After Morazo's hernia, Laszlo's tracheotomy and Alphonse's duel, the relationship between Kawi and Berget is no longer just strangers.
In Berget's eyes, after all, the two of them had gone through adversity together in Laszlo's manor, and their relationship was that of both enemies and friends, but with more elements of enemies. He has a very strong sense of competition in his heart, but due to the prominent status of his family, it seems that it doesn't matter on the surface.
In Kawei's eyes, Berget is just a child, at best as good as the original intern, and even more "stupid".
Under Ignatz's leadership, major events such as replacing assistants became a matter of course. The applause that has not subsided for a long time in his ears is telling Bergt that this stage does not look at his identity, does not look at the money in his pocket, only looks at the bloody scalpel in his hand.
Both the surgeon and the audience are so realistic.
Kawei knew that Beget was unwilling to give in, and even a fool could see the displeasure on his face.
If Alina just takes her to see the dean and raise her salary, considering the friendship over the past few days and Berget's pretty good character, Kawei will choose to feint and stay in the ward to wait. Hemorrhoids in the afternoon.
Alphonse is a good friend, but he still doesn't trust Ignatz, so he has to go on stage and watch.
But Alina's hard and soft tactics just now gave Kawei a sense of crisis. He had no choice but to fight for performance opportunities and try his best to earn money and fame. Anyway, he could make whatever he could. If he got into trouble, he might still have a way out for himself.
The patient who underwent the operation was a 30-year-old mother with a bilateral cleft lip. The degree should be double II degree [1] and there was no cleft palate [2]. The surgery was not too complicated.
In the 19th century, cleft surgery was uncommon because the mortality rate was high. The mother went to the Municipal General Hospital for surgery entirely out of concern for her child.
Cleft lip not only affects appearance, but also causes difficulty in pronunciation or unclear pronunciation due to incomplete lip sealing. So after discovering that her child also had bilateral cleft lip, she quickly judged his future based on her own experience.
In order to completely cure the child's cleft lip, she approached Ignatz. If your surgery can be successful, then consider sending your child over.
"Considering that Mrs. Gale is very sensitive to surgery, I will choose the more conservative Rose-Thompson method this time."[3]
Ignatz seemed to be explaining the surgical method to the audience, but in fact he wanted to teach Kawei more: "We first deal with the uneven skin tissue on both sides of the split, trim them to the extent that they can be aligned, and then make straight lines. Suturing. Because it is difficult to find the exact position, we usually use the philtrum as a comparison."
Kawei knew very well that this method was far from modern plastic surgery [4], but he had never done this kind of surgery, so he focused on learning and didn't talk much.
Before he returned to the theater, Ignatz had used a quill to draw a few lines on Mrs. Gale's split lip, identifying the areas that needed to be trimmed. Next, you just need to cut these parts out according to the marked path, and then sew them accurately in position.
In fact, the process is the same as carpentry splicing, except that what is in the hands of the surgeon is soft and tender skin and flesh tissue.
The clefts of Mrs. Gale's bilateral cleft lips were somewhat wide, and the tension during apposition was high, but the surgery itself was not difficult. After simple trimming and alignment, Ignatz took out the most eye-opening thing for Kavi: "Everyone, the operation went very smoothly. Now we have to do the final suturing."
Kawei looked at the three silver needles that were 5-6cm long and was a little puzzled: What is this for?
"You help me close the skin, and I'll draw a few insertion points."
Ignatz gave up the three lips in his hand to Kavi, wiped the blood on his hand, and took the quill from Berget. The tip of the pen left several small dots on the three lips of Mrs. Gale, and then Ignatz said: "These are the suture needles used to close the cleft lip."
Stitches? ? ?
Doesn't it look like an ordinary long nail?
Ignatz used a needle to pass through the three lips in sequence from left to right, then used a thin thread to wrap three figure-eight shapes on the line, and finally tightened, knotted, and fixed [5]: "It's done! The next step is just You need to wait for the wound to heal and then remove the long needle!”
Unlike Morasso's hernia surgery, when it comes to plastic surgery such as cleft lip repair, Ignatz will let the audience in at the end, which helps them observe the results of his superb surgery.
"This surgery was nothing short of perfect, Dr. Ignatz."
