Nineteenth Century Medical Guide

Chapter 171 168. Postoperative Aftershock (4)

For Carvey, who had met King Franz several times, the banquet in front of him should not become a big scene that he couldn't handle.But the difference is that at the beginning, the focus was on other people, and he was happy and quiet, but this time it fell on himself.

The voice of praise has been heard endlessly since the pre-dinner soup was served. After working for so many years, Carvey has heard too many. Except for the different languages ​​and some changes in wording, the general meaning is the same.

It's nothing more than hard work, youth and talent, and so on. He has long been tired of it.

Perhaps at the beginning stage of practicing medicine, it could be the motivation to continue studying and working, but after a long time, this kind of templated praise became less and less important in Carvey's heart, and finally he completely threw it out. outside the scope of

At his stage of ability, his own evaluation is the authority, so his own approval is more important, which is commonly known as self-esteem.

In the eyes of people in 1866, radical mastectomy was a brand-new treatment method that had not yet been proven. Everything was an attempt, and the success of the operation itself was already remarkable.But in Carvey’s eyes, radical surgery has long been eliminated by modern medicine (the reason for the elimination is mentioned above), and success is no longer the criterion for measuring true success.

There is no reasonable radiotherapy and chemotherapy, and radical surgery may take a long time.

The operation was rushed from confirmation to implementation, and the result was good, but Carvey was not satisfied.There is still room for adjustment in the details of the operation, and there is still room for improvement in many operations.

"Second course, appetizer, royal pheasant roll and fresh deep-sea oysters."

The servants took away the soup plates one by one and replaced them with appetizers. Alphonse, who was standing by the table, was very excited: "The thickest chicken breast slices are used for low-temperature cooking, and they are served with pea puree and mushroom granules. The oysters are even more delicious." Needless to say, it was just shipped from the train today, so freshness is guaranteed."

"Mr. Alphonse's craftsmanship is still amazing." Edward cut a large piece of chicken and put it in his mouth, praised, "It makes me feel like I am in the Palace of Versailles in the 17th century."

"Thank you for the compliment."

Carvey lowered his head and cut the chicken. While they were discussing the delicious food, his mind was thinking about some details of the operation.

No matter how you look at it, the radical operation just completed is inconsistent with the concept of minimally invasive surgery in the 21st century, and the incision is too large.Especially when the upper edge comes to the front of the armpit, this is the location of a large amount of venous return in the upper limbs. Cutting here may cause upper limb edema.

Is it possible to make the incision smaller, for example, only make a horizontal incision, avoiding the front of the armpit.

It seems that it will affect the vision of the armpits, but in fact, after removing the mammary glands, the space becomes wider, so it should not be too troublesome.

Speaking of incision selection, in fact, when suturing at the end of the operation, Carvey also saw some small flaws in the incision alignment.After all, he is not an expert in breast surgery. This is the first time he has encountered this kind of surgery, and he is not skilled enough to grasp the space under the skin after mastectomy.

The incision design requires the accumulation of a lot of clinical experience, and there is no shortcut
"Doctor Carvey, is French food to your liking?"

"Well, it's very delicious. I haven't eaten Mr. Alphonse's craftsmanship for a long time." Carvey cut out a large piece of oyster meat with a knife, mixed it with olive oil and red wine vinegar, and quickly put it into his mouth, chewing After swallowing it, "the taste is crisp and delicious."

"It turns out that Dr. Carvey has been to Rosh Shuat Restaurant before."

Carvey looked at Alphonse: "It's also a kind of fate, the kind on the operating table."

The experience of abnormal postoperative pain made Alphonse couldn't help but tense: "Dr. Carvey's technique is really superb."

Carvey took a sip of the wine and said with a smile: "Mr. Alphonse, you must pay attention to your health. If you find that it relapses in the future, please come and see it. Don't delay."

"Recurrence? Don't, don't, the operation is too painful." Alphonse waved his hands again and again, "At that time, it felt like being forced apart by a dozen small knives."

After hearing this, everyone was in an uproar: "Is it that serious?"

"Didn't you drink ya tincture? I heard it can relieve pain."

