Transfusion (Part 2)
I had prepared several needles well in advance.
After all, isn't this an era where sterilization doesn't even exist? Even in an age where sterilization was common practice, hypodermic needles were strictly single-use; the slightest carelessness could turn them into a breeding ground for rampant contagion. More to the point, this was the nineteenth century. Even someone who looked perfectly robust on the outside would probably turn out to be crawling with bacteria and viruses if you ran proper labs on them. For all I knew, our esteemed Sir Jamie over here was probably harboring a storied venereal trophy or two, like syphilis or hepatitis C.
"Why? Why cannot it be me? Surely you do not mean—!"
Ah, right. I hadn't drawn any blood from our good Sir Jamie either. It wasn't out of any Confucian reverence for our elders; it was simply an unacceptable medical risk. Do you know why old people are old? To put it plainly, because they've aged. And it isn't just their outside—everything inside has withered, too. If a sudden volume of blood is pulled out, the heart must beat faster and harder to compensate while peripheral vessels promptly constrict. Could Sir Jamie's decrepit frame possibly endure that kind of hemodynamic shock?
"No, Sir Jamie, that is not the reason at all."
"Then why must you deter me when I, a proud peer of our Great British Empire, have volunteered to make the sacrifice!"
Could I really tell him the clinical truth? The situation was suspicious enough as it was. 'You must provide compatible blood...' I had blurted that out on impulse. Did I really need to compound my troubles by lecturing them on hemodynamics? Absolutely not.
"I fear an excessive disparity in age would be ill-advised for the recipient!"
"Ah. Is that so? Aha!"
And so, I ended up feeding him a rather bizarre rationalization, something reminiscent of medieval folklore about witches bathing in the blood of youth. Still, it turned out for the best. With tales of that ilk already lingering in their cultural memory, Sir Jamie nodded sagely and dropped the matter without further fuss. In truth, since Sir Jamie wasn't a direct relative anyway, taking his blood would have been entirely pointless in the first place.
"Now then..."
Meanwhile, I drew a small amount of blood from the patient's vein with a needle, divided it among four iron tins, and mixed in samples taken from each prospective donor. Conveniently enough, there were four tins—just like the four major blood types. Well, factoring in the Rh system makes it far more complex, but let's gloss over that. If I had to account for every minor antigen right now, I'd never get this operation done!
"Hmm."
"Could this truly be?"
"That blood must match... what an extraordinarily radical notion."
At any rate, the lot of us began staring intently down into the four iron tins. It didn't take long at all. Incompatible blood clumped together in an instant, but fortunately, one tin held out without agglutinating.
"Oh? Look at that!"
In under a minute, the difference between the clumped samples and the fluid one was plain for everyone to see. The students were utterly astonished, and Liston looked equally wide-eyed. Blundell, however, reacted differently.
"Actually, I have witnessed such phenomena on numerous occasions! Whenever bloods are mingled together, they often curdle into clots. I merely presumed the blood of diseased patients possessed an innate propensity toward coagulation..."
Did they really think I was crazy enough to toss out such radical ideas on a whim? Everything I did had precedent. Even in this backward era, there were existing records. Experiments conducted more than a century prior had noted the very same thing: that certain blood curdled when mixed, while others did not. When you think about it, it was only natural. This was an age of unhinged, mad-scientist experimentation, after all. They simply had never connected the observation to clinical practice.
"It is quite understandable if one does not hail from a land of perpetual warfare like Joseon." Even so, bridging that conceptual gap was an extraordinary leap, so I had to concoct an excuse.
"Oho... Is Joseon so skilled in the art of war?"
"Well, er..."
They say one lie begets another. Was my homeland truly... skilled at war? At the very least, we never went around invading other countries. We were often called a peace-loving people—not that I particularly fancied that phrase, since it always sounded too much like an excuse for lacking the strength to fight back. Ugh. Is this... the stirring of latent patriotic pride within me? Something twitched deep inside my chest.
"A certain General Eulji Mundeok once brought about the total ruin of the imperial dynasty that preceded the Qing."
"Astonishing! Did you not mention your kingdom was vastly smaller in scale?"
"In Joseon, fighting odds of one against eighteen is considered quite ordinary."
"One man against eighteen? How could that be possible?" Blundell cocked his head in disbelief.
I felt a slight twinge of embarrassment. One against eighteen... honestly, that was absurd by any reasonable standard.
"Why should that be impossible?"
Reinforcements arrived from an unexpected quarter: Liston. Eighteen men? Even a hundred and eighty men would struggle against Liston wielding a cleaver. In combat, momentum and raw intimidation matter far more than people think.
"There may well be many men cut from the same cloth as myself."
"Ah, yes, precisely! Well, perhaps not many, but they certainly exist. Take Admiral Yi Sun-sin, for example—a commander of the naval fleet, essentially our Royal Navy..."
"Fascinating. Pray, do tell. I have an immense fondness for martial tales."
Now that I had verified which blood didn't clot, the brother who provided the matching sample was officially slated for blood-bag duty. Four hundred milliliters should be the safe ceiling, right? Would four hundred be enough? That was barely a single standard blood pack. I couldn't be certain. In any case, I had neither the instruments nor the methodology to measure the volume accurately right now. And I certainly couldn't drain it into a bowl and pour it back in like Blundell had done.
"He was a peerless admiral who utterly shattered the Japanese invasion fleet. With a mere twelve warships, he engaged and defeated an armada of one hundred and thirty-three."
"Good heavens... A naval genius on par with our Lord Nelson..."
"Indeed, quite so."
