Nineteenth Century Medical Guide

Chapter 151 148. A good suggestion is a suggestion that suits the other party's ability
[Work is a bit chaotic recently, my daughter has just started school, the update frequency remains the same, but the release time will be unstable]

Uterine prolapse is caused by the weakness and relaxation of supporting tissues around the uterus. According to the conventional thinking of "fix whatever goes wrong", shorten the elongated ligaments, which will fundamentally improve the degree of uterine prolapse.

The ligament reduction mentioned by Denever will be effective as long as it is successful, and the reconstruction of pelvic floor function based on suspension surgery is considered a more advanced version.

But because the recurrence rate of uterine prolapse is very high, as long as the lower yd opening is still there, the uterus may still protrude out.Simple ligament reduction cannot completely solve all problems, and the difficulty of pelvic floor reconstruction is very high.

So far, neither of the two conventional ideas can be realized.

Since the conventional method does not work, Carvey gave his own suggestion based on the principle of getting rid of the person who caused the problem if he could not solve the problem: "Or you should cut off the uterus, anyway, the patient has gone through menopause and cannot bear children. "

Hysterectomy is also a common surgical method to solve uterine prolapse in modern times. For women who have gone through menopause, the ovarian function is reduced, and the uterus loses the most important reproductive function.The other function of maintaining the stability of the organ also disappeared due to its prolapse.

So for these patients, hysterectomy can basically cure the prolapse without changing the daily life too much.

If it was Carvey, he might not consider any ligament reduction or suspension at all, and a hysterectomy would be planned from the beginning.

However, even if the existence of the uterus has lost its original meaning, the patient's consent is still required before the operation.In the preoperative conversation, it is also necessary to explain the possible problems after resection to the patient, and then make a decision.

Bessim and Denever certainly hadn't talked, because in this day and age the doctor's choice of diagnosis and treatment has nothing to do with the patient.

Patients do not have the right to informed consent, and doctors can "do whatever they want" as long as they are on the operating table.Of course, any chaos will be seen by the audience, and it will immediately affect the reputation of the surgeon.And any highlight moment will follow the same path and be reflected in the eyes of every audience.

Hysterectomy was not difficult for Carvey, but it was much more difficult for Denever and Besim.

Now the prolapse of the pelvic tissue has changed after a long period of stretching, the technique of resection must be different from the original, so the difficulty of the operation will not be much worse than yesterday's pelvic adhesions.Even Olgi, who has decades of work experience, can't do the surgery. The two of them definitely can't do it.

Denever is very confident in his medical skills, but he still shook his head when he heard "hysterectomy": "This operation is too difficult. I don't have the ability to cut it, and Mr. Besim probably doesn't have it either."

"Hysterectomy, there are very few doctors in Vienna who have done hysterectomy, and the ones who can do it here are Dr. Carvey and Dr. Olgi."

Unlike his own students, when Besim heard "hysterectomy", another scene flashed in his mind: Carvey got off the auditorium amid the applause of others, walked to the operating table and took the seat of the chief surgeon , and then easily ended the complicated operation that made everyone suffer.

Besim acknowledged Kavey's strength, but did not allow others to intervene without authorization.

So after Carvey proposed hysterectomy, he thought that the young doctor wanted to help on stage, so he quickly refused: "Since the patient belongs to the gynecological ward of Graze Hospital, I still hope that we can complete the operation by ourselves. Hysterectomy is too dangerous. , I think it is enough to solve the bilateral broad ligament and cardinal ligament to achieve the purpose of surgery."

"In that case." Carvey didn't think so much, and immediately gave a second suggestion, "It's okay not to cut off the uterus, just close the vaginal opening directly on the basis of the ligament reduction."

In just two to three minutes, Carvey changed his mind again.

If you can't solve the problem, and you can't solve the person who created the problem, then get rid of those who are helping.What Carvey means is to seal off the path of prolapse and hide the uterus in the pelvic cavity forever.

The method is good, in fact, there have been similar treatment methods long ago.

"Is it just a simple suture?"

"Can this support the uterus?"

