Nineteenth Century Medical Guide

Chapter 453 449. He just sneezed
After witnessing two delicate surgeries performed by Carvey on June 6, Holmes worked in the ward for nine days.

One reason is because of Landreth.

If it was during the period when Cediyo was there, Kawi could have intervened and performed more surgeries at the Hospital-Dieu. Now it was Landreth's turn to take control, and the criteria for judging surgical indications had changed. With his conservative personality, there were not many patients who could go on the operating table at the Hospital-Dieu. The fewer surgeries Holmes performed, the fewer opportunities Holmes, a new recruit, had.

The second is Kavi.

After the surgery that night, Carvey suggested that he start as a ward doctor, reviewing anatomy and solving some small bedside problems, without rushing to follow too many surgeries. Holmes was mainly responsible for managing the last large ward, where the patients were in complex conditions and had all kinds of diseases, which could improve his surgical skills faster and more effectively.

So when Devin was howling, he still followed Kavey's request and did his own thing.

Among them was Fisher, the carriage driver who had been hit by the bomb.

Today is the ninth day after his eye removal surgery. Normally, he should be discharged soon, but recently inflammation has appeared at the site of debridement and suture, and his body temperature and pulse have begun to rise, which is obviously an infection.

"Mr. Fisher~" Holmes came over with disinfection equipment in his hand, "I'm here to change the dressing again. How do you feel today?"

"I have a severe headache. I can't turn over or get up from bed. I can only lie sideways like this! It's so uncomfortable!!! I still have a headache. These days, the headache is getting worse day by day. Today, I dare not get out of bed to walk around, for fear that if I move, the headache will get worse."

Fisher leaned on the pillow at the back, touching the left side of his face with his hand, feeling very depressed. In addition, in order to block the leakage of cerebrospinal fluid, a cloth was stuffed in the left nostril, and even the voice of his voice changed: "Why did you come to me? Can you cure me? You win, I don't want a doctor! I just want to be alone!!!"

"Your wound still needs disinfection and dressing. How can you stay alone?"

Holmes comforted him, put the sterilized plate beside the bed, and tore off the tape that stuck to the gauze with both hands: "If you really want me to leave, I have to wait until the dressing is changed. I'm going to lift the gauze for an examination. Please bear with me."

He could definitely endure it, as this kind of pain was nothing compared to what Devinke's calf felt.

Fisher had endured it for nine days. If the night of the 19th was counted, it had been ten days since he was injured. He was already in a bad mood after having his eyeball removed, and now even his wound could not heal. He began to worry about his future life and even worried about dying here.

"Dr. Holmes, when will I be well?"

"It's coming soon, it should be coming soon"

Holmes felt bad when he saw the yellow gauze, and his heart sank after he opened the gauze. Previously, there was only exudation at the suture of the left upper eyelid, but now there was necrotic skin falling off. The yellow-white purulent secretions in the eye socket also increased, and the smell became stronger. After a simple wipe and cleaning, ulcerated tissue could be seen under the secretions, and the infection was very serious.

He placed the small basin next to his pillow, and while drawing saline with a syringe for a simple cleansing, he asked, "Can you move your right eye?"

Fisher, who had originally closed his right eye, reluctantly raised his right eyelid. Because of the pulling of the skin muscles under the joint control of both eyes, the area around his left eye twitched slightly twice: "My eye can move, but it hurts a little."

"Can you see clearly?"

“Yes.”

"Don't worry. Dr. Kavi is coming to check on you today. I will definitely ask for you. I will tell him about your situation when he is done." Holmes said with a smile, "When your eye is fully healed, you can ask him to make you an artificial eye."

"Artificial eye?" Fisher showed some interest. "It's a fake eye that's inserted into the eye socket?"

Holmes continued to comfort her: "Yes, it looks just like the real thing. It's pretty good."

“That’s going to be expensive.”

Fisher thought about his job again. His employer had not visited him since he was hospitalized. It was unclear whether he could continue to work as a driver after he was discharged. How could he afford the fee? "I heard that Mr. Devinke next door spent 100,000 to heal his leg."

"He's different from you. The equipment he uses is the latest model, which must be expensive. But even so, his condition is not good. His leg looks very swollen. I wonder if it will be amputated."

Holmes spoke very tactfully, avoiding many subjective emotional outputs, but he must have felt a little gloating in his heart. Obviously, he had encountered many people who did not follow medical advice in New York: "But he is him and you are you. With your income, how could Dr. Carvey charge so much?"

