Chapter 187: More Advanced Surgery [4]
“Fuck…”
“So, are you feeling better now?”
“Yes, teacher.”
He even taught me how to swear. It was not entirely my idea. Liston told me to. Strangely, cursing like that really did offer a bit of relief. I told him that if he was going to squeeze someone’s back without anesthesia, he should at least give them something to scream.
To be honest… I was like that too.
Squeezing out pus without any anesthetic was something dermatologists did, but this? This was a hundred times more painful. And we had no proper equipment, either. The fact that we were doing this with the intention of helping only made it more painful to watch. I taught them swearing as a kind of psychological buffer, a desperate measure, but it turned out to be surprisingly effective.
“Is that so? Well, today is the last day…”
I muttered as I examined the wound, which remained silent no matter how much I pressed. No more pus, no inflammation. Nothing. It had been a full week.
“It’s beautifully clean.”
Liston, who had been lurking nearby to avoid witnessing the screaming and cursing, finally stepped forward.
“Yes. It’s clear now that the treatment worked.”
“She says she’s been sleeping well since that day. All the pain is gone. Miasma can cause pain like that… There’s so much more research to be done.”
“Research?”
“Yes. When I get back, I plan to go around looking for anyone else with abscesses.”
And I’ll slice them open.
If this were months ago, I would have hesitated. Not anymore. I understood the concept now. Well, apart from calling pathogens “miasma,” it was still progress. The likelihood of anyone doing something completely unhinged had dropped significantly.
“Good. Anyway…”
“Is it today?”
“Today.”
“It’s going to be a busy day. I’ve got surgery… and you want to give an anatomy lecture too?”
An anatomy lecture, officially, anyway. In reality, it was a demonstration. Even if I was not a formally trained anatomist, compared to these nineteenth-century doctors, I might as well be da Vinci. The flies might disagree, but today I planned to wipe away all their doubts.
We should have done it earlier, but our group held us back.
“You’re going to dissect a cholera victim? Think of the miasma!”
“What are you even talking about?”
“You savages. You still think miasma is a literal poison… Miasma is a real microorganism! Invisible! Of course there will be more of it in the bodies of cholera victims!”
“Shut it, will you? Want to get choked out again?”
It was not a peaceful negotiation. It was more like a standoff. I honestly thought Liston was about to explode. These people had been testing my patience since day one. It took days to find a cadaver that had not died of cholera.
How we got it, who it was, and how it was transported were all secrets I chose not to investigate. I was curious, but I kept my mouth shut. I did not want to feel complicit in a crime.
“You must be busy today, right?”
“Well, I’ll see how it goes. One surgery shouldn’t take more than thirty minutes, right?”
Oh, Liston. You said it yourself. Beyond one hill lies another.
With the introduction of anesthesia, the amount of time a surgeon could spend on a patient skyrocketed. In our case, that meant a dramatic increase to about thirty minutes. Cutting itself still took only thirty seconds. Just do the math. How many limbs could you go through?
Dr. Liston… in under two hundred years, some surgeries will last over thirty hours.
I was not the one doing them. I only assisted. Head and neck cancer resections… That was when I realized what true surgical complexity was.
“I’m not sure how long this will take. But definitely longer than that.”
“Really? Wouldn’t it be easier to just slice it off and stitch it up?”
Liston glanced at the patient lying on her back, a clean dressing over her drained abscess. She had looked ancient and frail before, but after a few days of rest and sleep, she looked like a different person.
“That would be easier, but I can’t do it like that.”
“It didn’t take that long for the prostate case, did it?”
“No, it didn’t.”
I wanted to ask if he thought a mastectomy was the same as treating benign prostatic hyperplasia. But I held back.
Why?
Because right now, our anesthesia lasted about an hour. Maybe two at most, with luck. Dosing was still guesswork. We judged by watching the patient’s breathing and reflexes. That was all we had.
And we really need research on this too.
Anesthesia dosage and duration had to be tailored to age, gender, and weight. It would not be easy. It was essentially a clinical trial each time.
But first, the patient in front of me.
My thoughts spiraled for a moment. I shook them off. Fortunately, in the nineteenth century, one quickly learned how to simplify one’s thinking.
