Naya's shout was like pouring a whole bottle of "Venice Carnival Night" [1] into her mouth. The strong stimulation that went straight into the depths of her brain instantly made Ignatz energetic: "Miss Naya, something is going on inside." What happened?"
He tried his best to restrain his impulse and knocked on the door gently as a gentleman should, but there was no other reaction in the room except Naya's cries and some comments.
Ignatz raised his voice again and struck harder: "Doctor Fatorade, it's me, Ignatz. I'm back, please open the door and let me in! Mr. Laszlo must be suffocating!"
"..."
"Only I can save him!"
It was only then that the door was opened, and what came to my face was the faint smell of blood, a patient who was agitated due to lack of oxygen, and a series of slightly helpless faces.
It was already obvious in the room that the blood-letting treatment for oral mucositis had failed completely.
The course of the disease was exactly as Ignatz had expected. After the skin and mucous membranes became red, swollen and itchy, the tongue began to swell, and then he was unable to speak properly, and eventually developed into respiratory tract obstruction, difficulty breathing and even suffocation.
Internal medicine failed.
The amount of bloodletting was pushed to the limit, vomiting pills and laxatives were tried, and even a new treatment using whiskey mixed with quinine powder was found to be ineffective. Now the swelling has become more serious and beyond the scope of what they can solve. Laszlo's body rising and falling after breathing hard and his hands with nowhere to rest are the best proof.
Physicians are either rich or noble, and these big shots at the top of the pyramid are even more so. They usually have an arrogant and elegant attitude. Even if they encounter difficulties and setbacks, they will suppress the humiliation deep in their hearts and maintain a calm appearance on the surface.
Of course, these are not absolutes.
Those who are not confident in their medical skills cannot face a tragic failure and generally choose to escape in order to prevent being defeated by failure.
As soon as Ignatz, Berget and Kavi entered the door, several doctors declared that they could not be treated in the same room as a lowly surgical barber and left the room angrily. For them, this is the most direct way to maintain their own dignity. Anyway, the next time they meet, they don’t know when it will be the Year of the Monkey or the Horse.
In the eyes of Fatolad and Bosa, they were already famous all over the world, and they also knew the boundaries of medical treatment. Failure of treatment was a common occurrence.
The ineffectiveness of bloodletting stimulated their desire for knowledge.
If you run away now, you won't get anything, you will become the laughing stock of others, and you will lose the opportunity to observe the surgical skills of the strongest surgeon in Austria up close. It's not easy to get live tickets for this guy as soon as possible, and sometimes you may not be able to buy them with money alone.
Ignatz didn't care about the little thoughts of these guys.
The swelling of the respiratory tract is like being stuck in the neck, which can kill people at any time. He directly crossed the crowd and informed the importance of Berget and Kavi in a preventive way: "These two are my assistants. I need them to assist me." Do the surgery, please give us some room to maneuver.”
Fatolad and Bossa were both sober and quickly asked the remaining people to disperse, leaving the bedside area free.
However, Naya was not awake: "Operation?"
"Actually, it's not a formal surgery. It just creates a metal channel to send air to the lungs."
Ignatz said it very lightly, but after flying into Naya's ear, his appearance completely changed.
More than 300 ml of blood in the basin had stimulated her nerves. At this time, the operation was completely roasting her on the fire: "I just said that bloodletting can cure the disease. Now that the blood has been drained and the medicine has been taken, there is no cure at all." It’s not good! Now we are talking about surgery, how can I rest assured?”
"Your father is in danger now, he needs air! [2] So I am helping him!"
It was difficult for Ignatz to explain the various anatomy structures to a little girl, so he just said casually and asked Berget and Kavi to step forward: "Come and hold down the body, don't let him move! "
Naya became anxious when she saw it: "My father is already very uncomfortable now, why are you still holding him down? Do all the doctors in Vienna treat patients like this?"
