Cesarean Section (Part 1)
A race against time.
In the realm of surgery, it would hardly be an exaggeration to call those words the absolute worst. You occasionally see surgeons in medical dramas preening because they finished an operation ahead of the clock, but in truth, it was a completely meaningless boast. Why? Because even for the exact same procedure, every single case presented a different battlefield. Just as no two human faces were sculpted alike, the anatomy inside every abdomen differed slightly. Making a simplistic comparison of operating times was utterly absurd.
“Quickly, quickly!”
I say this only so anyone watching might understand that my frantic pace right now was by no means my usual standard.
“Understood!”
“Scalpel!”
Normally, I never operated like this. Nor should any sane surgeon. Yet I had no choice. My trust in anesthesia at this very moment was scraping rock bottom. If this terror had been born solely of my own paranoid imagination, I would have forced myself to take it slow. But...
These days, Liston saws off an average of a hundred and fifty limbs a month... Of those, around thirty patients die, and more than ten of them perish simply because they never wake up from the ether.
Granted, it was shoddy statistics with zero controlled variables. But what else was I supposed to do? Controlled studies didn't exist in this godforsaken era.
Slice.
Reaffirming to myself that speed was indeed the lesser evil, I drew the cold steel blade firmly across the abdomen. It was Blundell's method: a midline vertical incision, and a rather long one at that.
The surgical field really is magnificent...
Even if I was rushing, that didn't mean I was flailing about in a panic. I had spent far too many grueling years inside operating theaters for that. Not a single hour of that past life had been wasted.
“Retract.”
“Right away!”
Including myself, five people were gathered around this operating table. Alfred was administering the anesthesia, while Blundell assisted as the first assistant. That left Joseph and Colin to retract the wound edges on either side. When it came to sheer dedication, neither of those two took a back seat to anyone, and their grasp of antisepsis had been drilled deeper into their skulls than that of most twenty-first-century doctors. Entrusting them with this task was second nature.
“Good.”
The view had already been decent, but once the edges were pulled taut, the exposure widened dramatically. Through the gaping incision, the massively distended uterus came into view.
“How shall we proceed? A cruciate incision, as planned?”
“Yes, most likely. But with the fetus inside, cutting through in a single stroke is far too dangerous.”
“That was how we used to do it,” Blundell murmured.
“Well... you didn't have anesthesia back then.”
Every time I performed a surgery like this, I was reminded of what a monumental difference the absence of pain made. Even under these conditions, it was grueling... What on earth must it have been like to slice open an abdomen, cut through a womb, and drag out an infant while the mother writhed and screamed in agony? Even Blundell, mild-mannered as he appeared, flashed glints of terrifying madness now and then. Perhaps that horrific past explained why.
In any case, circumstances were entirely different now, allowing us to incise the uterus with measured composure—in a neat cross-shaped pattern.
“I see it.”
“Whoa...”
“A baby...”
“It's so tiny.”
Inside the opened uterus lay an infant. A baby girl, appearing to weigh roughly 2.7 kilograms. Excluding Blundell, the remaining four of us—myself included—were seeing such a sight for the first time, or at least found it utterly alien. A collective gasp escaped our lips.
So this is the miracle of life...
Yet I couldn't simply bask in wonder. Instead, a sudden jolt of terror seized me. This child nearly died. It wasn't a cliché or an empty exaggeration; she truly would have had a one hundred percent mortality rate. People talked about astronomical maternal and infant mortality rates in this era as mere statistics, and while I had always known it was tragic, witnessing it with my own eyes made it feel devastatingly real.
“Quickly!”
What made it all the more crushing was that I wasn't even afforded the luxury of savoring the moment.
“I shall take over from here,” Blundell said.
“Ah, yes. Please do.”
In my stead, Blundell eased the baby out and severed the umbilical cord. A nurse standing by immediately received the child into waiting linens.
“Waaah! Waaah!”
