Nineteenth Century Medical Guide

Chapter 430 426. Unexpected Surprise

Holmes completed all medical courses at Harvard University and graduated successfully after completing his thesis last summer.

According to the requirements of local hospitals in New York, any medical student who graduated from a medical school is eligible to become a doctor. Unfortunately, the working environment of the New York Love Hospital has never satisfied him. The work is repetitive like a copy machine, and patients die one after another, but the medical skills have not improved at all.

In order to treat a patient, he went to several university libraries in New York, but couldn't find a suitable solution.

Earlier this year, when Holmes saw the strength comparison between the world's medical universities and hospitals, he completely collapsed.

Paris has a total of 15 hospitals, providing medical services to more than 5000 people each year, while New York's scattered hospitals have a total number of patients less than 3. Correspondingly, the University of Paris Medical School has a collection of more than 4000 books, while the total collection of the three medical schools in New York is only books.

He quit his high-paying job at the Ai Xin Hospital and, taking advantage of the new wave of studying abroad triggered by the Paris World Expo, resolutely boarded a transatlantic cruise.

In February this year, Holmes used half of her savings to pay tuition and became a student at the University of Paris Medical School. But unlike those who also came to Paris to study, Holmes plans to repeat a year of undergraduate studies before continuing her studies.

In addition to the need to get used to the language, the more important difference is the difference in courses.

Studying for one more year means paying one more year's tuition. In order to earn tuition, Holmes is busy all the time.

However, the busier he was, the more opportunities he had. As his French improved, he found that there were too many areas to learn and study. He worked as a handyman in a veterinary hospital and watched simple surgeries; he worked as a nurse in a children's hospital and listened to lectures on whooping cough, measles and chickenpox; he took time out to secretly listen to chemistry classes at the Sorbonne; he went to Saint-Louis Hospital to observe the diagnosis and treatment of skin diseases.
As for the Main Palace Hospital, it is of course the obstetrics and gynecology and surgery departments.

Mrs. La Chapelle's midwifery class is an elective course in medical school, and it is also her personal private lesson. The class is short, but it is difficult to sign up because hundreds of people are scrambling to see the obstetrics ward of the Divine Palace Hospital.

Holmes was one of them.

In the ancient Hôtel-Dieu, each ward was like the hall of a castle, with waxed oak floors polished to a shine and rows of beds on both sides, numbering more than a hundred.

Each bed here has a separate white curtain hanging from the high wall, and the windows are of appropriate size, allowing light and ventilation. Even though the hospital has more than 1000 patients, it does not seem crowded, and everything is so orderly.

Every morning when Director Hugill makes his rounds, there are at least 20 people following him. In the surgery department where Landreth works, the number is doubled. For everyone who sees it for the first time, such rounds are a spectacle.

There are so many great things about this place, but the only thing that makes Holmes regretful is that he missed out on Cavi's trip to Paris at the end of last year.

Even those Parisians who were used to big things couldn't help but talk about Kavi's name. He wanted to see what this Austrian doctor, who was about the same age as him, looked like and whether he was as amazing as others said.

Now is the chance.

"Mrs. LaChapelle cannot teach today." A nurse ran into the ward and took out a set of hospital gowns and medical records from the storage box. "She was called to the operating theater by Dr. Kavi. A lady is about to undergo a cesarean section. If you are interested, you can go in and take a look with Mrs. LaChapelle's invitation letter for teaching."

Carvey's cesarean section was definitely a gift from God, much better than private midwifery lessons. This is not what Holmes said, but what Mrs. La Chapelle said herself.

The five of them followed the nurse to the operating theater. This was not their first time here, but the tension in the central operating area was far greater than before.

Completely different from surgeries in the United States, the pre-operative preparations here require five people to be responsible for the work. Not only water, but also a lot of medicines, syringes and infusion bottles, and the cleaning of surgical instruments is carried out in several steps.
The nurses and interns were very busy, and the doctors were also busy.

Madame La Chapelle, who usually had everything under control, was sitting next to the operating table, looking at the handwritten medical record in her hand, and constantly exchanging opinions with Director Hu Jier beside her, as if she was about to face a major war.

Ten minutes later, as laughter and scolding came from far away, the door opened and the pregnant woman who was about to give birth was brought in.

There was an uproar in the audience.

"What's happening here?"

"He looks like a lunatic. Why would a mentally ill person be sent here?"

Anyone with a discerning eye could see that she was different from ordinary pregnant women. She was thin but extremely excited.

