Chapter 34: I'll Handle the Knife [1] "First, we need to move him inside. Dolseok, Makbong!"
"Yes, Young Master!"
In any case, Dolseok and Makbong were far bigger than the sturdy men who had carried him there.
Though they did need a little direction from Kanghyeok.
If his head was injured that badly... I can't rule out injuries to the neck or elsewhere either.
So they could not just lift and set him down carelessly.
The attempt to help could very well make the patient worse.
Maybe it's already too late.
He was used to being handed patients by rescue personnel who had trained every day.
This was the first time he had seen a patient transported in such a terrible state.
"F-first... Makbong, hold the head, and Dolseok, take the legs. I'll support the waist and neck, so let's get him into the room."
"Like this?"
"Yes. Like that."
"Yes."
Once the three of them combined their strength, it was done in an instant.
Kanghyeok carefully lowered the patient onto the bedding.
Dolseok quickly shut the door.
The two sturdy men who had brought the injured man shouted something from outside, but they did not dare come in.
He's unconscious.
That was not a good sign.
"Dolseok, check his blood pressure first."
"Ah, yes."
"Yeoni, bring boiled water."
"Yes."
The fortunate thing was that the two of them had grown fairly capable as assistants by now.
Because of that, Kanghyeok was able to spend a little more time examining the patient's condition.
The skull isn't fractured... but what about the eyes?
Kanghyeok shone his penlight into the patient's eyes.
The pupillary reflex was intact, but the surface of the eyeball looked abnormally bulging and uneven.
Fortunately, there were no signs of bruising around the eyes.
A CT scan would have been ideal, but for now he had to infer everything from clues like these.
"The intraocular pressure has gone up. It points to cerebral hemorrhage. It doesn't look like there's a basilar skull fracture."
Unfamiliar tools and unfamiliar words.
Heo Jun stood by the doorway with a deeply flustered expression.
This was the first time he had ever seen a patient examined in such a way.
"Scholar, what in the world are you doing?"
There was no reproach in his tone.
Only the pure curiosity of a medical man.
It was clear he possessed a remarkably flexible mind.
That's fortunate.
If it had been someone like Jeong Changgwon, he would obviously have exploded by now.
"There's no time for a long explanation. But one thing is certain: if we leave this man as he is, he will definitely die."
"Is there nothing I can do?"
There was no disagreement that Heo Jun was an excellent physician.
But right now, Dolseok or Yeoni would be more helpful.
The structure of the knowledge they had built up was completely different.
"Until now, I've been the one learning. This time, let me repay the favor."
"Mm."
Heo Jun let out a soft groan.
Seeing a patient before him, he clearly found it hard to keep his hands still.
He really is a physician by nature.
A different kind of man from Kanghyeok.
In the better sense.
"Mm."
Heo Jun continued watching Kanghyeok's treatment.
"Wake up! What's your name? No response. He's in coma [2]."
He shouted while pressing rather roughly into the man's upper chest,
and then yelled,
"Hand me the scissors!"
before casually shaving off another man's hair.
"What are you doing, shaving his head like that?"
And then there was even the punch with which he instantly subdued Dolseok's timid protest.
It looked less like treatment and more like savagery.
A complete overturning of all common sense up to now.
Yet, strangely, Heo Jun did not feel like stopping him.
More than rejection toward a new technique, he felt expectation and admiration.
Kanghyeok's widely spread reputation also played a part in that.
"All right. I will simply watch."
"Yes. If possible, I'll explain as well."
Though judging by the state of things, it did not seem likely he would have the chance.
Blood was pouring steadily through the torn scalp.
That was because the area had such rich circulation.
Damn it. I can't cauterize it either...
It was not as if there were no fire or metal.
The problem was that everything was too large; he would end up burning the healthy scalp too.
If that happened, the patient might die from burns instead.
I'll do it like this. If we keep pressing, it should stop. I already injected a vasoconstrictor too.
It was a crude thought, but in truth there was nothing more correct than that.
