Episode 70: Absence [1]
“Aaaaaa!”
“S-Save me!”
“I-I’m not! I’m not a patient!”
“Come to work! You’re a patient!”
The luxurious carriage provided by my senior’s father stopped in front of the hospital. Joseph and Alfred still had to attend classes like regular students, but me? I was effectively known as Doctor Pyeong. In truth, they were practically acting as my personal assistants under the pretense that Dr. Liston or Blundell would be giving them lectures.
“It’s a peaceful ward today, hmm.”
I made my way toward Dr. Liston, passing through swarms of patients, many of whom didn’t even seem to know what they were doing, being herded through painful treatments. Or at least, I tried to make my way. I had no real plan today. Mirror Therapy was underway in the next room, and I had been thinking of mentioning the term phantom pain sometime today or tomorrow.
“Ugh, wow!”
Suddenly, one patient caught my eye. To be fair, everyone here was screaming, but this one? His scream drew attention. There was no special reason. It just sounded like the most painful scream of all.
“Is that… real?”
I mean, why else would anyone come to the hospital in the nineteenth century if they weren’t seriously ill? Back in Korea, when a country doctor asked a villager, “Why didn’t you come in yesterday?” the answer was usually, “Because I was too sick yesterday.” Only doctors came to hospitals daily. Everyone else came as a last resort.
And this guy? This guy looked done for.
“Hold on.”
“Huh?”
“Hey, we’re still students—”
“Shut up, idiot. This is treatment, man!”
“Y-Yeah, but that guy over there… I’ve never seen that patient before.”
So I walked straight over. I wasn’t asking permission. And sure, there were exceptions, but most of the time, this kind of pain required surgery. And for some reason, if someone other than me diagnosed it, they would just ignore it. Maybe it was a sterilization issue, maybe not, but they would draw blood and stop there. They wouldn’t operate. Crazy bastards. Why draw healthy blood from someone clearly in agony? Did they think drawing blood helped you live?
“Patient.”
I addressed him.
“Ugh… Ugh…”
Of course, there was no real answer. I didn’t expect one. So I focused on observing him closely.
Lower back… laterally… yeah. With this level of pain—
I got the answer just by looking. It wasn’t some complicated diagnosis. Even an emergency room intern would spot it after a month of rotations. Still, it was excruciatingly painful.
Urinary stones.
“It hurts more when he tries to urinate!”
Ordinarily, I would give him a container to pee into and collect a sample. That way, we could confirm Hematuria and administer painkillers. After that? I would usually just refer the case to urology and forget about it.
Lithotripsy… not like they have that here.
Ultrasound lithotripsy didn’t come around until the twentieth century. If it existed now, it would be tucked away in some mad scientist’s basement. I was sure I would have heard about it.
“Oooooh! It hurts! Aaaaaagh!”
Well, the patient was definitely confirming the diagnosis with vigor. This was worse than most cases I had seen. And I think I knew why: he had probably avoided the hospital, trying to endure it on his own. But this? You couldn’t pee this out no matter how hard you tried.
“Um, am I absent? Am I? Are you absent?”
“Oh?”
And just like that, the patient diagnosed himself. It wasn’t a nonsense term either. “Absent” was their term for what we now call urinary retention or obstruction. It was a surprisingly accurate diagnosis for the time.
“Feels like I’m absent…”
“Oh no! No! Damn!”
I nearly collapsed. That hit harder than expected. Before I could react further, a group of staff burst in.
“Absent?”
“You’re absent!”
“All right, this way!”
They were people I had seen around the hospital before, but I didn’t know them well, especially since I worked mostly with Dr. Liston. Still, they seemed to be the team in charge of these “absent” cases.
“No! Save me! Please!”
The patient began to panic the moment he saw them. They yelled back at him.
“It won’t hurt with anesthesia!”
“Right, the anesthesia’s gone now!”
Great. So now my Anesthetic discovery was being used as an excuse to perform barbaric surgery. I felt personally responsible. So I stepped forward, partly out of guilt and partly because Dr. Liston had just shown up behind me.
Even in a normally chaotic hospital, today felt worse than usual.
“Hold on, hold on. This patient… is he the one I saw earlier?”
“Huh?”
“What do you mean? He’s absent. We’re sure of it.”
“More importantly, who the hell is this guy?”
The three of them turned toward me, scowling. The unspoken accusation, he’s Asian, hung in the air.
I’ve felt that before.
“Who are you? The person who discovered the Anesthetic is Dr. Pyeong.”
Before I could reply, Joseph stepped in. He was tall, strong, and famously capable of throwing punches in Upton. That shut them up.
I guess they only knew the discoverer of anesthesia was an Asian doctor, and I was the only one around who fit that description.
