Chapter 83: We Do Lung Surgery Too [1] A dropping blood pressure implied several possibilities.
First, that blood was escaping.
In this patient's case, the bleeding was not especially severe, so that possibility could be set aside for the moment.
Second, that damage to the head was preventing normal regulation.
Without a CT or X-ray, it was difficult to determine it precisely, but that possibility also seemed small.
For one thing, there was no obvious external trauma to the head.
The eyes look fine too.
There was a widely used saying in medicine: the eyes were a window through which one could see the head.
It meant that by looking at the eyes, one could roughly assess the condition of the head.
Kanghyeok agreed with that to a certain extent, and he was the type to examine the eyes first.
No papilledema, and the pupillary reflex is normal. So it's not the head either.
Third, that there was a direct or indirect effect on the heart.
In this patient's case, that third possibility was the strongest.
At least, that was what Kanghyeok thought.
Breath sounds are generally decreased in the right lung. The heartbeat is shifted toward the right….
Then it had to be tension pneumothorax.
He still did not know the cause, but as a result, that was what it was.
Just as Kanghyeok was sorting out his thoughts, Dolseok handed him the syringe.
"Young master, here it is."
"Good. As for Yeoni… oh, well done."
They said that if a dog from the village school stayed there for three years, it would learn to recite poetry.
Yeoni had already scrubbed the upper right side of the chest clean with brown Betadine disinfectant.
Some rather unfamiliar instruments were sticking out, but no one could raise any objections.
That was because all the people who could not understand speech had already been driven outside by Cheomjeong Heo Jun and the thug Makbong.
Inside the room were only the group Kanghyeok had brought, Heo Jun, and one of Heo Jun's disciples.
He had heard so much praise for Kanghyeok that he had instead stuck right to his side, watching Kanghyeok's technique.
"I'm going to pierce now."
Kanghyeok removed the plunger from the back of the syringe and stabbed into the upper right chest.
—Pshhhhh.
With the sound of escaping air, the air that had filled the right pleural cavity rushed out.
At the same time, a sound like air escaping came from Kim Gyehan's mouth as well.
"Huuuh."
Blinking rapidly, he began looking around in every direction.
He probably felt as though he had taken a trip to the afterlife.
In truth, he had gone from death back to life.
Heo Jun hurried over to him.
"For now, stay still."
"Ah, Heo Jun…"
"Do you remember being treated here earlier?"
"I do. I remember that. But after that, it seems I suddenly lost consciousness."
Listening to their conversation, Kanghyeok began piecing the situation together.
The patient had probably been conscious right after falling on the stairs.
Even while he was being brought to the Royal Medical Bureau and treated.
Then, all at once, he must have collapsed.
That's one of the traits of tension pneumothorax too.
At first, the patient seemed fine, and then suddenly died.
Because of that damned feature, there were not a few cases where people lost the patient while simply staring blankly.
There were plenty of cases in traffic accidents where a lightly injured patient who had seemed perfectly fine and had even been helping other people suddenly died.
"Mm. Your pulse suddenly became impossible to feel, and then that happened. How do you feel now?"
At Heo Jun's words, Kim Gyehan winced.
It seemed he was feeling a throbbing pain in his chest.
He even made a hurried gesture as though to sit up.
Makbong and Dolseok stopped him, so he was unable to do it.
"My chest hurts. But who are these men?"
To Kim Gyehan's eyes, Makbong and Dolseok were absolutely not people who worked in the palace.
Of course, their clothes were rather neat, and they were even using good-quality cotton.
But that did not change the fundamentals of what a person was.
No matter how favorably he looked at them, he thought they were lowborn fellows.
"Ah, they are the men serving Scholar Baek Kanghyeok, of whom I spoke before."
"Ahhh…"
Kim Gyehan narrowed his eyes and recalled an old memory.
It was from when Heo Jun had cured Imhae-gun and risen to the post of Cheomjeong.
At the time, he had attributed all of King Seonjo's tremendous praise entirely to a man named Baek Kanghyeok.
He had thought it was merely an expression of humility, but now it seemed that was not necessarily the case.
"Then is he here now?"
"He is. The one who just saved you was Scholar Baek himself."
"Huh."
By the time Kim Gyehan finally became aware of Kanghyeok's presence, Kanghyeok had already finished assessing Gyehan's injury.
Tension pneumothorax was not something that happened merely because someone had fallen down the stairs.
No matter how stone those stairs were, and how hard.
There had to be some reason.
The rib must have broken and torn the lung.
And that also meant the time he had been given was not very long.
If left like this, within an hour Kim Gyehan would turn into a cold corpse.
That could not be allowed to happen.
First, it would reflect badly on Heo Jun, and second, it would scratch Kanghyeok's pride.
Personally, the latter bothered him much more.
If he's passed through my hands, then he has to live.
If it was someone whom anyone could see was beyond saving, then there was nothing to be done.
But in a case that was not like that, the patient had to live.
No matter what anyone said, Kanghyeok had to be the finest physician.
"Hm. Patient, your name?"
At Kanghyeok's words, Kim Gyehan answered quickly.
"My name is Kim Gyehan."
Kim Gyehan.
It was a name he felt he had heard somewhere before.
Not elsewhere, but in a historical column, perhaps.
Ah. So this is that eunuch who later carried Seonjo on his back while fleeing and became a meritorious subject.
Had it been something else, he would have forgotten it.
Kanghyeok had no particular interest in anything outside medicine.
But this man's name had remained firmly lodged in his mind.
That was because he had wondered how a castrated eunuch had managed to carry the king on his back while fleeing.
Now that he saw him in person, his curiosity only deepened.
