Nineteenth Century Medical Guide

Chapter 432 428. John Wolfgang
More than 20 years ago, when Sherina was still lying in the cradle, her father put some money in the bank for her life path, a reserve fund for planning for the future.

Then she never saw the father or the money again.

Her mother soon found a librarian, and Shilina had a second father. Unlike the previous one, this time the reserve fund was deposited in a bank called "Brother". Also unlike the previous one, this time Shilina knew the specific amount of the reserve fund, a full 1000 francs.

Perhaps influenced by her two fathers, she likes reading.

Even though her father was partial to her and never looked at her straight in the eye, and her brother was a loser who couldn't even understand the most basic words and sentences, Shilina didn't care, because the Goethe, Schiller, Pope, and Voltaire that her brother didn't want stayed by her side and accompanied her throughout her childhood.

Time passed quickly, and her father arranged a marriage for her. The other party was a principal of a rural school, who sounded good, but unfortunately after two brief contacts, she found that he was a sloppy man with no literary accomplishment but claimed to be a Parisian poet.

It was obvious that the other party was not worthy of Shilina, and everyone with a discerning eye could see it. Even her wish for a bouquet of white violets could not be fulfilled. She could buy them at any flower shop in Paris. The reason why he could not give her was simply because he did not have that much spare money.

Oh my god, it's only 10 francs! If he can't even afford 10 francs, how can he give himself the life he wants?

Is it because he is a descendant of a poor noble family? Or is it because he can receive a 25 franc allowance every month?
Shirina confronted her parents and then ran away from home with the few belongings she had.

She went to many places, watching the sunrise on the beach in Montivilliers, attending mass at Chartres Cathedral in La Roupe, having lunch at the castle in Nemours, wandering around the small towns in Brittany, tasting fine wine and French cuisine in the vineyards of Bordeaux, and soaking in hot springs at the foot of the Pyrenees. Finally, she returned to the seaside, climbed the lighthouse on Guernsey Island, and quietly overlooked the English Channel under the night sky while enjoying the sea breeze.
The "Fantasy" Travel Notes on France is Sherina's first work and her masterpiece. Although this work, written while she was thinking, drawing and writing, has never been published, it is her spiritual food while she was living in the monastery of Burgundy.

Unfortunately, writing could not bring her any substantial income, and the income from the monastery was also limited, so her money was soon used up.

Shirina returned to Paris.

When she left Paris, she was a charming little girl, a natural beauty. Three years later, she was still beautiful, but her personality became withdrawn and boring, and she no longer had that intoxicating aura.

The secluded and impoverished life of living alone in the provinces, and the narrow, paranoid and stale interpersonal relationships made her soul constantly washed away by the world, and finally turned into a cold organ, limited to maintaining the basic functioning of the body in exchange for a few francs to barely survive.

She also thought, forget it, stop being reserved, give up those unnecessary dreams, and throw herself into the world of fame and fortune, so as not to waste this beautiful body.

But even selling one's body requires talent, and there is a first come, first served distinction. The competition in the upper class is extremely fierce, and the good positions of high-end "goods" and bourgeois life have long been occupied. Shilina became a victim in the erotic struggle before she even started, and was divided up and eaten up by a group of scum.

To be honest, she would rather go to Antwerp than the Palace of Versailles.

When the spire of Antwerp Cathedral disappeared in the morning mist, she climbed the steps one by one, stood in front of the skylight of the bell tower, felt the accumulation of hundreds of years of human art, history and thought, called out to the glory engraved in the cracks of the old city's stones that was about to disappear, and waited for them to respond to her.

However, the final response she received was.
"Sherena! Shherena!!!"

Kavi slapped her face twice, but her pale face still showed no color, and the woman showed no sign of waking up. He looked at the amount of ether and the duration of anesthesia, and found that things were not good. He turned to the nurse and asked, "When did this start?"

"It seems like I didn't take long." The nurse had never seen Kavi like this before, and for a moment she was a little flustered and couldn't explain herself.

At this time, Kavi only believed in himself and did not care about the principle of sterility. He directly pressed against Shilina's carotid artery. Seeing that her heart rate was still normal, he said to the intern beside him: "Where is the stethoscope? Bring it over."

