An Independent Center [1]
The good news finally took concrete shape several months later.
Truth be told, I had seen it coming. Alfred, Colin, and even the hospital director were hardly men renowned for keeping their mouths shut.
"Splendid, isn't it?"
"It certainly is."
Kensington. By any metric, it was the prime jewel of London—a district boasting astronomical real estate prices. And right in the heart of it stood our brand-new center, the clinic where I and my companions would now practice medicine. It was not a gleaming, ground-up construction like something from the twenty-first century, of course, but an existing townhouse refitted for our purposes.
Thank you, gentlemen... truly.
They had pooled their fortunes like some collective spirit bomb to buy the property outright. Naturally, Liston and I had pitched in our share of capital as well. One had to be a stakeholder if one wished to pocket the proceeds as business equity rather than a common doctor's salary. In the interim, whispers of an aristocratic title had surfaced yet again, but I had flatly declined once more.
"Well, there is no need to carry too much on your shoulders," the hospital director said, clapping me warmly on the shoulder before the facade of our Clinic No. 2. The exterior was aged brick, but the interior had undergone a lavish renovation. Before I knew his pedigree, I had simply taken him for an easygoing, materialistic old scoundrel. Yet ever since discovering he was the descendant of refugees who had fled religious persecution across the continent, he appeared in a rather different light. A grizzled veteran of life, one might say.
"My father and I began with nothing to our names," the director continued, "but you, my boy, needn't fret over management or ledgers in the slightest. We planted this clinic here primarily to look respectable to high society anyway. Your sole duty is diabetes. Just manage the sugar, and you have done your part."
"And my surplus hours remain entirely at my own disposal, correct? That agreement still stands?"
"Naturally! Ha-ha, who would dare drive Pyungshin like a common draft horse? You need only see diabetic consultations in the morning. Besides, you have your subordinate over there now. Between the two of you, it will be more than manageable."
At the tip of the director's finger stood Alfred.
My original intention had been to groom him into London's first specialist in anesthesiology, but that scheme had fallen flat. It was no fault of his, nor was anyone acting out of spite. It was simply the insurmountable limitation of the era. The practice of surgical anesthesia had emerged barely a few months ago; how could the medical establishment possibly recognize a certified specialist in it? Granted, the existing "specialists" of this century were mostly charlatans who simply declared one morning, Starting today, I fancy treating the bladder, and called it a day.
"Yes! Leave it entirely to me!" Alfred chimed in eagerly.
His father, Patrick, along with the rest of the respectable medical fraternity, seemed to believe that merely turning brass valves on a gas canister was unbefitting a true physician. In truth, the anesthesiologist was the captain of the operating theater, holding the thread between life and death. But explaining modern perioperative medicine to nineteenth-century gentlemen was an exercise in futility. Thus, I had resolved to employ Alfred as both an assistant anesthetist and our primary diabetes practitioner.
Though his hands lacked blinding speed, he possessed a delicate, meticulous temperament that made him remarkably well-suited to endocrinology. Natural bovine insulin was inherently inconsistent in potency from batch to batch. People in modern times were fond of worshiping the word "natural," but in pharmacology, natural extracts were a nightmare—you could never be certain precisely what compounds were present, nor in what exact concentrations.
Titrating the dosage while closely observing the patient's subtle physical changes... he is undeniably the best man for that.
In that sense, it might truly be Alfred's calling. Treating diabetes in the nineteenth century was a wildly delicate affair compared to the modern era.
"Now then... this chamber here is your consulting room, that one belongs to Liston, and over there is Blundell's," the director said, turning toward Blundell, whose position had appeared somewhat ambiguous during the move. "Blundell, are you truly certain you will be content here? The expectant mothers will inevitably flock to the main hospital."
Of course, calling it ambiguous was merely my own impression. Blundell himself harbored no doubts whatsoever.
"I must remain here if I am to pursue pioneering medicine," Blundell answered without hesitation. "Whether it be the cesarean section or blood transfusions... would anyone dare call Pyungshin a living god without reason?"
"Well, I suppose that much is undeniable."
"Furthermore... good heavens, if I stay over there, I shall be forced to labor alongside those savages."
