Chapter 158: We Remove Brain Tumors Too [3] Kanghyeok's unexpected sigh instantly chilled the atmosphere in the room.
Sayaga, who had been standing at a distance, reacted the most abruptly of all.
"An aneurysm…? What is that? Is it serious?"
The pronunciation was apparently unfamiliar to him, so Sayaga stumbled over the word for quite a while.
The sharp intelligence that usually lingered in his eyes had long since vanished.
He looked exactly like someone who did not understand a damned thing.
"It's serious."
"How serious?"
Sayaga's face was full of worry and concern.
Kanghyeok always felt it, but he truly was a remarkably loyal man.
"Mm."
Kanghyeok turned to look at Sayaga again.
Perhaps because he was fairly well educated, he was also a man of strong curiosity.
To make someone like that understand would require quite a bit of time.
Maybe after the surgery is over… but right now, that would be difficult.
Even the surgery they had originally planned already boasted an extreme level of difficulty.
If Kanghyeok had not been arrogant and brimming with confidence, he probably would never have laid a hand on it in the first place.
But now, on top of that, he had found an aneurysm in the carotid artery as well.
There was neither time nor mental energy to spare.
"I'll explain later. For now, just know one thing: it's not good, and you need to trust me and leave it to me."
"Ah… so I just need to trust you?"
The word trust sounded a little strange somehow, but Kanghyeok nodded anyway.
His mind was too pressed to add any proper explanation.
One fortunate thing was that his disciples knew what an aneurysm was.
"Then… do we remove this first? It's not small. If we leave it like this, there's no telling when it might burst."
Yeoni asked while still retracting the incision.
Just looking at how serious her face had become made it obvious that she understood perfectly well what aneurysm meant.
As expected, teaching them a bit during dissections really paid off.
It had been sheer luck that they had once opened the head of a corpse with an aneurysm.
Though of course, the biggest reason was that Kanghyeok had taught it well.
Looking very satisfied with his own teaching method, Kanghyeok nodded.
"We have to. If you hadn't been retracting here, this could have turned into a disaster."
Even in an irritating situation, Kanghyeok did not hold back on praise.
If not for her devoted assistance, he never would have found the aneurysm.
"Then how…? Doesn't blood travel through this artery to the brain?"
"That's the problem."
Kanghyeok looked down at the aneurysm, which measured about half a centimeter, with a deeply dissatisfied expression.
The best method would have been to insert a coil into the vessel and block off the path leading into the aneurysm.
That was a procedure usually done in neurosurgery or radiology, and it worked very well.
It was also much safer than surgery.
But in this place, there was not even decent wire, let alone a coil.
That option is out.
Kanghyeok forcibly erased from his mind the treatment that stood at the peak of modern medicine.
Obsessing over a treatment that was impossible anyway was like drunkenly calling your first love after you had already broken up.
Completely pointless.
Then there's no choice but to remove it directly…
Of all things, the aneurysm was located in a branch of the carotid artery heading toward the brain.
If he blocked the blood flow carelessly, it could cause a cerebral infarction.
And it's not as if I can do an EEG here.
Normally, whenever one performed any intervention on the carotid artery or another artery leading toward the brain, there was a test that absolutely had to be done first.
That was confirming whether enough blood could come across from the artery on the opposite side.
The method was very simple.
One manually compressed one carotid artery and then performed an EEG or blood flow study.
If there was no problem, it indicated that blood was flowing well through the opposite carotid artery. If there was a problem, it meant the blood was not crossing over.
But that was impossible here.
EEGs and everything else like them were completely out of the question.
"What do we do? You said earlier we didn't have time."
Dolseok, oblivious to any of this, hurried Kanghyeok along.
The instant Kanghyeok looked up at the bastard positioned above, he felt the urge to hit him.
Even the way he spoke, using that rough tone he did not usually use, irritated him somehow even more.
Goddamn y— …hm?
But as he looked at where Dolseok was positioned, his mind shifted a little.
Because a way occurred to him to assess blood flow without using any sort of imaging.
I already opened the skull.
Why bother taking images?
He could just look directly.
"Hey, move."
"Whoa. Why all of a sud—"
"Want to die?"
"No."
Dolseok quickly moved aside.
Kanghyeok peered into the area he had dug through with the chisel earlier.
Sure enough, quite a few blood vessels were visible inside.
Among them was a vessel continuing on from the carotid artery.
"Bingo. Looks like fate isn't trying to kill us after all."
"Huh?"
Ignoring Dolseok's blank face, Kanghyeok turned to Yeoni.
"Yeon. That thing in front of you."
"The carotid artery?"
"Yes. Compress it."
"This…? But if I do that, he'll die."
At the word die, Sayaga visibly flinched.
His lips kept twitching, as though he had an enormous amount he wanted to say.
But he did not dare interfere.
He was afraid that if he angered Kanghyeok here, Yoshitoshi really would die.
"No. He won't die from having it compressed for a moment."
"And how long exactly do you mean by 'a moment'…?"
"Just press it. Why are you turning into Dolseok too?"
"Hah. I'll press it."
After suddenly being told she was becoming like Dolseok, Yeoni seemed to come sharply to her senses.
She pressed down on the carotid artery with all her strength using her thumb and forefinger.
At once, the artery above the compressed section began turning white.
It was a striking contrast to how the lower part swelled red.
"Hmm."
What Kanghyeok was looking at on the inside was not much different.
Not even a second after Yeoni compressed the vessel, it too had already blanched white.
And once it had turned white, the color did not seem inclined to return.
"How much longer should I keep pressing?"
Yeoni asked in an uneasy voice.
If she had known nothing, it would have been easier.
But now she knew all too well how important the carotid artery was.
Kanghyeok was anxious too.
