Episode 85: Do I Need Surgery for This? [2]
“Father.”
If it weren’t for Alfred, I probably would have backed out by now. Honestly, it was frightening. Most people in the nineteenth century claimed to be scientists, but their thinking was almost medieval. They were extremely conservative, even stubborn, and they did not accept new facts easily, especially if those facts came from someone from the East.
“Please believe me just this once. This hand… I wouldn’t have been able to keep it if it weren’t for him.”
“Ugh…”
But things had to be different now. We couldn’t keep ignoring people dying just because we were scared.
Now I have quite a reputation too.
I tried to rationalize it, but that didn’t mean I wasn’t scared. I thought about the director’s face earlier today, full of greed. I wondered how a person’s face could look like that, but thinking about it, maybe it wasn’t such a bad thing. Would a man like that throw me out just because I felt a little attacked? Honestly, I felt like I was laying golden eggs right now. No, there would be more in the future.
“I don’t think my medical knowledge or skills are inferior to those of the other professors. Senior Alfred isn’t following me around for no reason.”
“That…”
“There are things you can understand without learning them formally. I am one of those people.”
“Hmm…”
“Sir… if we don’t open him up, he’ll die. There is a high possibility he will die as time passes.”
Appendicitis, or typhlitis, was nothing in the twenty-first century, but that was thanks to surgical techniques and antibiotics. Back then, germs were far more deadly than we imagined. It didn’t seem like it had ruptured yet. When rupture happened, symptoms sometimes improved briefly before full-blown peritonitis spread. The pain then extended beyond the lower right abdomen in all directions.
“We need to operate quickly. Of course, the choice is yours and your father’s, but I promise I’ll do better than anyone else who might try.”
“Ugh. Hmm.”
Fortunately, the man was shaking, probably because of Alfred. Alfred, a surprisingly dutiful son for the nineteenth century, spoke to his father often, if not every day. Naturally, their conversations included praise for me. Above all, the story of a senior who died from similar symptoms struck a chord, and Alfred had also given his father a small ring.
“Ah, Father. I… I believe in Pyeong…”
Add to that the words of Senior Alfred, struggling in pain, and there was nothing more to say.
“Damn it… can he really die?”
“Yes.”
“Eww… Aaaaaa!”
Alfred’s screams as he endured appendicitis without proper painkillers were enough to make his father panic. Although I had never been married or had children, I had plenty of indirect experience. A parent’s love for their child was not always rational. Even if what I said was hard to accept in this era, that much was the same.
“Ah, I see. Then… then please do me this favor.”
“Yes. Please have the carriage stand by. I’ll go to the hospital quickly and come back. In the meantime, give him willow bark extract. It should ease his symptoms.”
“Ah, I understand.”
“Keep this in mind: symptom improvement only means the pain is reduced. It does not mean the condition is actually better. I’m only giving it because he’s so exhausted.”
“Uh… I see.”
Like Joseph and Alfred, he didn’t seem to understand what I had just said. If the pain got better, didn’t that mean the disease was better? That was obviously what they were thinking. Painkillers were either too rare or unheard of back then, so it was inevitable. No, you didn’t even have to go that far. Painkillers were still often used as mere treatments even in the twenty-first century, especially where medicine was scarce. I felt that keenly at the medical volunteer site I was forced to visit halfway across the world.
“Let’s go!”
I went out with the quick-footed servant. The coachman, half-awake and probably drunk, drove the carriage recklessly. He ran the horses so hard that I thought we would have died if there had been even one pedestrian, but as expected, the police stopped us.
“Ah… Chamber of Commerce… Excuse me. Let’s go.”
Should I say I was fortunate? Back then, there was no concept of drunk driving. If you were rich and powerful, breaking laws was tolerated. Thanks to this, we were able to reach the hospital with a police escort.
“Bring that bag with you!”
“Yes, yes.”
“I’ll go to the dissection room. Don’t worry.”
“Ah, yes. Thank you.”
As soon as I entered the hospital, I saw the running servant stiffen with fear. It was understandable. First of all, the smell was overwhelming. Since the dissection laboratory was near the lecture room, a foul stench wafted through the halls all year round.
Aaaaaaaaaaaaaaaaaaaaaa.
On top of that, screams came from down the hallway, loud enough to chill any stranger’s heart. And I was telling him to go to the dissection lab? It looked like there would soon be two patients to treat. Maybe I’d have to remove the appendix right on the spot.
“Where… right.”
To be honest, I was scared too. Not because I feared the body would come alive. I wasn’t afraid of that…
“Hey, damn it. You damn rat!”
Despite the room being sealed, rats came in at night wherever they could.
Sometimes dissected bodies were damaged by rats. I had suggested several times that this was a serious problem and needed fixing, but to no avail. The administration knew, but they had no solution. We would have to seal the bodies completely, but with the technology here, if we sealed them properly, they would never be opened again.
“Right. Here it is.”
I searched the practice room, muttering to alert rats and bugs that I was there. I found a bag with some instruments. I had soaked them in boiled water once, but they wouldn’t be usable as they were.
Now… it must be around two in the morning, about three hours after the inflammation reached the peritoneum… There’s still time before rupture. Since we don’t have antibiotics or proper anti-inflammatories, there probably isn’t much time left…
We couldn’t rely on hospital procedures. If we did, Alfred would surely die.