"The alignment of the philtrum and lipstick is very precise, there is no difference, just like a normal person."
"I think Mrs. Gale will definitely look in the mirror and laugh out loud when she wakes up..."
"That's the wrong thing to say." Ignatz put away the scalpel and crow's beak forceps and corrected him with a smile, "You can't smile after cleft lip surgery, even smiling [6], otherwise the wound will tear. Tearing. Pain and bleeding are secondary. It would be a pity to tear such a perfect alignment."
After hearing these suggestions, many people around him applauded and paid tribute.
However, besides the praise, some discordant voices appeared: "Dr. Ignatz, there is one thing I don't quite understand."
The person who asked the question was Varela, a daily reporter who specializes in reporting on surgeries. Ignatz had dealt with him for many years, and his reports had always been mainly about praise and praise, so he didn't make much mental preparation: "What's going on?"
"I remember that the first time you had a cleft lip repair was 8 years ago. At that time, straight sutures were used."
"You have a good memory." Ignatz could only vaguely recall some fragments, but he had long forgotten the time. "I was still young at that time, and my skills were not very skillful."
"Well, that's the next best thing." Varela's focus was not on the surgery. "At that time, I was just a young intern reporter. After the surgery, I had nothing to do, so I did some follow-up reporting."
"Um, what next?"
"I'm afraid Dr. Ignaz has not seen their wounds after they are completely repaired." Varela opened the notes in his hand and said, "Although the alignment and anastomosis was done well, it can only be a static situation. If you talk or smile, your upper lip will become completely crooked."
Ignatz sighed: "There is nothing we can do about it. Today's surgeries are difficult to achieve perfection."
"I know that." Varela finally said the real purpose of his question, "But it must have been 20 years since linear suture was proposed. Has Dr. Ignaz ever considered innovating?"
"..."
"If there is a new surgical method that can further change this lady's appearance, maybe tomorrow's headlines will have to be left to you." Varela looked at the patient lying quietly on the operating table and said, "But over the years you have There is really no innovative method that can be used, and I think it is still lacking in this regard.”
This can be said to be a sore point for Ignatz.
His skills are by no means inferior to anyone else. Surgeons from Britain, France and Germany, who are known as the top European surgeons, may not be as skilled as him when it comes to various surgeries. But the reason why Ignatz's fame cannot go beyond Austria is because there is no surgical procedure named after him.
This is the flaw that he least wants to mention, and it is also the black spot that he usually tries to avoid.
But now this rotten scar was torn open in public, with pus overflowing and blood dripping from it.
There was deathly silence in the venue. None of them expected that this reporter, who had praised Ignatz for so many years, would change his writing in an instant because of Laszlo's angry accident. In the final analysis, these media people just tasted the sweetness of others' falls.
"This is...Mr. Varela?" Kawei suddenly spoke.
"right."
"I think your understanding of teachers is biased."
"oh?"
"It is said that only children who have been kissed by God will have cleft lips." Kawei said, "The traces left by God cannot be erased so easily."
Varela smiled: "I didn't expect Mr. Kawei to be so pious."
Kawei didn't have the time to beat him around the bush: "Although Mr. Ignatz is not innovative or dazzling enough in your eyes, and is a conservative traditional doctor. But you have ignored the most important point of being a doctor. The reason why doctors are called doctors , saving lives is the first priority.”
"I admit this, but it does not conflict with innovative surgery."
Kavi looked a little angry and said while packing up the instruments: "Mr. Reporter, you may not have realized that you just questioned a surgeon who has been practicing for more than ten years and has been performing operations wholeheartedly for the people of Vienna.
His surgical mortality rate and surgical speed are among the highest in Europe. Continuously improving technology for the sake of patients is an innovation. "
"this......"
This time it was Varela who lost her voice.
Such an impassioned statement once again received a wave of applause.
Varela's face was thick enough, and he stuck there like a piece of brown sugar, with no intention of leaving. After taking some notes on Kavi's speech, he asked a new question: "I heard that Dr. Ignatz plans to try a cesarean section again?"
"Yes, there is indeed a woman who needs a cesarean section."
