Knock, Knock, Care to Open Up? (Part 1)
"Wait, hold on a moment."
Just as I was about to part my lips, Liston cut in, his rugged features twisted into an expression of profound concern.
"Why... what is the matter?" the gentleman inquired, blinking in bewilderment.
Liston's renown was no longer confined to the medical fraternity. Even back when he roamed the public squares lopping off arms and legs like kindling, whispers among the street gangs had already branded him a sword master. Now, with the advent of surgical anesthesia allowing him to perform multiple amputations a day, his fearsome reputation resounded not merely across London, but throughout the whole of Great Britain—if not all of Western Europe.
How must Liston look through the eyes of a sitting Member of Parliament? At best, something resembling a licensed butcher. When a man of that caliber abruptly interjected with a scowl, a touch of panic from the patient was only natural.
"Ah, pray forgive us, sir," I smoothed over quickly. "My senior colleague possesses a rather impetuous temperament. It appears he has an opinion to share."
"Q-Quite so! An opinion! A matter of professional consultation between medical men," Liston chimed in, rallying his composure. "Might we confer in private for just a brief moment?"
Easy as it was to forget beneath that hulking exterior, Liston was, after all, a civilized gentleman of science. On rare occasions, he was capable of producing remarkably sensible words.
"B-By all means, proceed."
Thanks to his sudden intervention, I was hauled by the scruff into the adjoining chamber just as I stood on the precipice of delivering a crucial verdict.
Slam.
The atmosphere had felt perfectly pleasant right until we crossed the threshold, yet the very instant the latch caught, the man slammed me flat against the wall.
"What... what is it now?" I gasped.
Did I slip up and call him a bald bastard again? No, impossible. I certainly hadn't. While it was true that back before my transmigratory misfortune I had taken great pleasure in humming Gwana's Thirty Perks of Being Bald, my instinct for sheer self-preservation was far too honed to ever let such heresy cross my lips in front of Liston.
"I ought to be the one asking!" Liston hissed, looming over me. "What in God's name has come over you?"
"What did I do?"
I rapidly sorted through my thoughts, arriving at absolute certainty. I had nothing to feel guilty about. I hadn't breathed a single syllable even hinting at hair loss. I had contemplated a head, certainly, but that was the MP's skull. I merely wished to pry the bone open; I had no interest whatsoever in parting his hair.
"Do you have any earthly idea what sort of face you were just making?"
At Liston's reprimand, Blundell—who had slipped into the room behind us without my noticing—nodded vigorously in assent. In fact, he was not alone; Alfred, Joseph, and Colin were all huddled in the corner, nodding along with identical, terrified solemnity.
Wait, if this entire gaggle had trooped in here together, didn't that mean the patient had been left completely unattended in the parlor? What manner of respectable clinic operated like this? Since I had no mirror to discern what expression had possessed my face, I simply held my tongue. It wasn't as though he had asked because he genuinely needed an answer anyway. Give him three seconds, and he would blurt it out himself.
Sure enough, before my lips could even twitch, Liston barked: "You had the exact countenance you make right before carving into a fresh cadaver!"
"Precisely!" Blundell chimed in, trembling. "What ungodly scheme are you brewing in that head of yours? The man is a Member of Parliament! An MP! A prominent figure of the senior benches! He might well secure a Cabinet minister's portfolio by next year or the year after!"
"Me? Schemes?"
"Yes, you! If you have an excuse, out with it!"
"Well, you see..." I began mildly. "I merely thought I would like to open his skull."
Dissection, of all things? How dreadfully unfair. An anatomical dissection can only be performed once a fellow has already breathed his last. I could swear before the Almighty that I had never once harbored the intention of killing a patient. If anything, I spent every waking hour struggling desperately to keep them alive. True, there were instances where I had failed to stop other butchers from botching a slaughter on the operating table, but those were acts of God beyond my control.
Yet when I offered this perfectly reasonable correction to their absurd suspicions, their expressions curdled into something far more horrified than before.
Ah... right. Trepanation hasn't established itself as standard surgical practice in this era.
Which was rather bizarre when one thought about it. While I had never formally studied the history of medicine, even I knew that craniotomy had been practiced for thousands of years. Civilizations spanning antiquity had drilled holes into skulls and patched them up, yet nineteenth-century European physicians—men who possessed a fervor for experimentation that bordered on the deranged—had somehow balked at standardizing the procedure. It was utterly bewildering.
"Open his skull...?"
"That is no different from declaring your intent to murder the man!"
"A-Ah... Could it be that you hail not from Joseon, but from the Qing Empire?" Blundell stammered, his eyes widening with wild conjecture. "Is that it...?"