While keeping the banter going, I had the brother lie down beside the patient. I drove a needle into his vein, coupled a thin iron cannula to its end, and drove the other needle directly into the patient's vein. If the brother were positioned higher, gravity would speed up the flow by creating a greater pressure gradient. But artificially forcing the rate carried the very real risk of killing our donor. Moreover, with rigid metal tubing, any sudden jerk or awkward angle could obstruct the flow or tear the veins at either end.
"Magnificent! I must pay a visit to Joseon at least once in my lifetime."
Thus, I managed to wrap up this delicate, high-stakes procedure under the cover of spinning war stories. Blundell belatedly started peppering me with questions, but the hard part was already done. The circuit was established. Furthermore, my approach wasn't without sound theoretical backing. I had studied transfusion extensively while preparing for the Cesarean Section; obstetric procedures were notorious for causing catastrophic hemorrhage, so transfusion was a natural prerequisite.
"Wait, can such a method truly function? With both lying on the same horizontal plane, how can the blood possibly travel?"
"Haha. You are familiar with Robert Boyle, are you not?"
"Of course. The natural philosopher and chemist."
"He conducted transfusion experiments between dogs long ago."
"Experiments, you say...?"
"Indeed. Come, let us consider the physics."
Thank you, Boyle. Memorizing Boyle's Law back in school had given me endless migraines, but here it was, paying dividends across the centuries! The geniuses of old never confined themselves to a single discipline; they dabbled in everything under the sun. Boyle was no exception—the man had actually performed blood transfusions! Between dogs rather than humans, granted. Still, it was a remarkably forward-thinking method, certainly an improvement over Blundell's open-air contraptions. While Boyle likely had no modern clinical pathology in mind, he had proven that animals could survive the direct exchange.
Proof or no proof, if the brother drops dead, I'm ruined. Whenever matter is transferred—be it blood or vital organs—the donor's safety is always paramount. If a healthy person dies during a medical intervention, it ceases to be a complication; it becomes an unmitigated disaster. Keeping a vigilant eye on the brother's complexion, I continued my explanation.
"Now, as any anatomist knows from dissection, the vascular system forms a continuous network, does it not?"
"It does. Though... I have yet to observe the microscopic conduits connecting the arteries and veins, I personally suspect minute capillaries must exist."
"Haha, my dear colleague, that is hardly a settled fact! There remains the theory that blood is generated independently within the heart and the peripheral tissues!"
Ha. God damn it. I wanted to strangle Liston on the spot. Since murder was out of the question, I forced myself to let it slide. By now, I knew all too well that dumping too much nineteenth-century medical heresy on them at once was a fool's errand.
"Well... regardless, we can all agree that the blood resides within a finite, enclosed volume, yes?"
"Naturally! I tell you, minute vessels must bridge the two!"
"Be it continuously generated or not, the internal capacity remains fixed."
Good enough. I pressed forward into concepts that would have sounded baffling had Boyle not laid the groundwork. Boyle really was a brilliant mind.
"Consider this: that finite space is filled with fluid—blood. In this patient, a substantial portion of that fluid has been lost. Were the vessels rigid tubes, a vacuum would form. But blood is liquid, and our vessels are remarkably pliable. What happens then?"
"The vessels would collapse."
"Precisely. Take a pulse, and the reality is unmistakable: the internal pressure has plummeted."
"Indeed! Blood pressure falls! Which only proves that higher blood pressure is invariably superior!"
Now I wanted to throttle Blundell. Why did these two take turns blurting out blatant misconceptions with such unwavering confidence? Still... I couldn't entirely blame him. When blood pressure bottoms out, a person dies. It was only natural for them to deduce that higher pressure equated to greater vitality. It was rather tragic that this fallacy would persist well into the mid-twentieth century, of course. If you're curious about the historical absurdity of that, feel free to consult that masterpiece of military history, The Black-Haired American Generalissimo.
At any rate, I swallowed my irritation once more.
"Quite so. Now, our donor brother possesses normal pressure, while the patient suffers from critically low pressure. What follows from that disparity?"
"Ah... Ah! The fluid will be propelled from the region of higher pressure toward the lower!"
"Precisely. Boyle demonstrated this very principle in the seventeenth century during canine transfusions. By severing a vessel in one hound to induce acute hemorrhage and drop its pressure, he enabled blood from a robust hound to flow directly into it."
"Wait—then once the pressures equalize, the flow will cease?"
"Indeed. And once equilibrium is reached, both parties survive."
"Aha! Brilliant! This... this is an utterly flawless method!"
It is not. If direct arteriovenous transfusion were truly flawless, modern medicine would still be doing it today. Blood banking didn't evolve purely out of convenience for long-term storage. He claimed the flow would halt once pressures equalized, didn't he? What guarantee was there that the equalized pressure would be anywhere near normal? None whatsoever. More often than not, both donor and recipient would simply perish together.
In this case, I had already clamped and ligated the bleeding site. But if there were still an active leak, hooking up a live human donor would be like pouring water into a shattered vase. When administering stored blood packs, you can transfuse continuously to buy precious time while surgical hands frantically secure hemostasis. That's why trauma surgeons talk about pumping in ten units or more. Ten units means replacing the patient's entire circulating volume! Try doing that with a living human being tethered as a direct blood bag.
They'd die... Both of them would drop dead without question. The flow is driven entirely by pressure difference. If the patient has an open, bleeding wound, the transfusion does nothing except accelerate hemorrhage out of the breach! Unless you miraculously stop the bleeder in the handful of minutes you've bought, you haven't saved a life—you've traded two lives for one botched gamble.
I'll have to talk him out of doing this later. For now, the patient was visibly stabilizing. That was enough. I decided to just smile. Though our brief exchange had laid bare a mountain of lingering physiological misconceptions—blood pressure chief among them... The more absurd things got, the more a man had to smile. If I didn't, I'd end up laughing like the Joker. And that would be genuinely dangerous.