1.9.0

Four systems, and all four are about one thing: finding out what is actually wrong.

A clot

Everything else in this mod arrives on the end of something - a blow, a blade, a fire, the wrong dinner. This is the opposite of an event. It is what a body does to itself when nothing is happening to it: blood that is not moving sets, and what stops it moving is a strap, a splint, a broken leg, and an hour on the floor waiting to find out whether anybody is coming.

Which makes it the first injury here caused by treatment. Not by a mistake - the tourniquet was the right call, the splint was the right call, and so was the stillness that let them both work. It is the first time this mod charges for a correct decision.

The leg is not the danger. It swells, it is warm, it aches, and that is all it will ever do: nothing to see, nothing to put a hand on, and a quiet icon on the chart that nobody would cross a field for. The only way to find it is to ask the patient where it hurts.

What it is waiting for is you to stand up

A clot that has been sitting in a still limb goes when the limb starts working. And it does not stop in the leg.

What arrives in the chest is something solid where the air was going: the breathing goes first - measured on a live server at thirty and laboured - the heart follows it up, and the chest comes apart faster than anything in this mod except an artery. No bandage, no drip, no course of anything. One drug - the blood thinner, a new item - breaks it up rather than treating the damage, and it has about a minute and a half to be found in somebody's bag.

So the danger is not the injury. The danger is the recovery.

Six operations instead of one

The surgical kit was one item, one screen and one game for six different jobs. A limb beaten to nothing, a spleen with a hole in it, a burn that needed a knife, a skull that needed opening, a leg with the bone outside it and a bone that healed in the wrong shape were all "use the surgical kit", and all of them were the same two minutes of clamping bleeders.

That said the wrong thing twice: that these are the same problem, and that the answer to all of them is the same hands doing the same thing.

Which one is decided by SurgeryJob, and both sides read it: the screen that picks the game and the server that applies the outcome. They cannot drift - nobody plays one job and is handed another.

And a leg with the bone outside it and a burn on the same leg is now two operations, because it is two operations.

The pulse stops printing itself

The chart used to show a live pulse to anybody who opened it. Walk up to a stranger and the screen handed you a heart rate nobody had ever felt for.

That made taking one worth nothing, and it made the second medic to arrive repeat everything the first had already done.

The chart now shows the notes. Until somebody has felt for one the line is empty: not taken. A pulse that was taken goes on the notes with the name of whoever took it, and it goes stale: after forty-five seconds the chart keeps the figure and says how old it is. A pulse from four minutes ago is a fact about four minutes ago, and on a patient who is bleeding that is the difference between a number and a lie.

A temperature measured with the instrument goes on the notes too - as the figure rather than the word. And a film leaves a line saying a picture exists.

The X-ray

The one thing in this mod that looks inside somebody, and the only reading with no opinion in it anywhere. It asks the patient nothing: it cannot be fooled by morphine or a concussion or the patient being unconscious, and it does not care how steady your hands are. What is on the film is what is in the arm.

It shows bone in every state the mod has - sound, cracked, broken, out of line, healed crooked, including the cracks nobody can feel and the ribs and skulls that have no outside to look at - and metal, which is every fragment still in somebody, counted.

And nothing else at all. No bleeding, no infection, no clot, no torn spleen: a film of a man dying of a ruptured organ is a clean film. That is not a limitation anybody had to invent, it is the most important thing to know about the instrument, and anybody who learns to trust the picture instead of their hands will kill somebody with it.

Its screen is black rather than printed on the usual cream card, because a chart is what somebody believed and a film is what is there.

The machine is heavy and stays where you built it. That is the trade: everything else a medic owns travels, and finding out what is really broken means bringing the patient to the machine.

The medic's house

The village clinic was a nine-by-nine box - cobble plinth, plank walls, a stepped pyramid of planks for a roof - and inside it one bed, a cauldron and the table. It worked, and it read like a shed. Nothing in it said what the building was for, which for the one building this mod adds to the world is the whole job.

It is now a clinic. Two beds rather than one, with an aisle between them and a lamp on a post at the height of the person being looked at. A bench along the south wall in the order anybody would use it: water to wash in, the table to work on, a stand for brewing, a barrel of supplies - a couple of bandages, tags, string, sometimes a splint. A stone floor under that bench and planks everywhere else, which is the oldest thing a clinic does to a room. A real gabled roof of stairs with eaves that overhang, and a flat one with a parapet in the desert, because a pitched sandstone roof in a desert village looks like somebody else's house dropped in the street. Windows at head height on both long walls with a post between them, so the facade has a middle.

The five village styles are now generated from one plan by _tools/clinic.py rather than being five files drifting apart: a change to the layout is a change to all five.

The guide

Fourteen sections, eighty-two pages, forty-six with something to run. The new heading is the operating table, with a page for each of the six operations, and each of them can be tried over nobody.