Chapter 142: Cutting a Belly on the Ship [1]
At Kanghyeok's words, Yeoju and Makbong's expressions turned strange.
He said he would make a stomach for him.
Was that not an absurd thing to say?
Wondering if this was another joke like usual, they looked at Kanghyeok, but his face was serious beyond measure.
Well, the young master never jokes around when it comes to a patient.
Yeoju looked down once more at the stomach torn into a complete mess and thought to herself.
Baek Kanghyeok was definitely a carefree drifter in all things. Despite being born to a noble household of high standing, he was not bound by etiquette or custom in the slightest. He was so naturally like that that no one could force such things on him anymore. Even Baek Seungmun, his father and a renowned scholar, had refrained from laying a hand on him, so there was no need to say more.
But when it comes to medicine, he is strangely a perfectionist.
In particular, he never disregarded a patient once that patient had passed through his hands. Even procedures that Yeoju, Yeoni, or Dolseok were fully capable of handling, he insisted on doing himself in the end. Only then, he said, could he feel at ease.
Makbong, who had suddenly ended up in charge of the patient's breathing, was not all that different from Yeoju in what he thought, though his reason was a little different.
The young master did not get angry over other things. From the start, it would have been more accurate to say he almost never got angry. That alone set him apart from other noble households, where beatings large and small happened every other day. However, once surgery began, he became a different person, and that figure was exactly... yes, like he was now.
"What are you staring blankly at? Didn't you hear me say we're cutting the intestine?"
They had all heard him well enough. Even Kim Seongil, Hwang Yungil, and Sayaga, who were not participating in the surgery, had heard it all. The reason they all remained quiet was probably because they did not understand what Kanghyeok meant.
"Uh... so, you mean all of this...?"
With a face that plainly said she could not believe it, Yeoju pointed at the swollen intestine. It certainly did look to be in very bad condition. The group had not fasted before boarding the ship, after all. Gastric fluid and food were flowing out from the ruptured stomach, and because of that, the small intestine around it had swollen red.
"Then should I just leave it alone? If it bursts inside later, then we truly won't be able to do anything."
"Huh..."
"Stop sighing. Give me the thread. Makbong, are you watching the blood pressure properly?"
"Yes, yes."
The truth was, he had been standing there out of his mind. He had done quite a bit of dissection, but cutting open the belly of a living person was a different experience altogether. Squirming intestines did not give the viewer a particularly pleasant feeling. Moreover, the ruptured wounds here and there were seriously upsetting Makbong's stomach.
"What is it?"
"Pardon?"
"I said, what is it?"
"Uh..."
"I swear, I'll kill you."
"I'm sorry."
With an expression like he had truly committed a sin worthy of death, Makbong hurriedly checked the blood pressure. Fortunately, it was exactly at the proper level. Eighty over sixty, neither too high nor too low. If it had been outside that range, Makbong would have been hit somewhere for sure.
Kanghyeok was in an extremely sensitive state right now.
"Watch it carefully."
"Yes, young master."
Leaving the flustered Makbong behind, Kanghyeok turned his head. For a place where a life was being saved, murderous energy flashed brilliantly, and Sayaga found that deeply interesting.
It's very much like sparring at a swordsmanship dojo.
It was the Warring States period. Even when fellow disciples sparred inside a dojo, there were times when they used real blades. Naturally, from the dojo's point of view, the best outcome was that neither side got hurt. So they were cautious upon caution so that even a small accident would not happen. The atmosphere could not help but be harsh.
Then again, this too is work where the slightest mistake is directly tied to life and death.
Sayaga looked at Kanghyeok with a face full of renewed admiration. There had been something he could never understand, even while traveling with Kanghyeok's group until now.
Why does Yeoju follow Kanghyeok? In insight, in depth of learning, there is nothing in which she does not surpass Kanghyeok. The same is true of Yeoni and Makbong. Those two are masters rarely seen even in Japan, which has gone through long years of war. As for Dolseok, anyone who sees him would think he is the sort fit only to be a servant, so I can let that pass. Only now do I understand. In the end, the greatest master in this whole group is Baek Kanghyeok.
In truth, Kanghyeok was the greatest master in the world in this era, and one without any opponent who could match him. But even Sayaga's eyes could not discern that much. He only regarded him as a rare master.
"Elder Yungil, you are not too dizzy, are you?"
Kanghyeok looked at Yungil, who was breathing as though he were a dying man.
Of all the people I've seen since coming to Joseon, this elder makes the biggest fuss. Right, those other people are the strange ones. This is what's normal. If a needle is suddenly stabbed into you on a ship and you're turned into a living blood bag, would it not be abnormal to remain calm? If one is human, it is only natural to feel some tension and some worry.
"I am dizzy."
Yungil nodded as though he had been waiting only for those words. He nodded so quickly that it seemed the wind itself made a sound.
"And it doesn't hurt too much?"
"It hurts."
"Yes. You only need to endure a little longer."
"Endure?"
"Yes. I know roughly how much to take, so don't worry."
"Uh..."
Yungil looked at Kanghyeok with eyes that constantly seemed to beg, but Kanghyeok was not even looking at his face in the first place. He only continued observing the IV line with the needle stuck in it.
The amount drawn so far is only around 150 mL at most. There may be some error, but it should be fine. By contrast, the amount of blood pooled in the patient's abdomen is easily around 800 mL. It's not that there is no sense of shortage, but I'll proceed for now, trusting in the patient's youth. Fluids are going in too. It's only 500 mL at most, but still. Since that and the blood are both going in through the other arm, things should not immediately go wrong. And from my point of view, there no longer seems to be massive bleeding. The gauze I stuffed in roughly is turning red, but not very quickly. I just need to hurry.
