Varela, the surgery reporter for the Vienna daily, had his first taste of being kicked out of the Theater an der Wien today.
The direct reason was that he taunted Hills after he failed to expand the incision, and was kicked out by Carvey on the grounds that it would interfere with the operation. Facing the sticks in the hands of the two theater guards, his usual slickness was completely useless and he could only leave the theater obediently.
Varela looked back at the sign, took out the cigarette case and matches in his arms, and lit a cigarette for himself.
He knew that he went too far today, and he would never have done this before. He has followed and reported on surgical performances for more than ten years, and he must know that keeping as quiet as possible during the operation is the most basic respect for doctors and patients.
But Varela still couldn't hold it back.
He didn't know why Yingenatz was not present today. The operation was so difficult that he was still an unknown factor. Now that there was no chief surgeon, the result was self-evident.
Maybe it was because Ingenac didn't play that he felt a little absent-minded, or maybe it was because Hills fell short when he was about to succeed and made him impatient. Anyway, for Varela, today was a terrible day.
The cold water that Kawei poured on him calmed him down a lot, but one step after another, the failure of the operation was inevitable.
"The time is approaching the 20-minute mark, and the baby hasn't come out yet, and there is so much blood. Hills is like a fool. He doesn't know how Yingenatz teaches people..." Varela blew smoke rings into the sky and complained about the operation and the person, "Twenty minutes is a long way to go. It's over, it's definitely over. The operation failed again."
He has traveled to many countries and seen other people's surgeries.
Britain and France are major medical powers, and they are ahead of Austria in both surgery and internal medicine. There are also faint signs that Germany in the west and Tsarist Russia in the east are surpassing each other. The cigarette case in his hand was a gift he received when he visited Tsarist Russian medical officials. 【1】
Healthcare reform is underway across Europe.
The United Kingdom has already opened the University of London that accepts civilian admissions, as well as several well-known European medical journals; France and Germany have successively increased medical industry standards, and the Russian Department of Surgery is also actively seeking exchanges with other countries.
Among the big countries, only Austria is still planning the big event in Hungary, and does not put medical care on the agenda at all.
Although belittling Yingenatz is a new attempt by the newspaper to increase sales, Varela does not deny that he also hates the fact that iron cannot become steel. Remarks such as "not actively innovating" and "resting on our laurels with old theories" are all labels placed on Austria by the health systems of other countries, and they are used by him to borrow flowers and offer them to the Buddha.
He is not like Yingnaz who guards his three-acre Vienna land and encloses it for himself.
As a columnist who travels all over Europe, I have to exchange some surgical techniques with other countries every time I travel. Not to mention Britain, France, Germany, and Russia, even surgeons from the Netherlands, Sweden, and Belgium are shaking their heads at the Austrian operation. That is to say, a guy like Yingenatz can still put it on the table and say a few words.
He badly needed a victory to prove his country's surgical skills.
"never mind."
Varela stubbed out the cigarette butt, feeling a little frustrated, pulled up the lapel of his coat, and stopped a carriage: "Go to the Vienna Daily newspaper office."
"I Have a Picture Book of Ghosts and Gods"
"Isn't this Mr. Varela? Why do you go to work so late?"
"I have to write in a hurry. Tomorrow's headlines will be on the front page..."
...
The placenta is a highway for the fetus to obtain nutrients from the mother's body and send away waste products. The large amount of blood flowing through it is the carrier of these nutrients and waste products.
In the 20th century, formal modern obstetrics gradually entered the market. Before performing cesarean section, B-ultrasound examination must be completed to clarify the location of the placenta. In addition, the selected lower uterine segment incision can naturally avoid non-placenta previa. Unless the patient has never been examined and the surgery is urgent, the placenta will hardly be damaged by the surgery.
Of course, there are no absolutes in the world. It is normal for poor people not to have prenatal check-ups. In clinical practice, placental damage will still be encountered during surgery. Once the placenta is injured, it is equivalent to cutting off the entire highway. The amount of bleeding is extremely exaggerated, and it is not easy to stop the bleeding.
There was definitely no B-ultrasound in the 19th century, there was just luck. Obviously, luck is not on their side today.
No one knew Nora's placenta would be in this position, not even Kavi. Therefore, when performing a cesarean section, you cannot rush to incise the uterus to remove the fetus, but you need to observe the position of the placenta first. 【2】
It's not that Hills has never seen blood. On the contrary, he has seen blood every day to the point of numbness. The blood splattering everywhere was not a good sign. His rich experience in amputation told him that if he messed up the operation, Nora would definitely die.
