Chapter 208: Dullahan Saving Project (2)

“L-Lord Saint!”

Before anyone in the operating room could stop me,

my hammer struck the chisel.

Clack! A bone fragment fell away with the sound.

Lauren stared at that fragment with a pale face.

“L-Lord Saint. This is quite different from the original plan, is it not?”

He was right.

Our pre-surgery plan had been to extract C6 (the sixth cervical vertebra).

Not to shatter it like this.

“Since you have detached it above and below, can you not now carefully remove just the bone?”

Lauren carefully continued while watching my fingertips.

“What is the reason for using such a noisy method?”

Tap.

Instead of an answer, the hammer moved.

Another bone fragment fell away.

At the unspoken signal that I had no leisure to answer, Lauren’s mouth closed.

“......”

If I had my way, I wanted to explain.

Why I was hammering.

Why I had suddenly changed the plan.

But right now, it was impossible.

Because I had to focus my entire attention on the sensation coming through the tip of the chisel.

Clack!

'If I had a surgical round bur, I could have explained comfortably.'

In modern surgical equipment, there exists a tool that can shave away nothing but bone.

If I had that tool.

If I had it, I too would have explained the situation with a little more composure.

But this world had no such tool.

The only equipment for precisely shaving bone was my own sense of touch.

In this situation, there was no room to converse with people.

Fortunately, there was someone here besides me who could explain.

“Mr. Ludwig. Explain.”

Because we were in the operating room, I gave the order in my habitual casual speech.

Ludwig, receiving the order, did not answer immediately.

Instead, while I tapped the hammer two or three more times, he merely examined the tip carefully.

Then he shifted his gaze to the edge of the remaining bone,

“Ah.”

and with a small exclamation, explained the situation to Lauren.

“The adhesion is too severe. Like this, we cannot extract it as planned.”

“Adhesion, you say...”

“The bone is firmly attached to the surrounding tissue. If we try to pull it out forcibly, the structures attached to it will be torn out along with it.”

Saying that, he picked up a forceps.

And joined my bone removal work.

Clack!

When I split the bone,

Ludwig picked out the freshly broken bone fragments.

Sweeping away the small pieces that had fallen beneath them was a bonus.

“Assistant Healer. Please prepare for irrigation.”

Even without any particular instruction, he was preparing in advance what needed to be done next.

Seeing that, I made a decision.

'Good. I'll train Ludwig into a cervical spine surgery specialist.'

You ask if Ludwig is an otolaryngologist?

I'll just have him double board, or whatever.

As I advanced toward becoming all-board certified, I realized that a dual specialty wasn't that difficult.

Perhaps because it is a world where magical power exists.

The upper limit of intelligence seems a bit higher.

Clack!

With that thought, I moved the chisel and tapped a few times.

After most of the sixth cervical vertebra had been broken apart, Ludwig opened the surgical field along the direction I was about to move.

And before I could move my hands further, he asked me.

“Should I hold it like this?”

“Keep holding it just like that. Don't move.”

I replied briefly and changed the chisel.

From one with a blunt tip to one that was slightly pointed.

Tap.

This time, a slightly smaller sound was made.

From the tip of the chisel, a small bone fragment—one that could even be called powder—fell away.

Instead of striking with the hammer, I shaved the surface of the cervical vertebra little by little, as if giving it vibration.

What mattered here was not pushing the bone backward.

The direction the chisel dug in.

The fragments that fell away.

I gave delicate vibrations so that everything came out toward me, not toward the patient.

It was all to touch only the bone and not the spinal cord behind it.

With such minor techniques, I could compensate even slightly for my lack of technical skill.

“Irrigation.”

“Irrigation.”

Repeating my order, Ludwig handed me a syringe filled with water.

When I sprayed the water, Ludwig sucked it back up.

It was a procedure to wash away invisible bone fragments and wipe away the pooling blood once.

“Ayla. Refresh.”

“Ah, yes! Refresh.”

For micro-bleeding, Refresh was used instead of a Bovie.

