First, I tried to recall the indications for a cesarean section.
The most common one that comes to mind is when the pelvis is too narrow due to physical structure… but in reality, such cases are rare.
Even among mothers who had previous cesareans, about two-thirds deliver vaginally.
This mother, Sir Jamie's granddaughter-in-law, didn't seem to have an especially narrow pelvis.
Then, I needed to consider other causes…
Without ultrasound or any other tools, all I could assess now was her position…
'Uterine inertia would have to be inferred from the duration of labor. Placenta previa from bleeding… Well, if it were visible, she'd likely already be dead.'
The fetal heartbeat?
I couldn't even measure the mother's heartbeat with a stethoscope—how was I supposed to measure the heartbeat of a baby inside the womb?
I'm constantly reminded how much modern medicine has advanced thanks to developments in countless other fields.
Anyway, organizing these thoughts in my head, I finally stood before the patient.
Blundell, who had been here earlier, handed me chlorinated lime and soap.
- For humanity's sake, let's wash our hands with soap.
I…
Actually, when I first arrived here, I thought this was a world without soap.
Because no one used it.
But surprisingly, it existed!
Well, I was the one who introduced chlorinated lime for shock therapy…
- Isn't chlorinated lime too painful? Soap would be much better.
Originally, humans are creatures that tend to do the hard thing first and the easy thing later. Even something that seems easy can be objectively difficult, but we just do it.
So, that's why I did it…
- Then wash with both soap and chlorinated lime.
Huh?
Weren't these bastards absolutely averse to washing?
But perhaps the cholera incident was too shocking, as things were strangely progressing.
Somehow, the handwashing process was only getting more meticulous.
Even everyone I knew was being mobilized as monitors.
Look now.
Blundell and the guys who came with him—Alfred, Joseph, and even Colin—are all just watching my hands.
"Ahem."
So, reluctantly, I washed with soap, then with chlorinated lime, put on gloves, and wiped those gloves with chlorinated lime and phenol.
Even after all this, an overwhelming smell and pain surrounded me, making it clear that anything less wouldn't be nearly clean enough.
"The cervix hasn't dilated more than an inch. It's already been… 8 hours in this state. Look at the mother."
"Ughhhhh."
The time wasn't wasted.
Since washing my hands took so long, I'd managed to glean some practical wisdom thanks to it.
Blundell chattered the entire time I was washing.
"In my experience, when it gets like this… I called you at the 7-hour mark. But there's still no change."
One inch.
2.54 cm.
Fuck, such an ambiguous measurement.
Even though it's been over 10 years since I was born and raised in England, I still can't get used to it.
It's unbelievable that the British Empire became what it is while using such measurements.
It's not like all the British people I know are incredibly outstanding or anything?
Well, there must be some amazing people somewhere, enabling them to invade other countries and create colonies…
"Hmm."
Anyway, I also performed an examination.
Clearly… it's about an inch. It hasn't dilated beyond that.
"Can you try pushing?"
"Ugh… not anymore."
"Just once more."
"Ugh."
The struggling patient, with Sir Jamie's nod, mustered all her strength.
This is purely a subjective feeling, but…
I could tell the patient was pushing, but no pressure was being transmitted.
She was probably exhausted.
Or perhaps it was outright uterine inertia.
'This isn't good. If this continues, she won't make it.'
Whether Blundell read my expression or had already come to the same conclusion himself, he made a grim face and said to me:
Clearly…
If this continues, she will die.
Both the mother and the baby.
You might think, 'Do people die this easily?' but if you look closely at the process of childbirth, it's incredibly arduous.
The fetus must perform a strenuous maneuver, twisting its head and body within the narrow birth canal to change position, just to enter the world.
To align with the shape of the pelvis, the head must rotate 90 degrees, and then another 90-degree rotation is needed for the shoulders to emerge.
'Let's do it.'
'Do it? Really?'
'Didn't you call me here to do it?'
'Well, yes, but… you see.'
Is there a difference between an intact corpse and one that isn't?
To me, a doctor, there's little difference, but to the bereaved family, it matters greatly.
One can't help but think, 'Maybe we should've done nothing.'
Of course, in the 19th century, death is so commonplace that a patient dying during surgery wouldn't really be an issue…
But isn't the other party Sir Jamie?
'I'm a bit scared. There's a rumor that he's become quite vindictive since getting his balls cut off.'
It wasn't just because he's a high-ranking noble.
Even Sir Damien, his closest friend and fellow noble, finds him difficult to handle—or so I've heard.
I heard it directly from Sir Damien himself.
It's not hard to understand.
Well…
It's a bit much, you know?
There's even talk that Butcher Harry faced punishment almost like a private sanction without a proper trial and was executed—no, murdered. I can understand it.
'But there's no other choice. If we do nothing, she will die.'
Still…
I have Sir Damien.
I was confident he would protect me at least once.
If he can't?
Then I can always flee to France.
The baguette-eaters might be more uncivilized, but haven't I helped plenty of them?
'Damn it. Having to perform a cesarean on a noble lady. I shouldn't have bothered with obstetrics and gynecology.'