Kavi put on the stethoscope again and moved the head quickly across Shilina's chest. There were still breathing sounds, but they were very weak, even weaker than the old man who was paralyzed in bed and had been sentenced to not live for more than a few days.

There is a problem, a big problem!!!

Kavi pulled off his stethoscope and looked at the other intern assistants standing by: "Someone come and pry her mouth open for me, and then someone get a laryngoscope! Quick!!!"

Landreth was still confidently handling the roundworms flowing out of the intestines, feeling the sticky intestinal fluid and the tenacious worms mixed together in his hands. Suddenly seeing Kawi so excited, he couldn't help but ask, "What's wrong?"

"She's not breathing!"

Surgery has always been the work of an entire team, not just one or two doctors. The highlight of surgery in the 19th century was the unknown. There were no imaging tests, no cardiopulmonary function tests, and no coagulation function tests. Even if the patient died in front of him the next second, Kavi would not be surprised.

The heart rate is still OK but there is almost no breathing sound, which means that the breathing is inhibited. Is there a problem with the respiratory center, or pneumonia causing respiratory function problems, or a problem with the respiratory tract itself, or something encountered during the operation caused a severe allergy or other reasons affecting the patency of the airway.

Because there was no preoperative examination, Kavey didn't know the answer, but if he had to choose one, he would definitely choose the last one.

It’s not that the first three items have a low probability of occurring, but that he can only handle the last one.

Kawi's first reaction was that the sputum produced by pneumonia caused the airway obstruction, which was also what he had anticipated before the operation. There are many ways to relieve the obstruction, the only difference is the speed and degree of trauma to the body.

He pinched Shilina's cheeks hard, and could barely see the inside of her mouth through the gap between her upper and lower teeth. Unfortunately, it was pitch black inside and he couldn't see anything: "Someone put down the candle lamp on the ceiling and bring the oil lamp over!"

No one dared to ignore his words. All the people and objects serving the abdominal surgery area, as well as the eyes of the audience, turned to Kavi.

Shilina's face, which looked like a lime wall, looked very fragile, as if it would be crushed into pieces by Kavi's hands in the next second. Her chapped lips and slightly bloody nose did not react to any external stimuli, and she looked like a fresh female corpse.

"Give me the baffle."

"Baffle. The baffle is out."

As soon as he finished speaking, Kavi pulled out the baffle that was inserted into the abdominal incision to block the other intestines, wrapped it in a simple layer of white cloth, and stuffed it into Shilina's mouth. The muscle relaxant effect of ether was not very good, and it took a lot of effort to fix her mouth.

"Hold her mouth. I want to see what's going on inside."

After Kawi finished speaking, he used a piece of gauze to clamp the hemostatic forceps to press down Shilina's tongue, finally exposing her throat. However, apart from a lot of oral inflammation, no cause of suffocation was found: "We have to explore further. Where is the laryngoscope I need? Why hasn't it come yet? "

"The laryngoscope is in the medical instrument box, it's a ways away."

Kavi didn't dare to wait any longer. Shilina's body might collapse at any time. "Give me the suction device." "It just sucked out the amniotic fluid."

Landreth realized the seriousness of the problem and handed the task of playing with the bugs to another surgeon. He picked up the suction head and stuffed it into a clean basin of water: "Instead of explaining, it's better to think about how to do it. Pump out the water!"

After two simple suctions to ensure basic cleaning, the suction device was handed to Kawi.

The current suction device is a straight metal tube, not a modern soft suction device. It has no bends and no way to control the suction force. All Kavi had to do was to lift Shilina's head as far back as possible and straighten the originally curved airway: "Bring a cushion."

The cushion was placed behind Shilina's bent neck, her head tilted back and her throat raised, which was the most common anesthesia endotracheal intubation posture.

Because there is no laryngoscope yet, the light source still only stays at the front of the mouth and cannot reach the deep throat. Kawi can only try to control the suction head to suction the sputum. The key to suctioning sputum is not the suction head, but the hand-cranked pressurizer controlled by Landreth: "This is the first time I use this thing to suction sputum. Are you sure it works?"

"Try it." Kavi placed the suction head on his palm to feel the suction, "Lighter. Lighter. Okay, keep it like this."

