Chapter 169: Kasai Op [2]
Chapter 169: Kasai Op [2]
Unlike Hideyoshi, who had still been uncertain, O-no-dono had long since completely fallen for Kanghyeok.
So she had prepared this and that exactly as Kanghyeok had instructed.
First of all, there was Tsurumatsu, unconscious.
“The baby’s asleep, right?”
“I mixed the medicine you gave into his milk and forced him to drink it.”
“Good. What about the rest?”
“Here. I had these made according to the drawings you gave me.”
O-no-dono pointed to two small platforms and the various instruments laid out on top of them.
“Mm.”
Kanghyeok nodded as he examined what O-no-dono had indicated.
First, the platforms were exactly right in height and width.
Of course, since they were made to suit the tall Kanghyeok, they would be brutally high for Yeoni, Dolseok, and Makbong, who would be assisting.
As always, Kanghyeok was self-centered.
And he did not particularly think that was wrong.
The lead surgeon is the most important one. Naturally.
That was true, but it was also a part that could easily have been improved.
If they had made something like footstools, the others could simply have stepped up on them.
But that sort of thing did not fall within Kanghyeok’s range of concern.
Even the members of his own party took their discomfort as perfectly natural.
That was because Kanghyeok had never once told them that such a thing was even possible.
“This was rather difficult to make… what do you think?”
O-no-dono pointed to the instrument that had been the most difficult of all the items Kanghyeok had instructed them to make.
It was the metal airway tube to be inserted into Tsurumatsu’s throat.
Naturally, it was much smaller and thinner than the one Kanghyeok normally carried around.
“Hmm. Well… it doesn’t seem too bad.”
“Then does that mean we won’t have to make the hole in the throat like you mentioned before?”
“No. I’ll try first, but if it seems too dangerous, I’ll cut right away. That may be distressing, but it’s much safer.”
Both then and now, guardians tended to prefer intubation over a tracheostomy.
There was no need to use a blade, and it felt like something that simply slid in and then came back out, so that was understandable.
But from the doctor’s perspective, especially a surgeon’s, a tracheostomy was often cleaner and better.
It was safer and easier than people thought.
Especially in the case of a baby as small as Tsurumatsu, if intubation was left in too long, the chance of damaging the vocal cords was high.
Kanghyeok had already explained these things to O-no-dono several times, but a parent’s heart was not so simple.
“Still, avoid that if you can.”
“Well… all right. But if, during the surgery, I judge that it’s necessary, I’ll do it. If that happens, you must not interfere.”
Even after confirming that Hideyoshi was standing behind O-no-dono, Kanghyeok kept his tone firm.
No matter what anyone said, his belief that the lead surgeon had to come first in the operating room never wavered.
“Cutting the throat?”
Unlike O-no-dono, Hideyoshi was hearing this for the first time.
So he widened his eyes and stared at Kanghyeok.
He looked full of the desire for an explanation.
I don’t want to waste time.
Kanghyeok looked toward Tsurumatsu, who had been moved onto the platform wrapped in blankets.
Though the child had been examined by Kanghyeok up to now, he had not received any meaningful treatment beyond drainage of the ascites, so his condition remained much the same.
And ascites, once drained, simply built back up again.
Because of that, he was still short of breath, his belly still protruded, and his face was still yellow.
“Yeoju, go explain it to him. We’re draining the ascites first.”
“What?”
“You know all this already. Go explain it.”
“Ah…”
Yeoju looked at Hideyoshi with a troubled face.
Whatever happened, he looked like a man who absolutely would not leave the room unless he heard the explanation.
When she looked next at Kanghyeok’s face, it too was full of stubbornness.
He clearly had absolutely no intention of explaining it himself.
Damn it.
For her, Yeoju cursed in a way that was highly unusual.
But what could she do?
Kanghyeok had already begun checking Tsurumatsu’s abdomen.
From all she had seen so far, if she wanted to change Kanghyeok’s mind right now, she would probably have to hold a knife to his throat.
It’s better for me to explain than try to bend that man’s stubbornness.
She had already heard Kanghyeok explain it to O-no-dono four or five times.
And among the group, was she not the one with the most scholarly learning and the sharpest mind?