"Could he be... a foreign agent...?" Liston rumbled, his brow furrowing.
While I stood momentarily lost in contemplation, Liston and Blundell were busy spinning a grand geopolitical conspiracy out of thin air. If I didn't disabuse them of this madness immediately, the conversation was going to escalate straight into high treason.
"I-It is nothing of the sort!"
"Then what is it?!"
"Please, I beg of you, let us simply bleed him," Blundell pleaded, clutching his temples. "What extraordinary remedy could there possibly be? O-Or perhaps I might procure an electric eel from the docks? A sharp galvanic shock should suffice!"
I waved my hands frantically, but it did little to stem the tide. Possessing far less stomach for violence than Liston, Blundell had let his nervous imagination run entirely amok. An electric eel? Now that sounded like an ingenious method of assassination.
Think, brain, think!
I scrambled to construct a plausible pretext. Though at this rate... all that ever bubbled up to the surface was unadulterated fraud. Granted, I often suspected the heavens had cast me into this filthy century precisely because I was a grandmaster of fabrication, but even this felt like a stretch.
"In Joseon, you see..."
Completely detached from my inner turmoil, my mouth was already weaving lies with practiced fluency. Tales of a homeland I had never once laid eyes on in this life poured forth without friction.
"Did I not mention before that we are a warrior race? The Korean people, that is."
"Uh... so you claim," Liston muttered. "I recall you mentioning their repertoire of profanities is extraordinarily vibrant."
"Indeed. But we do not merely trade insults; we engage in bloody brawls. And when men come to blows... strikes inevitably land upon the head."
"Hmm... striking the skull is certainly efficient," Liston mused, staring down at his massive, cast-iron hands. "Though in my experience, people generally die when struck there."
If anyone else had made such a remark, I would have dismissed it as cheap bravado, but that distant, glazed look in his eyes was unquestionably fond reminiscence. Watching him reminisce was doing terrible things to my nerves, so I averted my gaze toward the door. Through the narrow crack stood the MP's private attendant.
Fortunately, the boy appeared not to have caught our frantic whispers of dissection and assassination; his face wore only a look of curious anticipation. Surely the lad wasn't a Qing operative either.
"Let us suppose the strike was delivered with moderate force," I continued smoothly. "In most cases, the victim recovers without incident. Yet on occasion, as days turn into weeks, an agonizing headache takes root, worsening by degrees until the poor wretch abruptly drops dead."
"Ah... I believe I have witnessed such an affliction," Liston murmured, scratching his chin. "Yes, I have seen men perish in precisely that fashion... Wait, did not the MP mention earlier—"
"Precisely! It is an identical presentation, which led me to this deduction. In any event, a practitioner in Joseon once resolved to open the skull at the exact site of impact. The patient perished in the end, of course... for they lacked the sophisticated doctrine of miasma that our great British Empire has so brilliantly refined."
"Ah, quite understandable," Liston nodded sagely. "An infection of the cranium would spell certain doom. But go on—what did they discover?"
"They found that dark blood had pooled beneath the bone."
"Blood? But blood is meant to reside within the body, is it not?"
"Not stagnant, sir. Blood must circulate. What had gathered beneath his skull was dead, corrupted blood."
"Aha!" Liston slapped his thigh. "Then we must perform phlebotomy directly upon the head!"
Phlebotomy... good grief, how do I steer them away from that blasted word?
The trouble was, this time he wasn't entirely mistaken. Draining the trapped, clotted hematoma was indeed the crux of the operation. Never mind that what these gentlemen called 'phlebotomy' usually meant draining perfectly healthy blood from living veins under the delusion of purging foul humors...
"The blunt impact likely tore a delicate vessel beneath the bone," I explained in earnest. "Blood seeped out, pooling steadily in the confined space... and as it expanded, it compressed the brain, bringing about this relentless agony."
In truth, rather than merely pressing upon the tissue, the expanding mass increased intracranial pressure, triggering the debilitating cephalalgia. But what would be gained by burying them under such modern terminology? Framing it in concepts they could grasp was the wisest course. Confusing them further served no one.
"Oho... I see! That makes eminent sense," Liston rumbled, his eyes lighting up with a sudden, feral gleam. "Then we must pry it open without delay!"
His eyes were rolling back with surgical bloodlust. He was the one who had dragged me into this room to scold me, and now he was the most unhinged lunatic in the room.
"Wait, hold on!" Blundell squeaked, raising his hands in terror. "What if we rashly bore into his cranium and find no blood whatsoever? What then?!"
