Professor Blundell did say that they would all die anyway, but…
From my perspective, such words were nothing more than a defense mechanism.
How many deaths had he witnessed in this damned hospital until now?
If Blundell were an insensitive person, his heart wouldn't have been hurt.
He probably wouldn't be working with us either.
"Let's try a little more. At least before it rots further."
Blundell was someone who had put enormous thought into the judgment of death, far more than others.
Even if he wasn't the very first to conceive of the Rust Bell, he was one of the first doctors to introduce it in London—isn't that truly remarkable?
Blood transfusion…
Although whether it should even be called a blood transfusion is up for debate…
Anyway, he was also the type to lead by example, offering his own blood first to save lives.
"Professor, I can't anymore…"
"No, no. When will an opportunity like this come again?"
He says that, but look at him now.
Dawn was already breaking.
Joseph and Alfred had long since collapsed, even Colin—the stubborn one—was clicking his tongue in amazement, yet Blundell was still moving, drenched in sweat.
As for the results…
Well…
Yes, since it's practice, we can overlook it and say it's acceptable, but that's actually to be expected.
No, I'd say that level is quite impressive.
'I roughly know the correct answer.'
Human memory is truly fascinating.
When I was sitting at the desk, honestly, it felt so dark and unclear that I wondered if I had ever really learned how to perform a cesarean section.
Well, the entire field of obstetrics and gynecology was unfamiliar to me…
But then, when I entered the dissection room earlier and stood before the cadaver, the incisions came to mind naturally.
That alone was surprising, but as I practiced the actual surgery, even more came back to me.
Since most of what I learned was from my student days, the academic knowledge came first.
'Cesarean section… It only began to be properly established in the late 19th century. Even then, it was rare for the mother to survive.'
'At least save the child' was a mindset maintained for a very long time.
The mothers probably wanted that too.
They say maternal instincts take root from the moment of conception.
As someone who hasn't even been married, let alone had children, it's an emotion I can hardly imagine, but anyway.
I had absolutely no desire to go through such trial and error myself.
'The sutures we use, even the best ones, are silk. These sutures…'
They have long since disappeared from operating rooms or at least moved to the periphery.
There were likely many reasons for that.
Cost, issues with material supply…
But the biggest reason synthetic polyamide sutures became mainstream was undoubtedly infection.
'We have to move toward hysterectomy. This is an unavoidable trend of the times. Considering fertility is a luxury right now, a luxury.'
Even now that abdominal surgery is possible, the reason we still mostly perform appendectomies is obvious.
Removing something and simply suturing the site versus leaving numerous sutures to fully restore the original organ… Ugh. They're fundamentally different problems.
Maintaining this approach, I pondered the incision method.
The incision mainly used in the 21st century is horizontal.
It's made quite low…
So I tried to do it that way too.
"Pyeong-a, what is this?"
"Uh… No, it's nothing. Don't mind it."
It didn't work.
I pride myself on having fairly good hands, but it's still challenging.
Although the esteemed professor probably chose the location considering both scarring and visibility…
I realized I still couldn't do it and gave up.
So I decided to just open it vertically, like Blundell did earlier.
The uterus?
The uterus…
'Considering we're removing it, the incision can be as large as needed, right?'
We could literally open it in a cross shape.
The field of view would be enormous, right?
Then, not only could we safely extract the fetus, but we could also learn about the position and shape of the placenta, the distribution of blood vessels, etc.
As such positive experiences and knowledge accumulate…
Someday, much earlier than in the original timeline, we'll be able to achieve improvements in some way.
Whatever it is, Blundell is a hardworking professor, and his assistants and other professors are also highly passionate people.
"So the final form you have in mind is this."
"Yes."
I ligated the blood vessels entering the uterus and cleanly excised it.
I left the ovaries intact.
It was for female hormones, and naturally, Blundell followed up with a question.
"Why are you leaving these?"
I couldn't answer immediately.
Why?
I couldn't talk about hormones here, could I?
Just think about why Sir Jamie ended up wearing a fake beard…
Why people without testicles don't go bald…
It's an era where these things remain mysteries.
'Would saying I left them without thinking be too careless?'
But I couldn't make up an excuse either.
It wasn't just about protecting my reputation.
If these fellows recklessly excise everything just to be thorough, what would happen to that patient?
It could easily be misinterpreted: removing the uterus causes loss of female characteristics, so uteruses shouldn't be removed.
No, it would definitely be misinterpreted that way.
These people are cautious in strange places and impulsive in unnecessary ones.
"Lord."
With a prayerful heart, I began to lie.
No, it's not a lie.
I decided to truly believe this now.
"Huh? Suddenly?"
Blundell started looking at me with a 'what is this guy doing?' expression.
Should I call it fortunate?
Colin was dozing off in his chair, nodding, while looking at what I had done.
Liston?
