Duel at Trafalgar Square (Part 3)
“Urrgh…”
“Aaargh! S-Somebody help me!”
Casualties numbered around ten.
Among them, the lightly wounded were… three by twenty-first-century standards, and roughly six by the standards of the nineteenth century. If a man could haul himself to his feet under his own power, he was considered lightly wounded. If you poked and prodded someone in that state under the pretense of offering treatment, you were far more likely to make matters worse. In fact, the odds of causing further harm were dangerously high.
“Joseph, move out.”
“Disinfect and wrap?”
“Precisely.”
“Understood. Heh-heh.”
Even so, leaving them entirely unattended was out of the question. And so I dispatched Joseph first. A virtuoso of sanitation and an absolute fanatic for antisepsis, Joseph immediately set about dousing the moderately injured with carbolic acid. He spared no one.
It may be a duel, but… I can hardly let people die on the cobblestones.
The least we could offer was disinfection. Naturally, handling every patient classified as critically wounded—even by nineteenth-century standards—was beyond our current capabilities. Even with me present, the reality remained unchanged.
Why? Because since arriving in this godforsaken era, I had learned a sobering truth: a modern, twenty-first-century physician can accomplish remarkably little on his own. The entire paradigm was fundamentally different from the ground up.
“Out of the way! Out of the way before these quacks murder a man!”
Over from the opposite side came Dr. Josef, his face pale as chalk as he sprinted forward. That bastard’s specialty was murder—no, nose removal—no, cosmetic rhinoplasty. But look at him. Just look at him now.
“Where does it hurt? Where is the injury?!”
He rushed in like a madman, seizing a critical patient we hadn’t even triaged yet and shaking him violently by the shoulders. If you don't know what you're doing, the least you can do is stand still. Where on earth did he summon the gall to act so recklessly? Who in their right mind examines a blunt-trauma patient like that?
“Professor! Over here!”
My irritation was mounting steadily, but unfortunately, I didn't possess two bodies.
If this were my old university hospital…
I would have dispatched the specialists and residents into the field while I stayed back to conduct initial triage. Triage sounded noble on paper, but in practice, it was essentially the process of deciding whom to abandon. It sounded merciless, yet it was the only rational way to confront a mass-casualty disaster with finite resources. It was born of the conviction that because all lives are equal, saving two lives is better than saving one, and saving three is better than saving two.
Triage, was it?
Yet in my current situation, even basic triage was an impossible luxury. What would happen if I barked, ‘Secure the airway, ensure respiration, and stabilize circulation immediately!’? For starters, not a single soul would understand what I was talking about. Normally, confusion leads to hesitation, but not here. Instead, these men would simply follow their primal surgical instincts and start hacking away with cold steel.
“Brother, Brother! Put the knife down!”
See? Just look at my dear brother Liston. His engine was already revving at full throttle.
“What is it? The leg is crushed! Pinned beneath that fallen column, no less! A wound like this will fester and turn to gangrene without fail. It must come off at once!”
True to his renown as the peerless maestro of amputation, he had already drawn the massive Liston knife strapped across his back. The only minor consolation was that the blade gleamed so brilliantly it scattered London’s gloomy, soot-choked sunlight in every direction. At the very least, it meant the steel was immaculately polished and razor-sharp.
“No, no. Let us inspect the wound first.”
“Why waste precious seconds inspecting it?”
In Liston’s hands, there was likely nothing in this world that could withstand that blade. Without exaggeration, the man could probably cleave a stone pillar in twain if he put his back into it. Taking off a human leg would be as effortless as slicing butter. But before any slicing could begin, certain prerequisites had to be met.
“We must inspect the wound to determine whether it even requires amputation.”
“What nonsense is this? Ah, hahahaha!”
Observation. The wound had to be examined. It was such an elementary clinical rule that I hadn’t bothered emphasizing it until now. Perhaps that was why Liston merely threw his head back in roaring laughter.
“Bring the boiling oil!”
Through the booming laughter, I thought I heard someone shout something completely insane from across the square. Surely my ears were deceiving me, so I chose to ignore it. Managing Liston alone was consuming every ounce of my energy.
