Nineteenth Century Medical Guide

Chapter 409 405. It’s the end, it’s also the beginning

At 11:05, Payon began to sew up Bertha's belly, and Carvey and Landreth came off the stage to wash their hands and change out of their leather skirt masks and gloves.

At 11:15, the operation officially ended, and Albaran accompanied the theater staff and nurses to help clean the theater.

The anesthesia mask must be put away into the wooden box, the ether gas must be exhausted, and the remaining ether and other drugs must be returned to the pharmacy warehouse. Infusion bottles, leather straps, suction pumps, and wide-mouth bottles must be disassembled, cleaned, and recycled. Surgical instruments, masks, gloves and gauze, and even the bloody mattress and blanket where Bertha slept must be cleaned and then enter a long disinfection process, waiting for the next use.

Landreth looked at the busy crowd in front of him, and stood alone at the door smoking: "It turns out that you also have an operation that you can't handle."

"Of course." Kawei refused the cigarette he offered, "I didn't expect you smoked cigarettes."

"The pipe is at home. The teacher specially bought it from China from an Arab businessman. It is very long." Landreth gestured at the length with his hand, then took two puffs of smoke and returned to the topic, "This is the first time I have seen such a pipe. A large hemangioma, or an abdominal aortic hemangioma”

This is true.

In the 19th century, the average expected age hovered around 30 years old. It was generally considered good to live to 35 years old. Most people would encounter fatal dangers at a young age like Bertha. Dissecting aneurysms like this mostly occur in middle-aged and elderly people. The number of cases is very small. In addition, there is no way to check and treat them. Unless you try your luck by dissecting cadavers, it is difficult to see them.

Kawei doesn't like to discuss "failure", but he hasn't figured out how to face the mother of his child, so he can only stay here and chat: "What do you think of Chinese medicine?"

"It's okay, it's quite interesting. It's just that the translation is too troublesome. I don't have the language talent like the teacher, and my senior brother knows nothing about medicine, so I can only do it slowly by myself." Landreth suddenly looked at Kawei, "Kawei Is the doctor also interested?"

"She looks fine now. She will probably wake up in half an hour. She needs to rest now. The nurse will send her directly to the ward. The bed number is 14." Kawei finished the basic situation first and did not want to hide it. The real meaning is, "But...,,,,,, this is only temporary, surgery cannot solve the real problem in her body."

Happiness, doubt, confusion, and pain. All emotions were squeezed into just a few dozen seconds and flashed across Veronica's cheeks.

The joy that had just emerged was abruptly suppressed.

Hearing this, she couldn't help but bite her lips and suppress her tears. She thought the key problem had been solved, so she couldn't help but interrupt Kawei: "Is she okay?"

"It's over, but it's just the end of this show." Kawei explained, "Sometimes choosing the end is not to give up, but to start a better one."

"Wait a minute!!!" Landreth would never have thought that Kawei's body contained a native Chinese. "I will not give you the collection of Chinese books on the bookshelf."

In less than 2 hours after it appeared in the public eye, several reporters came to the hospital smelling the smell. Kawei didn't have time to talk to them about "the current situation" now, so he sent them away after just a few words.

At 11:40, an hour and a half after the operation started, Bertha's mother Veronica finally saw Kavey outside the theater.

Kawei briefly introduced the situation: "We bandaged and sutured the wound on the arm. The fracture was not too serious and has been fixed. After we opened the abdomen, we found that the spleen was ruptured, but there was not much bleeding and it was repaired quickly."

Spleen rupture is a condition that Veronica has explained before.

"Surgery? What kind of surgery?" Landreth was a little interested, but only a little bit. "I know how to do cesarean section, and I can almost do appendix, hernia, intestinal segment suturing, and skin grafting. I already know how to suture and cut spleen." What other surgery?”

"I know, I heard about it."

He looked a little tired, and his face showed no expression. Of course, she knew that this was the norm for Kavi, even when he held a clinic in the basement. As long as you are at work, even the smile at the corner of your mouth must always serve your career and will not be taken out easily.

"Ah? You said... cough cough cough!" The smoke that had just been breathed into the lungs seemed to be as shocked as Landreth, violently stimulating his lungs. "The operation, isn't the operation over?"

"Temporarily? You just said..."

"Bertha's surgery." Kavi pointed to the empty operating bed.

