Nineteenth Century Medical Guide

Chapter 299 295. Amazing Appetizers

Chapter 299 295. Amazing Appetizers
The time was set back to 12 a.m. on the 8th, when the original bed 97 began to suffer from unbearable abdominal pain. Most doctors, including the director of the obstetrics department Hu Jier, started early rounds.But the surgery on the other side had already finished the ward rounds, and the 24 beds were pushed into the preparation room of No. [-] surgery theater early.

Carvey presided over this operation, which can be regarded as the first operation of his trip to Paris.

Because the content of the operation is not complicated, it is only necessary to find out whether there is stricture in the urethra and whether there are stones in the bladder, and then choose one of expansion, conservative treatment, lithotripsy, and stone removal.Therefore, the assistants assigned to Kavey are very limited, and there is not even an anesthesia before a clear diagnosis and follow-up treatment.

This is also a small part of the "cons" brought about by free treatment.

Such a large hospital has tens of thousands of daily expenses, and it is not easy to maintain it. Some expenses can be saved as much as possible.Of course, doctors are willing to make treatment more comfortable if the patient requests it and pays the right amount of money.

It's a pity that this guy named Ender Wells has no money for 24 beds. He can't afford a centimetre.

The surgery was not challenging, maybe even a little boring.As the benchmark of surgery in Paris, the Palace of the Lord Hospital has never been short of such patients, and they do urethral exploration and dilation almost every day.

Usually, the number of people watching this type of operation will never exceed 20, and most of them are medical students.The appearance of Carvey today did not bring much exception. There were scattered students in the auditorium, and there were only three doctors who could be regarded as doctors.

Cedieu, Guyon and another urologist from Sabert Hospital.

Given such an operation that is as light as clear water, there will not be many waves, but since he is here for a demonstration, Kavey still wants to come up with some tricks.

"Today is my second day in Paris, and I am honored to be appreciated by Professor Cedieu, who let me deal with this patient who suffers from frequent urination, urgency and painful urination."

Carvey signaled the nurse to send the patient into the theater, and continued: "If I were in Vienna, I would choose the brand-new endoscopy system invented by Dr. , can only choose these (old) dilators."

At the beginning, he cast the bait, which immediately attracted the attention of the three doctors.

"Endoscope system? Is it a urethral endoscope?"

"I remember someone used it before, saying that they could see the inside of the urethra, which is the same as the gang door speculum. But the actual operation is very troublesome, and the imaging effect is not good."

"The urethra is so thin, the light source is not enough."

"It wasn't enough at the time."

After a brief discussion, Cedieu asked what they were most concerned about: "Dr. Carvey, it's not that we question your level of equipment improvement. After all, any well-known surgeon should have this ability. We Curious, how did you solve the light source problem for the endoscope?"

"I changed the external candle into a built-in oil lamp, and the specific structure has to wait for my assistant to come to Paris to show." Carvey took out an expansion tube and continued, "I used it to observe two weeks ago. Reached Mr Erdem's bladder. Fair clarity, although limited field of view and inability to rotate."

Erdem, a patient who baffled all Parisian urologists a month ago.

If Paris can't be cured, then the whole world should be cured. No one will believe that he has been properly treated in Vienna.

In particular, some doctors who are not optimistic about surgery firmly believe that what Edm suffers from is only an internal disease, and he can recover with a little adjustment.Doing surgery indiscriminately and wishful thinking after the operation to claim that the operation was successful is no different from a liar.

Cedieu, Guyon, and another doctor at Sabert Hospital also had doubts about this.

But for Carvey, this is not a difficult problem to explain: "Mr. Edem's problem is hematuria. After the operation is over, his hematuria is basically over."

The solution of one problem always leads to the emergence of more problems.If Erdem's hematuria is really resolved, the solution will become something everyone is curious about: "Is it really the bladder cancer that the media said?"

"Bladder cancer, indeed."

"You chose to suture the bladder after removing the tumor?" Guyon could only guess the operation method based on his own imagination.

"No, I don't think so! If the tumor is too large, it will be difficult to suture the bladder, and the volume of the bladder will be greatly reduced after suturing, which will still affect the urination function."

"Should I just cut off the bladder? What about the urine? How to store it? It doesn't mean that you can urinate as much as the kidneys produce. You can't live in the toilet?"

