Chapter 152: Abdominal Surgery [3]
Abdominal examination.
It might not sound like much. When you go to a clinic, they press on your stomach, right? But what most people do not realize is that even the simplest physical examination is backed by an enormous body of accumulated knowledge.
“Does it hurt?”
“No... It’s fine.”
The patient was calm for now. Probably because there was someone nearby with an actual puncture wound in the abdomen. It had not gone all the way through, but still, just remembering the speed and force of that moment sent chills down my spine.
Honestly, Robert Liston should have been born earlier than he was. If he had, the entire royal lineage of Britain might have changed.
“What about here?”
“There too...”
“No, Pyeong. Press here. The patient said that spot hurts.”
Liston was right. I had only been pressing the firm, less sensitive areas.
Of course, I was not doing that randomly. I was a super genius armed with twenty-first-century medical knowledge. I was saving the most painful spot for last. If I pressed there first, the patient would tense up from the pain, making it harder to examine the rest of the abdomen accurately.
It’s a subtle concept. Not easy to explain.
“Ah, your mother must be an extraordinary woman. Otherwise, how could she have raised such a genius?”
I did not know how things would go in the future, but for now, I decided to accept the praise and stay quiet. Thankfully, Liston and the others were too polite to make a Tallulah joke, so they let it go. Whatever they were thinking inside did not matter. What mattered was the present, and how I handled it.
“Okay, now... what about here?”
“Ugh!”
Finally, I pressed the lower right quadrant after examining the solar plexus, the left lower abdomen, the left upper abdomen, and the right upper abdomen.
The reaction was dramatic.
A full-on scream.
I had not pressed any harder than before. I had used the same pressure throughout.
“Can you tell the difference now?”
“Oh, yes. Definitely. Hmm... so it’s like this...”
I say this often, but Liston might lack modern knowledge, yet he was no fool. He caught on immediately. So did the others.
If anyone in the room could not tell the difference between Liston’s brutal probing and my methodical examination, maybe they should reconsider medical school.
“Look closely.”
“Still more?”
“Now, patient. How does it feel when I release the pressure?”
“Agh!”
That was tenderness. Expected.
But what mattered more was Rebound Tenderness, the pain that came after the hand was released. That indicated irritation of the peritoneum and strongly suggested pus, an abscess, or significant inflammation inside.
Ultrasound would be far more accurate, of course...
Still, this test alone could not be used for diagnosis. Even in the twenty-first century, some patients had their appendix removed unnecessarily. Even so, it was far better than cutting people open blindly.
I glanced at Liston and remembered how he had drawn a cross on the patient’s abdomen earlier.
That man is insane.
Who cuts open an abdomen in the shape of a cross? How could anyone even think of doing that?
“Why does it hurt more after you let go?”
Liston was fixated on that point. It was not the wrong line of inquiry. He was pressing and releasing the abdomen himself. Of course, if there was no peritoneal irritation, releasing the pressure would not cause pain.
I can’t blame this on my mother...
Even I could not shamelessly blame this kind of mess on her.
Still, I was not out of ideas. After all, I was Kim Taepyeong, the Bluff Master. I always had something ready.
“When doing dissections—”
“Oh, go on.”
“Not bodies from outside suppliers, but those who... pass away in the hospital. When we open their abdomens, we sometimes find pus.”
“Placental cases too,” Liston said with a nod.
The others nodded as well, as if this was just another ordinary thing.
No! That’s not normal!
Peritonitis was not supposed to be a standard finding. Even in the twenty-first century, despite several generations of antibiotics, some patients still died from it. But this was not just neglect. It was institutional. They were relying on moldy bread and luck instead of anything on the level of penicillin.
But pus in the placenta? Really?
That was a clear sign of hospital-acquired infection. That did not happen with bodies brought in from outside. Even in this era, most people did not die from full-blown sepsis.
“Think of that pocket of pus folding and unfolding inside the abdomen. Wouldn’t that hurt too?”
“Oh... yes, that makes sense. Pus does hurt when trapped.”
“Exactly.”
“That’s what gave me the idea.”
