Nasal Reconstruction [1]
Lose to some fellow who had merely dabbled for a few months? Never going to happen. Absolutely out of the question.
Of course, if asked whether I had performed dozens of rhinoplasties, well, not quite. But to call me a total novice would also be untrue.
General surgery in South Korea... climbed into its coffin ages ago.
Whether a proud surgical specialist—one who had even been appointed a clinical professor at the nation's largest hospital—ought to say such a thing was debatable, but by the 2020s, general surgery was no longer a coveted specialty. No, putting it like that pricked my conscience. It was flat-out ruined. It was exhausting, paid poorly, and decent positions were practically nonexistent. Naturally, applicants with lower board scores ended up trickling in. No, let's call a spade a spade. Even the students at the bottom of the class avoided it, leaving the residency quotas chronically unfilled.
A man had to find his own way to make a living.
Did earning a board certification and completing a surgical fellowship mean you could actually perform those procedures once you opened a private clinic? Far from it. Do you know what a brilliant senior of mine—a master of the liver, pancreas, and biliary tract—did after failing to secure a tenure-track professorship and leaving academia? He planted hair. I had nothing against hair transplants. It was simply lamentable that a surgeon possessing such hard-won expertise had nowhere to apply it in the real world. Though, to be fair, we were still far better off than thoracic surgery or obstetrics and gynecology...
“Alright, welcome, everyone, to the Rhinoplasty Symposium! We occasionally get general surgeons trying to sneak in, so please check the colleagues sitting in front, behind, and to your sides. If you spot a completely unfamiliar face, report them immediately.”
And so, one had to learn procedures that could actually generate revenue out in private practice. Among those, plastic surgery was the undisputed king. Operations like two-jaw orthognathic surgery couldn't just be picked up anywhere. Rhinoplasty, at least, offered an opening; it didn't cost a fortune compared to major craniofacial reconstructions, yet it was so technically grueling and fraught with complications that plastic surgeons often avoided it. That left room for outsiders to slip in. Even so... it was a road paved with humiliation and hardship.
“Over there! It's a military surgeon!”
“Catch that bastard!”
Fortunately, luck was on my side, and I never got nabbed. Come to think of it, I'd always enjoyed a steady streak of good fortune. For starters, I had died and come back to life, hadn't I? Whether contracting cancer, being struck by a truck, and getting hurled back to the nineteenth century counted as good fortune was up for debate, but still...
“You look rather accustomed to this, don't you?”
At any rate, summoning those distant memories, I sliced the nose off the newly delivered cadaver. As long as one understood the basic anatomy of the nose, it wasn't particularly difficult. Dodge the nasal bones and lop it clean off.
“I told you, all it takes is a proper anatomical understanding.”
“R-Right.”
Having lopped it off with such practiced efficiency—perhaps a touch too swiftly—I felt the onlookers hesitate. But then again, these were nineteenth-century men. Their shock lasted only a heartbeat before each began hacking away at the nose of his assigned corpse.
And Liston? That man was...
“Hmm. Why does mine look so different?”
“Because you sliced straight through the bone as well!”
“This? Is something this wafer-thin truly bone?”
“Of course it's bone! Look how hard it is!”
Good grief, he wasn't even using his famous amputating knife, just an ordinary scalpel—how on earth did he cleave through a human nose like that? Truly...
“What are you staring at?”
“Oh, nothing. Just wondering if you possess mana.”
“Mana?”
“Doesn't seem like it, though.”
Was he a swordmaster? Was he secretly channeling sword aura along the blade? Pushing that absurd suspicion aside, I checked to see that the rest of the lads had severed their respective noses.
Apart from Liston, everyone had done the deed properly—performing a standard rhinectomy, as it were. Strictly speaking, cutting off someone's nose wasn't something anyone ought to do, so slapping the dignified label of 'rhinectomy' onto it felt a bit perverse, but whatever.
“Bring them all over.”
“Yes, sir.”
Weaving between the corpses lined up on either side, Colin and Alfred brought forward the literature on nasal reconstruction that they had painstakingly tracked down. I had assumed nothing of the sort existed, yet lo and behold, here it was. Whenever you expected something to be there, it was absent; whenever you assumed it didn't exist, it turned up. An utterly baffling era, this nineteenth century.
Ah, and what was Joseph doing?
“Why are you scrubbing the corpse?”
“Disinfection is a habit.”
“I... I see.”
He was disinfecting the cadaver. Normally, Liston would have sorted him out, but Joseph's brand of madness wasn't something ordinary violence could tame, so even Liston simply let him be. Well, applying extraordinary violence might have stopped him... but it might also stop him permanently, so this was the wiser course. And frankly, excessive disinfection never hurt anyone, did it?
“Let's see... Ah.”
Skimming through the reconstruction procedures my apprentices had unearthed, I was struck completely dumb. It was too... this was simply too horrifying. It might sound rich coming from me now, but to someone who had dreamed of being a transplant surgeon long before he ever aspired to a trauma center, it was pure butchery.
“Oh... quite plausible indeed.”
“Fascinating... hmph...”
Of course, that was merely my perspective. Liston and Blundell were stroking their chins and nodding in earnest approval.
“Replacing the skeletal framework with iron...”
“And fashioning the flesh from calfskin. Hmm... how ever did they conceive of such an idea in those ancient times?”
The nineteenth century was ancient history, certainly. But compared to the seventeenth century, it was practically modern. That fact hit me squarely as I read the passage. Iron in place of bone... Granted, in the twenty-first century, we inserted metal pins and plates too. But we only called them 'pins' colloquially; in truth, they were biocompatible alloys specially treated to sit harmlessly inside the human body. Raw iron... you could never implant such a thing. Rust aside, the foreign body rejection would be catastrophic.
