[From the beginning of this chapter, the author’s words are moved to this chapter]
Kawei did not know that Ignatz also had an abdominal surgery, because there was no such patient in this general surgical ward. The other two wards treated ordinary fractures, sprains, and several postpartum women.
Of course he hopes to go to the operating table. It is difficult for a surgeon to be busy with operations.
Being on stage can not only satisfy your hand addiction, but also remind you of Ignatz and make some improvements to current surgical methods. But if he had any hopes for this abdominal surgery, Ignatz would be disappointed.
The abdominal cavity was a restricted area for surgery in the 19th century. If you really dared to do it, it would be a trivial matter. After all, the time left for surgical operations at this stage is very short, and the cutting and splicing of tender organs are often handled very roughly.
Roughness represents hidden dangers. Swelling, necrosis, and collapse of the anastomosis at the ends of the intestinal tube can eventually lead to intestinal fistulas and peritonitis, which are the inevitable outcomes of almost every gastrointestinal surgery.
This is not only a matter of knowledge, but also the rudimentary surgical instruments, sterilization, anesthesia, and suturing methods.
According to Carvey, there were only two surgeries that Ignatz could perform: appendectomy and inguinal hernia repair. Even so, the mortality rate of the two operations is still at the forefront of surgery under the haze of postoperative infection, about 45%, second only to 60-70% of cesarean section.
This is because the surgeon is given extra points. If it were anyone else, he might not even have the thought of touching it, and there would be no chance of success or death rate.
In the anatomical atlas compiled by Ignatz, Kawei had seen the increasing perfection of amputation and the repeated failures of abdominal surgery. He can feel the pain of the author's continuous frustrations from the accompanying text and painting lines, and he can also feel his perseverance to continue to actively explore forward after setbacks.
I'm afraid this time is another new attempt by Ignatz.
As for where he got the patients, Kawei didn't care, maybe they were just sent to the hospital. The only thing he cares about now is to treat the wounds of the 11-bed children, so that he can leverage Ignatz's post-operative care concepts and achieve the goal of improvement step by step.
Of course, the premise is that he can really do it well.
According to Kawei's method, the child's wound first needs to be debrided. Use clean water that has been boiled, sealed and cooled. The dirt and other dirt on the surface need to be cleaned as much as possible. Some skin and flesh that have become necrotic must be cut off immediately to prevent the spread of infection.
Of course, severe pain and screams during debridement are unavoidable. Ether is not cheap and cannot be used at this time.
Next is the stitching.
There is nothing wrong with the suturing itself. The needle and thread are just larger and thicker, and they don't look as detailed, but they are not difficult to operate.
The key difficulty lies in how to deal with exudation after wound infection. 【1】
Under the dual effects of strict debridement and preventive anti-infection, ordinary wounds will heal after suturing. The amount of exudate is not large and ordinary gauze dressing can handle it. If it is a large-scale degloving injury, the doctor will cover the injured person with a VSD (closed wound negative pressure drainage set) [2] after debridement surgery to deal with the leakage.
Kawei had nothing in his hand, and the only thing he could think of was the lint he asked for earlier.
Cotton cloth has good water absorption, but its function is still too single, lacking the ability to drain exudate and the necessary airtightness.
There is really no good solution for drainage. The only thing that can be done is to change the dressing frequently every day. Creating an airtight seal is relatively simple. Without the modern film application, Kawei can be replaced by oil-soaked cotton cloth.
There are many types of oils, including industrial oils, such as whale oil and kerosene, and edible oils, such as last night's French meal.
"Let's rent a carriage and go there. The restaurant is quite far from here."
"No need, the public carriage [3] is much cheaper for a round trip."
"Here you go, take it..."
When Kawei was about to leave the hospital, Ignatz suddenly returned to the ward and brought him carriage money. The two 1-kronor coins were given happily, but his expression was not very good: "After discussion with the upper management of the hospital, your salary is not much, and you can only be given 7 kronor a month."
"so little?"
In fact, Kawei is somewhat mentally prepared for wages. If you look at the income of doctors who are trained in the hospital and formally admitted to the hospital, you should know that technology will develop over time, but money is difficult to change.
However, being mentally prepared and acting indifferent are two different things. Even if you can't get a satisfactory answer, you still have to ask: "Last night you said you could pay about 12-15 kronor a month. Why have you cut it in half now?" ?”
"Seven kronor is indeed a bit less, but you can eat the staff lunch here for free, which can be considered as saving some money."
Ignatz felt a little embarrassed and avoided his sight. He looked back at the cotton cloth that had been wrapped around the little boy's left leg and comforted him: "Actually, the money is not much different. I will give you a certain amount at work." As compensation for your help. Just now you said you would give me a chance, and I also gave it..."
He cleverly gave the legs of bed 11 to Kawei, taking this opportunity to excuse himself. If the child dies, he dies. The main responsibility lies with the patient and his family, not himself. At that time, we can still observe Kawei's reaction to adapt to the pressure.
Kill two birds with one stone.
At this point, Kawei's mouth was basically blocked: "Okay, 7 crowns is 7 crowns, but I have a request."
"any request?"
"I can't pay the rent, and I can't keep asking you for money. Why don't you put me in the hospital?"
Ignatz thought that Kawei was going to ask him for rent money. He originally wanted to agree, but he didn't expect this result: "Stay in the hospital? Where to stay?"
