* Congratulations! [Oath of Elaine to Lyra] has reached level 116!]

[*ding!* Congratulations! [Constellation of the Healer] has leveled up to level 148! +10 Free Stats, +15 Mana, +15 Mana Regen, +15 Magic power, +15 Magic Control from your Class! +1 Free Stat for being Human! +1 Mana, +1 Mana Regen from your Element!]

[*ding!* Congratulations! [Celestial Affinity] has reached level 148!]

A note from Selkie

"Justice" is not exactly a light-hearted Christmas topic, but I promise you, there are Doctors, PAs, nurses, and pharmacists working the world around today dealing with these topics. Send a thought their way - with COVID, this topic is becoming more topical than ever before.

More reading can be found here:

If you could give me an advanced review, that'd be great. They're weighted more heavily than anything else, and I've been looking carefully at trending - it's clear that the rating the novel has is super important. Hence, advanced reviews help me go up in the trending list. They help more people see it, which gets more people rating and following it, which has a synergistic effect that hopefully turns into a runaway effect, which gets enough people interested that I get to do this full-time. Seriously, it matters, and it helps.

BTDEM is bog standard in many ways. However, I'm willing to do things that turn some readers off - and so far, more of my reviews have been from people that I make mad more than people who are happy. Just how the internet works. I'm hoping some of you that are enjoying things are willing to leave reviews or advanced reviews. They matter. You matter.

Help keep BTDEM going - it's as simple as rating, as easy as reviewing.

Or you can help pay my rent, which is a MUCH more direct way of keeping things going! It's the start of the month after all, max Patreon benefits!

Discord for chatting:

Now, if you'd like to help me pay my rent, you can! With 10 advanced chapters, bonus chapters, bonus worldbuilding content, discord roles, and more!





Book 1 of Beneath the Dragoneye Moons is for sale on Amazon! Click Here to be taken to it!


Support "Beneath the Dragoneye Moons"

About the author



Log in to comment
Log In

Log in to comment
Log In