Obstetrics and Gynecology (5)
“Ugh...”
The Obstetrics & Gynecology Annex was called a ward, but in truth, it was little better than a prison. Then again, that applied to virtually every hospital in this era. Shove a few filthy cots into a cramped room, lock people inside, and feed them slop unfit for livestock, and what else could you call it but a dungeon? Of course, this ward had seen some improvement since it was the very first place where hand-washing was instituted, further blessed by Joseph's borderline-obsessive hygiene surveillance. At the very least, it was clean.
“Does it hurt?”
“Of course it hurts. She's groaning, isn't she?”
“I meant, does it hurt severely?”
“Doesn't she look like she's in severe pain?”
“Still, one ought to ask.”
“Fair enough.”
Other than that, however... With windows positioned far out of reach, beds jammed shoulder to shoulder, and patients tossed together without a shred of triage, it remained the quintessential nineteenth-century sickhouse. For starters, the doctor asking a suffering woman whether it hurt with such utter indifference was a problem in itself. What was this, an interrogation chamber? Even a torturer inflicting deliberate agony would sound more engaged than that.
“Here, feel for yourself.”
“Er, yes.”
His bedside manner left much to be desired, but I had neither the time nor the luxury to critique such trivialities. If we didn't intervene immediately, this woman was going to die. As little as I knew about obstetrics, even I could see it.
Her water broke already...
What else could that strangely colored fluid soaking the bedsheets be? If the fetal head were presenting downward, there might still be hope, but the woman's upper abdomen was rock hard. Without ultrasound—or even X-rays, for that matter—I couldn't confirm anything with certainty, but this distinct, rounded firmness beneath my palms was unmistakably a cranium. Which meant that the part pointing toward the ruptured membranes was the fetus's feet. It was a breech presentation—one of the absolute worst forms of dystocia.
“Well? What do you feel?”
“The head appears to be at the top.”
“Yes, quite. In cases like this, normally... we wait. And if the head still doesn't turn, then...”
“Then what do you do?”
I wasn't trying to pick a fight; I was genuinely curious. Surely they did something, didn't they? They were supposed to be medical doctors.
“We pray.”
“Ah. Prayer. And after that?”
“And if that fails, we try pulling it out, though it rarely goes well.”
Heh.
Should I punch him just once? Judging by his track record, he must have killed quite a few already, so surely one punch was justified.
“There were times we resorted to a Cesarean section as well, but... I shudder to even think of it.”
Yet the moment my hand balled into a fist, Blundell's expression turned so thoroughly wretched that I couldn't bring myself to strike. Indeed, what physician deliberately murders his patients? They did it out of pure ignorance. The sheer number of fatalities and the centuries of enduring darkness were the real tragedy, but given the limitations of the era, one could hardly blame the individual.
“Back then, we had neither anesthesia nor proper tools. The patient screamed endlessly... and when she finally went quiet, I found she hadn't fainted, but expired. We managed to pull the child out, but by then...”
“Ah.”
Blundell was in visible agony as he relived those deaths. In truth, even in the twenty-first century, few specialists witness tragedy quite as acutely as obstetricians. How could it be otherwise? Obstetrics was supposed to be a place of joy and blessing, where new life came into the world, yet it was also a place where both mother and infant could perish in an instant. That was doubly true in modern tertiary hospitals, where difficult and complicated deliveries were funneled by the dozen.
I offered Blundell a gentle pat on the shoulder and turned back to the patient. Her husband, having arrived late after being summoned, was standing beside the bed.
“We need to perform a Cesarean section.”
“Pardon?”
“You madman! Save my wife!”
The man had looked reasonably mild-mannered, yet the moment the words left my lips, he flew into a blind fury. Thinking about it calmly, it was my oversight. I hadn't factored in that in this era, a Cesarean section was practically synonymous with murder. Even so, grabbing a man by the lapels and shaking him was crossing the line.
“Whoa, hey, that hurts!”
“My wife will die!”
“I'm trying to save her! We're doing this to save her!”
“Don't mock me!”
A second longer and he would have actually punched me. Fortunately, Robert Liston was part of our retinue.
“Ngh!”
Having lagged behind to clean up the cadaver he had been practicing on and scrub his hands with meticulous care, Liston stepped forward and seized the husband's wrist. Instantly, the man's face twisted into an agonizing grimace. It must have hurt terribly. No, it probably felt like his bones were splintering. I knew for a fact that Liston could bend iron bars with that grip.
“Aaaargh!”
“He speaks the truth. We are attempting to save her.”
“Aaaagh! My wrist! Let go of my wrist!”
“If I let go, will you stand quietly and listen?”
“Y-Yes! I will, I swear!”
“Very well, then.”
“Haaah...”
The husband instinctively cradled his wrist, where deep, purple indentations looked as though it had just been crushed in an industrial press. In this singular moment, neither his wife nor his unborn child likely crossed his mind. It couldn't be helped; human instinct under pure agony supersedes love and devotion every time. In any case, I was freed, and Liston had bought himself time to explain.
“The era when a Cesarean section meant certain death has passed,” Liston declared.
Those who knew his history would understand: though Liston was now celebrated as one of London's foremost surgeons with patients queueing out the door, merely months ago he had been a man barking for business in the public squares. Hacking off limbs without anesthesia was hardly an easy sell. People dreaded it, and Liston had been forced to talk them into surrender through sheer oratorical force. Naturally, he did so to save lives, but he also needed to put food on his table. For that very reason, Liston was surprisingly eloquent for a man of his brutish stature.
“In the past, that may have been true. But in those days, there was no anesthesia.”
“Ah... anesthesia.”
“Indeed. And this professor whose collar you just grabbed happens to be Dr. Pyeong himself—the very man who invented it.”