The room had been so deathly silent until that second that my stomach had knotted, but thank God, the newborn let out a lusty, vigorous wail. Even so, there wasn't a split second to look away. Liston had bragged about having done this a few times, but in truth, this was my very first Cesarean. I hadn't performed one in my past life either. Obstetrics and gynecology... I had never once wished to touch it.
“Suture!”
“R-Right here!”
Still, the anatomical layout was fully mapped in my head. I had run countless mental simulations. Above all, I had practiced on cadavers. Offering a silent prayer of gratitude to the unnamed pauper's corpse that had served as my practice dummy, I ligated the vessels near the ovaries and tied off every arterial branch feeding into the uterus.
“Scissors!”
“Here!”
Snip, snip. I severed the ties. These scissors had been procured for me by Sophie Germain, who claimed they were German-made. Now as ever, German craftsmanship was nothing to scoff at; they were incomparably sharper and sturdier than English steel. Seeing how exceptionally they manufactured goods, one might almost suspect they started the First World War simply because they lacked colonies to sell all their wares to. If it sounds like I'm babbling, you're absolutely right.
“Phew.”
“It's done.”
The uterus had been completely excised. To the naked eye, there didn't appear to be massive bleeding. In difficult deliveries, the structure that caused the most catastrophic hemorrhage was the placenta. But we hadn't even touched the placenta; we had excised the entire uterus along with it. Bleeding was naturally minimized.
My wishful thinking is burning at full throttle...
Of course, blood could be pooling somewhere out of sight. How I missed the shadowless surgical lamps of the future. Those were so blindingly bright... Right now, we were relying on the dim, flickering glow of gas lamps. Surgeons in this era didn't drag patients out into open courtyards for surgery just for the theater of it—it was because you literally couldn't see a damn thing inside!
Stitch, pull.
What good did it do to fret over what I couldn't see? I just had to close while praying. If I rummaged around needlessly, the patient would require more ether, and if things went south, it would be a disaster. So, whispering prayers to the Almighty, I pressed on with the closure. Even though we hadn't sutured the uterus itself, with all those ligatures tied around major vessels, anxiety gnawed at my gut. The instant a single knot slipped, the patient would bleed out and die.
Should I just declare we never do this again...? No, that's out of the question...
Just a single operation, yet my soul felt sucked dry. It was genuinely a perilous procedure. In the twenty-first century, iterations of surgical advancement had made it routine, but not here. Hazards lurked at every corner. It felt almost like tiptoeing through an active minefield.
“Phew.”
“Whoa... Professor Pyeong, you're drenched.”
“Cold sweat is pouring off you,” Joseph chimed in. “Was it really that difficult? From where we were standing, it just looked like you sliced open, pulled out, took off, and stitched shut.”
Now that it was over, my knees were trembling. Listening to Colin and Joseph chirping on either side drained what little energy I had left. What infuriated me was that they weren't entirely wrong. Yeah, all I did was open, pull out, take off, and close up. Though more precisely: open the belly, pull out the baby, excise the womb, and sew up the belly.
“Madam, can you hear me? Are you all right?”
As much as I wanted to collapse right onto the floor, the situation wouldn't allow it. Alfred, our resident anesthesiologist and the very epitome of a gentle physician, was already waking the patient. He was doing splendidly. And no, I wasn't being sarcastic; I meant it. The whole point of my breakneck speed had been to cut down on anesthesia time—to minimize the dosage entering her lungs. Though I felt as if I had surrendered several minutes of my own lifespan in exchange...
“Uungh... mmh...”
“The child has arrived safely. Do not worry yourself, madam.”
No sooner had Alfred spoken than the nurse presented the newborn. Since the amniotic fluid hadn't even been properly wiped away yet, the infant looked nothing like the angelic babies people picture in their minds. A bit... wrinkled, to say the least. Truth be told, when I first laid eyes on her, The Curious Case of Benjamin Button had popped into my head. That was practically an old man's face right there.
“It is a lovely baby girl.”
“Ah, aah... Thank you! She is... she is truly beautiful.”
