If Your Son Wanted This Surgery, Would You Still Make Him Do It?
Ailene Calendar, November 14th, Monday.
It had been a week since Kellogg arrived at the Beauty Tower.
"Disposable syringes, needles, subcutaneous needles, spinal needles, pen needles, sutures, IV sets, extension lines, pressure lines, three-way stops, Levin tubes—we've started production on those first."
"...Impressive. And I only told you the names once for each type."
"Miner, I'm a dwarf who could have become the 18th generation Lonely Hammer. Getting a client's product names wrong is simply unforgivable."
In the meantime, Kellogg's hammering had continued without pause, and true to my promise, he had produced the medical disposables.
As Kellogg, who had come to the director's office on the 11th floor, showed me the items he'd brought, I inwardly stuck out my tongue in admiration.
How the hell does he make these with a hammer...? It's factory-level quality.
It was an astonishing sight every time I saw it, so I couldn't help but be amazed each visit.
"More importantly, Miner, is the surgery prep going well?"
"Of course. Everything's on track. Just as you said, it's astonishing."
"Astonishing? What do you mean by that?"
"The blood composition and most everything else is identical to humans'. Of course, bone density, muscle flexibility, and elasticity are far superior."
Kellogg tilted his head at the explanation.
"So that means... no problems for the surgery?"
"It means it's perfect. I was just about to discuss the surgical method with you. Have a seat for a moment."
"The surgical method?"
With the main surgery three weeks away, it was time to discuss the procedure and the total height gain possible.
I handed him the EOS (full-body X-ray) photo we'd taken the day Kellogg first arrived at the Beauty Tower and continued the explanation.
"Limb lengthening surgery is broadly divided into external fixation, where the fixator is installed outside the body, and internal fixation, inside the body. For your case, we'll use both."
In truth, there are far more types of limb lengthening. External fixation, where pins are driven into the bone outside the body, was devised by Soviet surgeon Gavriil Ilizarov and is the oldest method. There are also variations like LON (Lengthening Over Nail) to speed up external fixation, and LATN (Lengthening And Then Nail), an improved version for very short, bowed, or narrow bones.
Internal fixation uses techniques like Precice, made of titanium, or Stryde, made of special alloy.
But with too much information, he wouldn't understand, so I decided to focus first on the external fixation he'd receive initially.
"External fixation is also called the Ilizarov method. We drive steel pins connected to a cylindrical external fixator into the outer leg, secure it, and use the device to gradually lengthen the severed bone, growing new bone along with it. But we won't do full external—we'll use the LATN technique."
"La...Tarn? What's that?"
Even with Kellogg's sharp mind, specialized terms were tough. I tailored the explanation to his level.
"LATN means doing external fixation first, then inserting internal fixation in a second surgery. Internal fixation is basically inserting a lengthenable steel rod into the bone marrow and extending it from outside."
"Hmm... fascinating. In the magic tower, they just saw it off and—"
"Erase that so-called 'surgery' from your memory. If you hadn't gotten that butchery, we could've just lengthened one leg."
"Ahem... Understood."
One of Kellogg's legs had a severe knee flexion deformity where he couldn't fully extend it; the other bowed backward like a bow in reverse genu recurvatum. No matter how you looked at it, the miracle was that he walked at all with crutches.
External fixation involves driving pins connected to a cylindrical fixator into the outer leg or arm. But it pierces skin, muscle, and more, so pain and scarring are inevitable.
Not just scars and pain. Complications like joint contractures can happen too. Damn it, we need to wipe out those magic towers. What the hell—torture, not surgery!
Mages' intellectual curiosity was obvious just looking at the witches. But most of their 'treatments' were Russian roulette at best—praying over spilled water.
"First, we'll do external fixation on the most bowed parts. Once complications from the prior surgery resolve, we'll insert internal fixators to equalize both legs' lengths."
"W-wait... so my legs will be even shorter than now? My legs are already shorter than the dwarf average!"
Kellogg's hands trembled gripping his crutches. His reaction was understandable.
His measured height from the precise exam was 121 cm—like a first-grader.
Before I could continue, Kellogg spat fire in rage.
