Nineteenth Century Medical Guide

Chapter 316 312. Money is not a problem

It took less than 3 minutes from when Kavey opened the amniotic sac to when the fetus was delivered.

The cervix is ​​opened, the suction device is inserted, the fundus of the uterus is pressed by hand, and the child's legs are pulled out at the gap.The whole process went so smoothly that the doctors on the stage couldn't see clearly: "What happened just now?"

"I didn't see anything!"

"I just felt that he put one hand into the womb, and then the child's legs stretched out. When I realized it again, he had already lifted the whole child upside down in his hand."

In fact, let alone them, even Cedieu, who sat in the first row and stared at Kawi's hands carefully, didn't see clearly.There was no room for explanation or buffer in the whole process, and it ended almost instantly.

Modern cesarean section videos can be seen everywhere. If you can't see clearly, you can slow down, pause frame by frame, or even watch it back and forth repeatedly.As technology becomes more and more open source, as long as you are willing to learn and work hard, you can still learn a lot of things, and the content that can be called unique skills is very limited.

It's a pity that it's the 19th century. In Cedieu's eyes, every movement of Kavi doesn't look gorgeous, but it looks extremely smooth and precise.

If you look carefully, his movements are actually very simple, but a lot of useless parts have been removed, and there is no muddy place.This is a stunt that can only be obtained by giving up all private life and leisure time after the operation, and forcing oneself to do thousands of boring trainings over and over again.

What genius. This may be the true face of genius!

Carvey held the baby in one hand, and with the other hand, he and Hujill clamped the umbilical cord back and forth with a hemostat, and quickly cut it open with a scalpel in the middle.The baby was taken away by nurses who were already there, and they handled the rest of the placenta.

"When the placenta is delivered, you must be careful not to have any residues. Residues mean endless bleeding." Carvey quickly put a hemostat on the uterine incision, and then went deep into the uterine cavity with his right hand to take out the placenta. The integrity of the placenta. How about your side, it sounds like a lot of crying."

Carvey asked about newborns, of course, and two nurses were in charge.

They prepared dry towels, warm water and newborn bedding in advance, and they could clean and wipe off the meconium in the first place, and then judge the baby's condition.In the past, they would only judge by their feelings, but now they have a card from Kawei in their hands, which can quantify the situation of the newborn. 【1】

"According to the score on the card form." The nurse is not yet skilled, and replied after doing simple mental calculations, "The score is 9 points, and the weight is 3850g, very healthy!"

"It is estimated that the skin color of the limbs is a little blue, and I will check it after 5 and 10 minutes."

"Ok."

The safety of the newborn gave Carvey a reassurance, allowing him to focus on the mother: "There is a lot of bleeding, how is her heart rate? Is there a problem?"

"It's faster than before, now 103 beats/min."

"Continue to test, call me after 110."

"Ok."

The placenta came out quickly, and Kavi pulled it out by peeling off the surface a little.However, it can be seen that there are many defects in the placenta, and the bleeding in the uterus continues.

"Take the largest pliers and wrap two layers of gauze." Carvey began to massage the uterus with both hands, "Get ready to suture the needle and thread, and then let those reporters with the correct blood type wait at the door, and they may come in at any time."

"Yes."

"What about the hirudin?"

"Ready."

"There is a high probability that it won't be needed, but when the time comes, don't forget where it is."

Compared with yesterday's shortage of personnel, today's public operation is equipped with a luxurious lineup.

There are not only three assistants, but also four nurses and three assistants in the preparation area who handle chores, who are ready to follow instructions to deal with a lot of chores at any time.

As Carvey said, he took the uterus out of the abdominal cavity, took the gauze pad forceps that he had requested just now, squeezed and massaged the uterus with his left hand to induce contraction, and at the same time inserted the gauze pad into the uterine cavity to wipe off the remaining fetal membranes and blood clots : "This process has to be repeated 2-3 times until the yarn pad is clean enough."

The baby was delivered very quickly, and the mother's body was also strong. The uterus was not ready at the beginning. After the uterine cavity was cleaned, oxytocin began to be secreted in the body, and the contraction was very beautiful.

"The operation is basically a success." Carvey looked at the shrinking uterus and the clean margins, very satisfied, "Heart rate?"