“Ugh… well…”
“Still, it’s our professor who handles absence cases…”
“What’s going on here?”
Just as the mood was getting tense, Dr. Liston stepped forward. He didn’t say much, just asked a simple question. And that was enough. The group slowly backed off, confused and unsettled.
“That, um… sorry!”
They scattered in all directions. It was weird. Still, it was a relief for the patient.
“Uuugh… no…”
Of course, he didn’t see it that way. To him, it must have felt like he had just been captured by an Asian monster and the Liston monster. He probably saw death flash before his eyes.
“Why are they running away when I’m just asking what’s going on?”
Liston looked confused. I filled him in on the situation. He frowned thoughtfully.
“Hmm… So they diagnosed ‘absence,’ huh? In that case, let’s take a look.”
“Ugh…”
“What’s wrong?”
“Ah, nothing.”
Liston placed a hand on the patient’s shoulder, and the man instantly tensed. The pain seemed to vanish under sheer terror. Normally, he would scream from the contact, but now he just nodded furiously.
Click.
We shut the treatment room door. The patient’s face darkened immediately. Of course it would. This was an era without effective painkillers. How did they even treat stones?
Wouldn’t it be better if he didn’t know it comes out in urine…?
Unfortunately, he did know.
What the hell kind of surgery did they use…?
I didn’t want to imagine it. Just the thought filled me with dread. Apparently, Dr. Liston saw it on my face and spoke.
“I don’t know if I should say this as someone who specializes in Amputation… but in my opinion, lithotomy isn’t surgery. It’s a method of murder. It’s so horrific I’ve never even considered trying it.”
“…Ah.”
If Liston said it was horrific, what else was there to say?
“Even with Anesthetics, they’re still doing that same surgery. I’m guilty of similar things, so I shouldn’t talk, but…”
“Hmm.”
“Wait, do you even know the procedure? Let me show you. Here.”
He handed me a booklet. It wasn’t thick.
“Ah…”
It was mostly illustrations, so I got through it fast. And immediately realized:
This wasn’t surgery. This was insanity.
Urinary stones were famously among the top three most painful conditions. And yet the actual “absent” they were trying to extract? It was tiny. Maybe the size of a fingernail. And they were cutting up the entire lower abdomen for that?
No wonder the mortality rate exceeded 50%.
Wait. Over 50%?
As I was reeling, the patient began screaming again. His pain was finally overpowering his fear.
“Ugh! Aaaaah!”
I understood. I really did.
If you didn’t treat it, you would die in agony. If you did treat it… you might die from the treatment.
That was the nineteenth century.
I felt terrible watching this man suffer. But I also couldn’t bring myself to subject him to that surgery.
“Patient.”
“Y-Yes!”
“Give me one day. I’ll find a better method.”
“One… day?”
Damn. His bloodshot eyes looked terrifying. Even a murderer wouldn’t glare like that.
But I understood. He was in hell, and I was asking him to stay there just a little longer. In the modern emergency room, people got violent if they had to wait just a few minutes. I had been hit before. A drunk patient once smacked me in the face, and the laws at the time didn’t protect medical staff, so nothing happened.
No one here’s going to protect me, either.
If I kept talking, I might get stabbed. Didn’t some medical schools teach horseback riding? Maybe that was the escape plan. Get stabbed, hop on a horse, run.
“Tonight. I’ll come back with something better than this.”
“Uhh… mmm…”
The patient fainted before he could answer. I took that as consent.
“All right, let’s get ready.”
“What are you saying? After reading that book? I’d rather do nothing. That kind of surgery shouldn’t be done to anyone.”
“Exactly. So we have to change it.”
“But the surgical method is already written down…”
Liston looked at me, puzzled. And honestly, from a nineteenth-century perspective, he was right.
But I was from the twenty-first century. I knew how modern surgery worked.
All we had to do… was adapt it to the times.
Translator’s Notes:
Mirror Therapy — A treatment using a mirror reflection to create the illusion that a missing or affected limb is present and moving normally.
Phantom Pain — Pain felt in a missing limb or body part after Amputation.
Hematuria — Blood in the urine. It can help confirm urinary tract bleeding or irritation.
Urinary Stones — Hard mineral deposits that form in the urinary tract. They can cause severe pain, especially when blocking urine flow.
Urinary Retention / Obstruction — Difficulty or inability to pass urine because urine flow is blocked or impaired.
Lithotripsy — A modern treatment that breaks urinary stones into smaller pieces, often using shock waves or ultrasound.
Lithotomy — Historical surgical removal of bladder or urinary stones. In this context, it is described as extremely dangerous and brutal.
Mortality Rate — The rate of death from a disease, condition, or procedure.
Anesthetic — A substance used to block pain during procedures or surgery.
Amputation — Surgical removal of a limb or body part.