Unless a major vessel was badly damaged, pressure would stop the bleeding.
And it was not as though there was no one available to apply that pressure.
Dolseok was already standing by with gloves on.
Kanghyeok handed several pieces of gauze to him.
"Here, press this here."
"Uh... I think blood's going to get on me."
"You're wearing gloves."
"Even so, this just feels..."
"You're going to see a lot of blood today anyway. Brace yourself. Yeoni, are you all right too?"
For all his complaints, Dolseok actually had a fair amount of experience.
After all, he had assisted Yi Sun-sin's surgery to the very end.
Yeoni, on the other hand, had only helped with simple procedures so far, which made Kanghyeok uneasy.
Though thinking about her usual personality, she would probably be fine.
Sure enough, she nodded with a resolute expression.
"Yes. I'm fine."
"Good. Then let's do it."
Kanghyeok picked up the scalpel.
Instead of his usual easygoing, relaxed air, taut tension filled the room.
Can I really do this?
No matter how skilled Kanghyeok was, this was brain surgery in a thatched house.
Being confident would have been the strange thing.
If I fail, he dies.
At a glance, the man did not seem high-born.
Wasn't it pitiful for him to suffer his entire life and then die like this?
In any case, if it isn't me, no one can even attempt it.
A wound that even the great Heo Jun could not touch.
That meant it was simply an injury one had no choice but to die from in Joseon.
Thinking of it that way made his mind much lighter.
Srrrip.
With the scalpel, Kanghyeok extended the tear in the scalp.
"Pull it apart. Yeoju, draw it if you can."
"Uh... yes, Young Master."
"Yes."
Using the instrument Kanghyeok handed her, Yeoni pulled the wound open to either side.
The tool scraped against bone with a creaking sound.
Scratch, scratch.
Yeoju stood behind them so as not to interfere, her hand moving rapidly.
This was far more vivid and difficult than drawing medicinal herbs.
How often could one watch blood splatter and flesh part and then draw it?
"All right, now the hammer and chisel."
"Uh... there is one, but you really want me to give it to you?"
Thanks to all that desperate pressing, the bleeding had eased considerably.
Dolseok had finally gotten a moment to breathe, but the moment Kanghyeok asked for a hammer and chisel, his face darkened again.
White bone had just begun to show between the split scalp.
It really looked like he intended to strike that.
"If I ask for it, give it to me."
"Ugh."
For some reason, Dolseok was more conscious of Heo Jun than anyone else.
Yeoni and Yeoju would probably be fine no matter what Kanghyeok did.
Heo Jun was another matter.
The amount of affection and debt between them was different.
But the words that came from Heo Jun's mouth were unexpected.
"If the master asks for it, you should hand it over. What are you standing there for?"
"What? Ah, yes."
In a daze, Dolseok put the hammer and chisel into Kanghyeok's hands.
While taking an undeserved scolding along with it.
"You rascal, when I ask for something you refuse, but when another man says it, you listen?"
"No, I... I'm sorry, Young Master."
"Hold him tight. If he moves, it'll be a real disaster."
"Good grief."
"Yeoni, help too."
"Yes."
Why else would he tell them to hold down a blood-soaked head?
What is this, he's not butchering a pig...
Dolseok squeezed both eyes shut and grabbed the patient's head.
This time even bold Yeoni did the same.
Only Yeoju continued recording the entire scene in her drawing.
Though it was hard not to think she looked like a detective taking crime-scene photos.
"All right, here I go."
"Hhh."
A deranged-sounding groan slipped out of Dolseok's mouth.
He had hoped otherwise, but soon enough a merciless sound followed.
Thunk, thunk.
What landed on the back of his hand was probably bone dust.
What a cruel, ruthless nobleman.
Dolseok shook his head.
That irritated Kanghyeok.
"Hold him properly! He'll die!"
With a large man shouting while holding a hammer, terror washed over him.
And he could not even tell whether the one who would die was the patient or himself.
