Chapter 123: Officially a Doctor (2)

"Ah, I have a leg to amputate today."

"I need to go check on a delivery too."

"Right, right."

Dr. Liston and Blundell returned to their duties.

Those were procedures that would need serious refinement someday.

A leg to amputate…

In modern medicine, we did amputations in orthopedics.

It wasn't as if modern medicine had completely eliminated amputations—sometimes they were unavoidable.

Diabetic foot, traumatic limb injuries from accidents… There were cases where it was the only option.

"If the bone is completely shattered, there's no choice," a friend had once explained.

But still…

Wait.

The way they did it here was just wrong.

Well… Dr. Liston already wants to advance surgical techniques, so I should step in and help.

I'd been hesitant at first.

Part of me believed Liston, being a genius, would figure it out on his own.

But upon reflection, pioneering a new surgical technique was like founding a martial arts school—rare and monumental.

If it were easy, everyone would've done it.

Neither I nor my past-life mentor had managed it, so leaving things as they were wasn't an option.

"Just find what you need… Can I speak casually to you now?"

For now, reviewing the late professor's research was the priority.

"Huh? We're friends. Just call me 'Professor' in front of others."

"Oh… Right… Tae-pyeong…"

Reviewing the material was my job, but fetching it? That was grunt work.

And grunt work was for subordinates.

In 21st-century Korea, dumping menial tasks on juniors without compensation would've caused an uproar, but here?

Students obeyed professors without question—even if it meant pulling teeth.

"Should I look for things like this?"

"Yeah, exactly."

"Got it."

So asking them to fetch documents was nothing.

If anything, they seemed enthusiastic.

Their friend was now a professor—wasn't that fun?

Of course, if they'd been petty, jealousy might've taken over.

But Joseph had respected me for years, and Alfred owed me his life.

"Would this work too?"

"Uh, yeah. But really, speak casually."

"But you're a professor now… Especially since I've been learning from you lately."

"Well… If that's more comfortable for you."

"Yes."

Colin, once the most hesitant, had long since become a loyal subordinate.

Thanks to them, I quickly had the materials in hand.

I started with hemorrhoids—my unofficial specialty.

I hadn't specialized in colorectal surgery, but…

Hadn't I studied it exhaustively during residency?

"This is your livelihood once you're out there—your bread and butter"

Calling a patient's unhealthy rectum a "breadwinner" was crude, but…

Not wrong.

90% of private-practice surgeons treated hemorrhoids.

Let's see…

Leaning on the desk, I began reviewing the late professor's notes.

The sketches were alarmingly detailed.

Some were so vivid they turned my stomach.

Not necessarily a bad thing—such thoroughness suggested genuine dedication.

The problem? In this era, a doctor's best efforts didn't guarantee the best outcomes.

Napoleon suffered from hemorrhoids too…

His era was slightly earlier, but had things really changed in just 20–30 years?

If even he struggled, that said it all.

Good grief, what is this?

Amid the hand-drawn illustrations was a colored print—likely an engraving, given the lack of brushstrokes.

The patient's posture alone was shocking.

Bent forward, bracing against a wall, lower half exposed.

You'd think this position would provide clear access, but no—otherwise, everyone would've used it.

Wait… Are they cauterizing the hemorrhoid?

Judging solely by posture would be hasty, but…

The surgeon—no, butcher—held a branding iron.

His target?

The illustration wasn't clear, but it had to be the hemorrhoid.

It had to be.

Burning anything else would be horrifying.

But a half-hearted cauterization would just make it bleed worse… Oh, is that a bellows?

An assistant pumped air to heat the iron.

Meaning this patient…

Had their anus seared in a position that didn't even provide proper visibility.

Wow…

Did this professor also—Ah, there's a note.

"This method often burns surrounding tissue and can seal the anus shut, causing fatal complications. We must instead follow the technique of Sir Felix, who operated on Louis XIV."

Thankfully, he hadn't used this method.

Relieved, I flipped further and found cruder sketches—likely the professor's own.

Unfortunately, the patient's posture remained the same.

Well… Proper patient positioning only became standard after anesthesia.

In modern medicine, positioning patients for the surgeon's convenience was basic practice.

Some might call it selfish, but…

A comfortable surgeon meant better outcomes.

Especially as surgeries grew more precise—and thus longer—this became unavoidable.

But this required unconscious, relaxed patients.

In other words, anesthesia had to come first.

Anyway… Oh—tying off the hemorrhoid? To clot the blood?

Surely there wasn't some mystical reason.

Reading on, that was indeed the case.

The professor waited over an hour for the blood to clot before snipping it.

Hmm… Not bad, but…

It was unclear if he'd properly identified the hemorrhoid.

Worse, he didn't distinguish between internal and external hemorrhoids—or account for the four stages of severity.

Well… He just didn't know.

If he had, he wouldn't have done it this way.

This must've been agony. No anesthesia either.

Wow…

Hemorrhoids were painful.

The anus was densely innervated—evolution's way of protecting a critical area.

And he'd operated without anesthesia?

"Ugh…"

A sigh escaped me.

Before it fully faded, I closed my eyes in silent tribute.

Sure, it was better than branding irons, but…

Patients in this era weren't exactly fortunate.

And one critical step was missing: sterilization.

Common sense says you'd clean the area first, no?

What kind of madman operated bare-handed without washing?

I mean—

In an era without proper toilet paper, how clean could it have been?

"Just wash with water?"

Ever tried cleaning yourself with water? You'd understand why Indians did it.

In fact, I'd bet hemorrhoid rates in India were low.

Anal hygiene did play a role.

Anyway, we'll start with the basics. Good grief… Patients just chose surgery or not, huh?

The deeper I read, the more flaws emerged—fundamental ones.

But given the era, it was inevitable.

Still, this was excessive.

Was it because of the… location?

For such a common condition, standards were shockingly lax.

Even in the 21st century, hemorrhoid surgery carried a stigma.

People hid it.

But still… No criteria for which patients needed surgery?

No defined indications.

For a surgeon, few things were more critical.

Even my past-life mentor—a terrible person but brilliant doctor—had drilled this into us:

"'How to do' comes later. First, 'When to do' and 'What to do.'"

In other words, technique was secondary. Timing and decision-making were paramount.

He was right.

Hemorrhoids had plenty of non-surgical treatments.

Operating on Stage 1 or 2 was borderline malpractice—especially in an era with so many limitations.

Ironic for a surgeon to say, but what choice was there?

Patient care came first.

We'll start with sitz baths… Then revise the surgical approach. The director said he'd postpone scheduled patients, so… Good.

With that settled, I turned my attention to…

My assistants—no, students and friends—still diligently gathering materials.

Given the depth of knowledge, hemorrhoid resources were quickly exhausted. Now, they brought materials on prostatic hyperplasia.

I was genuinely surprised.

How had they pinpointed an enlarged prostate as the cause of urinary issues in aging men?

Well… Dissection probably gave them an intuitive grasp.

The prostate did enlarge with age.

If they'd seen that during autopsies, the leap wasn't far.

But how had they treated it?

Modern medicine had drugs and refined surgeries, but back then?

With slight trepidation, I examined the instrument Joseph had placed on the desk.

"Oh… Is this… an endoscope? No, wait."

It lacked a lens for visualization.

The shape suggested insertion, but the tip resembled a blade.

A bad feeling settled in.

"Do they just… stab it through?"

"Seems like it."

"If it's blocked, you… unblock it."

"Ah…"

Good lord.

The mere thought was terrifying.

No—excruciating.