Ignatz did not expect that at this time, he would need to break down the process step by step for his family to listen to.
He took the tool box handed by Kawei, took out a long black metal tube with a specific curvature at the end [3] from the box, and said: "Your father has respiratory obstruction. The first thing we need to do is to use the newly developed An artificial airway was inserted deep into his nasal cavity to help him breathe. If I don't hold him down, I can't guarantee success."
"But......"
"Stop it!" Ignatz stressed, "I am the best surgeon in Austria, not to mention Mr. Laszlo, even if the Hungarian prince comes here, I will still treat him like this. Time is limited, please Don’t interfere with my work.”
This explanation was full of momentum and finally overcame Naya's nervousness.
Berget and Kavi took their positions, and with Count Morasso's lessons learned, they quickly suppressed Laszlo's hands and feet.
However, Kawei still has some opinions about this tube and is skeptical about the choice of approach: "Teacher, the tip of the nose is some distance from the throat. Is the tube too short?"
"There is a protruding section inside, and you can probe down after entering." Ignatz pushed forward from the end of the tube, and the front mouth of the tube protruded another full 5cm. "Actually, I also wanted to enter through the mouth, but he My tongue was too swollen, so I had to try the longest nasal tube first."
After Ignatz explained, he approached the patient while preparing the long tube and said, "Mr. Laszlo, please relax as much as possible. I need to put the long tube into your nose. You will definitely feel uncomfortable or even a little painful." , but there is no other way, please be patient!”
As he spoke, the long black tube slowly penetrated into the nasal cavity with Ignatz's hands [4].
The tube is made of metal and is certainly much rougher to operate than a modern nasal endoscope. After entering the nasal vestibule, the tube would continue to stimulate the soft tissue in the nasal cavity, and Laszlo's reaction was very violent.
"Without ether, it seems the stimulation is a bit too great..."
Ignatz gently stirred his wrist back and forth, but still could not find the passage into the throat, and Laszlo's condition did not improve: "No, it seems that the nasal cavity cannot be entered, and the lower section is completely blocked, so we can only Try it from the mouth again.”
"Are you coming again?" Naya looked at the heartbroken Naya with tears in her eyes, "Father, he feels very sad."
"I know he is feeling very uncomfortable, so I have to skip many unnecessary procedures, such as anesthesia. If we use ether anesthesia now, he will indeed feel comfortable all over, but I'm afraid he will never wake up again."
This time, Ignatz's hands were replaced with another white artificial airway [5], which was thicker and had a larger curvature. Two metal pressure plates were also taken out: "Here, one for each of you. Open his mouth and move quickly!"
Kawei knew what he was going to do, which was nothing more than an endotracheal intubation set. But as he said just now, Laszlo's oral condition is not good, his tongue is severely swollen, and there is no intubation aid. Whether he can enter the epiglottis is entirely up to luck.
This time even Berget on the other side saw the problem: "Teacher, the mouth is too swollen, can it go in?"
Ignatz was a little displeased: "Of course I know it's swollen. I just tried the nasal cavity and it didn't work. Now I can only insert it here. How can I know if it can go in if I don't try it."
Seeing that Berget was scolded, Kawei did not dare to challenge his authority again, but followed the modern precautions before tracheal intubation [6] and reflexively asked: "Is the patient's teeth all good? "
This is a very strange and funny question, because if you live to the age of Laszlo and you are a rich man, a large amount of sugar and tobacco will cause immeasurable damage to your teeth. It is good to keep half of it. .
So everyone’s answer is simple: “Of course it’s not good.”
They didn't know why the young assistant asked such a ridiculous question at such a tense moment, but Ignatz's reaction quickly merged with that of Kavi, realizing that this was a very serious question: "You Are you afraid that the pressure plate will damage the teeth and the teeth will be sucked into the airway after falling off?"
"right."
Ignatz glanced at Kawei and nodded: "It's a good suggestion. I will pay attention to it next time, but I can't control that much at this time."
