Prevention Is Crucial, After All [1]
Practice for the surgery? I had done plenty of it. After all, for someone as seasoned as me, even an unfamiliar operative technique didn't require ages to master. While I wouldn't go so far as to claim I had attained boundless, effortless transcendence, surely I stood right at its doorstep, didn't I? Calling a local flap procedure a mere trifle—especially one involving a mandibulectomy—might be pushing it, but the point was that there was no reason to chicken out over an operation like this.
“Alright, making the incision. Keep the anesthesia steady!”
“Yes, sir!”
Even so, this operation was undeniably a beast. For starters, the anesthesia alone posed a monstrous hurdle. We had to administer the gas through the mouth and nose to keep the patient under, but we were operating directly on the mouth. That meant delivering it solely through the nose, yet our trial runs showed that nasal inhalation alone fell short of a sufficient dose; the patient kept stirring awake.
How did we know?
“Why are you glaring at me, Senior?”
“Hm? Oh, no reason… Just felt the urge today, for some reason.”
We had tested it out on our seasoned guinea pig, Alfred. To be fair, it might have been because Liston was the one inflicting the pain to test the depth of sedation. Still, even if Liston dug his knuckles into the sternum with all his might, could that really hurt more than slicing through living flesh and sawing through bone?
And so, we opted for a bit of a gamble. First, we continuously pumped gas into the nose.
“Now!”
“Yes!”
Then, intermittently, we forced it through the mouth as well—during the brief windows when my hands were clear.
“Hold—hold your breath! Did you breathe that in?”
“No-o-o, I didn't…?”
“You inhaled it, you bastard.”
“Move!”
Naturally, hazards lurked at every turn. After all, our anesthetic of choice was nitrous oxide. Better known as laughing gas, owing to the pleasant euphoria that washed over anyone who took in a whiff. Feeling good is generally a fine thing, but what happens if the man holding the scalpel feels entirely too good?
Usually, the patient dies.
Liston and I shoved a woozy, giggling Joseph out of the way. Since he couldn't have taken in that much, he would shake it off soon enough. Meanwhile, we strained to hold our breath every time gas was pumped into the patient's mouth. We had agreed that whoever suspected they'd inhaled any would step back immediately, yet, being a colorless, odorless gas, discerning that was easier said than done.
“Good.”
“Good? What's good? Feeling good, Pyeong? You too?”
“No, I mean the surgery is going well, so it's good!”
“Ah. Thought we lost you for a second.”
Because of that, we ended up using feeling good as our distress signal. Since the person affected wouldn't be able to judge their own state, the people beside them had to evaluate. The surgery itself was demanding enough, but with the anesthesia turning into such a circus, it was truly exhausting.
“Take over here, Professor.”
“Good.”
“Hm?”
“I mean, I shall do a good job of it!”
“Right.”
At any rate, we barely managed to clear the oral mucosa and expose the bone. Getting to this stage required exquisite delicacy, but severing bone belonged to an entirely different realm. If only I had a Gigli saw, I could have managed somehow, but when I described one to a blacksmith, he looked at me like I was a madman. Then again, how could anyone forge a wire-thin metallic thread possessed of enough hardness to saw clean through human bone? In wuxia novels, legendary spiders could shoot threads like that out of their asses, but this was the uncompromising real world. Or perhaps an alternate Earth that bore an uncanny resemblance to reality only in all the most useless, inconvenient ways.
“Huuup!”
Still, it was fine. We had our very own Sword Master. Here was a man who could slice through bone in the blink of an eye—and at an exact, perpendicular angle—using nothing more than a diminutive hand saw.
Scritch.
Perhaps because this patient's bone was partially decayed, or simply thinner on account of her being a woman…
“Eh?”
“You cut through already?”
“Aye. Nearly cut too far.”
It parted so swiftly that calling it the blink of an eye felt like an understatement. Liston’s saw had ground to a halt right below the jawbone. A fraction deeper, and he would have struck an artery. It would have severed the carotid artery itself or one of its major branches.
She would have been dead on the spot…
Every operation I'd performed since arriving here had been perilous. Back before proper antisepsis, hadn't every single surgery carried a deadly risk of infection? Not that we were entirely free from those dangers even now, yet today felt exceptionally harrowing. The surgery itself was just too perilous.
