The time goes back to a week before Kawei entered the Municipal General Hospital.
The cesarean section performed by Ignatz was actually very similar to the one performed by Kawei. It was also an afternoon operation, and it was also a temporarily added surgical item. The ticket sales were also very popular, and the tickets were sold out less than an hour after the opening. Sold out.
The chief surgeon was the unstoppable Ignatz, and Hills and Hermann were assistants. There were not many surgeries that allowed the three of them to perform on the same stage, and cesarean section could indeed be counted as one.
"The operation was difficult, really difficult. In order to seize the time, I cut the knife too fast. I didn't know what the knife blade would cut after entering the uterus, and it was difficult to control the maternal bleeding."
Ignatz seemed to have returned to the familiar theater of surgery, with his trusted assistants beside him, an audience full of curiosity and waiting for victory in the distance, and the uterus and child at hand who needed to race against time.
He sighed, not escaping from failure:
"I can still remember the appearance of the surgical incision at that time. The blood was red in front of my eyes, the warm and sticky texture was in my hands, and the bloody smell left on the tip of my nose was instantly ignited when I heard the words 'the mother's pulse disappeared'. Everyone You must have all had that feeling. Even if you try your best, you can still only watch the fresh life slowly disappear in your hands..."
"There is nothing we can do about it, Professor Ignatz."
"We have to learn to live with this pain."
"Don't blame yourself too much..."
The people in the audience are all Ignatz's colleagues and competitors, they are also doctors, and they have experienced it all. They were deeply affected by this passage, and many voices of helplessness and recognition soon emerged.
"The Romance of Fairy Wood"
"Okay, okay, after all, this is a surgery seminar, not Professor Brentano's small emotional class [1]. Besides, surgery shouldn't involve too much personal feelings." Ignatz quickly exaggerated. The heavy atmosphere put on the brakes, "The emotion is over, let's just focus on the surgery itself."
The mother was an 18-year-old girl. She started to have a small amount of irregular bleeding two weeks before the operation. The amount was not large, but the bleeding persisted, so she was quickly diagnosed with placenta previa and was admitted to the hospital.
At 12 noon on the day of the operation, the mother's bleeding suddenly began to increase. Ignatz was in the ward, quickly finalized the operation, and took Hills and Herman, who had been training with him for a while, into the theater.
The exact time of the operation was 2:11 p.m., and the anesthesia ended at 16 p.m. At the same time, Ignatz's scalpel blade opened the mother's belly.
However, every minute and every second that followed undermined Ignatz's confidence in having a cesarean section.
"The mother's bleeding was so violent that the visible area was filled with dark red blood that was constantly pouring out, and the visibility was 0. The suction speed of the suction device at that time was very low, and I could not find the bleeding point, nor could I suture it." Hills I have been helping to expose the visual field, and I am also trying to use a suture needle to do blind puncture, but several positions are not ideal and the bleeding cannot be stopped..."
Ignatz's voice became softer and softer as he spoke. It was not easy to get rid of personal feelings immediately. After he took a deep breath and made some adjustments, he said:
"The speed of fetal removal is not slow. Although it cannot be compared with those rare cases of successful cesarean section, please believe me, our speed is not slow at all. Unfortunately, after the fetus was removed, the uterine bleeding became more serious , I wasn’t even given the chance to choose to have my uterus removed.”
Although from the content point of view, the speed of tire removal has met Ignatz's expectations, in fact, there are still some flaws in the whole process.
A cesarean section operation requires at least one nurse and one midwife. The nurse can help deliver the surgical instruments, while the midwife can help remove the fetus and be responsible for the fetus' body.
When the operation was about to begin, only the nurse arrived, but the midwife never showed up. It was later found out that she was rushing home to take care of the elderly at noon, and accidentally sprained her foot on the way, so she missed the time.
The staff in the maternity ward was really tight, and the mother was not allowed to wait due to the amount of bleeding, so Ignatz took the three students to the surgical theater.
Removing a fetus is a technical job.
The more stable the midwife is, the smaller the uterine incision will be and the less bleeding will occur. If the fetal removal technique is not in place, a larger incision will be needed. The incision may only grow 1-2cm, but the amount of bleeding is likely to double.
The midwife was not available, so Ignatz could only try to remove the fetus by himself, so the incision would be longer and the speed would be slightly lacking.
During this period, the three students not only slowed down the pace when passing blood-absorbing sponges and gauze strips, but also accidentally kicked over the glass bottles containing blood, leaving the scene in a mess.