Fortunately, Blundell possessed the constitution of a frightened sparrow. Whether being a coward was a virtue remained up for debate, but as someone charged with managing Robert Liston, having such an effective dampener around was a blessed relief.
The only trouble was, my honest reply did little to soothe his nerves.
"What then? Then there is nothing for it."
"You mean to say... we drill open an MP's skull, find nothing, and simply say 'there's nothing for it'?!"
Blundell began to sway as if struck by apoplexy. A glance toward the doorway revealed that the attendant's face had drained of every drop of color. Only Liston remained utterly unperturbed.
"Such is the very essence of surgery!" Liston bellowed cheerfully. "How can any man be certain of what lies beneath until the blade goes in? Half the bellies we cut open, we simply sew right back up!"
"Then the odds of his survival are no better than a coin toss?!"
"No..." I countered quietly.
I suspected our chances were substantially higher than that.
The fact that his headache temporarily eased following a standard bloodletting... meant that dropping his systemic blood pressure briefly alleviated the pressure inside his skull. If this were a simple case of acute sinusitis, bleeding him would not have offered a shred of relief.
If it were an intracranial neoplasm... a similar drop in pressure might grant temporary comfort, but the history of recent head trauma is far too neat a correlation. Given that he was attending to parliamentary business without issue prior to the carriage jolt, it cannot be a chronic malady.
Perhaps I was spinning an overly optimistic narrative in my head, but there existed no other viable remedy to deliver the man from his torment.
"Ugh... uuuugh!"
While we stood locked in debate, a ragged groan drifted from the parlor.
"Ah!"
Led by Liston, our entire procession burst back into the examination room. The MP, who had appeared reasonably composed just a short while ago, was now doubled over, clutching his head in sheer agony.
"Is the pain severe, sir?" I asked, stepping forward.
"It is... God in heaven, it is intolerable..."
"Oh, Lord, sir!" the attendant cried, wringing his hands. "We bled him just yesterday evening... yet these wretched fits grow more frequent by the hour!"
"Please... draw the blood again... anything..." the MP gasped, trembling.
"I beg of you, gentlemen!" the attendant pleaded. "He has a crucial vote in the Commons this very afternoon..."
Having confirmed his distress, I leaned in to inspect the patient's eyes and reflexes. The agony appeared diffuse across the entirety of his cranium, accompanied by a distinct retro-orbital pressure. Classic clinical hallmarks of dangerously elevated intracranial pressure.
We have to open it. There is no other way.
Did Liston discern the absolute certainty in my eyes? He slammed his massive fist onto the wooden side table with a resounding crack.
"My dear sir!"
"Y-Yes? Speak, doctor, I beg of you..."
"You ventured to our clinic because you placed your unwavering faith in Sir James, did you not?"
"I did... but more than that, who in the whole of London does not know the name of Dr. Pyung-shin these days? A worker of miracles, they call him. Ah, and yourself as well, of course, Mr. Liston!"
"Well, then," Liston declared, puffing out his chest. "It is our unified medical consensus that we must open your head."
"...Pardon?"
The MP cocked his head, his clouded eyes struggling to comprehend the meaning behind the words, even while his fingers remained glued to his throbbing temples. The sheer intensity of his suffering made it abundantly clear that this was no ordinary migraine.
Which stood to reason. Men of the nineteenth century rarely darkened a hospital door unless death was already knocking on their shoulder. For an esteemed gentleman of Parliament, that went doubly so. Would any educated man forget that entering a hospital ward was practically signing one's own death warrant? Yet here he sat, submitting himself to bizarre ministrations—proof enough of the sheer desperation driving him.
"We must open your skull, sir."
Liston delivered the pronouncement with booming authority, but having not the faintest notion of how to actually execute such an operation, he discreetly slid his gaze toward me.
In truth... it wasn't as if I possessed vast clinical experience with the procedure either. I had never performed a burr hole on a living human skull myself. Yet the operation required today was mechanically straightforward.
All we truly needed to do was open the door and relieve the pressure.
"Was it roughly here that you sustained the blow, sir?" I asked, gently parting his hair to indicate the temporal region.
"Ah... y-yes. Precisely there."
"Then we need only open a modest little window right here."
"The human skull is exceptionally solid, doctor..." the MP murmured through gritted teeth, his brow slick with cold sweat. "Can it truly be unlatched as easily as you make it sound?"
A politician to the very bone. Even while enduring agony fit to split his brain, his eloquence remained remarkably intact.
You needn't worry about that, sir.
It was only natural for a patient to tremble at the prospect of someone chiseling into his skull... but in our hands, failure was out of the question.
After all, we had Robert Liston.
"Yes, sir," I smiled reassuringly. "It will open."