“Hold your breath!”
“Mmh!”
Just having to hold our breath at unpredictable intervals was exhausting. If I can help it, I should really avoid facial surgeries in the future…
“Still, only someone of my caliber could have pulled that off safely.”
“Quite right. Had it been me, she’d be dead.”
Liston wasn't lying. Precisely because he possessed such terrifying brute strength, he had the fine motor control to brake his own momentum; had it been me, I would have driven the blade straight through in sheer panic.
Scritch.
At any rate, the opposite mandible was severed as well, and the resected bone tumbled out alongside the necrotic tissue in a grisly mass. Since the operation was being conducted in the amphitheater as usual, the onlookers—including the Hospital Director and the staff doctors—were thoroughly shaken.
“Good heavens…”
“To perform such a horrific butchery…”
The bastard who muttered that was Kane, the lithotomist. To hear such sanctimonious drivel from the man who made a living out of the single most barbaric procedure known to medicine! The real trouble, however, was that their shock was premature. The truly gruesome spectacle was yet to come.
“Oh, dear lord…”
“I heard rumors, but…”
“To conceive such an ungodly notion…”
“He is nothing short of Frankenstein himself!”
“Indeed. Frankenstein stitched together corpses, but this man is stitching together the living! Far more horrific!”
Even to my eyes, it was an appalling sight. We were cutting an incision into her chest and tucking the flap of living flesh up into the hollow of her jaw. Still, their outrage felt rather unfair. And stitching? There was a perfectly noble term called reconstruction! Why reduce it to mere sewing?
“Ugh…”
“Hrrg… My stomach is turning…”
“She must remain in that state for a whole month?”
“How on earth is a soul meant to survive that?”
I've said it before and I'll say it again: I was saving a person who would otherwise be dead. Granted, whether she would truly pull through remained to be seen. For one, portions of the raw tissue were left exposed, inviting the ever-present danger of infection. Moreover, she had been emaciated to the bone, so there was no guarantee her body could even withstand the sheer trauma of the operation. Thinking about it like that was starting to make me gloomy, but…
“Splendid.”
“Good. Wait, that isn't the gas talking, is it?”
“Certainly not. What about you?”
“Neither am I. The operation seems to have gone exceptionally well.”
“Aye. It went magnificently. Now that it’s done, the structure looks surprisingly viable.”
Looking at the finished work, I felt confident we had made the right call. Because we managed to pack in even more bulk than the internal defect required, even if it didn't look pretty right now, it was, in fact, a complete success. Flaps shrink over time. The human body adapts remarkably well to new circumstances, and skeletal muscle adapts best of all. And the tissue I had transposed into her jaw was muscle harvested from the pectoralis major. She would lose a degree of mobility in her chest, but a person has to eat to stay alive. We had sacrificed an expendable motor function for a vital life-sustaining one.
“Just to be safe, let’s make an airway here.”
“Hm. Yes. That would be sensible.”
With the oral cavity crammed so full of transposed tissue, breathing through her mouth was bound to be precarious. Right now, with us right beside her monitoring every breath, she was safe; but if she choked in her sleep during the night, she could easily asphyxiate. So, I made an opening in her windpipe.
“Ugh!”
“Merciful heavens…”
“Madness…”
The peanut gallery erupted into another round of frantic clutching of pearls. If it were up to me, I would have marched up there and cracked every single one of their skulls. Hypocritical madmen… Seriously! Acting so high and mighty when they never gave a second thought to the atrocities they committed daily!
Regardless, we wrapped up our first patient and immediately plunged into the next. The first one had concluded far faster than anticipated, which made a back-to-back run possible. Otherwise, we would have been forced to postpone it until tomorrow.
“How is your stamina holding up?”
“I’m fine, mostly.”
“You’re frail.”
“I’m fine. What about you, Brother?”
“I am immense.”
“Right, then… let’s get right to it.”
“Good.”
