'Lord.'
It's been a while since I prayed.
Why?
Because I… don't really know much about obstetrics and gynecology either.
Even though it's broadly classified under surgery, OB/GYN is one of the five major specialties.
The gap between surgery and OB/GYN is as wide as the one between internal medicine and psychiatry.
But…
"Let me demonstrate first."
"Yes, yes."
At this point, the most skilled obstetrician here…
No, not just here—he's a renowned expert whose fame has spread throughout London, even if not to the extent of Lister.
"Now, look. Fortunately, thanks to antiseptic practices, we can be bold about opening the abdomen."
"Yes."
With that, Blundell made a slicing sound and cut open the abdomen.
Since it was slightly decomposed, it actually cut more easily.
Well…
Since he was opening it vertically, it was almost inevitable.
"In the past, some used a cross-shaped incision, but that led to high mortality… so we use Lister's method: a vertical incision."
"Yes, Professor."
Vertical…
Right, actually, vertical is much better than a cross.
A cross is…
A bit problematic.
If I outright say a cross is unacceptable, I might feel like I'm being attacked, but it's still a no.
'He's making a long cut too.'
In the 21st century, cesarean sections use a horizontal incision, not vertical.
Well… I'm not entirely sure, but it's probably an incision考虑到了疤痕.
Because it can be hidden by the panty line.
Moreover…
Considering the shape and position of the uterus, the incision can be made quite low, making it possible to place it in a less noticeable area.
If you think back to biology class… you probably know what the uterus looks like, so you can imagine the details, right?
The uterus is located in the lower abdomen and is wider horizontally.
Of course, in pregnant women, the uterus rises upward, but its original shape doesn't change, so its horizontal diameter is much longer than its vertical one.
'So, even with a vertical incision, there's no need to start all the way up at the sternum. If we're only considering visibility… well, a large, generous incision is best, but still.'
Blundell had made a vertical cut from the end of the sternum down to near the pubic hair area, cut through the peritoneum, and spread it open left and right.
It was a massive incision, literally.
With an opening this large, delivering the baby wouldn't be a problem at all.
The issue is…
'The mother's chance of dying is too high.'
Blood…
It's a given that a larger wound means more bleeding.
On top of that, the risk of infection also skyrockets.
Even though we are obsessively diligent about antisepsis…
We can't do anything about the air.
Moreover, trust in the iron instruments is also low.
You can see the tiny grooves with the naked eye… these crevices could all serve as breeding grounds for bacteria.
"Hmm, this is the uterus."
"And this?"
"That's the bladder."
"Ah."
Regardless, Blundell's dissection continued.
Since my students and even Lister were all unfamiliar with the organs within the abdominal cavity, and especially with female organs, a lively discussion ensued.
To put it simply, if we look at the organs from the front in order: bladder, uterus, and then large intestine.
Ah, I'm talking about the lower abdomen.
It's different higher up.
"First, we push this bladder aside…"
Actually, during a real cesarean section, there's no need to push the bladder aside.
In pregnant women, the uterus is enlarged and rises above the bladder.
You don't even need a macrosomic baby; just think about fitting a 2-3 kg fetus inside—it's enormous.
So, you just make a horizontal incision and take the baby out.
"This is where the dilemma begins."
This was where our Blundell was stuck.
Given the incredibly high number of maternal dissections, he surely knew the anatomy.
Puerperal fever.
Didn't this cursed disease kill an enormous number of women?
Of course, such incidents have decreased significantly in our hospital now…
But the period when women died in droves lasted for decades, so someone with Blundell's experience would be very knowledgeable about the anatomy.
"If we open it vertically, hmm. Then the baby inside should be clearly visible, but it's not."
"At this point, it looks quite easy, doesn't it?"
"Hoh."
Blundell, mid-sentence, looked at Joseph who had interrupted and clicked his tongue.
Unlike most cases, it wasn't to be stubborn or to upset me with nonsense.
He continued speaking very logically.
"There's this thing called amniotic fluid. It's filled to the brim. Now, if we cut it like this, what do you think will happen?"
"Ah…"
Right, the amniotic fluid would spill into the abdominal cavity.
You might ask what's wrong with that…
But in this era, there's no suction.
Well…
With our iron-willed medical students, we might be able to suck it all out using straws or something…
But there's also meconium.
It's poop, just poop.
What would happen if amniotic fluid mixed with that spilled into the abdominal cavity?
Given that our antibiotics are about as reliable as a lottery with moldy bread, it's no exaggeration to say it's 100% fatal.
Why are we… doing this dog's work of having the police scavenge for bodies in the slums?
It's all to save mothers, so we can't have that.
"Let's open it horizontally."
So I said that.
I'm not entirely sure… but I think that's how it was done during my student practical training.
"Horizontal…"
"Yes. If we make a horizontal incision at this point to extract the fetus, and pull upward to prevent as much amniotic fluid as possible from flowing out, what do you think?"
"Ah…"
"If we cut while pulling upward vertically too… we might be able to prevent it from flowing down, but the area would be smaller."
I don't know if that's true.
But would they use a horizontal incision for no reason?
There must be a rational reason I can't recall right now.
