Chapter 159: We Remove Brain Tumors Too [4] Now that he heard it, it really was true enough.
If it weren't important, why would it have been tucked inside the skull in the first place?
If there was one thing Dolseok had realized while learning anatomy from Kanghyeok, it was that the human body was even more intricate than he had imagined.
For one thing, anything enclosed in hard bone was extremely important.
For example, inside the ribs were the lungs for breathing and the heart for sending blood.
Inside the skull was the brain.
But how am I supposed to move all this out of the way…?
With the forceps in hand, Dolseok probed at the crisscrossing structures.
Originally, he had meant to just sweep them aside, but that proved impossible.
Because of Kanghyeok.
"Have you lost your mind? Since when do you grab the facial nerve with forceps?"
"Uh… I wasn't trying to grab it."
"Don't lie. I saw you opening the forceps."
"I really didn't mean it on purpose."
Dolseok protested with all the injustice in the world.
But Kanghyeok only shook his head.
"Put the forceps down first. Use this."
Kanghyeok held out an instrument whose tip curved like a hook, though it was not sharp and was instead flat.
A vessel retractor.
It was designed so that blood vessels or nerves could be retracted without being damaged.
Even as he handed it over, he felt a little strange.
This bag really does have every damned thing in it.
These days he used it so naturally that it barely felt unusual anymore.
But every now and then, just looking at the bag sent a chill down his spine.
A bag that renewed itself every day.
Why in the world had such an object ended up in Kanghyeok's hands of all people?
Well… for now, it has let me live well and eat well.
If that bag had not existed, or if it had not renewed itself, life would have been much harsher than it was now.
For now, I should just be grateful and use it.
No matter how much he wracked his brain over it, there was no answer.
He had even casually asked travelers and people coming and going whether they knew anyone from South Korea or the future, but no one knew anything.
There was not even a single book related to it.
So in the end, the main thought that remained was that it was enough if he just took proper care of himself.
"Should I retract with this?"
Dolseok took the unfamiliar instrument and asked with a blank expression.
Then what, did I hand it to you so you could push with it…?
Thinking back on his days at the university hospital, Kanghyeok felt like his blood pressure might burst from sheer frustration, but he held it in.
This was too important.
He even demonstrated it himself.
"Hook it with the blunt part like this and pull."
"Like this…?"
"No, no. If you pull too hard… damn it, nerves are delicate. You can sever them inside just by tugging. Exactly as much as I did. No more."
Kanghyeok was only retracting it just enough that it lay less than a centimeter away from the tumor.
His face was full of frustration and anger, but Dolseok could not see it.
Because Kanghyeok was wearing a mask.
If Dolseok had been looking straight at Kanghyeok's face right then, he probably would have wet himself.
Since he was not, he stayed fairly calm.
"Ah, okay. But if I only pull this much, will it really be enough? If you jab in from below with a pop, it feels like you might stab it."
"You idiot. Do you think I'm you? For an excellent surgeon, a gap like this… hell, a truck could drive through it."
"A truck?"
"Enough. Just keep retracting. I can't tell you every little thing, so use your judgment and retract what needs moving. Got it?"
"Yes. I'll try."
It was a deeply unconvincing answer, but there was nothing else to be done.
Among the people here, Dolseok was still the best option.
"All right. Yeon, you just keep retracting from below the way you were before."
"Yes, Young Master."
"Actually, it's fine if things tear a little down here, so just pull as hard as you can. Even to you, it really is hard to see, right?"
"Yes, well… honestly, I can barely see anything. Are you really all right, Young Master?"
At Yeoni's words, Kanghyeok burst out laughing.
Strange though it was, when Dolseok said the same thing, it irritated him, but when Yeoni said it, he felt rather good.
"I'm fine. I'm a genius."
"Ah, yes. Sure."
At times like this, it was a little disappointing.
I really am a genius, and she doesn't know it.
Truthfully, Kanghyeok was the kind of surgeon who would not be found wanting even if he were placed not in Joseon but in America, no, in New York.
And he was still young, the kind of rising talent who made people wonder just how far he might advance.
Is this why they say no matter how successful you are, you never get proper appreciation in your hometown?
Letting out a sigh at the thought that they had seen him too long to realize how precious he was, Kanghyeok moved his hand again.
"Dolseok, can you see it?"
"Yes. I'm retracting."
"Good. You need to do this well. If you fumble around, this surgery is over."
"Yes."
With that, Kanghyeok said no more to Dolseok.
He had decided to trust him, so even if he was unreliable, Kanghyeok would trust him.
In truth, he had no extra room to keep talking anyway.
Tok.
The operation had become an exercise in true microsurgery.
Damn… even the scissors barely go in.
The passage was so narrow that not even his hand, much less the instruments, could fit properly.
On top of that, the tumor was so large that there was almost no space between it and the other structures.
The difficulty had reached nearly the worst possible level.
It was only because the forceps were a little longer that he could manage at all. Otherwise, he might have been forced to cut blindly and crudely.
It's benign, so if I just reduce the size, things would still get a lot better.
In tumors this large, surgeries like that were sometimes done.
Though only if one of two conditions was met.
There's no radiation to finish the rest here… and Yoshitoshi is too young.
If the patient had been extremely old, it might have been worth considering.
Benign tumors grew slowly, after all.
If the patient died before the tumor finished growing, there was no real problem, was there?
Or one could remove the large bulk surgically, then use radiation on the part that remained.
These days, some radiation devices were so precise they could strike only the lesion itself.
Of course, they were so expensive your eyes would pop out of your head.
Here, though, even a mountain of gold wouldn't make it possible.
So what else could he do?
He had no choice but to remove it as cleanly as possible.
Tok.
Tok.
Cursing inwardly, Kanghyeok kept snipping away.