They were inevitably scolded afterwards, but Ignatz knew very well that even if the midwife arrived and the three students made no mistakes, the operation would be difficult to succeed. The amount of bleeding from the uterus was so overbearing that he refused to reason with himself. Even if he took the fetus 30 seconds faster, it would be difficult for him to stop the bleeding from the incision.
"I think the core of the problem is hemostasis and subsequent uterine suturing." Ignatz explained, "As long as these two difficulties can be solved, the difficulty of cesarean section will fundamentally change."
This is the experience he summed up after experiencing the failure of many cesarean sections and repeated discussions with Kawei.
But as another surgeon on the stage at the same scene, and as a typical representative of failed cesarean sections, his views were different from Ignatz: “Dr. Ignatz’s ideas are too idealistic. After I turned 18, I felt more and more that surgery was not a panacea."
Ignatz had not left the stage at this time and was left behind by a chair from the host.
He could vaguely hear something different from this sentence, but considering the importance of the meeting, he still did not order the insertion: "Of course it is not a panacea, but when the fetus is in an abnormal position, placenta previa and the birth canal is narrow, if it can Finding another delivery channel will definitely save the lives of many women."
"Can it really be saved? If it could improve the survival rate from the beginning, I might still believe it, but it doesn't seem to be the case now. I hope everyone can jump out of the original framework and stop thinking about how to perfect the surgery, but think more about doing this Does it actually bring about the expected results?”
Ignatz had always thought that Kavi was the spoiler in this regular meeting, but after listening to the doctor in front of him, he suddenly found that the doctor in front of him was more like a spoiler: "Doctor Massimov, what you said is What's the meaning?"
"I have had no less than 20 cesarean sections. Except for three early cases that were lucky enough to preserve the uterus, all the others failed."
Massimov is in his fifties, and his gradually declining surgical skills may not be as good as Ignatz's, but his surgical experience is quite experienced and he can be considered a well-known surgeon. After all, before Ignatz graduated, he had already started performing amputations at St. Mary's Hospital.
But after so many years, his thoughts have also changed. It is not difficult to hear his pessimistic attitude towards the future of surgery from between the lines:
"Surgery still needs to have some degree of control. You can't cut wherever you want, or make holes wherever you want. Cesarean section has now exceeded the limit of surgical capabilities and is an act that defies nature."
"Are you just looking at a pregnant woman like this..."
Ignatz wanted to retort, but was immediately overtaken by the other party: "What you are going to say has been said over and over again for hundreds of years. I am tired of hearing it. Look at the development over the years. It has taken a long time." We have spent a lot of manpower and material resources, even "human" resources in the literal sense, but we have not been able to solve the problem of extremely high mortality in cesarean section."
"Doctor Massimov, I don't know why you suddenly said this."
Ignatz said: "Even if you really want to express your opinion, you should not choose to come to the surgical symposium to present intestinal output surgery after a perfect cesarean section has appeared in Vienna. Useless theory'."
"So what if it happened? Look at the UK, France, and Germany. Which one of them has not reported a successful cesarean section? What happened next? Has the success rate of the operation really become higher? It's not all random events. It's all random. Life!"
Massimov still badmouths the entire industry: "When the success rate of an operation remains unchanged after a hundred years of development, don't you find it strange? Don't you have a little awe? We are all too stubborn. They all think that they are the God of patients, but only God can be the God of patients."
Ignatz could not complain about this: "He is indeed a doctor at St. Mary's Hospital, (what a guy who majored in theology and medicine, even his speeches smell of pre-meal prayers)..."
Massimov glanced at Kavi, who was sitting in the audience, and then at Ignatz: "It is indeed worthy of joy that your student can have a successful cesarean section, but I still have to pour cold water on you. Baron should I don’t think that this young man who did not go through medical school could become the founder of cesarean section just by luck."
The founder of surgery must have created or at least standardized a new surgical procedure for a related disease.
If Carvey's cesarean section method can be popularized and significantly reduce the mortality rate after cesarean section, then it is not an exaggeration to call him a founder.
But in Massimov's eyes, cesarean section has reached a dead end. Success can only be the result of the patient accidentally impressing God, and has little to do with the surgeon.
Science and religion have been arguing for hundreds of years. Ignatz knew that he could not convince him at all, and he certainly could not convince himself, so he was too lazy to argue and just wanted to speak with the facts: "By the way, why did your cesarean section fail?" of?"
