It began half as expected, half out of nowhere.
The medical officers were gathered into a conference room.
Maomao
had been called in the role of a scribe, but from the assembled faces, she could imagine what they wanted to discuss.
Liu
the physician,
Luomen,
— Senior Nagai and Senior Mijikai. Chūdōhai was not among them. In his place was
Tenyū,
with his usual darting eyes, and several other medical officers skilled in surgery had gathered as well.
(This must be about the Emperor.)
Maomao, too, would have been in the same position as Chūdōhai—liable to be shut out. The reason she had been called as a scribe was perhaps
at Jinshi's
arrangement, or perhaps to keep an eye on Luomen. Still, she found it curious that Tenyū was present; though, when it came to sheer technical skill, even Maomao had to admit he was in a class of his own.
Maomao sat beside Luomen and began noting down the contents of their discussion in her notebook. The topics centered on Luomen for pharmaceutical matters and on Liu the physician for surgical matters.
There were also groups
that had been researching anesthesia,
and groups that had been studying post-operative medications.
(Well, she had
at least given her father the materials she received from Suirei,
but—)
She wasn't sure if they would prove useful, but perhaps they could at least serve as a reference.
Carefully spread before Liu the physician's desk were old, tattered sheets of paper. The restored
Hua Tuo
It was Hua Tuo's book. Detailed illustrations of dissected human bodies filled its pages. Given that only physicians would be present and the entrance was locked, it must have been left out on display.
"Now then, each of you—explain what progress your assigned tasks have made."
At Liu the physician's words, Senior Chang was the first to stand.
"So far, the usefulness of the medication has been confirmed, but—"
There was a clear difference between the group that had received the medication and the group that had not. The prescribed medicine was effective. However, individual variation meant that even among those given the medication, some recovered while others did not. It could be argued that those who recovered had originally presented milder symptoms. Nevertheless, it was discovered that the rate of deterioration was slower compared to the unmedicated group.
Luomen spoke in a manner that supplemented Senior Chang's report.
Liu the physician wore a look that said this was exactly what he had expected.
Maomao jotted down notes with ease. Since she already knew the contents, writing them down was simple enough.
Next, the anesthesia team began their presentation. In addition to herbal remedies as the primary approach, they presented the degrees of pain achieved through alcohol, acupuncture, compression, and cooling methods. Naturally, the more effective the method at eliminating pain, the greater the danger.
Datura
and
aconite,
,
love eggplant,
and
poppy seeds,
along with cannabis—dangerous names kept appearing.
(Surgery inevitably comes with pain, of course.)
The question was how much could be tolerated. There were plenty of tales of bold souls who performed surgery without a care for pain. However, alleviating that pain meant reducing the chance of the patient losing their mind during the procedure.
(Whether to classify anesthesia as medicine or as poison.)
It was a difficult distinction to make.
Maomao took care to record everything as accurately as possible. There was one other physician serving as a scribe besides her, so if she made any mistakes, she could cross-reference their notes.
It was the surgical team whose research had progressed the most unexpectedly.
"Regarding the disease—depending on the conditions, we've found a fundamental breakthrough."
Maomao's eyes went wide, and she stared intently. Because this was such a significant announcement, Liu the physician was making it himself.
"If the diseased site is not the cecum but the appendix, removing it can prevent recurrence. Autopsy results have shown that in many cases, the cause is the appendix rather than the cecum."
Maomao stared at Physician Liu unblinkingly.
"Maomao."
Luomen nudged her, reminding her that she was there to take notes, and she set her brush in motion.
The appendix—that was the organ that had poked out like a small worm when she was performing autopsies.
"Is it safe to remove the appendix?"
A physician in the audience posed the question. It was helpful that someone was asking what Maomao wanted to know.
"It is generally considered a relatively insignificant organ. At the very least, if pus continues to accumulate in the appendix and it ruptures, the damage is far worse."
If pus spills into the abdominal cavity, it can trigger other illnesses and lead to death.
The medical text by Hua Tuo placed before Physician Liu contained a detailed drawing of the appendix area.
"Has the procedure been attempted?"
"It has. Based on the outcomes so far, it has succeeded roughly eighty percent of the time."
"What about the remaining twenty percent?"