It only takes a moment of discouragement for death to rob a doctor of his will and courage.
"Teacher Hills! Teacher Hills!!!"
"The amount of bleeding is too much..." Hills looked at Herman who was still trying to pump blood. Although he tried his best to press the bleeding hole with the gauze in his hand, he had no fighting spirit in his heart. "What's her condition now?" Sample?"
The nurse quickly answered his question: "The heart rate is 110 beats/minute."
"It's a bit fast..."
Hills pressed on the bloody incision, and although he was still trying to stop the bleeding, there was no fighting spirit in his eyes.
Carvey knew that Hills was no longer useful, but he couldn't kick him out just yet.
He had just kicked out the annoying Varela, and he would look very arrogant if he kicked him out again. The more important point is that the ensuing endgame is not easy to deal with, and it will be difficult for himself and Heman to complete it alone.
However, before deciding whether Hills should stay or go, the audience must first be appeased, or at least let them know the progress of the operation.
"We cut the placenta and the bleeding was a bit heavy, but there is still a chance and we have to get the baby out first."
After clarifying the direction of the next operation, Kawei turned to the midwife beside him: "Two of you, come and help. The taller one will help Herman pump blood, and the shorter one will come over and get the baby out first. Herman will go and get it." Two pairs of umbilical cord clamps and the bottle of medicine I brought, hurry!!!”
Under the command of Kawei, this makeshift surgical "team" began to look like a first-aid operation.
The tall midwife worked hard to pump blood, while the shorter one's small hands easily reached into the enlarged uterine cavity and pulled out the child who was covered in blood immediately. Herman followed up, clamped both ends of the umbilical cord, and quickly cut off the umbilical cord, leaving all of Kavey's attention on the operating table.
"The fetus has been delivered, and the next thing to do is to peel off the damaged placenta as soon as possible..."
As soon as the words were spoken, Kawei's hand had already reached into the uterine cavity, and at the same time he said to Hills beside him: "Teacher Hills, there are two bleeding holes here, use gauze strips to suppress them."
"..."
"Teacher, I need gauze strips to stop the bleeding!!!"
"Um?"
Hills was just like the panicked Berget. He held the uterine incision in his hand, but what he was thinking about was how to face all this after the operation. He had already lost his mind: "Stop the bleeding?"
Kawei no longer cared about status, snatched the gauze and crow's beak forceps from his hand, leaned forward and said in a low voice: "If you still want her to live, just do everything I say. Do it. If you can’t do it, get out of here! Nora doesn’t need a piece of wood to operate on!!!”
Hills was a little confused by the scolding.
The "colleagues" around the operating table also heard something and were confused.
Even some spectators in the stands smelled something and saw some hints of infighting within the team.
Kawei was just an assistant. He was from a civilian background and had not received any systematic medical training. It was a big taboo for him to make the following mistakes during the operation. But Hills' failure and numbness were obvious to all, and Carvey's reaction at least saved Nora's life and allowed the operation to continue.
Moreover, the right to speak has been in Kawei's hands from the beginning, and outsiders cannot tell that the command has been handed over.
Hills seemed to wake up from the scolding, and looked at Nora who looked slightly pale again, and nodded: "I will do it."
"There are not enough manpower and crow's beak forceps, so just cover both sides of the incision with gauze and leave it alone." Kawei made a judgment and then said something shocking, "All you have to do is stand on the operating table and reach into her abdominal cavity. , pinch the uterine body tightly with your palms." [3]
Hills had never heard of this method of stopping bleeding: "Pinch the uterus?"
"Do it!"
Kawei stopped talking to him. After assigning the task, he needed to completely remove the placenta as soon as possible. As long as the placenta remains in the uterus, the uterus cannot contract properly. If the uterus contracts poorly, the blood vessels inside will continue to bleed out like an unscrewed faucet.
The placenta is deeply embedded in the uterus, and you need to find its edges, separate it with your fingers, and then tear it off in one piece.
"Don't have an implant... don't have an implant... don't have an implant..." [4]
A minute later, Kawei pulled out a large black-red mass of tissue from the uterus, and left Nora's body along with the umbilical cord and umbilical cord clamps he had just taken out: "Everyone, we are pretty lucky, Nora. There was no adhesion or implantation of the placenta, it was peeled off very smoothly, and then all we had to do was wait for further contraction of the uterus to stop the bleeding.”
He breathed a sigh of relief. Delivering the placenta was the first step in stopping the bleeding.
