Tracheotomy [1] is indeed not a difficult surgery. It is simple to operate, has few steps, and does not require high medical equipment. The reason why level 2 is positioned in the modern surgical classification is entirely due to the complexity of the anatomy of the neck and the risk of failure.
Tracheotomy was first performed using a bare short metal tube, but it soon became what it is today because it could not be fixed.
In fact, the silver horn-shaped artificial airway used by Ignatz already has a modern prototype. You only need to make a hole and insert the tube into it, and then pull the ropes on both sides to fix it around the neck. 【2】
In modern times, the upgrading of tubes is actually just to facilitate the operator and reduce the risk. The really important surgical step is to open the hole before intubation.
The neck is one of the most important parts of a person's body. In the eyes of people who have never done it before or who know little about anatomy, this area is too special and has a low error tolerance. It is inevitable to feel fear when going under the knife because you really don’t know what to do.
Ignatz is certainly not this type of person.
In terms of the number of dissections he has performed on cadavers, he is definitely top notch, and he already knows the structure of the neck well. Even if he has not actually practiced surgery, his years of surgical experience will not deceive others, and his rich experience will help him make correct judgments.
In this case, he may be a little nervous and a little anxious, but he will be more focused than usual, just like when he dealt with inguinal hernia before.
That's how Kavi judged it.
He stood aside with a pillow stained with blood in his hand. He seemed to be concentrating on it, but he felt annoyed when he saw the fleeting opportunity slipping through his fingers. Because as long as there are no accidents, Ignatz can successfully save Laszlo's life.
However, accidents have always been a matter of probability.
When low-probability events come together, as long as you are a little unlucky, something that should never happen will happen immediately.
Under the dual effects of long-term fatigue and drunkenness, Ignatz's hand had become somewhat unstable. Coupled with Laszlo's continued lack of oxygen, the time left for him was passing by.
The earliest tracheostomy generally used a longitudinal incision [3]. The operation was rough and very direct. It was just a knife that directly penetrated the skin and the front wall of the trachea to make room for the artificial airway tube.
But haste makes waste. His first knife was too hasty and the position he chose was a bit off. It penetrated the skin under the Adam's apple and did not hit the trachea directly. When he tried to find the position of the trachea again, his field of vision was covered by the blood and nothing could be seen.
Kawei quickly wiped away the blood with a pillow and tried his best to expose the muscles and deep cervical fascia that needed to be completely separated.
The incision made by Ignatz was indeed crooked, violating the requirement that the tracheotomy must be kept centered, but there was still a chance to remedy it. Kawei used a pillow towel to cover some unnecessary areas, and secretly helped correct the position of his vision.
"teacher......"
"Yeah, I know, the position is crooked."
The sudden stabbing made Laszlo tremble in pain and scream. Naya's crying behind her continued, and the surroundings were filled with the cold gazes of her colleagues.
Ignatz resisted the pressure and tightened his grip on the scalpel again, using the pads of his fingers to press the skin on both sides to try to stop the bleeding. He needed to make a new incision.
The second knife...
This time the position was correct, the tip of the knife completely penetrated the midline of the muscle fascia. Judging from Ignatz's reaction to the touch, it seemed that his trachea had been cut.
But the scalpel used by Ignatz was very small, with a blade width of less than 1cm. Such an incision was obviously not enough. In order to allow a catheter with a diameter of more than 1cm to pass smoothly into the trachea, the incision needs to be enlarged, at least to 2cm.
With success imminent, there is only one final step left in the incision.
But at this time, the large amount of alcohol accumulated in the body, fatigue, and a slightly relaxed mentality after successfully passing the first step, made Ignatz make a small mistake that only appeared in the 19th century.
He did not change the direction of the blade to open the trachea upwards, but chose to continue cutting the trachea directly downwards.
The blood vessels around the trachea are richer the further down the trachea is, and a lot of blood will definitely bleed after this incision. Kawei wanted to persuade him, but his reaction couldn't keep up with the speed of his hand. Before the words were spoken, the knife had already been cut.
But after thinking about it carefully, he felt it was nothing.
After all, this was the 19th century, tracheostomy was a new surgery, and there were naturally no standardized operations [4].
