Episode 58: Going to surgery [1]
Episode 58: Going to surgery [1]
Yes, patients could be anxious. Even in the twenty-first century, didn’t people still say all sorts of things before surgery? Some even asked the surgeon directly, “Are you good at this?” They knew it was a rude question, but they still asked. Which meant that as long as it didn’t cross a certain line, it was understandable.
“No. No! You can’t cut off my nose!”
How was I supposed to respond to that?
“No! Help me!”
Wasn’t that crossing the line a bit? No one ever said we were cutting off your nose. There was a knife, yes, but it was small. Sure, I could split your gums with it, but I wasn’t slicing off your whole nose.
“People of the neighborhood! These bastards are trying to cut me up!”
Anyway, I couldn’t leave it like this. There was another patient right next to me who needed the exact same surgery.
Would you want to get surgery while that lunatic is screaming beside you?
“Uh…”
Just look at him. Already pale with fear. There was no way I could let this continue. So I stepped outside.
“Patient, you’re saying some strange things. I am not cutting off your nose.”
“Then what’s that knife for?”
“To cut your gums.”
“To cut off my mouth?!”
“No, that’s not—”
It was no use. Looking back, it made sense given the times. The surgeries people here had seen were all… extreme. Mostly Amputations. I had even seen Dr. Liston chop off a patient’s jaw once. No one ever said whether that poor man lived or died.
“Leave it to me. Even a genius like you can’t manage without experience.”
I didn’t know what to do. In Korea, if you told someone they needed surgery, they usually nodded and signed a consent form. Of course, sometimes the procedure on the form sounded terrifying, and complications did lead to complaints, but at least we had consent forms. Nothing like this.
I was about to try again when Dr. Liston appeared.
“Ah, yes.”
Right. This guy always had his own way of doing things.
“Turn on the gas.”
“…What?”
That “somehow” I had been expecting wasn’t this. Dr. Liston had zero intention of persuading anyone with words. Instead, he pulled out the Laughing Gas he had brought with him. Actually, scratch that. I hadn’t even realized what he meant. But for Dr. Liston and his people, it was as natural as breathing. Without hesitation, they turned on the gas and knocked the panicked patient out, pressing down on his forehead and shoulders.
And… this was insane.
What kind of hospital was this? It felt more like a kidnapping. Or an execution.
“Is that okay…?”
This was one of those moments when I should have spoken up. I should have said this wasn’t right. But I opened my mouth before I could even think.
“Yes.”
“Good. Let’s go.”
So the patient was taken to the “operating room,” or more accurately, the room of truth.
It’s not even an operating room…
It really wasn’t. What should I call it? A surgical platform? A surgery stage? I wanted to say something about sterile technique, but this was the nineteenth century. They had their own version of common sense, and I couldn’t argue.
There are too many people… I’ll make a mistake at this rate…
Luckily, Liston accepted my concern. So instead of going to the open surgery square, we went to a classroom. Compared to a modern OR, sure, it still felt like a public plaza. But at least we were indoors. Only about twenty people had gathered. Of course, none of them were wearing masks. A mess, truly.
“All right, lift him up.”
“Yes.”
While I was still mentally preparing, we arrived at the classroom. According to Liston’s instructions, the patient was placed on top of several desks on a platform. No actual surgical table in sight.
I have to fix this eventually.
If there were no anesthesia, I would understand. Patients would thrash around, after all. But an anesthetized patient couldn’t move. They lay still.
They’re going to get pressure sores, you idiots!
These desks were uncomfortable for anyone, and a motionless patient forced to lie on them could feel pain even in places unrelated to the surgery. I knew this from experience, and thankfully, modern medicine knew it too. Surgery today took into account not just the doctor’s ease, but also the patient’s long-term comfort. But in those early days? The doctor’s comfort came first.
I need to finish this fast.
The good news was, this surgery didn’t take long. Even if it did, anesthesia was so poor that if the patient stayed under long enough to develop pressure sores, he would probably die before that from Respiratory Depression.
“Come on, Joseph. Alfred.”
“Uh.”
“Huh.”
I took a deep breath and positioned my assistants, Joseph and Alfred. They had practiced on cadavers with me several times, so even though this was their first real surgery, they followed my instructions smoothly. Now, the rest was up to me.
“Whew…”
I took another deep breath.
This wasn’t Kim Taepyeong’s body, but Joo-hyuk’s memory. Still, how many surgeries had I done? Though it was my first time in this body, my soul had already gone through hundreds.
“Scalpel.”
In that moment, I returned to a state of focused calm and extended my hand. The assistant today was Colin. During our practice sessions, he constantly complained about being my assistant, but now, this wasn’t a corpse. This was a living, breathing human being. Anyone who treated this lightly didn’t deserve to be called a doctor.
“Yes.”
At least Colin wasn’t a total idiot. He handed me the knife. It had been specially made for this day. It was roughly the size of a scalpel, but since metallurgy here wasn’t great, the blade had to be changed frequently. Still, click, it fit my hand perfectly.