“You don't know much about trauma surgery, do you, lad? Hahaha! A wound of this severity must be severed! There is no other recourse! It will rot, I tell you!”
Had this been the Liston of old, stopping him would have been sheer suicide. Imagine a hulking giant brandishing a massive butcher’s knife, itching to carve flesh—interfering with him was an invitation to lose a limb yourself. Furthermore, his rationale wasn’t entirely unhinged. An open, filthy wound was often far safer amputated, especially given nineteenth-century standards of hygiene. However…
“What causes a wound to rot, Brother?”
“Eh?”
“I asked, what makes a wound fester?”
As I spoke, I glanced sideways to watch Joseph pouring carbolic acid directly onto our patient’s ruined leg.
“Aaaaaaaargh!”
It had to hurt like absolute hell. Standard medical procedure dictated that such a wound should first be copiously irrigated with sterile saline. Pouring raw antiseptic directly into exposed tissue was closer to torture than medicine. But what alternative did we have? This was the ceiling of our current resources. Procuring clean water on the filthy streets of London was an ordeal in itself. I wasn't asking for sterile saline from some modern fantasy; I merely meant water that wasn't catastrophically, lethally putrid.
“Miasma, of course.”
“Indeed. And what happens when we eradicate that miasma?”
We continued our scholarly dialogue against the ambient melody of carbolic acid glugging from the bottle, punctuated by the patient’s blood-curdling shrieks reverberating across Trafalgar Square. Described in words, it sounded peaceful enough, but anyone witnessing the spectacle would have felt their knees buckle in terror. It was chilling—two physicians engaging in casual banter while their assistant elicited screams fit for the depths of the underworld.
“Ah! By Jove, you're right! Then could it be…?”
“If there is a compound fracture or severe vascular ruin, amputation may still prove inevitable. But… don't we need to see what lies beneath the grime before swinging the blade?”
“Then we must wash it clean at once.”
“Joseph is already attending to it. The boy is a consummate professional.”
“Ah, haha! Quite so. You are entirely correct.”
“Let us examine another casualty. Look over there—they're already hauling two away.”
“Hmph. It seems we are falling behind.”
From where I stood, the only ones falling were the corpses on the other side. They weren't just falling behind; they were dropping dead. Who on earth transports acute trauma victims by grabbing their limbs willy-nilly and swinging them through the air like sacks of grain?
“Let us observe them for a moment. It is far more likely they are merely hauling away cadavers.”
“Is that so…? Yet the spectators appear far more alarmed by our conduct than theirs.”
“By ours?”
I glanced toward the crowd, and truth be told, their reaction made sense. Our patient was screaming bloody murder, while the other side was…
Dead silent…
In clinical medicine, when a trauma patient grows progressively quiet, it is almost universally a harbinger of doom. A person making a racket is usually not at death's door just yet. When a human being is truly, critically damaged, their body falls silent. And naturally, corpses make no noise at all.
No time to dwell on idle thoughts.
I couldn't afford to worry about the tragedy unfolding across the square; matters on our own patch were growing perilous.
“Khh… urgh…”
The patient Colin had just unearthed from the rubble was clutching his chest, emitting an ominous, strangled groan. He had been crushed beneath the collapse of the stone pillar.
Riiiip!
The screaming patient earlier might have appeared far more gruesome to the untrained eye, but the real mortal peril lay right here. A mangled leg could kill a man, certainly. But blunt trauma to the thorax was infinitely more lethal. Without hesitation, I ripped open his shirt down the center.
“Good heavens!”
“What in God's name is he doing to the poor lad?”
“Hush! Don't you know who that is?”
“Who might he be?”
“It's Pyeong… the Great Physician of Joseon!”
“Ah!”
Murmurs rippled through the gathered crowd. In an era where stripping someone bare in public was an egregious social taboo—hospital grounds or not—their shock was predictable.
“Oi! Shut your bleeding traps unless you fancy an early grave!”
“Eek!”
The clamor died down instantly, quelled by the weight of my reputation and the timely intervention of the local street toughs. Come to think of it, you would be hard-pressed to find men more genuinely useful than these London gangsters. They provided fresh animal pancreases free of charge. They screened recruits for urine tasting. And now, they were enforcing perimeter security and maintaining civic order.
