Nasal Reconstruction (3)
"All right, form a single file."
Practicing on cadavers had not taken long at all. In truth, strictly speaking of technique, the procedure was not especially difficult.
I don't care for the shape. I understand beggars can't be choosers, but still... hmph.
Just as Liston had grumbled, factoring aesthetics into the equation would send the difficulty skyrocketing. But agonizing over cosmetic elegance by the standards of nineteenth-century medicine was sheer lunacy. Trying to sculpt a pretty nose would only get the patient killed. No, scratch that. I could state it with absolute certainty: they would die. Every last one of them.
"Now then..."
And so, armed only with the rudimentary concept of a simple local flap—rotating a pedicle of skin down from the forehead to bridge the nasal defect, then pulling the donor site taut and stitching it shut—we resolved to dive headlong into live trials.
Ah, my hands sting like hell.
Naturally, I had thoroughly scrubbed my hands before laying eyes on any patient. Chlorinated lime had finally been banished from our repertoire. Through repeated trials, I had personally proven that bacteria could be wiped out without going to such torturous extremes. Why? Because the damn stuff hurt too much. Not that scrubbing with carbolic acid and lye soap felt like a stroll through a flower garden, but at least my hands no longer flared into a raw, festering scarlet as though rotting off my wrists.
"You'll be our first."
"Y-Yes, sir! Right away!"
Even while my hands throbbed, I surveyed the candidates with hawk-like scrutiny. I was not doing anything particularly noble; I was simply cherry-picking patients whose defects looked manageable with our present capabilities. First and foremost, a smaller nasal deficit was preferable. At the same time, I needed someone whose forehead possessed decent skin laxity. And, ideally, someone young.
Frankly, this is vastly harder than operating in the twenty-first century.
Even after all that screening, the defect was by no means small. If modern plastic surgeons witnessed this, their jaws would drop. The senior surgeons who trained me back in Seoul could never have fathomed such monstrosities. Who on earth knew there were this many noseless wretches wandering the earth? An outsider might easily conclude that the British penal code mandated rhinectomy as standard criminal punishment.
They don't... right? Tell me they don't.
To be honest, I could not say with absolute certainty. On several occasions, I had watched mounted constables mercilessly beat people bloody—whether actual felons or hapless bystanders caught in the crossfire, I could not tell—and it had been genuinely terrifying. They swung their truncheons with complete indifference to whether the poor bastard might perish on the cobblestones.
"Right, step this way."
Shelving those grim musings, I escorted the patient—whose nose had presumably been devoured by syphilis—into the operating room. Calling it an operating room was an act of extreme charity; until quite recently, it had served as a research laboratory, leaving it deficient in nearly every regard. Still, I took immense pride in the fact that it was leagues better than any other surgical space in London. Starting from the seamless iron operating table to everything else...
"Bloody hell, it's freezing!"
"Bear with it a moment. It won't take long anyway."
The chilled iron was entirely for infection control. In an operation of extended duration, hypothermia would naturally demand vigilance, but under present circumstances—relying on crude, temperamental anesthetics—one had no business attempting protracted operations in the first place.
"Y-You are paying us, right, guv'nor?"
"Naturally. Have you ever heard a whisper that our hospital stiffs a man on his wages?"
"N-No, sir, never. Well, then..."
"Ah..."
Alfred, presiding over the anesthesia, was beginning to look visibly exasperated. For a physician to display irritation before a patient was, by modern metrics, completely unacceptable. Try pulling a stunt like that in the twenty-first century, and you would face immediate disciplinary proceedings. In fact, such an impulse would never even cross a doctor's mind. Perhaps I had simply worked in unusually pleasant institutions, but contemporary doctors were unfailingly courteous. A patient was already enduring agony, so treating them poorly was abnormal. In an age where one expected baseline hospitality at a local corner store, patient expectations were understandably high.
"I... I'll live, won't I?"
"Ah."
Yet this was the nineteenth century. Gentle, compassionate souls simply did not exist here. Even stepping inside a church offered no solace; it was a sanctuary where one went to be berated rather than comforted.
"Why... aren't you saying anything...?"