"I... shall still be over there, you know," the director muttered, rubbing his chin.
"You, Director, at least grasp the premise of foul miasma and practice antisepsis, which makes you a blessing. But the others... good lord! No matter how many times one explains it, they simply refuse to listen! I begged them to employ the stethoscope, yet they stubbornly decline, burying patients alive to this very day!"
"That... does prove rather exasperating, I must admit."
Blundell was now enduring the very same maddening frustration that had plagued me upon my arrival in this backward century. Things had improved, certainly. Washing one's hands after dissecting putrid cadavers had finally become routine among our immediate circle. But scrubbing down prior to touching an open surgical wound—practices that required a firm grasp of microscopic pathogens—remained hopelessly lost in the intellectual fog. Basic sanitary protocols were routinely trampled underfoot.
There had been no shortage of opportunistic quacks attempting to steal our crude diabetes treatments, but fortunately, we had fortified our defenses. The extraction protocol for insulin remained a closely guarded secret, and procuring fresh bovine pancreases in bulk without our blessing was an impossible hurdle.
Why? Because we had forged a pact with the local street syndicate. In exchange for them delivering fresh cow pancreases to our doorstep every dawn free of charge, we extended our protection over their enterprise.
Though calling it 'protection' feels rather absurd on the face of it.
Yet thanks to our aristocratic connections, the police treated the gang with remarkable leniency, and should push come to shove, they had the terrifying threat of Liston the Sword Master in their corner. For the underworld, it was an indisputable bargain. And for us, an endless supply of glandular tissue.
"Well, if that is your conviction, so be it," the director conceded, walking onward. "In any case, here is the operating theater. I still fail to see why you insist on isolating the surgical suite so drastically, but since you demanded it, I had it partitioned according to your specifications."
"My deepest thanks, Director."
We strolled past the theater and into the recovery wards. Because the structure had not been erected as an infirmary, the rooms were exceedingly compact. Yet that was hardly a disadvantage. Shoving twenty groaning, festering souls into a single cavernous hall was not a hospital—it was an open-air crypt. A layout that restricted each chamber to three or four convalescents was a luxury I had not anticipated, but now that it was realized, it was magnificent.
"It is... remarkably intimate, in every sense," the director murmured. Accustomed to presiding over a massive, bustling institution, the modest scale clearly left him feeling uneasy. Perhaps that was why his parting instructions dragged on.
"Mind you... separating yourselves here does not mean you are barred from the main hospital's resources. If any scoundrel gives you trouble... Liston, do not take matters into your own hands. Report them directly to me. Do not hospitalize them in the morgue, do you understand?"
"Yes, yes, quite."
"Do not give me that halfhearted drone! The Metropolitan Police sent a formal complaint just last week, begging you to cease fracturing jawbones!"
"Understood, sir."
"And... well, I am sure you will manage splendidly. If any intractable trouble arises, consult me at once."
"We shall."
"Excellent. Let us amass a staggering fortune! One can name any price under heaven for diabetes treatment. Ha-ha!"
Only after a prolonged barrage of chuckles and warnings did the director finally board his carriage and rattle off toward the main hospital.
"At long last, we are on our own," Liston remarked, exhaling a deep breath of satisfaction.
"A relief, truly."
"Indeed. It cleanses the soul to be rid of those ignorant buffoons."
"It certainly does."
Though it was rich hearing Liston brand others as ignorant barbarians, our faction unquestionably stood at the bleeding edge of the civilized world. No one else gave a damn about antisepsis. Or rather, even those who suspected its merits refused to acknowledge them out of stubborn pride.
Regardless, now that we had established an independent center, we had to earn our own bread. Not that financial ruin was a concern—we had already been raking in coin hand over fist.
"Who is our first consultation?" Liston asked.
"Lord Jamie, of course. The man requires daily maintenance."
"Ah, yes. But tell me, Taepyeong, once diabetes takes hold, must the wretched soul endure treatment until the grave? Is there no surgical recourse?"
