Chapter 200: Endolymphatic Sac Decompression [2]
Chapter 200: Endolymphatic Sac Decompression [2]
Even with the scalpel laid flat, Baek Kanghyeok’s hand did not hesitate in the slightest. From the side, it almost created the illusion that he was sketching with a pencil.
Scratch, scratch.
The sound echoing through the room was also much like someone drawing. It was the sound of connective tissue behind the ear being severed, and from that alone, one could roughly guess how tough those tissues were.
From the surgeon’s standpoint, that actually made things better.
That’s the advantage of fibrous tissue.
It really was. As long as the one pulling retracted well, and the one cutting found exactly where to cut. Fortunately, Baek Kanghyeok was the sort of man who could do both tasks at once, and because of that, the incision progressed very smoothly.
Zzzk.
Soon the incision was nearing its final stage. What had begun about 1.5 centimeters behind the ear had now extended all the way to directly behind the ear canal. Baek Kanghyeok placed his thumb on the incision side and his index finger toward the ear canal, then looked at Yeoni.
“When operating behind the ear, the incision has to be made like this. If it goes any deeper than this, what do you think will happen?”
“I think... a hole would open into the ear canal.”
Yeoni answered while looking at the thin skin, as delicate as a sheet of paper.
Baek Kanghyeok nodded, clearly pleased.
“Right. But if you’re so scared of that that you stop the incision too shallow, what do you think happens then?”
This time, Yeoni’s gaze shifted toward the incision itself. Beneath the slanted incision plane Baek Kanghyeok had created, white bone was exposed. It was about 1.5 centimeters wide.
Suddenly, she remembered something she had learned during a dissection practicum the year before.
What was this called again...?
At the time, she had thought she would never forget everything inside it. But after only a little over a year, she had forgotten it all.
Still, there was one person who had not forgotten. It was Dolseok, with his excellent memory.
“I don’t think the mastoid process would be fully exposed. Am I right?”
“Oh. Dolseok. Amazing that you remembered.”
Baek Kanghyeok looked at him with an approving expression. Dolseok, who was especially weak to Baek Kanghyeok’s praise, looked so pleased he did not know what to do with himself, and silently renewed his determination.
At the very least, I have to do my best at holding the head steady.
Yeoni, on the other hand, was full of frustration. She was the one who had actually suffered through all the assisting, yet Dolseok had stolen the praise outright. But the oblivious Baek Kanghyeok was not even looking at her face. He was only staring down at the white mastoid process.
“As Dolseok said, this is the mastoid process. Inside it are air-filled pockets... but when chronic otitis media sets in, inflammation fills them instead of air.”
“Ah! Right. Back then, the cada— no, I mean, anyway, there was something really hard in there.”
Overjoyed that something she knew had finally come up, Yeoni nearly blurted out “cadaver” before hurriedly changing the subject. Fortunately, the Seonjeongwan standing farther off did not hear it, and Yi Hangbok, who was nearby, only tilted his head in puzzlement. Who in Joseon would ever think of cadaver dissection?
He looks like he wants to ask something... but let’s just pretend I didn’t notice.
Baek Kanghyeok deliberately ignored Yi Hangbok. Even Yi Hangbok, greatest of his kind, could only purse his lips and did not dare ask. They were in the middle of surgery on the king. What if he distracted them? Seeing that, Baek Kanghyeok let out a secret sigh of relief.
Then, keeping up the act of ignorance, he continued speaking.
“That’s right. Once inflammation fills it, fibrosis and ossification progress, and the bone hardens. Then surgery becomes a real headache. And today’s operation is one where I have to smash through all of this mastoid process.”
“Ah, I see. You said the part that needed surgery was deep inside.”
“Yes. Very deep.”
At the same time as he answered Yeoni, Baek Kanghyeok picked up the hammer and chisel.
The first time he had seen them, he had wondered why on earth he had put such things in a house-call bag, but now he realized they were essentials. How many heads had he cracked open since coming to Joseon, after all? Even counting only famous figures, there had already been quite a few, and if ordinary people who had gone unmentioned were added, the number was impossible to count.
If these bones get excavated someday, historians are going to be terribly confused.
The operations Baek Kanghyeok performed were on an entirely different level from simple trepanation. Even though the tools were only a hammer and chisel, the precision was in no way inferior to surgeries done with a drill. They might even run their mouths and call it proof of aliens.
Imagining some future fool making a huge fuss, Baek Kanghyeok gripped the chisel firmly. It looked as though he had just set it down roughly, but in truth the placement was exquisite.
Before swinging the hammer, he met Makbong’s eyes. From this point on, Seonjo absolutely could not wake up.
“Hey. We’re good, right?”
“Yes. Breathing and pulse are both stable.”
Makbong gave a very professional answer. There had been a reason Baek Kanghyeok always used him for anesthesia work. Now he sounded just like a proper anesthesiology specialist.
“Dolseok, what about you?”
“Don’t worry. I’ve got him locked down.”
Dolseok answered, thick veins bulging across his forearms. There had been a reason Baek Kanghyeok had fed him well and made him exercise.
“Yeoni, you’re ready too, right?”
“Yes, Young Master.”
Yeoni answered while holding the incision open with one hand to expose the bone and clutching wet gauze in the other. That meant she was doing the work of two people at once. At a university hospital, they would have used a retractor to expose the bone, but that was not possible now. And there was no way to bring in additional people. The field was tiny, and the space cramped.
At least it’s fortunate that Yeoni is assisting. Right. Maybe because she trains in martial arts, her body’s quick.
She probably could not keep it up forever, but for a short while, it should be fine.
Only after checking everything thoroughly did Baek Kanghyeok begin to strike the hammer.