Those internal medicine doctors always said I couldn’t do anything without medicine… If I had dropped out and gone into internal medicine, it would have been a disaster in this era.
I was glad it was surgery. I could still wield a scalpel and do something. To be blunt, internal medicine would never treat appendicitis successfully here.
“Did you find it?”
“Yes, is this right?”
“Uh… yes. Okay, let’s go.”
“Yes, yes.”
I carried the bag out of the dissection lab as fast as I could. The servant carried some other instruments I had left in the classroom. To be honest, it wasn’t enough. These tools weren’t made for opening the abdomen. It was a shame I had sold the gold ring the man had given me earlier. Otherwise, I might be forced to cut him with some strange knife and pull open his stomach with a spoon.
“Let’s go!”
When we left, the police and coachman took us back to the mansion. Even though it was the middle of the night, candles and lanterns were lit here and there, so the mansion was fairly bright.
I’m glad he’s from a rich family.
It seemed unlikely that the surgery would be impossible due to a lack of fire. With so many servants, there were plenty of hands to hold lamps. While trying to keep a positive outlook, I instructed them to boil the instruments first, then went straight to Alfred’s second-floor bedroom.
“Huh…”
Perhaps because he drank the boiled willow bark water, he was definitely much quieter than before.
No, no. Maybe it ruptured…
If I thought negatively, the disease could have progressed. Normally, when appendicitis ruptured, symptoms improved immediately because the pressure causing pain was relieved. It was similar to otitis media. When the eardrum swelled, it hurt badly, but when it burst and pus drained out, the pain lessened.
“How are you feeling?”
“Better than before… much better.”
I took a quick look. His complexion was definitely more relaxed. My pulse was steady too. I couldn’t measure blood pressure since there was no monitor yet, but judging by feel, his systolic pressure was at least over one hundred.
“Hold still a moment. Like before.”
“Then… then it hurts.”
“I’m sorry. I have to monitor the progress.”
“Eww… okay. You usually treat pain…”
“Say that again. They saved my life.”
“Sorry… It’s just that the pain is so bad…”
Yes, what? The patient was king. As a doctor, you couldn’t argue with that. Thinking that, I had Alfred lie on his back again, bend his legs, and take the position that would make his abdomen softest.
“Now, tell me if it hurts when I press.”
“Uh…”
“How about here?”
“Uhm… similar to before.”
I pressed the solar plexus area. If it had ruptured, it would have been extremely painful, but fortunately, it seemed about the same as before.
“Here?”
“Aww!”
“What about when I let go?”
“Uuuuuu!”
The area near the lower right abdomen was similar. Alfred’s face, which had calmed down after drinking some water, suddenly darkened. Not long after, a servant came running, but I ignored him for now.
No matter who comes, it won’t change what has to be done.
I thought this as the servant pulled laughing gas from the bag. The instruments that had been submerged in boiled water must have been taken out. The servant must have gone to the wrong place and confirmed that Alfred’s condition wasn’t yet critical. There was no reason to hesitate.
I’m sorry.
I turned on the gas first and placed a crude, custom-made sheet-metal mask over Alfred’s face. If the gas leaked, I would get dizzy and wouldn’t be able to operate.
“Uh, um.”
Alfred soon lost consciousness. I looked at Joseph.
“Wear gloves and dip your hands in this.”
“Uh… uh, uh.”
I put on gloves and dipped my hands in the Lime Chloride I had brought. I rubbed Alfred’s abdomen with the same disinfectant. It turned red immediately, so I knew I would have to find a better disinfectant later, but there was no time now.
It was surgery time.
Footnote 1 — Translator’s Notes
Appendicitis — Inflammation of the appendix. Without surgery or antibiotics, it can rupture and become fatal.
Typhlitis — Older term associated with inflammation near the cecum; here, Pyeong uses it while clarifying that the condition is appendicitis.
Antibiotics — Medicines used to treat bacterial infections. Their absence makes appendicitis far more dangerous in this era.
Peritonitis — Inflammation or infection of the peritoneum, often caused by a ruptured appendix or abdominal infection.
Peritoneum — Membrane lining the abdominal cavity. Irritation of this membrane causes severe abdominal pain and rebound tenderness.
Painkillers — Medicines used to reduce pain. In this era, reliable pain control is limited.
Willow bark extract — Crude pain-relieving preparation made from willow bark, associated with salicylate compounds.
Drunk driving — Modern term for driving while intoxicated. The narrator notes that the era lacks a clear legal concept for it.
Dissection laboratory — Room used for anatomical dissection and corpse study.
Anti-inflammatory — Medicine that reduces inflammation. The narrator notes that proper anti-inflammatory treatment is unavailable.
Otitis media — Middle ear infection. The narrator compares ruptured appendicitis to the way ear pain may temporarily lessen after pressure is released.
Systolic pressure — The upper number in a blood pressure reading, indicating arterial pressure when the heart contracts.
Laughing gas — Nitrous oxide, used here as a crude anesthetic.
Sheet-metal mask — Improvised metal mask used to deliver gas anesthesia.
Lime Chloride — Harsh disinfectant used experimentally for handwashing and surgical preparation in the hospital wards.