Nineteenth Century Medical Guide

Chapter 92 89. Three unlucky guys and one "lucky guy"

The new trend in the morning is more limited to brainstorming on paper or a small number of operations. Through the flashes of inspiration from the doctors, we are looking for some new development directions for surgery.

In the afternoon, the operation report work is much more practical, and the content is specific and detailed operation process.The doctor who made the report will start with each cause, and then analyze the whole process of the operation in detail.

The program list has been summarized and selected by the School of Surgery. Even if it is not an excellent work within three months, it must have a certain "famousness" to be included in the list.

If the surgery itself has no bright spots, then you have to see the chief surgeon, so there will definitely be bias in the selection, and some novices will be rejected.

The list has already started queuing up after the end of the previous meeting. It is a seemingly simple but not difficult competition mechanism.The basic rule is to conform to the ratio of 1:3:1, which is the same as filling in the blanks.

In the regular meeting of a single quarter, there are often two or three high-quality surgeries, which basically take turns in the hands of aspiring chief surgeons like Ignatz, Edinson, and Watman.

Then there are some upper-middle-level operations, and the number is hard to say.

When there are many, it can be crowded with recommendation letters in the hands of the judges, and when there are few, there are seven or eight.They need to select surgeries that meet the standards of the conference from a large number of surgeries, and then squeeze out 2-3 surgeries for those veterans with certain prestige.

Even if the surgery they perform is simpler, they still have to stuff it in for warm-up for the sake of worldliness.

Of course, one is taller than a dwarf, and these general operations cannot be performed casually, and one must have a bright spot to do it.

As early as the end of the last regular meeting, that is, at the end of December last year, Watman had already started to prepare for the March regular meeting.He and the academy jury have reviewed thousands of surgeries and are constantly improving this list.

According to the original plan and the practice of ordering, the order will be closed after Ignatz's cesarean section and inguinal hernia are completed at the end of February.As long as one of the two stations succeeds, one can be included in the program as a presser. If all fail, it doesn't matter, at least it can be queued for a warm-up.

As a result, Ignatz's cesarean section failed and the inguinal hernia repair was successful, so the jury included inguinal hernia surgery.

envelope
After the operation, the judges did seal the form.

Because those doctors who give speeches all the year round have no major surgery in early March, according to the usual experience, the earlier the invitation letter can be sent earlier, so that the selected doctors can prepare for the speech in advance.

As a result, as soon as the letter was sent out, Laszlo's urgency caused a lot of trouble in the city.

Laszlo is involved in many investment projects, with his own traffic, and all the onlookers present are doctors who can be ranked first.The operation itself is very difficult, but also enough topical.The key was successful in the end. For this reason, Laszlo not only invested more in the Municipal General Hospital, but also spent money to expand the hospital area.

If this cannot be entered into the form, it is really unreasonable.

The meeting time was limited, and one had to be removed to enter one, so after hearing the operation process, Watman picked up the quill and wrote a letter of resignation to some unlucky guy. 【1】

According to unwritten rules, he needs to protect the interests of certain people, so he can only attack the middle ratio.

In the letter, he tried his best to attribute the reason for the withdrawal to force majeure, and at the same time praised the other party severely.After writing, Waterman always felt that he had personally killed a young doctor's enthusiasm, but there was no way, sometimes he couldn't help himself.

However, things have only just begun.

The cesarean section came next. According to Ignatz, the operation time was scheduled around the expected date of delivery, that is, in mid-March.If you succeed, you will be able to enter the regular meeting of the next quarter. If you fail, you will enter the warm-up meeting like this time.

No one could have guessed that the delivery would be early, and no one could have guessed that Ignatz would miss the operation, and no one could have guessed that the cesarean section not only ended successfully, but also the mother and child were safe.

Simply a miracle!
If this kind of miraculous operation is not included in the list, wouldn't it be contemptuous of the difficulty of the uterine-style cesarean section with an infinitely close to 100% failure rate?

Just when the judges were still hesitating whether to make a substitution, Watman keenly realized that something was wrong.