Only then was the cleaned space inside the neck revealed.

The hard shell had disappeared, revealing the soft bone inside.

It meant the hammer's turn was over.

“Curette.”

“Curette.”

A hook-like surgical instrument was placed in my hand.

With it, I carefully scraped out the inside of the bone.

Scrape, scrape.

The sound of scraping something echoed through the operating room.

Only then did Ludwig carefully ask.

“Are you hollowing out the inside?”

Ludwig asked as he picked up a curette.

“Yes. So that no force is applied to the outside.”

“Because of the tissue attached behind it.”

“That's right.”

I like how quick he understands.

Ludwig joined my work.

While I shaved one side, he shaved the other.

The curette went deeper little by little.

Crrrk—

And by the time I gnawed away the last remaining hard rim with a bone rongeur.

Beneath it, a whitish tissue was revealed.

Only then could I briefly look around the operating room.

Unlike the piecework where a slight slip could cause catastrophe,

the work from now on did not require that level of delicate sensation.

“Lauren.”

I resumed the lesson I had put off while shaving the bone thin.

“Yes, Lord Saint.”

“You mentioned Regeneration earlier, did you not?”

Lauren nodded.

Without stopping my hands, I asked.

“If we cast Regeneration here now, what would happen to this adhesion?”

“......”

Lauren's gaze turned toward the open inside of the neck.

He stared there for a while, then hesitatingly opened his mouth.

“It might have restored the missing bone. But as for what would happen to the parts already fused... honestly, I cannot guarantee it.”

“Yes. That is exactly the problem.”

Regeneration is possible.

But there are problems that cannot be solved by regeneration alone.

“There are cases where a patient stabbed in the heart receives Heal, the wound closes, and yet the patient dies, correct?”

“There are.”

“Why does that happen?”

This time, Ayla answered.

“Cardiac tamponade... is what you mean, correct?”

“That's right.”

Blood pools in the sac surrounding the heart.

The pooled blood presses on the heart, and the heart can neither properly receive nor pump out blood.

If you cast Heal in that state?

The wound on the heart closes.

The bleeding stops as well.

But the blood already pooled there does not disappear.

“It seems the patient should live because the wound was sealed, but the patient keeps dying. Because the blood pressing on the heart remains as it is.”

“That is why you taught us the blood must be drained.”

“Yes. Not by casting Heal one more time.”

I pointed to the scar.

Naturally, Lauren's and Ayla's gazes followed.

“This is the same problem. Heal is a miracle that raises regenerative power and immunity. But it does not selectively tear away tissue that has already healed.”

Divine magic does not remove tissue that has already formed.

The same goes for scars.

Therefore, ordinary scar removal surgery cuts off that body part and casts Regeneration.

But this patient's problem is that the scar is on the neck.

“Lauren. Do you think the ordinary scar removal method would be possible on this patient?”

“...I am not sure.”

“Then let me change the question. Try answering the name of this structure, and what happens if it is damaged.”

I slightly lifted the curette and pointed to the side.

It was at a distance the tool's tip did not touch.

Lauren, not yet accustomed to surgery, did not answer easily.

The one who answered as if cutting in was Ayla.

“This is the vertebral artery. If it is damaged, blood flow to the brain is compromised, and the patient's brain can become ischemic.”

I nodded and moved the tip of the curette backward.

This time too, Lauren could not answer.

Instead, it was Ayla who seized the opportunity.

“That is the dura mater. If it is torn, cerebrospinal fluid can leak.”

At Ayla's explanation, one of the healers unknowingly flinched.

Meanwhile, I moved the curette again.

“This one will be difficult.”

“Is it the nerve root bundle?”

“No. It is the phrenic nerve. If this is injured, the patient can be unable to breathe and die.”

Besides what I pointed out, countless landmines were stationed in the neck.

The recurrent laryngeal nerve, jugular vein, vagus nerve, and so on.

They were landmines that could send the patient to the next world before there was even time to use Regeneration if even one was injured.

