A Way When There Was No Way

Kraft steadied himself. The patient and her family could panic, but he absolutely couldn't. There was no senior doctor here to bail him out.

"The situation is that we may need some special treatment," he replied to Gris as calmly as he could. "But I'll need a little time before I can give you a definite answer."

"Before that, I need to ask: has she eaten or drunk anything since last night?"

Gris thought for a moment, then answered, "No. She hasn't eaten anything since last night. She's only had a little water."

"Good. Don't give her anything to eat for now. If she's thirsty, she can wet her lips with a little water, but she mustn't drink it." After giving his instructions, Kraft turned and headed for the door. "I need a little time."

Kraft opened the door. The students were still outside, and Lucius stood at the entrance with a blanket in his arms.

"Thank you, Lucius. Give the blanket to Gris, then come to the classroom next door... Actually, everyone come over. And could someone go fetch the other lecturers?"

To some extent, the Priest had been completely right about one thing: "From here on, all we can do is leave it to God's will."

Kraft knew perfectly well that, under these circumstances, there were only two possibilities.

Either they did nothing and watched. As time passed, the trapped section of intestine wouldn't return to its proper position on its own. The blood vessels couldn't supply blood to the pinched-off loop, and her condition would gradually worsen.

After a day or two without a blood supply, the intestine would become completely necrotic, and the patient would die in agony. There were no autopsies or other means of confirming the cause of death in this era, so no one would know that such a simple anatomical structure had led to such a horrific end.

That terrible secret would remain hidden until, who knew how many years later, surgery truly rose on the foundation of modern science, and this incurable condition became a "minor problem."

Or Kraft would have to come up with a solution right now, in this godforsaken era when even amputations were performed without anesthesia, and devise a feasible surgical plan within the limited time they had.

He would have to put that plan, thought up in a hurry, into practice—perform a surgery that he had barely seen during his years of training—return the section of intestine to its proper place, and pray that there wouldn't be any postoperative infection or the like.

If an infection did break out, Kraft couldn't bear to imagine what would happen, given Lis's condition and the state of medicine here.

If anyone had suggested something like this during his pediatric surgery rotation, something that would send the department chief's ECG into a frenzy, the chief would have taken him down with a single slash before leaving.

One option meant certain death, the other probable death. It didn't seem like there was much of a choice—but if anyone was to choose, it had to be Lis and Gris. All Kraft could do now was find the best possible plan to offer them.

Kraft set up a slate board in the classroom next door. Once everyone had arrived, he sketched out the situation, hoping the others could offer some help that fit their circumstances.

"I'm sure you all paid close attention in my Human Anatomy class, so I won't waste time explaining exactly where this is.

"We need to make a small incision in the abdomen, put this section of telescoped intestine back in place, and then stitch the incision closed.

"Sounds simple? To be honest, there's no need to be too cautious about this at the Medical School. Quite a few of you have probably watched dissections, or even performed them yourselves—just not on the living.

"But this time is different, gentlemen. This time is completely different."

Kraft rapped his knuckles against the slate board. The gesture was obviously unnecessary; everyone was already focused on him, including the few lecturers who had just come in at the back.

"Are there any special requirements?" one of the lecturers asked. He sometimes dropped by Kraft's classes, listened quietly, then left just as quietly. Kraft remembered his curly hair.

"I need everything to be as clean as possible: linen, thread, iron needles, a knife, and people to help. I can't really explain my ideas about sterility to you, so let's put it this way: it would probably help to boil everything." This was the only method Kraft could think of. They had neither formaldehyde nor pressurized steam, and even high-concentration alcohol would depend on distillation.

The man sitting beside the curly-haired lecturer offered an idea of his own. "We have plenty of lime. I've never seen anything sprinkled with it go bad. At the very least, you could wash your hands with limewater."

He pointed at the small piece of chalk Kraft was holding to write on the board. It was a blind spot right under his nose: Kraft used it to write every day, yet hadn't thought of it. He'd been wondering whether they could find some distilled liquor to use as a disinfectant, but there was no such thing here.

Sterility was impossible. They would just have to keep everything as clean as they could. Kraft felt a pang of worry for the patient's postoperative recovery, then moved on to the next topic.

"Forgive my ignorance on this subject, but I'd like to ask whether there's any way to make a patient temporarily lose sensation, so that cutting into flesh and skin wouldn't affect them."

"Couldn't we just tie the patient down and get it over with as quickly as possible?" Lucius asked. That was how all amputations were handled at present—if they could even be called surgeries.