A surgical cure for diabetes did not exist even in the twenty-first century. If one stretched the definition, bariatric surgery for morbid obesity offered metabolic remission, but Duke Jamie's condition was a tangled knot of advanced age, severe physical inactivity, and a total void of male hormones following his castration. What he desperately required was rigorous physical conditioning and strict dietary intervention, yet enforcing such discipline upon a high-ranking peer of the realm was a harrowing prospect.
"Well... I intend to subject him to exercise," I said.
"Exercise? I am told he rides to hounds regularly."
"Not leisurely country jaunts. True therapeutic exercise that suppresses glycemic spikes."
"Such a discipline exists? If so, I should like to test it myself."
"Come observe, then. I set aside an empty chamber specifically for that purpose."
"Ah... the room with the iron bells?"
"Precisely."
I had converted a spare room into a gymnasium. Forging custom dumbbells and barbells of modern proportions would have cost an exorbitant sum, so I had simply purchased standard iron bells of uniform weights. Bells—the very reason modern weights came to be christened dumbbells, barbells, and kettlebells. Training with actual bells was historically orthodox enough, so it would serve our ends well enough.
"Greetings, gentlemen."
As we lounged in the consulting room exchanging banter, Duke Jamie made his entrance. Months of insulin therapy had worked wonders; his complexion was incomparably healthier than the sallow, half-dead visage he had worn upon our first acquaintance.
"A very good day to you, sirs!" barked the man standing briskly beside him.
It was His Grace's personal sommelier. His palate was so exquisitely refined that he had become an indispensable diagnostic instrument for our clinic.
"Yesterday's sample bore not the faintest hint of sweetness!" the sommelier reported with military vigor. "The humors appear to be under magnificent control!"
I occasionally questioned the morality of allowing a human being to make a living by tasting another man's fresh urine, but quantitative chemical analysis of urinary glucose was still dreadfully primitive in this era. Hiring a dedicated taster remained vastly cheaper and faster than burning through reagents for every single test.
"Splendid," I said. "Then we shall proceed with the standard dosage."
"Yes, yes, please do. Ah... one would think I should grow accustomed to this, yet it never ceases to unnerve me," Duke Jamie grumbled, lifting his waistcoat and linen shirt to expose his soft, pale abdomen. He prepared himself to receive the morning's dose of bovine insulin, extracted fresh at dawn.
I sank the needle into the flabby flesh of his belly.
Our months of labor had yielded significant mechanical upgrades. The syringe now featured a properly vulcanized rubber gasket at the plunger. As I depressed it, the pneumatic pressure transferred with seamless precision, driving the liquid cleanly into subcutaneous tissue. Unfortunately, the needle itself remained as brutally thick as an iron awl.
"Bleeding! It is bleeding again!"
"Ugh... confound it, that smarts..."
Every injection concluded with a firm press of gauze to staunch the flow. Refining the gauge of the needles was paramount, but metallurgy of this era made ultra-fine hollow bore manufacturing agonizingly difficult. Still, we could not simply surrender to despair. If we could stimulate muscular hypertrophy through resistance training, his peripheral insulin sensitivity would rise, potentially reducing the frequency of these wretched injections.
Though given his complete lack of testicles, building substantial muscle mass is an uphill battle.
Keeping that indelicate medical reality strictly confined to my internal thoughts, I placed a firm, restraining hand upon His Grace's shoulder.
"Hmm? What is it?" The duke turned, eyes widening in panic as I arrested his hasty retreat toward the door.
"You engage in no physical exertion, do you, Your Grace?"
"I told you, I ride to the hunt!" he protested, his face twisting into an expression of wounded indignation. It was an utterly laughable defense.
"Your heart must pound against your ribs, and sweat must pour from your brow."
"Preposterous! Are you commanding me to perform common manual labor?"
"Come now... allow me to instruct you in proper regimen starting today. Right this way, please."
"U-ugh... it terrifies me when you wear that look upon your face."
"Whatever look could you mean?"
"The arsenic dress look."
"Ah. Perish the thought. Why on earth would I harbor malice toward Your Grace? You are, after all, a paramount investor in this very clinic."
"Precisely! Would my untimely demise not leave you holding all the spoils?"
"I am hardly so wicked a man."
"I... I see..."
His Grace hesitated, casting a desperate, pleading glance back toward his personal urine sommelier.