Opening the Door [1]
Snip, snip.
Robert Liston was in the middle of severing a head.
Ah—not the head itself, to be clear, but the hair on top of it. If anyone else were the subject of that sentence, there would be no room for misunderstanding, but given that the man holding the blades was Liston, confusion was entirely warranted. After all, wasn't he someone who could cleave off an entire head in a few brisk strokes, whether with a dull scrape or a single resounding chop? Because he possessed such fearsome dexterity, his skill at cutting hair was nothing short of miraculous.
Good grief... No matter how many times I watch him, the man is an absolute lunatic.
His hands were undeniably gifted. Had he been born in the twenty-first century, his name would have been carved in gold in the annals of surgical history. Not that he was destined for obscurity in the nineteenth century, either. Even in his original timeline, he was destined to be remembered as the Master of Amputation and the Saint of the Scalpel—and now he had teamed up with me, of all people.
"Heavens..."
"A truly magnificent display."
The operating theater was not occupied by our surgical team alone. To call that obvious makes me a little melancholy, but such was life in an era where the understanding of miasma—let alone germs—was still woefully primitive. The Member of Parliament's personal retinue stood inside looking thoroughly self-important, while Sir Jamie, who had recommended me in the first place, watched with an air of solemn, self-imposed responsibility. The puzzling additions to the gallery were the police officers and newspaper reporters.
It was a bit late in the game to kick them out, however. When I operated on Sir Jamie, we had invited journalists to observe the entire spectacle, hadn't we? If I suddenly barred them from the room now, the reporters would raise a stink, and Sir Jamie would find it utterly suspicious. At any rate, with blade work so dazzling that even complete laymen could sense its sublime precision, the honorable parliamentarian's head was swiftly shorn down to the skin.
"Very good. Joseph!"
"Yes, sir!"
Calling it a close shave was an understatement; it was practically a monk's tonsure. In plain terms, the man was bald as an egg. And wasn't rubbing a smooth, bald crown with bare hands an oddly satisfying pastime? On top of that, Joseph was an utter fanatic when it came to sanitation. He lunged forward like an eager hound and began scouring the scalp according to his strict, personal routine.
Until recently, even I had not been entirely familiar with Joseph's exact sequence. It was only after we established our separate clinic center and I observed him closely that I finally grasped the method to his madness.
Swab, scrub.
First, provided there were no open wounds, he applied iodine. I say "applied," but he slathered it on so thickly that the skin took on a deep, unmistakable stain. In the past, absurd rumors had circulated claiming that this concoction was a mysterious elixir invented by 'Lord Taepyeong' to turn white men into Orientals. Fortunately, once people realized the discoloration gradually faded and restored the skin's original complexion as dead skin cells flaked away, the slander died down. In the meantime, I had used it freely on several patients, naturally proving its antiseptic efficacy beyond a shadow of a doubt.
Scrub, wipe.
Next came the carbolic acid—phenol. Following up with phenol stripped away a good portion of the dark iodine stain, which was precisely why he arranged the steps in that order. In hindsight, it made total sense. Why? Because phenol acted as a bleaching agent. It was, quite literally, a chemical meant to erase stains, so naturally it wiped away the iodine. One might wonder if wiping it off compromised its antiseptic power, but iodine actually completes its germicidal work right about the time it dries on the skin. In other words, every single microscopic beast lingering on that scalp was already thoroughly dead.
"Phew..."
Given that the cranium had a simple structure, compounded by the fact that it had been shaved down to a sleek, polished surface, Joseph finished his disinfection far more rapidly and thoroughly than usual. Even without inspecting the surgical site myself, the look of sheer pride on Joseph's face was enough to tell me the job was done properly. Still, I gave the dome a quick once-over.
All set. Time for the steel to bite.
"Right then."
While Joseph scrubbed the patient, Liston and I had washed our hands, slipped into gloves, and washed them once more. We had donned our masks and surgical caps as well. Greedy as I was, I would have loved to wear clean gowns too, but...
"A gown? Can you guarantee the thing would be any cleaner than the clothes on our backs right now?"
