Episode 57: Sinusitis Surgery… How Did They Do It? [4]
Episode 57: Sinusitis Surgery… How Did They Do It? [4]
And… I stopped what I was doing and moved up to the patient’s head. When I looked where Alfred was pointing, I saw that part of the brain had collapsed, as if moth-eaten. This was the first time I had seen anything like it.
They told me not to underestimate ENT surgery… and they were right.
We were so focused on the abdomen, dismissing this because it “just” came from people with stuffy noses. But in the end, we all had brains. And I… had dug into one. I thought it was a joke and kicked myself for it.
If your vision is poor, an accident is bound to happen…
Wasn’t it fair to say visibility was everything in surgery? If you couldn’t see, you shouldn’t proceed. I thought it was a spot I could just skip pulling on, and that mistake was mine.
“You really can’t be greedy in surgery.”
“Huh?”
“No, I just meant… you can’t just dig at the brain and expect it to be fine.”
I thought of the two patients I had classified as needing surgery. Both of them had headaches so severe they couldn’t function. To make things worse, when I tried cleaning their sinuses, they developed otitis media. I thought it would get better if I could just open their nasal passages.
But the ear canal is even narrower. How do I operate there?
Two patients had come in with headaches and now had ear pain. A rough plan started forming. Wasn’t the root cause of ear pain in otitis media inflammation pressing against the eardrum? Ideally, we would remove or reduce that inflammation, but in this era, without antibiotics or anti-inflammatory drugs, slitting the eardrum might work. Then the buildup could drain. I had heard it healed and sealed well. The problem was, I didn’t have the tools or confidence to make a hole in the eardrum through that narrow canal.
First of all, I don’t even have the instruments for it.
It would help if I at least knew what the tools looked like or how to use them. ENT was a minor rotation. The GPA weight was 0.5, so I mostly crammed for the practicals and memorized anatomy charts. Past me… should you have studied more broadly? If you had, maybe you wouldn’t be suffering now after dying and ending up in the nineteenth century…
“First… let’s try it on the next cadaver.”
I shook off the useless thoughts and moved to the next body. I pulled off the sheet covering the face. Another young one. Why were so many young people dying in this damned London and ending up in dissection rooms?
When will this ever improve?
The situation was dire. But worrying without knowing how to fix it was pointless. I was trained as a scientist to rely on facts. I shook my head and turned to Joseph.
“Uh… huh.”
Joseph was still staring into the patient’s head, nose, and mouth with a puzzled look. No surprise. Anatomical knowledge in this era was primitive. I could mentally visualize the entire skull in 3D, bone by bone, but I couldn’t expect that kind of skill from anyone here. He probably had no idea how this had happened or what had gone wrong.
Still, just like before, Joseph pulled the corpse’s upper lip back and exposed the gums. I made an incision there with a small knife. Then, using something similar to a retractor, I separated the gum tissue from the bone. A soft pop followed, and the bone gradually came into view.
I reminded myself not to drill right away just because I got excited.
Last time… I saw the roots of the upper teeth.
Oh God. I pulled out three teeth. Unintentionally. But the nineteenth-century barbarians, Liston, Alfred, and Joseph, didn’t even blink. They had broken jaws during surgery before, and all they said was, “It’s just three teeth. What’s the fuss?”
Don’t get swept up in that mindset…
Was it okay to think that way? I paused. No. I couldn’t be like them.
“Give it to me.”
Back in the twenty-first century, I had been educated in one of the most advanced medical systems. I wasn’t a specialist, but I had made it to fellow, clinical assistant professor, and even full-time assistant professor. I couldn’t just abandon that mindset. So I only drilled into the bone once I had exposed enough of it through careful dissection.
Kang! Knock!
As I worked, I started to feel it. That tactile sense in my fingertips. You learned to read bone by touch. As soon as I felt that telltale hollow cavity, I struck harder. The bone shattered, revealing the interior.
“Hm.”
As expected, something was off.
“Was it always like this?”
Joseph, still pulling the lips back, tilted his head. Coincidentally, all three corpses we had worked on had inflammation in their maxillary sinuses, so it made sense that he was confused.
“No, I don’t think so.”
“Really? Then why are they all like this?”
“Well…”
I stopped myself from bringing up the problem of London’s air. Scientists in this era weren’t particularly interested in air quality. Though surprisingly, they did know about oxygen. Still, pollution wasn’t on their radar. It would have sounded too strange.
“I think there’s something in London irritating people’s noses.”
I said it vaguely, knowing I would have to explain it more clearly someday.
Naturally, the people of the nineteenth century around me didn’t give it much thought.
“Anyway, scrape it all out. Looking at it now, I think I can do it too.”
Liston was just twiddling his thumbs after surgery. He probably felt like he could already operate on several noses. Same with Alfred and Joseph. Their hands were itching. Future surgeons, maybe.