Then suddenly Dolseok shouted.
His voice sounded extremely urgent.
"Uh-oh!"
"What, what is it!"
Naturally, Kanghyeok also looked startled.
From below, he could not see what was happening above at all.
That's strange. I didn't feel the scissors catch on anything.
It had felt as though he had cut only exactly what he aimed to cut.
But it was always hard to completely rule out the possibility that the tip of the scissors had snagged something.
In fact, while operating, even truly tiny mistakes, things that did not even feel like mistakes, could change the prognosis.
"Ah, no. It's just that the tip of the scissors caught on the instrument I'm holding."
"Ah… that's fine. If anything, it means you're doing well."
"Really? That scared me."
"It's okay. Keep doing exactly what you're doing. You're doing well."
"Yes. Thank you, Young Master."
After calming his startled heart, Kanghyeok focused on the scissors again.
Still, somehow it's working.
The tumor was slowly, very slowly, being separated.
Normally, a tumor this large often ended up cutting into nerves or damaging them.
But thanks to Kanghyeok's almost supernatural skill, only the tumor itself was being cut away from the nerve sheath.
Though I did chew through the sheath a little.
Looking closely, there were places where the rough nerve itself was exposed instead of a smooth nerve sheath.
But even in those places, the nerve itself was completely uninjured.
At that level… there'll probably be some complications left, but it'll still be far better than now.
Nerves were the most delicate tissue in the body aside from the brain.
And the vestibular nerve that Kanghyeok was handling now was one of only twelve cranial nerves in the entire body.
It was practically brain tissue, and that made it even more delicate than ordinary nerves.
Delicate enough that even a small injury to the nerve sheath could have some effect.
It'd be nice to suture it, but that's impossible.
If he got cocky and meddled with it unnecessarily, he might drive a needle straight into the nerve.
Then all the enormous effort he was putting in now would become completely pointless.
At this point, he absolutely refused to take that sort of risk.
Tok.
At last, Kanghyeok's final snip came to a stop.
The tumor was still dangling near its site of origin, held only by the forceps in Kanghyeok's hand.
"Dolseok, let go of the nerves now."
"Ah, yes."
As soon as Dolseok released the instrument, the nerves sprang back into place with a twang.
The movement was so pronounced that even Kanghyeok, looking up from below, could see it clearly.
It's the first time I've ever seen the seventh and eighth cranial nerves flopping around like that.
They were usually structures people treated as if they were sacred relics, trembling in fear around them.
But right now they were being handled like laundry lines.
"Anyway, this part is out."
Carefully, Kanghyeok lifted the removed tumor out of the head.
Once it came out from the pressure inside, it loosened on its own.
Because of that, it looked even larger.
Its lumpy outer appearance was every bit as vicious as could be.
"Hah… so something like this was inside my lord's head…"
Sayaga stared at the tumor with a face that looked on the verge of fainting.
"Could you step aside?"
"Ah, yes, yes."
"I'll be showing it all in the drawing later anyway, so move over there. You've been blocking it with your head for a while now."
"Yes… my apologies."
Then Yeoju scolded him.
Normally she seemed to have a fairly easygoing personality, but when it came to drawing, she was sharp to an extreme.
Sharp enough that the word vicious suited her.
"Let's see…"
Once Sayaga stepped back, this time Kanghyeok blocked the view instead.
No matter how much nerve Yeoju had, she could not exactly speak harshly to Kanghyeok.
Thanks to that, Kanghyeok was able to inspect the tumor at leisure.
He even cut into it here and there with scissors as he examined it.
The cut surface is clean… and there's no sign of rampant blood vessel growth. The surest way would be to stain it and look at it under a microscope, but that's pure luxury right now.
So only a clinical estimate was possible.
It's old, and it only compressed the surrounding nerves rather than destroying them. It's benign.
There was still a chance it could be malignant.
Benign tumors could sometimes change after a long enough time.
If that's the case, then that's just his fate.
It was not as if Kanghyeok could start suspecting malignancy now and cut away all the surrounding tissue.
So at this point, he decided to stop the cutting.
Of course, there was still one thing he needed to check before closing the wound.
"Makbong."
"Ah, yes."
Even though his name had been called suddenly, Makbong showed no sign of panic.
Kanghyeok had not called him for no reason.
He really is diligent.
He had been checking the blood pressure steadily, checking the pulse steadily.
And while doing that, he had never once neglected the breathing.
At this point, he was practically a living anesthesia machine.
With a pleased look, Kanghyeok nodded and spoke.
"All right, now squeeze the artificial respiration bag hard."
"Yes…?"
"Squeeze it and raise the blood pressure."
"Uh… why?"
"So the intracranial pressure goes up."
At that, everyone in the room looked utterly baffled.
Was not intracranial pressure something that was supposed to be lowered, not raised?
Yeoni's eyes narrowed especially sharply, because Yoshitaka's case had come back to mind.
Surely he doesn't mean to ruin Yoshitoshi too?
But all their worries were unfounded.
Once Kanghyeok made up his mind about something, he was not the sort to reverse it.
"Why are you all so nervous? The intracranial pressure has to rise so I can see whether there's anywhere cerebrospinal fluid is leaking from. Hurry up and squeeze it."
"Ah… yes, Young Master."
Only then did Makbong begin squeezing the artificial respiration bag with all his strength.
He did it without giving the patient any time to exhale, so the pressure in the chest kept rising.
Eventually the blood pressure went up, and by chain reaction, the intracranial pressure began to rise as well.
One corner of the brain could be seen pulsing, but there was no leakage anywhere.
Only then did Kanghyeok tap Makbong's hand.
"That's enough. Let's finish it now. I want to wake him quickly and see if he's all right."
"Yes!"
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