Tokyo, 1994, starting with medical training

Chapter 53 Straightening the Bookshelf

After washing your hands.

When the two entered the operating room one after the other, the patient had already been anesthetized and was lying quietly on the operating table.

My right ankle has been disinfected and covered with a towel, leaving only the swollen and deformed ankle joint exposed.

The nurses were taking inventory of the equipment, and the anesthesiologist sat behind the monitor, holding a comic book in his hand, looking somewhat bored.

This is a routine surgery.

There were no important figures involved, and no tense or exciting rescue efforts.

If Imagawa Ori were the lead surgeon, everyone might be a little more on edge, for fear of being scolded.

But the surgeon was Takikawa Takuhei?

Then there won't be any pressure.

They were even chatting casually about the food in the cafeteria at noon.

"Dr. Takikawa, may we begin?"

The circulating nurse glanced at the clock on the wall and urged them on.

She was well aware of Takikawa Takuhei's skill level and knew that this surgery would probably take longer than expected.

So when I left home early in the morning, I arranged for my husband to pick up the children who had finished their winter workshop at seven o'clock.

"Ah, okay, sure."

Takikawa Takuhei walked to the surgeon's position, took a deep breath, and raised his hands in front of his chest.

The operation begins.

He held out his hand, and the scrub nurse slapped the scalpel into his hand.

"Skin it."

Takikawa Takuhei gripped the hilt of the sword.

According to the preoperative plan, the lateral malleolus, which is the fracture of the fibula, will be treated first.

The incision is about 10 centimeters long and runs along the posterior border of the fibula. This step is not difficult, as long as the superficial peroneal nerve is not severed.

His movements weren't particularly fast, but they were well-behaved and methodical.

Kazusuke Kiryu stood in Ichisuke's position, holding two hooks in his hands, responsible for exposing his position.

Watching Takikawa Takuhei's movements, he roughly understood what was going on.

The basics are okay, and the anatomical layers are clear, but the person is too hesitant.

Each incision had to be paused to ensure no blood vessels or nerves were damaged before continuing, which slowed down the surgical process.

"Expose the fracture ends."

Takikawa Takuhei used a periosteal elevator to clean the soft tissue at the fracture site.

Everything is going smooth.

Until he saw that the distal fibula had a long, oblique spiral fracture with shattered ends and a butterfly-shaped bone fragment protruding from the bone.

His hand stopped moving.

Preoperative X-rays are two-dimensional, while the tangled mess in front of you is three-dimensional.

The loose bone fragments became stuck in the muscle, hindering repositioning.

"Periosteal elevator".

He reached for the instruments and tried to pry open the bone fragment.

But he dared not use force.

The distal fibula has poor blood supply. If the dissection is too extensive, the bone fragments will become necrotic and turn into dead bone, leading to nonunion.

But without applying force, the bone fragments didn't budge.

"Tsk."

A fine layer of sweat appeared on Takikawa Takuhei's forehead.

The atmosphere in the operating room became subtle.

The nurses, who had been chatting, stopped talking, and the anesthesiologist put down his copy of Weekly Shonen Jump and looked up at the monitor.

Everyone could see that the surgeon was stuck.

This is very awkward.

It took 5 minutes to cut the skin, and now another 10 minutes have passed since I started staring at the bone.

"Dr. Takikawa, do you need any help?"

The scrub nurse couldn't help but ask, her tone lacking in respect but rather conveying a sense of "I knew it" helplessness.

Takikawa Takuhei blushed.

He wanted to say no, he could manage on his own.

But he really didn't know where to start.

The few words "remove embedded soft tissue and anatomically reposition" written in the book were, in reality, a huge mountain standing in his way.

"Takikawa-senpai."

Just when he was about to despair, he heard Kiryu Kazusuke's voice.

Takikawa Takuhei looked up and, through his fogged-up goggles, saw a pair of completely expressionless eyes.

There was no mockery, no impatience, and no pity.

There is only one kind of calm that brings peace of mind.

Kiryu Kazusuke sighed inwardly.

Takikawa Takuhei is now a typical example of "tubular vision".