But to a mother's eyes, beauty held a different meaning. In truth, having known only hardship without proper nourishment, compounded by the ordeal of major surgery, the mother looked like a walking ghost herself. Yet watching her face light up with a radiant smile as she gazed upon her child... I thought that shaving a few minutes off my own lifespan wasn't such a bad trade after all.
“Thank you! Thank you so much! To think London possessed such a miraculous healer... and I dared doubt you!”
The father was beside himself with joy, practically dancing around the room. And who could blame him? From what I heard, while we were in surgery, the midwives and other accoucheurs had explained to him what a breech presentation meant. They had probably told him that if things went wrong, it was simply an act of God, so he shouldn't entertain false hopes or cause a scene. It might sound callous, but that was nineteenth-century London for you. A person died? A pity, but nothing could be done. That was the daily routine.
“Aaaah! My child lived! My wife is alive! She's alive!”
Even people accustomed to living under grim resignation could be this overwhelmingly happy when their family was brought back from the brink. Watching them, a warm glow seeped into my chest. During the operation, all I had wanted was to dump everything on Blundell and scurry off to do something else...
“Must be nice. Most of my patients just stare in stunned despair at their severed arms and legs.”
“Ah.”
It seemed Liston was feeling something similar. No, his feelings were probably far more complicated than mine. Truth be told, his hair had been thinning noticeably lately. In nineteenth-century London, an unmarried man over thirty wasn't just a bachelor—what on earth would you even call him? He genuinely needed to find a wife soon. Otherwise, society wouldn't merely suspect he had a defect; they might brand him as an outright degenerate.
It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife.
Besides, Liston had amassed quite a fortune by now, hadn't he? It was hardly a coincidence that the opening line of Pride and Prejudice crossed my mind.
“I envy them. I should really be getting married soon myself.”
“Y-Yes, quite.”
“Stop staring at my hairline. Shall I make yours match?”
“N-No, please have mercy!”
“At any rate... ah, that reminds me.”
“Reminds you of what?”
Having struck upon a thought, Liston clapped his hands and looked at me.
“By Joseon standards, aren't you an old bachelor yourself?”
“Pardon? Ah, well...”
Indeed. Early marriage was rampant in Joseon. A land of Neo-Confucianism where producing an heir trumped all else... Wait.
“How did you know that?”
“Oh, well, a man has his ways. It's the homeland of none other than yourself—should I not study it?”
No, don't study it... Don't try to know... You'll get us all killed.
“Speaking of which, what will you do for this party?”
“A party?”
“The anatomical gala.”
“Ah, that. Are we truly going through with it?”
“Of course we must. You have no idea how eagerly everyone is anticipating it.”
“Mmh.”
Fortunately, the topic had shifted, though that didn't mean the horizon was flooded with sunshine. An anatomical gala... Well, word had it that if a nobleman's festival lacked an anatomical dissection demonstration, he was deemed thoroughly incompetent, so it wasn't unheard of. In nineteenth-century Britain, dissection was practically a spectator sport.
“If things go well, our popularity will skyrocket.”
“Oh...?”
And I was the star athlete. When had a sports star ever not been the darling of the crowd? Thinking of it that way made the future seem bright—until the very next day, when London reminded me once again that one can never see an inch into the future.
“Sir Jamie...?”
“My daughter-in-law is in labor, and I hear you are a miracle worker.”
“No, I am not an obstetrician—”
“Don't give me that nonsense! If I had only listened to your words earlier, I wouldn't have ended up in this wretched state, would I?”
Sir Jamie had come barging in. He was in such a frantic state that he hadn't even attached his fake mustache. Seeing him in such disarray softened my heart.
“Besides, it is no ordinary labor. She has been in labor for hours on end, yet... there is still no sign of progress.”
Well... when a gentleman who had his testicles removed came pleading, how could I refuse?
“Very well. I shall go.”
Furthermore, the man was a high-ranking aristocrat. Putting him in my debt would prove advantageous in more ways than one.