Nineteenth Century Medical Guide

Chapter 324 320. A Challenge Never Before

For an apprentice like Gustav, the daily work is not easy.He needs to contact clients and appraisers for Mr. Bernard, arrange the order of the auction, and make a catalog of auction items.

That is, only when he encounters a small auction with no reputation, he can come to the stage and strike the hammer under Bernard's care.

If he hadn't taken Bernard's words seriously before and thought that making contacts was still far away from him, then after going through the auction, he had sorted out all such naive thoughts, packed them up and threw them out. skull.

Now most of the auction work for Ingres's paintings has ended, the auction center has entered a period of steady rest, and Gustav, who has been busy for more than half a month, also has a long-lost vacation.

He didn't memorize many auction skills, and his mind was full of images of Kawei talking with the two queens. After tossing and turning all night, he didn't fall asleep until seven o'clock in the morning.

Compared with other people who advance in theory, Gustav is an absolute activist. Otherwise, he would obediently follow the development path given by his father, study hard, follow in the footsteps of his two older brothers, and enter the University of Zurich to study economics, philosophy or law.

After graduation, you can become a part of the management department of a family private bank, or choose to start your own company and try your luck.

But he is obviously unwilling to succumb to other people's plans, and he has his own artistic ideals.
Although at the age of 7, 10 and 12, a certain painter A, a certain musician B and a certain sculptor C were judged to have no relevant talents, and their ideals were shattered one by one, but Gustav still hopes for his future. The work can be closer to the artwork.

This is not the first time he has gone abroad. Before coming to Paris, he had already been to New York and London by relying on his poor high school academic performance.

In the eyes of ordinary people, there is no inherent logical relationship in it, but in the eyes of my father, it is a completely different idea.He felt that if he didn't go out for a walk now, Gustav might spend his whole life in the small town of Winterthur in the canton of Zurich in the future, and there would be no chance to go abroad to broaden his horizons.

Who knew that the two trips for fun made Gustav find his purpose in life.

He is by no means expected to manage a bank, and the business scope of his own small private bank is not enough to show his strength.If you want to do it, you have to do those jobs that can change the world. Since you can't lead the trend of world art, you should become a middleman like Bernard who controls the price of world-class art.

He thought so and did it.

After biting the bullet and studying (dao) at the Divinity School of the University of Zurich (luan) for two years, he successfully dropped out of school, and under pressure, his father had to write a letter to his old friend [1]. Send yourself into Drouot "Experience".
At ten in the morning, Gustav, who had only slept for three hours, woke up.

The mind did not become calm due to sleep, but the appearance of that person became more and more clear.Unable to hold back his thoughts, he got up, put on his clothes, washed up briefly, stuffed half a piece of bread in his mouth, and rushed to the hotel where Kawi was.

Bernard asked Gustav to get to know Kavi, but the "knowledge" he understood was by no means simply knowing the existence of this person, or having a deeper understanding of this person's character and habits.Or just to open up the news channel, simply plug him into his network of contacts, and wait for a special time later to pull him out to chat and squeeze out information resources.

Gustav's "acquaintance" is to become friends with the other party, at least it must be the relationship between his father and Bernard.

In short, he has deeply realized the importance of making friends with Kavi.

It's a pity that Gustav has his own ideas and drive to do things, but lacks stability and carefulness.After the auction, relying on the far-fetched reason of sending the return receipt, he wanted to go to the address of Kawei's residence, but he never thought that the other party was a busy person with very little free time.

"Sorry, Dr. Carvey is not in the hotel right now."

"Where did he go?"

The waiter shook his head helplessly: "I don't know, Dr. Carvey's itinerary is personal privacy, and we have no right to ask."

"Then" Gustav took out the pad, wrote a paragraph [2] neatly with the pen at the front desk, and handed it to the waiter, "If he comes back, please give him this note. "

Leaving messages is very common in hotels. The waiter habitually raised his hand to pick up the note, but stopped in mid-air.His eyes were a little flustered, and he hesitated, not knowing what to say.

Gustav just found it strange and didn't care. He thought he didn't hear clearly. Just as he was about to say it again, a man in black suddenly appeared next to him: "Who are you? Why are you looking for Dr. Carvey?"

"Who am I to you?"

Almost at the same time as he answered, Gustav subconsciously noticed something was wrong.The other party dressed in a strange manner, did not speak French very neatly, and his eyes were very uncomfortable for him to inquire back and forth.

