Episode 72: Absence [3]
The patient’s eyes darted wildly. Naturally so. Was he facing a dark assassin or a murderer? In reality, both men were doctors, each with their own convictions. But being called a murderer still felt unfair.
“Patient. Trust me.”
I hesitated, unsure if I should really get involved here. In his eyes, I must have looked like some mystical Oriental healer. What would that be? A powwow doctor? Whatever it was, I certainly didn’t look like someone trustworthy to him.
“I-I will.”
But apparently, it worked. The patient cautiously inched toward me. It made sense, considering those tools. They were deranged. I wasn’t going to use a murder device like that. And what was with the gag? He was supposed to be anesthetized.
“Come here.”
The patient moved toward me, while Kane, no, Dr. Kane, watched in clear confusion.
“You’re going with him? Not even with Liston? He’s a beginner!”
“Well, I still trust him more…”
“What kind of situation is this?”
What kind of situation? Just look in the mirror. No matter how you sliced it, you looked like a killer. Me? Well, aside from being Asian, I had a fairly harmless face.
“This way.”
“Ah, yes.”
“Professor, let’s go.”
“Uh… Right.”
Robert Liston followed us to his own operating room. From the patient’s point of view, it must have felt as if he was simply being transferred from one torture chamber to another. Truthfully, there wasn’t much difference. This room was more open, that was all. Stone surgeries were usually hidden away because they were painful and shameful. Amputations, on the other hand, were public events, often performed in the town square. Everyone saw everything.
“This place…”
The patient followed, wide-eyed, looking around the space that resembled a lecture hall.
He’s probably thinking, “This is insane…”
Fortunately, only members of the so-called “Liston Division” were present. Unfortunately, that group still numbered over ten. Amputation made Liston popular, and after the introduction of anesthesia, he was more popular than ever. Even Colin and the other students were there.
“Do I… need to get into that position again?”
The patient glanced at me with a desperate look. He meant the humiliating position he had been in earlier, legs up, underwear off, strapped down like a prisoner on a torture rack.
“No need. Just lie down.”
I had no intention of doing that to him. The stone was likely near the bladder. There was no reason to make things worse. I needed to cut into the abdomen.
Rattle.
Just as I was gathering my thoughts, Kane and his group entered the room.
“Ugh.”
The patient panicked, but Kane simply raised a hand.
“We’re not here to interfere. I just want to see how this quack performs surgery. If things go south, I’ll step in. That all right with you?”
“Ah… yes.”
He sounded like he genuinely cared. And oddly enough, he probably did. Doctors of this era were harsh but often sincere. Still, I had no intention of letting him near the patient again. Even if I made a mistake, it would still be more humane than whatever they had been planning.
“Hey, are you going to make him lie like that?”
I tried to ignore him.
“Yes.”
But he just wouldn’t shut up.
“Do you even know where stones form? If you do that, where exactly are you going to aim?”
I wasn’t about to slice open someone’s genitals. This was the most brutal operation imaginable, practically torture, and yet he had the gall to question me?
“I’m cutting into the abdomen. Here, specifically.”
I pointed from the navel down to just above the groin, where hair usually began to grow. Kane scoffed, as if I had just announced that I was cutting into the heart.
“Are you insane? You’re going to cut into the abdomen? That’s forbidden!”
He genuinely believed it. I didn’t want the patient to panic again, so I turned on the gas.
Shhhh.
The hissing sound filled the room. The patient, who had started to speak, went quiet.
“Ah, shut it off.”
It worked. I had fine-tuned the dosage after multiple amputations. Even Liston was still trying to understand it, but I knew the truth. The dose had to be adjusted for body weight and recorded.
“Good.”
“You lunatic! Did you just put him to sleep?”
Do you know what it feels like to be called crazy by someone already insane? It was infuriating. And terrifying.
“I need to disinfect now, so please be quiet. This isn’t housework.”
But thankfully, Liston was with me. Joseph Lister and Alfred were here too. And this was the perfect time to teach proper operating room behavior. Noise led to mistakes.
“What are you even talking about? We usually operate in the town square!”
Kane looked bewildered, as if I had started speaking a foreign language. Understandably so. Silence wasn’t something they associated with surgery.
Besides, didn’t they fry potatoes in the square these days?
“Anyway, silence. Joseph, bring the lime chloride.”
Joseph nodded and did as instructed. He poured it over the patient’s abdomen, just like we had practiced.
Slosh. Slosh.
