A Surgeon Who Uses Martial Arts [EN]: Chapter 357

The Martial Surgeon – Episode 357

Chapter 69: First Surgery (2)

Maxwell, following Jun-hoo’s gesture, began the ‘shaving.’

Shaving, or ‘sakdu’ [a traditional term for hair removal before surgery], was the process of cutting the patient’s hair with a razor to prevent contamination of the incision site before and after the operation.

Even though he should have performed countless shaves after earning his residency.

Maxwell’s touch was clumsy and awkward.

Jun-hoo couldn’t tell if it was simply because his hands were large, making him appear clumsy, or if something was lacking in his technique.

He felt tempted to offer advice, but Jun-hoo held back.

Hector was watching Maxwell with a satisfied expression.

The shaving took a full seven minutes.

Jun-hoo could have finished the same task in just two.

As the shaving concluded, Jamie’s bald head gleamed under the operating lights.

Swoosh. Swoosh.

Hector, now acting as the second assistant, wiped the front of Jamie’s head with a disinfectant swab.

He covered it with a sterile surgical drape.

“Number 10 blade.”

Jun-hoo inserted the blade Hector handed him into the handle.

Click!

A crisp sound echoed as the blade locked into place.

“How do you plan to proceed with the craniotomy?”

Hector asked.

“I plan to perform a frontotemporal craniotomy.”

“A classic approach. But there might be cosmetic issues due to skin depression after the surgery, wouldn’t there?”

Jun-hoo paused, looking at Hector.

It didn’t seem like Hector was trying to undermine him because he was attempting a difficult surgery.

Hector seemed to be testing him, probing the depth of Jun-hoo’s medical knowledge.

“Maxwell, how would you open the patient’s head?”

“I would perform a temporal craniotomy. Because the incision range is narrow, it can also address the patient’s aesthetic concerns.”

“Then let me ask Jun-hoo again. Is performing a frontotemporal craniotomy really the right choice?”

“Yes. I haven’t changed my mind.”

“What’s the reason?”

“After the surgery, a metal plate can be placed in the temporal area to prevent depression. It’s a procedure that takes less than 20 minutes.”

Jun-hoo continued calmly.

“If we perform a temporal craniotomy as Maxwell suggested, access to the surgical site becomes more difficult. Aesthetics are important, of course, but I believe removing the tumor properly is more crucial.”

Hearing Jun-hoo’s firm answer, Hector nodded.

“Looks like you’ve studied in advance? You don’t fall for the traps.”

Maxwell’s face flushed as he realized he’d been caught out.

“I was fortunate enough to observe a similar case in Korea.”

“That’s not luck, it’s learning and skill. From now on, I won’t interfere unless it’s a significant issue. You can focus on the surgery.”

“Yes, Professor.”

To regain his focus, Jun-hoo took a deep breath.

Then, he made a 10-centimeter-long incision horizontally on Jamie’s head.

The sensation was distinctly different from incising an adult’s head.

A soft, yielding feeling transmitted from the tip of the scalpel.

Jun-hoo instinctively reduced the pressure from his wrist.

Soon, a curved incision marked Jamie’s head, as smooth as if drawn in a single stroke.

Everyone seemed surprised, though they remained silent.

The curve of the incision was as precise as if drawn with a protractor.

But for Jun-hoo, a former swordsman, this level of precision was routine.

“Maxwell, what are you doing? Wipe the incision and retract.”

“Huh? Oh. Okay.”

Maxwell quickly snapped to attention and wiped the blood flowing from the incision with gauze.

He held retractors in both hands, widening the wound.

Jun-hoo continued the incision relentlessly.

After incising the scalp and subcutaneous tissue, the hard skull came into view.

By then, Maxwell’s hands were free again.

He had installed a fixed retractor on the incision.

“Diamond drill.”

With the drill Hector handed him, Jun-hoo began the craniotomy.

Wee-ing.

The drill bit into the skull, creating a hole, and bone fragments, ground into a slush-like consistency, leaked from the opening.

As the drill whirred, the operating room took on the atmosphere of a workshop.

‘Better than expected. Professor Austin has a good eye.’

Hector, watching Jun-hoo, admired him inwardly.

He had initially thought Austin was ‘overestimating’ Jun-hoo.

He also thought Jun-hoo was ‘overestimating’ himself.

Now, he was even starting to suspect that Hector had been ‘underestimating’ Jun-hoo.

Although it was only the beginning of the surgery and the tumor resection hadn’t even started.

If Jun-hoo maintained this level of stability, it seemed the surgery would be a success.

Jun-hoo possessed extensive medical knowledge.

He had remarkable courage.

And above all, the dexterity to support both was exceptional.

As Hector carefully observed Jun-hoo’s hands throughout the surgery, he noticed they didn’t tremble.

It was like watching a robotic arm.

Some might argue that steady hands are not a big deal, as if hand tremors are uncommon.

But that’s absolutely not true!

The human hand is naturally prone to trembling.

Especially when holding something for a long time.

The hand will naturally tremble.

If you exert too much force to stop the trembling, that can also cause problems.

You could get cramps in your hand, or injure the surgical site by applying more force than necessary.

In that sense, Jun-hoo’s unwavering hand was truly special.

It would prove invaluable when performing highly difficult cerebral vascular sutures or anastomoses [surgical connections between blood vessels] in the future.

Hector, who had been focused on Jun-hoo, turned his attention to Maxwell.

Compared to Jun-hoo, his movements were less refined, but Maxwell was a meticulous and detail-oriented individual, despite his large size.

When bleeding occurred, he immediately suctioned it away.

He applied hemostatic gauze [gauze treated to promote blood clotting].

He periodically sprayed saline solution to prevent the intracranial tissue from drying out.