"Is there any chance to avoid surgery?" Varela's purpose became more and more obvious, which was to make Ignatz look embarrassed. "Because everyone in Vienna knows that cesarean section is extremely dangerous, and it seems that if you insist on the surgery, it will be taken away easily. The life of the mother is contrary to the reason Mr. Kawei used to defend you just now."
"This is a decision made out of desperation." Ignatz defended. "The mother has a very obvious narrowing of the birth canal and will definitely have a difficult delivery. Only a cesarean section can save her."
"Then are you sure?"
"......have."
Ignatz regretted it after saying this, because he had no idea how to deal with postpartum hemorrhage.
A large incision will continuously release blood out of the uterus, and this situation will only become more serious when the placenta is peeled off. Ordinary crow's beak forceps cannot handle such a large area of bleeding, and many previous cesarean sections have failed here.
But there was no possibility of taking back the words, so I could only bite the bullet and finish, "I have introduced new suction equipment and more reliable crow's beak forceps, and also practiced the entire process of cesarean section repeatedly during the dissection. I hope Try to do everything you can.”
"Would you consider cutting out the uterus directly like British doctors did?"
"My principle is not to do it if possible. After all, the mother is still very young."
"I hope it won't be like last time..." Varela sighed and said no more, "I made a note of it."
...
The audience retreated one after another. Kavi helped carry the toolbox and followed Ignaz out of the theater.
He did not expect that Laszlo's gastrotomy would have such a chain reaction, and newspaper reporters would not consider the true feelings of the interviewees at all, they only thought about sales. It’s always cold at the top, no matter what industry you are in, and the Vienna Daily News is no exception.
"Actually Varela is right."
Ignatz, who got on the carriage, suddenly started chatting: "I really don't have any new surgical techniques that I can use. After working for so many years, the only things I'm proud of are the speed of surgery and some newly developed surgical instruments."
"These are already very..."
"Not enough! This is not enough!!!"
Kawei could feel his unwillingness and pressure. The previous failed cesarean section and the upcoming cesarean section made him breathless: "Teacher, you need to rest."
"Rest... Nola's belly won't let me rest." Ignatz rubbed his eyes and said, "But the two corpses you sent before really helped me a lot, at least Hill and I Their cooperation is even better."
"Is the problem still with hemostasis?"
"Yes, bleeding during cesarean section is very difficult to control. Success depends on stopping the bleeding." Ignatz asked, "Has your father never had it?"
"He is just a young doctor and has never done anything." Kawei didn't dare to brag for fear of being exposed in the future.
"Originally, the bleeding points were numerous and difficult to find. We tried using crow's-beak forceps in previous surgeries, but it was impossible to stop them without five or six forceps." The more Ignatz talked, the more headache he got. "Secondly, there are sutures, and the uterine body. The suturing is not easy, and the pliers can easily slip off, making the operation very troublesome."
"Have you ever considered using medication to stop the bleeding?"
"Besides making people dizzy and causing vomiting and diarrhea, what else can the medicines in the pharmacy do?" Ignatz said with a wry smile, "The only thing that can truly stop bleeding immediately is a soldering iron..."
At this point, he suddenly stopped and looked out the window, his mind returning to the bustling barber's room two or three hundred years ago.
"Teacher, there is no difference between using a soldering iron and a complete hysterectomy."
Kawei reminded me abruptly, and Ignatz finally recovered: "That damn Varela, it took my train of thought astray."
"Teacher, I actually have my own ideas about stopping bleeding." Kawei thought about the future experiments, and there was no point in hiding oxytocin. He might as well show off his cards now, "My father made a homemade medicine before, which seems to be specially used to stop bleeding." Used to stop bleeding."
"Oh? And this kind of medicine?"
"It's just that I moved away a long time ago and I don't have the finished product in hand."
"Is there a formula? I can make it myself!" Ignatz was very excited, but soon realized that he was impulsive and immediately changed his words, "Ahem, since it is your father's medicine, even if there is a formula, it must be you. Come and do it.”
"I don't know if there is a formula. I have to go back and look for it to find out."
"Okay, I'm waiting for your good news."
Having said this, Ignatz felt slightly better.
However, Kawei's surprise did not stop: "Teacher, are the two corpses from before still there?"
"Here, what's wrong?"
"My reporter friend just reminded me. I think the reason why cleft lip repair has not been innovative is because we always ignore the anatomical structure of the lip."