"I'm not being greedy here, but an adult dwarf male is about half a handspan taller than mine. Females are two finger-widths shorter than that."
Kellogg's hands and feet were large for his height: palm span about 15-16 cm (shorter than mine), finger joint roughly 2 cm.
So adult dwarf males around 128 cm (second-grader height), females 124 cm. Kellogg was a full 4 cm shorter than female average. Easy math.
"Dwarves are small folk, but shrinking more here—"
"Calm down. Your height will increase, not decrease."
His barrage cut off, Kellogg's eyes widened.
"R-really? Not just the same, but... taller?"
"Yes. Straightening the bowed bones and symmetrizing the legs can make you taller than now."
"Khuh... Th-thank you. Not just walking without crutches, but taller..."
"..."
When we first met in Breath of Fire, he'd said just walking without crutches would be enough.
But now, the trauma hidden behind that showed.
Suddenly, Dr. Gu Bon-seok's words came to mind—the ortho specialist we'd planned to hire.
Height surgery isn't just about height. It's healing the heart.
Kellogg sobbed like he was venting rage, then caught his breath and continued.
"Miner, you're tall for a human, so you might not get it. But for tiny dwarves, my smallness brings immense mental pain... Bigger than you think. Thank you... truly."
"..."
Dr. Gu had said that too. He'd be an ortho doctor even in the next life.
"People curse limb lengthening as dangerous. But I say, what do you know of their pain?"
"Hmm... Dr. Gu, if you join our hospital, tone down that aggression."
"Haha, got it. But people need to know. 'So what if you're short? Live with it'—they don't grasp the mental agony. I'm not just adding 6-7 cm. I'm rebuilding collapsed self-esteem."
"Then, if your son wanted this surgery, would you make him?"
"Heard that one before. Of course I'd rather not. But if my son came with the same heartbreak as my other patients... I couldn't say no. No—I'd have to. For my child."
Dr. Gu's story lingered: a congenital deformity patient with uneven legs who walked on both and shook his hand firmly.
"Three weeks until leg immobilization ends. Let's do this right."
"Much obliged, Miner."
The callused blacksmith's hand met mine in a firm shake. Thinking of the day he'd shake it without crutches, I gripped back hard.
December 5th, Monday.
Unlike the midsummer when I first arrived in this world, it was now deep winter.
And today was finally Kellogg's first surgery.
"Director, here."
"Thanks."
After scrubbing in, Hazel, today's scrub nurse, handed me the towel and gown as I entered the OR.
In the month since Kellogg arrived, we'd studied hard and practiced endlessly in the VR surgery room.
Still, this was outside my specialty—requiring utmost caution. So not just Stella, but Rebecca and Hazel were assisting too.
"If everyone's ready, we'll start surgery now."
"Yes!"
Whirrr— Whirrr—
Kellogg was already under general anesthesia.
I started drilling holes in the bone with the drill bit.
Screws into the ankle and tibia for fixation—now osteotomy time.
"Scalpel."
One key part of limb lengthening is the osteotomy.
Slice—
Skin incision for osteotomy complete. About 1.5 cm long.
Stella handed over the osteotomy hammer and osteotome.
Tap— Tap tap— Tap tap tap— Tap— Tap tap—
There are various osteotomy methods: electric saws or Gigli wire saws.
But Dr. Gu Bon-seok, who'd done these, always used hammer and osteotome by hand.
Thud— Tap— Thud thud— Tap tap—
Patients might call it crude, but hammer and osteotome are safest and most effective—no electric or wire saws.
Saws cut cleanly, sure. But osteotomy isn't about smooth ends.
Using a saw requires 10-15 cm incisions minimum for guards, leaving big scars. Plus inevitable tissue damage from saw heat.
Thud— Tap— Thud thud thud— Thud thud—
Hammer and osteotome minimize heat on the cut surface, spare the periosteum and surrounding muscle, keep incisions tiny—scars minimal.
Using the mobile C-arm X-ray, I checked fracture lines and continued.
Crack!
About 10 minutes of hammering later, the bone snapped beautifully.
Now, into the main surgery.