In First Surgery, Professor Nishimura was nearly seventy and had long since stopped being able to hold a scalpel.
As for Associate Professor Mizutani, he was excellent at writing papers and equally excellent at office politics, but if he were truly asked to take the table for a life-or-death emergency operation like this, he would absolutely find some excuse to flee to the bathroom.
There was also Associate Professor Takeda, whose skills were quite good, but he had gone to Tokyo the day before yesterday to attend a surgical conference and was not in Maebashi.
So in all of First Surgery, the only one they could really put forward was Imagawa Ori.
Over in Second Surgery, another associate professor was said to have gone to Tokyo for a conference as well, which meant Professor Nakamura had no choice but to take the field himself.
The work at the operating table was still continuing.
Professor Nakamura Hiroshi was worthy of being the helmsman of Second Surgery. Decades of clinical experience had made him intimately familiar with the anatomical structures within the abdominal cavity, and the movements of his hands were astonishingly fast.
“There’s a hematoma at the root of the mesentery, but no active bleeding. Leave it alone for now.”
“Contusion at the edge of the liver. Compression hemostasis will be enough.”
“The most important thing right now is saving his life, not chasing perfection.”
Exploration, ligation, irrigation—a series of maneuvers later, the abdominal cavity that had originally been a chaotic mess rapidly became clear under his hands.
When the patient’s physiological functions were on the verge of collapse, one did not perform complex, time-consuming definitive surgery, but instead used the simplest and fastest methods to control fatal bleeding and contamination.
Save the life first, treat the disease afterward.
On the other side, the packing work on Imagawa Ori and Kiryu Kazusuke’s end was also nearing completion.
Six large gauze pads were packed tightly into the spaces around the pelvis. The immense physical pressure forced the ruptured vessels to close.
The bleeding had stopped.
Imagawa Ori glanced at the monitor. The C-clamp had reduced the pelvic volume, the preperitoneal packing provided direct compression, and with massive fluid resuscitation added on top, the blood pressure had stabilized at 95/60, while the heart rate had fallen to 110.
Although he was still in the danger zone, at least he would not die for the moment.
“Wrap it up.”
“Close the abdomen!”
“Suture only the skin. Leave the subcutaneous tissue and muscle layer open, and close with towel clips.”
“Place drains. Two in the abdominal cavity, two in the pelvic cavity.”
Nakamura Hiroshi made the decision without the slightest hesitation.
The patient could not withstand a prolonged closure right now, and with gauze packed inside the abdominal cavity, the pressure was extremely high. Forcibly suturing the fascia would lead to abdominal compartment syndrome.
They would have to wait forty-eight to seventy-two hours, until the patient’s condition stabilized, before performing a second operation to remove the gauze and deal with the fractures.
Kiryu Kazusuke quickly handed over the towel clips.
Click. Click.
With the sound of metal closing, the abdominal incision was temporarily sealed.
Possessing “Surgical Incision Suturing—Advanced,” Kiryu Kazusuke’s hands moved extremely fast. Large needle, thick thread, full-thickness skin sutures.
This method of closure would leave a scar as ugly as a centipede, but its advantage lay in speed and tensile strength. It could effectively prevent the incision from splitting open under high intra-abdominal pressure.
In less than five minutes, the abdominal incision was closed.
“Send him to the ICU.”
Imagawa Ori took off her bloodstained surgical gown and threw it into the recycling bin.
She glanced at the wall clock. It was exactly five in the morning.
In other words, from the time the patient had been brought in until the end of the operation, roughly an hour and a half had passed.
And the main reason this surgery had lasted so long was Kiryu Kazusuke.
If he had not proposed the C-clamp and preperitoneal packing plan, this patient would already be a corpse, and the operative time could have been shortened to just over half an hour.
Nakamura Hiroshi removed his gloves. His gaze swept over everyone present before finally stopping on Kiryu Kazusuke.
“What’s your name?”
“Kiryu Kazusuke, resident in First Surgery.”
“Mm.”
But Nakamura Hiroshi said nothing more. He merely nodded, then turned and left the operating room.
Kiryu Kazusuke, Doctor Inoue, and the others pushed the stretcher and followed close behind.
The moment they passed through the airtight doors of the operating room, the sight in the corridor made Kiryu Kazusuke narrow his eyes.
The hospital corridor in the early morning should have been empty, yet now quite a few people were standing there.
Besides Imagawa Ori and Professor Nakamura Hiroshi, who had just participated in the surgery, Professor Nishimura of First Surgery was there as well. Even the hospital director was present.
These big shots who usually stood high above everyone else were now together with a middle-aged couple.
The man looked to be in his fifties. His expression was weary, and he was leaning on a cane. Beside him, the woman was sobbing softly.
On both sides of the corridor stood seven or eight bodyguards in black suits and earpieces, each expressionless, hands crossed in front of them.
With a scene like this, he really was no ordinary person.
“To have called you all here so late—my son’s life is in your hands.”
The middle-aged man bowed slightly to the director and the two professors.
