Episode 73: Absence [4]
When I took it out, the stone was even more absurdly large than expected.
This crazy thing was inside his bladder?
I glanced back at the unconscious patient, full of admiration.
How did he even endure this?
People of this era had incredible pain tolerance. They had no choice. Getting sick often meant staying home, because going to a hospital lowered your odds of survival.
But still…
“This…”
I was so stunned that I picked up the stone and tested its weight. It was hard. Solid. How long had this been building up? The absurdity of it almost made me laugh.
Of course, I held back. Nobody wanted a surgeon who laughed while holding a knife.
“It’s amazing.”
“This is… this is an abscess.”
Everyone else looked just as shocked.
Abscess? I think someone misunderstood the term. If you knew the original size of what they called an “abscess,” you’d know it was barely the size of a fingernail. But explaining that now felt pointless. This wasn’t the time.
I was still worried about the open bladder and peritoneum.
From this point on, I’m no longer a man. I’m operating in the realm of gods…
Technically, the bladder should be stitched in layers: the inner layer with absorbable sutures, the muscle and fascia with a second layer of absorbable sutures, and finally the skin with nylon. But calling that a “principle” felt silly. It was common sense. You couldn’t leave the bladder open, obviously.
I should have used Vicryl, but I didn’t have any.
Nylon… They say it greatly reduces infection risk because it has no gaps, right?
People usually associated surgery with manual skill, but infection control was far more important. In modern medicine, operating room infections were almost nonexistent, but that wasn’t magic. It was thanks to sterile systems so thoroughly managed that outsiders often felt anxious just watching.
But if I sew it with silk… the risk itself is built in.
The sigh that escaped me felt like it had been building up since I got here.
The worst part? I was the only one who realized how inadequate all of this was.
These people thought I was being excessive.
“But why are you boiling the thread?”
“Because the strands fray easily… and it’s expensive.”
Alfred, ever the merchant, was back to complaining about cost. And this was despite the fact that doctors here charged whatever they wanted. If you had money, you received more. Simple as that.
But this man doesn’t look rich.
It would be great if excellent treatment came cheap, but if someone died just to save a few coins, that was a tragedy.
“Quiet now. Watch how I sew.”
“Uh… okay.”
“But did the needle have to be round like that? It costs more to make those, you know. Yes, I’ll shut up.”
I gave Alfred a look that could kill and threaded the needle made just for me.
I really should train a successor before I get too old.
Modern sutures came pre-threaded, and reusable needles felt strange by today’s standards. But making a proper curved needle in this era required serious labor. Every stitch meant rethreading by hand. I was still young and had good eyesight, but I knew this would become a problem when I aged.
Snick.
Anyway, I pierced the swollen bladder and began to sew.
Ideally, each layer should be stitched separately: muscle to muscle, fascia to fascia, skin to skin. But using silk meant a massive risk of infection. So instead, I stitched through all the layers in one go.
“Hm… Compared to barbed needles, this seems to pass through much more smoothly.”
Robert Liston, watching from the side, looked impressed. He should be. Sure, I ignored the layering protocol, but my hands knew what they were doing.
Back in my time, my mentor emphasized stitching technique so intensely that I was better than many full surgeons.
Just because you hold the same needle doesn’t mean you’ll match me, doctor.
With that thought, I finished stitching the bladder and began closing the abdomen.
There was a brief hesitation. The abdominal wall bore a lot of tension. A careless suture could tear open.
The records said someone died when their stomach burst…
There was a saying: “Don’t mess with the belly unless you have to.”
It wasn’t just about infection. If the sutures failed and the abdomen ruptured, it was game over. Even in modern medicine, we sometimes left the abdomen temporarily open, covering it with sterile film until the swelling went down.
Snick.
Despite all those worries, I chose full closure.
There’s a lot of suture material… and this silk is thick.
It wasn’t just thick. It was twisted from several strands, making it strong under tension. Unfortunately, that also meant bacteria could nest in the gaps.
But still, if it had strengths, I had to use them.
I didn’t know when nylon would be invented, but until then, this was all I had.
“And…”
“Hey… That looks pretty solid.”
I tightened the stitches and closed the wound. The others weren’t surprised for nothing.
Even from the start, their skills didn’t compare. Incision planning was half the surgery, but these people tended to just slash away.
No muscle in the midline. That makes it neater.