Liston had shot down the idea with razor-sharp logic, forcing me to abandon it. When I thought about it, he was entirely right. Aside from our immediate crew, it was safe to say that not a single soul in this country had the faintest grasp of antisepsis or miasma. And burdening Joseph with boiling and sterilizing linen gowns felt like an atrocious waste of his medical talent. He might be acting as a mere assistant for now, but he was a lad destined to become a brilliant lead surgeon one day.
Thus, covering only the areas that would directly contact the patient's body and the spots most likely to spew fluids, we drew our initial incision line across the patient's scalp.
Slit.
Blood welled up and poured forth in an instant. It had been so long that I had forgotten: the scalp possesses an extraordinarily rich vascular network. A minor scrape alone bleeds heavily enough to make a man look like his head has exploded. In modern surgery, one would start by generously pumping local anesthetic mixed with lidocaine and epinephrine into the tissue, and if that proved insufficient, one would clamp the scalp margins with specialized clips to arrest the bleeding. But did we have access to such luxuries here? Not a chance. Not for all the money in the world.
"Wipe it!"
"Right away, sir!"
That didn't mean we were helpless. Compared to a pampered twenty-first-century resident, a nineteenth-century apprentice proved far more industrious in every conceivable way. Though calling them apprentices was perhaps an insult, considering Colin was a blue-blooded aristocrat and Joseph was my dearest friend. At any rate, thanks to the two of them dabbing frantically with gauze, I was soon able to incise the scalp and retract the flaps to either side.
A pale expanse of ivory skull revealed itself to the room. In that moment, Liston leaned in and whispered in my ear.
"This fellow's bone looks entirely intact, does it not?"
He meant that while the cadaver we dissected had a fractured skull, this living patient's cranium was completely whole. In other words, was there a chance we had drawn a blank?
"It's only intact on the surface."
"And if it isn't?"
"Then we bluff our way through. There's plenty of blood pooling here anyway."
"Ah... Pass off the surgical bleeding as stale, clotted blood?"
"What? Is your conscience troubling you?"
"Hardly. I was thinking it was a stroke of sheer genius."
For all his bluster, the man possessed an unexpectedly timid streak. It tended to flare up whenever he stood before high-ranking politicians or wealthy nobles. Regardless, having soothed the sycophantic side of Liston with my silver tongue, I yielded the floor, pressing the scalpel into his palm. Liston looked between the handle of the instrument and the patient's cranium before giving a decisive nod.
Gulp.
Even those who knew nothing of medicine—those who could not possibly foresee what was about to unfold—sensed the suffocating gravity settling over the room. It felt remarkably like the aura surrounding a martial arts grandmaster on the verge of ascending to the Transcendent Realm.
Thwack!
Amidst the breathless silence, Liston struck the parliamentarian's skull with the weighted butt of his instrument. A collective gasp rippled through the gallery. He was not hailed as the Master of Amputation for nothing; every single strike cleanly punched a neat little indentation. What was truly astonishing was that no bone fragments splintered outward. Even modern electric drills produced minute bone dust, yet Liston worked with surgical immaculateness.
"Back in my day, boy, we really cracked open skulls with a cold chisel and mallet!"
I used to scoff whenever old professors spun those heroic tales, brushing them off as shameless exaggerations, but watching Liston at work made me think their boasting might not have been entirely false after all.
Thwack! Thwack!
Liston worked his way around in a steady circle, driving points into the calvarium.
Pop.
With a crisp sound, a neat disc of cranial bone lifted free like the lid of a jar. In that breathless instant, Liston and I widened our eyes, peering intently into the dark void beneath the lifted plate.
Please!
Dear Lord!
We stared with the desperate fervor of men offering up prayers. Until a moment ago, I had felt reasonably confident that something would be there. If blood had pooled, it explained the agony; he had struck his head, and the pain had escalated ever since, hadn't it? That had been my deduction, but once the skull actually opened, an icy prickle of dread crept down my spine. Opening an abdomen only to find nothing was bad enough, but cracking open a human cranium felt on an entirely different level of catastrophic.
"Hallelujah!"
Thank God. It was there.
"What did he say...?"