The three of them further started to discuss the method and possibility of the operation, and the surrounding medical students were stunned.For these young people in their 20s, the information volume of a tumor resection is still too large.

Seeing them like this, Carvey smiled and sat between the patient's legs, and began to rinse the operation area with clean water that was prepared yesterday: "I will talk about the operation process later, and now let's pay attention to this 24-bed patient. From yesterday morning until now I have only urinated three times, and there is already urinary retention."

"It still feels like a stone."

"It should not be a large piece, but small pieces accumulated together, so that it cannot be touched by palpation, but it can also block the urethral opening and cause intermittent urination."

"Indeed, there is such a possibility."

Ender's situation is special, and he refuses to say anything. There are few clues that can be used for diagnosis. Carvey is really not sure; "Doctor Albaran, help me fix it."

"kindness."

Carvey put on a mask and gloves, lifted the small thing with two fingers of his left hand, and then sent the urethral probe with the thickness of half a finger directly into it.To everyone's surprise, the whole process went very easily, and there was not much resistance when it met the prostate, and it went into the bladder with a little force.

"The process was really smooth. But considering the patient's age, it's normal not to have BPH."

Kavi originally thought that the urethra would be glued due to inflammation, and before entering the bladder, Ender would definitely suffer.But when the spies went in, he realized that it was weird. Apart from the unobstructed urethra, Ender's patient didn't seem to react as strongly to the spies as other patients.

"Dr. Carvey, how is the inside of the bladder? Have you encountered a stone?"

Kavi came back to his senses and began to turn the silver rod in his hand, hoping to touch the surface of the stone with the swing of his bent head.However contact is touching something, but it doesn't feel like a hard stone.

It's not soft, it's not hard, what is this?
Even Carvey had trouble, but he was not strong enough to judge the complex situation inside the bladder just by the feel of the probe: "I did touch something, but I'm sure it's not a stone."

"It's not a stone? What else could it be?"

"There will be more stones in the bladder." Guyon thought of Erdem, "Can't it be another tumor?"

"No, it's impossible for tumors to be suspended in urine." Carvey didn't give up yet, still turning the silver rod in his hand repeatedly, feeling the touch from the frontal collision, "Wait, this feels a bit strange."

"what happened?"

"It's not in the form of a block, but in the shape of a rope." Carvey carefully described his judgment, "Yes, it's in the shape of a rope!"

"What are the cords?"

"Dr. Carvey, you have to investigate carefully, are you sure it's a rope?"

"I" Carvey was also a little skeptical at first, but after repeated provocations, he said, "I'm sure."

This is a situation that no one has seen before. Neither bladder stones nor tumors should be in the shape of cords, and the possibility of neoplasms like polyps is even smaller.They were puzzled by the nature of the symptoms in the patient's body and the reasons for their occurrence, but Carvey seemed to have his own judgment.

In fact, this situation is very common in modern times, and many people have this habit.After working in the emergency department for so many years, he has seen everything from boys as young as a few years old to old people who have retired for many years.

As for why there were no such patients in the 19th century, it is not a human problem, but because they cannot obtain soft and long enough props without conditions.It's not because hard objects can't be used, but because hard objects are difficult to completely enter the urethra when using them, and pulling them out is much easier.

If it is replaced with a soft rubber tube or other slender props, it is easy to "miss" during use, resulting in a similar effect.

From the touch of the hand, to the reaction when the spies probed in, Carvey had to lean on the foreign body in the urethra.With the object of suspicion, the first thing to do is to confirm it: "Mr. Ender, did you put some things in this that shouldn't be misplaced?"

Everyone present, including Ender, who was lying on the operating table, showed incredulous expressions.

"No, I, I didn't"

"No?" Carvey looked at him suspiciously, and exerted force on his hand again, "But you don't seem to hate me stirring this stick."

"Hiss..." Ende felt the stimulation coming from below, and he struggled to control his facial expression, "You are a doctor, and the doctor only needs to cure my illness. Why do you keep asking so many questions?"

"Given the extent of the dilation of the urethra, your reaction to the urethral probe, and the shape of the suspicious foreign object in the bladder, I have reason to suspect that this is not the first time you have encountered trouble." Carvey sighed: "This length and The shape needs to be removed by surgery.”