He's confident in his stamina, but there were many limbs to amputate today, plus abdominal surgery, so he went to sleep first.
"Although we remove the organs given by the Lord to save the patient… wouldn't it be better to minimize it?"
"Doesn't that contradict what you said earlier?"
"No. Since we're removing organs to protect the life given by the Lord, it doesn't contradict."
"Is that so?"
Blundell?
Well, Blundell… he's a master at enduring through sheer will, but no one can stay up all night without consequences.
His mind was probably wavering.
"Yes. Besides, do we even know what function this has?"
"That's also true, but…"
"We should leave it if possible."
"I see. Yes, hmm."
In his dazed state, he nodded.
After glossing over Blundell's question like that, I quickly sketched our guidelines on a piece of paper next to me.
The drawing was crude, but I included all the anatomical features, so any doctor should be able to understand it.
In summary: make a long vertical incision, open the uterus in a cross shape, and during hysterectomy, preserve the ovaries whenever possible.
I thought that once the guidelines were set, we would begin surgery that very night.
But that didn't happen.
It wasn't because there were no mothers in labor, nor because there were no mothers in poor condition.
"Doesn't that patient seem worth trying?"
I pointed to a mother who had been in labor for over ten hours already… her complexion was so pale it wouldn't be an exaggeration to say she looked already dead.
But Blundell shook his head firmly.
"No. We should only do it on those who are truly likely to die."
"Then what about the one who died earlier?"
As mentioned before, there are two obstetrics wards.
Each ward has four 20-bed rooms…
Ward 1 is mainly managed by doctors, Ward 2 by midwives.
That's all I knew.
If I had engaged in typical medical student activities, I would naturally know more details…
But I'm already a professor, and I'm working with Liston from surgery, right?
So today was the first time I properly saw how this place operates.
"Who?"
You might think it's impossible for a doctor to ask "who?" when told someone died in their ward, but based on what I observed today, it's entirely possible.
Three people died in Ward 1 alone today.
Two in Ward 2…
"Five people died, didn't they?"
"Ah… but that's unpredictable and unavoidable. I need to see them when they're about to die, but that's not easy, truly."
Is this something a doctor should say? I thought.
But honestly, I couldn't really argue against what he just said.
To predict, you need to know vital signs…
But do we have a proper blood pressure monitor? An ECG? A pulse oximeter?
Wow, saying it out loud, we have nothing, damn it?
Then how do we select cases?
'The indications for surgery are the problem from the start.'
Come to think of it, we were also handling appendicitis quite loosely.
Going to Zemel's clinic, getting pressed on the abdomen before dying by Zemel's hand, and if it seems like appendicitis, cracking open the belly—isn't that the reality?
Even that…
The golden hour is relatively long, so even if diagnosis isn't instant, they can hold on, but this isn't like that.
For difficult labor cases…
Without a pelvic exam or something beforehand, there's probably no way to know.
Even if I rant here, it's not like blood pressure monitors will be invented…
So I had to change the methodology.
"Let's think about it first."
"About what?"
"Why do mothers have difficulty giving birth?"
"Because they're weak."
"Uh…"
Right.
They are weak.
No, wait.
Am I crazy?
"Other than that…"
"Is there another reason? Doctors are supposed to help the weak."
"Not that, I mean let's think of medical reasons."
"Medically?"
"Yes."
"Medically… they're weaker than others."
Should I hit him?
"Uh."
"Why?"
"You sounded like Liston just now."
"That can't be."
"No, there was murderous intent. Anyway, ah, right. Well… I guess if the birth canal is narrow, that would cause it. Actually, if the pelvis is small, difficult labor is inevitable."
I think hitting him would be right.
I just thought about it, and the answer came out.
If I had actually hit him, probably a much better answer would have…
"Why are you like this? You're scaring me."
"No, it's nothing. What other reasons are there?"
"Hmm… Ah, right. Before. Damn it. Previously, a patient died because the baby came out feet first. The baby got stuck in the middle, and there was absolutely nothing we could do."
Breech birth.
Humans have large heads compared to other animals, and babies' heads are even larger than their bodies.
So the head should come out first, and it should be positioned downward before labor, but this refers to cases where the head is still up even when labor begins.
Well… even in the 21st century, this was challenging, so what can you do?
"Isn't there a way to know that in advance?"
"In advance? Ah… well… you can tell by feeling the belly. People with the head up have a firm upper belly."
"Exactly. Shouldn't we perform a cesarean section right away for those people?"
"Is that so?"
"Is that so?" What kind of "is that so" is that!
Struggling to suppress the urge to shout, I continued.
"Has there ever been a case where everything turned out fine after a birth like that?"
"No."
"Exactly."
"Is that so? Well, then, for that case, in advance, hmm. I think we have one today too."
"Then let's go. What are we doing?"
"Yes, yes. Let's go."