Nineteenth Century Medical Guide

Chapter 466 462. Another Apology Letter
I don't know when it started, but the original three-person group of American students became a solo group of James and Wade. Although he could still see Holmes and Delafield occasionally, he was lonely in his mind and it was difficult for him to go back to the past in his life.

Looking back on the past half month, the turning point was Holmes. If he hadn't made up his mind to leave the two of them behind and go to the Hospital Main to ask Landreth for a job, Delafield wouldn't have followed his example and disappeared.

The starting point of a series of chain reactions was the unexpected encounter with Cavi's surgery that day.

Holmes has now completely integrated into the surgical work of the Hôtel-Dieu, participating in the daily diagnosis and treatment process. Recently, he also got a good opportunity to perform Cavi's surgery with Landreth.

He had boarded the surgical clipper, and in just a few days he had changed his appearance, just like James Bennett, the publisher of the New York Herald, who squeezed through the docks crowded with thousands of people in May 1838 and boarded the paddle steamer Sirius to experience the historic moment when a steamship set sail from the United States to Europe for the first time.

Next up is Delafield.

Unlike Holmes, he had little interest in clinical practice. Instead, he was particularly interested in small things under the microscope. So he did not go to work in the hospital, but found a job in the laboratory of the Paris Medical School.

The last time I saw him was two days ago, and I haven't heard from him since then. I think he has become completely obsessed with pathology.

James and Wade themselves are still confused. They still don't know what their interests are, let alone which path they will take in the future.

He is very similar to Holmes, who has been working in internal medicine and has also worked in internal medicine after graduation. In his eyes, surgery is too rough and too dirty. In addition to enduring all kinds of body fluids and blood, he also has to endure the heartbreaking screams of patients.

Even though anesthesia is becoming more mature and stable nowadays, surgical technology still cannot serve patients well. In the eyes of internists, except for some diseases that have been confirmed to be only resolvable by surgery, they will only try surgical treatment reluctantly when the disease is terminal and even doctors feel hopeless.

This purposeless surgery often results in the patient's death.

James and Wade have always believed that internal medicine is the orthodox medicine, and surgery can only be regarded as auxiliary. Even when he first came to the main palace hospital and stood in front of the memorial portrait of the emperor of surgery Dupont Itran, he still complained like this.

The difference between him and Holmes is that he has been a staunch internist since he came into contact with medicine, and he also specialized in cardiopulmonary medicine when he came to Paris. It was not until he saw Cavey's surgery that he realized that surgery could accurately locate the disease and the damage to the patient's body could be completely controlled.

Whether it is the digestive tract, limbs or brain, it seems that no part can stump Kavi.

It was then that James and Wade realized that the positioning of the Emperor of Surgery was wrong.

The so-called emperor is not a quick surgeon who cuts madly with a scalpel and haggles with other doctors about the length of the operation. Nor is he a control freak who builds up his prestige by scolding junior doctors in order to gain absolute power.

Instead, one should be like Kavi, who can use extremely fast hand speed to complete precise tissue separation, cutting and suturing, while being able to keep abreast of everything happening around him at all times. Even the patient's slightest reaction is within his observation and expectation, and he can make the most reasonable response to any problem that may arise.

Only Kavi, who has achieved perfect control over the operation itself, is qualified to be called the emperor.

Anyone interested in medicine would dream of becoming Kavey, and James and Wade are no exception.

But he doesn't have the same passion for anatomy as Holmes, and it's impossible for him to turn around and switch to surgery without any worries. James and Wade don't have the confidence to become a doctor like Kavey. Now he is simply interested in treating diseases and hopes to conquer them one by one by himself. As for the treatment method, whether it is internal medicine or surgery, it doesn't really matter.

This also made his originally firm determination in internal medicine waver.

After two days of being in a daze, James and Wade returned to the deserted rental house in the afternoon. He wanted to lie in bed and read the headlines about Kaveh that he missed in the morning, and then have a drink and chat with the girl when she came. The day passed like this. Unexpectedly, as soon as his eyes fell on the newspaper, the picture of the headline was like a slap in his face, burning.