Yet in this patient, the bone was stuck to these landmines.

“Because these structures are adhered to the bone, I abandoned the original plan and changed to the method of shaving the bone away.”

I spoke while pointing around the whitish tissue.

“The back of the vertebra is almost integrated with the dura mater, and the side is almost integrated with the scar around the vertebral artery.”

There must be a boundary between bone and flesh.

At the very least, one must be able to distinguish where the bone ends and the flesh begins.

But in this patient's neck, that boundary had disappeared.

Broken bone.

Torn ligaments.

Tough scar that grew to fill the surrounding area.

They had hardened, tangled together as one.

In this situation, could one cleanly pull out only the bone and cast Regeneration?

Who knows.

Someone might be able to.

But I am not.

And most surgeons would not be either.

If I had been greedy to cleanly extract the bone in this situation.

The surgery would have ended in failure.

After finishing the explanation, I gave Ludwig instructions again.

“Ludwig. Do not forcibly shave all the bone away; leave it in a Floating Island state.”

“You mean Floating Island?”

“I mean let us be satisfied with shaving it extremely thin.”

The purpose of removing the cervical vertebra is decompression in the first place.

It means freeing the spinal cord nerve that the bone is pressing on.

In other words, the purpose could be achieved even by shaving the bone extremely, extremely thin.

Ludwig and I began to shave the bone thin.

Ayla, watching the work, muttered quietly.

“It was not a matter of removing a single cervical vertebra.”

“That's right.”

Have you ever pulled up a potato stem in a field?

You only pulled one stem, yet the potatoes attached below come trailing out one after another.

A similar thing could happen in this patient's neck.

Except what comes trailing out is not potatoes.

Blood vessels.

Dura mater.

Nerves.

There was a risk that things that would be troublesome if even one was injured could be torn out all at once along with the bone.

“The question is whether the patient can wait while you restore it with Regeneration after making that mistake.”

Lauren did not answer.

“Because being able to remake it and being able to stay alive while it is being remade are different matters.”

Remove the cervical vertebra and regenerate it.

Said aloud, it is simple.

I wished it were so too.

How convenient would it be if removing the bone and clicking Regeneration healed everything?

But reality was not so simple.

Applying that as is to this patient was practically close to suggesting we cut the neck once and then try reattaching it.

“So.”

Only then did I stop my hands.

The last fragment fell from the tip of the bone rongeur.

The originally thick cervical vertebra had almost disappeared.

What remained there was a thin shell of bone attached to the tissue behind.

“I will leave this part behind.”

Looking at the cervical vertebra thinned to almost paper-like thinness, I wore a satisfied smile.

*

“Hold this for me. But do not pull.”

“I am holding it.”

Even after extracting the cervical vertebra, the surgery continued.

I told you.

The inside of the neck is a mess of scars.

In this state, it is impossible to insert a new cervical vertebra.

Amid this chaos, work was also needed to find the arteries and nerves and classify them by looping thread around them.

It is not that difficult a task.

Just think of it as roughly organizing computer cables.

There is only the minor difference that a mistake kills the patient.

While I was organizing the wires—no, the blood vessels and nerves.

The ducal family healer who had been observing let out a long breath.

“...With Lord Saint's hands, you could even peel off wax that has burned and stuck.”

As soon as I heard that, the corner of my mouth twitched.

Because it was the highest praise for a surgeon.

But I replied as if it were nothing, without taking my eyes away.

“Is that not basic? For a healer in surgery, that kind of thing is basic practice.”

“Pardon?”

A brief silence passed.

In that silence, I realized.

That the ducal family healer had never practiced with such things.

“You mean... that is something one must practice?”

“At Meyer Infirmary, I train all the healers working in nerves that way.”

At Meyer Infirmary, wax separation is part of basic training.

It was training to develop sensation in the fingertips.

Because you do not necessarily have to open a human body to practice surgery.

I set down a piece of the tissue I had separated.

“However, wax is on the easy side. Once you get used to it, it is better to switch to something else.”

