Pandora Unchained - a Cultivation Progression Fantasy

"Decisions," said Sorin as he looked over the fifty or so hopeful physicians who had made it through nearly five years of intense medical study. "Physicians make decisions every day.

"Most decisions are trivial, but occasionally, critical decisions must be made. Should we try to fix the mangled leg or amputate it? Should we try to purge the disease working its way through the patient's gut or remove an afflicted section of the bowel, permanently reducing their ability to digest food going forward?

"While such decisions have some small effects on the physicians making them, it is, for the most part, the patients who will bear the consequences. Their lives and deaths are in our hands."

Sorin walked over to a projection stone and tapped it. An image of a middle-aged man in hospital clothes appeared on the white screen at the front of the classroom. The tips of his toes and fingers were black.

"The patient is male, 41 years of age. He is an early Bone-Forging cultivator who recently returned from an adventure in the North Parnassus Forest.

"His vital signs are normal, and the only physical abnormality found was discoloration and numbness in his fingertips and toes. Cultures are not yet in and will likely take twelve hours, but the darkness on his fingertips and toes is currently spreading at a rate of 2 millimeters per hour and accelerating."

"Question!" said a young woman with short bangs at the front.

"Go ahead, Esther," said Sorin.

"Did the patient test positive for poisons?" asked Esther.

"Negative," said Sorin. "Or at least, he didn't test positive for any of the more common poisons. The battery of tests included Black Thorn Adders and related snakes, Spotted Spiders, Man-Eating Wolf Spiders, and an assortment of poisonous plants. Yes, Andrew?" He pointed to a man with short black hair in the middle rows.

"Were toxins related to ingestible substances tested for?" asked Andrew.

"Unfortunately, there are too many potential substances to test for, and this foolish cultivator did not pack enough rations. He's produced this list of 57 potential toxicants that he ingested, over three-quarters of which are unidentifiable.

"Time," said Sorin as he looked around the classroom, "is not on our side. There are many potential causes for the symptoms observed, and it is too tedious to test for all of them, even with a group of assisting physicians. What's more, support from life-aligned doctors doesn't seem to be ameliorating his condition. Necrosis is setting in faster than can be reversed with healing.

"If we act now, we can cut off the tips of this man's fingers and toes. He will need prosthetics that will result in a 30 percent decrease in his dexterity and a 50 percent decrease in sensory receptors. His cultivation, which has long since stagnated, will regress a single forging. Oh, and he's an amateur painter who's been making waves—amputating his fingertips will likely both dampen his momentum and greatly hinder his ability to create stunning artwork. Yes, Matilda?"

"We should amputate his fingertips if that's all the information we have," answered a red-haired girl with a freckled face. "Though the cost is great, the risks are great as well. There are two likely explanations for the symptoms: the first is a complex necrotoxins found only in nature, and the second is a necrotizing disease. Both must be potent if they are resisting Life Treatment Protocols. As physicians, it is our duty to safeguard his life before anything else.

"That is certainly an option," said Sorin. "The safer option. A mediocre physician should choose this option. Who else agrees with Matilda?" Out of the fifty or so students, roughly 25 raised their hands.

Sorin walked over to the projection stone and tapped it once again. "Three hours later, the man's fingers and toes were completely black. The tissues are filled with puss, and the ailment is making its way up their palms and onto the soles of their feet.

"At this point, most complex poisons are accounted for. Most of the unidentified plants have been analyzed and rejected, and another choice needs to be made: should his hands and feet be amputated to preserve his life, or should we continue attempting to treat the condition. In the case of amputation, major prosthetics would be required, and the patient's life quality would be greatly affected.

"Who chooses amputation?" This time, 45 doctors raised their hands, leaving only his five best students. "Cedric, how would you narrow down possible afflictions?"

"Is there are need?" asked Cedric. "Can't we just poison the patient half to death and rehabilitate him?"

"That's an option, but a dangerous one," said Sorin. "Gloria?"

"I believe that at this point, the patient's life quality will suffer irreparable harm, and it's best to try a specific solution, even if we don't know the exact cause of his condition," said Gloria. "Assuming his condition is caused by a disease, there are four aggressive albeit conflicting treatment methods that can be pursued. At most, two treatment methods can be attempted.

"Thomas?"

"Have sampled his bones?" asked Thomas. "I believe amputating a single finger to perform an autopsy would be beneficial in this case. Besides, who knows if the fingers are truly dead?"

"Of course they're dead," interrupted Simone. "So, we can amputate without any worries. A finger and a toe would be preferable. Perhaps relevant information can be gleaned from their runes."

A meek, albeit intelligent student called Jeffrey raised his hand. "Can't it just be corruption?"

"Corruption?" scoffed Thomas. "Have you ever seen Madness do that to someone?"

"Let's see what Jeffrey has to say," said Sorin.

"First, I'd like to ask if the patient was questioned on exactly what he was doing in the wilderness," said Jeffrey. "Adventuring is too broad a categorization."

Sorin smiled. "He was indeed questioned about the details," said Sorin. "His goal was harvesting metallic ivory in the forest, a product that can be obtained from the notoriously violent Iron-Blood Elephants."

Jeffrey frowned. "Iron-Blood Elephants. Rich in resources but abnormally strong compared to other two-star demons. Did he have companions?"

"Three others in the early Bone-Forging Realm," said Sorin.

"Then I would most definitely suspect death-aligned corruption," said Jeffrey. "Hunting down Iron-Blood Elephants with his party's capabilities is impossible, even when using traps and poisons. This is because Iron-Blood Elephants wander in large groups, and ivory can only be obtained from the more powerful members of their species.