“Anyway… I don’t know. But I’m sure things will get better now that we’ve got your brother helping.”
“Let’s hope so.”
“Professor Blundell.”
“Yes?”
“Since this is a gynecological case, you’re assisting.”
“Ah… yeah, of course. But I’d rather… just assist.”
That let me focus. We moved the patient onto a makeshift operating table I had prepared at home. In London, I had to bolt it onto a classroom desk, but here, no one questioned it, though there were comments.
“There’s a bed right there… Why all this fuss?”
It was unfamiliar to them, sure. But soon it would become common sense: the surgeon had to be comfortable. And once you experienced a proper operating table, you would never go back.
“It’s cancer, isn’t it?”
“Yes. And cancer is a death sentence… It’s not something you touch for fun.”
I tied the patient’s legs and arms down to the cross-shaped table and thought about Blundell’s somber tone.
Cancer.
The nemesis of humankind.
In the nineteenth century, cancer was not common. Luckily. There were not many treatment options. When I read the existing literature, it felt like wading through despair.
“It’s from touching the dishes, huh? Just do it properly.”
“Is that how it works in Joseon…?”
“…Yes.”
I did not know anymore. Just assume it did. Move on.
“Joseon…”
“A land of miracles…”
“I’ll ask my father to take me there someday.”
They were strange, but both professors murmured in awe.
“Alright. Bring the distilled alcohol.”
I exposed the patient’s breast and poured pure alcohol over the area. It was not an open wound yet, so this was manageable.
I’ve done this before. It’ll sting. The patient will scream.
Alcohol caused tissue damage. It hurt like hell. But for now, the skin was unbroken, and this was the only way to disinfect.
“That’s scary.”
“No way I’m going to Joseon.”
The students hesitated, nervous. But that was fine. This was necessary.
“Colin, anesthesia.”
“Yes.”
The students had learned to follow orders. Colin brought over the bellows, a makeshift Ambu Bag, and began gently ventilating the patient. Since she was still breathing on her own, there was no resistance.
“Breathe slowly. If anything feels wrong, let us know. We’re about to begin.”
“Yes.”
Colin was skilled. If this had been a shorter procedure, even Alfred or Joseph could handle it. But for a long operation, Colin was our best bet.
“Scalpel.”
“Here.”
Alfred, the assistant, handed me the tool. Everyone else crowded around, wearing masks and hats. Were they sterile? No. But it was progress.
Slice.
I made the incision.
“Why not cut through the center?” Liston asked.
“I don’t want to touch the tumor.”
“But isn’t the goal to remove it?”
“We’re exposing the site fully, not poking at the mass.”
“Oh… You mean a full mastectomy?”
“Yes.”
“Now I see… But why?”
I could not explain that leaving a single cell behind could lead to recurrence. Iatrogenic metastasis, cancer spread by the surgeon’s own tools, was not something they could grasp yet.
“Think back. Have you ever seen a case go well after poking at a tumor?”
“No… It always worsens. I thought that was just fate.”
“We don’t touch it. We remove everything.”
“…I’ll just watch.”
The good thing was that Liston now believed in my method. He assumed I had some genius-level reasoning. Whether that was good or not, I was not sure. It felt like being branded a witch. But at least I would not be burned at the stake.
Slice.
I made an incision beneath the breast, then another above it. I wanted to spare the nipple, but the location of the mass made that impossible. Thankfully, there was plenty of fatty tissue, which gave me room to work.
Tuk-tuk.
Bit by bit, I excised the tumor, wiping the blade and the site clean with gauze.
Thunk.
When I set it down, all eyes turned to the mass.
“Hmm.”
Even though it took far longer than the usual surgeries of the day, no one lost focus. It was like a dissection lecture, only this time, the subject was alive. Their expressions were somewhere between awe and horror.
“You didn’t even touch the tumor…?”
“You took that much?”
“Huh…”
They did not yet understand cancer. But that was okay. As far as I remembered, mastectomies with decent survival rates only began around the 1890s. We were a few decades early.
But it would not take someone like Liston long to catch up. Radical doctors were already trying mastectomies and failing. If you gathered all those failures, you would eventually find the path to success.