Chapter 1711 - Surgery
At that moment, the young man's eyes fluttered open, weak and unfocused. Seeing someone taking his pulse, he summoned what little strength remained to speak: "Sir, please... don't trouble yourself. This intestinal abscess is an old ailment of mine. I won't survive it this time. I only beg that my benefactor grant me a proper burial rather than leaving my body exposed to the elements. For such kindness, I shall repay you in my next life as a beast of burden, tying grass and bearing rings of eternal gratitude..."
Liu San knew that without surgery, there was nothing to do but prepare for the worst. He was searching for words of comfort when a crewman arrived to report that they were approaching the Guangzhou World dock.
"Guangzhou World has a clinic," Meng Xian said. "They can perform minor surgeries there."
Liu San remembered. Guangzhou World did indeed have a small clinic—not open to the public, but established to safeguard the health of transmigrators stationed in Guangzhou and senior naturalized cadres. After all, Ming-era medical standards hardly inspired confidence among those who had crossed over from the future. More recently, the Ministry of Health had begun planning to use it as the foundation for a Provincial-Hong Kong General Hospital, monetizing medical services to generate local revenue under the official justification of "meeting transmigrators' health needs after the northern offensive." Considerable equipment and materiel had been shipped to Guangzhou World as a result, leaving the clinic quite well-equipped.
With such resources at hand, saving this man's life should be possible. Liu San hurriedly ordered the sailors to fetch a stretcher, loaded the young man onto it, and rushed to Guangzhou World.
Zhang Yikun, the facility's manager, came to the gate personally to receive them. Liu San had no time for pleasantries. After a brief greeting, he asked directly whether Guangzhou World had the conditions for surgery. Zhang Yikun nodded. "There's a small operating room. Who requires surgery?"
Liu San quickly explained the situation. Zhang Yikun's expression grew troubled. "Saving lives is certainly the right thing to do, but this person you've rescued is a complete unknown, and you want to use controlled materials. This, this..."
"His life hangs by a thread," Liu San said urgently. "We have the ability to save him—I cannot simply stand by and watch him die."
Like most transmigrators posted abroad, Zhang Yikun had long grown accustomed to the casual cruelty of medieval society. The life or death of a non-naturalized native meant little to him. Despite Liu San's plea, he still hesitated.
"How about this," Liu San proposed. "I guarantee I won't use a single piece of Class-1 controlled material. Only instruments, equipment, and a small amount of consumables—all of which I'll pay for at cost. Will that work?"
Put that way, Zhang Yikun could hardly refuse. Without further discussion, he led Liu San to the clinic. Liu San surveyed the instruments and medicines in the cabinet—they would be adequate for the procedure. The operating room contained a single surgical table but no shadowless lamp; however, the available lighting equipment would suffice.
Though Liu San specialized in pharmacology, he was a proper medical-school graduate and could handle routine surgical procedures.
At this point, all he could do was try everything. He enlisted the clinic's medic and nurse as assistants. First, they washed and sterilized their hands and changed into surgical garments. His two apprentices also scrubbed in and changed, prepared to observe.
The clinic had no modern anesthetics—even if any had remained, they would be long expired. Instead, he used nitrous oxide for anesthesia, one of the easiest anesthetic gases to produce in the Yuan Council's inorganic chemical industry, synthesized by heating ammonium nitrate powder to decomposition. It was typically administered mixed with oxygen, but since producing pure oxygen remained difficult, they used a mixture of nitrous oxide and air.
Once the anesthesia took effect, Liu San picked up the scalpel and made the incision. He had neither EKG nor blood-pressure monitoring available. Moreover, because the abdominal situation remained unclear, he forgone the standard McBurney's incision in the right lower abdomen in favor of a large opening along the right rectus muscle. Since the patient was for all intents a "John Doe," a failed rescue would bring no family to storm the hospital demanding compensation. Thus Transmigrator Liu operated with comparative boldness, while the patient lay unresponsive beneath the anesthesia.
He operated while explaining to his apprentices: opening the muscles and peritoneum layer by layer, suctioning out the pus, lifting the cecum to find the appendix—already severely inflamed and gangrenous. He first clamped it with hemostatic forceps, ligated with No. 4 thread, and made a purse-string suture on the cecum wall about half an inch from the appendix base before cutting. The stump was swabbed with povidone-iodine, then inverted and buried within the purse-string suture; as the suture was tightened, the mosquito forceps were withdrawn, and finally the suture was tied off so the appendix stump was completely buried. A few reinforcing interrupted stitches of No. 1 thread secured the seromuscular layer. After irrigating and suctioning all pus and exudate from the abdominal cavity, he replaced the cecum, inserted a drainage tube through an opening below the incision, used absorbable thread for continuous closure to seal the cavity, irrigated the wound with saline to prevent infection, applied No. 4 non-absorbable thread for interrupted sutures on the external oblique aponeurosis, and finished with No. 1 non-absorbable thread for interrupted sutures on subcutaneous tissue and skin.
Though a minor procedure by modern standards, Liu San was drenched in sweat by the end. His two apprentices, who until now had only studied traditional Chinese medicine under him, were clearly awed—they gazed at their master with admiration and wonder.
Liu San had little confidence in the outcome. The post-operative hurdle was infection; without antibiotics, recovery depended entirely on the patient's immune system, and the mortality rate was alarmingly high. Having promised not to use controlled materials, he couldn't administer the antibiotics brought from the original timeline. He could only use those produced by the Health Department's pharmaceutical plant—of limited purity and considerable side effects. Every year, patients treated by the Health Department died from adverse drug reactions.