"Most Iron-Blood Elephant hunters do not fight them head-on and instead target elephant graveyards. These are difficult to find, but if successful, it would be possible to obtain a large amount of ivory at minimal risk."

Seeing that the other students didn't get it, Sorin added to the explanation. "What Jeffrey is saying is that while Iron-Blood Elephants are most definitely creatures of violence, their graveyards will be filled with death-aligned energies. If the graveyard is large enough, it will even form a Core of Death. The graveyard will then produce its own undead creatures that will guard the bones from outsiders.

"Metallic Ivory is valuable, but a Core of Death? Much more so. And if the patient got greedy and tried to retrieve it…."

Sorin moved on to the last image. The man's hands and feet are completely cured. "The necrosis, it turns out, was a result of death-aligned corruption, as Jeffrey suggested. Such instances aren't commonly seen near Delphi, but Mattapan is quite experienced with such matters.

"Basic corruption wasn't initially suspect, but a Night Hawk looked him over just in case. When he identified dense corruption in the man's body, the attending physician consulted with Mattapan, who advised him that cases of sudden necrosis weren't unusual in areas of concentrated death energy. Treating them was easy with the intervention of an experienced necromancer.

"Due to the shortage of necromancers in Delphi and the limited window in which to act, the attending physicians combined his knowledge of necrotoxin neutralization and corruption removal and were able to design a poison that was extremely harmful to death energies and death mana but completely harmless to living creatures.

"This poison was used to purge the patient's body of Death-aligned corruption and chase the corruption back into his fingertips and his toes. Twenty needle pricks were then all it took to expunge the poison from his body, completely curing his condition."

For a while, no one said anything. Several students took notes, but one individual—Simone—was frowning deeply. "Thoughts, Simone?"

"I don't think I could have figured that out in the time allotted," confessed Simone. "My decisions would have likely killed the patient or cost them all four of their limbs."

Sorin nodded. "Self-awareness is important for a physician. It's not something we're born with but something cultivated through experience. We make mistakes, and we learn from them. By evaluating our limits and pushing our boundaries, we come to terms with our capabilities and are then able to make better decisions moving forward."

He pointed to the five physicians that had remained. "Out of the five of you, likely only one or two would have succeeded. As for the other twenty who didn't decide on immediate amputation, you would likely give up after the first round of encroachment and amputate the patient's hands and feet.

"That said, all twenty-five of you would have learned a valuable lesson. This lesson would add to everything you've been taught in the classroom and guide any future decision-making.

"What's right? What's wrong? I can't tell you that. Twenty-five of you tried. Twenty-four of you didn't even hesitate to chop off his limbs and learned nothing. This decision, combined with countless other cowardly decisions, will ensure that you remain mediocre physicians at best and fail to obtain your two-star designation.

"That's not fair!" called out Andrew. "Backing out at this point is the responsible thing to do."

Sorin nodded. "It's definitely the responsible thing to do, assuming you know your limits and that nothing can be done.

"But what if you don't know those limits? What if you don't know what can be done? What if you're just uncertain and unwilling to accept responsibility?

"I'm not telling you that every one of you should try, as it was, in hindsight, quite the tricky case. I'm telling you that when you encounter difficult and uncertain situations, your instinct shouldn't' be to cut the patient's losses.

"We are not bankers. We are not conservative investors. We're not politicians. We are physicians. We are living, breathing creatures capable of learning. Capable of adapting.

"We should not be satisfied with mediocrity. We should aim higher!"

Sorin walked over to the projection stone and flicked off the image. "I say this to you because I don't want you to get tied up in conservative nonsense. I don't want you to let other people decide what your limits are.

"We poison-based physicians are not life-based physicians. Our methods are not the same. They are diverse and inherently risky. Fighting poison with poison is far from a straightforward game.

"More importantly, there is currently a lot of bias out there in the medical community. You are the first wave of poison-based physicians, which means that you will frequently be told by other much older physicians what can and can't be done.

"But how can they know when they haven't tried? It's like an alchemist trying to advise a smith or an enchanter giving advice to a pyromancer on how to best burn things down.

"We poison-based physicians have a gift. A dangerous gift, but a gift, nonetheless. It is a gift that has been scorned and trampled on, a gift that has been persecuted. Many will hate and judge you for possessing this gift, but that is not something that can be changed in the short term.

"That is why we must aim higher. We must persevere. Only fragments remain of our once-wide body of knowledge, and rebuilding it will require ambition and risk-taking." He looked around and was satisfied to see an ambitious glean in their eyes. It wouldn't last, but he was certain that the memory would remain imprinted in their minds, ready to support them in trying times.

"And with that, students, I end my class. This will be the last class I teach at the Kepler Medical Institute. I hope you've all learned a thing or two from me and that I imparted you a satisfactory amount of knowledge these past five years. If not, books exist, and the Kepler Medical Library will always be open to you."

"Will you be coming back?" asked Thomas. "And where are you going exactly?"

"I'll be heading off to Olympia," said Sorin. "Should anyone wish to find me after obtaining their license, I'll welcome them with open arms. As for coming back, I have no idea what the future holds for me." He looked over the classroom of five years one last time before retrieving his projection stone, making his way over to the door, and pausing there.

"Though this is the end of my lecture, I'll be outside the classroom for another half hour. If you have any questions you've been burning to ask me, now's the time. The remainder of your classes will be taught by my mentors, Elder Nolan and Elder Calvin. With their guidance, you should have no issues passing your final examinations."