Knock, Knock, Would You Mind Opening the Door? (Part 2)
“How do we open it?”
Opening it today was out of the question. For one, there was an important meeting scheduled, and worse still, the patient was severely debilitated from having been bled half to death. I hadn't taken his blood pressure, but if I had, his systolic reading probably wouldn't have cleared a hundred. Good grief.
Come to think of it, how do you even measure blood pressure right now? When did people start doing that?
I would have to resolve the present crisis first and figure out blood pressure later. If my hunch was correct, an apparatus or method ought to exist somewhere. That was the beauty—and horror—of the nineteenth century. If you hunted thoroughly enough, virtually everything already existed. The trouble was that people either blithely ignored the inventions or deployed them in completely absurd, unrelated fields.
“I asked how we open it.”
At any rate, the blood pressure conundrum would have to wait. And no, my urgency wasn't merely because Liston was glaring at me with that imposing face of his. I wasn't backing down out of fear. Not at all.
Shifting my focus, I looked down at the corpse Liston was pointing toward. Naturally, it had been dispatched courtesy of the police department. Where on earth they kept finding so many fresh corpses was beyond me, but whenever we made a request, they sent them over by the wagonload.
“First, we shave the hair.”
“Why? Why shave it? Does that carry some occult significance?”
To operate on a skull, shaving the head was basic common sense. Loose strands fluttering about would obscure the surgical field, and above all, the miasma clinging to the hair—no, damn it!
Bacteria and viruses were the real hazards. Furthermore, hair posed a massive obstacle during post-operative recovery. One needed a clear view of the wound to monitor infection, and a thick mop of hair made proper inspection impossible. When I explained this, Liston, who had been rearing up like an agitated warhorse, flushed red with embarrassment.
“I… I see. You have convinced me. That is eminently rational.”
“Naturally. I don’t shave people for my own amusement.”
“And yet, staring intently at my scalp at this precise juncture does not strike me as particularly rational, does it?”
I had merely thought that a bare scalp would make cranial trepanation exceedingly convenient. But had I voiced that thought aloud, I would have been the one laid out on the operating table. Worse, someone else would be holding the knife—which was functionally a death sentence. The harder they tried to save me, the quicker I would end up in the grave.
“No, of course not. Now then… fetch that for me.”
“Right. You mean the shears, yes?” Alfred asked.
“Precisely.”
Taking the shears from Alfred, I sheared away the corpse’s hair down to the root. Honestly, it didn't matter which section I cleared since this was merely a dry run. However, figuring it would serve as better practice if we mirrored the Member of Parliament's injury, I shaved half the scalp around that corresponding area. As I snipped away, I was reminded anew that even haircutting was backbreaking labor without modern conveniences. Electric clippers… Oh, how I missed the twenty-first century.
“Hand those to me,” Liston said, stepping forward. “We simply need to crop the hair as close to the skin as possible without nicking the scalp, correct?”
“That's right.”
“Then allow me. Your notions are undeniably brilliant, Taepyeong, but when it comes to raw manual labor, your hands are dreadfully clumsy.”
“I… well, if you say so.”
I consoled myself with the reminder that Robert Liston was on our side. A man of his caliber could substitute for half an arsenal of specialized instruments. Better yet, whenever you assigned him a physical task, he took to it with immense, boyish delight, heedless of time or place.
Snip, snip, snip.
Just look at him. His speed was terrifying. In the blink of an eye, the hair had been stripped bare. The man was an absolute marvel of dexterity. His hands were the size of dinner plates, yet he manipulated them with surgical delicacy. In terms of final surgical outcome, we were comparable, but his sheer velocity was an unfair advantage.
“Splendid,” Liston rumbled, stepping back. “Do we smash it open with a hammer now?”
“No! Absolutely not.”
Taking a hammer to a living skull was called murder. Shaking my head vigorously, I held out an open palm toward Colin. As an assistant, Colin had achieved a level of competence that bordered on telepathic.
“The scalpel, sir?”
“Yes.”