And countless bodies must have piled up before that reason could be established.
"Is that so? That sounds plausible. But there's one more problem."
"What is it…?"
I asked purely out of curiosity.
As everyone knows, London is really, really crowded, right?
Among them, the number of poor people is enormous…
Most of them come to the hospital to give birth.
You might wonder how the poor can afford the hospital, but in this era, 'poor' is synonymous with 'laborer,' so they aren't completely penniless.
They just earn money that's insufficient for a proper living.
Anyway, for this reason, Blundell had a vast amount of experience.
Probably even a fairly famous OB/GYN in 21st-century South Korea wouldn't compare in terms of the sheer number of mothers he's seen.
"Now look. If we cut the uterus vertically, it's easier to suture back together. But horizontal isn't as good."
"Hmm…"
Well, vertical suturing is generally easier, one way or another.
Because the human body is mostly bilaterally symmetrical.
The uterus is no exception.
If your suturing skills are excellent, it might not matter much, but…
'The suture…'
The tools we use are also a problem.
Let's not say 'a bad workman blames his tools.'
No, that's not it!
Equipment is too important.
Especially when it comes to saving lives, you shouldn't skimp.
'Leaving our suture inside the body, inside a mother who's just been through a cesarean delivery and is completely exhausted… along with a crudely sutured uterus…?'
Ugh, it gives me the creeps.
Isn't this another form of murder?
"Do we absolutely have to leave the uterus?"
To my knowledge, hysterectomy performed alongside cesarean section is not uncommon.
Inevitably, because in cases not done simply due to fetal position (breech), large head size, or a narrow birth canal (for vaginal delivery), but for reasons like placenta previa, the uterus itself remaining is a risk factor.
Many people don'know this, but there are only two departments in a university hospital that can burst into the OR shouting "It's an emergency!" without anesthesiology approval, and one of them is OB/GYN.
The other one?
The trauma center led by Baek Kang-hyuk. (TL Note: Character from another novel/series by the same author)
Basically, if you don't have thugs, OB/GYN is the only one left.
The reason is clear.
If things go wrong, both mother and baby can die, and once bleeding starts, even I, as a surgeon, get weak in the knees seeing how much blood there is.
"Huh?"
So I said it casually.
If you just preserve the ovaries properly, there shouldn't be hormonal issues…
As far as I know, aside from not being able to get pregnant again, if the surgery is done well, there aren't major problems.
"Can't we remove the uterus?"
"What? What are you talking about? How is she supposed to live without it?"
"Right, Pyeong. How can you suggest removing an organ given by God so arbitrarily?"
There was fierce opposition.
'Ah, was this the common sense of this era?'
Right…
Given by God.
Even so, shouldn't surviving come first?
This isn't about "one's body, hair, and skin are received from one's parents" (Hyunchalbuso sujibumo - Confucian concept); are we just going to leave behind something that has a high chance of becoming a host for death?
"It was given by God… but please consider."
In the past, I would have backed down the moment God was mentioned.
What if I'm accused of being a witch?
But not anymore.
At least the people here are prepared to listen to whatever I have to say first.
"If we leave this… you know our sutures are basically miasma clusters, right?"
"Hmm."
"So that's basically mercury–"
"Stop talking nonsense."
"Yes."
After shutting down Joseph who interrupted again, I continued.
"We've seen it under the microscope."
"That's true."
"Leaving this much inside the abdomen… is that acceptable?"
"Hmm… Is that so? But we leave it in one way or another, don't we?"
Yes, they do leave it.
Because aside from tying off blood vessels or something, there's nothing else but these sutures.
When will nylon or Vicryl ever be invented?
"We just pray each time."
"Hoh, prayers are always answered."
"Is that why your hair is gradually falling out, hyung? Ah. Did I just say that out loud?"
Did I say that out loud?
Not just in my head?
I was soon faced with a devil.
A paradoxical devil who prays to the Lord.
"Lord… please grant me one more today…"
"Lister, stop it!"
"Save me!"
I immediately knelt and begged.
Wow.
I went through all the trouble of reincarnating, and I almost died again.
Dying is scary enough, but what if I end up in the Middle Ages in an East Asian body?
"No, I said your hair isn't falling out! You have plenty of hair."
"Yes, that's right. Unlike Professor Blundell."
"Why is that coming up here?"
"So are you saying you have no hair, hyung?"
"No, that's not it."
While making eye contact with Blundell, I barely managed to calm Lister down.
Blundell, pulling at his own innocent hair a bit, continued with teary eyes.
"Look at this, I'm in big trouble."
"Right, I see. Phew. You startled me. There's no way I could be bald."
"Right, how could the lion doctor Lister be like that? You have a mane-like head of hair."
"Right, right."
To the now-calmed Lister, I cautiously presented my idea.
"Anyway, my opinion is that it's better to remove it."
"Hmm…"
Lister, devout enough to seek the Lord even before killing someone, naturally couldn't give an immediate answer.
Well, it didn't matter.
Actually, the obstetrician is Blundell.
"But anyway, it doesn't matter. Most of them die."
The problem was that the obstetrician was saying something like that.