In the eyes of every surgeon, cesarean section [1] is a major operation. From the moment the operation is performed to one month after the operation, the maternal mortality rate can be said to be horrific.
The most embarrassing thing is that the mortality rate of other surgeries is higher after surgery than during surgery, and infection accounts for a large proportion. In cesarean section, on the contrary, the mortality rate during the operation is much higher than after the operation, and dying on the operating table is their normal state.
For other people with surgical conditions, they still have options. Unless the outcome is death, no one wants to lie on that blood-stained operating table.
But for mothers, they have no choice. Cesarean section is the only solution for women with difficult labor and placenta previa [2]. Without surgery, difficult labor and massive bleeding from placenta previa will cause fetal death. At this time, the death of a mother becomes "good news."
The existence of cesarean section will always remind those surgeons who have a sense of achievement from time to time. Although they have escaped the dark age of using irons to stop bleeding, the light of the candles and oil lamps they hold tightly in their hands is still limited, and there is still chaos ahead.
Therefore, many people only dare to guard their own one-third of an acre of land and are unwilling to have a cesarean section.
Of course, there are always rebels in this era. They knew the outcome was not good, but faced with a certain death situation, they still took part of the pressure on their shoulders, hoping to lead pregnant women to give their fate a try.
Ignatz is one of them.
I have to say that courage is indeed commendable, but the reality is cruel.
Even he himself couldn't remember how many times he had tried cesarean section before. The most recent one, the pregnant woman died directly on the operating table. At that time, he vented his anger on the intern doctors, but Ignatz knew in his heart that this kind of operation would have been a narrow escape.
Without oxytocin [3], strong hemostatic agents, and appropriate uterine suturing techniques, cesarean section will cause intraoperative heavy bleeding that is difficult to control. Even if the uterus and appendages are removed, the weakened body after heavy bleeding will have difficulty resisting the attack of postoperative infection.
"So, we must be fast!"
While Kawei and Musil were bargaining with each other, Ignatz had already pulled Herman, Hills and the three intern doctors together to do the dissection work. In this rare practice, speed became the primary focus he repeatedly emphasized.
"My goal is to complete the process within three minutes." Ignatz looked at the five colleagues behind him. "There will be obstetric midwives to assist, but you as assistants and preliminary assistants also need to practice."
In order to treat this pregnant woman and successfully perform a cesarean section, Herman and Hills made a lot of preparations.
"Teacher, it is difficult to sew the uterus and the healing is very poor. Should the uterus be cut off after the baby is delivered?"
Ignatz held the scalpel in his hand, looked at Rosa's body, shook his head and said: "Nora is still very young, only 19 years old. It would be a pity to cut off the uterus directly. I hope to try suturing the uterine incision. "
Hills was startled and quickly warned: "Two years ago, the cesarean section performed by Dr. Morrow next door was due to problems with the sutures, and the pregnant woman lost too much blood. The one a few days ago was also due to problems with sutures and hemostasis, and the pregnant woman ..."
"I was the one who performed that cesarean section, of course I know." Ignatz had no reaction: "So I just said, the speed must be fast."
"I went to see him and he was very fast. It took less than 3 minutes to suture the uterus, and the total process was controlled within 10 minutes."
"Then we will reduce the suturing of the uterus to 2 minutes."
Hills still felt something was wrong and continued: "No, this is not a matter of time. By then, the swollen uterus will continuously pour blood into her abdominal cavity, and the crow's beak forceps [4] will not be able to clamp the entire Uterus. There is blood in front of your eyes, how can you sew it up?"
"So I asked the hospital to buy a hand-operated suction device [5], made in Germany."
"I've seen that tube. Although the flow rate is greater than the previous one, it is still not enough to cope with the amount of bleeding caused by cesarean section. It only takes less than 10 seconds for her abdominal cavity to be filled with viscous blood. When......"
At this time, Herman next to him gave him a gentle push and continued: "At that time, you and Teacher Ignatz just do it, and I will just shake it faster next to you."
"The faster you shake it, the better..."
"You still don't believe me? I've been practicing recently." Herman smiled and showed his upper arm muscles. "It only takes half a minute to drink 1 liter of water."
Ignatz finally raised his head and looked at Hills: "It's better to practice quickly after talking so much nonsense. God knows when that girl will give birth."
...
Even a girl with a graceful figure cannot retain her original appearance two days after death. What's more, Rosa's face was already rotten, and obvious bruises and bruises could be seen. If the weather hadn't warmed up in Austria at the end of February, those annoying little bugs would have visited her cheeks one after another.
Two pieces of coarse cloth covered her upper torso, legs and feet, exposing only her flat, firm abdomen.
Ignatz's scalpel landed about 6cm above the umbilicus, made a midline incision, and gently cut down to her lower abdomen. After three or two knives entered the abdominal cavity, they pulled apart the thin fat and muscles and began to search for the uterus.
The cesarean section they want to perform is very different from the modern cesarean section that has been improved many times. It is called classical cesarean section by modern people [6]...the earlier "ancient style" cesarean section. The incision is similar to the classical method, but because the operation method is too rough and there is no decent practice, the process will be very messy.