Taking the blade, I cut a firm incision across the scalp, tracing the exact location of the politician’s trauma. As the flesh parted, I noticed what looked like faint purplish discoloration underneath. Then again, living in the nineteenth century had forcibly taught me that dead bodies developed post-mortem lividity in the strangest places, so I paid it little mind.
“Hand me the spreader.”
“Right here.”
This time, Joseph passed the instrument. When I said spreader, it wasn't anything extraordinarily high-tech. Picture the ratcheted mouth prop a dentist shoves into your jaws to keep them forced open. I had simply commissioned German craftsmen to refine that mechanism, and thanks to their exquisite metallurgy, it functioned almost identically to a modern surgical retractor. I had originally designed it for appendectomies, so it was slightly oversized for cranial work, but expanding the incision was a deliberate choice.
Better to secure a wide, unobstructed surgical field than cause a catastrophic mishap out of petty squeamishness.
Had I possessed modern monitoring equipment and an intensive care unit, I wouldn't have resorted to this. Nobody wanted to slice a seven-centimeter gash into a man's scalp just to bore a hole and clear a blood clot. But what choice did I have? I was running a one-man show in an era of medical barbarism. The smartest course of action was to make the procedure as straightforward as humanly possible.
“The connective tissue anchoring the scalp here… if we tap gently with the flat of the blade, it should peel away cleanly.”
Even now, I had to act the role of the humble experimenter, pretending I was working it out on the fly while carving flesh. It was exhausting.
“Oh… it truly comes away,” Liston murmured, leaning in.
The problem presented itself an instant later.
“Wait. Is a skull supposed to look like that?”
“No…”
The bruised scalp had looked suspicious, but the bone underneath was downright bizarre. A man dying didn't cause his skull to turn to mush. This had to be the consequence of massive blunt-force trauma. When I applied gentle pressure, the bone yielded inward by nearly two centimeters.
This is beginning to feel like a forensic autopsy.
Had the police really dumped this off as a common, unclaimed vagrant? The corpse looked barely out of his youth. Granted, young men dying in London gutters was hardly an anomaly, but shouldn't someone have investigated whether he’d been bludgeoned over the head first?
“At any rate,” I said, clearing my throat, “could you bore a circular set of holes right around this margin?”
“With what tool?”
Though part of the cranium was already fractured, an intact perimeter remained. We needed to breach that intact bone with the utmost precision. Or rather, not 'we'—Robert Liston, London's human bone drill, was going to do it.
“Could you attempt it with this?”
Properly speaking, I should have handed him a trephine or a cranial drill, but I handed him a scalpel instead. More specifically, I directed his attention to the heavy pommel forged onto the base of the handle. Being the handiwork of German master smiths, the steel was extraordinarily dense.
“I feel as though I could cave your skull in with this,” Liston remarked, tapping the butt with a gloved thumb. His tone was terrifyingly conversational, though he mercifully directed the blade toward the corpse’s bone rather than my head. “So, rather than shattering it haphazardly, you wish for the bone to part in a neat, continuous ring?”
“Yes, exactly. As expected of you, brother. Just like an amputation—hew through the bone cleanly so we can pop the lid off.”
“Must you accompany your explanation with that ridiculous hand gesture?”
“Pardon? It makes the concept easier to grasp.”
“It makes me feel as though you are eagerly anticipating my own lid popping off.”
“Ah…”
Perhaps because his own temper—and hairline—had already blown its lid long ago, everything appeared through that lens to him. Still, knowing it was merely his personal insecurity, Liston simply clicked his tongue and refrained from grumbling further. Instead, he resumed rhythmically tapping against the cranium.
“Can you gauge the density from that?”
“Aye… once you have broken enough bones, you develop an instinct for how the strike must fall. Since you may have to perform this without my presence someday, Taepyeong, you ought to practice smashing things in your spare time as well.”
“Uh… certainly.”
“If you instruct our lads from the street gangs, they can round up some subjects for you. Or you could simply practice on fresh corpses.”