In medical dramas, you just heard “Scalpel!” and saw a cut, but behind that was anatomy. To these people, my work must have looked like sorcery.
“How is that even possible?”
“Well… you sure live up to the way you talk.”
Even Kane was nodding. Understandable. They had never seen a surgery like this before. Hell, they had probably never seen anyone operate with anatomy mapped out in his head.
“Alright, all done. Phew.”
Of course, I closed my eyes and bowed slightly before saying anything.
“What are you doing?”
“I’m praying. Asking that the patient survives.”
“Huh. Very faithful.”
Liston chuckled and followed my lead. It wasn’t just theatrics. The surgery had gone well, but that didn’t mean the patient would live. From here on out, it really was up to fate.
“Dr. Kane, what do you think?”
“Ugh. You cut the stomach open and pulled that thing out…”
“Don’t call it heresy. Wasn’t this more humane than your method?”
Kane looked bitter. Understandable. Coming from a man who hacked off limbs daily, “humane” probably felt insulting. Still, he couldn’t argue. From positioning to cutting, this had been far gentler than his usual butchery.
You didn’t even have to cut the genitals… and it worked?
Judging by his face, that was exactly what he was thinking. Crazy bastard. Why cut the genitals at all? That area was prone to infection. And psychologically, the trauma would be immense. Even in an era with zero mental health awareness, that kind of shock was brutal.
“I suppose we’ll have to wait and see how this turns out.”
“Yes. But whatever happens, I think it’s better than your approach, so take a good look.”
“…Alright.”
Kane looked extremely displeased, but he had nothing else to say. He gathered his assistants and left.
As the uninvited guests exited, Liston’s original team moved in closer. Colin was visibly impressed.
“Wow… that was amazing.”
He hesitated a little, but he meant it.
Should I accept the praise?
I smiled at him. I had scolded him before. And though it wasn’t intentional, I had also accidentally knocked him out and yanked out a tooth when we first met.
If I don’t make peace now, I’ll just look like a jerk.
Medical school life was rough. Still, Colin had grown. His skills had improved too. He might not be the brightest, but he worked hard.
Colin was a true noble. Different from the rest of us.
Even Alfred acknowledged him. And in London, status still meant everything. Sure, Colin had lost his chance to inherit, which was probably why he chose medicine. But when I became hospital director someday, having someone like him on my side would be useful.
“What? You could do this too. You’ve got good hands.”
“Really? Thanks.”
Youth. So bright. I was exhausted.
“Alright then, let’s move him to the ward.”
“Sure. Um… can I put him in the room I set up earlier?”
“Huh? Does that even matter?”
Liston asked casually. It seemed fair, but…
The ward…
It was a nightmare. The so-called “ward” was a hellhole.
Why were there maggots on hospital beds? Even seeing them, the doctors didn’t blink. Patients had to bring their own bedding. If they didn’t, they just used whatever was lying around.
I’m still worried about infection. That’s not going to work.
I kept my tone calm.
“Opening the abdomen was a big challenge for me. I want to give him every chance I can.”
“Hmm… I get it, but why is someone so squeamish about blood so good with a scalpel?”
“That’s…”
How did being hygienic equal being squeamish?
“Anyway, let’s do it.”
Thankfully, Liston was understanding. I was able to move the patient to a relatively clean bed.
“You know I’m paying for all this out of pocket, right?”
Well… with Alfred’s help.
“Ah, then I’ll repay you when the condom comes out—”
“Oh, while we’re at it, let’s measure the size.”
…Shit. Wrong word.
Translator’s Notes
Abscess — A pocket of pus caused by infection. The line appears to be a mistaken or awkward use of the term in context, since the object removed was a bladder stone, not an abscess.
Bladder — The organ that stores urine before it leaves the body.
Peritoneum — The membrane lining the abdominal cavity and covering many abdominal organs.
Absorbable suture — Surgical thread designed to dissolve naturally inside the body.
Vicryl — A modern absorbable synthetic suture material.
Nylon — A non-absorbable synthetic suture material with lower bacterial retention than braided thread.
Silk suture — A traditional braided suture material. Strong, but its braided structure can harbor bacteria.
Fascia — Connective tissue surrounding muscles and internal structures.
Surgical site infection — Infection that occurs at or near the area where surgery was performed.
Midline incision — An abdominal incision made along the body’s central line, often chosen because it avoids cutting through major muscles.