Nineteenth Century Medical Guide

Chapter 302 298. A Short Rest

1 pm.

Carvey was alone in a cafe not far from the hospital, holding a newly bought newspaper in his hand, drinking coffee absently.

Since he left the front line of the war, it has been a long time since he had two surgeries in one morning.The body is definitely not tired. Compared with the original high-intensity working environment, this place is simply a paradise, but this does not bring any benefits, but makes Carvey feel tired.

The operation in Paris is far more difficult than in Vienna. There is nothing to do, and even the normal saline to maintain the total body fluid cannot be prepared in advance.The ectopic pregnancy operation just now consumed all the pituitary extract and sodium citrate, so he had to suggest that the operation be postponed.

Carvey certainly has his reasons.

The location of rectal cancer itself is embarrassing, and the tumor in bed 13 is even closer to the dentate line, making it even more troublesome to deal with.Coupled with the lymph node dissection during the operation, a large number of blood vessels in the pelvic floor and the dissection of complex tissue structures, this operation looks "big" no matter how it looks.

There is no preoperative examination, stable intraoperative anesthesia, sign monitoring, and decent drug support.If the sodium citrate infused from the blood and the pituitary extract used to stop bleeding during the operation are lost at this time, the operation will lose the last protective barrier, and the fault tolerance rate is 0.

Maybe it's because the rules and regulations of modern surgery are too comprehensive, and Carvey will not perform this kind of surgery unless it is a last resort.

"Professor Cedieu, the last resort I'm talking about is the girl in bed 97 just now." Carvey put down the newspaper and coffee cup, and beckoned to the waiter, "Can I have another piece of paper, please?"

The waiter looked at the three sheets of paper with anatomical and surgical sketches on the table, and muttered in his heart: "Okay, please wait a moment."

"I admit that the abdominal approach you mentioned requires a lot of surgical steps, involving the surrounding lymph nodes and blood vessels." Cedieu turned the densely drawn paper at hand to the back, and drew another picture, "I chose the sacral Caudal approach, cut off the coccyx, and then directly face the rectum for resection."

"How to deal with the sphincter?"

"Avoid the sphincter and only remove the tumor," Cedieu said. "The location has been determined by the digital examination, so it should have no effect."

Regardless of whether the sphincter can be preserved, Carvey first mentioned the common complications of the sacrococcygeal approach: "It is a good way, but I think the anatomical structure of the approach is simpler, but it is easy to cause intestinal fistula."

"Intestinal fistula?" Cedieu frowned, and soon his mind was full of all kinds of negative effects brought by this word, "Intestinal fistula. Is it because of the infection you mentioned earlier?"

"Correct."

Carvey took the fourth blank paper from the waiter, picked up a pen and began to write his own things: "French surgeons don't seem to care about 'infection', that is, the excessive bacteria in the wound advocated by Mr. Pasteur. The dangers of growth."

"I have heard of it, but is this statement really reliable?" Cedieu glanced at Kavey's paper, "You are writing"

"The operation records will be sent to Professor Hu Jier later."

Carvey continued to explain: "The concept of 'infection' is very new and has a wide range, but Mr. Pasteur is not alone in proposing this point of view. Dr. Semmelweis proposed it more than 10 years ago, and now includes Lister The doctor and I firmly believe that the culprit of surgical wound ulceration is bacteria.

And I personally even think that as long as surgery exists, infection will accompany it. After all, the world is full of those little things. "

Compared with those diehards who cling to the old principles, Cedieu, who is also somewhat stubborn, appears to be more rational.What Carvey said just now has a close logical relationship, and it cannot be dismissed casually with a guess.

In the process of "surgical incision-incision infection-tissue swelling unable to grow-increased exudation-incision ulceration-further infection", adding bacteria as a medium can work perfectly
But in fact, if you don't understand the operating mode, it can make sense to put other things in it.

"So we all tried to 'sanitize,' which is to wash everything that came into contact with the incision surface, even the air and all the hands of the doctors." Carvey explained, "I took it a step further and even did the mouth and nose blocked."