'But if I succeed, what then?'
'It would be no joke then. Actually, I wasn't fully committed from the start.'
Where Blundell's gaze was fixed, there were midwives.
Frankly, when it comes to childbirth in general, those ladies would be far better than me, though maybe not Blundell.
I…
Paradoxically, I don't know how to perform a vaginal delivery.
When I see professors, they do induced deliveries like this and that, right?
But despite obstetrics being a major and crucial specialty, what students learn is pitifully little compared to surgery or internal medicine.
In terms of sheer volume, it's almost like a minor subject.
'Those people have already spoken to Sir Jamie about the possibility of the mother dying.'
'We should too, right?'
'I guess… so?'
'Yes. We must give proper warning.'
Anyway, I needed to emphasize the risks further.
So, I signaled my master assistants with my eyes to prepare for surgery and then went straight to Sir Jamie.
He had glued on a fake beard in the meantime—so poorly that it would've been better not to wear it at all.
'Is this a test?'
A loyalty test, or something like that?
It reminded me of the成语 (chéngyǔ) 'pointing at a deer and calling it a horse.'
Comparing Sir Jamie to the eunuch Zhao Gao…
'Huh? Both are missing. No, wait.'
Fuck, I almost laughed.
If I were misunderstood as laughing at the fake beard, I'd be dead; if they found out I was actually laughing at the thought of a eunuch, I'd definitely be dead.
"Ahem."
"So, how is her condition?"
He sounded anxious, his voice still a bit thin.
To think he ended up needing this surgery because of benign prostatic hyperplasia.
It's tragic.
Seeing him in this state before me almost brings tears to my eyes.
"Not very good. The chance of her passing is high."
"Y-you're an excellent doctor, aren't you? Huh? Not that you're not… everyone who knows says so. They say you're even more capable than Liston these days."
"Uh, who says that?"
"The Director."
"Ah."
Yeah, that sounds like something he'd say.
What exactly is their relationship?
What kind of relationship allows him to act so frivolously in front of him without getting hit?
He even talks behind his back—isn't that right?
"Anyway, I will do my best."
"Yes, yes. Please proceed."
"We need to perform surgery."
"Surgery… So, it's come to that. What are the chances my daughter-in-law will survive?"
At this moment, it was hard to even laugh about the fake beard or anything else.
The man before me was the head of a household.
And now, a member of that family was dying.
At times like this, there's only one thing to say.
"I will do my best."
"Yes…"
What meaning do probabilities or such things have?
They matter in research, but…
For patients or their families, it's 0 or 1.
Life or death.
"Hmm."
Having finished the explanation, I returned to find the surgical preparations already complete.
The patient had also been briefed to some extent, so even though we were suddenly cutting open her abdomen, she didn't seem overly agitated.
Well…
Even if she were agitated, there wouldn't be much she could do.
She had no strength left.
"Ma'am, please don't worry too much."
Anyway, I tried to reassure her while simultaneously nodding.
Alfred also nodded and turned the gas valve.
He had already placed a crude rubber mask over the patient's nose and mouth.
He was removing and reattaching it in sync with the patient's breathing almost supernaturally—even an anesthesiologist from the 21st century probably couldn't do it that well.
That's something you can only do with 19th-century sensibility.
The faint-hearted would be too scared for their hearts…
Whoosh.
Along with the gas, the patient's head lolled to the side.
'Is it safe?'
I don't know.
What is certain is…
The person I operated on yesterday is still alive, and the baby is also alive.
The surgery took less than an hour.
Including closing up…
"Scalpel."
We disinfected while the patient was still awake.
Phenol has a strong smell and causes some pain, but since we couldn't guarantee the safety of the anesthesia, we had no choice.
To minimize anesthesia time, we had to do everything possible.
Sschick.
Anyway, I cut the patient's abdomen with the scalpel.
I hesitated for a moment.
Should I make it shorter than yesterday?
But…
'A breech birth would be better. But now, too much time has passed.'
There will be bleeding.
Uterine contractions aren't just about pushing the baby out.
They also compress blood vessels.
That helps reduce bleeding, but after all this delay, what would happen?
If I mess around and the field isn't clear, causing her death, how could I live with the guilt?
Scars or whatever, saving her life is the priority.
Sschick.
So, I made a large incision, just like yesterday.
"Oh my."
"Good heavens…"
The midwives I had asked to help receive the baby, who were standing nearby, gasped first.
It was a relief they didn't faint.
Cutting open the abdomen was a long-standing taboo.
Yet, obstetrics was the field that had dared to do it, and in an era without disinfection or anesthesia, it was the obstetric medical staff and midwives who had to face the most horrific outcomes.
Trauma must be bubbling up inside them.
"Huu…"
Actually, you don't need specific memories to find this painful.
Even Sir Jamie shuddered.
The son standing beside him?
He was already leaning against the wall, just praying.
It was chaotic in many ways, but it was an unavoidable situation.
'Lord.'
I was praying too.
The uterus now exposed before me clearly looked different from yesterday's.
'Please, let her live.'
A desperate prayer burst out uncontrollably.