Nineteenth Century Medical Guide

Chapter 17 17. Focus
Carvey has indeed passed the age when he needs to show off his abilities too much to reflect his value. Years of clinical work experience have allowed him to develop the habit of doing risk assessment in advance.Facing the inguinal hernia in the lower right abdomen of Moraso, after repeated evaluation, he chose to keep silent.

This is the result of the superposition of many factors. From the moment he stood on the operating table, this question has been swirling in his head: Should I help Ignatz with hernia suturing?

The first thing he thought of was the purpose of the operation.

Surgery is an act of destroying the patient's body tissue. Every cut must have a purpose, and the benefits of every cut should exceed the cost of destruction.The nature of the operation in front of him has changed since Ignatz's scalpel opened Morazo's groin.

There is an essential difference between ordinary irreducible inguinal hernia and intestinal incarceration necrosis.

In the former case, the intestinal tube is good, and only need to release the adhesions to bring the protruding intestine back into the abdominal cavity. The focus is on tightening the hernia suture, and the goal is to restore the patient to health.In the latter case, the intestinal tube has been necrotic, and the necrotic intestinal segment must be cut. The focus is on the anastomosis of the broken ends of the small intestine, and the goal is to keep the patient alive.

The case of Morazo is the latter. Even if the intestinal anastomosis is eliminated, the surgical goal is basically achieved. The hernia itself is not life-threatening, and if it is stitched wrong, it will only recur.

The second thing he has to consider is the suturing technique required for the operation.

The reason why Carvey was able to put forward his own opinions during intestinal anastomosis is because the intestinal anastomosis technique was mature 20 years ago, and it has been recorded in various surgical books.He is definitely not able to perform surgery with a small assistant, but it is not surprising that he has read a few books.

The reason why Ignatz made mistakes in stitching was due to his status, proficiency and the cooperation of his assistants.

Compared with intestinal anastomosis, the hernia gap suturing technique in this era is a blank. Regardless of the technique or the needle insertion position, it is very different from the repair technique with a recurrence rate of less than 15% created by Dr. Bassini more than ten years later [1].

Kavey's ability is definitely no problem, but the timing is not yet ripe.

It is really shocking that an assistant who has not even read a book and has just been on the operating table for the first time can speak out a set of suture techniques that can be applied to modern times.He must have a process of practicing and summarizing, so as not to arouse suspicion.

Finally, and the most troublesome point is disinfection.

Even if Carvey did risk the Bassini repair, and Ignatz did take his advice, the patient would still have to deal with a lottery of wound infections.Bacteria do not select their gathering places based on surgical suturing techniques. No matter what suture is used, they will encounter infection problems.

Instead of arguing for a while now, it is better to let it go for a while, and then perform a second operation on Morazo after the surgical disinfection is completely resolved.

Of course, all of this has to wait for Moraso to fully recover, and what Carvey has to do is to do his best and obey the destiny.

After combining these factors, he chose to shut up.

With the help of Kavi, Ignatz was in a brave state and quickly completed the gap stitching, and the follow-up took less than 15 minutes.

"The suturing is over." Ignatz was like a king who was all alone, narrating the last part of the operation like the audience around him, "Then just stick the skin on both sides of the gap, and it's over!"

At 15:45, the nearly two-hour operation finally came to an end in the shock of Kavey.

Ignatz naturally received full applause and applause, and became everyone's focus.Even those colleagues who attacked each other and were jealous of each other left the table one after another, politely expressing the most basic congratulations that a gentleman should have.

"This operation definitely has a special meaning!"

A shout from the audience shocked everyone present: "Not only did the suturing speed of the second intestinal anastomosis break the record, but the length of the operation itself has also broken the record in the Austrian surgical field. "Vienna Daily" will publish it tomorrow Its whole process, those readers who are used to your amputation reports, will definitely be interested in this operation!"

It was a daily reporter who spoke, and Ignatz has always been a frequent visitor to the headlines of this newspaper.

