Episode 86: Do I Need Surgery for This? [3]
“Scalpel.”
“Ah… Are you talking about this? A knife?”
“Uh. Isn’t it about time you understood the term ‘scalpel’?”
“Oh, yes. Sorry.”
“Pull the abdomen.”
“Uh. But why are you pulling this?”
I didn’t know if this was surgery or a training session… Seriously, Joseph, if this bastard weren’t my friend, I would have punched him in the face by now.
Professor… Is this how you felt?
How did you endure that, really? When I thought back, when I was a student, I went through the motions without really understanding… As I forced myself to think of frog tadpoles as enemies, I started to accept it. No, maybe I was just rationalizing it. Whatever you called it…
“You have to pull the abdomen to make the incision straight. You saw how we did it in dissection, right?”
“Ah… Is that so?”
“Look carefully.”
I was so familiar with surgery that even the slightest interruption didn’t feel like a disruption. Was I really a professor of surgery? Though I died shortly after officially being appointed. Originally, the training period to become a professor was brutal.
Anyway, I soon drew a diagonal line across Alfred’s McBurney’s point with the scalpel. Joseph looked a little surprised. Even though I had told him to pull there in the first place, his reaction was understandable. During dissection, I had cut all the way from the solar plexus to the pubic area. Compared to that, this felt almost trivial. You could even cut horizontally here.
“Uhm… Is this how it works?”
“If we open it any wider, the patient will die.”
“Okay? I once heard that visibility is important.”
“Of course, good visibility is important. But… you can’t just open him up for your own convenience. Senior says it hurts here. So why would you tear open this whole area?”
“Is it…”
“Pull this part first. No… don’t comfort me. Yes, on both sides. Just a little upward. Yeah, like that.”
I handed Joseph a crudely made Richardson retractor. To be honest, it looked closer to an Army-Navy retractor than a Richardson, but it was fine. Whatever it was, it would be used to pull.
“There, light. No, sir, my face will burn. In moderation. Yes, there.”
The abdomen was pulled open, but I couldn’t see inside clearly. Of course I couldn’t. There was no ceiling light here. No operating room lights, only handheld lamps. Fire wasn’t a problem, but everything taken for granted in the twenty-first century was not a luxury here. It was something they couldn’t even dream of.
After.
I briefly glared at the servant holding the lamp too close to my face, then looked inside the abdomen.
More difficult than I thought.
Light was more critical than I had imagined. Maybe it was because I had always operated in a proper environment before. Wasn’t there a saying that in an operating room, the person holding the knife was always the highest-ranking person, no matter their actual rank? Thanks to that, I had performed surgeries properly even before becoming a professor. But here, nothing was the same.
Slowly… Let’s stay calm. Still, this is just an appendix. It’s not a difficult surgery…
I took a deep breath and inserted my index finger into the abdomen. Far from difficult, this was a basic surgery, right? Different departments had their own standard first surgeries, and appendectomy was usually one of them. I had been doing this regularly since my third year as a resident. Later surgeries were much harder. The abdominal anatomy was clear to me even with my eyes closed.
“That’s right.”
I first found the area leading from the ileum to the ascending colon with my hand, then felt around the cecum. I was taught that the appendix was a protruding structure like a tail.
I’m confused… it’s really swollen.
Because it was a small tissue connected to the cecum, fecal matter or hard food could block it and cause inflammation. The swollen part that didn’t heal was what we called appendicitis.
“Utcha.”
I pulled out the appendix, which should have been thin but was now puffy and swollen.
Rattle.
Just then, the door opened. I didn’t bother to look. This was an important moment. I expected no one would dare interrupt now.
“Hey, master. I brought someone!”
“Shh. Quiet.”
“Yes?”
“Dr. Pyeong seems to be doing well, so stay for now.”
When any act reached a certain level, it looked different even to outsiders. In that sense, wasn’t my appendectomy a kind of art? Ever since I picked up the scalpel, I had been able to perform without a hitch. Plus, I had just pulled it out. It looked strange just seeing it, right? Anyone would think this was the cause. The internal organs, which should have been pink, were dark red and swollen as if about to burst. Anyone could see it needed to be removed.
“Then why did you bring me here?”
Hearing the old, grayish voice, I turned my head without thinking. It was the first time I had seen him. I thought Liston would be the surgeon they called, but that wasn’t the case.
“Just in case. Sorry about this.”
“Sorry! Are you trying to move on by saying that? Look at that thing over there! Opening the abdomen! This… this is nonsense!”
“But look at that.”
Of course, I didn’t argue.
We had to hurry. Senior Alfred wasn’t in immediate danger, but the lack of antibiotics was a serious problem. Opening the abdomen and taking too much time increased the risk of bacteria entering.