"Everyone, what I'm talking about is definitely not a simple suture." Carvey explained, "Next to the prolapsed cervix is ​​a thickened vaginal wall. You only need to take out a piece of square mucous membrane at the upper and lower ends, and push the cervix into the body. , suture the two mucous membranes together to form a perfect shield.”【1】

"."

The abstract text description made everyone present unable to react immediately. After thinking for a long time, many people still took out the pen and paper and began to use images to deepen their understanding: "Dr. ?”

"Yes, cut out a piece of mucous membrane, and the end is connected to the wall of the vagina." Carvey took Olgi's notebook beside him, "It's like turning over a piece of paper, turning over one piece at the top, one piece at the bottom, and turning back in the middle. Push it, and then the sides are sewn together to hide the middle page."

".I see."

"Great idea!"

"The thinking is too clear, how did you come up with this???"

This is actually a very traditional yd closure surgery, mainly aimed at those elderly patients with uterine prolapse who cannot withstand abdominal surgery, and it can be regarded as a product of compromise.Since it is a compromise, there will be shortcomings, and the shortcomings of yd closure are obvious.

"The patient is only 53 years old, and menopause does not mean that he has no sexual life, so the operation needs the consent of the patient." Carvey said, "Besides, this is a yd-operated operation, and the two of you still need to practice, and you will definitely not be able to do it today. You might as well wait for the patient to recover for a period of time after surgery, you can ask her for advice, and at the same time, you can do more exercises yourself."

The operation is not complicated. It is much easier than total hysterectomy, but it is more difficult than ligament reduction. It is a new challenge for Besim and Denever.

This is a suggestion given by Carvey after consideration.

If the general surgeon with seven or eight years of experience in surgery like Hills stood in the audience, then Carvey would definitely not propose uterine closure, and might let him try a total hysterectomy.

If it is Olgi who has some experience in pelvic floor surgery, Carvey will suggest that on the basis of hysterectomy, he should be recommended to perform fold reduction repair of the anterior and posterior walls of the loose yd.

If the main surgeon becomes the more successful Ignatz or Watman, then Kavey will go a step further. Suspension of the uterus + complex pelvic floor function repair will be a good challenge for them.

There is no universal surgery in the world, only the one that suits the patient is the best. This sentence also applies to doctors who are climbing the peak of surgery.

The operation ended quickly on Carvey's suggestion.

The whole process is simple and lackluster, and Carvey can't find any bright spots.But for these two novice surgeons, the operation can be said to be quite successful, at least the patient's uterus was indeed retracted into the abdominal cavity, and the prolapse was greatly improved.

As for what the patient said after waking up, he was not interested in the content of the operation talk, and the compliments from the people around him, so he left the theater after the operation.

At two o'clock in the afternoon, Carvey just walked out of the gate of Graze Hospital, and wanted to quickly return to the medical school, and then plunged into the laboratory to find out the active ingredients of the two bottles of herbal medicine in his hand.I never thought that as soon as I opened the car door, I was stopped by the young man behind me: "Dr. Carvey, I finally saw you."

It was Amor Godwin, a surgical assistant at Graze Hospital who wanted to learn anesthesia techniques, oncoming him.

"Mr. Amor." Carvey stopped, greeted the driver, took him to the side of the road, and asked, "Why didn't you go to the operation just now? I thought I could see you."

"Surgery?" Amor shook his head, "I've been too busy with work recently, so I don't have time to go to the surgery."

"Aren't you an assistant?"

Carvey has also done this kind of chores, just some repetitive and simple tasks.In fact, Amor was similar at the beginning. He could finish his own work and then increase his clinical experience by watching the operation.

But today is different.

"Recently, an assistant was removed by the army. Sears and Lockard also need to go to the military political department and the military medical committee frequently." Amor couldn't tell, "I'm the only one doing odd jobs in the whole surgery now. Didn't Teacher Olgi ask me to go shopping again just now?"

"buy what?"

"The ureter-lined copper tube you used yesterday." Amor took out a sample from his pocket, "He said to prepare ten tubes first, and buy more after you get used to it."

"I just came up with an emergency solution." Carvey was very troubled by this follow-up operation. "There is no way to prove the impact of the copper pipe on the human body, and the pipe itself has no support, and it will leave its original position at any time." , it’s actually not safe.”