"98."

"Okay, now the uterus is contracting very well, and there will be no bleeding for the time being." Carvey opened the uterus and put his hand under it, "Let's see what is behind the uterus."

The lower uterine incision was not sutured for the time being to prevent accidents, but after Kavey confirmed that the bilateral appendages were intact and the posterior wall of the uterus was normal, he began to suture the uterus: "The location is in the sacral tail, and the volume is not small. Let's suture the uterus first." .”

After suturing the uterus, the bladder reflexed the peritoneum, and then further exploration of the pelvic cavity finally found the culprit that made the mother risk going to the operating table.

"At the back of the cervix, near the sacrum, there is a huge cystic mass. It blocks the passage of the child descending into the pelvis, forcing the mother to choose a cesarean section." Carvey said with his hand A simple measurement was made, "The mass looks 10cm in diameter and is covered with mesentery on the surface. It is very troublesome to separate."

Although the mass is large, it has a cyst, which can be easily removed as long as the anatomical structure of the cyst and surrounding tissue is separated.

But the cyst wall of this mass is very thin, there is a little fluctuating feeling inside, and there may be fluid.Judging from the adhesion situation, no matter how good the operation is, it is difficult to separate without injury.Once the lump ruptures and its contents spill out, there is no guarantee that the mother will be safe.

Sacrococcygeal mass.
Carvey made a quick differential diagnosis of a possible sacrococcygeal mass, and quickly ruled out lipoma, tuberculosis, and bursitis, leaving only lymphangioma and teratoma.It is difficult to distinguish from the feel, and the risk of contents spilling after cutting is not too great.

In this case, it is better to give up passive rupture and choose to actively open the tumor, remove the inner tissue, and then deal with the outer capsule.

"The capsule wall is too thin, and it is a miracle that it can persist until now without rupture." Carvey said, "There are various uncertainties in the direct separation, so we choose to open the mass directly, and prepare two hemostats, tweezers, Scalpels and sutures. Good wishes, pay attention to attracting.”

"Ok, no problem."

Carvey's hands are very fast, and it has only been 33 minutes since the operation.

No matter from which point of view, he has completed the cesarean section demonstration he promised before, and the mother and child are safe.The following huge mass resection of the sacrum should actually be regarded as an accessory.

But even if it is an accessory other than the original product, it is enough to make a lot of people on the stage difficult.

In fact, just a few months ago, Massimov also dealt with teratoma, and finally ended in failure.But in the hands of Carvey, it is easy to do, showing a solid foundation in pelvic surgery.

This is a solid technology, and it cannot be changed by slander and deception.

After four operations, Cedieu fully recognized Kavey's strength and was convinced.

But at the same time, he had to sympathize with the child. He was destined to pay a huge price for such a pure surgical technique.What accompanied Kavi’s childhood may not be toys and games among his peers, but cold scalpels, suture needles and threads, hemostats, and flesh and tissue from various animals and corpses.

What kind of devil father is this?
When Cedieu thought of this, his heart became more and more uncomfortable, and he was in a panic: "Dr. Carvey, how many hemostats did you clamp in total?"

"Six or seven." Carvey was doing the work of removing the contents of the tumor, while showing his "trophies", and asked puzzledly, "What's wrong?"

Cedieu used his right hand to perform a simple action of clamping and releasing the vascular clamp, and praised: "Your ability to quickly open and close the hemostat with one hand will take three to five years to master."

"You say so?"

After speaking, Carvey picked up three hemostats, and opened and closed the locks at the same time with only one hand. The speed was very fast: "Isn't this the basic operation required when encountering heavy bleeding?"

What a terrible strength control technique, what a terrible training intensity, it is breathtaking.

Since the introduction of elastic steel into medicine in the early 19th century, many instruments with screw fixation devices have been replaced with simple fixed locks, that is, fixed teeth.In this way, the doctor can control the clamping force by adjusting the force with one hand, and maintain the clamping state by fixing the teeth.

Although the operation is simple, if the operation is not skilled, it will affect the hand speed.

This is not a big problem in ordinary surgery. If the operation is done step by step, there will be no major problems. But if there is a massive bleeding in the emergency department, a slight delay in the hemostat will cost a life.

