Chapter 200: What Was to Come Had Come… [4]
The empty smile on my face gradually turned into a real one. Now that I thought about it, it had been a long time since I had attempted something this ambitious. This was not a technique learned through apprenticeship. No, what I was about to do was a procedure I had pieced together entirely in my own head. Or at least mostly. I had seen hints of it somewhere, in fragments.
“Huh?”
“What are you doing…?”
“What are you doing?”
The most critical part was filling the defect left behind after resecting the lower jaw.
I’m planning a local flap procedure. This is going to be completely different from anything they’ve done before.
Had anything like this ever been done? Almost certainly not. That was not arrogance, just historical fact. Medical development followed a timeline, and based on everything I had seen of nineteenth-century surgery, no one had even thought of attempting this kind of reconstruction.
Ga-ga-gak.
With Liston’s help, I began excising sections of mucosa and muscle tissue from the inner mouth, including the affected portions of the mandible. The team had cut into it assuming necrosis, but the rot was real. The body had already started to decay.
Good. That was what made this feel like real life and not just rehearsal.
And Liston… I noticed it again.
He was like a human chainsaw. The speed and force with which he cut meant there was minimal damage to the surrounding bone. It was impressive.
The problem is, not everyone can cut like that.
The patient’s prognosis would likely vary wildly depending on whether you had a Liston at your side. Where would you even find a replacement for a man like that? This was still the nineteenth century. No power tools. No precise saws. Just raw muscle and skill.
I’m sure more patients will pour in again after this.
Smiling to myself, I looked down at the patient.
Well, corpse, technically.
“Oh god, he’s smiling…”
“So scary…”
“He just cut off someone’s chin…”
I could hear the murmurs. They did not understand what they were seeing. Was this what prophets felt like? Didn’t even Jesus get rejected in his hometown?
Ignoring their chatter, I proceeded with the flap rotation as planned.
Jiik—
If the defect had been small, I might have used intraoral tissue alone. I had first tried rotating cheek muscles inward, but without the lower jaw as an anchor, it was hopeless. There simply was not enough support.
It’s going to look terrible… but function matters more than aesthetics right now.
Form could come later, if we ever got there. So I made an incision on my own chest.
“What are you doing now?!”
“Have you gone mad?!”
Even those who had seemed supportive before began to murmur uneasily. Liston, who had only been half-informed, leaned over and whispered:
“What now?”
“Just watch.”
There was a saying in Joseon: seeing once was better than hearing a hundred times. And it was especially true in surgery, even more so when the observers did not fully grasp anatomical terminology.
Even Liston, the best among them, lacked modern anatomical knowledge. So I simply continued, letting the knife speak.
Jiik—
The goal was to keep the skin and muscle attached to the chest’s blood supply, then lift the dissected tissue and redirect it into the jaw defect.
“Ugh!”
“Dear god!”
Once positioned in the oral cavity, I stitched it closed. As for the open wound on the chest, I just pulled the surrounding skin together and sutured it shut.
The result?
Well… it did not look great.
“What is this?”
Liston repeated his question from earlier, more bewildered than ever.
I shrugged and replied, “This way, the defect is effectively sealed.”
“But you expect people to live like this? Isn’t that absurd?”
“In about a month, we can excise the connecting tissue. By then, the graft will have developed a new blood supply from the mouth.”
“…What does that even mean?”
Only then did I realize I had jumped several conceptual steps ahead. Not just Liston. The whole room looked confused.
Shit.
They did not understand what I was saying. The concepts of angiogenesis and vascularization were completely foreign to them. Hell, they were still getting used to washing their hands.
“I know how that sounds…”
I had come so far. And now, this. This was what held me back?
Just as I began worrying that this would get me labeled a heretic or worse, Colin raised his hand. He had that familiar blank expression, which somehow made me even more nervous.
Watch him say something like, “Actually, that doctor Kim Taepyeong is the spawn of Satan!”
You might laugh, but such rumors could get you killed. Britain called itself a modern legal state, but public punishment still happened. If the crime seemed like “common sense” to enough people, even the police turned a blind eye.
“Isn’t there someone who does similar surgeries?”