But before he could change his words, the other party patted the waiter on the shoulder and left.

what's the situation?
Gustav was a little confused by the accident. Seeing the waiter's face was strange, he asked, "Who is that person? Someone from the hotel?"

"I am not sure as well."

"That's weird." Gustav looked back and forth between the man in black and the waiter, and didn't go into it any further. "By the way, when will Dr. Carvey come back? If it's in the afternoon, I can be here Wait a minute."

"This..." The waiter was stunned, and quickly replied with a smile: "I don't know exactly when he will come back, but I will hand over the note when he comes back."

"Okay then, trouble."

On the other side, Carvey had already left the University of Paris, boarded a taxi, and rushed to the main palace hospital.

The mother's sudden labor also caught him by surprise. Hearing Wan Wang's description, he couldn't help but ask, "Why did you give birth after only one night?"

"We don't know. She is in good health, and her fetal heart rate and fetal movement are normal." Shanwang reviewed her medical history and said, "Even the fetal position is normal, and it was still normal during the examination last night." It's not in the pot yet."

Kavi had asked before, so he naturally knew the position of the fetus, otherwise he wouldn't be so surprised: "Forget it, it's not important, what matters is how long has passed since you found out."

"I found out that it was 9:10, and now it is 13:[-], which is almost an hour."

"After all, it is the third child, and there is still a distance from the hospital. It seems that it is too late." Carvey changed his mood and basically abandoned the illusion of surgery, "The next thing to do is how to keep the child during the natural delivery, At the same time contain the hemorrhage."

Clinical practice is not about reciting medical books. It is difficult and important to temporarily change judgments and put them into practice immediately.

This requires great courage and self-confidence, but at this moment, Carvey made this judgment not because of self-confidence, but because the cesarean section itself has lost its meaning.

From the perspective of time, the birth of a child is certain, and once it enters the birth canal, it will become very easy.As long as the child enters the birth canal of the multiparous woman, it is equivalent to getting on the highway, and the natural delivery is much faster than the cesarean section.

Next, it will be divided into three cases according to bleeding.

The first is that the amount of bleeding is not much, which is almost impossible, but it is also a possibility.If you encounter this situation, it does not mean that the mother is safe, and it depends on the separation of the placenta.Only when the placenta is completely peeled off and the vital signs are safe can we rest assured.

The second is the huge amount of bleeding. The child has bleeding of more than 1000ml just after birth. The situation is extremely critical, but there is no need to think too much.Open the abdomen directly, stop the bleeding if it can stop the bleeding, cut off the uterus if it cannot stop the bleeding, and cut off the source of bleeding.

The third type is also the most troublesome one for Carvey. On the surface, the amount of bleeding seems to be stuck in the middle of the two. It is more or less, and the key vital signs have not fluctuated much.

Laparotomy is inherently dangerous, and one should not blindly open the laparotomy just because the previous operations were all successful.But if the abdomen is not opened, and the amount of bleeding is very ambiguous, maybe when the heart rate and blood pressure will collapse, it is simply a fantasy to rely on those simple medicines in hand to save lives.

At this time, it is necessary to judge the situation carefully. If one step is wrong, the next step may be wrong.
Carvey leaned on the back of his chair and looked out the window. There were not many cars on the road at noon, and the distance between the two places was not too long. With this little time, he quickly went through the possible situations and plans, and finally at 10:[-] I went to the preparation room of the surgery theater earlier.

It has now been an hour since the mother went into labor.

"How is it?" This is the first sentence that Carvey opened the door and entered the room. After hearing the mother's cry, it was followed by the second sentence, "How is the amount of bleeding?"

"About 400 ml, with blood clots. I just vomited once. It was something I ate last night." Karen reported, and the others gathered around the mother to stop the bleeding and deliver the baby. /124, heart rate 76."

Carvey breathed a sigh of relief, at least now it seems that the amount of bleeding is not too much, and his team has opened two venous accesses, one for infusion of normal saline + oxytocin, and one for infusion of anticoagulated autologous blood.

But these are not enough. There is a crucial thing in the whole labor process. As long as this thing does not come out, the so-called treatment will not even step on the starting line: "I remember that she has a central placenta previa, and the placenta should be faster than the baby. Earlier, now an hour has passed, has the placenta come out?"