“...On the easy side?”

“Next, using an egg or a grape would be good.”

“What do you mean?”

“You separate the shell with surgical tools. Without making a hole in the shell, and without pulling out the egg's membrane or the grape's flesh along with it.”

I spoke while precisely pointing out a paper-thin capillary with the tip of the surgical tool.

“For the last stage, orange pith is good. Separating each segment without damaging the thin membrane makes for sufficient practice.”

“...You mean you do that with surgical tools?”

“Human nerves are more delicate than that, so you have to be at least this good.”

It is a neurosurgery training technique widely known even in the 21st century.

With things like this, surgical fellows would gather and bet on who was more delicate...

For reference, I have never lost that bet.

Because my advising professor was determined to kill me if I returned after smearing the reputation of trauma surgery.

Even though he himself came back after being crushed by the neurosurgery professors...

Anyway.

“Once you get used to it, doing origami with surgical tools when bored is also good.”

It is fine for passing time.

I know from folding roses and cranes with surgical tools many times.

“This... is basic...?”

Leaving the dazed, muttering healer of the duchy aside.

I continued the surgery.

“Good. Now let us go to the posterior side.”

As I had said in advance, we changed the patient's position.

Protecting the opened anterior side.

We supported the head and body together so the neck would not move.

We also rechecked the equipment connected to the breathing tube.

If even one line caught here and pulled the patient's head, all our efforts so far could become wasted.

“Are you ready?”

“Ready.”

“Then slowly.”

Many hands moved at once.

After the patient was prone, we opened the back of the neck.

Thanks to having organized from the front, the work was much easier.

But there was still work to do on the back side.

Joints that had become caught on each other.

The connections that had hardened in that state.

And various other tissues holding the cervical vertebrae so they could not be returned to place.

I released them one by one.

“Maintain traction.”

“Maintaining.”

“A little more. Yes, there.”

I slowly corrected the fifth vertebra that had been pushed forward.

While the fifth cervical vertebra returned to place, I checked again and again that no excessive force was applied to the surrounding tissue.

Move a little.

Check.

Move again.

Check again.

Continuing at a snail's pace for several minutes like that.

The twisted alignment was corrected.

“Reduction complete. Now beginning reconstructive surgery.”

The cervical vertebrae returned to their places.

Now it was time to fill the missing bone with a leg bone.

After stabilizing the posterior side, I laid the patient flat on his back again.

“Measuring instrument, please.”

Between the fifth and seventh cervical vertebrae.

We measured the space that the body of the sixth cervical vertebra had occupied.

It did not end with measuring only length.

We needed to measure the shape and angle of the surfaces where the two ends would meet.

If too long, it would spread the surrounding area apart.

If too short, it would not fulfill its role.

After finishing the measurements, I moved to the patient's leg.

“Now let us harvest the fibula.”

There are two bones in the calf.

The thick tibia that mainly bears the body's weight.

And the slender fibula (calf bone) running down parallel beside it.

What I needed was the latter.

I selected a length of bone as needed.

Along with the periosteum surrounding the bone, and the blood vessels.

Because to keep the bone alive, I had to keep those blood vessels alive and bring them to the neck.

“Be careful not to damage the blood vessels.”

“Understood.”

Working in sync with Ludwig, I cleared the surrounding area.

After a while, a piece of bone with delicate blood vessels attached came into my hand.

After checking it, I turned my head to Lauren.

“Please take care of the leg.”

“Regeneration?”

“Yes. Because this is a clean wound just made.”

Regeneration.

As soon as permission was given, Lauren wore a bright smile.

It seemed he had been bothered by being completely defeated by Ayla in terms of knowledge.

“Understood. Leave this side to me.”

A golden light rose from his hands.

Leaving the leg to him, I began shaping the bone I had brought.

I shaved it little by little, compared it, and shaped it again.

I brought the fibula, shaped in that way, to the place where the sixth cervical vertebra had been.

Tap.