I tied the root of the appendix with thread. Normally, it would be tied with silk or sterilized thread, but I only had ordinary thread that had been boiled once. This could become a problem.
Still… our senior is strong.
Honestly, if he was going to die, it should have happened when he injured his finger before. Could a person who survived germs from a corpse really die from appendicitis? Thinking that, I tied it tightly and held out my hand.
“Scissors.”
“Uh? Uh.”
Joseph’s attitude was different now, which was natural. He sensed that something unusual was happening, but what could a medical student really understand? He probably had many questions. This wasn’t just genius. It was technique more than a hundred years ahead of its time, impressive no matter how crude the tools were.
You… if you ask me later, I’ll just pray.
Should I say I was lucky? Joseph’s eyes looked like he had witnessed something sacred, his face full of awe.
Pop.
I cut the appendix with the scissors he gave me. The removed specimen was placed on the iron tray next to me. This was the end of the operating room’s role. Normally, the specimen would go to pathology. But was there a pathology department here? No, only doubters. The old doctor had been impressed for some time, and since the guardian was here, there shouldn’t be any problem…
It’s a bit unsettling whether he’s really a doctor or not…
I was a little concerned about the old gray-haired man.
“Scalpel.”
“Huh? Another one?”
“This. Aren’t you curious what it looks like?”
“Ah… I am curious.”
“It will stink, so be careful.”
“Uh? Uh, uh, uh.”
Joseph handed me a scalpel after hearing that. I held it, looked at the doctor for a moment, then made a sharp cut.
“Ugh.”
“Cadet.”
“What is this…”
As soon as the swollen appendix split open, a foul smell filled the room. Honestly, even before that, there had been a slight bloody odor, but now it was overwhelmingly foul.
“I can’t believe this was inside his body. Good thing we got rid of it.”
“Ugh, uhm.”
“Do you still think it was wrong to open the abdomen?”
“That… wow.”
The doctor couldn’t even respond. His expression was dissatisfied, but what could he do? He probably didn’t know anything. To be blunt, he probably didn’t even know where that thing came from. The abdomen was taboo, and even Liston, a master of anatomy in this era, only considered it an object of study, so his knowledge was limited.
“Good. Let’s close now.”
“Uh? Close it?”
“Are you trying to keep it open?”
“Ah… yes. We have to close it. But how…?”
“Look carefully.”
Things had changed since the days of basic needles. I had just made a custom needle that looked like a fishing hook. Using this, I could sew properly.
Hooked.
Of course, due to the limitations of the thread, I couldn’t sew every layer perfectly… But unlike before, when I saw patients with stones, I was now able to suture the peritoneum, abdominal muscles, and skin separately with thinner threads.
Whoops.
“And…”
“How can you be so brave…”
If the layers were pulled and sewn all at once, it could never have looked like this. But when only the peritoneum was sewn carefully, something almost magical happened. Thanks to the clean incision, Senior Alfred’s peritoneum came together neatly, as if untouched except for the thread marks.
Hooked.
I closed the abdomen and continued, holding back the shaking in my shoulders as cheers rose around me.
“And…”
“You should cut this with scissors.”
“Uh? Uh-huh.”
“Don’t cut too close. We’ll have to loosen it later, so leave one centimeter.”
“One centimeter?”
“Ah… about the length of a fingernail.”
“Uh, uh, uh.”
As the skin was closed, the cheers grew louder. Opening and closing the abdomen required great effort and tension, so appearance wasn’t the priority, but this incision was possible because there was room. The skin came together so neatly that one might think it would hold even without the thread. They cheered because they had never imagined, let alone seen, this type of suturing before. This was also possible because there was no convention of silence in the operating room. It was annoying because every word increased the risk of infection, but it was too early to worry about that.
“Okay, it’s over. Let’s watch him for now. The surgery went well.”
I still had a lot to carry alone.
Footnote 1 — Translator’s Notes
Scalpel — Small surgical knife used for precise incisions.
McBurney’s point — Anatomical point in the lower right abdomen, commonly associated with appendicitis and appendectomy incisions.
Appendectomy — Surgical removal of the appendix.
Ileum — Final part of the small intestine.
Ascending colon — Section of the large intestine on the right side of the abdomen.
Cecum — First part of the large intestine, where the appendix is attached.
Appendix — Small pouch attached to the cecum. When inflamed, it causes appendicitis.
Appendicitis — Inflammation of the appendix. Untreated appendicitis can rupture and become fatal.
Richardson retractor — Surgical instrument used to pull back tissue and improve visibility.
Army-Navy retractor — Simple handheld surgical retractor used to pull back tissue.
Peritoneum — Membrane lining the abdominal cavity.
Pathology — Medical field that examines tissue specimens to diagnose disease.
Specimen — Tissue or organ sample removed during surgery for examination.
Suture — Medical stitching used to close wounds or surgical incisions.