As Landreth's hand wheel kept turning, the suction head quickly captured the target at Shilina's throat. Immediately, a mouthful of sputum flowed through the metal tube into the wide-mouthed bottle: "It's sputum! The sputum was really sucked out."

"I feel it is more useful than the suction tube used in internal medicine!"

"Not enough, there should be more." Kavi glanced at the bottle and continued, "One more time."

However, no matter how many times he came, the amount of sputum could not satisfy Kavi. Just a few mouthfuls of sputum could not completely block the airway, and Shilina's breathing was still suppressed, her breathing sounds completely disappeared, and her lips and nails were also lilac.

Even without an ECG monitor to monitor oxygen saturation, Kavi knew that the oxygen in Shilina's body was almost used up.

Where is the problem?
Is it central nervous system depression? The anesthesia lasted for so long, if it was going to be suppressed, it should have been suppressed long ago, it shouldn't have happened at the last moment. And even if it was central nervous system depression, there was nothing I could do about it.

Is there something wrong with the lungs? If the suffocation was caused by poor lung function, it should have been gradually reduced, rather than suffocating directly in a short period of time.

So it is still obstruction, and the most likely cause is sputum.

However, the metal tube of the suction device in his hand was not long enough, only 11cm. The back was a leather hose, so he couldn't go any deeper. But Kawi chose to try again, this time not holding the suction device with his hands, but clamping it with oval forceps, which could further increase the depth of penetration.

However, the effect was not ideal. There seemed to be something blocking the front, and she could not move forward. Maybe it was not phlegm blocking her airway, but something else. If it was something else, let alone the laryngoscope, even if it did come, he would not be 100% sure to take it out.

"We can't wait any longer." Kavi put his eyes on Shilina's neck, "Do a tracheotomy."

"Let me do it." Landreth seized the opportunity and quickly felt the incision site on the body surface. "Give me the hemostat and the scalpel."

Usually, there are not many patients who need tracheotomy, but Landreth's proficiency in the operation is not low. From cutting the skin, separating the muscle fascia, to cutting the trachea, it only took less than 3 minutes, which is comparable to Kawi.

It was obvious that he usually spent a lot of time on the corpse, not only the operation itself, but also the connection between the instruments. He had done a lot of practice: "After cutting it open, how is the breathing?"

Watching Shilina's chest rise and fall slightly, the original light purple color on her skin and nails did not continue to deepen. Kavi listened to the breathing sound again: "The breathing sound has recovered, it's still the same rales, but it's weaker than normal. Give her a little more time, and she should be able to return to her original state."

"Intubate me."

Landreth began putting the finishing touches on the tracheotomy, inserting a claw tube and placing a neck immobilizer, while Kavey, after checking for intestinal worms, wanted to know what was blocking her airway.

Tracheotomy can restore breathing, which means that there is indeed airway obstruction, and the obstruction is located in the distance from the incision point to the throat. Kavi chose to use a laryngoscope that refracts candlelight to enter her mouth, and a thin and long hemostatic forceps on the other side: "I see."

"What's blocking the airway?"

"Give me the largest hemostat you can get."

Kavi chose to answer directly with a real object, a roundworm that was 23 cm long: "That's it."

8:42, the operation begins.

8:57, delivery was successful.

9:20, uterine suture completed.

9:41, start cleaning the roundworms.

10:38, small intestine repair completed.

At 11:00, Landreth completed abdominal closure and the operation was over.

Shilina's operation was successful, but her condition was not good after the operation. She had a high fever that reached over 39 degrees. Although her malnutrition was corrected and her other physical conditions were normal, pneumonia further reduced her respiratory function and the continued high fever made her body function weaker than before the operation.

Kavi rejected the Health Administration's proposal to send Shilina out of the Hospital twice in a row, and even called Osman to support him. Even Landreth, the chief surgeon of the Hospital, who had always refused to accept her, acquiesced to the patient.

On June 6, the afternoon of the eighth day after the operation, Shilina closed her eyes forever while holding her son.

In accordance with her wishes, her son was named after the great poet Goethe: Johann Wolfgang.

The second book of Shelina was revised and compiled by the descendants of the Osman family, renamed "Multiverse Survival Guide", and sold. Later, Johann Wolfgang added a Christian name to himself and changed his name to Johann Krafft Wolfgang.