She was tied to a pushchair, struggling with all her limbs, with a few bloodstains faintly visible on her wrists. But the pain was nothing to her, and it did not stop her from saying:
"You guys who love looking at other people's butts, you even don't let go of men's butts, do you feel good? Haha, do you want to go to the Seine and wash your face with feces? Oh, forget it, spare the cesspool, the cesspool will vomit when it sees you, and it smells more disgusting than God!!!"

Holmes could barely make out the French mixed with some Irish and English, but her eyes were fixed on the young doctor standing behind her and slowly entering the room: "Is he Kavi?"

There was no need for a portrait or to know the face in advance. The relaxed demeanor and walking posture when entering were enough to reveal the identity. Someone who could still raise his head and speak naturally, and even give instructions in front of the chief of surgery and obstetrics and gynecology of the Palace Hospital, was naturally not something that students like them could compare to.

"It's really Kavi, he made a fortune today!!!"

"If it were in Vienna, the cheapest ticket for this surgery would cost at least $50!"

"Not only that, today's woman is in labor!" The classmates next to him echoed, "Mental disorder plus labor, this can only be seen in a place with advanced medical care like Paris."

"I feel like watching this surgery is more useful than spending three years in Harvard!"

"The operation hasn't even started yet, can you guys stop being so excited?"

"How can I not be excited? This is Dr. Kavi's surgery! Who wouldn't be amazed after watching it? At the end of last year, even several major newspapers in the United States published reports on his surgery."

While Holmes and his colleagues were saying these words, they had already skillfully taken out notebooks and pens, ready to record the start of the operation.

They have no medical records of the mothers who have given birth, and have never seen a cesarean section. Any public speech from the operating area will be a great piece of knowledge and a work experience that people will think about for months. Missing even one word will be irresponsible for the money you spent to study in Paris, and you will most likely regret it for the rest of your life.

Even with this awareness, the medical report at the beginning still made their scalps tingle.

"It's 8 p.m. now. 8:42. The operation came a little unexpectedly. You're all lucky." Landreth glanced at the wall clock and started the conversation. "The woman is from the suburbs. She has severe mental disorder, severe pneumonia, intestinal obstruction caused by ascariasis, severe malnutrition, and what else?"

Kavi picked out the instruments he was used to from the ones the nurse brought and pointed to his ears and mouth.

"Oh, yes, there are also maggots on the body surface, moderate dehydration, and systemic poisoning symptoms."

Landreth finally finished his diagnosis, and before his colleagues on the stage could start discussing, he continued, "We don't know the month of pregnancy, but we measured the baby's biparietal diameter to be 7.8cm, which is smaller than the average fetus. Considering the mother's severe malnutrition, this value is normal.

The mother had strong rhythmic contractions two hours ago. Because there is very little subcutaneous fat, people sitting forward should be able to barely see the exaggerated contractions. "

As soon as these words were spoken, the crowd stood up and leaned forward.

Even though it was past get off work hours, there were not many spectators who were lucky enough to come and watch the operation, about 30 or 40 doctors. The operating area of ​​the Palace Hospital was not large to begin with, so they thought about breaking through the fence and moving forward.

"Everyone, pay attention to the surgical rules!" Landreth hurriedly shouted, "If you don't want to be kicked out, stay behind the fence and wear a mask and hat, and don't make me angry!" Holmes was very disciplined. When everyone rushed forward, he found a good seat at the back. When the crowd retreated, he had a perfect observation position, and could clearly see the upper part of the operating table. But soon, a bald head of a forty-year-old French doctor squeezed into the gap between him and his classmates, and casually uttered a long-prepared "Sir, I'm sorry!"

In Holmes' eyes, these European gentlemen were more like rednecks than the American rednecks they described, but they were the quickest way to learn knowledge.

"In addition to mental disorder, there is also ascariasis. How should this situation be handled?"

"What else can I do? Cut open the cavity."

"Shh~" Holmes made a gesture to silence the conversation on the operating table. "It's about to begin!"

Kavi asked the intern to carry the patient to the operating table and tie up her limbs. Then, with all the instruments ready, he began ether anesthesia. "Everyone, this is not a teaching operation. Considering the poor physical condition of the parturient, I will increase my hand speed a little. I hope it will be helpful to you."

Shilina kept shaking her head to refuse the anesthesia mask, but in the end she inhaled the ether gas under the coercion of several people. In the blur, she even became more conscious for a while, mumbling some vague words, and soon fell asleep.

"Dr. Kavi, the anesthesia is complete."