"No. We can't solve this with a single cut like an amputation," Kraft said, rejecting the suggestion. "At least, I can't."

Abdominal surgery often wasn't that simple. The actual state of the abdominal cavity was very different from the clear, colorful diagrams in anatomy books. The boundaries between structures weren't nearly as obvious as one might imagine. Membranes around the organs, ligaments, and adhesions caused by all kinds of things could turn the view into a complete mess.

Once you made a small incision in the abdominal wall, figuring out where you were in the surgical field, without any clear landmarks, obviously wasn't as simple as performing a crude amputation.

The patient was only a three-year-old girl, not Guan Yu or Rambo. Cutting open her abdomen, searching around and operating without anesthesia, then stitching her back up—no one could imagine what might happen to her during that time.

"There are certainly things that can make someone lose consciousness, but..." A student flipped through a book, then trailed off. He felt that none of the drugs described in it would meet their needs.

Some would put a person to sleep and never wake them again. The rest had only mild numbing effects, unsuitable for an operation that would take time.

That was the fundamental reason complex surgery didn't exist in this era. Infection and blood loss were secondary concerns. Without anesthesia, a patient couldn't endure an operation like this.

"Lecturer Kraft, I have to say that this is a plan that works only on paper, based on Human Anatomy."

The speaker was the Academy's pharmacology lecturer, Romolo. Kraft remembered his name because they'd shared a table at lunch one day and discussed medicine, but they hadn't seen eye to eye on their views.

Kraft was rather skeptical of Humorism, while Romolo was a staunch traditional believer, fond of using its framework to explain the relationship between the four elements and the effects of drugs.

"Unless the White Fluid or Red Fluid dries up, there's no way to make a living person completely insensitive to pain." Aside from Professor Calman, Romolo knew more about medicine than anyone else at the Academy. He was the only one present qualified to make such a judgment.

"But losing a large amount of Red Fluid and White Fluid would quickly lead to death, so I don't think this is realistic. It's a plan that only considers the anatomy. But there's no other choice for now. We can only tie the patient down and try."

He said they could try, but his tone held not a trace of hope. Shaking his head, he sat back down and ended his speech.

"If even Lecturer Romolo says so, then I suppose all we can do is hope we're fast enough." Kraft set down the piece of chalk and took one last look at his sketch. "Everyone, go to class. We've already delayed things long enough today."

The students got up to leave. The curly-haired lecturer came down from the back row and took a small box from inside his black robe, offering it to Kraft. "Allow me to introduce myself properly. I'm Liston. Please accept my admiration."

"Why do you say that?" Kraft didn't take the box. From how finely made it was, whatever it contained couldn't be cheap.

Liston smiled. "I suppose I admire a pioneer. I secretly sat in on a few of your classes. Your understanding of anatomy impressed me, but it's not easy to apply what you've learned from the dead to the living."

"I don't believe no one's ever tried before."

"But they had no clear goal. Before cutting open the abdomen, they had no idea what condition they'd be dealing with." He gazed at Kraft with shining eyes, as if looking at a treasure. "You're different. Even before seeing it, you already know what you need to do."

"So I thought I ought to be part of this historic first. Consider this knife my introduction gift. I designed and commissioned it myself for dissections, and it's never even been used."

Liston held out the box, waiting for Kraft's response.

"Of course. I can't do this alone." Kraft took the box and smiled politely. An assistant with a good grasp of anatomy was exactly what he needed.

The smile vanished almost as soon as it appeared. His worries about the surgery ahead made it impossible to keep it up.

Liston noticed Kraft's mood and took his leave, giving him some quiet space to think. "I'll go to the Observation Classroom and clean the stone table. That's the only place suitable for this."

"Thanks. Remember to use lime. We'll come over once we've gathered the other things." Kraft held the box absentmindedly, not even noticing that Lucius hadn't left the front row.

Lucius sat quietly, looking as though he were organizing his notes. He waited until Liston had left and only Kraft and he remained in the classroom before standing and walking over to hand Kraft the notes he'd taken.

"Thank you so much, Lucius. I don't know what to say."

Kraft glanced at the notes. He didn't need them, but Lucius's thoughtfulness still moved him. It really hadn't been a waste to worry about the kid all these days.

Lucius would probably have to help Kraft again for the entire day, going with him and Liston to prepare for this surgery, which was more likely to end in disaster than success.

Lucius didn't respond. He fell strangely silent for a moment, glanced at the classroom door, and, after confirming that only the two of them were here, blurted out a sentence with no preamble.

"Actually, there is a way."