Chapter 185: More Advanced Surgery [2]
No matter how popular Dumas was in Paris, he could not simply summon craftsmen at will. That might have worked in normal times, but right now? The entire city was in ruins. Finding a carpenter was like asking for a miracle. Even if he knew someone, chances were that man had already died.
“Hmm.”
“You truly are blessed as a patient.”
So it was not Dumas who ran around to find help. My companions arrived first.
Blundell, Liston, Joseph, Alfred, and Colin had all come. Since they were men used to the smell of dissection labs, the stench did not faze them. But they were extremely curious about the surgery, especially Blundell and Liston.
“Breast cancer?”
“A boil on her back?”
Their focus split according to their specialties. Blundell, as an obstetrics-focused physician, was particularly interested in women’s diseases. Liston, meanwhile…
“Why do you need anesthesia for that? Just slice it open.”
Of course he would say something like that. Given what he usually did, it was not unreasonable.
I’m still holding on to most of my restraint.
This was not just because Liston had a bit of a thug streak. The truth was that general anesthesia, whether ether or nitrous oxide, was risky. I had not said it outright, but the mortality rate hovered somewhere around one in twenty, maybe one in thirty. It was enough to scare anyone. And people of this era had long since grown desensitized to the deaths of patients undergoing surgery.
“If you just cut it open, the pain will be unbearable. The patient is far too weak for that.”
“But you know the risks, right? Anesthesia is still experimental.”
“That’s… true.”
Still, I had no choice but to go with local anesthesia.
Lidocaine.
One shot should do the trick, right?
Come to think of it… Lidocaine really is a miracle drug.
To think a single injection could numb the surrounding tissue. In the twenty-first century, we took it for granted, but in the nineteenth century, it was nothing short of divine intervention.
“She can’t possibly endure breast surgery without it.”
“No. She definitely can’t. It’s unbearable.”
Liston and I debated the risks. He believed that if the patient could tolerate the pain, she should. If I left it up to him, he might actually try to perform a mastectomy without anesthesia. So I stopped him. Thankfully, Liston had some compassion. He did not want to see the patient suffer unnecessarily, and he was soon persuaded.
“Well then. Here’s what we’ll do. I’ll talk to the patient… and you take care of the rest.”
“Hmm.”
“As for the breast, we’ll use local anesthesia. She doesn’t need to lie down.”
“That… makes sense.”
If I had heard this plan back when I first became a doctor here, would I have believed it? I did not know. But now? Yes, I thought I could manage. Honestly, what was the big deal?
“Patient.”
While I was caught in thought, Liston walked over to Sophie Germain. Her face filled with fear, which was natural. In her eyes, he probably looked like Death itself. Frankly, many doctors of this time were not far from that.
“Yes? Ah… I suppose I’ll just have to endure it. But… can you really operate on the breast?”
“I don’t know.”
Sophie, like a true scientist, suppressed her fear with reason and continued calmly. When she asked that, Liston pointed at me and shrugged.
“That’s up to Dr. Pyeong of Joseon. I’m sure things work differently in Joseon.”
The sarcasm was obvious. He definitely knew what I was doing. That was his way of letting it go without confrontation.
Still, the fact that he’s letting me take charge means he won’t interfere. That’s a relief.
Liston, to his credit, was generous when he wanted to be.
“How advanced! Joseon must have an abnormally developed medical system.”
“Dr. Pyeong is the best among us. He even trained in Britain.”
“Yes, our professor really is the best.”
Was that sincere? I could not tell. Joseph, Alfred, and Colin sounded supportive, but I could not help wondering whether their words would sway someone as rational and scientifically minded as Sophie Germain.
“Actually… I was told this was an incurable illness. I was preparing myself for death. But if you say there’s hope, then I believe you. After all, what’s better than dying?”
Surprisingly, it worked.
Maybe I should start leaning into the whole “Joseon genius doctor” angle.
No, I was not trying to sell out. That was not what I meant.
Well… maybe just a little.
“Yes, I’m Dr. Pyeong from Joseon. We’ll proceed as discussed. We’ll begin with anesthesia for the breast, and then surgery…”
I approached Sophie and drew a rough diagram on a sheet of paper. It was not a formal consent form, more like a simple explanation. Legally unnecessary, but morally right.