"Surgery?" Ender shook his head, "Can we not have surgery?"

"If you don't do it, you can only stay in it."

"Let's keep it, but it's so uncomfortable for me to go to the toilet, can you solve it?"

"So you have to take it out!"

Ende glanced back and forth at the surgery theater and saw that they were all discussing the feasibility of a layman inserting a foreign body through the urethra. His heart was still shaking and he immediately made a decision: "I don't want to have an operation."

Ender's generous appearance of dying to keep the secret made Kawei shake his head, but it also aroused his curiosity to know what was in the bladder: "If you don't have an operation, you may die within a month. "

"No, don't be joking." Ender said with a smile, "It's not like I haven't experienced it before."

"Oh? Experienced?"

Ender didn't bother to explain to him: "Anyway, I don't have surgery."

After all, his coordination began to decline, and his legs that were originally placed on the shelf began to become restless, as if he was ready to leave the operating table at any time.

At this time, the spies were still inside, and tampering with them would definitely cause damage.But Carvey believes that a man who dares to stuff a mess in the urethra can definitely do this kind of thing.

Nowadays, it is no longer the doctor who occupies the absolute dominant position between doctors and patients. The treatment depends entirely on the patient's own wishes, not the doctor.What's more, the main palace hospital was originally free of charge, and there was no monetary exchange between patients and the hospital.If Ender insists on not treating him, not to mention Kawei has nothing to do with him, even the big director Cedieu on the stage has nothing to do with him.

Although the foreign body in the bladder will not have much impact at the beginning, it will definitely cause secondary infection over time, and local infection will cause stones or more serious systemic infection.

In the lightest case, re-operation, in the most severe case, death.

Carvey considered again and again and was ready to stabilize him, persuading him to stay for surgery.Firstly, it was because of my curiosity, secondly, it was to save his life, and thirdly, I still hoped to get off to a good start and let the three on stage see my skills.

"Don't worry, just listen to me."

Carvey didn't say much, but calmly exchanged something that the other party couldn't refuse: "I'll give you 100 francs and keep it for surgery."

Ender froze.

All the medical students and the three doctors in the audience were also stunned. They only saw the hospital free of charge, but never saw the doctor give money to the patient in reverse.

"What did you say? You gave me 100 francs?"

"Yes, it's quite a lot." Carvey looked back at Cedieu who was sitting in the auditorium with a surprised face, "But I don't have any money with me, and I will send it to you after the operation is over. Of course , if you are afraid of being cheated, you can ask Director Cedieu to get the money first."

"Hey, Dr. Carvey, you." Cedieu couldn't help himself.

"This is a high-quality case." Carvey asked. "Don't you all have any interest in his bladder? Don't you want to see what's hidden in the bladder?"

Guyon was the first to stand up: "Teacher, I think 100 francs is worth it. Teacher Kaushik, what do you think?"

"Anyway, he paid the money, of course I have no problem."

Sediyo had no choice but to take out a hundred-yuan bill from his pocket and have someone hand it to Ende: "It's getting late, find someone to fill him with ether, and then start quickly."

The operation itself is still not difficult, but the operation method chosen by Carvey is different from the mainstream vaginal incision for stone removal, but a suprapubic incision.

The first step is to find the bladder inwardly, suture two stitches with silk thread for traction on both sides, make an incision in the middle, and insert a suction device into the bladder to suck out urine. 【1】

The second step is to probe into the bladder with fingers to find the location of the foreign body, and then under the guidance of the fingers, use the stone removal forceps to pinch the foreign body out. 【2】

The shape of the foreign body in Ende's bladder meant that it would not be difficult to retrieve it, and soon a dark rope-like thing was pulled out of the body by Kawei.While everyone was excited, they began to guess what it was.

"what is this?"

"Cloth?"

"Rope? Or some metal?"

"It may also be wood, which looks softened."

"No, not at all." Carvey frowned and looked at this thing carefully, and suddenly a strange but quite reasonable idea popped up in his mind, "This should be the tail of an animal, if I guessed correctly, It probably came from a very fat mouse."

"Why put the tail of a dead mouse in the urethra? Is he a pervert?"

Carvey smiled: "How can you be sure that the mouse is dead?"

(End of this chapter)

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