Hmm, he certainly does look as though his muscles are underdeveloped.
By contrast, he had accumulated quite a bit of fat.
Enough that Kanghyeok thought it was no surprise he had tripped while going down the stairs.
"Th-Then… what kind of treatment do we need now?"
While Kanghyeok was lost in thought, Heo Jun asked the question.
For him, it was difficult to deal with an injury of this severity.
He had built up a fair amount of anatomical knowledge through his exchanges with Kanghyeok, but it was still too much to apply in real practice.
He had never done it himself.
"From what I can see, a rib has broken and driven inward. In the process, it tore the lung."
"Huh."
"Air leaked out from the torn lung, so he could not breathe, and the heart could not function properly."
"I see."
It was an explanation difficult to understand in that era, but Heo Jun grasped it surprisingly well.
That was because he had learned medical concepts here and there through the letters he exchanged with Kanghyeok.
At the very least, he had acquired enough knowledge for the two of them to understand each other.
"So…"
Kanghyeok paused briefly and looked down at the patient.
Kim Gyehan was still gasping repeatedly, apparently finding it difficult to draw breath.
Naturally so, since part of his lung was torn.
The measure taken for the tension pneumothorax had only been an emergency improvisation.
"We need to cut open the chest, set the broken rib, and remove the torn part of the lung."
"What did you say you're going to do?"
Kim Gyehan was so busy trying to breathe that he had not fully heard what Kanghyeok said.
Even if he had heard it, he would have found it difficult to understand.
So naturally, it was Heo Jun who asked that question.
His eyes were round as he stared at Kanghyeok.
"Exactly as I said. Cut open the chest, set the rib, and remove part of the lung."
"I-Is that possible?"
"It is."
Kanghyeok nodded as he looked around at the people with him and at the bags and bundles they had brought.
If this had been right after he first dropped into Joseon, then of course it would have been impossible.
He would have lacked both manpower and equipment.
But not now.
He had as many as two quite capable disciples, and he also had a way to anesthetize the patient.
"Oh. Then let's do it at once."
"First, we have to put the patient to sleep."
"Ah, was the medicinal material I told you about of help?"
"Yes. Very much so."
While Kanghyeok wore a satisfied smile, Dolseok busied himself pulling a decoction from the bundle.
It was an anesthetic prepared by mixing Seomsu and Cho-o in a golden ratio and adjusting the dosage.
"Patient, please drink this."
"What is this?"
"It's good for your body, so please drink it."
Kanghyeok pulled down Gyehan's lower jaw and poured in the decoction.
As a result, Gyehan had to gulp it all down, half willingly and half by force.
"Kh."
Since it did not seem to taste all that bad, he even let out a faint sound of approval.
"How is the effect?"
Heo Jun had now fully taken on the position of an observer.
Keeping his fingers on Gyehan's pulse, Kanghyeok continued explaining.
"He'll fall asleep before I count to seven. His heartbeat has already slowed a little."
"Oh."
Just as Kanghyeok said, Gyehan's eyes began drooping more and more.
He muttered incoherently for a while, then fell completely asleep.
His last words had been something about His Majesty, which made it clear that he was a man filled to the marrow with loyalty to King Seonjo.
That king really is fortunate, isn't he.
For his personal ability, he seemed to have received far more than enough talent and devotion.
Anyway, I suppose it's time to get moving.
Now that the patient was asleep, it was time to begin the surgery.
There was not a single benefit to dawdling.
"All right, Makbong, take the bag and stand by the patient."
"Yes, young master."
Blowing air into the iron-ball bag was something anyone could do.
But there were very few people who could keep doing it tirelessly and without stopping the way Makbong could.
He himself clearly agreed strongly on that point, because he took his place by Gyehan's head without a word of complaint.
Once the surgery began in earnest, he was going to force air in.
"Dolseok, face me. Yeoni, to my side."
"Yes, young master."
The surgery was not going to be easy.
Unlike usual, it would be difficult to proceed with only a single assistant.
"Ye—… no, you, don't miss a single thing and keep drawing. And help Makbong too."
"Yes, young master."
Kanghyeok had almost called her by name, but just barely swallowed it back.
It did not seem likely that Heo Jun would go around talking about it.
Still, there was no need to increase the risk unnecessarily.
After all, there was a saying that birds heard words spoken by day, and rats heard words spoken by night.
"All right, then let's begin."
Kanghyeok roughly traced the place to be incised with his finger.
That was far better than cutting blindly.
"Now, anesthesia."
"Yes."
Dolseok quickly handed over the local anesthetic injection he had already measured out.
Kanghyeok carefully injected it along the line of the incision.
Its purpose was not merely to lessen pain.
Even with a patient already under general anesthesia, the principle was still to use local anesthesia as well.
This way there'll be less bleeding.
In the past, they said anesthetics made only of lidocaine had often been used.
But now, compound preparations containing a vasoconstrictor called epinephrine were used almost all the time.
The reason was that they reduced bleeding and made the anesthesia in that area far more effective.
"That's done. Now give me the knife."
"Yes."
With the scalpel Yeoni handed him, Kanghyeok drew a long cut between the ribs.
At once, blood flowed out, and Yeoni carefully wiped it away.
"Mm. Dolseok, pull."
"Yes."
Thanks to that, the wound spread open, making it easy to see at a glance where he needed to cut.
Placing the scalpel against the muscle covering the pleural cavity, Kanghyeok spoke.
His face was grave in a way it had not been before.
"Makbong, you're ready, right? Actually, you're the most important one here. I'll do this as fast as I can, so you need to blow air in."
"Yes."
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