Chapter 58
There are many reasons skin turns black.
Burns.
Frostbite.
Infection.
Pressure.
Or when a blood vessel becomes blocked and blood can no longer reach the tissue below properly.
In the end, there was one central point.
The blood flow and oxygen supply necessary for tissue to survive are cut off, and the cells can no longer withstand it and die.
We called it 'necrosis'.
'The problem is that necrosis isn't a lesion defined solely by the color visible on the surface.'
You can't assume all blackened skin is dead tissue.
Conversely, even if the surface still looks fine, the subcutaneous tissue or muscle layer underneath may already have been destroyed.
Especially when the affected area is the chest, you had to be even more careful.
Beneath the skin was breast tissue, beneath that the pectoralis major, and deeper still the ribs and pleura.
And inside those would be the lungs and heart.
Whether the black marks were confined to the skin.
Whether they had penetrated into subcutaneous tissue.
Whether they had invaded the muscle layer.
Or whether toxic inflammation might spread into the chest cavity.
Without checking that, you couldn't casually put a knife to it.
“I'll start by checking with a Hunter MRI.”
I deployed the equipment I had taken out of the system.
A Hunter-only device capable of imaging far faster than a real-world MRI.
But that didn't make it omnipotent.
Imaging was only a guide.
Ultimately, whether tissue was alive or dead had to be determined by looking directly after incision.
Whether blood was flowing.
Whether the color returned.
Whether the tissue still retained elasticity when touched with forceps.
Whether blood welled up from the cut surface.
I had to check each of those things one by one.
Even so, imaging came first for now.
Ms. Baek Sawol carefully laid Guild Master Jin Yeoryeong down on the equipment.
Her breaths were short and shallow.
Her lips were parched, and cold sweat beaded on her forehead.
From the bandages wrapped around her chest rose a mixture of old blood, exudate, and the damp, heavy odor characteristic of necrotic tissue.
I gritted my teeth and checked the screen.
T1.
T2.
Contrast enhancement.
The blackened chest lesion emerged in the layer-by-layer cross-sectional images.
The skin covering both breasts was extensively discolored.
Some areas looked like hard, dried eschar, while others had broken down into a wet mess.
But.
“⋯Phew.”
“What is it?”
I answered Ms. Baek Sawol's pleading question without taking my eyes off the screen.
“It's fortunate.”
“Fortunate⋯?”
“Yes. It isn't as deep as it looks from the outside.”
That didn't mean the situation was minor.
A wide area of skin had died.
Some of the subcutaneous tissue also appeared to have already become necrotic.
At this level, if she had been an ordinary patient, it would have been no surprise if she had collapsed from sepsis or if her life had already been in danger from an infection spreading deeper into her chest.
But Guild Master Jin Yeoryeong was a top-tier A-rank Hunter.
Perhaps it was because she was once considered, after Madam Yoon Mi-ja of Hyeonmu, Guild Master Han Yura of Baekho, and Guild Master Jang Mi-ran of Geumseong,
a candidate to become Korea's fourth S-rank Hunter.
That monstrous physique of hers seemed to have forcibly halted the poison's progression.
Thanks to that, the lesion was still mainly confined to the skin and shallow subcutaneous layers; the deeper breast parenchyma,
the pectoralis major,
and the pleura
showed no signs of having been completely destroyed, either.
“I can save her.”
At my words, Ms. Baek Sawol's eyes widened and quivered.
“Really⋯ really?!”
“Yes.”
I nodded.
“We need to remove the necrotic skin and contaminated subcutaneous tissue. If we leave dead tissue behind, whether it's poison or infection, it will keep eating away at her body.”
“Then⋯.”
“However, we don't need to cut all of it away.”
I pointed to the cross-sectional image of the chest on the MRI monitor.
“Can you see here? The area that appears black and the area that has actually died are different. If the tissue inside the breast and the pectoral muscles are still alive, we can minimize the extent of the resection.”
“Then Guild Master⋯.”
“We should be able to restore her to the point where it won't interfere with her daily life.”
Of course, it wasn't an operation as easy as it sounded.
The necrotic area was extensive.
There was toxic damage mixed in, and the location was the chest, dangerously close to the heart and lungs.
If I misjudged the depth even slightly, I could remove more healthy tissue than necessary; conversely, if I left dead tissue behind, the infection would spread again.
An ordinary doctor would have hesitated here.
No, it wouldn't have been strange for one to give up.
But I had seen it clearly on the MRI screen.
Breast parenchyma that had not yet collapsed.
Living pectoralis major.
And the boundary remaining between the necrotic and healthy tissue.
All I had to do was follow that boundary precisely.
Remove the dead tissue.
Leave the living tissue.
Control the bleeding.
Remove the source of infection.
Preserve the breast parenchyma and pectoral muscles as much as possible.
It was difficult.
But it wasn't impossible.
At least within the range visible on the current imaging, as long as I was the one holding the knife, there was no reason I would fail.
“Thank you! Thank you, Doctor!”
