A hollow laugh soon turned into a genuine smile.
It's not that it wasn't warranted; come to think of it, it's been a truly long time since I last attempted such a challenging surgical procedure.
Moreover, it's not something I learned through an apprenticeship under someone.
The surgery I'm about to perform now is...
Yes, you could say it's a procedure I devised by scouring the depths of my mind.
Of course, it probably isn't entirely my own original idea.
I've definitely seen something similar somewhere before.
"Huh?"
"What is he..."
"What is he doing?"
The most crucial part is filling the defect caused by the resection of the mandible.
'In other words, I'll be rotating a local flap... This will be completely different from any surgery these people have seen before.'
Did such a type of surgery even exist back then?
It probably didn't.
This isn't arrogance.
Medicine naturally develops in stages.
The level of 19th-century medicine I witnessed was generally horrifying, beyond just being pitiable, so they naturally wouldn't have conceived of such a procedure.
Click, clack.
Anyway, with Liston's assistance, I resected part of the patient's inner mucosa and muscle, including the lower jaw.
We excised it as if it were necrotic, and since the actual cadaver was also beginning to decay, it felt quite realistic.
Good.
It's good that it feels like the real thing, not just practice.
'Besides, Liston... this...'
I felt it during the amputation too; he's almost like a human chainsaw.
Because he can cut so swiftly and powerfully, there's actually much less damage to the remaining bone.
'The problem is that not everyone can cut like this...'
The prognosis would likely differ significantly depending on whether one had a Liston or not.
Unless someone invents a chainsaw somewhere, but would that even appear?
In the 19th century?
'Once again, an enormous number of patients will flock to me.'
Chuckling with satisfaction, I looked down at the patient—no, the cadaver—for a moment.
"Ooh, he's laughing..."
"Scary..."
"Cutting a person's jaw like that."
There was murmuring from the ignorant ones.
Was this how the Prophet felt?
I hear even Jesus was treated like this in his hometown.
I tried hard to ignore their words and decided to proceed with rotating the local flap as originally planned.
Squeak.
If the defect was small, I had planned to rotate tissue from inside the mouth.
So, I intended to rotate muscle from the cheek area toward the lower jaw, but it seemed there wouldn't be much jaw left either.
Then, what should be done and where?
'It might look a bit too gruesome, though...'
Let's focus on survival.
The limitations of the era are too great for aesthetic considerations.
Thus, I made an incision in the chest area.
"What is he... what is he doing?"
"Is he insane?"
Now, even those who had been looking at me favorably began to murmur.
Liston, who had only received a brief explanation before entering, also whispered in my ear.
'What is this, now?'
'Just watch.'
Isn't there a saying in Joseon: "Hearing a hundred times is not as good as seeing once."
It means showing once is better than explaining a hundred times.
This was especially true for surgery.
Even more so if the other party wasn't familiar with anatomical terminology.
Unfortunately, since even Liston, the best among them, lacked modern anatomical concepts, I wielded my knife with gusto.
Squeak.
The goal was to leave the part where the blood vessels connect to the remaining skin and muscle on the chest, then pull the excised section upward and...
"Ugh!"
"Ughhh!"
...insert it into the defect inside the mouth and suture it shut.
As for the opened chest, there was plenty of skin left there, so it was just a matter of pulling it together and suturing it.
The trade-off, however... was that it looked very bad.
'What is this?'
Liston repeated his earlier question.
I shrugged my shoulders and spoke.
"This way, we can effectively cover the defect, right?"
"But keeping a person alive like this? That shouldn't be possible."
"In about a month, we can excise this cartilage part. By then, blood vessels would have grown into the area grafted inside the mouth."
"What on earth does that mean?"
Only after looking at Liston's face did I realize I had jumped too many steps ahead.
Not just Liston;疑问 (yíwèn - doubt) was evident in the eyes of everyone in the lecture hall.
'Shit.'
How do I talk my way out of this?
The concept of blood vessels growing...
How...?
What do I say...?
"I know about that."
I've managed to bluff my way through so far, and I get caught here?
Will I be burned at the stake?
I hate pain.
The moment I thought that, Colin raised his hand.
He had a completely clueless expression, which made me even more uneasy.
-"Actually, that guy Kim Tae-pyeong is a son of Satan!"
What if he spouts that kind of nonsense?
You'd think it wouldn't work, but surprisingly, it might.
Legally, perhaps not, but even though our Great British Empire had declared itself a nation of laws quite some time ago, extrajudicial sanctions were rampant.
And if those sanctions were based on a 'common sense' rationale that people found acceptable, even the police would turn a blind eye.
There's a high probability that someone like me would be killed...
"Isn't there someone who performs a similar surgery?"
There is?
Better than a witch hunt, but this was still surprising news.
Someone performs a similar surgery? Does that make sense?
As I was thinking this while watching him, Colin began to speak very smoothly.
"As you all know, when one contracts syphilis, sometimes the nose rots away, right?"
"That's right."
"Of course. Who wouldn't know that?"
Liston and Blundell chimed in together.