"So I want to ask if you have any here"

Chatting in French with a French surgeon about traditional Chinese medicine always left Kawei feeling disconnected: "I only know a little bit of Chinese characters and am interested in oriental calligraphy, painting and other artworks."

"That's not true."

Veronica finally met Kawei, and while she was happy, she was also very worried, fearing that something big would go wrong with her daughter. She subconsciously tidied her dirty clothes, then hurriedly leaned over and asked, "How is Bertha?"

Kawei originally wanted to help translate Chinese medicine content and buy some antique books, but then he thought that translation would still take up too much time, so he chose surgery: "Otherwise, I can take you with me when I have my next surgery, and you can do it for me. Assistant. Accordingly, you have to show me the Chinese book.”

Veronica didn't understand, her language was messy and she didn't know what to express. Kawei did not interrupt or explain further. He had to wait for the temporary confusion in her brain to disappear before continuing to listen to what she wanted to ask: "Yes, was the surgery just not done well? Or was there something else wrong?"

The surgery wasn't done well, it wasn't done at all.

Kawei took her to the small garden in the hospital to sit down, and briefly introduced the time bomb just like he had explained the diagnosis and treatment process to his family before.

The inner diameter of the abdominal aorta is an important reference for the evaluation of abdominal aortic aneurysm. It continues to grow from less than 1cm in infancy to about 3cm in adults. As long as the dilation does not reach 50%, conservative treatment is still possible.

The reason why it is said to be "possible" is because the abdominal aorta of a 6-year-old child is generally about 1.5cm, but now Bertha's abdominal aortic dissection aneurysm has an inner diameter of just over 2cm, which is stuck in the indications for surgery. In theory, Surgery may or may not be performed, and conservative treatment is also an option.

The second reason is because there was no other evaluation method in the 19th century and the only way to judge the pipe diameter was to directly observe the pipe diameter with the naked eye. After closing the abdomen, my eyes went dark and I had no idea how far the dissecting tumor had progressed. The so-called conservative treatment was actually the same as giving up treatment. There was no difference.

So it can only be considered possible.

If it were placed in modern times, Kawei would definitely choose surgery.

The child is still young, so no one knows what the consequences of conservative treatment will be, and it is impossible to do a lifetime of imaging tests to evaluate the status of the dissecting tumor. But now Kawei really has no way to deal with abdominal aortic dissecting aneurysm. He will definitely die faster if he moves than if he doesn't.

After briefly explaining her choice, a mother burst into tears soon after.

Veronica was just crying, crying hard, like other family members who chose to vent their emotions in the garden. However, this woman did not make things difficult for him. If she could waive the surgery fee and send the child to the hospital, she would have done her best. After all, before coming here, he was just a human being locked up in the basement.

Kawei really tried his best, and whenever possible, he would do his best. Only this time, the operation will definitely fail.

Aortic dissection destroys the intima of the blood vessel and may also affect the media. The main blood vessels of the body are only supported by a layer of outer membrane, and there is a risk of explosion at any time. In addition, she must also consider the shedding of the intima and the formation and subsequent shedding of thrombi. Even if she is alive, there are other risks, large and small, waiting for her.

If you want to solve the problem of this section of blood vessel, you cannot simply and roughly cut off part of the dilated blood vessel wall and then suture it. This will cause severe stenosis of the blood vessel. You cannot cut off the broken blood vessels and reconnect them, because the blood vessels themselves are limited in length and cannot be reached at all. It is also impossible to do blood vessel transplantation in the body because there are no other blood vessels that are so thick.

If an aortic aneurysm is to be cured, the entire expanded aneurysm must be cut out and replaced with a blood vessel substitute—an artificial blood vessel.

Kawei is confident that the operation will be successful, but without the blood vessel replacements that are only available in modern medicine, it is difficult for a woman to make a living without rice in the true sense.

"Fortunately, we still have time. Bertha is generally fine. I will try my best to study this operation and let Bertha stay in the Cathedral Hospital in the next six months to wait for my news." Kawei said , "I have already made an agreement with the director of surgery here. I will pay for the ward room, so you don't have to worry about it."

Veronica wanted to grab this straw that might be taller and taller than a big tree, but she always felt awkward in her heart: "We already owe you a large sum of money for surgery, and it's really hard to ask you to pay for hospitalization."

