Chapter 56: How Do You Even Perform a Sinus Surgery?

First, I categorized the patients who seemed to need surgery.

If this were something like an appendix, I would have just removed it without a second thought.

If you don't remove it, there's a very high chance things will go south, and more importantly, isn't that a surgery I'm actually good at?

But this was different.

Would they die if they didn't get the surgery?

Well… technically, yes.

"If you leave it untreated with antibiotics and just let it be… yeah, that could happen."

But isn't that true for all diseases?

If the host is weakened, even sinusitis could wield the scythe of the Grim Reaper.

Especially in an era where antibiotics—or any other definitive means to aid the host—are scarce.

But then again, there's probability to consider.

"And besides… I don't even trust my own surgery skills."

I had seen endoscopic sinus surgery before.

Not that I was watching with the intent to learn, but during a three-week rotation, I saw it more times than I cared to count.

In fact, it was during those three weeks that I completely ruled out ENT as a specialty.

I just didn't have the temperament for working in such tight spaces with that level of precision and frustration.

But at least, to ensure I had no regrets about my decision, I made sure to observe properly while I was there.

"But what does it matter? I don't even have an endoscope."

No, I misspoke.

An endoscope? In this era?

If such technology existed…

"Peña, what are you doing?"

"Ah."

The voice that pulled me from my thoughts belonged to Joseph.

Right. I had already categorized the patients.

Out of everyone, I had identified two who absolutely needed surgery.

As for the rest, since the effects wouldn't be significant, I decided to just stick with mindless irrigation.

So what was I doing now?

Practicing.

"Alright, pull this here a little."

…

"Keep pulling."

"You hold the head, senior."

"Oh. But I'm kind of terrified…"

What was I using to practice?

A cadaver, of course.

There was no other option.

I couldn't very well practice on a living person.

That would be crossing the line into outright crime.

Of course, in this era, many doctors were doing exactly that.

So many, in fact, that it was hard to single anyone out. It was basically common practice.

"But I refuse to do that."

Yeah.

That's a line I absolutely cannot cross.

At the very least, I was taught not to do things like that.

Sigh.

"What's so scary about this?"

"Then why don't you hold the head?"

"No thanks. Who would show me the surgery then?"

"Hah."

After taking out my frustration on poor Alfred, I picked up the chisel again.

There was no such thing as a surgical chisel available, so I had to make do with a regular one.

"Hahaha! Peña, you're really becoming a doctor now."

In this era, the ability to use brutal instruments was what defined a skilled surgeon.

Seeing me wielding such a crude tool, Dr. Liston laughed and clapped his hands.

I was about to hammer a chisel into someone's face, and here he was applauding me.

Regardless, I had Alfred holding the head steady while Joseph pulled back the lips to improve visibility.

I had already made an incision along the right gumline.

Even then, the view wasn't great, so I dissected a bit further with the scalpel—though I kept second-guessing myself the entire time.

"I can't leave an open wound, so… this is the only way."

The easiest approach would have been to make an incision along the side of the nose, peel back the skin, expose the cheekbone, smash it open, and remove the trapped pus inside.

Wow.

Just imagining it felt satisfying.

But cutting open someone's face just for a sinus surgery was ridiculous.

Besides, with the poor-quality sutures available, the scarring would be severe.

Can someone please invent nylon already?

"Whoa. I can actually see the bone now."

Of course, this was just my train of thought, but to Joseph, Alfred, and Liston, it was a remarkable sight.

Taking bits of second-hand knowledge and anatomical expertise, I had haphazardly begun a procedure, and yet, it was coming together in a convincing way.

To them, I must have looked like a prodigy.

I'm sorry.

To the unknown pioneer of this surgery, I sincerely apologize.

"Now I'm going to break this with the chisel."

"How do you even break bone?"

"We already confirmed that it's a hollow section, didn't we?"

I couldn't just go in blindly, so I had done a test run on another skull beforehand.

That was when I first truly identified the exact boundaries of the sinus cavity.

If I had gone in purely based on my assumptions, I would have collapsed the orbital floor.

But now, I had a proper plan.

I placed the chisel against the bone and gently tapped it with the hammer.

It didn't need much force.

This was a bone that could crack from a solid punch.

Crack!

Sure enough, after just a few taps, the bone fractured.

Some fragments fell inward, which worried me a little, but what could I do?

What mattered was that I could now clearly see the sinus cavity with my own eyes.

"...Whoa."

"There's something inside."

Even the cadaver had pus filling its sinuses.

Not an enormous amount, but enough to confirm a case of sinusitis.

It was proof of just how much dirty air affected the human body.

"...Wait."

"Let's clean this out first."

Out of habit, I nearly asked for a suction device before catching myself.

Wow…

21st-century doctors were truly blessed.

They had suction.

And proper lighting.

Right now…

"How long do I have to keep holding this?"

"Until I say otherwise."

I turned to see Colin, who had been dragged over to hold the light.

After the Rust Belt incident, he had been somewhat withdrawn, so Liston had assigned him this task, thinking it would help him focus.

Not that Colin seemed to agree.

But I turned away from his miserable expression and back to the surgical field.

Using the crude gauze I had prepared, I wiped away the pus.

The space inside was larger than I had expected.

On the other hand, the passage connecting this sinus to the nasal cavity was completely blocked.

"No wonder irrigation alone isn't working."

And the worst part?

The maxillary sinus was actually the easiest to access.

Behind it, the ethmoid sinus was even trickier, and the sphenoid sinus at the very back? That was a nightmare.

The real kicker? The sphenoid sinus was often the main culprit behind sinus-related headaches.

"Alright, things are about to get tricky. Pull harder. Senior, stop holding the head and come help pull."

"Huh? Oh, uh… But shouldn't someone still hold the head?"

Accidents were highly likely from this point on.

The sphenoid sinus was basically dead center in the skull.

Even in the 21st century, where high-resolution endoscopic surgery was available, mistakes still happened.

I had a friend who was both a doctor and a lawyer, and he often reviewed cases like this.

"Yeah, keep an eye on it while pulling."

"Oh… Uh… I'm terrified."

And so, to make sure I wasn't making a fatal mistake, I had already removed the top of the skull, exposing the brain.

The nasal roof is essentially the brain's floor—so if I messed up, we'd see it immediately.

Which is why Alfred's fear was understandable.

"What are you scared of?! We'll soon start neurosurgery now that we have anesthesia!"

Liston scolded him.

But hearing that… now I was terrified.

"No… Please… Don't…"