"It's useless! I feel that the postoperative pain has exceeded the scope of the medicine." Alphonse described his experience vividly, "It only took two hours, and the sweat on my body could soak a hospital gown. "

"terrible."

"Actually, it's because of the special location of the operation, but now I have a new drug in my hand, which can guarantee that I won't feel any pain within half a month after the operation." Carvey mentioned methylene blue, "especially for Alphonse's disease. Very applicable."

Half a month happens to be the recovery period after hemorrhoid surgery.

Within 24 hours after the operation, the patient's pain will be extremely severe and almost unbearable. Modern pain relief pumps can relieve a lot.And in the long recovery period that followed, because of the complicated environment in the anus, every dressing change must be thoroughly disinfected, coupled with the rough gauze, the sour feeling can be remembered for a lifetime.

However, in fact, in the 19th century when there were no local anesthetics, any movement that could affect the sphincter would cause unbearable pain.

Defecation, wiping paper, daily walking, even coughing and sneezing can make people shiver with pain.And this kind of pain is not linearly related to time. Five or six days after the operation, part of the scar at the incision of the anal canal will fall off, and when you have a bowel movement, you can return to the tragic 24 hours after the operation.

Alphonse still shook his head: "Let's go, I don't want to lie in bed for another half a month."

"Oh? I didn't expect that Mr. Alphonse is also a patient of Dr. Carvey. I don't know where the incision is? Can you show us?"

Edward didn't know the location of the previous operation, so he said something casually, which caused Alphonse a burst of embarrassment.But the words were all out of the mouth, so many pairs of eyes on the table were looking at him, and he definitely couldn't avoid it: "The location is a little. Well, it's rare for you all to have a meal together, so I won't affect your appetite."

After that, he quickly left the restaurant.

"This"

"Mr. Ambassador, what he's doing is hemorrhoid surgery."

Carvey wiped his mouth with a napkin, and told the truth lightly.Everyone looked at each other in astonishment, and after a moment of hesitation, they couldn't help but burst out laughing
The dinner was a traditional French meal. The interval between dishes was 15 minutes, and the total time was basically about three hours.This not only gives the diners enough time to communicate, but also gives the kitchen time to fully prepare.

"For the third course, I chose the combination of eel and salmon, charcoal grilled eel and wild salmon baked in golden yellow sauce, and served with seasonal vegetables."

When Alphonse brought out these two bowls of fish dishes, several people were still laughing: "I'm really sorry, we shouldn't laugh at a patient like this. But, but I can't help it!"

"Okay, everyone, let's eat it while it's hot." Alphonse briefly introduced the fish recipe, "I'll spend more time on the main course, about 18 minutes apart, please wait a moment."

"It's okay, follow your rhythm." Edward sent him away, and then asked the servant beside him, "Where is the evening paper?"

"It's in the living room."

"Go and get them all, I want to have a good look at them."

"Yes."

Since it was a celebration banquet to celebrate the success of Dr. Carvey's operation, how could there be no newspapers to add to the fun.It's a pity that the operation ended too late, and the interview time was greatly postponed for the sake of security. The newspapers were more concerned about the expectation of the operation.

"A lot of pages were spent on Justina." Edward looked at the daily newspaper and shook his head. "There is no description of the surgeon who really needs attention."【1】

"Maybe it's to introduce the importance of patients."

"The Countess is the daughter of Marshal McMahon, but what does it matter?" Edward Carvey complained, "If you really want to introduce her, you can create another article on another page, why bother to take the lead here. "

Although the words are good, Carvey understands why Varela wrote like this.

The reason is simple, because like Ignatz, he has already become a frequent visitor to the headlines of daily newspapers.People who often read surgery reports are familiar with Carvey, and the report on Carvey's recent situation is far less eye-catching than the report on the French Countess.

This is also an important foreshadowing for detonating the result of the operation. No matter whether the result of the operation is good or bad, as long as Justina's foreshadowing is done enough, tomorrow's newspaper sales will not be bad.

Carvey didn't point out this reason, because he believed that these people who could climb to such a position in the political whirlpool in front of him would not miss this point: "It's just newspapers talking nonsense."