"In ten percent of cases, the appendix had already ruptured, causing peritonitis. The appendix was removed and as much of the scattered pus was extracted as possible, but the patient died from the resulting damage. In the other ten percent, infection entered through the surgical wound and festered, and the patient's condition did not improve, leading to death."
Twenty percent—was that number considered high or low?
(Not exactly a reassuring figure.)
"What happens if the appendix is not the diseased site?"
"Then we would have to reconsider the approach."
Physician Liu's words conveyed a sense that time was running short. Maomao continued summarizing and writing down the information with as little personal bias as possible.
At the end, there was an explanation of post-operative care. This included methods for keeping the wound clean to prevent festering, as well as a description of herbal medicines that could suppress infection.
(There's probably nothing more we can do for His Majesty at this point.)
If the premise was that surgery would be performed, then recovery through medication alone was impossible.
"Pardon the intrusion, but may I ask a question?"
A physician from the anesthesia team raised his hand.
"Go ahead."
"And who will our research results be used on?"
It was a question, but really a confirmation. No one in this room would fail to know who that "who" was.
"Just who you're imagining."
Physician Liu didn't say it outright. Whether holding back was the right call, he couldn't say. But his refusal to name names in front of the other physicians spoke to just how precarious his plan really was.
Performing surgery on the Emperor. That meant administering an anesthetic that was essentially poison, cutting open the abdomen with a blade, and excising internal organs — all without a single misstep. And even if the surgery itself went well, the postoperative period would be just as dangerous.
(If everyone here were implicated, the entire medical bureau would cease to exist)
So the thinking was to keep the number of people who knew the surgery's details to an absolute minimum.
(Physician Liu, the old man, and a handful of others)
Failure meant beheading. In the worst case, the extermination of all nine relations.
(Which would mean I'd be killed too, I suppose)
The eccentric strategist, and —
Luo Ban —
those two would be an acceptable loss, but she wondered whether there was some way to save Luo Ban's older brother.
Of course, she refused to even consider the possibility that the old man she respected might fail.
"Those of you who will be called from here on — please stay behind."
Physician Liu began calling out names. Every person summoned wore an expression of grim resolve.
Among those faces, one looked almost nonchalant — Tianyou.
(Well, his skills are top-notch, I'll give him that.)
Maomao clicked her tongue.
"Maomao."
(?!)
Called last, Maomao flinched. The tall senior and the short senior gave her worried looks as they filed out of the room.
Maomao hadn't expected to be called, either. The medicinal herbs she'd been preparing were of little use after surgery.
Looking around uncertainly, she rose from her seat and made her way toward Physician Liu.
"You've got that look on your face — like you don't have the faintest idea why you were called."
Yes.
"Simple enough. If I'm going to be tied to Luomen regardless, choosing you over some unrelated people will minimize the damage."
"I see."
It could be called a rational decision.
"Also, if anything happens, it'll let me drag the Grand Commandant of Kan into it for certain."
"I see—"
Maomao squinted.
If she were ever on the verge of execution, she was probably hoping the eccentric strategist would stir up some commotion and smooth things over.
Physician Liu was not someone to be taken lightly.
Over the following days, Maomao received briefings on how the surgeries would proceed. That said, in keeping with the principle of putting the right person in the right place, her main role would be selecting and compounding the crude medicines used. Under Luomen's instructions, she would purchase higher-quality herbs and carefully prepare them. In effect, she would be assigned to the postoperative care team.
Senior Chang and the others continued their clinical experiments with the drugs. Patients whose conditions worsened were anesthetized, underwent surgery, and then had their recovery monitored.
As for anesthesia, datura was never used. As Cuiling had warned, the risk was deemed too great, but also because they believed His Majesty could endure it even if the pain wasn't completely eliminated.
If the patient were still young, willful, and sensitive to pain, having their body cut open while fully conscious would be unbearable. However, Physician Liu apparently concluded that His Majesty could endure it. After all, the fact that His Majesty had continued performing his duties without visible difficulty despite chronic pain spoke to extraordinary willpower.
She had assumed the treatment would proceed smoothly.
"Surgery?! Don't be ridiculous!"
—that is, until a high-ranking official started spouting nonsense.