Ms. Baek Sawol bowed so deeply it looked as though she might nearly bang her head against the floor.
I did my best to ignore the excessively deep dogeza and began preparing for surgery.
First, I needed a space equivalent to an operating room.
Sterile drapes.
Disinfectant.
Suction device.
Electrocautery.
Instruments for excising necrotic tissue.
And a way to cover the extensive skin defect that would be left after the resection.
There were quite a few things I needed.
But then.
“No⋯ don't⋯.”
A thin voice reached me.
Grab.
At the same time, a cold hand seized my wrist.
“Guild Master?”
It was Guild Master Jin Yeoryeong.
She could barely open her eyes.
Her breathing was still rapid, and there was almost no strength in her fingertips.
Even so, she did not let go of my wrist.
“Doctor⋯”
“Please don't speak. Even breathing must be difficult for you right now.”
“I know⋯.”
Guild Master Jin Yeoryeong moved her dry lips.
“But⋯ I have to say this⋯.”
I fell silent.
Her unfocused eyes turned toward me.
They were not properly focused.
But the determination held within them was still alive.
“You know that a Hunter's chest is a pouch that stores mana⋯ right?”
“What? Ah, yes. I know that much⋯.”
“Then⋯ we'll be able to understand each other⋯.”
She struggled to catch her breath.
“I⋯ have to return to Cheongryong⋯.”
“⋯⋯.”
“I have to fight again⋯ and take back what was stolen from me⋯.”
Faint strength entered the fingertips gripping my wrist.
“So⋯.”
And then, the words that followed forced me to swallow hard.
“Could you make me a body capable of fighting again⋯ instead of merely keeping me alive?”
“W-what did you say?!”
“Guild Master!”
Ms. Baek Sawol cried out in horror as well.
It was an obvious reaction.
Even by ordinary standards, this was already a serious injury that would make doctors want to avoid responsibility merely for putting her on the operating table.
Yet immediately after hearing that she might barely survive, she wasn't asking to be saved—she was asking to be made capable of fighting again.
“What exactly do you mean?!”
I let out a short breath.
Then I deliberately lowered my voice.
“Guild Master Jin Yeoryeong. I think there's been a misunderstanding. I'm a doctor, not a god.”
Her fingertips trembled ever so slightly.
“Necrotic tissue is already dead tissue. I can't turn dead skin back into living skin. Nor can I leave the rotting tissue in place and simply draw out the poison.”
I pointed at the MRI monitor once.
“What I can do right now is remove the dead tissue, prevent infection, and save your life by preserving as much living tissue as possible.”
There are cases like that among patients from time to time.
Someone asking you to save a leg that is rotting away.
Someone asking you to restore a finger that needs to be amputated.
Someone asking you to cure the disease while leaving the dead tissue exactly as it is.
It wasn't that I didn't understand how they felt.
Losing part of one's body wasn't simply losing a few pieces of flesh.
That person's life.
Their profession.
Their pride.
Even their future prospects would be cut away with it.
But that didn't mean I could call the impossible possible.
Back when I was a rookie being worked to the bone in a trauma center in my previous life.
I'd been shaken by eyes like those countless times.
Eyes that begged to be saved.
Eyes pleading to be returned to the way they were.
There had even been times when I couldn't bring myself to say no before those eyes and left behind ambiguous hope.
And I came to learn how cruel the end of that was.
Pretending to give hope, only to snatch it away at the final moment.
I learned that was like cutting a patient apart twice.
So I had to say it.
Even if it was cold.
Even if it was cruel.
“It's impossible.”
“⋯!”
“Doctor Seo Jihoo⋯.”
Ms. Baek Sawol swallowed hard.
I did not avert my eyes from Guild Master Jin Yeoryeong's.
“I don't know why Guild Master Jin Yeoryeong wants to fight again. But what can't be done can't be done.”
Silence settled.
“Let me make this perfectly clear. Guild Master Jin Yeoryeong's life as a Hunter is over.”
It was hardly different from a death sentence.
Not her physical life.
A death sentence for her life as a Hunter.
For a moment, the area in front of the MRI became deathly quiet.
No one could say anything.
I felt the strength drain from Guild Master Jin Yeoryeong's hand.
The fingers that had been gripping my wrist slowly loosened.
I thought that was the end.
But.
Grab.
The hand that had been slipping free seized my wrist again.
And then.
Grin.
Guild Master Jin Yeoryeong was smiling.
Despite being unable to breathe properly, she looked nothing like someone who had just heard a death sentence.
“Then⋯ could you change the surgical method?”
“The surgical method?”
“Yes⋯ as you said, Doctor⋯ if I can't return to the way I was⋯ it only needs to be for a little while.”
The grip on my wrist tightened again.
“One day.”
“!!”
“No, even a few hours will do. Just make me capable of fighting at full strength, if only for a little while.”
“Guild Master Jin Yeoryeong⋯.”
“And reclaim my Cheongryong.”
Her blurred eyes became frighteningly clear.
“To protect my country.”