“I-I apologize. But to suddenly propose a Cesarean... to slit her belly open... surely that has nothing to do with anesthesia?”
“Listen first. I am speaking.”
“Ah, y-yes, sir.”
Watching him, I honestly couldn't tell whether he was good with words or simply terrifying with his fists. Regardless of whether people agreed, he compelled them to listen. That particular talent...
I could never pull that off.
Was it an aura of intimidation? Whatever it was, both the patient and her husband stood in stunned, mute compliance, hanging on Liston's every word.
“We have already successfully performed more than ten abdominal operations,” Liston boasted.
That was a boldfaced lie. To be precise, it was eight. In three of those, we had opened the abdomen, found nothing operable, and stitched them right back up. Two of those patients were dead now. Not that they died from the surgery itself—I tracked surgical fatalities separately. The cause of their abdominal agony had simply been something else.
Pancreatitis, aortic dissection, mesenteric infarction... there were so many possibilities. Or perhaps cancer...
Had modern diagnostic tools been available, we might have identified it. But even if we had, what good would it have done? Suppose, by some miracle, we managed to treat acute pancreatitis. What about an aortic dissection? Looking at it would only break your heart. An infarction? Same story. And cancer? Needless to say, cancer wasn't even conquered in the twenty-first century.
Fortunately, Madame Germain still seems in good health, but... it'll recur eventually.
For external, protruding lesions like breast cancer, one could at least attempt a mastectomy—there was a reason breast cancer was the very first malignancy surgeons ever attempted to excise. Yet even that fell far short of a definitive cure. We had no way to confirm clean surgical margins, to say nothing of chemotherapy or radiation. As for visceral abdominal cancers, which were exponentially more complex, touching them in this era was out of the question.
“Men who would have perished in times past are walking about hale and hearty, that is what I am telling you!” Liston boomed on. “The same applies to your wife. From what I see, the infant is inverted. Do you know what the mother's survival rate is in such a state?”
At the mention of statistics, Blundell and I both pricked up our ears.
“Zero percent! Absolute zero!”
Another shameless lie. It was classic Liston. He was a man who would do whatever it took to achieve his ends. Thank heavens he wasn't a villain; had Robert Liston turned to crime, London would have been burned to ash long ago.
“Yet with surgery, nine out of ten survive.”
“Ah... Have you performed many such operations already?”
“O-Of course.”
Yet another lie! This was our very first one! At least a sliver of conscience remained in him, as evidenced by that slight stammer. But ordinary mortals rarely kept their wits about them when conversing with Robert Liston—unless they dealt with him daily, like Blundell or me. The terrified husband was no exception, letting out a ragged sigh of relief.
“Ah... Thank God.”
“Indeed, thank God. Therefore, leave her in our hands.”
“Yes. Please... I beg of you...”
“Consider it done.”
When it was just Blundell and me, I had feared we might get beaten to a pulp before we could even touch a scalpel. Yet the moment Liston stepped in, the matter was settled in the blink of an eye. Both the husband and the laboring wife were thoroughly persuaded, repeating their tearful gratitude over and over. With that, the patient was shifted onto a stretcher and wheeled toward the operating theater. Carrying the stretcher was a task for the students, so Blundell, I, and Liston—who by all rights had the build to carry it single-handedly—hung back slightly.
“Listen to me, lads,” Liston muttered, throwing his massive arms over both our shoulders.
The gesture vividly dredged up memories of my middle-school days when I ran into neighborhood thugs near Moran Station. And as he kept talking, I realized my instinct hadn't been far off.
“Do it properly.”
“Pardon?”
“We always strive to do our best, but... as you well know, this is a difficult procedure,” I replied cautiously.
“No. Today, you will keep her alive no matter what. My honor is at stake.”
“What rubbish is this? We are the ones performing the operation, so why on earth is your honor at stake?” Blundell sputtered.
“Exactly,” I chimed in.
It was absurd. We were holding the blades; why was his reputation on the line?
“I gave that man my solemn word, did I not? Told him we'd done it heaps of times.”
“Then why did you lie in the first place?!”
“Ah.”
“Would we have been allowed to operate otherwise?”
“Well... no, I suppose not.”
“That's true, but still...”
When he put it like that, it was undeniably logical. I didn't care for his reasoning, yet I found myself thoroughly persuaded. Why? Because the arm Liston had slung around our shoulders was tightening with alarming force. One wrong word, and my clavicle felt ready to snap.
“Save her at all costs. This is not a request.”
“A-All right, I understand.”
“Understood. We will save her.”
Was this that legendary skill, Persuasion: Physical?
Though Blundell and I had only ever practiced this procedure on cadavers, we were now ablaze with an ironclad determination to keep the woman alive. Exchanging a single grim glance, we scrubbed our hands raw, donned gloves, scrubbed once more, and pushed through the doors into the theater. Inside, Alfred—who could now legitimately be called a specialist in anesthesiology—was already waiting by the station.
“Shall we begin?”
“Mm, go ahead.”
“Let's do it.”
With a mechanical click and hiss, the valve turned, releasing the gas, and the patient soon drifted into unconsciousness. Was this anesthetic gas entirely safe? Not a chance. It was almost certainly delivering chloroform straight across the placental barrier into the fetus. Even if the transfer wasn't absolute, medical foresight demanded that one assume the worst-case scenario.
“Let's hurry.”
“We must save her, remember?”
“Which is precisely why we must hurry. That anesthetic gas is known to kill people on occasion.”
“Well... yes, that is true.”
“And a baby is bound to be far more fragile than an adult, wouldn't you say?”
“Fucking hell.”
The logic was so irrefutable that even Blundell cursed under his breath.