Clang.
Crack.
At the same time, a chilling metallic sound filled the room, and bone dust began flying everywhere.
“Mm.”
One of the Seonjeongwan, who had already heard a rough explanation of the surgery, turned his head away. Unconsciously, his hand had already moved to the sword at his side. He had understood it in his head, but it had not yet sunk into his heart. To think that, after swearing to protect the king, he now had to stand by and watch such a sight. It was enough to make him laugh bitterly.
“Hmm. Well, this is something.”
Groans also escaped the mouths of Ryu Seong-ryong and Yi Hangbok. In particular, there was even pain mixed into the sigh of Ryu Seong-ryong, who was more deeply immersed in rigid Confucian principles. Seeing the king’s bone dust scattering disorderly before his eyes left his mind in turmoil.
Should I perhaps gather all of that up and preserve it?
But Ryu Seong-ryong soon shook his head. Had he not already spent days arguing over this issue? He had heard Yi Hangbok’s and Baek Kanghyeok’s arguments until he was sick of them, and had accepted them.
No. That is not His Majesty... it’s just bone, bone. They said they would not even be able to gather all of it anyway. So don’t give it too much meaning.
Ryu Seong-ryong barely suppressed the useless guilt of feeling like a disloyal subject.
While he was fighting his private battle, Baek Kanghyeok had already dug in quite deep.
Clang.
Crack.
Each time the hammer rang out crisply, a fixed amount of bone fragments flew up without fail. The ones that did not fly away and remained in place were removed by Yeoni with gauze.
There was another reason the work had been proceeding so smoothly: the condition of Seonjo’s ear.
Most people have had quite a lot of otitis media... but this man has none of that.
As everyone knew, Joseon was an age where one could not find an antibiotic even if one wished to die from one. As a result, complications from colds were something everyone went through at least once. In truth, not once. There were countless people who lived with them constantly. Especially with otitis media or sinusitis, which left inflammation in the bones, it was harder to find someone without them than with them.
But Seonjo’s ear was clean.
Being king really does have its perks.
Then again, maybe he was simply the kind of person who did not catch colds easily. But what did that matter? As long as the surgery was easier, that was all that mattered. Baek Kanghyeok kept hammering away, blasting through the mastoid process.
Clang.
Kakang.
The reason he suddenly stopped, as if possessed, was that the sound of the bone had changed. The motion was so abrupt that everyone else thought something had gone wrong.
“W-what is it?”
“What’s wrong?”
Naturally, it was Ryu Seong-ryong and Yi Hangbok, standing closest, who asked first. Looking at them, Baek Kanghyeok waved his hand. His face said it was nothing at all.
“Ah, no. It’s just that the tedious part is finally over.”
“T-tedious?”
“That sounds rather irreverent depending on how one hears it.”
To say something was tedious while operating on the king. And not just any part, but while cracking open his head. If anyone else had been present, they might have twisted that into a charge of treason.
But Baek Kanghyeok did not look flustered in the least. Instead, he simply moved his sharp tongue with full confidence.
“What I mean is, from here on out, we reach the truly dangerous and important part.”
“Truly dangerous and important?”
“Yes. So please calm yourselves and step back a little more.”
“Mm. Understood.”
Ryu Seong-ryong wanted to lecture him about the proper conduct of a subject, but for the moment he stepped back. Was he not in the middle of opening the king’s head? He must not interfere.
Good. Sent the bothersome people farther back.
Baek Kanghyeok turned his head back toward the operative field. Then he felt over the area he had just shaved with the chisel. To an ordinary eye, there would have seemed to be no difference at all, but to someone like Baek Kanghyeok, steeped in anatomy, the difference was obvious.
Just as I thought, the color changed.
Whereas the mastoid he had been happily hacking away at until now had held a faint yellowish cast, the area just revealed was white bone. That meant it was a different kind of bone.
Inside here lie inner-ear structures like the cochlea and the semicircular canals. Past that, you can basically think of it as the brain.
When one studies anatomy, there are times when one cannot help but think that nowhere in the human body was made carelessly. This was one of those times. The brain, a relatively more vital structure, was encased in such hard bone, not in light, air-filled bone like the mastoid process.
“Good. Dolseok, you’ve been doing well so far... but hold him even more firmly now.”
“Yes, Young Master.”
“Yeoni, keep doing exactly as you are. Ah, and don’t touch with that gauze unless I signal.”
“Ah, yes, Young Master.”
After warning his disciples, Baek Kanghyeok picked up the hammer again. This time he gripped it much shorter than before. From here on, accuracy mattered far more than force.
“Then I’m starting.”
With that brief declaration, Baek Kanghyeok swung the hammer.
Kakang.
Kakang.
A sharper, higher-pitched impact than before began filling the room. It was a grating sound, but no one frowned or covered their ears. After all, it was the sound made by the king’s bone. Showing discomfort would have been irreverent.
Whew, as expected, this is difficult.
Amid the strange atmosphere, Baek Kanghyeok let out a quiet sigh. Sweat began to bead across the forehead of the man who until then had shown no sign of strain at all, because shaving away bone near the inner-ear structures took no small toll on his concentration and mental energy.
Kakang.
Because of that, the speed of the work inevitably slowed markedly.
“Whew.”
It was only after quite some time had passed that Baek Kanghyeok finally let out a sigh of relief.
Thunk.
A dull sound came from his lower back and neck as he briefly stretched. After that, he stood still in a daze for a moment, then pointed at the surgical field. A deeply satisfied smile spread across his face.
“Look closely. This is the cochlea, and this is the semicircular canal. And this fat little sac in the middle connects the two. That’s today’s star.”