The media is the most powerful weapon for spreading prestige, and Ignatz knows this well: "Thank you, Mr. Varela."

"Tomorrow's daily newspaper will be very popular again. I'll just go ahead and see you next time, hahaha."

After seeing such a thrilling operation, no reporter could stop the storm of words in his mind, and every finger of Varela wanted to vent them on the buttons of the typewriter for the first time.

"He is such a guy who has nothing to do and can't get up early. I saw him almost falling asleep in the first half."

"He's justified in being excited."

"Tomorrow's newspapers will pass on this grand operation to every citizen of Vienna, and then it will spread to the whole country and even the whole of Europe through word of mouth, and even the other side of the Atlantic will know about it."

Several colleagues focused their eyes on Ignatz again, their faces were calm, but their hearts were equally excited.Because this operation indicates that as long as the suturing speed catches up with Ignatz, the current anesthesia technology can support surgeons to complete complex abdominal operations.

Regardless of postoperative infection, at least the operation can be successfully completed.

"Thank you for your support." Ignatz bowed again, thanking the peers and audience around him, "Next time I will show a set of long metal tubes [2] designed by myself, which are used to treat refractory urethra Narrow, should be able to help solve."

"New equipment? Where is it?"

"The design drawings were just finished a few days ago, and I'm already looking for a company to make them."

"So it's not finished yet." These people didn't have much enthusiasm for unknown equipment, and quickly shifted their focus, "By the way, what's the name of your assistant?"

"Oh, it's Kavi, Kavi Hines, my new apprentice." Ignatz replied casually.

"Medical school graduates? How come I've never seen them before."

Ignaz glanced at Elena who was still caring about his son on the sidelines, but just smiled and didn't answer directly.However, this brief evasion quickly pushed the problem to a direction beyond his expectations.

"How much do you pay him every month?"

Suddenly a strange question popped up, making Ignatz puzzled: "Why are you asking this?"

"Just asking casually, our hospital apprentices receive a weekly salary, 3 crowns a week in the first year, and then increase year by year, what about you?"

Ignatz was taken aback for a moment, then looked back at Kavey who was packing up the surgical instruments in the preparation area, and suddenly found that two guys had already secretly left him to find him.These two people also asked about trivial matters in daily life, such as whether there is a place to live, how is the food, and then wages.

ask wages again
What on earth are they going to do! ?

Suddenly Ignatz realized the real purpose of these people: "Don't go too far, he is my assistant!"

These people are colleagues, and they are Ignaz's competitors. They replied unceremoniously: "You are really stingy, and you exploit young people like this. Seven kronor a month, this income is comparable to that of maids who live and eat. Even lower [7]!"

"It's okay, Mr. Carvey, your hard days are over." A surgeon in a gorgeous long cloak took Carvey's arm and said with a smile, "Since you haven't officially signed a contract with the Municipal General Hospital Contract, Groz Hospital is willing to pay double salary to invite you to work in the surgical ward."

How could Ignatz bear it when poaching someone in front of him: "Hey, I haven't left yet, don't you take me seriously?"

"No, twice the salary is not enough. St. Mary's Hospital is willing to pay three times the salary to invite you to work in the surgical ward."

"Harrods Hospital Willing"

"Enough of you!!!" Ignatz suppressed his anger, "Please allow me to reiterate, he is my assistant, the surgical talent I discovered! And he is under 21 years old, and he is not an adult, there is no way Sign the labor contract."

"No, no, you forgot one thing."

"What? What's the matter?"

"According to the newly promulgated "Underage Labor Protection Law", as long as he is 15 years old, even if his parents are not around, Mr. Carvey himself has the ability to sign a labor contract. Since we have not signed it now, we have the freedom to invite him. At the same time He also has the right to participate in the choice."

"Indeed, everyone competes reasonably."

Ignatz lost his voice. At this time, he recalled the assistant work that Carvey had done just now, and it was indeed very beautifully done, without any novice feeling.He has no reason to give up this good seed, not to mention spending hundreds of kroner in order to win Kavey to his side, which is all money.

