Chapter 171 Kasai Op [4]
Chapter 171 Kasai Op [4]
“Mm. First, we have to cut the duodenum.”
“You mean the very first part of the small intestine, right?”
Dolseok asked back while catching the bile that kept pouring out without end.
That was just like him, the one with the best memory among them.
“That’s right. Another name for it is the salivary intestine.”
“Didn’t you say that part of the small intestine was the most important?”
“I did.”
“But you’re cutting it?”
“Ah… you’ll understand when you see it. I’m cutting it because it’s the most important.”
Baek Kanghyeok set down the scalpel and forceps he had been holding, then began feeling along the small intestine.
He worked from the point where it began below the stomach to a certain section. To be exact, it was the entire duodenum.
When I learned this as a student, I thought that because it was called the duodenum, it was about the length of twelve fingers.
Wasn’t that what its name meant, after all?
That was why he had roughly assumed it was just a little over twenty centimeters long.
But in reality, it was around twenty-five centimeters.
Its appearance itself was the same as the section that followed it, the empty intestine, in other words, the jejunum.
Because of that, beginners found it very difficult to distinguish between the two.
But there’s actually a handy trick.
If you did not know it, it was endlessly difficult, but once you knew it, it was very easy.
Kanghyeok kneaded the duodenum for a while, then stopped at the area where the intestine began to hang much more loosely.
“Okay, hand me the scissors.”
“Yes, Young Master.”
Yeoni had already been holding the scissors before Kanghyeok even gave the order.
So the moment he reached out his hand, she was able to place them in it.
The instant Kanghyeok took the scissors, he began cutting the section he had been holding without the slightest hesitation.
Snip, snip.
Yeoni tilted her head as she watched what he was doing.
From her point of view, she could not tell at all where exactly he was cutting.
Makbong, who had been fiddling with the artificial respiration bag, and Dolseok, who had become the one receiving the bile, felt the same.
“Um… what are you using as the basis for the cut?”
In the end, Yeoni could not hold it in and asked.
The operation had been going well, so Kanghyeok answered readily.
By now, the duodenum had long since been cut.
“Ah. Look closely.”
Kanghyeok held the part he had identified as the duodenum and gave it a slight shake.
They could see that the back side of the intestine was fixed tightly to the membrane toward the back.
“This part is different.”
Next was the section that had just been separated from the duodenum.
From here on, it was not fixed anywhere, so it moved very freely.
“Can you tell the difference?”
“Ah… yes.”
“The duodenum is stuck in place like this, so even if you cut it out, you can’t use it anywhere else anyway. And you shouldn’t.”
It was no coincidence that the duodenum’s other name was the salivary intestine.
It was where the gastric juice descending from the stomach, the pancreatic digestive fluids, and the bile that was now causing the problem all came together.
That also made it the place where the greatest amount of digestive enzymes in the body gathered.
Naturally, digestion was most active there, and among that long stretch of small intestine, it was the core section.
“Ahh.”
Only then did the three of them, including Yeoni, nod with faces that said they finally understood.
Leaving their astonished expressions behind, Kanghyeok moved his hands busily.
Things were going just as he had expected, but that did not mean there was no urgency.
“Dolseok, is it still coming out?”
“N-no. It’s slowly stopping now.”
“Let me see.”
“Here…”
Dolseok shifted his posture a little and showed Kanghyeok the cut surface of the liver.
Just as he had said, no more bile was flowing out.
Smiling in satisfaction, Kanghyeok brought the separated small intestine over to it.
“Good. This one’s a little thicker, but…”
With Kanghyeok’s skill, suturing it was entirely possible.
What was difficult was always when there was not enough. When there was extra, there was always a way.
“Now, hand me the suture.”
“Yes.”
“Yeoni, pull this downward so I can see clearly. Dolseok… while I’m suturing, hold the small intestine properly.”
“Yes, Young Master.”
“If it shakes, it’ll be a nuisance, so hold it really well.”
“Yes, sir.”