"This, this is true."

Fisher looked a little dazed and wanted to touch the wound, but Holmes quickly stopped him: "Uncle Fisher, I'm cleaning it, you can't move."

"Oh." Fisher's mind seemed to return to the previous topic, and he asked, "You mean he's going to have his limb amputated?"

Holmes felt something was wrong, raised his hand and touched his forehead, and replied: "I don't know about that. I wonder if Dr. Kavey has any other solution. If it were in New York, his leg would definitely have to be amputated."

"Dr. Kawi is treating him, why don't you go with him? Why are you coming to my place at this time?" Fisher suddenly pushed his shoulder hard, "Pack your things and go over quickly, I can take care of myself. If you see Dr. Kawi, don't forget to ask him to come see me, I'm in so much pain."

"Okay, I understand."

Although he said so, Holmes was still cleaning the wound. After several minutes, he finally removed most of the necrotic tissue, and then he dared to wrap Fisher's right eye socket with clean gauze.

The inflammation had developed to this point and it could not be delayed any longer. He could even sense that Fisher had mental problems.

He originally wanted to write a brief medical record summary while Kavey was still treating Devinke's calf, summarizing Fisher's postoperative condition in the past few days. Later, he found that it seemed unnecessary, and he left Devinke's ward in just half an hour.

The magical thing is that Devin, who was howling loudly just now, has become quiet since the door of the ward was closed.

Holmes suppressed his curiosity and went straight to Kavey without going to Devinke's ward where Landreth was taking careful notes. He said, "Dr. Kavey, I want to talk about Fisher in bed 112, the patient who had his eye removed that night."

"The driver?" Kavi still remembered him and took the medical records handed to him. "What happened to him?"

"The wound is not in good condition. When I changed the dressing just now, I found that it had festered and there was ulceration in the eye socket." Holmes said, "I touched his forehead and it was a little hot. His temperature was over 38 degrees this morning." Kavi looked down at the medical records and suddenly asked, "You went to change the dressing just now. Where are the gauze and bandages?"

Holmes didn't expect him to ask this. He turned around and pointed to the trash can at the end of the corridor: "All thrown away."

"Go, turn them out and show them to me."

Then I saw two respectable doctors in black uniforms standing in the corner, searching the trash can with pliers. Fortunately, it was not thrown away too early, so they took out all the gauze and bandages in a few seconds.

Kavi looked at the gray-yellow pus stain in the center and the yellowish liquid halo around it, and seemed to have discovered something: "There is blood, pus, and cerebrospinal fluid, and some of it has not completely coagulated in the middle. What about his nose? Is the rhinorrhoea getting better?"

Holmes didn't pay much attention to Fisher's nose, and kept telling him to just plug it with gauze. Now that Kavey asked him about it, he remembered this: "When I checked it three days ago, I found some. I didn't ask much about it these days, and he didn't say anything. Maybe it's blocked."

Kavi threw the gauze back into the bucket. "Maybe?"

Holmes suddenly felt that the ward corridor, which had been very noisy just now, became unusually quiet. Kavi's gaze was like a double-barreled shotgun from the last century, pointed at his head. He licked his chapped lips, not daring to look up at the young man who was a few years younger than him: "I just, I, I forgot."

"Forget it, let's go and take a look together."

Kavi said nothing more and took him into the ward again.

Fisher's case was rather special. It was not an open limb fracture like Devinke and Shelly's that could be seen at a glance, but a very subtle skull fracture. If there was only one symptom, cerebrospinal fluid leakage from the nose, then conservative treatment was the main approach, both in the past and in the present, and most cases could heal on their own after two weeks.

6◇9◇Book◇Bar

At that time, Kavey didn't see any major problems. Fisher was fine except for his eyeball, so he let Payon solve the eye problem first. He also looked at the operation afterward. The eyeball was removed well, and there was not much exudation, so he put him in the ward for observation.

He came again on the third day after the operation, mainly to check on the recovery of Devonk and Shelly.

Everyone recovered well by then.

Devinke had a small amount of inflammation in the nail channel, but the incision healed well. As long as he takes good care of himself, there will be no problem with the prognosis. Shelly's exudation gradually disappeared, and the redness and swelling of the incision also subsided. Fisher actually recovered well. There was indeed inflammation in the eye socket after the operation, but there was very little exudation, and he didn't have a fever. As long as he insists on changing the dressing, it should subside soon.