This is a knife? You’re supposed to cut human flesh with this?
Liston called it his small sword, his flagship tool. But for me, it was ideal. The incision was far more precise than anything I had seen them do before. In another type of surgery, this blade might have been even more useful. Unfortunately, it wouldn’t be used again today.
“I’m going to push now.”
“Yes.”
To separate the gum from the bone, I used a wide-tipped elevator. Creak. I pushed it upward along the bone. The gum and bone began to part, creating a larger opening than before. Liston had originally planned to make his incision higher, but after seeing my technique on the cadaver, he changed his mind. A higher incision could have damaged the lip unnecessarily.
“Good. Joseph, hold here.”
“Huh.”
Joseph responded like a seasoned assistant and pulled the separated tissue wide. Thanks to his sturdy build, the hold was steady. Yeah… I was smaller in this life than in my previous one. But I guess that was par for the era.
“Give it to me.”
“Yes.”
“Hammer.”
“Yes.”
I inserted the chisel and struck it with the hammer. Thunk. Thunk. The bone resisted more than the corpses had. Living bone was simply stronger. Strange thing to compare, but true. Still, the cadavers we used had only recently died, so the difference wasn’t massive. At the depth I expected, I heard the bone collapse.
“Light.”
“Yes.”
Colin brought over the lamp and lit the gap. Honestly, visibility was still poor. I had no choice but to keep going. I was still a few decades away from even headlamps. This was technically before they had even thought of attaching lights to the body. It was dark, and I had no idea how anyone managed surgery like this before.
Without anatomical knowledge, everyone would die.
That was the bottom line. No one but me could even attempt this kind of operation. Still, the reason for doing it publicly was clear: to demonstrate skill and show that future surgeries, though not all of them, would be far more precise than what came before.
“Gauze.”
“Yes.”
The maxillary sinus was a disaster. Pus, necrotic mucosa, swollen tissue, and even growths that looked nearly tumorous. Blood oozed out at every touch, not from any major vessel, just diffuse bleeding from irritation.
“Change it.”
“Yes.”
The gauze I pulled out was soaked in yellow and red, like it had come straight from hell. The smell was vile.
“Ugh…”
“Guh—”
It spread through the room. Disgusting as it was, the audience seemed impressed. These people loved gore.
“Pliers.”
“Yes.”
I packed the inflamed tissue with more gauze, then took the pliers. These were finer than usual. Not much good for anything but this type of surgery, but I made them knowing that this would probably become my livelihood for a while. Click. Click. I opened the ethmoid sinus. Unlike in the cadavers, blood flowed steadily.
Good thing I practiced…
My visibility was already limited, and now the blood made it worse. I had to rely on touch and instinct.
But I can’t let greed get in the way.
One mistake here, and I could damage the brain or the eyes. Damn. Forget the breadwinner idea. Too risky. As I debated whether to back out, the tip of my pliers reached the sphenoid bone. Strictly speaking, it was the wall of the sphenoid sinus. If this were like the cadaver, there would already be a natural opening I could widen. But I couldn’t see anything, and I wasn’t an ENT surgeon.
If you try to perfect something you only half understand, you’ll cause an accident.
It was a saying that applied not just to ENT, but to all surgery. I took the awl and carefully pierced the bone. It must have been weakened by infection, because it gave way easily. Thick pus poured out.
Hmm…
Only then did the blood catch my attention. During cadaver practice, I hadn’t even considered it.
Ah. Right. I have to stop the bleeding to finish the surgery…
Without realizing it, I nearly muttered, shit.
Translator’s Notes:
Laughing Gas — Nitrous Oxide, an inhaled gas that can reduce pain and awareness. In this scene, it is being used as a crude anesthetic.
Amputation — Surgical removal of a limb or body part. It was one of the most familiar major operations in nineteenth-century surgery.
Consent Form — A modern medical document confirming that a patient understands and agrees to a procedure and its risks. The narrator contrasts this with the informal and coercive practices of the era.
Sterile Technique — Medical practices used to prevent contamination and infection during procedures.
Respiratory Depression — Dangerous slowing or weakening of breathing, especially from anesthesia or sedating drugs.
Pressure Sores — Skin and tissue injury caused by prolonged pressure, especially when a patient cannot move.
Scalpel — A small surgical knife used for precise incisions.
Elevator — A surgical instrument used to lift or separate tissue from bone.
Maxillary Sinus — The sinus located in the cheek area beside the nose.
Ethmoid Sinus — A group of small sinuses between the nose and the eyes.
Sphenoid Bone / Sphenoid Sinus — Deep skull structures near the center of the head. Surgery in this area is risky because of nearby brain, eye, nerve, and blood vessel structures.
Necrotic Mucosa — Dead or dying mucous membrane tissue.
Diffuse Bleeding — Widespread oozing from irritated tissue rather than bleeding from one clear vessel.