Knock Knock, Won't You Open the Door? [4]
I had assumed only the constables would follow us inside, but behind them filed a sizeable crowd: reporters, Sir Jamie, and even the Hospital Director. Thanks to the sudden influx, the parlor that doubled as our waiting room was packed to the gills in an instant.
Yet it was by no means loud. Everyone held their breath in utter silence, straining their ears to catch the Member of Parliament's reaction to my declaration.
From my perspective, it was a little... baffling.
If your belly aches, you open the belly; if your head aches, you open the head. Isn't that just common sense?
That wasn't an axiom unique to the nineteenth century either. It held just as true in the twenty-first. Or wait—did that logic not apply in the nineteenth century? Wondering if I was letting my modern twenty-first-century sensibilities get ahead of me, I took a moment to reflect on the usual atrocities committed in nineteenth-century operating theaters.
It wasn't a difficult exercise. I had exerted tireless effort up until now just to avoid being branded a lunatic. Thanks to that, procedures like lithotomies and scrotal resections—surgeries that couldn't be called refined or civilized even as a joke—immediately sprang to mind.
Okay, I haven't done anything wrong. This guy is just being a coward.
Good. In that case, there was no reason not to double down with complete confidence.
"Yes. We must open your skull."
"Th-that's..."
I declared it boldly, gesturing politely toward the Member of Parliament's head. His retinue and the constables recoiled in shock, though the others remained still—save for Sir Jamie, who shook his head for reasons known only to him.
Regardless, the room remained quiet. In the midst of that hush, the MP was the first to find his tongue.
"Tell me, Pyeong."
"Yes, sir?"
"Do you, by any chance... have ties to the Qing Dynasty?"
"Pardon?"
I stared back at him, wondering what fresh lunacy this was. Liston clapped a heavy hand on my shoulder and stepped forward.
"Not at all. Pyeong-shin is unequivocally a man of Joseon. And as far as I understand, the Joseon people harbor a deep hatred for the Qing ever since the Pyeongja Horan."
Amazingly, he was pretty spot-on. Where on earth had he even heard of the Byeongja Horan—or rather, the 'Pyeongja' Horan? When I turned to look at Liston in astonishment, he gave me a sly wink and pressed on.
"Pyeong devised the opening of the skull purely as a means to cure you, my good sir. In fact... I imagine your headache has grown even worse recently, hasn't it?"
"It has, indeed. But could that not simply be because I haven't been bled?"
"Bloodletting, you say..." Liston paused.
Had it been me, I likely would have lost my temper right then and there. Bloodletting was the quintessential treatment born from that cursed humoral theory. And what was humoral theory? A hypothesis concocted by people two thousand years ago—a mere hypothesis!
Of course, I gave Hippocrates credit for proposing revolutionary ideas that were daring for his era. Some of his observations held up remarkably well even to modern eyes. But the four humors? Absolutely not. Any notion bred from an age devoid of accumulated empirical knowledge was bound to be clumsy at best.
"To tell you the truth..." Liston began.
He was taking quite a while to choose his words. Considering how sharp Liston's intellect actually was, it was rather surprising. His sheer physical might tended to overshadow it, but by any metric, the man bordered on genius. Anyway, if one were to critique bloodletting through the lens of modern hematology...
First of all, blood was produced in the hematopoietic organs—namely, the bone marrow. It wasn't made once and done; it was constantly synthesized every single hour. Why? Because the cells comprising blood possessed a finite lifespan. And not a long one at that: a few months at most, and merely a few days for the shorter-lived ones.
"What Pyeong has proposed is also bloodletting."
Once those cells reached the end of their lives, they were filtered out and destroyed by the spleen. That was why our total blood volume maintained an equilibrium despite the non-stop production of new cells. Of course, prolonged exposure or residency at high altitudes would trigger an increase in red blood cell counts to adapt to the thin air...
Wait. What did he just say?
"Pardon?"
"Eh?"
The question slipped out before I could stop myself. Fortunately, I wasn't the only one caught off guard; the rest of the room looked equally dumbfounded. Surprisingly, our own cohort—Blundell, Joseph, Alfred, and Colin—stood by with blank, receptive expressions. It seemed those rascals actually followed what he was getting at.
"There are many kinds of dead blood," Liston expounded smoothly. "Some gathers in the back, the arms, the ankles. But mixed within it, there is bound to be living blood as well. How could there not be?"
"Well... I don't quite follow, but coming from you, I shall take your word for it."
I don't follow either. What on earth is this giant rambling about?
Regardless of my bewilderment, Liston pressed on. The room was hardly spacious to begin with, and Liston's colossal frame utterly dominated the atmosphere. Everyone hung on his every word. In the midst of that rapt attention, Liston chuckled softly.
"A method to extract only the dead blood... that is precisely what our Pyeong has devised. Even I was astonished! Now then: your head aches because there is too much blood congesting within it. To resolve this, purging the blood would be ideal, would it not?"
"Indeed."
"The peculiar thing, however, is that even after you bleed yourself, the pain promptly worsens. That demonstrates the limitations of traditional methods."
"Mmm... It is true... Lately, even when I bleed myself frequently, the pain persists. It aches even now."
It was utter nonsense. Blatant, unadulterated quackery. And yet...
If I let him run with this, it might actually work.
Besides, I had tossed my reputation among future medical historians out the window long ago. The moment I started humoring all that miasma garbage to survive, my legacy was already ruined. So what if history recorded that I practiced trepanation under the guise of bloodletting? Future scholars would just say, "Well, Pyeong pulled a Pyeong again." And by then, I'd have been dead and buried for ages anyway.
"Imagine if we could drain solely the dead blood—how wonderful would that be?"
"Hrmmm..."
"Boys, bring it in!" Liston barked.