At Kanghyeok’s warning, strength entered Dolseok’s hands.
The veins on the backs of his hands bulged out.
“You brat.”
Kanghyeok smacked the back of Dolseok’s hand with the needle holder he was holding.
Dolseok’s eyes filled with grievance.
“Why…”
“Who grabs the small intestine that hard with bare hands? Are you eating gopchang or something?”
“You told me to hold it well…”
“Are you a monkey? Why are you using your hands when the tools are right there?”
“But… earlier, Young Master, you…”
Dolseok kept protesting the unfairness of it, but it was useless.
That was how it was in an operating room. The authority of the lead surgeon was absolute.
Even all kinds of unreasonable behavior were almost tolerated.
No matter what surgery it was, it was directly tied to the life of the patient lying there.
The lead surgeon’s convenience and judgment always came first.
“Are you the same as me? Use the forceps, the forceps. I’m already nervous enough since we’re diverting bile.”
“Yes… You should’ve told me beforehand…”
“At this point, you should know that much on your own. Stop talking and hold it. Time’s passing.”
“Yes…”
Only after letting out a burst of temper did Kanghyeok return to the suturing.
Looking at Dolseok, who had shrunk down, he did feel a little sorry, but at the same time, it was also true that the outburst had relieved his stress considerably.
Ah, look at how well this is suturing.
Even that difficult biliary anastomosis was going astonishingly smoothly.
Whenever he placed the needle, it landed exactly where he wanted it. Whenever he pulled the thread, the tension was exactly right.
How could I not get angry?
Kanghyeok kept stitching while endlessly rationalizing himself.
Thrust.
Thrust.
With skill so smooth it bordered on beautiful.
Meanwhile, Dolseok, who had been struck by a bolt out of the blue, had his lips jutted out like a bowl.
Ow, the back of my hand hurts.
Would it not have been better if he had just said it beforehand?
Why scold him like this without even explaining?
Of course, now that he looked again, it did seem he had done something wrong.
The marks of Dolseok’s grip still remained on the baby’s soft, delicate intestine.
Strangely enough, even though Kanghyeok had kneaded it with his hands as well, not a single mark remained.
What’s the difference, exactly?
Without realizing it, Dolseok pulled back in the lips that had stuck out.
Instead, his eyes lit up as he began watching Kanghyeok’s suturing.
No matter how many times he saw it, the skill was impossibly neat.
He never pierced the needle twice in roughly the same place, and not once did a knot he tied come undone.
“Good. Even with the forceps, it stays fixed just fine, right?”
Kanghyeok had finished suturing before they realized it.
Perhaps because he felt a little sorry for getting angry earlier, he offered praise that was more mechanical than sincere.
But Dolseok was not the sort who could tell the difference, and his face immediately broke into a wide grin.
The hurt feelings had already melted away while he watched the surgery.
“Yes, yes. Thank you.”
“Now we’re almost done. We just have to connect the duodenum to the side of the newly attached small intestine, and that’s it.”
“To the side?”
“That’s right. For this, you just make the hole the right size and connect it.”
As he said that, Kanghyeok drew the scalpel along the side of the small intestine.
It looked like a casual incision, but it matched the cross-section of the duodenum exactly.
“Now, hand me the needle holder again.”
“Yes, Young Master.”
“Let’s finish this.”
Originally, making a hole in the side like this and joining it was far more difficult than simply attaching one cut end to another.
First of all, there were inevitably limitations on how he could move his hands, and it was less clear where exactly the needle should go.
But just as before, Kanghyeok showed no sign of hesitation at all.
If anything, he seemed relaxed enough to keep explaining.
“Now, look. What do you think would happen if I tied a knot here right now?”
“The duodenum would end up stuck onto this intestine.”
“And then how would it be to suture the rest?”
“Since there wouldn’t be enough room… I think it’d be difficult.”
“Right. Of course, if it were me, I could still suture it. But there’s no reason to take the harder road on purpose. So…”
Kanghyeok only threaded the needle through each point to be sutured and did not tie the knots yet.