Any sane human being would obviously choose to practice on corpses! And what did he mean, 'smashing things'?!
Thud.
Before my internal indignation could mount into a protest, Liston struck.
Thwack!
Having tapped the surface several more times, he nodded to himself as though an internal equation had resolved. Then, with terrifying precision, he brought the rounded pommel of the scalpel down upon the bone.
Even an electric bone saw couldn't have executed a cleaner cut.
Does the man genuinely possess internal sword qi or something?
As anyone with basic anatomy knew, the human skull is solid bone. It is built to withstand formidable force. Yet Liston carved away a pristine, circular disc of bone using nothing more than the butt of a surgical knife.
“If we pry this loose… Sweet mother of God, what in blazes is that?!”
Liston lifted away the circular bone flap, and beneath it squatted what appeared to be a cluster of writhing, pitch-black worms.
“Carbolic acid! Disinfect it!” Joseph bellowed, instantly reaching for his carbolic sprayer.
“No, stop! Joseph, look closer!”
For a fleeting second, I had also assumed some horrific parasite had infested the corpse, but upon closer inspection, it was merely clotted blood. As Joseph froze with his disinfectant apparatus half-raised, the rest of the room stared fixedly at my fingers. More specifically, they gaped at the thick, congealed blob of hematoma resting in my palm, resembling a slab of boiled blood curd.
“Ah… it’s blood.”
“Indeed. A hematoma.”
“So it is.”
Had this been our early days together, they might have leaped to some wild, superstitious deduction, but not anymore. For better or worse, working alongside me had inundated them with blood to the point of utter nausea. Liston spent his days severing limbs and ordering buckets of gore hauled away, so he knew better than anyone what blood looked like once it coagulated. The others were no different; Blundell’s obstetrics ward saw enough catastrophic hemorrhaging to rival a battlefield.
“So this pooled beneath the skull… and by pressing upon the cerebral tissue, it provoked severe agony,” Liston reasoned, rubbing his chin.
“Did this fellow perish because the effusion grew too immense?” Colin inquired.
“Difficult to say with certainty,” I replied, “but severe trauma and intracranial pressure are fatal. It is entirely plausible.”
“Hah… which means this poor wretch did not simply drop dead. He was beaten to death by someone.”
The dissection had organically evolved into a remarkably constructive clinical seminar.
“Precisely,” I agreed. “Which brings us to the crux of the matter: we must evacuate all of this congealed blood. The question is… how do we clear it out?”
Being an exceptionally magnanimous educator, I allowed them to debate amongst themselves until their theories ran dry before posing the question. Naturally, I didn't simply hand them the solution. I cast the dilemma back onto them. To be brutally frank, it wasn't because of my pedagogical philosophy—it was because I genuinely didn't know how to achieve it without twenty-first-century equipment. Modern operating theaters had continuous mechanical suction. Here, we had nothing. And because this required delicate finesse rather than raw horsepower, Liston’s brute strength was entirely useless.
“Allow me to attempt it,” Joseph volunteered, stepping forward with a wad of sterile gauze.
One glance at his posture told me disaster was imminent.
“Joseph.”
“Yes?”
“What good is mopping up the blood if you turn the patient’s brain into mashed porridge in the process…?”
“Ah.”
Fortunately, Joseph wasn't stubborn. Comprehension dawned upon his face, and he sheepishly retreated a step. After that, no one dared volunteer. The human brain was a soft, gelatinous mass. While slightly more resilient than popular imagination suggested, it was still infinitely more fragile than any other internal organ. Clearing away a dense, adherent hematoma without damaging the underlying cerebral parenchyma was a monumental task. Of course, one could compromise and leave a thin film behind to be naturally reabsorbed by the body over time… but leaving dirty clots behind felt deeply unsettling.
Just then, Liston’s gaze shifted toward Alfred and Colin.
“If memory serves,” Liston murmured, a devilish grin spreading across his face, “Taepyeong once made mention of a ‘human suction device,’ did he not?”