And yet, at this precise moment, the trembling wretch was confronted by a genuinely sympathetic soul. Why? Because Alfred could not guarantee his survival. Human beings are inherently inclined toward gentleness the moment guilt seeps into their bones.
"You'll live."
Alfred... you still have a long road ahead of you. A surgeon must, above all else, exude unwavering authority! If you dither and stammer in front of a patient when you ought to be treating them, even a curable affliction will end in disaster!
Well... I suppose that sort of bravado only comes after you've pulled countless lives back from the brink.
Modern medicine... forgive me. Every time I ran my mouth whining about how modern science had its limits, how we still had not conquered cancer, and so on—I take it all back! Back then, mention a ten-percent mortality rate and people would swoon in mortal terror. In truth, a condition where ninety percent walked away alive was practically a minor inconvenience! Bring that exact same pathology to this godforsaken era, and the mortality rate would be ninety percent. The remaining ten percent would survive only if their constitutions were terrifyingly, inhumanly robust. In such an environment, demanding that an apprentice surgeon display effortless confidence was asking far too much.
Even so... a doctor must stand resolute. Watch and learn, boy. Look at me.
Sure enough, following my bold pronouncement, a glimmer of expectant hope flared in Alfred's eyes. And the patient? He was no different.
"R-Really, sir...? Oh—"
In an age where drawing one's final breath upon the operating slab was considered the natural course of events, where on earth could anyone find a physician promising survival with such unabashed certainty? Even the grandest equestrians of the Royal College of Surgeons always took pains to shield themselves in advance from the slaughter that routinely unfolded beneath their knives.
"Huh?"
"Come to think of it, this is my first time performing this procedure as well."
"So you just crank open the gas valve on him?!"
"I had no choice."
When I actually racked my brain, it turned out that even Bullshit Master Kim Taepyeong found it difficult to spin brazen fabrications straight into the eyes of a terrified man. My mind had gone entirely blank. Thus, I chose to terminate the conversation at once.
"Mad bastard..."
"Regardless, he's under! Come! Let us begin!"
The valve had been opened; the matter was settled. Alfred and the rest of the apprentices clearly harbored a mountain of grievances they wished to air, but what could they do? The patient was already sound asleep. In the twenty-first century, one could afford to operate at a measured, leisurely pace, but not here. Everyone had to move like greased lightning. Anesthetic disasters struck with terrifying regularity.
"Joseph!"
"On it!"
The task of antisepsis fell to Joseph. I had attempted it myself, but frankly, nobody rivaled his terrifying zeal. Of course, given that we were working on the face, he could not scrub with his customary savagery. Not out of concern for cosmetic blemishes—worrying about such trivialities would never allow a man to operate in the nineteenth century. The true peril lay in the eyes. What would happen if carbolic acid splashed into a patient's eyes? I did not even wish to imagine it.
"Colin, scalpel."
"Yes, sir!"
Accordingly, Joseph employed an applicator resembling an oversized cotton swab, disinfecting the field with blinding speed, meticulous precision, and absolute safety. Perhaps from having spent countless hours scrubbing every imaginable surface, his hands moved with astonishing celerity despite the clumsy instrument. Thanks to his efficiency, I was able to score the patient's forehead almost the very second the anesthesia took hold.
Slice.
I knew the vascular architecture like the back of my hand. That was knowledge drilled into my skull during gross anatomy long before I ever picked up a scalpel. South Korean medical school curricula were hardly forgiving enough to grant passing marks to anyone who failed to master such fundamentals.
Slice.
Focusing strictly on resurrecting a non-existent nose rather than obsessing over artistic contouring, my hands moved at blistering speed.
"Already?!"
Alfred gasped in disbelief even as his fingers adjusted the valve of the anesthetic cylinder. I was equally impressed, though with a sharp blade in my grip, I kept my admiration strictly internal.
Alfred truly is remarkably attentive. He is built for anesthesia.
If he were one of those vain glory hounds desperate to wield the knife, he would probably be daydreaming about cutting in my stead right this second—much like Liston, Joseph, and Colin beside me. Granted, Colin possessed the discipline to suppress such impulses, slapping instruments into my palm with impeccable timing, but still... Alfred, watching the very same operation, was actively titrating the depth of anesthesia. That was truly remarkable. Especially under current conditions, where anesthesia itself was inherently lethal and minimizing exposure was paramount.
