Episode 59: Going to Surgery [2]
Episode 59: Going to Surgery [2]
“Embarrassment… I think you just made it worse?”
“Oh, really? I can finally recognize Pyeong’s face now.”
It was supposed to be a virtue not to step on the surgeon’s shadow… These kids had no manners, either from a lack of education or because they weren’t raised under Confucian principles. Didn’t they know that telling someone they were embarrassed only made them more embarrassed?
“It’s loud! Bring the gauze!”
Of course, I was the exception. When I got angry, the shoulders of the ones who had been clowning around immediately stiffened.
“Uh… how much?”
It was clear that things had gotten serious. Blood was pouring out of the patient’s nose. I should have anticipated that, but I didn’t. Weren’t the nose and mouth connected? Blood was leaking from the mouth too.
“Holy shit! Bring gauze! Bring all the gauze!”
“Uh, uh!”
What I really meant was this: there was a chance the blood could obstruct the airway at the back of the throat. If the patient weren’t under anesthesia, he would be coughing by now, but anesthesia meant that reflex wasn’t working either.
Worst-case scenario… I’ll have to perform a Tracheotomy.
I wished I could at least check Oxygen Saturation, but there was no equipment for that here. All I could do was rely on visual cues. The problem was, I had never been trained to assess oxygen levels visually. Was that even a thing?
Anyway, the one thing I could count on was lip color.
As soon as they start turning blue… cut immediately.
How did I end up in this situation? How dare I even consider cutting someone’s throat? It might seem like an overreaction, but I refused to let a patient die on my watch, not because of my mistake.
“Fire! Fire, damn it!”
“Uh—uhh… Uh…”
I was so panicked I started cursing. Not that it was anything unusual. I was once known for having a temper in the operating room. Looking back now, I felt kind of bad. At the time, I wasn’t even sure if I would make it as a professor, and I was completely worn out from night shifts. That stress never really went away. Even Colin, who wasn’t one of my regular assistants, was so terrified that he managed to fumble for the fire and light it.
“You’re doing well, Pyeongi.”
Dr. Robert gave me a thumbs-up like he was genuinely impressed. Not the time, man.
Maybe because I had done so many surgeries with heavy bleeding, I had grown a little numb to it. Not that my skill matched my nerves, unfortunately, so it wasn’t much comfort.
“All right. Gauze!”
Colin, thoroughly scolded, held the fire close, too close, to the patient and me. But thanks to that, I could finally see the blood flowing down the back of the patient’s Nasal Cavity.
Thwap.
As soon as I saw it, I stuffed gauze in. It was rough and probably painful, but I had no choice. If blood kept draining down the throat, the patient would suffocate. The good news? He was still breathing. He looked a little worn out, probably because of the nasal blockage, but he was breathing through his mouth.
“Haah.”
I waited.
For an hour.
Honestly, I almost started swearing again…
“Why are you so worked up?”
“It’s not like it bled that much.”
“But you look so cool when you’re mad. Aww.”
These little punks made me even angrier. Was I the only one taking this seriously?
These kids… Have you never prayed before surgery? Or do you just not understand how dangerous posterior nasal bleeding is?
I didn’t know the reason, but I guessed they really didn’t know. It wasn’t their fault, I supposed. This era didn’t exactly provide a great medical education. But pretending to know everything? That was the real problem. Look at them. One even looked like he was blaming me, even though blood had been gushing out like a fountain.
“Gauze. Hand me the gauze.”
“Uh, yes.”
Thankfully, at least he listened. Thanks to that, I managed to stuff a large wad of gauze into the patient’s nose. Originally, I had planned to operate on the other side too, but that idea vanished the moment I saw how much gauze went into just one side.
If I pack both nostrils like this… the patient might actually die.
The gauze was so thick I started wondering if it had always been this bulky. Back when I was an intern, I occasionally stopped by the ENT ward. On gauze removal days, we would yank endless streams of bloodied gauze from a patient’s nose. You could hear the squelching. Even after all that, it never occurred to me until now that packing this much could be dangerous.
So I made a quick judgment: just treat one side. The sphenoid bone was the key anyway, right? If the symptoms persisted later, I would operate on the other side then. That was how fast my rationalization circuits were running.
“Haah.”
Of course, I was a genius. Even while thinking all this, I packed the gauze perfectly. Just when I thought it might be enough, I removed the gauze I had stuffed in the mouth.
“Give it here.”
“Ah, yes.”
I took the light from Colin and looked inside. Thankfully, there was no visible blood running down the throat. If the bleeding had stopped, that meant we were in the clear.
When do we usually remove the packing?
Thinking back, I remembered: about two days.
But that assumed the surgeon was skilled… Should I wait three days instead? No. This gauze was basically a foreign object, and probably not sterilized.
For all I knew, it was just some dirty cotton jammed into a wound.
The nose was a filthy place, and one crawling with active immune cells, but I didn’t want to risk infection. That just wasn’t acceptable. Neither my patient nor anyone else deserved to die from a rotting nose.