But the situation is not optimistic.

Not having a contract is flawed, and it needs to be reviewed by the dean before, so there is only a verbal agreement with Kawei.A verbal agreement has no legal effect. Facing the temptation of money, he would be swayed if he changed it. The salary of 7 crowns is indeed too unreasonable.

Just when Ignatz regretted it, Carvey didn't hesitate, as if he didn't care about the income: "I just want to find the best surgeon in Austria, is the best surgeon in Austria Mr. Ignatz? "

This is a very acute question.

In modern times, the quality of a doctor still depends on scientific research strength and some prestigious titles, but at the beginning, surgical technique and speed were the best criteria.

Whether it is the number of surgical records created or the patient's postoperative survival rate, Ignaz has overwhelmed them. Coupled with today's two new records in the field of abdominal cavity, it all proves that he is the best surgeon in Austria.

Seeing everyone's silence, Carvey smiled and said, "I just want to be with the best surgeon. The 7 crowns I just mentioned are actually just the starting salary, and I will make adjustments based on performance later."

"So it is."

"Your performance just now is worth 20 crowns."

"Oh, there's no play, let's go."

As soon as the doctors left, before Ignatz could open his mouth to explain, Elena walked over and said, "Doctor Ignatz, you have succeeded again, congratulations, and I hope my poor brother It can survive the festering period of the postoperative wound.”

"I will come to my house for a check-up every day. The earl is also strong enough, so there shouldn't be any problems."

"I hope so."

Elena was very angry at Bergett's resignation, and she was also angry at Ignatz's verbal provocation.But no matter what, this operation that no one in Austria would touch was successfully completed, and she had to thank him for her brother: "I also hope that Dr. Ignatz will mention more about my son in the future."

"That's natural."

Elena sighed, and then looked at Kavi who was standing beside her: "How old are you?"

"Me?" Carvey replied. "Seventeen."

"You're really young, younger than my son." Elena didn't say anything, and turned her gaze back to her son, "Bergett, remember to go home early."

"Um, I'm afraid I won't be able to go home on time tonight." Bergett said awkwardly by the bedside of Moraso, "Hans invited us to a banquet to appreciate his latest masterpiece, maybe it will be fun. later."

"Hans? Hans Shriarty?" Elena asked.

"Yes, he is now the most famous painter in Austria."

"All right."

As the flow of people slowly dispersed, cleaners entered the venue one after another and began to wash the blood on the ground.

The sound of brushes rubbing against the wooden floor made Ignatz completely calm down, and he recalled his picture book again.It was an anatomy enlightenment book. There were a lot of operations but they were all superficial, without recording the main points of Lembert's suture.

It may be that the memory has overlapped, and the content of other books has been confused with my own book.

"Carvey, why don't I remember writing this passage in my art book?"

"Huh?" Carvey was stunned and asked, "What are you talking about?"

"The seromuscular layer needs to be aligned during intestinal anastomosis."

"Didn't you write it?" Carvey started to play dumb, as if he didn't care about it, "Maybe it's connected with previous memories. I do remember that this content was written in a surgical book."

"Have you read surgical books before?"

"Oh, my dad was working as a surgical assistant in Lombardy at the time, and there has always been this kind of books at home, and now it belongs to Italy [4]." Carvey was a little embarrassed, shaking his head and said, "Damn Italians."

Carvey never mentioned his life experience, and Ignatz didn't want to delve into it.

Kawei's strength far exceeded his expectations, and half of the credit for the successful completion of this operation was also due to him.Thinking of what Carvey said just now, and the extremely shabby 7 crowns, Ignaz was a little embarrassed: "Today, you have such a performance on the stage on the first day, you should be praised."

"Thank you, I will continue to work hard."

"No, what I'm talking about is not the praise that floats on the lips, but the material reward." Ignatz asked, "What do you want?"

(End of this chapter)