"There are no dormitories here?"
"No."
"That's fine, as long as you have a place to sleep."
"Why don't you...sleep in my office." Ignatz made a good offer, "Sometimes I need an assistant when I dissect a corpse at night. Can you be on call?"
"no problem."
"That's it."
...
After leaving the hospital, Kawei quickly got into a carriage and rushed to the Roche Shuart restaurant.
The store manager and chef is a fat man, slightly taller than Kavi, with a very French name, Alphonse Françoise Rochechuart. He is of aristocratic descent, and after his family fell into disrepair, he relied on his superb cooking skills to serve as the royal chef of the French royal family. He came to Vienna two years ago and opened this high-end French restaurant.
With Kawei's identity, he would definitely not be able to enter the main entrance without Ignatz, so he could only find an opportunity to sneak in through the back door used in the kitchen.
He wasn’t here to eat anyway, it’s the same everywhere.
For chefs, the main hall where guests dine is the exhibition place for dishes, and the back kitchen is the battlefield. Before every battle, chefs, especially head chefs, need to check the preparation status of various ingredients to prepare for the upcoming lunch.
“Potatoes, onions, pork, steak, lamb chops, lamb loin, halibut, butterfly fish, chicken, duck, quail, partridge, pigeon, snail, black mushroom, mushroom, asparagus, lily, pepper, tomato…. .Where are the banana leaves and sage? Were they not delivered?”
"There are still a lot of unused ingredients in the food warehouse."
"when?"
"It was delivered at noon yesterday."
"Throw it all away tonight."
"yes."
"Where's the lobster? Where's the lobster I specially emphasized yesterday?" Alphonse flipped over the cooking table, a little anxious, "You must have run out of stock, right?"
"Austrians don't eat much seafood, and it's very difficult to transport lobsters. We really can't reach Vienna today."
"If there's no lobster, what should I do with the cold dishes? Today's special is Parisian lobster cold dishes, and the sign has been hung up!" Seeing that everyone was silent, Alphonse could only make his own decision, "Forget it, there are still chickens and quails. If you don’t have more, switch to Portuguese-style grilled stuffed chicken and hot quail pâté.”
"OK."
"Finally, let's review the Three Emperors Banquet menu [4] again. Listen carefully to me and make sure there are no mistakes..."
The menu comes from the "British Café" [5] during the World Expo in Paris, France. It was a skill that shocked everyone at the time, but now it is the dishes that our chefs are used to making. So after inspecting the ingredients, Alphonse only gave instructions on a few details before getting into his private kitchen.
Although he is a loyal fan of classical French cuisine, because he has been to the far East and tasted a lot of local southern specialties, his development of dishes is not conservative at all, and is even a little weird.
"Where is the dried salted fish I asked you to prepare half a month ago? And the bottle of honey barbecued pork sauce I brought back?"
"Just... holy shit, where did the thief come from!!!"
"What's wrong?"
Alphonse ran out following the sound, and the first thing he saw was the young man named Kawei from last night. Suddenly, what Ignatz said before leaving stirred in his mind, forming a sharp contrast with the current scene.
You promised to become a surgeon before eating, but why did you go to the kitchen and steal something just one day later?
"Aren't you the poor boy yesterday?!"
"I'm not a thief, I just want something from you."
Alphonse ignored Kavi at all and looked at the chefs in his hands holding on to his clothes. He sighed: "Your hands are used for cooking, so you don't think it's dirty if you pull on his clothes? You know how to use your feet." Don’t you understand? Kick me out!!!”
"Ahem, wait!"
"What are you waiting for? I don't want to see this guy again!"
"Master Chef, I just want to ask you to borrow something to save someone."
The title of Master Chef should have made Alphons feel comfortable, but the person who spoke was too humble, which had the opposite effect: "Only you? Are you going to save people?"
Alphonse shook his head, listening to the roar of laughter from all the back chefs, and said: "Doctors, especially those who can treat illnesses and save people, are all learned gentlemen. Don't think that just having a meal with Ignatz will make you happy. As a doctor, you should ask your teacher if you can join the Royal College of Physicians before you talk about these big words in front of me."
What he said was true. Surgeons did have a low status, but this had nothing to do with the bottle of oil that Kawei wanted.
"It doesn't matter whether I am a doctor or not, but I am certain that you must often have a dull throbbing pain or swelling in your upper right abdomen."
Pain is a very vague concept. From the patient's oral description to the doctor's completion of the medical history record, there are three points that need to be improved: location, nature, and degree. Kavi summarized all three points in just half a sentence, using the simplest and most direct method to make Alphonse change his mind.
"Why are you...ahem, you all go do your work, I will handle it myself."
Kawei already knew from the look in his eyes that he had guessed the answer, and a big stone finally fell to the ground in his heart.
Alphonse dismissed the chefs under him, pulled him into his room, and closed the door: "How did you know that my right upper abdomen often has throbbing and swelling? It's also faint...I can I haven’t mentioned it to anyone, so you probably didn’t learn any witchcraft.”
"This is medicine, science, not witchcraft." Kawei had the "health" trump card in his hand, and his tone became tougher, "It's okay to tell you, but I need to borrow a bottle of oil. You are the cleanest place here. of oil.”