"Suture!"
"Here, sir!"
When a nineteenth-century apprentice performed at such an extraordinary level, how could I afford to slacken my pace? I had to give it everything I had. That did not mean, however, that I sutured with delicate, obsessive density. Granted, the thread we used had been rigorously disinfected—steeped in carbolic acid, bathed in iodine, and subjected to every sterilizing rite we knew! Yet could we truly trust it?
"Hmph. Still no good, it seems."
Liston, whose curiosity could never rest until he tested matters firsthand, had already conducted an experiment. Not on a human, of course, but on a canine. And that dog had succumbed to fulminant sepsis. Violent inflammation had erupted along every single puncture site... Aigoo. Just recalling the memory sent a shiver down my spine. The only silver lining was that he had not experimented on a healthy hound, but had attempted to salvage a stray already mangled on the cobblestones.
Wide intervals... and never tie too tight.
In any case, that grim outcome had forged our governing principle: minimize sutures to the absolute bare minimum, and place as little tension on the thread as possible. Otherwise, the tissue would rot where it lay.
"Done!"
"Understood. Sir! Wake up!"
"Urrgh..."
The aesthetic result would likely fall far short of modern standards. Yet speed carried its own undeniable virtue. Heh. It felt somewhat as though we were rushing through shoddy craftsmanship, but Alfred had served as my assistant long enough to taper off the vapor with uncanny precision.
"Listen closely. You must not touch your face under any circumstances."
"Y-Yes, guv'nor. And... the coin...?"
"You'll receive your pay when you are discharged."
"Ah..."
"Naturally, all expenses for your lodging and board here will be covered in full."
"Ah!"
That grotesque pedicle bridging his forehead to his midface would be severed in three weeks' time. It required at least that long for the neovascularization to take hold and anchor the tissue.
"I don't mind the expense in the slightest! Once word spreads that we have crushed that upstart Josef, where do you think London's wealthy Jews will flock?!"
Naturally, all five patients operated upon today were admitted for a mandatory three-week stay. Furthermore, to prevent them from catching sight of one another's monstrous visages, they were quartered in individual rooms. To be sure, calling them private rooms was generous; they resembled solitary prison cells more than proper recovery wards...
"Blimey... a room all to myself!"
At least the patients were thoroughly delighted. At any rate, after concluding our rehearsal and confirming the following morning that every single patient was still drawing breath, the Hospital Director came bustling in to find me.
"Just as you instructed, I scoured the city and found candidates matching the degree of nasal deficit, forehead laxity... and age."
"How are their features?"
"Hideous. It pains me to say it, but even had they possessed noses, they would look much the same."
"And the patient dispatched to their camp?"
"The nasal defect is comparable. The forehead, however... stiff as seasoned leather."
"And their looks?"
"Ugly as sin, of course. How many handsome rogues do you expect to find wandering the gutters of London?"
"Fair point."
It was the day of reckoning. The probability of defeat? None. I was one hundred percent certain of victory. Yet I had once heard an old adage: even a lion exerts its full strength when hunting a mere rat. As an undisputed lion, I, Kim Taepyeong, was resolved to employ every ounce of my cunning to crush the rat named Josef. After all, this was an era that scarcely comprehended how profoundly patient selection dictated surgical triumph.
Well... for all I know, he might not even grasp the concept of using a forehead flap.
He likely had no inkling of the technique. In that case... victory was already mine.
"Come, let us depart."
"Must we truly conduct this spectacle in the public square?"
"Having listened to you lads, I have come to appreciate the virtues of clean hands and carbolic acid myself. But... what choice have we? The citizenry of London are already in a foul temper because one of their grand spectacles was snatched away."
"Haaah..."
"Besides, that is old news! With your renown soaring into the heavens, a public duel against a German challenger... why, I shouldn't wonder if Parliament itself endorsed it! London has not seen such magnificent public entertainment since the abolition of public hangings!"
"Ah..."
Though far from pleased with the theatrical circus, I set forth alongside the Hospital Director toward Trafalgar Square—a venue reputed to dwarf our customary surgical amphitheater by an order of magnitude.