Ignatz did not suture the surrounding small blood vessels, nor did he separate the thyroid isthmus from the muscle fascia and the entry point. After this series of operations, damage will be caused wherever it passes. Cutting down will only damage some small blood vessels, as long as it does not exceed the fifth ring of the trachea.
But what neither of them expected was that Laszlo's neck blood vessels were different from ordinary people and had special mutations [5].
Ignatz's fingers were very sensitive, and he stopped his hand as soon as he noticed something was wrong. The lack of clinical experience in tracheotomy made him very confused. He didn't know what he had cut, and he didn't know whether it was a success or a failure.
Suddenly, a strong stimulation forced Laszlo to break away from Berget's arm, bend his body and choked violently.
"Cough cough cough~~~cough cough~~"
The cough pulled the surrounding wounds, and while squeezing the scalpel open, two injections of blood spurted out. Both the height and the color told Kavi that Ignatz's blade must have cut an artery.
Instantly the room was in chaos.
The physicians in the outermost circle retreated one after another, fearing that the donated blood would stain their clean and bright gowns.
Berget, who was standing at the head of the bed, was shaken away by the powerful force, but his previous experience told him that he must control the patient immediately, so he quickly stepped forward and pressed Laszlo's shoulders and head: "Bear it a little longer. , it will be ready soon!”
Ignatz was closest to the wound and must have borne the brunt. His eyes and nose were covered in blood, so he could only retreat temporarily: "I can't see, please give me a piece of cloth."
Naya behind her didn't know what happened, so she reflexively handed over her handkerchief. But when she saw her father between the people, tears fell again. If Fatorad hadn't been holding her by his side, she might have jumped on her and started crying.
In the whole room, the only one who remained calm and thought of a remedy was Kavi.
He kept looking at the wound, avoiding blood injection, and immediately thought of the location of the bleeding [6]. While others were still panicking, he had already pressed the entire wound with a pillow: "Teacher, the artery must have been touched and needs to be ligated as soon as possible!"
Ignatz wiped his face and reached for his surgical instrument box: "Needle and thread...needle and thread...found it!"
"Teacher, give me another pair of crow's beak pliers."
"Pliers...here!" Ignatz wiped away the blood and threw away the handkerchief, "Did you see the bleeding location just now?"
"Well, it should be at the bottom of the incision, probably the artery that supplies the thyroid gland."
Kawi took the pliers, ignored Laszlo's shouts, carefully wiped the wound, and tried to accurately locate the bleeding area based on the newly emerged blood.
The needles and threads of the 19th century were not thin enough to properly treat this artery. Kawei could only use crow-beak pliers to grab his eyebrows and hair, then simply wrap the remaining fascia around the breach and perform a one-time ligation.
"Luckily, the breach was blocked."
The clamping force of the crow's beak forceps was very low, so Kawei could only slowly lift it at an angle to free up some space for Ignatz to perform the ligation: "Teacher, as long as this piece of tissue is sutured, the bleeding should be completely stopped."
The words slowly fell, but there was no response from Ignatz in the noisy space.
"teacher?"
Kawei withdrew his attention and looked up at the edge of the bed. Ignatz, who should have been standing there and listening to his instructions, was holding his forehead and shaking: "Teacher, what's wrong with you?"
"It's okay, I'm just a little dizzy..."
"faint?"
Ignatz was not just dizzy, there were countless small cold sweats on his cheeks, and the shirt in his dress was already soaked through.
These all point to a common condition: hypoglycemia.
"Teacher, you didn't eat much at the dinner?"
"Um, I've been chatting with Mr. Laszlo."
"I've been tired all day, and it seems I can't keep up with my physical strength." Kawei used a more down-to-earth term instead of "hypoglycemia after drinking" [7], and then suggested, "Teacher, why don't you take a rest first?" , let me finish it next."
"No, I'm fine."
Ignatz was still reluctant, wiping the sweat on his forehead with his sleeves, and holding the needle and thread to do the sutures.
Kawei had no choice, he was just an apprentice and there was no way he could embarrass him in front of so many people. If he seizes power without his approval, Ignatz himself would not have to step forward. Those physicians who attach great importance to the relationship between superiors and subordinates would be the first to stand up and denounce this rebellious young man.