But the surgical theater, which had been quiet just now, suddenly became noisy. Only then did Kavi realize that he had said the wrong thing.
The commentary just now would be understandable even by medical students in the 21st century, because that's how it is written in the textbooks. But if you put it in the 19th century, when there was nothing about cesarean section, it would seem unreasonable and confusing.
In addition to the upper-class nobles, there were also many medical students and working surgeons in the audience. It was difficult for their brains to accept so much irrelevant knowledge at once. After asking each other to no avail, they could only ask questions on the spot.
"Mr. Carvey, what does placenta accreta mean?"
"Implantation should mean that it is difficult to remove."
"But what does stripping or not stripping have to do with hemostasis? As long as the umbilical cord is clamped, massive placental bleeding can be prevented. Wouldn't it be more appropriate to control the break just now?"
"Yes, why didn't you just stop the bleeding and take out the baby first? Can't you stop the bleeding first and then take out the baby?"
"The child can still understand it. After all, leaving it in the uterine cavity will cause damage and affect the hemostasis operation. But it is difficult to understand if the placenta is removed first. I have read a lot of obstetrics medical books and cesarean section surgery records, and there is no mention of it. The placenta needs to be removed first.”
"Mr. Carvey just said that placental separation helps the uterus contract."
"Of course I know! I have been admiring this operation carefully and I must have written this sentence down. But I want to ask why? Why must the placenta be removed first? Judging from the operation process, this step seems to be very important... ....”
Once someone speaks first, questions will come flooding in.
Kawei has been introducing the surgical procedures and directing the team to stop bleeding. This time, he was careless and used the theater as a teaching operating room without making any distinction in time.
He faced those people's questions and used gauze strips to fill the uterine wound after the placenta was peeled off. He could only make a false shot: "The operation is not over yet. If you have any questions, please discuss it with me after the operation is over. "
This can be regarded as delaying time, but there are also seven points of truth in it.
The process of helping Nora deliver the baby and placenta first was very successful, but her uterine contractions were not good. With the joint efforts of seven crow's-beak forceps, the uterus was still bleeding slowly and could not be stopped.
Kawei had to prepare for the worst: "Nurse, how is she doing?"
"The heart rate is a little fast."
"I know the rush, I want specific numbers!"
"Probably around 125-130."
"Is your heartbeat weak?"
The nurse was a little nervous. Looking at Kawei's face, she nodded repeatedly in fear: "It is indeed lighter than before."
A faster and lighter heartbeat is a sign of insufficient blood volume. The bleeding must be stopped immediately. Nora will definitely die if the bleeding does not stop. 【5】
Kawei had no choice but to call Herman: "Get the syringe ready, it's in the drawer of Teacher Yingenatz's box. Hills, continue to squeeze the uterus hard to help it contract."
"good."
"knew."
After speaking, he picked up the test tube rack that Herman had placed on the ground just now. There were two tubes of transparent solution on the rack, which were the oxytocin that Cavett had left for Nora to save her life.
It's just that these oxytocins were mixed with vasopressin, which was difficult to separate in the 19th century and was considered a semi-finished product. Moreover, his experiment has just started. He only knows that the reagent must be effective, but he does not know the concentration and safe dosage. Now that the situation is critical, I can only take a gamble and break into her womb together.
"The needle is here."
Kawei unscrewed the plug of the test tube, took the syringe, filled it with oxytocin, and injected it directly into Nola's uterus. But it wasn't over yet. In the next two minutes, Kawei gave her four more injections. 【6】
A full five injections almost emptied Kawei’s reagent tube, but the result was still good, Nola’s uterus began to contract.
"Kavi, I can feel my uterus moving!"
The contraction moves the entire uterus, and the incision that was opened earlier also begins to shrink and compress the blood vessels in it. This natural method of stopping bleeding is much more effective than crow's beak forceps.
Until now, Kawei was completely relieved: "Herman, give me a needle and thread!"
－－－－－－Digression－－－－－
Thanks to the following book friends for their rewards (listed in no particular order): Xingyun Ruoyu Forgot His Account (Rabbit Jing Er Meng), Hundred Steps Returning Yang (The Big Brother San Meng in My Heart), Apple Is Not Loved by Apple I Don't Love Folding Quilts (The fourth cute Apple boss), an unknown love god whose name starts with 13 (he is a handsome guy), Shu Moliang, Shopkeeper Mo, Shao Shaoduo, Counter Spell. Thank you for your support after it was released, and thank you to all the readers who subscribed and read it as soon as possible. It is now updated on 1/20.