Kavi did some more checks and confirmed that the anesthesia was correct. He took over the sterilized forceps from Landreth and did the final disinfection. "It's the same as before. The manual tearing method is faster."

"You decide."

"As you all know, the fetus and the pregnant woman are connected by the placenta, and the fetus is supplied with nutrients through the pregnant woman's blood."

Kavi gently pulled apart the skin, fascia and muscles, hooked them with his fingers, and exchanged glances with Landreth before using all his strength to lean back and tear open Shelina's belly. The exaggeration was so great that even Holmes, who was used to seeing autopsies, almost cried out. It was so explosive.

"Please keep quiet!"

"."

"The placenta is like a huge sieve that keeps out some not-so-good things. But ether is a small molecule that can naturally enter the fetus' body and affect it. So we have to take the baby out as soon as possible, and then slowly solve her own problems."

Everyone wrote this sentence down in their notebooks, and a few even asked questions, but they were all rejected by Kavey: "Please wait until the operation is over."

The operation was just as Kavey had said, very fast.

Holmes had concentrated all his energy, but he still couldn't see how Kavi's hands, like an artist, achieved the complex separation. In his hands, the layers of tissue were extremely clear, and each layer was an extremely important frontier knowledge point of anatomy, which was a hundred times more vivid than the anatomy class he had taken.

Only two minutes into the show, Kavi's uterus had already been exposed, and as a violent contraction occurred, the entire blood-red mass of flesh began to twist in front of everyone.

"The contraction is over, give me the scissors." Kavi lifted the uterine membrane and cut a small hole. Then, before the instrument nurse could react, he quickly switched to a scalpel and cut it in the opposite direction, "Get ready to draw the amniotic fluid."

As the director, Hu Jier was now only responsible for being the second or third assistant. Compared with his previous confusion, he seemed more focused, fiddling with the suction head to suck out all the overflowing amniotic fluid.

"Give me oxytocin and increase the amount of fluids."

"it is good."

"How are the vital signs?"

“It’s normal.”

As the uterus continued to open, Kawi began to try to remove the fetus, saying: "The huge uterus of the parturient occupies the abdominal cavity for a long time, which will squeeze all the surrounding blood vessels except the main blood vessels. Because it is a long growth process lasting several months, the body will slowly adapt to this change.

But during the operation, because the fetus and amniotic fluid leave the body quickly, the squeezed abdominal cavity will return to its original state in a very short time. Most normal pregnant women can adjust well, but today's pregnant women are weak and need to pay attention to their vital signs at all times to prevent accidents. "

Shilina's body did not react violently as Kavi said. It was like a flag on the battlefield that had been baptized by artillery fire. Even though it was tattered, it was still hanging there with the few remaining stitches.

No one knows how long it can last, maybe it will break in the next second, but it just floats tenaciously against the wind.

"Baby." Kavi reached into the uterine cavity, grabbed the fetus' head and slowly pulled it out, "The baby is coming out."

Even Landreth, who was known for his calmness, couldn't help but look at the nurse beside him excitedly: "How is your blood pressure and heart rate?"

"It's all pretty good."

Landreth couldn't help but look at Shilina again. The bloodless face was sleeping there quietly. "It's a miracle."

"Madame La Chapelle!"

"give it to me."

La Chapelle had prepared a clean cloth in his hand. After receiving the child, he quickly wiped off the blood and meconium. There was no need to stimulate the child, the child immediately cried out: "Wa ...

"He cried out right away! His lungs are growing well!!!" Mrs. La Chapelle looked at the child with a smile, "It's a little small, but very healthy! He will grow up in the future!"

"There's nothing wrong with my mother's health!"

Kavi breathed a sigh of relief. The first hurdle of the operation was overcome and the operation landed smoothly. The next thing was uterine contraction and ascaris intestinal obstruction. As long as they were solved and Shilina could still hold on, the operation would be considered a real success.

"Increase the amount of oxytocin, and we will start to sew up the uterus." Kavi took the suture thread, "Start with the inner layer first."

However, at this moment, Mrs. La Chapelle, who announced with a smile that it was a boy, suddenly froze in her tracks: "Dr. Kavi."

Kavi was concentrating on stitching the uterine muscles and didn't pay much attention to her words: "Ah? Madam, what did you say? The child is screaming too loudly for me to hear!"

"I mean, this kid doesn't have..."

"nothing?"

Kawi realized something was wrong and turned around quickly, only to find a butt covered in white meconium in front of him. There was nothing wrong with the size, proportion and shape, the only problem was the "eye" in the middle.

The child has no anus.