Two metal plates forcefully opened Laszlo's mouth, and a silver metal catheter was inserted through the middle. The difficulty was obvious. Even after raising Laszlo's head, he still couldn't clear the space for entry and exit of his throat. His swollen tongue was like a huge oyster he had just eaten, and he pushed the catheter out of his mouth several times.
"Don't be anxious...I'll try again." Ignatz was obviously anxious and asked, "By the way, check his pulse."
"It's a bit fast." Berget put his hand on his wrist and said, "It's probably more than 100."
"I can still feel some gas flowing around my mouth. We still have a chance. Move the pressure plate forward to press his tongue as much as possible and give me a little more space!" Ignatz did not give up and still held the artificial airway tube in Las Vegas. Luo's throat was pounding, "Yes, just hold down here, okay, let me see if I can go in!"
"Teacher... there's bleeding in the throat." Kawei noticed something was wrong with his eyes.
"Well, it's okay, there's not a lot of blood."
Seeing that Ignatz didn't respond, Kawei really didn't dare to mess around. He glanced behind him to find a helper and found that they were all big physicians in expensive uniforms. He couldn't command these people, nor could he confront the anxious Naya, so he could only choose the cotton pillow cover under Laszlo's head to use.
Kawi didn't say much. When Ignatz made a slight adjustment, he temporarily pulled out the pressure plate, quickly wrapped the pillow towel around the plate, and then stuffed it into Laszlo's mouth again.
Although it doesn't help with intubation, it can at least absorb a lot of blood.
It has to be said that the rich people even use the best materials for pillowcases. The remaining blood was sucked up instantly and the vision became clear again, but the intubation progress was still not progressed. Seeing that Laszlo's mouth was being opened, there was a whimpering sound in his throat. His hands were getting weaker and weaker, but Ignatz's tube could not be inserted.
There is not much time for rescue after hypoxia, and the situation becomes increasingly dangerous.
Kawei was also hesitating whether to stop intubation in time and switch to a more reliable traumatic method. Unexpectedly, Ignatz himself suddenly stopped what he was doing, pulled out the tube, and asked the two men to take out the pressure plate: "The nasal cavity cannot be entered, and the oral cavity cannot be entered. There is only the last way to go."
This time he replaced an artificial airway that was shaped like a horn, about the size of a finger: "Miss Naya, I will next find the position of the trachea under Mr. Laszlo's Adam's apple, and use this knife to pierce the skin and tracheal wall. , place this tube in it.”
This sounds very painful. Looking at his father who has gone from being irritable to a state of drowsiness, Naya covers her mouth with both hands and cannot believe her ears: "Is there no other way?"
"No, and there is a certain danger."
"Wait a minute, doctor, can you..."
"I'm not asking for your opinion." Ignatz looked at Fatorad standing aside.
Although the two had conflicts between medicine and surgery and had completely different views on many diseases, facing such a troublesome patient and family, the two still had a tacit understanding that others could not match.
Fatolad naturally stood next to Naya and comforted him: "Be strong, kid. I don't want to see you crying when your father wakes up."
"But, I...I can't do it..."
"Dr. Ignaz is the best surgeon in Austria. He is even responsible for the surgeries of the royal princes. Please give him the utmost trust."
Naya leaned weakly next to Fatolad, sobbing softly with her eyes closed, not daring to look at the operation beside the bed. Contrary to her, others in the room slowly leaned forward, hoping to see the true appearance of the tracheostomy.
To this day, this strange way of connecting the lungs to the outside world only exists in England and France, and has never been practiced by conservative Austrian surgeons.
Ignatz also knew the danger, so he picked up the knife, his hands trembling slightly, and beads of sweat kept rolling down his forehead. At this point, he had no way out. He could only find Laszlo's Adam's apple with one hand and open the skin, and carefully place the tip of the knife on it with the other hand.
