Chapter 5
This year, I started my hospital rotations. It had taken a long time, but at last I had the chance to see patients!
This was the moment I'd been waiting for.
At last.
A doctor's clinical training usually worked like this: you rotated through each department, observing and taking part in the work doctors did in every specialty.
Experience was the most important thing in hospital work, after all.
There was even a saying that the worst second-year doctor was better at the job than the best first-year doctor.
And I'd been doing this for eight years.
It wasn't hard to become the hospital's most outstanding and talked-about medical student.
My reputation grew quickly.
It was like that wherever I went for rotations.
Radiology.
“A medical student diagnosed mycoplasma pneumonia from a single X-ray? You've got an eye for it. Come join radiology.”
Modern doctors learned to read X-rays from their undergraduate years, but in the 1970s, that was still the domain of specialists.
Hematology-oncology.
“You spotted multiple myeloma just by looking into the patient's eyes. I wasn't sure, but...”
Thoracic surgery.
“An Asian medical student diagnosed Marfan syndrome just by reading a patient's face? Are you some kind of shaman from the Orient?”
The experience I'd built up and the level of skill expected were fifty years apart from modern standards.
In a way, it was only natural.
God, what a headache.
Listening to these people, you'd think I was some kind of shaman.
As an aside, reading a patient's face was an essential skill for a doctor, but... In America, it became much simpler.
There was a huge difference called race.
Come to think of it, maybe the hospital staff were just applying that same logic to me.
Anyway.
Rumors spread that there was an Asian student with almost unbelievable abilities. There were truckloads of professors trying to recruit me to their departments.
This week, I was rotating through general surgery.
Surgical specialties were especially demanding.
This was the operating room at Stanford, and the surgeon performing a gastric cancer resection today was Harry Overhellman.
He was Stanford's chief of surgery.
He was a world-class surgeon, and he expected just as much from his students. I'd heard he'd really put several of my classmates through the wringer.
I put on my scrubs, washed my hands with antiseptic, and quietly entered the operating room.
Professor Overhellman was talking to the nurses as they prepared for surgery.
“Be careful around one undergraduate?”
“Yes. The internal medicine professors call that student a Mongolian shaman. I heard they diagnosed multiple myeloma just by looking into a patient's eyes...”
“Have them read our patient's face, too.”
The professor laughed heartily.
Why are you all like this?
This other world was a strange place. Maybe I'd make more money running a fortune-telling shop than being a doctor.
“Good morning, Professor.”
The professor turned his gaze toward me.
“Oh, you're here.”
I looked at the old-fashioned monitor in the corner of the operating room. I'd looked at the CT earlier, and there was something to watch out for in this patient's surgery.
Something you had to check in gastric cancer surgery.
I saw an abnormality in this patient's blood vessels.
It might have been difficult to spot with 1970s medicine, when CT had only just been invented, but...?
I had to bring it up.
I looked at Professor Overhellman.
“Professor. I was looking at this patient's CT, and it appears to be an unusual case where the left hepatic artery branches off the left gastric artery.”
“Oh, I was just about to ask you to read my patient's face. A replaced hepatic artery?”
“That's right.”
“You can see that on a CT? I had no idea.”
I could see it.
I'd trained for ages to spot things like that before I came to this other world, so of course I could see it.
RLHA (Replaced Left Hepatic Artery).
It's a normal anatomical variation in the blood vessels supplying the liver, in which the left hepatic artery branches from the left gastric artery instead of the proper hepatic artery.
Complicated stuff.
To use a restaurant as an analogy, um... imagine that a restaurant patron has an RLHA.
What does it matter how the blood vessels inside your body are arranged? Actually, it doesn't matter much.
Most people go through life without ever knowing. Unless they undergo surgery for gastric cancer.
But if you undergo gastric cancer surgery, that's a different story.
In gastric cancer surgery, the left gastric artery is usually ligated. If the left hepatic artery branches from the left gastric artery and you simply tie off the left gastric artery, blood flow to the liver drops dramatically.
Is that too complicated?
Put simply, it means this.
If you don't properly identify variations in the abdominal blood vessels, the liver could become necrotic after surgery.
Here's the problem.
Fifty years ago, checking for variations in the hepatic blood vessels every time wasn't standard practice.