Professor, what’s the point? The patient won’t understand anyway.
That’s why. Unlike us, patients aren’t always rational.
I may not understand everything, but I’ll trust the professor’s judgment.
That was the reaction from my students. In some ways, they embodied the entitled mindset of the educated elite.
Hmm…
Liston’s reaction was more interesting. Surprisingly, he did not often assist me directly in surgery, except for major procedures like prostatectomies.
Even in the nineteenth century, doctors would explain things before operating on nobles. But when it came to amputations, Liston’s standard explanation was:
“You have to cut it. Otherwise, you die.”
Straightforward, to say the least. No explanation of the process. No warning about the agony. No mention of phantom pain. I used to want to change that, but there were too many problems to fix all at once. At the time, I was also drinking Thames water, so my priorities were different.
“There’s something different about you.”
I looked up. Liston was watching me prepare the surgical tools.
“Yes?”
“Don’t your patients usually try to run away? It’s happening less now, though.”
“Ah… yes.”
As always, he was a little off in his observations, but the sentiment was positive.
“I used to have to hold them down. Once, I hit a patient in the solar plexus.”
“You hit… the patient?”
“Of course. It’s not like the patient was going to hit me.”
Well… In the emergency room, patients lashing out was not unheard of. Sadly, some doctors had been assaulted.
“Anyway, back then I had no choice. But with you, I think patients understand better when you explain things. Look at her. She’s not trying to escape.”
“Maybe because she’s too weak to move?”
“Oh? That’s even better. Either way, good. But if a patient ever runs after you explain things, I’ll just make it hurt more.”
“No, that—”
“Just joking! Hahaha! Of course not.”
…Was that really a joke? He looked disturbingly serious.
“Anyway, are you doing both surgeries today?”
Liston gestured toward the instruments I had laid out. Just a scalpel, a retractor, and some suture thread.
Common sense says… no.
Mastectomy was routine in modern times, even resident-level work, but this was not a procedure to rush through. First of all, I did not even have the proper tools. And there was no imaging, no way to know how far the cancer had spread. A biopsy? Forget it. There was no way to confirm whether the margins were clean.
Even if I could check… We can’t reopen the site. And there’s no chemotherapy or radiation therapy here either.
Even with twenty-first-century tools, curing cancer was hard. Trying to do it here would be delusional.
But I can at least reduce her pain. I can buy her time.
That was the goal now. Prolong her life a little, and minimize surgical complications. I made up my mind and decided what tools I would need.
Sorry, but I had to take it step by step.
“No. Just the boil today. That alone will be difficult.”
“If we anesthetize her, she won’t feel it anyway.”
“But her body will still know.”
“What do you mean?”
“Her overall condition is what matters. You saw it with cholera, didn’t you?”
“Ah. Yes… that’s true.”
Even now, they were slowly learning. When I first got here, it felt like I was digging through mud alone. But not anymore. They were starting to recognize the importance of immunity, of the host’s condition. Not theoretically, but empirically. That alone was huge progress.
“Yes, I agree.”
“After this, the patient should be more comfortable. She might even gain some weight. We’re not leaving anytime soon, right?”
“No. Because of the cholera outbreak, anatomy lectures were basically canceled. The problem is… half our audience is dead.”
“Ah.”
“But it’ll be a few more weeks.”
“Then we’ll let her recover a bit more before doing the mastectomy. Even one week will help.”
“Do as you like. I assume that’s how it’s done in Joseon?”
“Ah… yes.”
They gave me a few suspicious glances, but I thought it would be fine. After making rough plans with Liston, I returned to the patient.
To my surprise, my students were already cleaning her back and laying her on her side. They were using clean water.
“Hey, wash your hands.”
“Ah, right. We should.”
What followed felt like a miracle.
“If you don’t wash, you’ll catch cholera.”
“Ah. Yes!”
It was a misunderstanding, but I was not about to correct them. Even dipping their hands in lime chloride was better than nothing. Better red hands than a dead patient.
“Hey, Pyeong!”
“Yeah?”
“You soak your hands too!”
Ah… isn’t this great?