All right. Remove the packing in two days. If it bleeds again, re-pack with clean gauze.
Satisfied with that decision, I raised my head.
“The surgery went well.”
I wasn’t one hundred percent confident, but I said it anyway. After all, no one else here could have done it.
“Oh… Yes, judging by what came out, it looks like you removed something really nasty.”
Dr. Liston clapped, completely agreeing with me. The others followed his lead. Even Colin joined in, probably scared out of his mind. Couldn’t blame him. This might have been the first time he had seen someone angry while holding a scalpel, especially when the target might be himself. That was why surgical professors were so feared.
“All right, next patient.”
“You sure you’re okay?”
“Yes?”
Liston was pointing behind me. When I turned around, I finally realized: I was drenched in cold sweat.
I really was cold earlier…
It made sense. The patient had nearly died. And it would have been entirely my fault. This was also my first time performing this particular surgery.
“Yeah… I’m fine. I should go ahead before I lose my nerve.”
Physically, I was still okay. But I was exhausted. This surgery had taken less than two hours, but it had drained me.
“Also, I like my brother! Call me anytime!”
“Ah… yes. But first, let me clean this.”
“Come on, don’t blame everything on your age or experience.”
“It smells…”
“You’ve got to be able to handle the smell if you want to be a doctor.”
“That’s…”
Honestly, these guys were more exhausting than the surgery. Dr. Liston had simply taken the lead, but everyone else was giving me weird looks, as if they couldn’t understand why I was cleaning up all this precious blood and pus.
You lunatics…
Did they think we could just start the next surgery like this? Were they out of their minds? Even visually, it was filthy. Think how many germs must be floating around. This surgery was on an inflamed site.
“For me… when something smells awful, it messes with my concentration.”
“Then how did you manage to perform surgery so well in the Anatomy Lab?”
“Still, I—”
“Well, since you’re young and already skilled enough to handle a scalpel like that, I’ll respect your quirks.”
Thankfully, Dr. Liston respected me. That allowed me to soak my instruments in boiling water and disinfect them with alcohol. If I could, I would add Lime chloride, but I wasn’t sure whether it would corrode the metal. Nothing was simple here.
Not easy to get replacements… especially when Senior Alfred’s in charge of the tools…
As I thought that, the next patient arrived.
“P-please, save me!”
Well, arrived might not have been the right word. More like… dragged in.
“Turn on the gas.”
I even heard the whoosh. Somehow, that sentence sounded like something a villain would say.
“Huh.”
Anyway, the patient soon calmed down. Understandable. He had been gassed into unconsciousness. One of Liston’s loyal assistants even fainted from the fumes.
“If you fall, you’ll get hurt. Lie over there.”
“Haha… ha ha ha…”
So we laid the patient on the classroom lectern again. I placed some cotton cloth underneath this time. Not that it made much difference. At best, it made me feel better.
“All right… Shall we begin?”
I said it in the same tone as before, looking back at Colin, Joseph, Alfred, and the rest. They nodded, slightly more nervously this time. Probably because I had lost my temper earlier. Sorry about that…
Creak.
Anyway, I had just disinfected everything, so it at least looked clean. I cut into the gums, widened the gap with a retractor, then chiseled into the bone. This time, I had added a thin layer of gauze beneath the nasal passage so blood wouldn’t drain down the throat.
Knock. Again.
Feeling far more relaxed than before, I used the pliers to remove the ethmoid bone.
Pop.
Then I punctured the sphenoid bone with an awl, and a thick stream of yellow pus poured out. It felt like I had done it properly this time. Like I had grown a bit as a surgeon.
Of course, I knew the truth.
I’ll need to be extra careful in the next one…
When you thought you were failing, you had to reflect and try harder. Especially in this era, surgery didn’t end in the OR. I had to watch carefully from now on. See if the patient’s symptoms improved. But most importantly…
Make sure they don’t die.
Translator’s Notes:
Tracheotomy — A surgical procedure that creates an opening in the throat to help a patient breathe when the airway is blocked.
Oxygen Saturation — The percentage of oxygen carried in the blood. Modern hospitals monitor it continuously during surgery.
Posterior Nasal Bleeding — Bleeding from deep inside the nose, especially toward the back of the nasal cavity. It can be dangerous because blood may block the airway.
Anesthesia — Medical use of drugs or gases to prevent pain or awareness during surgery.
ENT Ward — Hospital department for ear, nose, and throat patients.
Nasal Packing — Gauze or other material placed inside the nose to stop bleeding.
Foreign Object — Any material inside the body that does not naturally belong there and may increase infection risk.
Immune Cells — Cells that help the body fight infection and disease.
Scalpel — A small surgical knife used for precise incisions.
Lime chloride — An early disinfectant compound historically used for sanitation and reducing infection.
OR — Short for Operating Room.
Retractor — A surgical instrument used to hold tissue apart during surgery.