“Please rest assured, Assemblyman Okawara. We will certainly deploy our very best resources.”
The director did not appear panicked like a lower-ranking doctor would. He only gave a slight nod, maintaining the reserve and authority befitting the head of a national university hospital.
His tone was steady, neither servile nor overbearing.
Okawara?
Kiryu Kazusuke rapidly searched his memory for that surname.
Okawara Genta, a member of the House of Representatives elected from Gunma Prefecture, a power broker within the ruling party.
At the same time, he served as chairman of the Standing Committee on Health and Welfare, responsible for coordinating the review and oversight of medical, welfare, and public health policies within the prefecture.
No wonder.
No wonder he could summon the professors of two surgical departments. No wonder Imagawa Ori had run faster than a rabbit.
This was not simply saving a life. This was clearly saving futures, saving budgets, saving the hospital’s funding for the coming year.
“The surgery was very successful. Your son’s vital signs have already stabilized.”
Professor Nakamura Hiroshi stepped forward and spoke in an even tone.
Seeing this, Imagawa Ori, who stood to the side, looked somewhat disappointed.
If it had been her, she would definitely have embellished the danger of the operation just now to emphasize her own contribution.
“You have worked hard, Professor Nakamura. The Okawara family will not forget this kindness.”
Okawara Genta’s tense face finally relaxed a little. He took the initiative to extend his hand and clasped Professor Nakamura Hiroshi’s.
……
By the time the patient had been settled in the ICU and all medical orders had been handed over, it was already five-thirty in the morning.
Although his life had been saved, the next forty-eight hours were still the gates of hell. Infection, multiple organ failure, coagulation disorders—any one complication could take the patient’s life at any moment.
But that was no longer under the surgeons’ jurisdiction.
Kiryu Kazusuke leaned against the wall and felt a wave of exhaustion wash over him. The side effect of adrenaline wearing off was extreme drowsiness.
Even though his physical constitution had been slightly enhanced, in the end, he was still human.
“Here.”
Something cold pressed against his face.
Kiryu Kazusuke turned his head and saw Imagawa Ori standing beside him, holding a can of lightly sweetened coffee she had just bought from the vending machine.
“Thanks.”
He did not stand on ceremony. Taking it, he pulled the tab and tilted his head back to gulp down a large mouthful.
The icy liquid slid down his esophagus, jolting his spirits awake.
Imagawa Ori leaned against the wall as well, looking at the tightly shut doors of the ICU in the distance. “A favor from the Okawara family is worth a lot.”
She said this out of nowhere.
Kiryu Kazusuke smiled. “It was all thanks to Doctor Imagawa and Professor Nakamura.”
But Imagawa Ori shook her head. “You were the one who proposed the C-clamp and preperitoneal packing. If not for you, that guy probably would have died on the table before I even arrived.”
She paused, then added, “You did well.”
This was the first time she had ever praised someone so directly.
In her eyes, there were only two kinds of people: useful people, and useless people.
The previous Kiryu Kazusuke had belonged to the latter. Now, he had clearly been promoted to the former—and to the category of “extremely useful,” at that.
“I just got lucky.”
Kiryu Kazusuke shook the empty can in his hand and casually fobbed her off.
He did not want to explain why he knew emergency techniques that were far beyond the syllabus. To explain was to cover up, and to cover up was to start telling stories.
But Imagawa Ori did not press him.
Just as a person buying a kitchen knife would not care about the process by which the knife was made; as long as it worked after being brought home, that was enough.
The two of them fell silent for a while.
Only the humming of the vending machine’s compressor remained in the air.
Kiryu Kazusuke looked at Imagawa Ori’s profile. Morning light spilled through the window at the end of the corridor and onto her face, gilding that cool outline with a soft golden edge.
He suddenly remembered something.
The branching world line about “This Saturday is her birthday; you bought a cake and wished her happy birthday.”
And today was Thursday.
“Doctor Imagawa.”
“Mm?”
“If you don’t mind me asking, when is your birthday?”
“Why are you asking that?”
Hearing the question, Imagawa Ori turned her head and narrowed her eyes slightly as she looked at Kiryu Kazusuke.
In her understanding, when a man asked a woman about her birthday, there were usually only two motives.
One was improper intentions.
The other was to use it as an excuse to give gifts, curry favor, or build connections.
But no matter which it was, it meant trouble.
Kiryu Kazusuke’s expression did not change. He had long expected her to react this way.
“Nothing much.”
“I’ve been studying horoscope divination lately. Apparently, doctors who are Virgos and Scorpios have especially good financial luck today. I wanted to see whether it’s accurate.”
“That’s all.”
“……”
It was an excuse so rotten it could not be more rotten.
But in an era when the whole populace was obsessed with horoscopes and blood types, it could just barely pass.
Imagawa Ori looked at him suspiciously for a few seconds.
In the end, she gave a cold snort.
“Boring.”
“December 24th.”
“I’m leaving. Going home to sleep.”
After saying that, she accurately tossed her empty can into a trash bin several meters away, then turned and left.