Karen shook her head, her face extremely ugly: "No."

Sure enough, Kavey's medical treatment did not come out, and the bleeding volume of 400ml was just an illusion. As long as the placenta did not come out, the bleeding would not stop, and the baby would not come out.

"In fact, children also"

It was only then that Carvey realized that the cries of the mother just now were not due to pain, but because the child who was 37 weeks pregnant was gone.

The placenta connects the child and the mother, and placenta previa is bleeding, not only the mother's blood but also the child's is lost.As long as the treatment is slow, even if the treatment is done in time, it will still cause stillbirth due to ischemia and hypoxia.

Now the fetal heart rate has disappeared, the bleeding is severe, and the placenta is stuck together and cannot be delivered, so there is no need to wait.

Carvey walked to the bed, let others go, touched the mother's stomach with one hand, and his face became more and more gloomy: "The uterine contraction is not very good, so we should prepare for the operation immediately according to the method of cesarean section."

"it is good."

"By the way, prepare the uterine hemostatic bandage, the amount of bleeding will be very heavy later. And let those who have matched blood come in quickly, and start the blood transfusion now."

"it is good."

The death of the fetus made Kaweiteng do his best to save the mother, and he was confident that he could solve the bleeding with surgery.If it really doesn't work, it's okay to cut off the uterus, after all, the other party already has two children.

But who knows, the mother suddenly grabbed his hand: "Doctor, doctor, is my baby gone?"

This is a piece of bad news that has been told to her a long time ago. It is useless to avoid taboos. Doctors and patients need to face it calmly: "Yes, the bleeding was too violent. We couldn't hear the fetal heartbeat after choosing several positions. In fact, you are more serious than us. Clearly, only you can feel if he's moving."

"Okay. Okay. I see." The mother's voice trembled, but she seemed to have made up her mind, "Doctor, I won't perform surgery."

Everyone who was still busy just now stopped suddenly, unable to believe their ears.Even Kavey had to carry a bunch of question marks on her head, wondering why she did it.

"Are you kidding me?"

"It's too dangerous not to have surgery. Dr. Carvey rushed back from university just to save you."

"This is more than dangerous. The placenta previa is stuck in the birth canal and keeps bleeding, and the uterus is weak. Can this survive?"

Three obstetricians, including Hujill, and three of Carvey's assistants agreed that surgery was the only answer to the problem.They have experienced too many death cases of placenta previa, even if the delivery goes well, they are very prone to postpartum hemorrhage, let alone now.

Carvey also had the same attitude before. The indications for surgery are quite clear, and there is no reason to object.

But after the other people chirped, he seemed to understand something: "Your husband also agreed to cut off the uterus last night in a critical moment, you don't have to insist."

"That's because the child is still alive, and now he is dead. You said in the previous examination that the uterus of cesarean section will have problems, and it may be more difficult to conceive later. Once pregnant, there is a risk of rupture of the uterus." The mother said, "I I don't want to do that."

"Didn't you already have two babies?"

Carvey recalled that simple medical history record, which did not record whether the child survived. "I'm talking about risks, not absolutes. If you can, you can reduce a lot of risks by undergoing a safe cesarean section." "

"No, Dr. Carvey, you're only staying in Paris for a month. Our family can't afford the train tickets to Vienna, and you're not going to leave all your work for me in a year or two and come to Paris at this time. .”

The mother turned her head, unwilling to explain further: "I love my husband, we cannot have children, and I don't want to live alone in my old age like Mrs. I can't do it with a cup of coffee in the market. If that's the case, I might as well die here!"

What Carvey had in his mind was modern surgical concepts, and the operation method should be suitable for the patient and the consent of the patient and his family should be obtained.

Now that the mother does not agree to the cesarean section or even the removal of the uterus, Carvey's first thought is to notify the family, bypass the mother, and obtain the consent of the family, that is, her husband.

But this is not enough. It is better to believe in your own hands than to believe in the care of men in the 19th century, especially the lower-level men.
Today is not a few days ago, medicines are sufficient, assistants are capable, and all equipment is properly prepared.For blood transfusion, more than a dozen reporters were waiting outside the preparation room, who could contribute at least 200ml of blood at any time, and there was no need to take care of the baby in the stomach during the operation.

Smooth birth
Maybe it's not entirely impossible.

.

(End of this chapter)