Nineteenth Century Medical Guide

Chapter 14 14. The Fifth Hand
Whether it's Ignatz's fame, Morazo's identity and illness, or the friendship between the two, they all add a touch of legend to this operation.

The Riverside Theater put out an advertisement introducing the operation two days ago, and the price ranged from 150 crowns for a special seat to 25 crowns for the last row.However, the tickets for public sale are only from the second to the sixth class, and they are sold out within more than an hour, so those who come late have no chance at all.

The so-called special seats of 150 crowns and first-class seats of 90 crowns have already flowed into the hands of royal family members through internal channels.

Once the royal family is involved, things get complicated.

The entrance was full of private carriages, and many people were guarding the entrance of the theater with guards.Because he missed the previous entry time, Carvey had to go through a lot of tossing just to enter the operating room from the gate, and he was allowed to enter after explaining several times.

His admission was in stark contrast to Ignatz's, with no introduction and no applause.It also attracted a lot of attention, but coupled with the tense atmosphere in the arena, it always made people feel particularly weird.

The operation started at two o'clock in the afternoon and has lasted for nearly an hour, and Ignatz's hands are still a mess.If it were placed in the 21st century, I am afraid that the second line would have been called to help.

Carvey has worked in the second and third lines outside the emergency department for more than 20 years, and has saved many operations, but this is the first time for an inguinal hernia.After all, the hernia surgery [100] after more than 1 years has undergone hundreds of improvements, the anatomical location is clear, and the method has long been mature, so there is basically no difficulty.

But that is based on early detection and early treatment of patients and "patches" [2].

Since the mesh was added, as long as the operation is proper, the patient has no underlying disease, and the postoperative recurrence rate is less than 1%. All hernia operations are inseparable from this thing.Especially those young general surgeons, who came to the stage to do inguinal hernia for the first time in their lives, learned the hernia repair with mesh.

If these young people are allowed to replace Ignatz now, the operation may be completed quickly, but the postoperative recurrence rate will still be ridiculously high.

Because of the loss of artificial mesh, there is only one surgical method left, which is forced suture.Modern suturing techniques are naturally not bad, but what really affects the surgical effect is the question of where to "sew".

Given the complexity of the anatomy around the groin, even if the anatomical position of each layer can be clearly recognized from the red and white mass【3】, where to sew is still a matter of experience.Inexperienced people, even if they are proficient in technique and understand anatomy, are still not sure whether their operations can effectively plug the gap, because there are too many combinations to choose from.

"Mr. Ignatz, here I come."

"Um"

Ignatz stared at the operation area, his hands were already covered in two or three layers of blood, and he was still buried in cleaning up his mess.He didn't ask about the results of the treatment of the wound on bed 11. Obviously, the condition of the groin at hand is not optimistic.

Carvey could clearly feel the difficulty of the operation, and Ignatz seemed a little flustered, and his thoughts also entered a dead end under the depressing atmosphere around him.At this time, it is necessary to give the chief surgeon a chance to breathe: "Teacher, do you need help?"

"."

Ignatz froze for a moment, then looked up at Kavey who was standing not far away: "Oh, you are the one who came back."

"Well, bed 11 is finished."

"it is good."

Pulling away his attention for a while, Ignatz relaxed a little: "Which oil did you choose in the end?"

"Flaxseed oil, use it first, wait a few days to see how it heals and then evaluate it," Carvey explained.

"I hope the result will be as you hoped." Ignatz looked towards the preparation area on the side, "You can find a place to watch."

"Oh."

Kavi nodded.

The operation is located in the center of the theater, and this small area is divided into an operating area, a preparation area, and two special seats.

The operation area is where Ignatz and Hills, another surgeon in the ward, stay. The only place Kawei can stand is the preparation area.Because of the conflict with the three interns just now, he could only stand with the two nurses.

The special seats are two high-padded chairs placed next to the operating table in the theater. Because the environment here is really not good, the workmanship of the chairs is a bit rough.But in any case, sitting is always more comfortable than standing upright, and the viewing distance is much closer.

The identity of the person who can sit here can be imagined.

"Doctor Ignatz, how is my brother?"

The one who spoke was a lady sitting on the left hand side of the entrance of the venue, wearing a gorgeous long dress, and the fan in her hand kept fanning away the bloody smell around her: "If I had known it would take so long, I wouldn't have come."

Knowing that she was impatient, the girl sitting in another special seat smiled and smoothed things over: "Wait a little longer, Aunt Elena, Dr. Ignatz will be done soon."

"You've said that three times."

The status of a nobleman is always special. With a few words from the two guests, Ignatz's blood pressure that had just dropped was raised again.

And it didn't end here, Elena was angry about things other than the operation: "I don't know when my son will be able to play, but he has always admired you, Dr. Ignatz."

"Your son." Ignatz looked at the three graduates in the preparation area, "Bergett is indeed a very good medical student with excellent grades. But the operation of the inguinal hernia is not so easy, and the operation on the operating table Lying there is your own brother, his uncle."

"Just say that he is not qualified."

"Madam, you know I don't mean that."

"Well, I didn't say it, but when will the operation end?"

Ignatz sighed, put down the needle and thread in his hand, and replied: "If Madam can calm me down, the operation process will definitely be smoother."

