Episode 71: Absence [2]
It’s not as easy as I thought…
The biggest issue was absenteeism. Another problem was that the patient was a man. Not that being a man was a problem in itself. Urinary stones were statistically more common in men, after all.
“I brought all the old surgical texts I could find.”
Since I couldn’t find a clear solution on my own, I asked Joseph Lister and Alfred to fetch some books. While I waited, I drew a rough anatomical diagram on a blank sheet of paper. I wasn’t blessed with a photographic memory, so I used a nearby corpse for reference. I didn’t bother with the entire lower abdomen, only the section from the urethra to the bladder, the path stones typically followed.
Could it be the prostate?
How old was this patient? Maybe it was just this shoddy hospital, but I hadn’t been given any patient information during intake. Gender and age should be basic data, shouldn’t they? I would have to go ask him myself…
“Ughhh! Aaaaaaagh!”
The man in the next room was screaming like he was on the verge of death. I already knew it was a painful condition, but this was excessive. Urinary stones usually didn’t kill you. Still, in this era, there was no real concept of pain relief. Maybe this kind of suffering was just normal. If that was the case, independence movements would do just fine here. There must be plenty of people with a high pain threshold.
There’s no pain relief, no medicine, no real treatment…
Good grief. A man with urinary stones, and this was how they treated him. And people complained about Korean hospitals. We should be grateful we live in a country where guns aren’t legal.
He’s probably over thirty.
He looked over forty at first glance, but people here aged quickly. Robert Liston looked closer to fifty than forty. Either way, that meant the prostate was probably not the issue.
“We brought them.”
“Here. Ugh, this book smells…”
The prostate theory was out the window, which was a relief. But as I turned the matter over in my head, Joseph Lister and Alfred returned with an armful of books. One of them reeked. I cracked it open. Some of the pages were damp or rotting, but they were still readable. I dove in.
“Ugh…”
“You’re not… really going to do this, are you?”
“Even for a heathen, this is too far.”
How should I even describe these so-called surgical methods? They were more torture manual than medical textbook. Even for this era, the techniques were downright grotesque.
“Insert this into the urethra, open it, and pull the stone out…?”
Just imagining someone inserting an iron rod into the urethra was nauseating. But two rods? Prying it open to yank out the stone? What kind of sadist thought of that? Honestly, if they had just used chopsticks, I might have been less disturbed. What gave them the confidence to do this and call it medicine?
As expected, the outcomes were horrific. Some patients bled to death. Others couldn’t urinate at all after the procedure. That likely meant the wound scarred shut, blocking the urethra and leading to death from internal pressure.
“Does this even work…? Pyeong, you’re not actually considering this, are you?”
Joseph Lister stared at me, horrified. I felt a little offended.
“What, are you insane?”
“Right? I knew it!”
“Look. Some patients literally bled to death. Others lost the ability to pee altogether.”
One explanation involved narrowing from scar tissue. The body tried to heal, the urethra closed, and urine became blocked, eventually leading to organ failure.
This is punishment… not surgery.
Just the thought gave me goosebumps, not only on my arms but all over. Then I turned the page and wished I hadn’t.
“What the hell is this?”
“I don’t know either! What are we even looking at?”
Joseph Lister and Alfred rubbed their eyes in disbelief. Anyone with a functioning conscience would be disturbed by this image. You couldn’t possibly be a doctor and think this was acceptable.
Wait… hand into the rectum… push the stone forward… cut it out from the front…?
There was logic behind it, strangely enough. The idea was to apply pressure from behind to move the stone forward, then extract it with a knife. But the size of the stone was what made no sense.
“AAAAAAGH! AAAAAGH!”
Right on cue, another scream rang out. As awful as it sounded, it gave the horrifying method a strange kind of plausibility.
Actually… if the pain is that bad, you would come here. Even knowing what kind of surgery is waiting for you. And they must know they should be drinking water and eating less salt… If they still came here, it must be impossible to pass it.
Apparently, these stones were much larger than the ones I had seen in the twenty-first century. One account described a stone the size of an egg. Madness. In such cases, even an endoscope would be useless.
So now what?
I didn’t even have a cystoscope. I couldn’t build one on the spot either. If only we had X-rays…
Maybe… should I just leave it to them?
Unconsciously, my mind drifted back to that earlier group. Sure, Robert Liston might be a human butcher, but they were just butchers. I had heard they sometimes split the penis in half to look for stones.
“Hold on. Let’s just stop for a second.”
“Huh? I am stopped.”
“What are you saying?”
I shook my head and regained focus. In this twisted era, if I didn’t step up, ninety-five percent of the time, the patient would be the one who suffered.
Even the government ought to intervene at this point.
“Honestly, this method seems the least horrible.”
“Huh…?”
“This one? The one where you put your hand up someone’s ass, Pyeong?”
Joseph Lister and Alfred stared at me like I had lost my mind. Fair enough. Even I thought it sounded barbaric. The records didn’t go into detail, but I could imagine the consequences: rectal rupture, permanent incontinence, a shredded sphincter…
And let’s not forget, it was all done without anesthesia.