They probably also sensed something was off with my situation and were playing along.
Then, Colin needed to do well.
Would he?
Frankly, I have no idea what's going to come out of that guy's mouth.
He's so ignorant, it's genuinely worrying.
"So, if the nose is rotted? Syphilis. Don't they call it that?"
"That's right."
"Many people do."
"I've heard there's a place that reconstructs that."
"Ah... I've heard that too. Yes, I heard there is such a place."
Seeing Liston nod, my anxiety eased a little.
It seemed there was indeed something.
"Actually, it's a bit embarrassing to say... but my elder brother has syphilis. His work involves frequent trips abroad, so... anyway, I looked into it in detail, and they perform surgery like this there. Like this."
Colin stopped talking, rolled up his sleeve, and pressed his forearm against his nose.
I wondered what he was doing, but then I remembered the surgery I was performing was a local flap procedure and finally understood.
"They attach the flesh from the forearm like this, and after some time passes, they cut the connection to the forearm, I heard. But one can't possibly go around looking like this, right? So, he's putting it off for now."
"Oho."
Blundell nodded with an understanding expression.
So did everyone else.
It was that kind of face—if that works, then mine should too, right?
'Thank goodness. There was such a pioneer...'
Trying my best not to reveal my inner thoughts, I nodded along too.
Yes, that's exactly what I used for reference—I tried to give off that nuance.
"Not much difference from going around without a nose... Why do you say that, Blundell?"
Liston did say something a bit strange in the middle, but anyway, everyone moved on like that.
It meant we could consider it settled.
"So, this is how we can fill the defect."
"Oho. But is it necessary to go through all this trouble? Can't you just cut and attach it directly?"
"Doesn't tissue die if it's separated from its original location? They probably do it this way because the direct method didn't work."
"Hmm."
This time too, Liston nodded with an expression that made people uneasy.
It seemed he might try something under the guise of an experiment sooner or later.
No...
Let's not think that.
He, too, is rapidly evolving from a 19th-century savage.
"Anyway, I intend to try it this way."
"Hmm."
"Why, again?"
I thought he was going to say something strange again, but this time he didn't.
Instead, he said something quite productive.
"If you cut the chest open like this, it seems like you're cutting too much... What about using forearm flesh, like for the nose?"
"Oho. Right, or the leg has more flesh, right? What about using that flesh?"
"Can't we use someone else's flesh?"
It started out sensible, but as more people added their comments, it gradually became stranger.
These madmen...
Using a leg—I can sort of understand that.
Of course, if one could attach a leg to the face and survive for over a month.
But someone else's flesh...
'They don't know about rejection...'
Fortunately, it was being rebutted for practical, non-medical reasons.
I didn't even need to step in.
"How would one walk with a leg tied up like that?"
"How can you stay attached to another person 24/7 for a month?"
It was shot down and sunk by arguments like these.
Eventually, what remained was the forearm flesh.
I had some reservations about this too.
Certainly... the resection range would be significantly reduced.
The patient would be extremely uncomfortable, but attaching flesh brought up from the chest wouldn't be comfortable either, would it?
"Let's think about this a bit more."
"Instead of thinking about it, ask the patient. We are a democratic hospital, after all."
Democratic...
Is there anything more dangerous than using majority rule in a specialist's domain of knowledge?
I thought so, but actually pushing back strongly felt a bit wrong.
'Even I don't know what the right answer is...'
Damn it all.
"Shall we do that?"
"Let's."
So, eventually, we decided to ask for opinions again, like with the antiseptic, and headed toward the patients.
The patients were all women, so they were in the obstetrics and gynecology ward.
It wasn't meant to be discriminatory; the male-only wards were just a bit dangerous.
Laws existed, but many people either didn't know about them or lacked any sense of wrongdoing when breaking them.
Moreover, if the patient had a melting jaw...
'They might beat her, asking what sin she committed to deserve that.'
The sin is just a pretext; they'd probably beat her just for fun.
It sounds too horrific, but the world was actually like that.
Weren't there human zoos?
I heard just a while ago that in France, a woman named Saartjie Baartman was put on display as a spectacle.
Even in the 21st century, violence against people who look different exists; what must it have been like in this era?
"Hmm."
Anyway, we walked shoulder-to-shoulder toward the patients.
Only after facing the patient again did I realize the forearm couldn't be an option.
She was too thin.
"Won't work."
It wasn't just me who thought so.
Liston agreed too.
Compared to his forearm, hers was half, no, less than half the thickness.
That said it all.
Perhaps she couldn't eat due to the illness, but honestly, this was the life of a laborer in this era.
I heard that if you go to the slums, among the corpses lying around, many died not from violence but simply from having nothing to eat.
"Then just use the chest?"
"Guess we have to. But the chest doesn't seem to have much flesh either."
"It won't be easy. Prevention is still the best solution."
"Let's just finish today's surgery... and you're coming to London with me."
"Yes, I think I should. We mustn't have any more patients like this."
"Good."
Liston tapped his scabbard a few times and then smiled at the patient.
The patient, already pale, turned deathly white.