He revisited the whole process of the inguinal hernia repair operation again, compared the success rate of the previous operation, and learned about the preoperative preparation work that suddenly appeared in the recent Ignatz operation. Watman had a bold guess:

There may be an interesting "monster" around his son.

In order to test his conjecture, Watman made an amazing decision.Holding the newspaper report, he excitedly shouted "Wunder (miracle)!" to the judges, while preparing to write a letter to the second unlucky guy.

This time he moved someone's cake.

The judges expressed their objections one after another. The School of Surgery has its own connections. Without them, it would not be able to get research funds. In the end, it was the school's own interests that were damaged.

After several discussions, Wattman withstood the pressure without compromise.He seemed to see the future of surgery, and he was going to use Carvey to fight against the pedantic spirit inside the academy.

What I wrote was still a dismissal letter, and clearly compared the other party's operation with the cesarean section.The content looks a bit fancy, but after reading it, you will feel that the same sentence is written all over the page: "You can't". 【2】

Soon Watman's conjecture was answered. Just three days ago, his son brought him another appendectomy.

Subhepatic mutation, super-long appendix, cancer cell infiltration, roundworm, this appendix is ​​covered with weird labels, and it will definitely be included in the list.According to the judges, it was supposed to be put in the next quarter, after all, there was already a cesarean section in this regular meeting.

It's a pity that Watman disagreed. He had to use a victory to completely bring back the embarrassing situation of his son's absence from the cesarean section.

In order to pave the way for the next dean, and also to win over Carvey, he did not discuss with the judges this time, so he "tearfully" found the third unlucky guy and wrote another letter. 【3】

However, this is not enough, because before he made a decision, Ignaz also said another more incredible operation.Let’s count it as an operation. Although there were no audience and no operating table, the man was stabbed four times and was covered in blood, and he survived in the hands of a certain young man.

Three surgeries, a total of three unlucky people, completely shattered the authority of the regular meeting judges.

The jury panel never imagined that they would have to backtrack three times in just half a month
"You old and stubborn! I changed my rhinoplasty surgery to the bottom four. Are you still not satisfied? Do you think these surgeries are not qualified?"

Watman scolded them, but quickly hid his desire for reform, and instead used the patient's dire straits to attack:

"You care about the feelings of those doctors, the funds of the college and some political interests, I understand. But have you ever thought about the feelings of the dystocia women who are waiting to die in the maternity ward, have you ever felt that they died under the knife of the enemy? The feelings of the soldiers! Are you still a doctor? How can you bear to watch them die one by one???"

Under moral torture, Waterman soon had the fourth and fifth letters in his hands.

The fourth letter was also an unlucky old man, but Edinson stood up for the overall situation and voluntarily removed his complete tonsilectomy.

His sacrifice was not completely unrewarded. It was worthwhile to help the next dean, and he also protected the interests of some people. He looked like he would go to hell if I didn't go to hell, but in fact he was pleasing to both sides, and no one was left behind.

Of course, Watman will not forget his "contribution". Not only did he take the operation to a new direction, but he also transferred a copy of "Liszt's New Viewpoint", allowing Edinson to take the lead in reform.

The fourth letter was thrown in the trash, but the fifth was mailed anyway. 【4】

This time he was lucky, at least on the surface, because he was specially invited to be selected for the afternoon operation list.Although the time for the surgery report was very tight, some squeezes could always be squeezed out. What's more, this person's tracheostomy only took 3 minutes from beginning to end, so it really didn't take much time to waste.

His existence can at least pave the way for Kavey's two tracheotomies, especially the second one, which is by no means an operation that a normal surgeon can perform.

Reform needs an opportunity, and more importantly, courage. In order to facilitate the reform, Watman offended many people and had to make a deal with Carvey. It was really too difficult.

He looked at the empty office of the dean, and in his hand was a letter of application for admission to the medical school that had just been written. , sold your old face, you have to show me a good performance, don't let me down."

By the time Carvey and Ignatz returned to the conference hall, the report had already reached the beginning of the second session.