"Go ahead and give it to him." He wrote a prescription and handed it to the nurse. "Is everything in stock?"
"All these drugs are available," the nurse said respectfully. "Chief, your surgery was truly brilliant."
"It was passable," Liu San replied. "I'm somewhat out of practice."
Zhang Yikun came over to chat and complimented him on his brilliant technique and boundless virtue. The weary Transmigrator Liu accepted the praise with quiet satisfaction.
Over the following days, Liu San departed to attend to official duties elsewhere. He returned only once, a few days later, to remove the drainage tube, take out the stitches, and handle other follow-up care. He instructed Liu De, who was staying behind, to administer Tongmai Sini Decoction daily, followed by restorative treatments with Huangqi Jianzhong Decoction and Guipi Yangxin Decoction. Zhang Yikun also assigned an attendant to look after the patient.
The young man had possessed a strong constitution to begin with. With proper rest and adequate nutrition, he gradually recovered over the following days. By now he had grown quite familiar with Liu San's apprentices. Upon learning that the man who had saved his life was one of the Australian Song transmigrators whose renown shook the entire south, he pressed his hands to his forehead again and again, overwhelmed with gratitude.
On the third day of the third month—the Shangsi Festival—Liu De informed him that Transmigrator Liu had returned. The young man immediately asked to be taken to pay his respects. Upon entering Liu San's temporary office, he found the cheerful physician chatting and laughing with Zhang Yikun. The young man immediately prostrated himself and kowtowed, thanking him for saving his life.
Liu San had his apprentices help him to his feet and inquired about his condition and background. The young man spoke in Mandarin accented with Shaanxi tones and answered respectfully: "I am honored that my benefactor inquires. My health has greatly improved. My surname is Yu, given name Qing, courtesy name Zecheng. I hail from Suide in Shaanxi Province. Because my hometown has suffered years of disaster, I had no choice but to leave. Along the road of exile, both my parents perished..."
He paused, collecting himself. "I drifted through hardship across Hunan and Hubei, where I heard that people in Guangzhou were recruiting refugees to farm in Qiongzhou—providing three meals a day of white rice, all you could eat, with no worries about food or clothing. I received this glad news and came specifically seeking a way to live. That day, as my boat was about to reach Guangzhou, who would have thought we'd encounter a White Dragon patrolling the river! Toward dusk, the sky and earth suddenly changed color. The wind rose, waves surged, and a white dragon whose head touched the clouds and whose tail hung down to the middle of the river came twisting toward us. In an instant the boat capsized. Every passenger drowned. After I fell into the water, I was fortunate enough to find a floating plank and thus escaped with my life. But then my old intestinal abscess flared up again; amid the storm and rain, suffering from both cold and pain, I was certain I would die..."
His voice wavered. "I never imagined that Heaven would be so merciful as to send a transmigrator benefactor to rescue me from the road to the Yellow Springs! Otherwise I would long since be food for the fishes! And my benefactor further healed my grave illness with divine skill. Such kindness, high as heaven and deep as the earth—I can never repay even a fraction in my lifetime..."
As he spoke, the memories stirred up old sorrows, and he wept uncontrollably.
Liu San comforted him with kind words. Yu Qing gradually stopped weeping and dared not cry further. Zhang Yikun, however, asked with keen interest: "That White Dragon you encountered—that must have been a tornado. They're rarely seen in southern China but common in the Americas. There's nothing supernatural about it. Tell us in detail what it was like."
Yu Qing clearly had no wish to revisit that terrifying scene, but he dared not refuse to answer. "At the time I was panic-stricken, my soul fleeing my body. I only vaguely saw the White Dragon stretching from sky to river; then the boat capsized. What happened afterward, I cannot remember."
Zhang Yikun smacked his lips with apparent regret. Liu San offered comfort: "You've only just recovered. Go and rest."
But Yu Qing spoke again: "My benefactor's kindness in saving my life is like a second birth—you are to me as a reborn parent. I have nothing to repay you with. I possess nothing of value except a volume of medical writings passed down in my family, the livelihood of my ancestors for generations. I wish to present it to my benefactor. I beg you to accept it."
As he spoke, he pulled an oilcloth bundle from his breast, unwrapped it to reveal a thread-bound book, and presented it with both hands.
Liu San took it. The book had a wax-treated cover bearing the four characters Qingniu Yifang—Medical Prescriptions of the Blue Ox—written upon it. It appeared to have been water-damaged; the characters were somewhat blurred. Inside, the pages were hard yellow paper, all handwritten: a collection of medical formulas. He closed the book and said solemnly: "A gentleman does not covet another's treasures. Since this is your family heirloom, you should keep it yourself. I am a physician. When I encounter peril, how could I not lend a hand? Saving lives is my calling—I seek no repayment. As for my medical skill, even if the highest officials and nobles of this Ming dynasty came begging, I might not be willing to treat them. That you and I should meet is simply fate. Healing your illness brings me satisfaction enough."
Half of Liu San's words were sincere truth; the other half were the elevated notes of virtue, meant to demonstrate an Australian Song transmigrator's magnanimity.
Yu Qing pleaded again: "I know my benefactor's medical art surpasses the divine—even Hua Tuo reborn or the Medicine King revived could not equal it. But I beg my benefactor to consider my heartfelt gratitude and accept this book. If it might fill even one gap in your knowledge, it would repay a small portion of my debt."
(End of Chapter)