When I finally establish my proper hospital, should I organize my own syndicate?
The thought genuinely crossed my mind. It wasn't mere idle fantasy; it was a remarkably viable business strategy. If Liston and I raised a banner and announced we were taking over the London underworld, hundreds of cutthroats would rally to our cause by nightfall.
“Pass me the… pass me the stethoscope!”
“Eh? Isn't that instrument merely used to confirm whether a man has expired? Has panic dulled your hearing, lad? The man is groaning before your very eyes.”
“Never mind that, just hand it over when I ask for it!”
“Now, see here, I am James Blundell, not your medical apprentice!”
“I don't care, just give it to me!”
“Y-Yes, very well!”
The patient’s chest was heavily mottled with dark, expanding contusions. He must have been knocked off his feet when the crowd stampeded, and while lying prone, a falling fragment of the stone pillar had smashed squarely into his ribcage. And what did that signify?
It meant he was utterly, comprehensively screwed.
“Hmm.”
Snatching the stethoscope, I pressed the bell to his chest to auscultate breath sounds first. Call it a blessing or a curse, but breath sounds were present. Instead, there was something else growing dangerously faint.
“Fuck…”
“What is it? Has he passed? Can you not hear his breathing?”
A curse slipped past my lips unbidden. The heart sounds were muffled, fading into an ominous distance. Back when I practiced medicine in the twenty-first century, I had hardly ever touched a stethoscope. Beyond my intern days when I had to verify whether a nasogastric tube had reached the stomach, I rarely had cause to use one. Why bother? You could simply order a chest radiograph. And if that didn't suffice, you could call an internal medicine consult. Here, however, such luxuries were nonexistent. You couldn't find an X-ray machine if your life depended on it, and calling an English physician meant they would immediately pull out lancets to drain the dying man’s blood.
“No. Syringe!”
“A syringe…?”
“When I ask for something, just hand it over!”
“Steady on, lad. I happen to be Robert Liston.”
“Please, just give it to me!”
“Right, here.”
It was only after being cast into this primitive century that I had undergone rigorous, desperate training with the stethoscope. And according to the clinical ears I had honed, this patient was suffering from cardiac tamponade.
“Fuck…”
The profanities kept spilling out. Cardiac tamponade—a condition where blood or pericardial effusion pools within the pericardial sac encasing the heart, physically compressing the myocardium. And what happens when the heart is choked under external pressure? It cannot expand. It cannot beat. Which meant it could no longer pump oxygenated blood throughout the body!
Could we perform cardiac massage or chest compressions? Useless. Compressing the ribcage when a pool of trapped blood was already strangling the organ would achieve absolutely nothing.
“Hup!”
There was only a single intervention left to me.
Thwack.
My nerves screaming with tension, I drew a sharp breath and plunged the large syringe directly into the precordial region of the chest.
Felt it!
To an ignorant onlooker, it must have appeared as though I had driven a spike straight into the dying man’s heart. But I knew the tactile feedback of the needle. I had breached the dermis and pierced the fibrous pericardium. I had not punctured the myocardium itself. At least, I prayed I hadn't. Either way, the dark fluid surging into the barrel was not originating from within the cardiac chambers.
“H-Hold on…”
“M-Murder!”
“He's killed him! The doctor murdered a man!”
It was the stagnant blood trapped inside the pericardial space. Had the needle entered an atrium or ventricle, blood would never drain in such a sluggish, passive stream. Especially from the ventricle—the sheer hydrostatic blood pressure would have forcefully shoved the stiff wooden-and-metal plunger backward out of the barrel.
“Shut your mouths, you absolute bastards!”
“L-Look! Look behind you!”
“Eh? What…?”
“The police! Fetch the constables at once!”
The illiterate rabble shrieked in horror, pointing trembling fingers at me. Hoping the assembled physicians might possess a shred more sense, I glanced in their direction, only to find them completely frozen. Every single one of them stood slack-jawed, staring at my bloody syringe with their eyes popping from their sockets.