In the picture, Holmes squatted in the corner, fanning the charcoal stove, and stared intently at the iron pot where isinglass was boiling. The small words introducing the characters below read:
[As long as they are willing to work hard and dare to show themselves, Dr. Kavi is willing to accept anyone. The young man in the picture is an American student who has just been in Paris for half a year. He is carefully preparing fish glue for Dr. Kavi. This is an important adhesive used to fill skull base fractures. Too cold or too hot will affect the results of the operation. This shows Dr. Kavi's trust in him.]
James and Wade were a little anxious.

According to the original plan, he came to Paris to find his own future path in his daily study and life. He knew that as long as he worked hard enough and spent time, these could be realized slowly. It could be two or three days, or two or three years, or even longer, he didn't care.

The day Holmes went to the Hospital Main, Janeway was just surprised that he could be so decisive. The day Delafield went to work in the pathology laboratory, Janeway just felt lonely and felt that he was a little behind, but did not feel too much pressure.

But now looking at the newspaper, he finally realized that if he continued to study and work at the original pace, he might never catch up with them.

Immediately, he wrote a note to the girl, left half of his savings and a 100-franc note, and ran directly to the Hôtel-Dieu.

[I'm sorry, Semantha. I need to find a suitable internship recently. I will be very busy and can't accompany you. I hope you can live a good life under your care during this period. Dance is very suitable for you. Don't give up easily! I will go to the theater to see you when I have time. - Love you, James and Wade]
His decision came very suddenly, and although it was impulsive, he was still somewhat prepared.

The medical wards of the Hospital Dieu have night rounds in the evening. The time is not fixed, usually between 5pm and 7pm. The surgery department did not have this originally. Only patients after certain operations would have postoperative checks by the surgeon. But after Kawi came, this was added. The time is more flexible. It may start at 3pm or it may be delayed until after 9pm.

In short, it is necessary to check the ward twice a day.

James and Wade would be able to encounter at least one ward round if they went to the hospital at this time. No matter who was doing the ward round, he decided to submit his resume like Holmes and get involved in the work first. Whether it was internal medicine or surgery, it was better to get involved in the clinical work of this top hospital first than to waste time in the rental house.

He was lucky, as he arrived at the hospital just in time for the surgical night rounds at around 4 o'clock.

James and Wade thought they could find some special charm of surgery from Landreth's ward rounds, and in fact, he did experience this "surgical charm". The ward rounds were prefixed with "director", which was Landreth's title, and the signature of the medical orders was also Landreth's name, but Landreth did not show up all day, not even a shadow was seen.

The person actually in charge of the night rounds was Payon, a doctor who was about the same age as Janeway and had just graduated from the Paris Medical School last year.

The entire ward rounds process was more like a formality, with only the surgical incision, bowel movements, fluid intake and output, and body temperature being the only concerns, and the rest being ignored. Of course, this also included James and Wade who inexplicably appeared behind him, and were completely treated as invisible by Peon.

In fact, Holmes' reaction showed that Peon's ward rounds were not important at all. What was important was the ward rounds that Kaveh had this morning. He was checking on the patients he had operated on recently, John who had an anal reconstruction, Fisher, Shelly, and Devinke who had just been blown up, and Bertha who would be involved in surgery in the near future. The key items he asked about were still the same, but the content of the questions was much more detailed. It was a pity that James and Wade missed them.

Without Landreth, James and Wade cannot submit their resumes no matter how enthusiastic they are about work.

At 5:30 in the afternoon, at Holmes' suggestion, he left the surgery department and secretly participated in the night rounds of the internal medicine department.

The internal medicine night rounds were much more formal, led by August Schommer, the chief internist who was about to retire, and surrounded by a crowd of internists of all ages. The internal medicine recruitment system was much more reliable than Landreth's casual decisions, and naturally had much more requirements.

"Graduated from Harvard Medical School and pursuing a doctorate here?"

"Yes, I came to Paris last year." Janeway was a little nervous. "I have been here before to attend extracurricular classes, mainly cardiology and pulmonology. You were the one teaching at that time. The course combines theory with case practice, which is very helpful to me. Recently, I was thinking about the topic of my doctoral thesis, and I thought of the Dior Palace Hospital. I hope to broaden my clinical horizons by participating in the internal medicine work here."

"Theoretically, you can't become a formal doctor here, at least not now, because you are still a student." August explained, "In the near future, if you want to work here after obtaining your doctorate from the Paris Medical School, I can consider it."