I soaked gauze in the lime chloride and scrubbed the abdomen. The gloves protected my hands.
“Is this okay?”
The patient’s stomach started to swell slightly. The skin was more delicate than the palm, after all. But there wasn’t any actual damage. I had done this before.
“It’s fine. Disinfection is the priority.”
“He’s not a corpse…”
“Then go ahead and wipe it down first.”
“Uh… okay.”
Joseph wiped away the excess, and it was finally time.
The surgical team was just me, Joseph, and Alfred. Liston stayed back. He had already declared that this wasn’t surgery but something worse. He backed off even more once I said I was cutting into the abdomen. At the time, abdominal surgery was taboo.
Slosh. Slosh.
We continued applying lime chloride while wearing gloves.
Not quite up to twenty-first-century standards… but close enough.
Back then, we had been borderline obsessive about sterilization. Surgical site infections were nearly zero. Everything from gloves to drapes, masks to gowns was disposable and sterile. Anyone from this era would have been shocked. Now?
“Why so much fuss?”
“Exactly.”
Even with all this effort, the others still grumbled. They were used to using their bare hands, sometimes with nothing more than Betadine and a good scrub.
“Quiet. I have the knife now.”
“Uh, uh.”
“Oh… but I’m the senior.”
“And I told you. The one holding the knife calls the shots.”
“Uh… okay.”
As their de facto teacher, I could override some complaints.
Slick.
With Joseph pulling back the skin, I sliced down the center with my knife. If I had something like epinephrine, I would have injected it first. But we didn’t, so we went in raw.
“Blood.”
Even cutting only the skin without a vasoconstrictor caused heavy bleeding. I hadn’t done it this way before.
“Uh…”
Alfred mopped up the blood with gauze. It had been boiled, though I still had doubts about its cleanliness. Normally, I would use a Bovie, an electric surgical knife, to cauterize as I cut. That wasn’t an option now.
“Okay, it’s open. Hold this.”
“Uh.”
“Got it.”
I was a veteran of opening abdomens by now. We reached the peritoneum without damaging the organs.
“Oh…”
“Huh.”
Liston, Kane, and the others began to gather closer. Without masks.
Idiots.
Did they have any idea how many bacteria they were breathing out?
“Why is he wearing a mask?”
“Maybe for the smell?”
“He’s sensitive.”
“I guess so.”
They muttered behind me, but I didn’t care. At least they didn’t tell me to take it off.
“Okay. This is the bladder.”
The bladder was distended, the result of being unable to urinate despite drinking fluids. That actually helped me find it. Just locating it was half the battle.
“Hold this.”
“Uh… is this okay?”
I pierced the bladder with a hook and handed it to Joseph, who looked shaken but did as told.
Normally, we’d use sutures… but the only thread here is silk. I’ll keep exposure to a minimum.
The thread might trigger inflammation. I had to stitch the incision anyway, so I kept the cut short. Fortunately, the bladder had filled during the wait. I had expected that, and I was confident I could find the stone even if I couldn’t see it clearly.
“And here…”
I pulled out the bladder as much as I could, then carefully sliced it open. I used another container for the urine. And there, right in the middle, something gleamed.
“Why? What the—”
“No way…”
It was a stone. The size of an egg. It practically filled the bladder. No wonder it had hurt so much.
“I’ll remove it.”
“Uh, okay.”
I pulled it out with a neutral expression. On the inside, I was already thinking about how proud I should be once this was over.
Translator’s Notes
Urinary stone / bladder stone — A hardened mineral deposit that forms in the urinary tract. In this scene, the stone is inside the bladder and is large enough to block urination.
Anesthesia — A method or substance used to block pain or consciousness during surgery.
Lime chloride — A historical disinfectant used before modern antiseptic techniques became standardized.
Abdominal surgery — Surgery involving an incision into the abdomen. In this period, it was considered extremely dangerous and often taboo because infection control was poor.
Bladder — The organ that stores urine before it leaves the body.
Peritoneum — The membrane lining the abdominal cavity and covering many abdominal organs.
Suture — Medical stitching used to close wounds or surgical cuts.
Epinephrine — A drug that can constrict blood vessels and reduce bleeding when used locally.
Vasoconstrictor — A substance that narrows blood vessels, reducing blood flow and bleeding.
Bovie — A modern electrosurgical device used to cut tissue and cauterize bleeding at the same time.
Betadine — A modern antiseptic solution commonly used to disinfect skin before procedures.
Surgical site infection — Infection that occurs at or near the area where surgery was performed.