Yeah… everything looks easy when you’re watching from the outside.
That was the trap of standard surgeries. The procedure I was practicing had a name, even if it wasn’t immediately obvious. Caldwell-Luc surgery. We didn’t use it much now, thanks to endoscopes, but back in the late twentieth century, it was standard sinus surgery, created through trial and error. That meant it was still the best method available in a non-endoscopic setting… and a surgery that easily became routine.
But once you tried it yourself, you realized how hard it was.
It might have looked like I was winging it.
“Okay… good. It’s open.”
But I wasn’t. I was doing my best. To call it sloppy would be unfair. First of all, remember: the roof of the maxillary sinus was the floor of the eye. You might ask, “So what?” But if you had ever seen someone get punched in the eye, you would know. The outer and upper bones around the eye were strong, but the floor and inner wall were thin and fragile. One misstep and the eye could literally drop. The field of vision would change, and the patient would see double.
“All right, let’s go deeper. Pull harder.”
“Ugh.”
“Senior, you can hold the head now. Pull here.”
“Uh-oh… You’re not going to drill into the brain again, are you?”
“I told you I wouldn’t. Just hold it steady.”
“Huh…”
Now we were going into the ethmoid sinus, which was far more dangerous. From here on out, the outer wall was the inside of the eye. The bone there was so thin it was called the Lamina Papyracea. Papyrus, like the ancient writing paper. That was how thin it was. If it broke, the eye could shift inward.
Haa…
Worse, the roof of the ethmoid sinus was the base of the brain. Another thin bone. One wrong move here, and it would crack. Visibility was terrible too.
Knock. Again.
This was why I used pliers carefully. If I lost patience and jabbed with an awl, I would end up a murderer. These guys were trying to advance surgery, but if they built something, they should also know when to take it apart.
Haa…
I finally saw a smooth patch of bone. I had drilled through like before, but this time I was more cautious. I tapped it.
Hmm… doesn’t feel like much.
If this was the sphenoid bone, I expected it to feel hollow. I couldn’t tell if inflammation was interfering or if I just didn’t know what to expect. Whatever. This was practice, right?
The cadaver wasn’t embalmed, so it looked disturbingly lifelike. But it was just a corpse. I pierced the spot, and pus leaked out. Judging by the volume, this person must have had intense headaches too. But they couldn’t get treatment.
Probably because they didn’t want to die from it.
There were too many Jémels in medicine. Robert, too. So many doctors thought headaches came from “bad blood.” With people like that around, who in their right mind would seek help?
“You’re not digging more?”
Dr. Liston spoke, sounding annoyed. He already had an awl in his hand. Of course he did. He always seemed to have the most dangerous-looking tool ready at the worst time.
“No. I had an accident earlier. I think it’s better to just drain the pus for now.”
“There was a lot of inflammation in the wall of the maxillary sinus, right?”
“Ah… I can see it clearly from here, but I can’t see what’s inside.”
“You just go by feel.”
“Ah…”
No. Surgery shouldn’t be done by feel alone. Just guessing in a delicate area like this could kill someone.
“I’m not confident.”
“You’ve got the skills, but you still lack courage. Learn from me.”
No… overconfidence killed patients. But I didn’t argue with Liston. Not out loud. In the end, I would operate on my patients the way I thought best. Besides, even though Liston talked big, he still respected the title “Doctor.”
“All right… lie back now.”
After practicing on several more cadavers, I finally faced a real patient. The patient was trembling. Understandable. Amputation was one thing, but nasal surgery?
That was terrifying in any era.
Translator’s Notes:
ENT — Ear, nose, and throat medicine, the specialty that treats conditions of those areas.
Otitis Media — Inflammation or infection of the middle ear. It can cause ear pain, fever, hearing problems, and pressure behind the eardrum.
Eardrum — The thin membrane between the outer ear canal and the middle ear. It vibrates with sound and can also bulge painfully during middle-ear infections.
Caldwell-Luc Surgery — A sinus surgery that accesses the maxillary sinus through the upper gum area. It was historically used before modern endoscopic sinus surgery became standard.
Maxillary Sinus — The sinus located in the cheek area beside the nose.
Ethmoid Sinus — A group of small sinuses located between the nose and the eyes.
Sphenoid Bone / Sphenoid Sinus — Structures located deep near the center of the skull. Surgery near them is risky because they are close to the brain, eyes, nerves, and major blood vessels.
Lamina Papyracea — A very thin bone forming part of the wall between the ethmoid sinus and the eye socket. Its name refers to paper-like thinness.
Embalmed — Preserved with chemicals to slow decomposition. The narrator notes the cadaver was not embalmed, making it look more lifelike.
Amputation — Surgical removal of a limb or body part. In this period, it was one of the more familiar major operations.