But since CT scanners had just been introduced around this time, it was time to start taking them into account.
That was the background to today's surgery.
When I had more or less finished explaining, the chief of surgery, Professor Overhellman, frowned.
He looked unconvinced.
“Stanford only adopted CT a few months ago... Where did you learn that?”
I shrugged shamelessly.
***
Gastric cancer resection.
It was just as I'd seen on the CT. The patient had gastric cancer, which was dangerous enough, but also a vascular variation that would make the surgery difficult. At my words, the anesthesiologist and the chief of surgery looked at me.
As if they couldn't believe it.
The professor in scrubs looked at me with a puzzled expression. It was the look of an Academy professor staring at a barbarian shaman...
At a talent he couldn't understand.
I'd gotten that a little wrong.
Right. I hadn't thought of that. I couldn't exactly say I'd learned it in my previous life.
I thought for a moment.
CT scans were still an experimental technology.
Stanford Hospital was relatively advanced and had adopted it early, but at this point, there were only a handful of doctors in the world who could read a CT.
I was probably the only one among Stanford's doctors at the time with any experience using CT clinically.
“I read it in a book.”
“I've heard the rumors. Maybe the shaman thing isn't just talk. Did they publish a book like that?”
I didn't know if such a book had even been published yet. The professor turned back to the operating table.
“Right. That's an excellent observation, but there's only one way to be sure. We won't know until we open the patient up.”
Am I Conan or something...?
I thought for a moment.
Of course I wasn't Conan. He meant we'd have to open the abdomen and look at the blood vessels directly.
General anesthesia was a complicated process.
The anesthesiologist stood in front of a machine that looked like the controls of a fighter jet. The nurses arranged the IV lines and prepared the surgical drapes.
The preparations for surgery were over in no time.
We stood in front of the operating table, and Professor Overhellman looked at me seriously.
“Why don't you open the patient's abdomen?”
“Thank you.”
I carefully took hold of the scalpel. Not just anyone got the chance to hold one.
Taking responsibility for a life was never easy. Even for a doctor.
I brought the blade to the skin with the lightest touch.
I opened only the skin, carefully going in without damaging the tissue beneath. The mirror-polished blade gleamed silver.
“Slowly. Deliberately.”
“Yes.”
I carefully raised the scalpel, tracing with my left index finger where I would make the incision. It had been a long time since I'd held a scalpel in front of an actual patient.
The first time since coming to this other world.
“Do you like surgery?”
“I think it's fun.”
Surgery is the only drug the government allows!
-as my thoracic surgery professor in my previous life used to say. What kind of crazy thing was that?
I thought he was just joking, but only later did I understand what he meant. Not that I'd performed a lot of surgeries myself.
It's hard for someone who hasn't done it to imagine what it feels like to hold a scalpel in front of the operating table. To explain, it's something like this.
The feeling of having the operating room completely under control, and the tension of holding someone's life in your hands.
It's exhilarating.
That's an extreme dopamine rush.
Performing surgery lets you maintain that extreme state of tension for hours.
I wonder if even drugs could put you in that kind of state.
I'd seen plenty of doctors perform heart and brain surgeries lasting over twelve hours even after they were past sixty.
Anyway.
The professor continued speaking without stopping his hands or taking his eyes off the surgical site.
“Come to surgery. I'll teach you. You're years ahead of the other students, so it'd be easy for you to become a Stanford professor.”
“I'll think about it.”
“Stanford has several of the world's best surgeons. We can train you into a truly world-class doctor and scholar here.”
I'd taken part in many surgeries over the course of my life.
But I didn't particularly want to become a surgeon. In surgery, precision of technique mattered just as much as knowledge.
It would be hard to make the most of my strengths.
I should think about it some more.
The surgery continued. I had my hand inside the patient's abdomen, pushing the liver upward.
We had to lift the liver to see the stomach.
The surgery was in full swing.
“Hold it firmly. Don't move.”
“Yes.”
The professor grasped the left gastric artery.
It was just as I'd said earlier.
The vascular variation, with the hepatic artery branching from the gastric artery, was clearly visible. It might have been dangerous if we hadn't known about it beforehand.
“Honestly, I wasn't sure, but I can't believe it really is an RLHA. You can tell from the CT alone?”
I nodded.
“It was visible.”
“You really do have a demonic talent...”