No, if anything, he was even more anxious than she was.
That was because he had actually seen an elderly woman suffer a cerebral infarction from this kind of thing before.
Back then it was a complete disaster… though this man is young, so he should hold out a little better.
It had been during his residency, and he remembered the emotional ordeal that patient had caused him all too well.
That had also been when he first learned that the phrase your heart turns cold was an actual physical sensation.
"Just hold it a moment longer. Just a moment."
Hiding his own anxiety as best he could, Kanghyeok stared at the artery.
He had a feeling.
A feeling that blood was coming through from the opposite side.
It sounded like sheer superstition, but Kanghyeok's instincts were surprisingly accurate.
Just like now.
"Okay. It's weak, but the blood is coming through."
Kanghyeok pointed at the artery, where color had begun returning.
It was clearly not flowing forcefully the way it did when blood came from this side's artery.
But blood was reaching it nonetheless.
That would probably be enough for him to hold out for about thirty minutes without neurological damage.
"Yeon, let go now. That's one big worry off my mind."
"Yes."
"Get the clamp ready and wait a moment. Once the blood fills the vessel again, we remove it."
"Yes, Young Master."
While Yeoni busied herself preparing the clamp, Kanghyeok turned to Dolseok.
"Hey."
Since Kanghyeok was a man, the way he treated Yeoni and the way he treated Dolseok was somewhat different.
Dolseok lowered his head with a wounded expression at Kanghyeok's particularly cold tone.
"Yes."
"You remember the vessel I was watching just now, right?"
"Of course."
Dolseok had a fairly excellent memory.
So once Kanghyeok showed him something, he usually did not forget it.
That vessel was no exception.
"While I'm operating, keep watching whether it keeps its color."
"Ah… yes. But right now it's completely white."
"That's because I just clamped it. Give it a little time and the color will come back."
"Ah. Yes. I think it's coming back now."
"Keep watching whether it stays that way."
"Yes, Young Master."
After placing the clamp into Yeoni's hand, Kanghyeok immediately picked up the micro-scissors and forceps.
Then he began removing the aneurysm, which had been sticking out so unpleasantly.
Pop.
With a somewhat brisk bursting sound, bright red blood spurted out.
The wall of the aneurysm was rather thin.
If left as it was, it obviously would have burst before too long.
"The dizziness wasn't even the real issue. He might have died within a few years."
What Kanghyeok said was the plain truth.
With the medicine of this era, there would have been no way to respond to a sudden rupture of the carotid artery.
But there was no real reason for him to mutter that in the middle of surgery.
Especially not loudly enough for the whole room to hear.
That was a deliberate act.
Kanghyeok glanced at Sayaga, who looked terrified of missing even a single moment.
He reports everything anyway. He'll pass this along too.
Since he had decided to cure him properly, Kanghyeok's goal was to burden them with as much gratitude as possible.
Of course, Kanghyeok was the only one in the room entertaining such dark thoughts.
Everyone else was wholly focused on the treatment.
Yeoni was the same.
"Young Master, here is the needle holder."
"Ah, right."
Only after accepting the instrument from her did Kanghyeok swallow down his hidden thoughts and return his full focus to the surgery.
Tak-tak-tak.
He truly was the kind of man who had dumped every ounce of talent into medicine.
He completed a vascular anastomosis that was nearly artistic, then asked Dolseok, "How is it?"
"There's still some color in it. Though it feels like it's decreasing little by little…"
"Okay. Then we release it."
"Yes."
Yeoni, following Kanghyeok's words, released the clamp.
The blood that had been blocked below it immediately surged upward with force.
With very elderly patients, they said the blood pressure at moments like this could even trigger a cerebral hemorrhage, but Yoshitoshi was not old enough for that to be a concern.
"Anything wrong above?"
"No. It's flowing well."
"Good. Retract again. We keep going up along the artery."
Kanghyeok had just dealt with a carotid artery aneurysm as casually as roasting beans over lightning.
There was no hesitation whatsoever in his hands.
In an instant, he advanced upward along the vessel branching from the carotid artery toward the head, that is, the internal carotid artery.
And at last, even from below, he could face the brain tumor itself.
"Good… from here on out, Dolseok becomes very important."
Normally, if a lead surgeon told you something like that, you would be delighted.
But Dolseok wore an oddly displeased expression.
Meanwhile, Yeoni, who had not been chosen, let out a sigh of relief.
"Hey, what's with that expression? You want to die, seriously?"
"Ah, no. I was just wondering what I'm supposed to do…"
"Look here. From below, you can't really see the tumor well, can you?"
Dolseok fixed his gaze where Kanghyeok pointed.
From below, there were too many structures in the way, and the path itself was long and narrow, so the view was poor.
"Yes. That's true."
"Especially the structures near the top of the tumor and the major structures passing nearby. You can't see them at all."
"Yes, yes."
"So… you need to use your judgment and move aside any structures I can't see so they don't get damaged."
"What?"
Dolseok's eyes went wide.
What in the world did it mean to move things aside using his judgment?
Fortunately, Kanghyeok did not seem inclined to continue the operation without any explanation at all.
This surgery was far too difficult for that sort of slapdash approach.
"Now, go back up again."
"Yes."
"When I pull on the tumor from below like this… you can roughly see it from above too, right?"
"Yes, I can see it, but…"
"Then, idiot, move every important thing near it out of the way. If I grab it with the forceps and damage one of those, the whole surgery is ruined."
Dolseok tilted his head as he looked at the tumor swaying in response to Kanghyeok's movements.
"What… counts as important?"
"Ha… you little shit. Are you seriously asking because you don't know?"
"I don't know. Me, of all people."
"Everything except the tumor, you moron. What structure inside the skull isn't important?"
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