It seemed like she could somehow manage it.
With a sigh, she went toward Hideyoshi.
Since Yeoju did not know Japanese well, one of the Japanese interpreters came along with her.
“Well… I’ll explain it in detail.”
“Mm. Please do.”
“We need to treat him here now, so let us step outside. O-no-dono, Lord Kiyomasa, you should come out as well.”
“Can’t it be done here?”
Hideyoshi looked with slight dissatisfaction at Yeoju and at Kanghyeok, who was acting as though neither of them existed.
But Kanghyeok had long since become absorbed in the thought of draining the ascites first.
The explanation had become entirely Yeoju’s burden.
She cursed inwardly once more, then forced a smile.
“There is a risk of infection. As you can see… our attire is rather unusual, is it not?”
Yeoju pointed to her cap, mask, and gloves.
The others were all dressed the same way.
Kanghyeok and Dolseok, in particular, had changed into sleeveless clothing in a rather radical fashion.
“Mm…”
“If hair or saliva from our mouths gets into the child’s body, it could become a grave problem. This is for the child’s treatment, so please cooperate.”
Even as he listened to Yeoju, Hideyoshi kept letting out low noises.
But just as people said, he was a man who loved his son dearly.
In the end, he abandoned his pride and headed outside.
Thanks to that, only Kanghyeok, Dolseok, Yeoni, and Makbong remained in the room.
“Good. Give me the needle.”
Only now looking like he could breathe, Kanghyeok held out his hand.
Yeoni handed him a thick IV needle.
Ordinarily, he should have gone straight to the vein and inserted it, but this time he did not.
Instead, he pressed repeatedly on the lower right side of the abdomen.
These days I hear they use ultrasound to check and then puncture.
Not even that old yet, Kanghyeok had once been quite surprised watching interns recently perform this procedure.
They used ultrasound to find the place where the most ascitic fluid had collected and where there was no bowel, then inserted the needle there.
The world’s gotten better…
But at the same time, he thought that if he had been trained in that weak way, he would not be able to insert the needle this confidently now.
Sometimes the old way is better.
Wearing a somewhat old-fashioned expression, Kanghyeok lightly tapped on the abdomen.
It was percussion, a method almost nobody used anymore.
But when it came to draining ascites, it was tremendously effective.
Good… this side gives the strongest wave.
Kanghyeok placed his hand on a point about five centimeters lateral to the navel.
Then he slowly pushed the long needle straight in.
Anyone who knew nothing would probably worry that he might injure the bowel.
But the bowel was, in fact, a very sensitive organ, and more than that, one that moved.
If the tip of the needle touched it, it would avoid it on its own.
“Okay. See that yellow fluid gathering here?”
Kanghyeok pointed to the tip of the needle he had just inserted.
Just as he said, yellow fluid had gathered there.
“Is that urine?”
Dolseok answered Kanghyeok’s confident expression with the sort of clueless response expected from someone who knew nothing.
“Urine… you punk. How many times have I told you this belly is sticking out like Namsan because of ascites?”
“But the color is exactly like urine…”
“If this much urine had built up, he’d already be dead.”
“Dead? In front of the patient?”
Dolseok, apparently, did not feel much hostility toward Tsurumatsu or Hideyoshi.
That was understandable. They had not done anything yet.
“Well, I suppose this child has no guilt of his own. His only crime was being born to the wrong parents.”
“Born to the wrong parents? No, his father’s a king. By your logic, Young Master, doesn’t that make him a gold spoon?”
“Enough. Things like that exist. Anyway… now, watch.”
Kanghyeok gently rotated the end of the needle.
He was searching for the best position for the fluid to drain.
That too was a primitive method, but it was always effective.
Gush—
Soon, an enormous amount of ascitic fluid began flowing out through the IV line.
“Oh…”
“You can see the belly going down, right?”
“Yes, yes. No matter how many times I see this, it’s still amazing.”
“Today we’re going to drain all of this and do the surgery too, so he’ll be all right for quite a while.”
“But… you said he still won’t live, right?”
“It’s too late. Still, a few more years is better than nothing. If we leave him like this, it’ll really be soon.”