However, Edward and the others seemed to be more than satisfied. After putting down the daily newspaper, they immediately looked at the Times and the Free Press sent by the clerk: "Don't worry, there are even more outrageous things. The Times wrote 'breast resection' as 'chest resection', From the beginning to the end, the names of the two chief surgeons were not even mentioned!"【2】

"The free press is even more exaggerated, even refuting the legitimacy of breast cancer removal???"【3】

There was a heated chat at the dinner table, but Kawei was not interested.

With different circles, the angle of viewing things and the choice of opinions will naturally be different. Even if the report seems a bit amateurish, it’s okay, after all, doctors are not very professional.Moreover, this is an extremely common trivial matter in the 21st century, and it will be relieved after a few years of clinical experience.

What Carvey really wants to do is to review the operation.

Looking at the fish bones on the plate, he thought of the location where the muscle was cut at the end of the surgery.

When the pectoralis major and pectoralis minor muscles were removed during surgery, the cutting point was too far from the root of the tendon.Although it has little effect on the operation result, it still brings unnecessary bleeding to the patient.Wouldn't it be better if the cutting point was leaned closer to the tendon?

There are also many vein branches under the pectoralis minor muscle, is the separation not enough?
If it is done again, will the degree of separation accidentally injure the lower vein and cause bleeding?

Also, I just thought of changing the position of the incision. Although the surgical field has not changed much, have I forgotten that there were no shadowless lamps in the 19th century?The light from the candlestick cannot reach the depth of the incision, so an anterior axillary incision is still required to expose the armpit
Carvey thinks a lot, and he will carefully analyze what flashes through his basic ideas, and then move on to the next one.

At this time Edward suddenly threw out a sentence: "Although saying this will attract a lot of criticism, as a Frenchman who has been working in Vienna all year round, I still have to express my dissatisfaction. Vienna is indeed a great enough city to be called It’s an art capital that rivals Paris. But it does a poor job of supporting surgical technology.”

"Yes, if it is in Paris, France, if it is a master surgeon like Alfred Virpeau." The clerk stepped forward in time and added details for his superior, "Paris newspapers will never would have been so hasty about the content of his surgery."

Edward slammed the copy of Liberty News on the table lightly: "It's so annoying! It's no longer the Middle Ages, and surgical technology is also a part of art."

"really."

"The ambassador was right."

"If a surgical genius like Dr. Carvey appeared in the French medical school, I am afraid that the major newspapers in Paris would have started to report on it."

Edward turned on the bragging mode. Anyway, Carvey has never been to Paris, so it doesn’t matter how you say it: “Every operation of his will be recorded in detail, and every action will be depicted by the artist on the cleanest drawing paper. The operation page of the newspaper Spaces are reserved every day to showcase the results of his surgery."

The more he talked, the more mysterious it became. From his mouth, Paris seemed to be the surgical center of the world, and the French people living in Paris seemed to care about surgery.

The rest of the people stopped their knives and forks to listen to his performance, but Eddinson, who had been silent all this time, suddenly said, "Ambassador Edward must have taken a fancy to Dr. Carvey."

"Look?" Edward smiled, "Although Dr. Carvey is indeed good-looking, it's a pity that I like women."【4】

"I mean, Karvey's talent." Edinson understood the other party's intentions, and couldn't help reminding, "Mr. Ambassador, Dr. Karvey belongs to the Imperial Army Medical Department and is a glorious military surgeon. if."

Diplomacy cannot tolerate such straightforward conversations, and Karl, who is good at talking to others, interrupted him directly: "Yes, Dr. Carvey has a very high surgical talent, and being able to enter the military medical office is definitely a benefit of his skills." Approved."

"Oh? Really?" Edward was a little disappointed. "I personally think that such a capable doctor should stay in the anatomy room and study more new techniques."

"I have a title, and His Majesty Franz personally recruited me." Carvey was also helpless. "It's about the safety of the empire, and we really should do what we can."

The sudden seriousness of the conversation caught many people off guard. Fortunately, the voices of the dining car wheel and Alphonse came from a distance: "For the fourth main course, I specially prepared two extra dishes. There are baked wild rabbits, pan-fried Lamb chops, Rouen blood duck and Portuguese roast stuffed chicken, I hope you will have a good time eating in the embassy.”【5】

(End of this chapter)