They only saw the broken bone and ignored the overall mechanical structure.

It's like a puzzle novice who frantically tries to cram a piece into the wrong place, forgetting to complete the frame first.

Kiryu Kazusuke said, "Stop it, ignore that piece of bone."

Takikawa Takuhei paused for a moment: "But it's stuck. If it's not straightened, the bone won't set."

Kiryu Kazusuke shook his head, sticking to his own opinion.

With his "perfect anatomical reduction of fractures" skill, he immediately spotted the problem.

"Senior, it can't go back because the space has shrunk."

"And the peeler in your hand will only disrupt its blood supply."

"So, we need to change our approach."

"Please put down the peeler and replace it with the dot repositioning forceps."

As Kiryu Kazusuke spoke, he gestured to the scrub nurse to hand over the tools.

Takikawa Takuhei hesitated for a moment, but did as he was told, dropping the peeler into the curved plate and replacing it with a pointed reset pliers.

But he held the pliers, unsure where to clamp them.

Kiryu Kazusuke pointed to the area above and below the fractured bone ends, which is the main shaft of the fibula.

"Senior, imagine it."

"We're tidying up a messy bookshelf right now, and this piece of bone is like a book that's fallen in the middle of the shelf."

"The shelves on both sides are crooked now, making the space narrower, so of course the books can't fit in."

"So it's no use trying to push it."

"What we should do is use repositioning forceps to clamp the two ends of the bookshelf, that is, the upper and lower main bones."

"Once you straighten the bookshelf and align the side panels, the space in the middle will naturally appear."

"That book, which is that bone fragment, is connected to muscles and periosteum. As long as the space is right, it will slide in by itself."

"This is the function of soft tissue hinges."

This analogy is very vivid; it's like common sense that even elementary school students can understand.

Takikawa Takuhei understood immediately.

He stopped obsessing over the bone fragment that was giving him a headache.

He opened the jaws of the reset clamp.

One tip is pressed against the cortex of the proximal fracture fragment, and the other tip is pressed against the cortex of the distal fracture fragment.

It avoided the pulverizing area.

"is that so."

"That's right, now slowly tighten the pliers."

Kazusuke Kiryu affirmed from the side.

Takikawa Takuhei took a deep breath and began to exert force with his palm.

The rack of the reset pliers made a slight meshing sound.

Under the force of the metal clamps, the two main segments of the fibula begin to come together, rotate, and align.

The space that had been distorted by the fracture was reopened.

Click.

A very faint bone-cracking sound vibrated and traveled through the instrument to Takikawa Takuhei's palm.

That is, in this very instant.

The butterfly-shaped bone fragment that had been stuck between the broken ends, which had left him helpless, slid into the gap that originally belonged to it, just like a bird returning to its nest, following the tension of the soft tissue.

Perfectly fitted.

Takikawa Takuhei stared wide-eyed at Jukuno through his goggles.

The spiral fracture that looked like a tangled mess has now been restored to the original straight shape of the fibula.

So... it's reset?

No need for forceful prying?

No need for multiple attempts?

Just by clamping both ends with pliers, the middle will heal on its own?

Takikawa Takuhei was momentarily stunned. His mind, like a runaway high-speed train, derailed with a crash and tumbled into the abyss.

He spent five years in the First Surgery Department.

From Professor Nishimura to Assistant Professor Mizutani, and then to various senior specialists, I've worked with quite a few people.

The seniors always liked to use difficult German vocabulary to explain the principle of repositioning, such as "soft tissue hinge" and "three-dimensional spatial configuration", which left him completely confused.

Once on the operating table, it's often a matter of experience and feel.

No one has ever explained the reinstatement problem that has troubled him for many years with such a simple analogy as Kazusuke Kiryu.

The scrub nurse was also stunned.

She didn't understand the principles of surgery, but she could see the results.

The surgeon who was sweating profusely and messing up the bones just moments before seemed like a completely different person after the trainee doctor said a few words.

It was done so quickly?

She couldn't help but glance at Kiryu Kazusuke again.

Is this really a trainee doctor who runs errands for his seniors at the medical center, buying them coffee?

(End of this chapter)