“You really are a genius.”
Even I blushed at that.
Especially since I had not invented the concept of Rebound Tenderness. I did not even know who had. But then I happened to glance at the patient’s face, and it caught my attention.
He seemed more at ease now.
It was not that he understood what we were saying. But hearing someone like Liston call another person a genius must have been reassuring.
Alright. If it’s come to this, I’m going with the Super Genius persona.
Not for me. No, no. It’s for the patient. Really.
“Anyway... if there’s pain like this, something is definitely wrong inside.”
“Right. I suppose we’ll have to open the abdomen.”
I watched the patient’s face again.
Even after being told we would cut him open, he looked more relieved than before.
That decided it.
I had to lean fully into the Super Genius image. To get that kind of reaction in an era where science and superstition still wrestled for dominance was practically a miracle.
“Let’s go.”
“Go? Why not just do it here?”
“Here? Seriously?”
I hesitated. Liston and the others looked surprised too.
“Why move the patient? Just bring the tools here.”
“Yes, that’s more efficient.”
Efficient? Efficient?!
I looked at Joseph, who was clearly trying to pass off laziness as scientific reasoning. I did not trust myself to speak right away. If I opened my mouth now, nothing but curses would come out.
And...
How could the hospital be this filthy?
Pus, flies, and maggots were apparently normal now. But since this was a ward for abdominal pain, even feces were smeared around in some places.
Isn’t the instinct to clean supposed to be universal?
“You know I’m surprisingly squeamish, right?”
Maybe I had seen too much. My anger drained away, replaced by fear.
Nineteenth-century barbarism was truly terrifying.
But then, as the Bluff Master, I immediately thought of a good excuse.
“Oh, right. I’m fine with doing it. Just not here. I might make a mistake if I’m not in a familiar environment.”
“Ah, yes. That’s a good point. You shouldn’t do anything that might harm the patient.”
When will these people understand that performing surgery in a literal shithole is what really harms patients?
I’m not squeamish. I just want a clean place to work. Is that too much to ask?
“Wake up. I’ve got things to do. Or should I do the surgery myself?”
As I drifted into thought, Liston jolted me with his usual tough love.
You? Do it yourself? With a cross-shaped incision? In a dirty room with zero disinfection and no negative-pressure protocols?
That’s murder. Just straight-up murder.
Not that it was new. God only knew how many people Liston’s techniques had killed.
“Yes, yes. I’m focused. I’ll do it. I’ve had some ideas since the last dissection.”
“Good. It’s our first abdominal case, so I have concerns. We need good visibility, so we should open it like this, the same way we do in cadaver dissections.”
That’s because it’s a dead body, man.
Who thinks it’s fine to open a living person like that?
Still, I had to admit he had his reasons. Familiarity and visibility mattered in surgery. It was a point worth making. Worth enough that he had become famous in London for it.
“Yeah, but if you think about it again... do we really need to open that much?”
“Still, we need to open it. What shape do you have in mind? A cross looks good.”
“Uh...”
You actually thought about the shape.
Lord... if You’re listening, now would be a good time for lightning.
“Alright, everyone’s here.”
There was no divine intervention. Just the team, heading to the small classroom I had converted into an operating room.
It was where I had performed surgery on Lord Damien and the others. I had kept it clean. I had closed the windows, swept the floor, and wiped everything down. It was nothing fancy, but it was the cleanest space in the entire hospital.
“Okay. Here we go.”
We moved the patient onto the bed. Compared to surgeries performed on podiums, this was VIP treatment.
“Colin?”
“Yes. I’m ready for the next one.”
“Good. You’ll assist. Alfred, you help too.”
“Yes!”
Colin brought over a gas can, turned the patient, and began administering Nitrous Oxide.
I washed my hands, put on gloves, and scrubbed with Lime Chloride. It was nowhere near sterile by modern standards, but it was better than nothing.
Everyone followed suit.
Once preparations were complete, I picked up the scalpel.
Whew.
It had been a while since I last performed a simple surgery. I was a little nervous, but mostly excited.
Yeah.
I missed abdominal surgery.