It must hurt that much for them to accept this.
Otherwise, who in their right mind would lie down and allow this to happen?
“I’m going to have to open the abdomen instead.”
I had ruled out the urethral approach. There was no endoscope, no modern equipment, and a screaming patient in the next room who had suffered for over an hour. I had to act.
“The abdomen…?”
“Isn’t that forbidden?”
“And what, you’d just leave the patient like this?”
“Well, pass him to someone else!”
“Exactly. It’s horrible, but still…”
I wasn’t trying to do something terrible. Sure, abdominal surgery sounded horrifying now, but with proper disinfection, it wasn’t that hard. I had gloves and lime chloride. It didn’t melt rubber, so the sterilization issue was already handled.
My anatomy knowledge is solid. But if the stone is anywhere outside the bladder, that’s a problem… It’s likely lodged in a narrow passage.
Even as I thought, Alfred and Joseph Lister kept talking.
“Isn’t that man…?”
“What?”
Alfred, as usual, led the conversation. I might have been the best doctor here, but they lacked the foundational knowledge I had, especially since I came from the future.
“There’s a song about stone surgery, you know.”
“A what?”
“A French composer wrote a piece after surviving it. I heard it once. It’s not bad.”
“Seriously?”
I usually ignored Alfred’s rambling, but this caught my attention. A composer survived the surgery? Wasn’t he a wrestler, not a musician?
“Yeah. That’s how infamous this surgery is.”
“But what’s with Pyeong? Why is he doing this?”
“He’s stubborn. That’s what Joseon made him.”
“Ah… well, yeah.”
Joseph Lister, who knew my secret, just nodded solemnly. What he meant was: Don’t go crazy. Just endure it.
But just then, I thought of a better plan.
Yes… If it’s stuck near the prostate or the bladder… this could work. I can do this!
I jumped to my feet, filled with sudden purpose, just in time for Robert Liston to walk in.
“Huh? Is the patient dead?”
A very Liston thing to say.
“What?!”
“It’s just… so quiet.”
“Ah, wait, what?!”
Only then did I realize the patient had gone quiet. I assumed he had fainted.
I rushed to check.
The room was empty.
“He’s not dead. He was taken.”
“What were you doing, not noticing that?”
“Taken? Where?”
“Apparently, someone else is doing the stone surgery.”
“What?! Why not me?”
“You were too slow, I suppose. It may already be over.”
When Liston said “over,” I didn’t know whether he meant the surgery was over or the patient’s life was over.
The two were disturbingly similar in this context.
“Wait. Let’s go!”
“Us too?”
“Aren’t you his friends?”
“R-right!”
I ran. I didn’t know where I was going, but I ran. What kind of arrogance did they have, taking my patient?
“Nooo! Help me!”
I expected screams. And sure enough, they came from a corner of the hospital.
The patient hadn’t been anesthetized yet. At least he was still alive.
Rattle.
I burst in and found him struggling while being strapped to the operating table.
“What the…?”
And there he was: the surgeon, Dr. Kane.
He looked like a movie villain. Not the charming, misunderstood kind. The kind who would poison you behind your back and laugh while doing it.
“Ah, that’s our patient.”
I was about to back away when a solid wall pressed into my back.
It was Robert Liston.
He stepped forward on my behalf, looking calm but dangerous.
“What are you talking about? That’s our patient.”
“And what you’re doing… you can’t even call it surgery.”
“What did you say?!”
“It’s torture.”
“It’s under anesthesia. It doesn’t hurt!”
“Then it’s murder.”
His voice was cold.
“Either way, the reviews won’t be kind. This man is a genius, and you’ll be remembered as the monster who tried to carve him up.”
I may have taken it too far with that last part.
Crap… what happens if I run into this man when I’m alone…?
Translator’s Notes
Urinary stones — Hardened mineral deposits that form in the urinary tract. They can cause severe pain when they move through or block the ureter, bladder, or urethra.
Prostate — A gland below the bladder in men. Enlargement or disease of the prostate can obstruct urination, though the narrator rules it out here based on the patient’s likely age and symptoms.
Urethra — The tube that carries urine from the bladder out of the body.
Bladder — The organ that stores urine before urination.
Scar tissue / narrowing — After injury, healing tissue can contract and narrow a passage. In the urethra, this can block urination and become life-threatening.
Rectum — The final section of the large intestine. Historical bladder-stone procedures sometimes used pressure through the rectum to move the stone before cutting.
Sphincter — A ring-like muscle that controls the opening and closing of a body passage, such as the anus or urinary outlet.
Anesthesia — A substance or method used to reduce or block pain during surgery. In this period, reliable surgical anesthesia was still new or inconsistently used.
Endoscope — A modern medical instrument with a light and camera used to look inside the body. The narrator notes that he does not have one.
Cystoscope — A type of endoscope used to examine the bladder and urethra.
X-ray — A medical imaging method that lets doctors see structures inside the body. It did not exist in the era of this scene.
Lime chloride — A disinfectant historically used for sanitation and antiseptic experiments.