"I never question what you mean, but I just feel that the length of the operation time is related to the assistant." Elena looked at Hills who was opposite Ignatz, "If you change an assistant, the operation will be smoother."

"Madam, my assistants are all excellent, and Hills is a surgeon with four years of clinical experience."

Facing Elena, Ignatz's status as a baron was obviously shorter, and he couldn't say anything clearly, so he could only mention his assistant's status first: "He can even perform amputations by himself, so he is fully qualified to stay On the operating table."

Seeing that she couldn't say a few words to the other party, Elena could only wave to the host at the side, took the freshly made milk tea, and said a few words in a low voice.

Seeing the host running out of the operating room in a hurry, she stopped talking, and the venue became quiet again.

The right to speak finally fell into the hands of Ignatz: "Now we have removed the incarcerated and necrotic intestine, and there were indeed some problems when suturing the two ends of the intestine just now. The suture is very difficult. But the difficulty is only temporary , now the intestinal tube will be sutured immediately."

Hills skillfully took out another needle and thread from the small box and handed it to Ignatz.

Ignatz took over the needle and thread, and continued: "The suturing of the hernia gap is very particular, and there are many tissue structures around it. The selected suturing object directly determines the recurrence rate of the patient after the operation. After the bowel suturing is completed, my assistant and I What Sears needs to keep stitching is."

At this time, the host who had left the stage for a while suddenly ran back.After entering the door, he quickly walked onto the operating table and said in a low voice, "Teachers, the patient in the next room has arrived."

"Is the patient next door yours?" Ignatz looked at Hills.

"Yes, the time for back massectomy is three o'clock." Hills felt strange, "But because of this operation, I specially changed the time. It should be half an hour away."

"Then let him wait."

The host was anxious when he heard this: "I can't wait, the patient is in a hurry to have surgery."

"In a hurry?" Ignatz said, "The only ether available is this bottle, and there is only one inhaler. Give it to him. What if something happens to the count?"

"He said he was in a hurry, so it doesn't matter to use the knife directly. If his business is affected, he will definitely file a claim with the hospital."

Ignatz is not a fool, as long as the amount of ether is controlled, the chance of anesthesia accidents is not high.Surgical patients today are not like 20 years ago. They are already used to painless surgery, and no one would give up anesthesia for half an hour.

He looked at the theater host in front of him who had been his partner for several years, and his gaze quickly followed his flickering gaze to Elena who was sitting in the special seat.

The Earl's own sister is also the Viscountess, and it was too easy to instruct a young theater host to spend a small amount of money to bribe the patients in the operating room next door.Even when she found Ignatz looking at her, she didn't hide it at all.

Elena's purpose is to get Hills to step down and get out.

Ignatz had no choice but to fight against Elena, so he could only help smooth things over: "Now the operation is coming to an end, and my assistant Hills needs to leave for a while. He also has his own operation in the afternoon, and the patient is here. The operating room next door has been waiting for a long time."

After some sparse applause, he could only comply with Elena's request and invite Bergett to the stage: "Let us send Hills away respectfully, and at the same time welcome the outstanding graduates of the Medical School of the University of Vienna, the Municipal General Hospital Mr. Intern Bergett."

He spoke fluently, but his inner struggle could be heard everywhere.

In the eyes of Ignatz, Bergert is not qualified to take the stage at all.But there is no way, who made his father a viscount.

"Can you stitch?"

"I practiced in the dissection room of the medical school." Bergett was a little excited, but he didn't expect to stand in the position of Ignatz's assistant on the first day he came to the hospital. Hold the suture, pinch under the knot, and then..."

"Okay, it's meaningless to say these things, follow me."

"Oh, I see."

The whole process of the substitution was watched by Kawei, but to him, it didn't matter.

Now he is just an extremely ordinary surgical apprentice. He is not qualified to be on stage, and he has no envy for his position on stage.

In addition, inguinal hernia surgery itself is not very dangerous. Even if Ignatz makes a wrong stitch, it will at most increase the recurrence rate.That's nothing in a hospital where wound infection rates exceed 60 percent.

So from the very beginning, Carvey never thought about going on stage. He just came here to see how the surgery in the [-]th century was done, and then feel the atmosphere of the theater to prepare for the future stage.

Unexpectedly, there is intestinal incarceration necrosis [4], which was an extremely difficult problem to deal with in the nineteenth century.Ignatz needed to cut off the necrotic intestine and then suture the stump, which was much more difficult than the operation performed by Cooper before.

If it is not cut, the necrotic intestine will definitely cause the patient to die of infection and shock.

If it is cut, the chance of poor intestinal anastomosis after operation is almost [-]%. Adding the large amount of subcutaneous fat in the groin and wound infection, Carvey feels a headache when he thinks about it.

"Don't wading in muddy water" has always been the motto of surgeons when they are wise and safe. Now that the situation is so special, he has not yet gained a firm foothold. There is no need to be a shit stick for a patient. Once he makes a mistake, the consequences will be disastrous.

But the development of things is always beyond everyone's expectations.

Just when Ignatz thought the operation was coming to an end, Elena thought she had achieved her goal, Bergett thought she had gotten her dream opportunity to be on stage, and Carvey thought she had watched a surgery for free.

A big black-haired hand protruded from nowhere on the operating table, and slapped it on the surgical incision.

"Ah, the Earl is awake."

(End of this chapter)