If the surgical object is replaced by a corpse that has been dead for two days, the blood will be coagulated and the tissues will have no elasticity or warmth. The scene will look extremely empty and even more fragmented.
"The unpregnant uterus is too small and has no blood, so it is difficult to simulate the feeling during surgery."
Hills pushed away the cold intestines and tried his best to make room for the surgeon to operate. Herman squatted on the side with a blushing face, shaking the suction device crazily: "It's been two minutes, can it be sutured?"
"Sew it up."
Ignatz took out a ball of cotton from the small uterus, threw it on the ground, and then took the needle and thread handed over by Hills: "To suture hollow organs, the endometrium and muscle layer should be sutured first, and then It’s the outer serosal layer…”
While saying these words, he inserted the needle into the muscle layer, using simple continuous sutures, and then continuous mattress inversion sutures at the serosa layer [7].
For Ignatz, who had undergone anastomosis of the small intestine, suturing the uterus did not seem to be difficult. From the time it entered the abdominal cavity to the time the uterus was sutured, it only took 5 minutes, which was already quite fast.
But they know that this is not enough.
"Again!"
Ignatz cut open Rosa's uterus again, stuffed the cotton cloth on the ground back into place, simulated the appearance of a baby, and practiced again in the same order as before.
This time it's faster.
"4 minutes and 43 seconds."
Ignatz shook his head: "Continue!"
"4 minutes and 39 seconds..."
"4 minutes and 28 seconds..."
Ignatz closed Rosa's uterus for the fourth time. The small uterus was covered with sutured incisions. The time kept shrinking, but he still seemed dissatisfied.
"Teacher Ignatz is so amazing. This speed should be second to none in Austria."
Berget, who was standing aside, had just been embarrassed yesterday, and today he wanted to stand back on the operating table with words of praise and repaint his image as a top student.
Seeing him like this, the other two students were not to be outdone and stood up one after another: "The teacher's needle insertion and threading are very stable, much better than Master Duran, which the French boasted about. I think we can book the front page of the Vienna Daily." ”
If these words were put after the operation yesterday afternoon, there would really be no problem. But now the three people on the dissecting table still have sad faces. The smoother the practice process, the more it reflects their inner uneasiness, because this kind of practice content cannot reflect the real situation during the operation.
The more unknown, the more frightening it is.
"You have time to talk nonsense, why not go to the meat factory and ask for a pig bladder." Ignatz looked at the sutured uterus and thought of an alternative, "Fill it with water and stuff it into her stomach. , doesn’t it look like that?”
Heman rubbed a circle in the air with his hand and nodded: "It does look similar."
Hills also agreed with this approach: "It needs to be hot water, which can also solve the problem of amniotic fluid."
"Why don't you go quickly?!" Ignatz yelled at the three interns again, "Are you going to wait for me to give you each a lunch before stuffing the travel expenses into your hands?"
The three of them looked at each other and knew that they had said the wrong thing, so they had no choice but to obey his wishes and leave the anatomy room.
Unexpectedly, as soon as they arrived at the door, a nurse hurried in, followed by a flat trolley: "Doctor Ignatz, the police station has sent another corpse. I hope you will sign for it."
"Oh? Did it arrive?"
Ignatz was very excited and very satisfied with Kawei's work efficiency. Now another male corpse has arrived. Although he is a little fatter, the abdominal fat and the enlarged pig bladder make it easier to simulate the appearance of a pregnant woman.
However, what he didn't expect was that a policeman who came in shortly after suddenly mentioned the money: "Dr. Ignatz, the body has been safely delivered to you. According to the verbal agreement, you need to pay We have 25 crowns, thank you.”
"Huh? 25 kronor?" Ignatz knew the verbal agreement between himself and Musil, but still didn't understand what he meant. "What 25 kronor? Hasn't the money been paid?"
"This is what Dr. Musil told me." The policeman was also confused.
"Didn't I give him my money?"
"I don't know. Dr. Musil just asked me to come here to retrieve 25 crowns and then go back to resume my life."
...
At this time, Kawei had already entered the drug store. He had no idea that the police station would make a decision so quickly and send the body to the hospital immediately. He also had no idea that Ignatz and the policeman who sent the body would do it for him. 25 kroner is still lingering.
He is now "intoxicated" in front of the colorful pharmaceutical containers, trying to find out something that can be used for himself: "Boss, I often feel pain all over my body. Do you have any recommendations?"
The boss is an old man in a black suit, sitting behind the counter.
He wore a pair of gold-rimmed glasses and looked at the old book in his hand. He seemed to have lost patience with his questions: "I suggest you go to the hospital, either the city general hospital or Grizi. Although I think it's nothing. Useful, but at least it’s better than staying here.”
"Huh? Isn't there any medicine to treat pain here?"
"Yes, there is." The old man adjusted his glasses, gently licked his fingers and turned the page. He said calmly while looking at the page, "But this medicine cannot treat the colds, sprains, headaches, etc. you just mentioned at the same time. Vomiting and diarrhea.”