The original questioning session turned into a conversation between two heavyweight surgeons: "It's the same as yours, what's wrong?"
"I'm just asking." After all, Ignatz is much younger, and there is a generational gap between them. Even with the title of baron, he can't be venomous at will. "If the religious factors are removed, Dr. Massimov should Do you agree with what I say?"
"What statement?"
"The two keys to cesarean section are hemostasis and uterine suturing."
Massimov thought for a long time and nodded: "I admit that this is a difficulty, but I don't think this is something that can be solved manually."
"This is too absolute. As long as the thinking is changed, there will be room for improvement in all surgeries. Professor Corigo's eye surgery just now is a good example."
Ignatz dragged Hills out and whipped him once, but Massimov refused to accept this trick, so he retorted and whipped him again: "Don't confuse the concept, it's just an improvement, and Losing an eye won't kill you, and the difficulty is incomparable to a cesarean section, far from reaching the upper limit of surgery."
"But it at least shows Kawei's ability." Ignatz pointed at Kawei in the audience and said, "It is not a coincidence that his cesarean section operation was successful. I have read the operation report, and it clearly states how Solving the two major problems of hemostasis and suturing.”
"How to deal with it?"
"The uterus can be sutured in multiple layers with silver thread. The muscular layer and serous layer have their own suturing methods. The most important thing is to stop bleeding, which requires the use of a drug." Ignatz gave a brief introduction.
"Drugs? The surgeon doesn't solve the problem himself, but instead turns to the internal medicine department to find a solution?"
Massimov snarled, suddenly realizing that he might not have kept up with the development of internal medicine pharmacy, and quickly asked: "That's not right, can medicine stop bleeding? Are the people in the internal medicine department now focusing on stopping bleeding instead of studying bloodletting and enemas? Or are they? Did the pharmacist find something new to get people high?"
Although Kawei thought it was nothing, after being said so many times, he had to give some response: "The teacher is wrong to say that. Ether used for anesthesia is also considered a drug, but now it has become a necessary item for surgery. "
"It was a surgeon's work, it was different."
"My medicine is also made by the surgeon."
Massimov was a little surprised: "Who? Which surgeon?"
"Me." Kawei pointed at himself, "I performed a cesarean section and a tracheotomy, so I should be considered a surgeon."
"......Calculate."
Massimov is the most typical old stubborn, still not expecting Kavi's solution.
But success is always a failure, and even if his own operation failed, he is not qualified to judge others: "No matter what your solution is, I still think that the success or failure of the mother's delivery is divinely ordained by God, and over-intervention is not good. Even if a solution is really found, , I think it’s also a huge harm to the mother’s body.”
"What the teacher means is that whether a woman gives birth successfully or not depends on how her belly looks like?"
"You could say the same thing."
"I understand what the teacher is saying. Is abdominal surgery the limit of surgery?"
"Yes! A qualified surgeon should not rush into the abdominal cavity!"
"I don't care if God doesn't give birth to a child, but if you only look at the teacher's words, it's still biased." Kawei retorted unhurriedly, "God can give mothers a belly that is easy to give birth to, isn't it? Can’t God give me something else?”
Massimov didn't react: "Something else? What else?"
Kawei made a gesture of raising his hands after washing his hands and said with a smile: "For example, a pair of hands that can help women with difficult labor get out of the sea of suffering."
－－－－－－Digression－－－－－
[Graduate thanks] Thanks to the following book friends for their rewards (in no particular order): It’s too expensive to change the name (Mr. Mao, will appear later); Return the Yang with a Hundred Steps; Xuan An Yin Inkstone (Li Ben, you must able to survive); Mu Mu 3; Shu Mo Liang (an old book friend, when he sees her, he will think that his books are not cool yet); An Alone; Panic Jiang; Book Friend 20220611171302365; Obsessed with Chemistry; Counter Spell; Escort Harmony; Bai Qingqingya; Lingjiang City; I am in the wilderness of the book; the strong sea monster; green peppers burning in the fire; a donkey flat river; book friend 20191031223835890; my God, my God; fan clouds and flowing water; Wu Shuangyu; wind and snow Yiling; book friend 150514184510363; Flipping the Sword and Blowing Sand; Book Friends 20220104100532409; gtboys; Book Friends 20220228174509263.
Thank you for your support and rewards, and also thank you to the book friends who voted for monthly votes to read and subscribe~~~ ps: I was caught in the dark this morning, so I’m sorry for the late update.