"I really recommend that everyone practice this operation more when they have time, it will help the surgical skills."

"Switch the hemostat?"

"Yes, familiarize your hands with this instrument, as the hemostat is used far more often than the scalpel in most procedures."

"Does this really work?"

"Believe it or not."

Carvey said something casually and stopped taking up the topic, and the operation came to an end soon.

The independent cesarean section and simple tumor removal are not difficult for Carvey, as long as the operation follows the main points of the two, the case itself is even more miraculous.

The contents found after the tumor cyst was opened included about 600ml of yellow jelly-like tissue and a small amount of light yellow liquid, and about 40g of hair and fat-like tissue.

With hair and fat, teratoma was basically confirmed.

Sacrococcygeal teratoma combined with full-term pregnancy. The former is more common in babies, while the latter is easily disturbed by mutations. Two completely irrelevant things are squeezed into one stomach without interfering with each other.

I have to praise my mother for her tenacity and good physical fitness, which allowed the operation to end quickly in less than an hour.

At the same time, everyone also praised Carvey's surgical skills, which completely broke through the limits of existing cognition.This kind of breakthrough from 0 to 1 is like slowly pushing open the door that has been closed for thousands of years. The penetrating light and the falling dust coexist, which makes people feel excited and at the same time a little confused.

The excitement is that there are not many steps in cesarean section, and everyone has a model to imitate.The confusion lies in the fact that many details cannot be seen clearly, and the meaning of many operations is unclear.But it is this hopeful sense of the unknown that motivates people to move forward.

Of course, these feelings have nothing to do with the current Kavi.

He is only interested in the case, and after the operation reveals the mystery, his sense of interest will be lost in an instant.Seeing those doctors leaving the auditorium one after another and preparing to surround him and ask questions, Kawei decisively pulled Shanwang, and walked towards the gate without saying a word.

"Everyone, be safe and don't be impatient."

He stopped the doctors and persuaded them: "I have urgent matters to leave first. I will tell you the specific operation process and the key points to be paid attention to in the next lecture at the University of Paris."

"It's too late to wait until three days later."

"I'm really in a hurry, sorry."

His hasty departure naturally had his reasons, and it was because of the upcoming auction.

Before the auction, Carvey needs to look at the catalog of the auction, identify the items he likes, and then ask Slang to prepare enough money.In fact, this step should be done on the spot, and more is to look at the real product, but Kawei, who has no money for the time being, made it ahead of schedule.

The reason for taking Shanwang away is to be half an inspector for himself, after all, he is not from the late Qing Dynasty, and he doesn't know anything about antique calligraphy and painting at all.There is no shortage of money in your pocket, and you can't just buy it casually.

Although Shanwang came from a bad background, his studies have always been supported by others.Aptitude and chance encounters allowed him to learn many things that people of the same age could not dabble in. At the same time, the people he made friends with were all the children of the rich and powerful at that time, so he naturally had a little impression of some old objects.

In the evening, Kawei and Shanwang left the theater together, and went to a coffee shop not far away to meet with Slang.

The two walked into the cafe before 04:30 as agreed, ordered two cups of coffee and began to wait for someone, but they didn't see the bank's vice president Slang until five o'clock: "I'm really sorry, Dr. Carvey, I'm coming late."

In order to achieve his own goals, BNP Paribas is an essential part of the guarantee of funds. Carvey will not really investigate how long the other party has been late: "It doesn't matter, let's talk about business."

"Who is this?"

"My Chinese friend, Good Hope." Carvey made a brief introduction, "After all, I am interested in the East but don't know much about it. By the way, do you have the video tape?"

"Bring it with you." Slang took out the photo catalog that had just been bound for this auction from his bag, "There are introductions next to the photos, including a brief introduction and background. Some have already set a reserve price, and some have already There are estimated prices, but my personal advice is to ignore them.”

Carvey is usually not a person who cares about the other party's feelings and sight, but today is different.

When he opened the catalog and saw some familiar and friendly pictures, he could clearly feel the good hope sitting beside him, and his mood changed a lot.

The reason why it is so sensitive is because now Kawei is as excited as him.
(End of this chapter)