"Teacher August, I just want to broaden my horizons. I don't need the title of a formal employee." Janeway's eyes were filled with the footprints of his two companions and his own pursuit of medicine. "You don't have to pay me anything. As long as I can stay and work by your side, that's enough."

August smiled and stroked his goatee. "You saw it during the ward rounds just now. I have no shortage of interns. By the way, who is your advisor? Why don't you go find him?"

“My mentor is Professor Stokes of Internal Medicine”

6◇9◇Book◇Bar

"Oh, it's him! I've met him several times, and his observations on lung breathing are amazing!"

August's eyes lit up. He was very interested in this professor who retired from Dublin and came to work in Paris. The conversation that was about to end continued because of his appearance: "I remember it was called 'Cheyne-Stokes breathing'. You should have learned it. Doctor Kavi also mentioned it when he was doing craniotomy before. This young man is amazing. He can even apply the most cutting-edge internal medicine research to surgical operations."

James and Wade highly recognized the ability of their mentor, and the reason why they became his students was precisely because of their admiration for him. However, after seeing the article in which Kavey used a thermometer and case to study elevated body temperature, he always felt that Professor Stokes's temperature research was too conservative.

"I came to you to look for a job not because I am dissatisfied with him. On the contrary, I admire Professor Stokes' research very much." Janeway carefully considered what to say next. "Because of this, I also hope to be like Professor Stokes, rooting medical research in clinical work and observing the symptoms through vivid cases one by one."

"understood."

August stood up and handed his resume back to Zhan Wei: "Since you want to become a doctor at the Main Palace Hospital, and you repeatedly emphasize the importance of clinical work, then as long as you show your clinical ability, I am willing to give you a chance."

"Thank you."

There were many patients in the medical ward with complicated symptoms. August picked out a middle-aged man who had just been admitted to the hospital yesterday from a pile of medical records:

"Mr. Batisseau, 52 years old, was admitted to Dr. Montpellier's clinic a week ago. He was admitted that day, and his symptoms have been greatly relieved after these days of treatment. He will be discharged tomorrow, so I skipped him during the ward rounds just now. He can be your first patient at the Hôtel-Dieu."

Battissot, as he called him, was lying on his sickbed reading the evening newspaper. When he saw August coming, he nodded respectfully and said, "Professor, why are you here again?"

James and Wade's first impression of him was that he looked like the Three Emperors.

Whether it was his beard, hairstyle, or even his manners, they were all copied from Na San. The only difference was that Batissot's hair was darker and thicker, and he was taller.

"There's a new person applying for the job, and I just thought of you." Perhaps because he imitated him too closely, August was very polite to him. "How are you? You'll be discharged from the hospital and return to work at the Ministry of Economic Affairs tomorrow. How do you feel about it?"

"It's all right," Battissot put the newspaper aside, "If there's anything you need me to do, just let me know."

"It's very simple. Just answer his questions like you did when you first came to the clinic." August said, and then he sent James and Wade to him and sat down on a chair. "Let's get started."

"it is good"

Janeway smiled at the patient and began to greet him: "Mr. Batisso, you look so much like the Emperor. I have seen many people imitating the Emperor, but no one can imitate him so closely."

Batissot was somewhat happy: "Thank you."

"Are you feeling unwell when you come to the hospital?"

"I took a leave of absence yesterday to go home and pack my things to move, and I felt very dizzy, so I came to see you." Batisso recalled how he felt when he first came to the hospital. After saying this, he did not forget to pick up the newspaper at hand and shook it again. "Even if I stop and sit on a chair to read the newspaper, I will feel dizzy, and even the words are distorted."

"Oh, it seems you have a blood problem"

James and Wade had worked in New York for two years and had some clinical experience. After listening to the description, several possible diseases and diagnostic clues suddenly appeared in his mind. He also described the symptoms with a pen in his hand:

[Mr. Batissot, 52 years old—sanguine, may be at risk of stroke.]
However, when he wanted to continue asking questions, an "apology letter" on the newspaper in Batissot's hand caught his attention.

If it was just an ordinary report, it would not have affected him at all, but the name "Holmes" that appeared at the end was too eye-catching.