Watching her back as she departed with such carefree ease, Kiryu Kazusuke could only feel envious.
The chief surgeon could simply dust off her hands and leave, going home for beauty sleep. As a resident, however, he still had to go back to work.
After returning to the medical office,
Kiryu Kazusuke took a stack of medical record sheets and a black ballpoint pen from the drawer.
Although electronic medical record systems were already being trialed in some top hospitals, in a place like Gunma University Hospital, paper medical records were still mainstream.
Before the morning conference began, he had to handwrite the operative note, progress notes, and transfer records for the emergency surgery just now.
And he had to write them using specialized terminology mixed from German and English.
This was one of the shitty traditions of the Japanese medical world.
The older generation of professors revered German, while the new generation revered English, resulting in medical records becoming this neither-fish-nor-fowl hybrid.
[Preoperative diagnosis: Pelvic fracture (Tile type C), hemorrhagic shock]
[Procedure: Pelvic packing + C-clamp fixation]
Kiryu Kazusuke’s pen flew across the paper.
This kind of mechanical work offered no pleasure whatsoever. It was purely consuming his life.
But he had to write every detail with painstaking precision.
After all, this was Assemblyman Okawara’s son. In the future, this medical record would surely be scrutinized by countless pairs of eyes. The slightest mistake would become a medical dispute.
By the time he finished writing the last line, the sky was already bright.
Seven-thirty in the morning.
People gradually began arriving in the medical office.
Tanaka Kenji walked in carrying his briefcase and came straight over. “Morning, Kiryu-kun. I heard there was a big case last night?”
News always spread faster than a virus.
Kiryu Kazusuke closed the organized medical record folder and rubbed his aching wrist. “Assemblyman Okawara’s son. Fell from a height.”
Tanaka Kenji sucked in a breath. “Doctor Imagawa was the lead surgeon?”
“Professor Nakamura from Second Surgery was there too.”
“Tsk, tsk. What a luxurious lineup.”
Tanaka Kenji smacked his lips in envy.
Being able to show one’s face in a VIP surgery of this level—even if only as someone holding the retractor—would be a heavy stroke of color on one’s résumé.
Kiryu Kazusuke pointed at the thick stack of papers on the desk. “Don’t be jealous. If you want to write these twenty pages of medical records, I can hand them over to you.”
Tanaka Kenji immediately shrank back. “Never mind, then.”
……
Eight o’clock sharp.
From the corridor of First Surgery came the sound of leather shoes striking the floor, dense and rhythmic, like an army on the march.
The professor’s rounds—commonly known as the “daimyo procession”—had begun.
Strictly speaking, today was not Monday, so Professor Nishimura would normally be too lazy to leave her own office.
Firmly controlling First Surgery as she did, she had no need to patrol her backyard every so often.
But today, the hospital had a patient who was an assemblyman’s son.
That made it worth making an exception.
Professor Nishimura walked at the very front, hands clasped behind her back.
Associate Professor Mizutani followed closely behind, his body leaning slightly forward, maintaining a distance of half a step. He held a small notebook in his hand, ready at any moment to record the professor’s instructions.
Behind them came lecturers, specialists, and senior residents. Only at the very end were residents like Kiryu Kazusuke.
The procession of more than twenty people advanced in grand formation, occupying the entire corridor.
When the other patients, nurses, and family members saw them, they all stood against the walls and bowed in greeting, not daring to breathe loudly.
The group headed straight for the ICU.
Although Okawara’s son was under the emergency department’s care, the surgery had, after all, been performed by Surgery. The professor had to personally inquire about him.
The ICU’s automatic doors opened.
Assemblyman Okawara Genta was sitting on a sofa in the rest area with his eyes closed in repose. Seeing Professor Nishimura enter, he immediately stood.
“Professor Nishimura.”
“Okawara-san, thank you for waiting.”
The two shook hands and exchanged pleasantries.
The patient was still unconscious. The ventilator operated in a steady rhythm, and although the waveforms on the monitor were weak, they were at least stable.
“How is his condition?”
Professor Nishimura asked with her hands behind her back.
Before Kiryu Kazusuke could speak, Associate Professor Mizutani stepped forward first.
“Professor, the patient’s vital signs are currently stable.”
“Last night’s surgery was extremely timely. At present, intra-abdominal pressure is within the monitored range, the drains are patent, and urine output is also recovering.”
He spoke with perfect confidence, as if he had personally stood at the operating table last night.
In reality, however, not even his shadow had appeared.
But being able to naturally transform someone else’s credit into the credit of “our First Surgery”—that was his skill.
“The C-clamp was used well. That was a highlight.”
Professor Nishimura nodded in satisfaction.
“Yes. At the time, the situation was urgent, and a decisive call had to be made.”
Associate Professor Mizutani pushed up his glasses and smiled modestly.
Kiryu Kazusuke stood at the very outer edge of the crowd, expressionlessly watching this scene.
This was the workplace.
The residents did the work, the specialists risked their lives, the associate professors claimed the credit, and the professors enjoyed the glory.