"Pardon?"
"Bring in the corpse from earlier!"
"Ah—right away, sir!"
At Liston's command, the apprentices darted out. A moment later, they hauled the cadaver into the room, gripping it by the arms and legs.
Could you at least put it on a stretcher...? Carrying it like that makes us look like a gang dumping a murder victim.
To make matters worse, the corpse wasn't even intact. The head was...
"Look right here."
Apparently, I was the only one bothered by the optics. The constables merely hummed with interest, peering closely at the dead body with intrigued expressions. And the Hospital Director? He was simply marveling at the neat circular bore in the cranium, whispering in awe, "Ah, the handiwork of Sword Saint Liston!"
None of them were in their right minds. Still, it seemed it didn't matter.
"Dead blood pooled right here, pressing down upon the brain," Liston explained. "We evacuated it... and in truth, this poor wretch likely perished because of it."
"Good heavens! Are you suggesting I, too, could die from this?"
"Precisely."
"Dear me... that simply won't do!"
Amidst this absurd spectacle, the patient was being rapidly, thoroughly persuaded. The reporters were nodding along with deeply moved expressions, scribbling furiously in their notepads. Naturally, strict censorship was underway; Sir Jamie, his cronies, and the Hospital Director hovered right over the journalists' shoulders, vetting every word committed to paper.
Nothing about this scene was normal. Then again, precious little in the nineteenth century felt normal to a man from the twenty-first, so I just let it happen.
"Which is why we must open it," Liston declared firmly. "With Pyeong and myself at the helm, no misfortune will befall you."
"Hrmmm... To be sure, you two are the finest surgeons in London."
"The finest in the world, sir. If we are the best in Britain, does that not make us the best on the globe?"
"That is true enough. Very well... I consent. Just give me a moment... may I have a moment?"
"Of course."
The MP was completely won over. The conversation to follow would amount to little more than meaningless comforts and prayers.
"Sir Jamie."
"Indeed. I never imagined you would need your head opened, but if it is the judgment of those two, they are almost certainly correct."
"I suppose so."
"I shall pray for you."
"Yes, please do. This operation is... sigh... such an enormous undertaking, the burden weighs heavily upon me."
"Leave your worries to the Almighty above. For now, you have only one duty: put your mind at ease."
"Yes, I shall."
Just as I had anticipated, they traded words of comfort and devotion. In truth... if I were being completely honest, the one who actually needed comfort and prayers was me.
What if we open him up and there's nothing in there?
The probability of finding nothing...
I don't even know.
Medicine was fundamentally an evidence-based science rooted in statistics. But would a case like this even exist in any statistical registry? Hell, did the concept of medical statistics even exist in this era? It probably did in some nascent form, though hardly anyone utilized it actively.
Well... I'll just cross that bridge when I get there.
I glanced at Liston. Was he harboring similar doubts? For some reason, he flashed an ominous smirk right back at me. Having exchanged the grins of two scoundrels, we waited in patient silence while our disciples hurried into the operating theater to inspect the instruments and the surgical table.
"Very well. I place myself in your hands."
"Right this way, sir."
"Are you truly not going to give me any spirits?"
"Unnecessary. You need only inhale that."
"I see... Is there anything else I ought to be aware of beforehand?"
"Ah."
Right. I forgot to get his informed consent.
Not that written consent forms existed in this era, of course. Who was the bureaucrat that eventually invented that essential yet excruciatingly tedious chore, I wondered?
"We must shave your head. You saw the other patient, yes?"
"Ah... that is fine. I can simply wear a hat. Those attending the assembly are well aware of my condition anyway."
"And as for the rest... I shall explain once you lie down."
"Ah, very well. Let us do that."
I laid out the one thing that couldn't possibly be hidden. You can't exactly shave a man's head and stick the hair back on later. Fortunately, hats were wildly fashionable for some reason, and plenty of high-society figures wore wigs to gatherings anyway, so the shaved head was accepted with surprising grace.
Could he take the other possibilities with such casual grace, though? Things like: Oh? There's no blood in here?
"Alfred."
"Yes, sir."
In accordance with our agreement, Alfred was scrupulously polite and formal in front of others—which is to say, before the patient. A truly dutiful senior. He handed over money, volunteered his urethra for catheterization, and treated me with deference...
"Turn it on."
"Pardon? But you haven't explained—"
"I'll explain while it's running."
"Wait, but if you do that—"
"Did you not hear Pyeong?" Liston growled.
"Y-Yes, right away, sir!"
And so, Alfred the Gas Master twisted the valve. Only then did the MP sense that something was amiss, but it was already too late.
"Mmm..."
His consciousness was plainly slipping away. Leaning close to the MP's ear, I delivered my explanation in the most polite, tender tone I could muster.
"Incraniectomiesthereisa30percentchanceofdeathorpermanentdisabilityandbecausenoprediagnostictestssuchasCTscanswereconductedtheremaybenothinginsidewhenweopenituprenderingtheprocedureentirelyuselesstowardsrelievingyoursymptoms."
I rattled it off at breakneck speed so that all necessary information was compactly delivered before he lost consciousness. When I pulled back from his ear, his eyes were already shut. For some reason, a solitary tear trickled down from the corner of his closed eyelid...
I doubt it's because he understood.
He probably didn't even know what a craniectomy was. Spacing wasn't just crucial in Korean; if anything, run-on English without spaces or pauses was completely unintelligible. Flatten the cadence and eliminate the accents, and to an Englishman, it sounded like an indecipherable cipher.
Regardless, I did my part.
Could anyone claim I hadn't given an explanation? Not in the slightest.
My conscience completely clear, I turned to Liston. Liston glared at me with an expression of sheer disapproval for a moment, then took up his shears and began shaving the man's head.