That way, the threads were passed through, but the cut surfaces of the two intestines were not pulled together.
It meant he could still secure the space and visibility to continue placing the needle.
Only after threading all the points like that did he begin tying the knots all at once.
“Good. We’re almost done.”
“Oh… so that’s how it takes shape.”
Dolseok nodded with an admiring look as he gazed at the completed surgery.
The blocked bile flow had been removed, and in its place, the small intestine had been connected directly to the liver.
The duodenum had also been attached to the side of that small intestine.
So aside from the path of the bile being a bit thicker than in normal anatomy, functionally it had become a state with almost no difference.
“The surgery went well, right?”
Yeoni asked as she closed the opened peritoneum.
Kanghyeok had set down his instruments for the moment and was resting.
By now, both her skills and Dolseok’s had improved enough that he could trust them with this level of closure.
“Hm? Yes, more or less.”
“But even so, he still won’t be able to live more than two years?”
“That’s right. Well, maybe three years, if we’re lucky.”
Kanghyeok nodded while looking at the liver still visible through the gap in the peritoneum.
It was definitely in far better shape than before the surgery.
All the stagnant, rotting bile had been removed, and any bile produced from now on would also drain out without issue.
But the problem was the liver, which had already been ruined because the surgery had come too late.
“That’s such a pity. He’s still so young.”
“If we’d left him as he was, he probably would’ve just wasted away and died before the end of this year. At best, early next year.”
“Then what will you tell the Kanpaku and O-no-dono?”
“To those people…”
Kanghyeok gave a bitter smile.
No matter how arrogant and ill-mannered he might have been, he had never lied to a patient’s guardian.
But I can’t help it. The other party is… Toyotomi Hideyoshi.
If he had truly been nothing more than some petty rat, Kanghyeok might have thought differently.
But from the brief impression he had gotten, the man did not seem easy at all.
I may not like him, but he was definitely a ruler of the realm.
Even those brilliant generals like Katō Kiyomasa and Kuki Yoshitaka showed astonishing loyalty to Hideyoshi, did they not?
Put another way, if something went wrong with Hideyoshi, everything might collapse on its own.
It’d be even better if he himself fell ill…
Unfortunately, that did not seem likely right now.
If an opportunity came later, maybe I could feed him some steroids or something.
So for now, he had to try at least a psychological attack.
Just as Kanghyeok was firming up his resolve once more, the door opened.
It was Yeoju.
“They asked me to come check how it was going… Oh?”
“You came at the right time. It’s all done. We just finished closing the abdomen.”
Kanghyeok nodded toward Dolseok, who had just completed the final stitch.
That made Yeoju go wide-eyed in surprise.
It had only been an hour or two at most since the surgery started.
Is Young Master’s skill improving more and more?
Kanghyeok walked past her as she stood there with her head slightly tilted.
“Where is everyone?”
“Ah, they’re in the place where they were drinking earlier.”
“Really? Shall we go together? I was about to explain it anyway.”
“Yes, yes.”
And so Kanghyeok headed toward Hideyoshi with Yeoju in tow.
Because the room where the surgery had been performed was very close, it took almost no time at all.
Before long, Kanghyeok arrived at the room where Hideyoshi was waiting and first glanced over the atmosphere inside.
Hm. Looks like no one managed to drink any more.
Their expressions were also extremely stiff.
Everyone seemed terribly tense.
That went doubly for Hideyoshi and O-no-dono, the people directly involved.
It looked as though they had aged several years in just a few hours.
“What… happened to Tsurumatsu?”
Forgetting her dignity entirely, O-no-dono rushed over and asked.
Hideyoshi, at least, did not open his mouth himself, but his lips kept twitching.
Just like the rumors said, he truly was a man who doted on his son.
I do feel a little bad for using that against him.
Kanghyeok pushed that feeling aside and grinned.
“It went very well. The problem has been completely resolved.”