"So thorough?"

"Everyone has a microscope, why don't you want to do a culture similar to the wound environment, and it won't take long."

Carvey shrugged his shoulders and continued: "Besides, we are all doctors, and the patient's health is our only pursuit. As long as it is beneficial to the patient, no matter how outrageous the new theory is, you can try it. In fact, this The new theory has already undergone a large number of clinical trials, and the mortality rate has dropped significantly."

Cedieu was willing to listen to Carvey so much because he could not deal with the intestinal fistula after the incision ulcerated, which is also the key factor why the surgery has not really entered the abdominal cavity.

Sedieu was very afraid of intestinal fistula. In all fairness, he might not have dared to use the sacrococcygeal approach without Kavey, who has proved himself capable of stabilizing the abdominal cavity.

"There is another issue to consider after ganging." Carvey said, "tumor expansion."

"Are you afraid that I won't cut it clean?"

This is what Carvey meant, but he still chose a more modest statement: "Professor, now who can pat his chest and say that he can remove the tumor completely. Look at the breast cancer. I am doing breast cancer for Countess Justina. It took a lot of thought when the cancer was removed."

Breast cancer, although Cedieu has dabbled in it, he doesn't know much about it.

Justina had approached him at the beginning, but they broke up badly, because he could only do excision, but he couldn't do reconstruction, and he couldn't guarantee that there would never be a recurrence.

After hearing that Carvey chose such a typical example, he also seemed to be aroused to a certain kind of self-esteem: "I also heard that Dr. Carvey used two surgeries, not only cutting off the tumor of the countess, but also reconstructing it for her. Your room. I am a little curious, how is the countess doing now? After all, she may not have returned to Paris for a long time."

"It's fine," Carvey said. "If all goes well, she'll be back soon."

"Oh?"

"Didn't the professor read today's newspaper?"

"No."

Carvey handed over the newspaper: "Look at this report."【1】

"Really coming back"

Cedieu thought that in four days, Carvey's breast cancer surgery would be spread as news to every corner of France, and he felt uncomfortable.This is not because of jealousy, he is indeed jealous, but now it is more caused by his self-esteem as the chief of surgery of the main palace hospital.

This kind of self-esteem will break through the seemingly solid line of defense in an instant, and make the original judgment take a turn for the worse: "Let's go back to bed 13."

"Oh, yes." Carvey also pulled back his thoughts, "I suggest you wait a little longer. When this train enters the Paris train station, I guarantee that I can take them to the operating table of the main palace hospital within two hours."

".I don't think so." Cedieu packed up his things, You Qi put the three pieces of paper into his backpack, "I will still choose today."

Cedillo's disapproval was beyond Kavey's expectations, but the doctor who was over [-] years old in front of him had a simple thought in his heart, that is, to create a more important news.In his view, complex rectal cancer surgery is fully qualified.

"Okay then." Carvey didn't choose to pander to it, but gave him a positive response, "Then I wish the professor a smooth operation."

Cedieu looked puzzled: "What does Dr. Carvey mean?"

"After all, you are a patient of the main palace hospital, and you are the one who makes the surgical plan, and I am just giving suggestions." Carvey finished the surgical record, and then signed his name, "It is more suitable to change An assistant you are used to operating will definitely make the operation go more smoothly.”

This is not the result Cedieu wanted.

Although he has studied the surgical procedures for rectal cancer and discussed with Carvey the possible risks of various approaches, he has no idea.This is a state based on thin technical practice, and it is impossible to overcome it by yourself.

Now there was a fork in the road before him.

On the left side is local excision of rectal cancer through the gang. The operation is simple and requires few operations. Although the amount of bleeding is large, it is within the controllable range.Sediyo is confident in doing it well, but the smaller the risk, the smaller the benefit, and the "benefits" brought by gang surgery are hard to move his heart.