"Did he crack open a skull and shout what I think he shouted...?"
My exclamation set the journalists muttering in bewilderment, but I couldn't care less.
"Is that a vermin inside his head?"
"Crying 'Hallelujah' at the sight of that...?"
"Could Taepyeong have planted that creature in there himself...?"
"How could anyone shove such a thing inside?"
"Through the nostrils, perhaps..."
"Ah."
The murmurs were spiraling into absurd conspiracy theories, but even that failed to dampen my mood.
"You see it, don't you?" I beamed.
"I see it indeed!" Liston bellowed.
I was far too euphoric to care about the ignorant gallery. Am I an absolute genius or what? In an era without so much as an X-ray, let alone a CT scanner, I had successfully diagnosed and localized a subdural hemorrhage! Good grief... I couldn't even brag about this to anyone who understood, yet I wanted nothing more than to run through the streets shouting like a lunatic.
"Bring the suction jar!" Liston roared, already springing into action while my mind wandered.
Following his command, Colin retrieved the suction jar he had been guarding like a sacred relic. Strictly speaking, the glass container didn't need to be scrupulously sterile, but thanks to Joseph throwing a fit, it had been thoroughly boiled. Perhaps because of that, the glass cylinder gleamed pristinely under the gaslight. Soon, that clear vessel would fill with black bugs... No, no. Hearing the onlookers drone on about vermin was beginning to muddle my own thoughts. It would fill with stale, clotted blood.
Liston slid the rubber hose extending from one side of the jar directly into the cranial opening. Then, as naturally as drawing breath, he placed the opposing tube between his own teeth.
"Why are you lot so pathetically weak?"
By all rights of seniority, Liston shouldn't have been the one providing suction; that chore belonged to Colin or Joseph. But drawing thick fluid through an intermediary glass jar demanded monumental negative pressure. Neither the apprentices nor I—having been roped into trying it once—possessed the lung capacity to move the sludge. But Liston...
Sluuuuurp!
The man was an absolute beast. Sucking viscous hematoma into a collection vessel was no simple task, yet he drew it up effortlessly.
"Good God."
"Ugh..."
"What in heaven's name is that...?"
Thick, blackened clots of blood came surging along the tubing, spilling in heavy ropes into the suction jar. The volume was staggering. The honorable gentleman had clearly been thoroughly pickled in liquor when he took his fall. People back home love to claim that foreigners drink moderately without getting blind drunk, but I wish those fools could stand here and witness this. These people were far worse. And how could they not be, when alcohol was hardly their only vice?
Cannabis... nitrous oxide... and raw opium to top it off.
Whenever high society threw an uninhibited party, the debauchery was downright madness. Formal aristocratic soirees held for diplomatic appearances were one thing, but when they gathered purely to indulge, it was a carnival of excess. Given that he hadn't merely been drunk on wine, it was hardly surprising he hadn't noticed his brain slowly drowning in blood.
"Have a look," Liston grunted, wiping his mouth.
"Right. Hmm... It's clean. Fortunately, there doesn't appear to be any fresh bleeding either. Joseph?"
"Yes, sir."
The cavity cleared by Liston's suction was spotless. Even when Joseph brought the gas lamp close to illuminate the intracranial space, the surface remained pristine. Just as I observed, there was no active hemorrhaging. Several days had elapsed since the initial trauma, so the ruptured bridging veins had likely thrombosed and sealed themselves off. Of course, bleeding was a fickle beast that could restart at any moment, but...
What else can we do? Over to you, Lord!
Our only remaining recourse was devout prayer. The patient was a distinguished Member of Parliament, so surely his faith was rock solid, right? The Almighty wouldn't pluck His own lamb from the flock so haphazardly. Yes, exactly—if anything went wrong from here, it wasn't my surgical failure, but the man's own lack of piety. The moment that rationalization crossed my mind, an immense wave of relief washed over me, and my slightly hunched spine straightened with renewed confidence.
Without further hesitation, I set the disc of cranial bone back into place and sutured the scalp closed over it. Perhaps because Liston had excised the bone with such immaculate precision, the flap seated back into the skull with a neat, satisfying click.