Everything seemed to be moving in the right direction, so Kavi handed everything over to several attending physicians and returned to the medical school to continue his experiments.

According to him, the experiment had reached a critical moment and he could not come to the ward recently. If there were any problems, he could go to the school to find him. But in fact, no one had ever found him until Devinke woke up in pain in the middle of the night and asked someone to find Kawi.

As a result, when we arrived today, there was a problem with Devin's calf, Fisher's eye socket, and all the patients we checked during the morning rounds had problems.

Kawi checked Fisher's eye sockets again. It was obvious that he had taken too long. "Why didn't you come to me earlier? When I came before, it was almost absorbed. Now it has developed to this point. Something must have gone wrong in the middle."

Problem? What problem???
Holmes frowned and thought hard, but the only response his brain gave him was: No problem!
"Doctor Kavi, every time I changed the dressing, I followed your method, using hydrogen peroxide, saline and borax solution." Holmes couldn't figure it out, so he told him everything that had happened in the past few days. "Not only the use of medicine and dressing changes, but also his temperature every morning and evening, vital signs, main symptoms, and even his eating, drinking, and defecation are all recorded in the medical records."

After hearing this, Kavi admitted that he was serious, but in the cruel clinical practice, seriousness does not mean success: "You missed the most important thing."

"what?"

"After surgery, we look at all aspects of the patient's changes, the most important of which is the changes in the incision." Kavi looked at the listless Fisher and took out a piece of gauze. "What do we look at in the incision? Alignment, suture, redness, swelling, and exudation. Alignment and suture will definitely be fine at the beginning. You probably won't be able to see redness or swelling, but you can see exudation."

At this point, he gently placed a corner of the gauze on Fisher's eye socket and said, "The exudate has changed a lot. Both the amount of exudate and the contents are different from when the surgery was just done."

The dry gauze seemed to have absorbed moisture, and a layer of light yellow halo slowly emerged. Although the amount was not much, only a corner was wet, it was quite outrageous for the clean wound surface that had just been changed.

"Did you see it?"

"Um"

"Don't you think this is abnormal?" Kavi put the gauze in front of him, "The amount of exudate, the color, the smell, and the time it appeared. Combined with some seemingly unimportant things, such as the chief complaint, the body temperature, and some things that were mentioned by chance but you didn't take it seriously, think carefully, when did he start to show this change?"

Holmes had not received modern medical education. After hearing what Kavi said, the medical concepts he had built up based on more than ten years of medical knowledge completely collapsed.

If Ignaz, Sediyo or Landreth were by his side, they might kindly remind him, "There's no need to be discouraged, everyone is the same." But now he was alone, and there was no way he could find the loophole he had overlooked.

Kavi did not rush to ask, but took out the gauze stuffed in Fisher's nose. Without the gauze, the cerebrospinal fluid that had been leaking slowly flowed out of Fisher's nostrils like a stream thawing in spring.

Then Fisher's headache, which had just eased, started again: "Ah, it hurts, it hurts so much! I have a terrible headache!!!"

Eye leakage + nose leakage, cerebrospinal fluid keeps running out, intracranial pressure keeps dropping, it's hard not to feel pain. As for why the condition didn't improve after resting for so long, but worsened, Kawi also guessed the reason with a high probability: "Mr. Fisher, have you had a cold recently?"

It’s the same question again, last time it was before the operation and now it’s after the operation, but the answer is slightly different.

Fisher was in a very bad mood. He held up half of his face with one hand and covered his head with the other hand. He said, "Recently? Are you asking about after the operation?"

"Yes, after the surgery." Kavi added, "Especially the fourth or fifth day after the surgery."

"It seems like I did, but it also seems like I didn't." Fisher recalled for a long time before saying, "Oh, one night it was raining and they didn't close the windows. I was so cold that I sneezed several times in a row. Others laughed at me and asked, "Is this a cold? Probably not because I was fine the next day."

Kavi nodded and pointed to the medical record next to Holmes: "Did you hear that? He sneezed. That's the loophole."

"Sneezes?" Holmes was confused. "It's just a few sneezes. What does this have to do with eye socket infection and worsening rhinorrhoea?"

However, Kavi didn't want to waste time talking about these things. He just told him to have the surgery tomorrow afternoon and left the hospital.