There is?
That was surprising. It sounded more plausible than a witch hunt, at least. I looked at Colin, skeptical.
He straightened up and spoke clearly.
“You know how people with syphilis sometimes lose their noses?”
“Yes.”
“What? You didn’t even know that?”
Liston and Blundell exchanged glances. They were probably trying to pull attention away from me for a bit.
Colin continued. “Well, when that happens, I heard there’s a place that can reconstruct the nose.”
Liston nodded, and some of my tension eased.
“Actually… my older brother has syphilis. He travels abroad a lot. So I did some digging. There’s a procedure. Like this—”
He rolled up his sleeve and pressed his forearm to his nose.
It took me a second, but then I remembered.
The Italian method.
A flap from the arm sewn to the face, left attached for weeks before being separated.
“They graft the skin from the arm like this. After a while, they cut the connection. But you can’t just walk around with your arm on your face, so they keep delaying.”
“Huh.”
Blundell nodded. The others followed suit. Their expressions said, If I lose my nose, I’ll need that too.
Thank god. There was precedent.
I nodded along as if I had planned it all along.
“Yes. That’s the inspiration.”
“It’s not much worse than having no nose at all… But still, Blundell—”
Liston mumbled something strange mid-thought, but the others did not seem to mind. Now that precedent had been established, I had my green light.
“So with this technique, we can fill the missing tissue.”
“But isn’t this all too complicated?”
“Why not just cut and stitch?”
“If you remove tissue from its original blood supply, it dies. That’s why people came up with this method in the first place.”
“Hm…”
This time, Liston nodded, but with a dangerous glint in his eye. He looked like a man about to use this as justification for some wild experiment.
No… don’t think like that.
He was improving.
“I’ll go ahead and try it this way.”
“Hm.”
“What now?”
I braced for another interruption, but this time Liston surprised me.
“If you’re cutting the chest, isn’t it a bit too much? What about using the forearm, like the nose procedure?”
“Oh, right. Or even the legs. There’s more flesh there. Why not use that?”
“Can’t someone else donate?”
It started with logic, then spiraled into madness. Sure, legs might work, if the patient could handle being tethered to her own shin for a month.
But from someone else?
They have no idea about immune rejection…
Thankfully, the idea was shut down for logistical reasons.
“How would you walk with your leg tied to your face?”
“And who’s going to stay glued to someone twenty-four-seven for a month?”
Common sense won this time.
In the end, we returned to the forearm, though I was not keen on it. The available surface area would be smaller. The patient would be uncomfortable either way, but I was not sure which route was better.
“Let’s think this through more.”
“Don’t overthink. Ask the patient. This is a democratic hospital, after all.”
Democratic…? Was there anything more dangerous than applying majority rule to specialized medical decisions?
Still, it felt hard to push back outright.
I don’t even know what the right answer is anymore…
“Is that so?”
“Of course.”
So, like the disinfectant debate, I decided to let them weigh in. We went to see the patient. She was in the women’s ward. It was not about discrimination. Male-only spaces were genuinely dangerous. There were laws against abuse, but most people did not know or did not care.
Besides, if your jaw was melting…
They might accuse you of a crime on sight.
Not because there was a crime. Just because it amused them. It was horrible, but that was how it was. There had once been human zoos, hadn’t there? I heard Sarah Baartman had just been put on display in France. Even in the twenty-first century, people still suffered violence for being “different.” So what hope did this woman have?
“Hmm.”
When I finally saw her again, it was clear the forearm would not work.
Far too thin.
“That’s no good.”
I was not the only one who noticed. Liston looked at her, then at me.
Compared to his own biceps, her forearm was half the width.
Maybe she was simply ill. Or maybe this was just how the working class looked. After all, in the slums, people did not always die from disease or violence.
Sometimes, they simply starved.
“Then we go with the chest?”
“We have to. Not that there’s much fat there either.”
“It won’t be easy. Prevention is the real cure.”
“I just finished the operation. Let’s go around London together.”
“Yes. We can’t keep seeing patients like this.”
“Good.”
Liston tapped his scalpel’s sheath and smiled at the patient. The poor woman, already pale, went even paler.