"Not safe?"

"Maybe it will get stuck in a narrow position [2]," Carvey explained. "It's okay if there is no incarceration. Once incarceration or extrusion occurs, it will also damage the ureter wall. After a long time, the copper will also be damaged." It will be oxidized, and whether it can remain unobstructed at that time depends entirely on luck."

"This..." Amor immediately wrote down this passage in his notebook, "I'll tell Dr. Olgi when I get back."

"Don't think about Olgi, think about yourself." Carvey sighed, "Think about why you are an assistant?"

Every intern or assistant who is willing to be a low-level labor force has the determination to become a real doctor, and so does Amor.What he was looking for was never the poor salary of 30 crowns per month, nor was it for a stable job, but the ability to stand alone on the operating table.

"I want to be on the operating table, but now there are too many chores, and there is no chance at all."

"I can give you a chance." Carvey said, "As long as you are interested, I will teach, including the anesthesia I talked about in the last letter."

The failure of anesthesia is a scar in Amor's heart. Now the number of assistants has dropped sharply. Considering the number of surgical patients and the probability of anesthesia accidents in Graze Hospital, this scar will soon expand.If you want to heal scars, you have to standardize the anesthesia process.

This rhetoric is equivalent to digging the wall. Thinking about the scene when he entered the surgery theater for the first time, Carvey seemed familiar.

Amor has concerns about poaching.Originally, Amor was the only surgical assistant left. If he was dug out, Olgi would be in a situation where no one could use him: "This is not very good."

"Sometimes they should also be given a taste of the working people at the bottom."

Amor's standard of living is slightly better than that of Carvey before him, and he is not eligible for unemployment at all.What's more, Graze Hospital had signed a contract with him, and if he breached the contract, he would have to pay a large amount of liquidated damages.He didn't want to pay liquidated damages, and he didn't have the money to pay at all, and Kavey didn't want to pay at all.

Carvey doesn't value money, and life is simple and doesn't cost much, but if he pays a lot of money out of nowhere for no reason, he will be very depressed: "Otherwise, anyway, my surgery frequency is low now, and it's okay for you to come here temporarily to be an assistant." It won't take much time."

"Is this really possible?"

"sure."

"I'm afraid Mr. Hills will scold me to death."

Carvey didn't have time to chat with him, so he took a note and stuffed it into Amor's hand, and opened the door of the carriage again: "This is the time for my next surgery, if you are interested, come to me one day in advance , I will ask you to come on stage as an assistant."

Amor is just an undergraduate graduate of a non-local medical school. He was not favored by the professor to continue his studies, and his own ability is very average.And this shortcoming is even more obvious in Graze Hospital, which is full of graduates with master's and doctoral degrees.

If nothing else, he will need another three to five years before he can become a regular with the help of Olgi.By then, he would at least be able to hold a scalpel himself and perform simple operations such as excision of superficial tumors and suturing of wounds.

Of course, in addition to this step-by-step promotion path, there is also a more efficient way, which is to become a military doctor and go to the front line.

Working in the military's logistics hospital can not only earn military merits, but also see a large number of surgical operations, which greatly improves one's technical and theoretical knowledge.It's a pity that Graze Hospital is currently short of manpower, and they don't want to let go at all, so Amor can only stay in the hospital and continue working.

Carvey gave him a chance, any more would be too much, and he didn't want to make the relationship deadlocked.

Suddenly the coachman knocked on the glass window behind him: "Dr. Carvey, the road ahead is blocked by the police. Why don't you just get off here. The gate of the medical school is not far away."

"police?"

Carvey opened the car door, and the tense atmosphere rushed over immediately.

The University of Vienna is located on the busiest street, and it is still lively here, but there are many policemen wearing tall hats and holding guns in the crowd.

Passing carriages were stopped by them for interrogation one by one, and pedestrians were sometimes randomly checked.Among these police officers were some plainclothes men who behaved strangely. They stood scattered on the corner of the street, with the brim of their hats on their heads pulled down, smoking cigarettes and scanning everything they could see.

Carvey just took a look and smelled a sub-Mick.

"What's the matter?"

(End of this chapter)