On the right is the sacrococcygeal approach just mentioned. Compared with the abdominal cavity, the operation is simpler, but there is still a huge risk of intestinal fistula.But this is the first rectal cancer resection in the world to try the sacrococcygeal approach. As long as it is done, the patient will not die on the operating table to earn him a reputation. 【2】

If complications were to be avoided, his reputation would have to go up at least one level.

Therefore, it is selfish for him to ask Karvey to help him, because only in this way can he rest assured to do the sacrococcygeal approach.

Now this auxiliary external force suddenly disappeared, and Cedieu suddenly retreated to this fork in the road.

If you already have the expectation of success in your heart, it will be very difficult to change the operation plan.He didn't know if he could withstand the pressure of the operation, but in any case, out of the character that an old gentleman should have, he didn't force Carvey to stay, but he just felt it was a pity:

"Well, I will say to the outside world that you have had two operations in a row, and you are tired."

"Thank you."

"No, you have already blocked two big thunders for our hospital. If you want to thank us, we must thank you." Cedieu got up and put on his hat. "It's getting late, I'll go back now."

Seeing this, Carvey also stood up and handed over the operation record [3] in his hand: "Professor, pass it on to me. I want to go shopping today, so I won't go back to the hospital."

"Not coming back?" Cedieu took the record sheet, looked at it twice, and asked, "What about the previous 24 beds, I have never seen this kind of patient."

Carvey remembered the pathological results given by Albaran after the ectopic pregnancy operation[4]. Even he didn't expect that someone would spend time and energy to process the ingredients in order to get "enjoyment"
But in any case, this is just a hobby, and it hasn't reached the point where outsiders can't tolerate it: "What else can I do, as long as the incision is sterilized."

"I'm not talking about that," Cedieu asked. "I mean, shouldn't he be sent to a mental institution?"

Carvey knew what it meant to be in a 19th-century mental institution, and there was little chance of getting out of there alive.But mental illness is not within the scope of his treatment, and all he can do is to suggest: "I don't know much about mental patients, but mental hospitals are not a good place. From a surgical point of view, I still recommend treating them as normal people. "

"why is that?"

"It's just an act similar to self-harm, and it didn't hurt others." Carvey said, "Besides, the development of surgical technology is closely related to the number of patients."

Foreign bodies in the bladder are very rare, and Cedieu also understood it: "In order to maintain the number of sources of disease. Well, I will tell Guyon."

It was just a simple coffee shop chat, but Carvey could feel some unusual sights.

He knew that it was Mick who was protecting him. The task was urgent and heavy, and it was possible that they were all hired temporarily.They have limited experience and lack of acting skills, and their glances from time to time make him very uncomfortable.

Of course, Carvey didn't question the meaning of Mick's work, if it was just an embarrassment in sight.

But now there was a note in his coat pocket, which only wrote the time and place, and nothing else.

It was very late, and the location was far away from the accommodation hotel and the main palace hospital. He couldn't make a judgment, but he already had a tendency in his heart.Paris is unfamiliar with the place, at least until the other party really shows up, he will never take risks.

After Cedieu left, Carvey called the waiter over again: "Excuse me, can you give this note to the two gentlemen sitting at the table by the door."

The waiter at the "table by the door" looked up and couldn't help muttering, "Oh, so it was them who ordered a cup of coffee after sitting for more than two hours."

Carvey wrote a sentence on the note, and put the note and a tip of 10 francs into his hand: "Trouble."

The waiter immediately changed his previous attitude, and the smile on his face became more real: "What else do you want, sir?"

"The rest is just..." Carvey suddenly changed his mind, pulled back the note, and asked, pointing to the name of the place, "I want to ask, what is this place?"

"Well, it should be a small road in the Pigalle district. I don't remember where it is." The waiter looked down and suddenly laughed, "Actually, as a guest, going to Pigalle is too cheap. Better go to the theater."

Carvey didn't understand what he meant, but his smile could explain a lot of things: "Okay, I see."

"The note"

"Well, let's give it to them."

(End of this chapter)