"No, this should be regarded as my personal compensation for Bertha's outstanding contribution to medical progress." Kawei said, "Wait a little longer, don't be anxious, and tell Bertha not to be anxious. Wait until I have a solution. And after successfully passing the experiment, she was immediately given blood vessel replacement surgery.”

Veronica couldn't hold back her tears and just sat there and nodded.

"Take time to go back and bring daily necessities. Then..." Kawei said, "If you see Lex, ask him to come to the Main Palace Hospital."

"Let him come over?"

Veronica's mother's identity instantly turned into an accomplice of the kidnapper, and her emotions also changed: "You said you would go back to find him, but now you want him to come here to find you?"

Kawi knew she was testing him: "I'll give him the money."

"I don't think he will come. When I stayed outside just now, I heard a lot of people talking about your disappearance. They looked at me very strangely, always feeling like they were doubting me." Veronica shook her head. , "It's too dangerous to contact you again."

"Have those reporters looked for you?" Kawei changed the subject.

"I looked for you. I followed the same story as before and lied and said I met you on the way."

"It's fine if you don't tell me. As long as you don't tell me, everything will be fine." Kawei really has no other ideas. "I just want to give him the agreed money and help them find a job at the same time."

This was a bit beyond Veronica's expectations. Just as she was about to continue asking, suddenly a large number of police officers in uniforms, boots and high hats came from the direction of the hospital entrance. The leader was a fat man, and behind him were two men wearing other clothes, both of whom looked to be of unusual status.

As soon as he saw Kawei, a man hurried over and pulled him up from the stone bench with a smile: "You are okay, I know you are okay! That's great, I have never been so grateful to God! Today will definitely Thank him very much!”

"Doctor Kawei, you can make it easy for us to find you." Henry finally breathed a sigh of relief when he saw that the man was alive and well. "You know how much the Three Emperors miss you. If we can't find you, my acting director I’m afraid I won’t be able to keep my seat.”

Kavi and Henry met once because of Shebasto's surgery. They didn't communicate with each other at the time, but now they think about it when they see each other: "I'm so sorry."

"No, you're not hurt, are you?"

"No, it's pretty good."

"It had been several days since we received the kidnapping letter." Henry also felt like he was surviving the catastrophe, "Who are the people who kidnapped you?"

"Ah," Kavi scratched his head, glanced at Veronica beside him, and replied with a smile, "They are just ordinary robbers. They locked me up when they saw that I had no money in my bag but I was well-dressed."

"What does it look like?"

"She looks ordinary, but her face is covered." Kawei didn't want to talk about this.

"When you go back and change your clothes, go into the palace to meet his old man as soon as possible." Henry smiled, stretched out his fat right hand to pat his shoulder, and his tone suddenly became serious, "When the emperor's affairs are finished, I hope you will Come to the police station and talk to us about those idiots."

"Um okay."

Morasso was also interested in the kidnappers: "I also want to know who are these people who dare to kidnap you in broad daylight. Fortunately, you are fine. If something goes wrong with you, I will lead a team of cavalry to arrest them. Catch them all and hang them!"

"Don't be excited, don't be excited, Mr. Morasso." LeBoeuf came out to smooth things over, fearing that Henry would conflict with him again, "It would be great if Dr. Carvey could come back, and leave the rest to Henry. When the time comes, the guilty will be pronounced. Even those who are not guilty can be shocked."

Veronica had long been frightened by the battle in front of her.

She had never seen so many policemen and soldiers in her life, and of course she had never seen any police chief, count, or military adjutant. Her aura was completely different from that of ordinary people on the street.

Kawei's identity is not bad, at least the certificate and the letters together can prove it. But when she saw them chatting together and even talking about taking the Three Emperors, Veronica realized what kind of big shot they had kidnapped.

She stood up awkwardly, wanting to sneak into the ward to see her daughter while they were chatting, and then sneak back to find Lex to make plans.

Suddenly, Kawei left the three of them behind and looked back at her with a smile: "Miss Veronica, are you going back?"

"Well, let's go see my daughter."

"If you go back, please give Mr. Lex a message." When he mentioned the kidnapper, the smile on Kawei's face became brighter. "Thank him for me. Without his help, I would not be able to escape from those people's dungeon." Escape."

(End of this chapter)