I heard the sound of the upper and lower surfaces interlocking.

While maintaining that state, I connected the harvested blood vessels to the blood vessels in the neck.

Then I called the ducal family healer.

“Could you come here for a moment?”

“Yes, Lord Saint.”

He came closer.

I yielded a little space.

“I will show you something amazing.”

The healer's gaze turned to my fingertips.

The bone that had been in the calf until just a moment ago was now in the middle of the neck.

That alone seemed amazing enough to him.

But what I wanted to show him was the next part.

“Cast Greater Heal on the upper and lower contact areas here. Only within the range I instruct.”

“...In this state?”

“Yes.”

His hand started to rise, then stopped.

“Lord Saint. There is one thing I am concerned about.”

“Tell me.”

“Is that not a leg bone? What if, after casting healing, it tries to return to its original form?”

I looked at him.

The healer's face was serious.

Well now.

I never imagined I would receive such a question.

It was such an unexpected question that my answer came a little late.

“...That will not happen. Bone is not a tissue that endlessly tries to regain its shape because it used to be a leg bone. Nor does an entire leg sprout from a single transplanted piece of bone.”

“Is it really all right?”

“Yes. But do not spread divine power toward the back. It would be troublesome if the part I left earlier were reattached.”

He peered once more into the open neck.

Then, with a deep breath, he looked at the ceiling for a moment.

It seemed he felt pressure from the fact that he had to finish the surgery with his own hands.

Then he slowly raised his hand.

Soft light filled the surgical site.

I held the grafted bone so it would not move.

Change began where the healer's divine power touched.

Between the fifth cervical vertebra and the fibula.

Between the fibula and the seventh cervical vertebra.

The boundary of the bones pressed against each other was gradually filled in.

White tissue filled the gaps.

The interlocked ends became connected as one.

“...It is attaching.”

“Yes. Keep it just like that.”

This was what I intended.

Human bones are all about the same anyway.

Even if you fill the place where a cervical vertebra was with a leg bone, as long as the shape is the same, there is no particular problem.

Of course, vertebrae are somewhat immunologically important, but.

That is not what is important right now.

Anyway, as long as it was filled with a leg bone, it was not much different from having a vertebra.

“Good heavens...”

The healer's voice grew small.

Even though he was the one casting the magic, what was happening before his eyes seemed amazing.

Meanwhile, I alternately checked the bone's position and the margin at the back.

“Good. That is enough.”

The light subsided.

Even after lowering his hand, the healer could not take his eyes away for a while.

“How... is something like this possible?”

“Because bone is a tissue that changes according to the way it receives force.”

I explained while examining the graft site.

“It means it is not simply a hard rock. Depending on where and what force is applied, its thickness and internal structure change as well.”

“Even if one knew that, the idea of replacing a cervical vertebra with a leg bone is simply...”

I know.

Since I did not develop it, I find it amazing too.

Leaving the dazed, muttering healer alone, I examined the spinal cord area again.

Now I could properly assist recovery.

Until a moment ago, even swelling or regeneration could worsen the compression.

But now the bone blocking that path was gone.

I checked the state of the nerve released from pressure and instructed that divine power be carefully sent only where needed.

Meanwhile, a voice came from the leg side.

“Lord Saint. This side is finished.”

When I turned my head, Lauren was lowering his hand.

The calf from which I had just taken a piece of bone had already been perfectly restored.

What a convenient miracle.

No need to seek someone else's bone.

No need to make the patient pay the price for borrowing bone for a long time.

I had built a new pillar in the neck, but nothing had disappeared from the leg.

The bone recycling had succeeded.

'This other world is great for freeloading.'

Regeneration.

What a convenient miracle this is.

Admiring the miracle, I checked both sides one last time.

Whether blood was pooling anywhere.

Whether any nerves or blood vessels were newly compressed.

Whether the fixed cervical vertebra was stable.

Only after finishing all checks did I nod.

“Good. Now let us close.”

And so we succeeded in reattaching the Dullahan's neck.