“That’s true.”
While they talked, Tsurumatsu’s abdomen began to sink visibly.
That was only natural, since the amount of ascitic fluid already drained had reached at least several hundred milliliters.
This should be enough to operate now.
Opening the abdomen and draining the ascites that way was also one option.
But if he did that, he might accidentally damage something while cutting into the belly of an already tiny child.
Blood alone would already obstruct the field. What would it be like if ascitic fluid were there on top of that?
In any case, this was enough now.
“All right, let’s start for real.”
“Yes, Young Master.”
Kanghyeok inserted the metal airway tube into Tsurumatsu’s mouth.
Then, as always, he handed it over to Makbong.
“If you squeeze too hard, his lungs will rupture, so go gently. You practiced, right?”
“Yes… like this, right?”
Makbong squeezed the artificial respiration bag with less than half his usual strength.
Even that delivered no small amount of air.
From Tsurumatsu’s point of view, with his usual gasping, it probably felt like sweet rain after a drought.
Looking at Tsurumatsu, whose fingertips had begun to twitch slightly because of that, Kanghyeok said,
“If he moves any more than this, or if his heart rate starts climbing, tell me. Before he regains consciousness, I’ll have to cut the neck and put in the tube.”
“Ah… yes. Understood. I need to watch the breathing, heart rate, and blood pressure, right?”
“Yes. And watch for movement too. Babies are fast to begin with, so it can get confusing.”
“Yes.”
“Do it well.”
“Yes…”
Leaving behind Makbong, who looked half dead already, Kanghyeok picked up the scalpel.
Dolseok and Yeoni had taken their positions just as he had taught them.
“All right, you two know too, don’t you? Just looking at this belly, you can feel it, right?”
Kanghyeok pointed at Tsurumatsu’s exceptionally small torso.
It really was small, and smaller still.
“Yes, Young Master.”
“Do it well.”
“Yes…”
Only after giving repeated warnings did Kanghyeok finally move the scalpel.
Unlike the fear he had instilled, the hand moving the scalpel was incredibly bold.
Rip—
In one stroke, the abdomen was opened vertically.
There was some bleeding, but not much.
Because the child had been sick for so long, the blood vessels had not developed well.
And besides, Dolseok and Yeoni had by now become very skilled at hemostasis.
This amount of bleeding could not obstruct Kanghyeok’s work in the slightest.
“Now this is the peritoneum, and don’t be startled. His liver’s going to look a little different.”
“Oh. Yes.”
“That doesn’t mean you just stand there staring, does it? Pull to the left and right.”
“Ah, yes.”
“Don’t lose focus. You’ll get us killed.”
“Yes, sorry…”
After roasting Dolseok and Yeoni for a while, Kanghyeok moved the scalpel again.
The peritoneum was not that thick, so the incision was quick.
The moment it opened, some of the ascites still remaining inside spilled out at once.
But since most of it had already been drained, the amount was not great.
Thanks to that, Kanghyeok and the others were able to look clearly into the abdominal cavity.
“It really does look a little different, right?”
“Yes. This… is this the liver?”
“Yes. That’s the liver.”
Kanghyeok pointed at the shriveled, blackened liver.
It was obvious that it could no longer function at all.
Ah, seeing this makes me want to do a liver transplant right away.
But Kanghyeok forcibly suppressed the impulse.
That was impossible, and there was nothing more foolish than obsessing over the impossible.
“Why is it like this?”
Yeoni, who had only been assisting, asked.
Her face was full of worry.
It seemed that having such a young patient made it affect her more.
By contrast, Kanghyeok’s face was utterly cold.
As far as he was concerned, a lead surgeon had to think only of the surgery while in the operating room.
If he let himself get swept up in emotion, he would only create something he would regret later.
“I’ve told you over and over. It’s because the bile can’t drain.”
“Then how do we…?”
“The liver’s already ruined, so there’s nothing to be done about that. We just have to stop it from getting any worse.”
“How?”
“We make the bile come out.”
“How do we—”
Kanghyeok shot Yeoni a look as she kept repeating the same question.
Then he answered, “We make a new path for it to come out. For now, spread the abdomen wider.”