Then this absurd surgery being performed atop this ship might actually succeed.
Blood pressure is fine, the living blood bag is okay too. Then I proceed.
Kanghyeok rummaged through his medical bag once again. Soon, a large suturing instrument and silk thread were in his hands.
"I'm tying off the small intestine. Ah, Sayaga!"
"Yes. Did you call for me?"
At Kanghyeok's call, Sayaga, who had been directing the sailors, quickly bowed his head. They were not originally close enough to use such extreme honorifics, but somehow the atmosphere made it feel appropriate.
"You have the water prepared for drinking, right?"
"Yes."
"Boil it and bring it in the cleanest container you can."
"Ah, yes."
Without asking why or questioning anything, Sayaga ran off as though flying. The ship was rocking less than before, but it was still on the sea all the same. Yet Sayaga seemed completely unaffected by such things.
That's at least fortunate.
If this had happened with only Kanghyeok's group present, they would have been too busy just trying to keep themselves upright, never mind saving the patient. It was a case of being Lü Bu on land and useless at sea.
"Good. First, tie it off."
"Yes."
"Don't pull too hard. The small intestine will rupture completely."
"Is it because it's swollen?"
"Gastric acid dissolves protein quite well. Especially when it's exposed to the outside like this..."
Even while speaking, Kanghyeok continuously examined the structures behind the stomach. It was none other than the pancreas, and if that had ruptured, the patient would already be dead by now, because not the intestine, but the abdominal aorta would have dissolved away.
Thankfully, the stomach absorbed the entire impact in a very tricky way. Because of that, the stomach had been utterly smashed. Still, it meant there was at least something worth trying.
Scritch, scritch.
With hand movements one could well describe as rough, Kanghyeok tied off both sides of the damaged small intestine. The damaged range was not short. Roughly estimated, it looked to be around three cheok, about ninety centimeters.
"Isn't that too long?"
"It's fine. The small intestine is long."
"Even so..."
"Don't cling to structures that can't be saved anyway. You only make the surgery take longer, and the patient dies."
Kanghyeok spoke in a very cool manner, but if one looked closely, it was advice worth a thousand gold. It was just unfortunate that Yeoju and Makbong were not yet capable enough to understand that.
"Alright, scissors."
"Yes."
Without the slightest hesitation, Kanghyeok cut away the small intestine. Part of one side included a portion of the stomach as well, but there was not a trace of regret on his face. That was because the "organ that could not be saved" Kanghyeok had mentioned also included the stomach.
"Feel here."
"Yes, yes."
"How is it?"
"I think this part is alright."
Yeoju answered while touching the end of the small intestine that Kanghyeok indicated. There was no sign of swelling at all, and the thickness was proper too. It was normal, plain and simple.
"Right."
"But why did you cut this far?"
"You can't leave damaged intestine behind. You can see it moving even now, can't you? Once food goes in, it will swell more and more until it bursts."
"Ah..."
"And I have to reconstruct the stomach too."
Kanghyeok looked down at the shattered stomach lying in ruins. The front side was in such a state that it was hard to recognize its original shape.
"How are you planning to reconstruct this?"
Yeoju recalled the structure of the stomach that she had learned during anatomy practice. It was an organ that secreted strong gastric acid, while at the same time secreting a substance that protected it from that same powerful acid. Moreover, it even had a thick muscular layer rarely found in other organs. It was not as though one could rummage around in the abdomen and have some replacement structure come popping out. At least, that was what she had learned in practical study.
"Well, watch."
Sometimes it was easier to show rather than explain with words, especially at a moment like this, when every minute and second mattered.
"Here it is."
"Good timing."
Kanghyeok received the water Sayaga handed him. It still held quite a bit of heat, but it was no longer boiling hot.
"Pour in the disinfectant."
"Into this?"
"Yes. I'm going to dilute it and clean out the entire abdomen."
"Ah. Yes."
Following Kanghyeok's order, Yeoju poured the brown Betadine solution into the warm water. Since it was such a concentrated antiseptic solution, the water quickly turned brown.
"Now... take the gauze."
"Yes."
Kanghyeok then poured that water directly into the abdomen. At the same time, the blood clots settled below, while things like grains of rice that had not yet been digested floated up to the surface. Yeoju quickly scooped them out with gauze.
Kanghyeok left the small bits alone for the moment and focused on scrubbing the surgical site, because seeing something and feeling it with one's hands gave different kinds of information.
Good. The part connected to the esophagus should still be usable.
Unexpectedly, this was the part that most troubled the surgeon in Gastric Reconstruction. If even this part had been damaged, food would likely reflux back up as soon as the patient ate. And because of that, it was not uncommon for secondary esophageal cancer to develop. It was a great relief.
And the back wall... there are parts that can still be used there too.
After washing it out with water, the field of view had become much better than before. Only then did Kim Seongil and the others finally begin to vaguely understand what condition this patient was in, and why Kanghyeok had been shaking his head before even cutting.
"So that's why you said earlier that it was the worst possible situation."
"This really is..."
Yeoju and Makbong each added a word of their own.
"This is the most severe I've ever seen."
"The blood pressure is the same as before."
Everyone was full of worry. But Kanghyeok alone was the exception. Once he had opened the patient up, a threadlike hope had started to appear.
It's definitely a difficult surgery. Post-operative care will be difficult too. Infection is the first concern, and what the patient can eat will also be heavily restricted. But if the surgery goes well, all of that can be offset to a certain degree.
"Stop making such a fuss. I can do it. Give me the scissors. From here on, I'm cutting away the dead portions of the stomach. And Yeoju."
"Yes."
"You, slit the remaining part of the small intestine... lengthwise, only as much as the length of your palm."
"Lengthwise?"
"Yes. I'm going to make a new stomach with this."
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