And on top of that, sewing calfskin to replace human nasal tissue?
I'd bet my life that every single patient who underwent that surgery perished. Well, given the centuries that had passed, they'd be dead by now anyway, but still...
“Shall we give it a try?”
The immediate crisis was: How on earth do I talk them out of this? Could I engage them in a sophisticated debate about immune rejection? Not a chance.
“Wait, hold on.”
Even if persuasion seemed impossible, wrong was wrong.
“Why?”
Liston asked with complete innocence, staring directly at me. Behind him... though currently out of view, were the patients the Hospital Director had rounded up, waiting somewhere in the hospital. When he had first suggested gathering patients, I wondered where under the sun one could find people missing noses, but London truly lacked for nothing; in the blink of an eye, he had assembled a whole flock of them. Naturally, most were destitute paupers. That had been beyond my reckoning. How could I have known what untreated syphilis looked like? In the twenty-first century, we not only had the almighty miracle drug penicillin, but a vast arsenal of antibiotics capable of pulverizing every conceivable strain of bacteria.
“Would this... would this even be clean? The miasma clinging to the iron and the calfskin would cause infection...”
“Can't Joseph simply scrub it down? Tell the lad to clean it, and he'll polish it until it sparkles.”
“Aye! Leave it to me, Pyeong!”
Don't smile so brightly, you idiot! Don't smile when you're about to butcher people!
“Ah, but wait.”
Blundell stepped forward. That rarely heralded good news. This man... was terrifyingly progressive. Even now, the memory of him mixing random blood types and calling it a transfusion gave me chills...
“Look at what was recorded subsequent to this. They attempted an entirely different procedure. Surely there must be a reason for that?”
“Oh?”
My alarm had been premature. Then again, there was a reason Blundell was so progressive. When conventional methods failed, he tried new approaches. Naturally, diving into untried methods in total ignorance was bound to be dangerous, but he was also a man who readily abandoned his stubbornness and followed along once steered in the right direction. Consequently, he knew how to read the historical progression of medical records.
“Indeed, they wouldn't have abandoned it without cause! Furthermore, look at this! It says here this method was devised by the French!”
“Ah, is that so? Then it's out of the question. There is no earthly way the baguette-munchers' method could be superior.”
“Precisely my point!”
Looking closer, that barbaric operation—fashioning bones from iron and flesh from calfskin—was indeed French. Fortunately, Liston was an exemplary Englishman who would dismiss even a correct idea if it came from across the Channel, so the technique was discarded immediately.
And Joseph? While less theatrical, he was an Englishman through and through, so he pressed the matter no further.
“It doesn't clean well.”
Besides, he had already ruined Colin's expensive calfskin bag with carbolic acid.
“Y-You son of a bitch!”
“Still, it's bound to be safer than before.”
“S-Safer?!”
Colin had an absolute fit, but what could you do? Even I welcomed such an enterprising spirit. In any case, as I watched this chaotic circus unfold, the others turned to the next passage.
“Draw the shape of the patient's nose onto parchment...”
“And trace that pattern onto the patient's forearm with a knife...”
“Then attach that flesh to the nose?”
“Hmm... It states that after attaching it, one must sever it from the forearm three weeks later... Can this be right?”
“Did you read that properly? Does such a surgery actually exist?”
“Do you take me for an illiterate? Of course I read it properly!”
Liston clenched his fists with an utterly indignant scowl. Blundell hurriedly reassured him that he certainly wasn't illiterate. Moments like this made me realize Blundell was completely unhinged in his own right. How dared he provoke Liston like that?
Still...
I could understand their skepticism. No matter how you looked at it, it sounded absurd. But when I examined the text myself, it wasn't entirely mad.
Aha... this is, in essence...
Reconstruction for defects in areas such as the face or breast generally falls into two broad categories: free flaps and local flaps. The medical jargon sounds complex, but put simply, you either harvest tissue from a distant site and transplant it, or rotate adjacent tissue into place.
It's a chimera. A blend of the two.
This historical method rotated tissue from a distant site while keeping its pedicle attached. Rotating local tissue inevitably left another scar on the face, whereas this approach shifted the primary scarring to the forearm—a substantial advantage.
Yet despite that advantage, nobody in the twenty-first century did this anymore. Why? First off, the patient's arm had to remain bound flush against their face for three solid weeks. According to the historical text, it was locked into an iron frame. It was practically medieval torture.
And even enduring that wouldn't guarantee the flap survived.
Three weeks was enough for engraftment to take place, yes. But growing large new blood vessels from scratch was impossible. And expecting a bulky flap of flesh to survive solely on microvascular sprouting was a fool's errand.
“Let's try this one!”
“Go capture... no, bring the patient in.”
Fortunately, I had a reliable way to halt these madmen in their tracks.
“Hold it!”
“Hm?”
“What is it now?”
Our impatient nineteenth-century gentlemen had already drawn their blades and were heading for the patients. They meant it quite literally when they said capture...
“I don't know who devised this procedure, but their anatomical knowledge was sorely inferior to ours.”
My profound-sounding pronouncement made everyone halt mid-stride.
“What do you mean by that?”
Words were useless; demonstration was everything. Rather than offering further verbal explanations, I drew my scalpel and made a long vertical incision straight down the cadaver's forehead.
“There he goes, doing that damn nonsense again.”
Liston and the others cursed under their breath, yet not a single one could pull his eyes away.