On the stage was Hodge, another surgeon from St. Mary’s Hospital: “I’m a colleague of Dr. Fermi, and I mainly do maxillofacial plastic surgery. I also participated in Dr. Fermi’s surgery in the morning’s regular meeting. I originally wanted to Like Dean Watman, he reshaped the patient's nose, but unfortunately the patient died on the operating table."

He scratched his head and said with a helpless smile: "We really tried our best, and the patient couldn't survive that operation."

Surgery is full of risks, and the surgeons in the audience are very aware of this.

What Hodge wants to talk about this time is a craniectomy he completed last month: "The patient is 35 years old. He was sent to our hospital by the mental hospital on the 11th of last month. His temperature was very high and he had severe symptoms. Headache, talking nonsense. After examination, he found that his scalp was red and swollen, about half the size of my fist.

The swelling of the scalp was very serious. I pressed it lightly and found obvious fluctuations.At that time, I suspected it was a subcutaneous abscess, so I made a simple scalp incision in the consulting room, and discharged a large amount of yellow-green viscous pus and some broken bone residue.

In fact, the skull has been severely damaged, and a sinus tract has been formed in the middle. I can clearly see his brain.The final diagnosis I gave was suppurative cranial osteitis, which was a very definite diagnosis. "【5】

From the symptoms to the final diagnosis, there is no big logical problem in the middle.

Only because of time constraints, he did not explain the cause of the skull inflammation, nor did he explain that the patient's mental disorder was caused because the inflammation had penetrated the skull, but only talked about the next surgical procedure:
"The patient was manic and had a very bad reaction to surgery. We had to tie him to the operating table and anesthetize him with ordinary ether before we shaved him bald. If it was a normal patient, the head should be shaved first." Then surgery, ether anesthesia is too unstable."

The surgery is actually not difficult.

Get rid of those unnecessary scalps, leave some usable, and open the infection site.On the premise of paying attention to hemostasis, first use a skull saw to cut off a large piece of skull, and then use forceps to remove unnecessary bone fragments. 【6】

However, the cranial surgery at that time was always accompanied by a problem that ordinary people could think of. It was easy to accidentally injure the dura mater under the skull, and then injure the brain.

"The patient woke up half an hour after the operation." Dr. Hodge said, "I know very well that the lesion has been completely removed, and the operation was quite successful."

Although the difficulty of the operation was average, there was still some applause from the audience.

For this kind of warm-up surgery, the postoperative questioning session is often skipped, because the report itself is just a formality, and there is no need to ask.

But this time, an unexpected voice jumped out: "Doctor Hodge, is the patient sent back to the mental hospital now?"

Hodge, who was about to step off the stage, stopped in embarrassment and looked at the young man who asked the question, and answered bravely, "No."

"Huh? Has the patient's mental disorder improved?"

After a question and an answer, the topic immediately became interesting.

Mental disorders are difficult to treat, and the patient's behavior will become extremely strange, so it was once misunderstood as being bewitched by Satan.If insanity could be cured simply by cutting off the skull, that would be a great discovery.

"No. Not getting better."

The young man was persistent: "Then why not send him to a mental hospital?"

"."

Hodge sighed, looking at the eyes of the audience looking at him, he had to tell the truth: "Because the patient died the next day."

"I see."

The young man nodded and did not speak again, leaving the surgeon who had worked in the clinic for more than ten years on the stage.Hodge couldn't stand this kind of questioning, and always wanted to justify something: "The patient lived a whole day, so it can't be considered a failure of the operation."

According to the prevailing view at the time, as long as the patient regained consciousness after the operation, the responsibility should not be borne by the doctor.In fact, even if the operation really fails, the doctor does not have to bear any responsibility, because failure is very common.

However, such a simple skull removal operation without difficulty, the patient died again, according to the selection rules, it should not appear here.

Looking at his silent colleagues, Hodge couldn't help becoming angry, and the target of his anger was the young man who asked the question just now: "Who are you? Which hospital? What's your name?"

"Kavi, Kavi Hines, a general surgical assistant at City General Hospital."

(End of this chapter)