However, there are no absolutes in the world, and risks and benefits coexist. If Laszlo's condition worsens, Carvey will still consider taking risks.
He took the opportunity to glance briefly at Laszlo.
This rich man is different from ordinary civilians. He usually eats nutritious food and is willing to exercise. He is indeed in good health. Three minutes have passed since laryngeal edema appeared, and he can still maintain some consciousness.
Fortunately, there is still time.
Kawei held the crow's beak pliers, ready to give his "mentor" another chance.
At this time, Ignatz seemed to be more awake. He stood still, picked up the thread and prepared to thread it into the eye of the needle. However, he failed several times: "Kavi, I hold the pliers, and you should thread the thread."
Kawei was a little hesitant, fearing that he would mess up the hemostasis he had just made: "Teacher, please be careful, there is an artery underneath."
"I know."
Kawei handed over the pliers, took the needle and thread on the bed and quickly inserted it, his eyes not daring to leave the crow's beak pliers for a moment. Just when he was about to hand over again and send back the threaded needle and thread, Ignatz suddenly said: "It's better for you to sew, the light here is better."
a little better?
The window of the house faced south, and Kawei was just an assistant. Naturally, he turned his back to the window and gave all the light to Ignaz. How could the light here be good?
It sounded like a lame excuse.
Perhaps realizing that what he said was a little outrageous, Ignatz quickly added: "I can't see clearly in the reflection here, and it's too late to change positions now. It's better for you to perform the sterilization. It's not the first time you've done it."
"oh."
Since he was given the opportunity, Kawei naturally would not let go, and soon he made a beautiful ligation on the lower end of the crow's beak forceps. In order to justify his teacher's words, he said while doing it: "I didn't expect that the ligation technique that Count Morasso learned from his teacher during the previous operation would be put into practice so quickly."
"Well, the knot is tied well."
Ignatz was so dizzy that he didn't even look at Kawei's operation. He just followed what he said and continued to ask: "Is the knot stable?"
"Well, it's stable."
"Okay, I let go."
The crow's beak forceps slowly left the wound, and the knot stayed quietly at the beginning of the wound. The surrounding area was very clean and there was no bleeding at all.
Kawei's response was perfect, and it took less than a minute to resolve the troublesome artery. Even in modern times, such a straightforward operation should be greeted with applause.
But there was nothing in Laszlo's room.
Physicians disdain surgery and simply don’t understand it. And Ignatz, who can understand everything, is suffering from dizziness and is not looking at all. The only person present who could clearly see all the operations was Bergt, who had been diligently pressing Laszlo's body.
This was the first time he had observed Kavi's operations so closely, and there was only one question in his mind: Why is this man so skilled?
Kawei is just a surgical assistant at best, and no matter how strong his learning ability is, he is still a semi-literate person who has not received medical education. But why can he do everything from clamping blood vessels to suturing tissue in one go? Why is he so skilled? He's so skilled that he doesn't even look like a novice.
In reality, however, there is no answer.
After ligating the ruptured artery, Ignatz picked up the horn catheter and inserted it directly into the bloody wound.
A sharp pain that tore his neck quickly swept through Laszlo's body, but the air that was continuously fed into his lungs through the artificial airway made him feel much more relaxed instantly. The restlessness was gone and consciousness was returning. In these three minutes, Laszlo completely realized what death was.
"Father!"
Laszlo could not speak and could only respond to his daughter with a smile on his lips.
There was finally some sporadic applause around him, and even a proud man like Fatorad did not hesitate to praise him: "Congratulations, Dr. Ignatz, you have once again created the history of Austrian surgery."
"Thank you doctor!"
Naya wanted to step forward and say sorry. Her willfulness almost killed her father just now. If Ignatz hadn't forced the operation, Laszlo would have become a corpse now. Unfortunately, Ignatz was no longer able to hear. After accepting the thanks and compliments, fatigue and hypoglycemia caused him to faint.
"teacher!"
"Quick, help him to a spacious place and get him some sugar water!"
Kawei said casually, and just as he was about to go around the edge of the bed to help, Laszlo's situation repeated itself again.