To be completely honest—looking back on it now—I think we were both a little intoxicated by the gas. No sane surgeon finishes a massive, grueling reconstructive procedure and immediately thinks, ‘Hey, this is totally manageable, let's do another!’ Yet judging purely by results, it worked out brilliantly. Perhaps the first run served as practice, because the second operation went even smoother. Well… in an era where a successful surgery and patient survival were two entirely separate matters…
Either way, well before the dinner hour arrived, we had concluded both operations and were able to review our cleaned-up, bandaged patients. I deliberately kept mirrors out of their sight. We isolated them completely. Since our hospital lacked private wards for such cases, we accommodated them in the research laboratory.
“It went well. You’ll be able to speak once some time passes and the swelling goes down.”
“Fsssh.”
Neither patient had much to say in return. A foregone conclusion, considering we had bored holes through their windpipes.
“Are you truly intending to take these with you?”
The one who had been truly busy was the medical illustrator. He had sketched both patients in uncolored monochrome. He had scowled in revulsion throughout the entire process, and from the faint, sour stench of vomit clinging to his collar, he had clearly stepped out to empty his stomach at least once. Had he set foot in our dissecting room before Joseph scrubbed it down, he would have spewed his guts across every four walls.
“Of course.”
Regardless, his sketches were brilliantly vivid. Both the before and after depictions captured the horrific reality with stark fidelity.
“Good work.”
Liston inspected the illustrations once more, his face settling into a satisfied smirk, before pressing some money into the artist's palm. Whether the amount exceeded what the illustrator expected, or whether he had assumed Liston wouldn't pay him at all, was anyone's guess. Whatever the case, the artist took his leave with profound gratitude.
“Come, Pyeong. If you aren’t exhausted, ride with me.”
Having settled the bill, Liston climbed up into the carriage. Then he looked back down at me. I stared at him in mild disbelief.
Aren’t we going there to raise hell…?
For a raid like that, wouldn’t a sword-wielding Liston alone be more than enough? What earthly purpose could I possibly serve? Seeing the bewildered expression plastered across my face, Liston broke into a hearty guffaw.
“You carry far more notoriety than you realize, my boy!”
“Me? Well… I suppose I did discover general anesthesia and a few other things.”
“Not in polite society—in the back alleys.”
“The back alleys? Why on earth would I have a reputation there?”
What had I ever done to earn a name in the slums? I had never even thrown a punch. Sure, I’d watched brawls unfold. Though when Liston was the one delivering the one-sided beatdown, calling it a ‘brawl’ felt like a misnomer—it was closer to a slaughter. In any case, I was thoroughly perplexed.
“Word has it you’re an enforcer from a Qing dynasty syndicate. They seem to think your visage exudes terrifying menace.”
“Wait… me…?”
“And consider your track record! You force people to swallow dung water, bore holes into their throats, hack off limbs, carve away jaws… Who else in the entire expanse of London possesses such a monstrous repertoire?”
“I didn’t do those things alone! And those were all medical treatments…!”
“How are common folk supposed to know the difference? The Hospital Director even remarked on it. He said you don’t even need my escort anymore—you could walk the streets alone, given how terrified everyone is of you.”
“Ah.”
Oh, dear. It seemed I had accrued a mountain of horrific misunderstandings. Regardless of my monstrous reputation, putting a stop to the manufacture of white phosphorus matches was of paramount importance, so I had no choice but to board the carriage alongside Liston. As our carriage rolled through the cobblestone streets, I strained my ears—and quickly discovered that, indeed, I had acquired quite the sinister reputation.
“It’s the Qing syndicate gangster…”
“No, not Qing! He’s a sorcerer from a land called Joseon.”
“A sorcerer? Then instead of just standing here, we should immediately—”
“Hush! Don’t even speak of it! You’ll bring down a curse upon us!”
“A curse?”
“You truly don’t know? Good heavens, how can anyone be so deaf to the world?”
It was clearly gossip about me, yet every word sounded completely alien. Intrigued despite myself, I leaned closer to listen.
“Did thousands not perish in Paris just recently?”
“Aye, so I’ve heard.”
“That pestilence was a curse conjured by none other than that very man! How else could it have broken out the moment he arrived, only to subside the instant he left?!”
“Merciful heavens…”
These bloody lunatics have completely lost their minds.