Dolseok clung to the patient's head for dear life.
"Yes, yes!"
Again that horrifying noise rang out.
Thunk, thunk.
White, rough bone fragments flew in every direction.
Even Yeoju, who had been drawing steadily all this time, had to turn her head away for a moment.
More frightening still was the fact that Kanghyeok's face was gradually brightening.
"It's working, good. Hold on just a little longer!"
"Ugh, yes."
He had no idea what exactly was supposed to be good about this, but for now he had no choice but to do as ordered.
There was no knowing when that hammer might head somewhere else.
Meanwhile, Kanghyeok was surprised at how naturally the hammer and chisel fit his hand.
I always used a drill before, but this isn't bad either.
It just took more strength.
If anything, it was actually faster.
And in terms of precision, it was not all that different either.
"Amazing."
Heo Jun could not stop marveling.
Dolseok and Yeoni might not have been able to see it, but Heo Jun could clearly tell what Kanghyeok was doing.
Each time the hammer fell, the chisel shifted little by little.
It was truly a technique close to the miraculous.
Thwack.
With a deeply satisfying sound, a hole opened in the patient's skull.
A circular hole, as precise as if it had been drawn with a compass.
"Good. Opening the lid."
Kanghyeok removed the round piece of bone.
At the same moment, the red blood pooled inside burst out in a rush.
The dangerously elevated intracranial pressure began stabilizing at once.
Just as I thought, a subdural hemorrhage.
Through the gaps in the dark red old clot, he could see a stream of fresh bright-red blood.
If the bleeding had been deeper inside the cerebrum, there would have been no way to treat it.
Not here, at least.
"Now we're halfway there. Dolseok, keep holding him, and Yeoni, help me."
"Yes, yes."
"You see the spot that's bleeding here?"
"Yes."
"Physician Heo Jun, you can see it too, right?"
"I can. Heavens, so this is what the inside of a human head looks like."
When would he ever have seen a brain directly before this?
Even Kanghyeok had only seen one for the first time when he started his clinical training.
And even then, from much farther away than this.
"Fortunately, it isn't an artery. It's a vein."
"What is that?"
Heo Jun blinked as he asked.
When Kanghyeok turned his head, Dolseok and Yeoni had much the same expression.
Ah. Of course.
What was common sense in the twenty-first century was a mystery no one in this era knew.
Kanghyeok felt anew that he had truly come to Joseon.
"I'll explain in detail later. First, we have to stop the bleeding."
"Ah, understood."
Heo Jun accepted that at once, and Dolseok and Yeoni were the sort who trusted Kanghyeok's words completely.
Kanghyeok turned his gaze back to the patient's head.
A superior cerebral vein... at this level, it won't matter much if I just ligate it.
If it had been an artery, the situation would have been far more complicated.
If it was not reconnected, the patient could be left disabled.
"All right, give me the thread."
"Yes, Young Master."
Yeoni handed him the black thread.
She did not forget to hold the wound open wider so that Kanghyeok could see better.
"You've got good sense."
"What?"
"You're doing well."
"Thank you."
Kanghyeok fully demonstrated the skill he had built up during his years as a professor.
Even through that narrow space, he tied off the vein without much difficulty.
Soon the bleeding stopped, and the patient rapidly stabilized.
The problem starts now.
Surgery in an age without general anesthesia was, in truth, an act very close to violence.
Why else would most books dealing with the history of medicine place more importance on the development of anesthesia than on the development of surgery itself?
If someone's skull were opened while fully conscious, anyone would recoil in horror.
No, before that, they might simply die.
From shock, for example.
The moment he wakes up, he'll move, won't he?
If that happened, it would be a disaster.
He had to suture him shut before that, or at least hold him so firmly that he could not move at all.
The first won't work. We'll have to hold him down.
Fortunately, there was one idle strongman nearby.
"Makbong! Stop just standing outside and hold this man down!"
"What? Ah, yes!"
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