The current boost-up program cohort seemed promising.

Another 30 minutes passed.

After the craniotomy was completed, the dura mater [the outermost of the three layers of membrane protecting the brain and spinal cord], a hazy membrane, became visible as the skull was lifted.

‘Is the real game starting now?’

The corner of Hector’s mouth curled up.

A smooth adventure without crises is no fun.

Soon, Jun-hoo would encounter a significant obstacle.

Through that obstacle, the true extent of Jun-hoo’s capabilities as the captain of this surgery would be revealed.

Even in that crisis, would Jun-hoo insist on navigating his own course?

Or would he recognize his limitations and hand the helm over to Hector?

The thought alone was exciting.

* * *

“Keep up the good work in the future.”

Jun-hoo straightened his back and praised Maxwell.

Maxwell’s shaving skills were questionable, but his assistant skills were outstanding.

It seemed he hadn’t been accepted into the boost-up program solely based on playing ttakji [a Korean game similar to pogs or milk caps].

“You’re pretty good too? It only took 30 minutes to access the dura mater. It usually takes at least an hour.”

“Someone was a good assistant.”

Maxwell chuckled at Jun-hoo’s joke.

They had bickered briefly before the surgery, but after working together in the operating room, they had become comrades.

The operating room was a battlefield, and brotherly love had blossomed.

“Let’s continue the surgery.”

Jun-hoo focused his eyes on the surgical microscope hanging from the ceiling.

The opaque dura mater, resembling the fat layer on milk, enveloped the brain.

First, all the meninges [the three membranes that surround the brain and spinal cord] had to be incised to reach the target brain.

If he had performed well so far, the process so far was merely a warm-up.

The section requiring his utmost concentration was about to begin.

“Electrocautery.”

Jun-hoo began incising the dura mater with the electrocautery device Hector handed him.

But from the start, the signs were ominous.

Severe bleeding occurred when making a 3-centimeter-long incision with the scalpel.

A pool of blood formed around the dura mater.

“What? Did you hit something?”

Maxwell frowned and used a suction device to remove the blood.

“No. I did it the way I always do.”

Jun-hoo blinked, equally puzzled.

Bleeding is unavoidable when making an incision in any area, as blood vessels run throughout the body.

Even so, the amount of bleeding was excessive.

The blood vessels distributed in the dura mater are mostly capillaries…

Why is there such massive bleeding…?

“Then, are you saying you usually see this much blood from a patient?”

“You saw me incising it. I didn’t specifically touch any blood vessels.”

“But if it’s not a mistake, how can there be so much bleeding?”

Jun-hoo couldn’t refute Maxwell’s point.

Jun-hoo didn’t know the reason either.

While they argued, the bleeding continued.

Red blood slowly pooled above the dura mater.

Jun-hoo’s brow furrowed, and wrinkles appeared on his forehead.

‘This is a disaster?’

Bleeding had occurred, but he couldn’t determine the cause.

It was incredibly frustrating.

“Bovie [another term for electrocautery device].”

Jun-hoo began with first aid, cauterizing the bleeding blood vessels with the electrocautery device.

Sizzle. Sizzle.

White smoke rose as the vascular tissue burned. A sweet smell, like dalgona [a Korean sugar candy], wafted through the air.

Only then did the bleeding barely subside.

“Can you measure the intracranial pressure?”

“15mmHg. It’s touch and go. Fortunately, the vitals and ECG are still fine.”

The normal range of intracranial pressure is 5mmHg-15mmHg.

The intracranial pressure was barely within the normal range.

“Professor, why did the bleeding occur?”

Jun-hoo asked Hector, dumbfounded. Maxwell also looked at Hector, curious about the reason.

“Do surgeons these days seek advice from the second assistant?”

“That’s not the case… It’s just that it doesn’t make sense from a common-sense perspective.”

“I can tell you if you’re curious.”

“Then please tell me.”

“But there’s a condition.”

Hector’s eyes twinkled mischievously.

Hector paused, as if teasing, then slowly continued.

“Instead of telling you the method, I will perform the remaining surgery.”

Jun-hoo bit his lip at Hector’s suggestion.

Was this his intention from the beginning?

Did he never intend to entrust the surgery to him?

“If you just tell me the method, I can somehow solve it.”

Jun-hoo retorted, refusing to back down.

He was struggling because he lacked experience and knowledge.

If he received a little guidance, Jun-hoo believed he could complete the surgery himself.

“Why are you so obsessed with this surgery? You can perform other surgeries, right?”

“…”

“I think you’ve already demonstrated enough of your skills and potential.”

“If you start giving up because it’s hard, it becomes a habit. And how can patients, guardians, and staff trust a surgeon with such a habit?”

“Hey, Jun-hoo. That’s a terrible contradiction.”

“What do you mean?”

“You said you don’t want to give up because it’s hard, right? Then shouldn’t you find the answer yourself instead of asking me for the answer?”

Hector retorted coldly.

“I think you can sometimes get help if it’s a problem you can’t solve alone. Colleagues exist for a reason.”

“Then what if I wasn’t here? Who would you have gotten help from?”

Hector hit a nerve.

He was right.

If Hector wasn’t here, Jun-hoo would have to face a problem with no apparent solution on his own.

Was that the reason?

Jun-hoo realized anew that he was helpless in the pediatric field.

“Professor, it’s my first surgery and a difficult one, can’t you give me a hint?”

Maxwell, who had been silent, spoke for the first time in a while.

He quickly closed his mouth after receiving Hector’s fierce gaze.

“Okay, there are only two options. Either hand over the surgery to me, or find a way to survive on your own. Decide quickly, because there’s no time.”

Hector’s ultimatum hung in the air.