Whether it is the definition of divine right or the debate on the factors for successful cesarean section, broadly speaking, the two are just mocking each other. There is no point in medicine, or even in this little surgical session, until it actually rises to the level of widespread practice.
Kawei didn't want to convince them with such nonsense, and he didn't think anyone would believe such nonsense as "Hand of God". He was just tired of being told what was right and what was wrong, so he used the other person's words to satisfy his cravings.
After the laughter and scolding in the venue ended, the regular meeting had to continue.
Massimov is a doctor and a priest, so he certainly has his limitations, but from a surgical perspective, his operation was pretty good. At least when he encountered the next huge abdominal tumor, he did not give up and resolutely chose to open his abdomen.
Of course, in terms of time, this operation was earlier than the failed cesarean section.
"Female, 23 years old, had abdominal distension and pain for two months."
This is the main complaint given by Massimov, concise and clear at a glance:
"I remember she came to the hospital at the end of November last year and saw a well-known internist. After a brief consultation of less than a minute, the internist easily attributed the cause of the disease to her gender and told her to go on a hunger strike. Three days, and then a whole roasted potato is pressed against the painful area during those three days.”
It became clear that this diagnostic and therapeutic approach could not resolve the girl's abdominal pain, and a week later she returned to St. Mary's Hospital, with the same internist.
Massimov sighed and continued: "This time the doctor realized the seriousness of the problem and once again emphasized her gender. At the same time, he did not forget to ask about X things. The cause of the disease did not transfer to her private life, but to hygiene. concept.
The treatment given this time was a bath once a day, two rides on horseback, a bottle of cathartic herbal juice, and, yes, an enema, because the girl told him there was a lump in his stomach. The guy prepared our hospital's exclusive enema formula on the spot, which can relieve abdominal distension and has a strong skin care effect, but it can't cure abdominal pain! "【1】
Two medical consultations once again delayed the girl's treatment. When she returned to St. Mary's Hospital, it was already the 52nd day since she discovered abdominal pain.
"This time the pain was even more severe. The internist said he was helpless and handed her over to the obstetrician next door." Massimov said, "Fortunately, the obstetrician didn't mind touching the woman. According to the feeling from her bulging belly, After going through some doorways, I concluded that it was an 'evil fetus'."
Upon hearing this word, everyone in the audience immediately thought of teratoma. 【2】
Teratomas are not unfamiliar to surgeons, because they have been doing dissections all the time. There are so many that they can always encounter some, and there are not a few recorded. But there are very few people who really think of incising the stomach to solve teratomas, at least Ignatz has not done it, which is why Massimov can be ranked in this position.
"Her abdominal pain is getting worse and worse, and I can feel that the thing in her stomach is causing trouble." Massimov explained, "I'm not sure whether I should have surgery because the risks are too high, the mortality rate and cesarean section." It was almost like a uterine delivery, but she was in so much pain.”
In order to calm the girl's mood and comfort himself, Massimov took her into the cathedral in the center of the hospital.
This is a typical rose window Gothic building with tall pointed towers, pointed arches, long beams and stained glass windows painted with biblical stories, which together create a light and slender feeling of flying into the sky. In the center is a wooden pulpit, as well as a statue of Jesus and a cross. There are many people in the nearly 100 seats, mostly family members, as well as some patients and doctors.
"I prayed with her and held her parents' hands in prayer. Together we praised God for his mercy, hoped to forgive their sins, and prayed that the girl would regain health."
Massimov sighed: "The operation was performed in a small room in the hospital. I chose a midline incision. After entering the abdomen, I saw a white spherical tumor, and slender and curved purple-red blood vessels could be seen on the surface. It It was connected to the girl's right ovary, and I was immediately ready to perform a right ovarian and tumor resection. But..."
The scene that followed the operation moved him and shocked everyone.
"You must have never seen bilateral 'evil fetuses'. Two oblong tumors hung on both sides of her uterus, like angels that fell in her belly. [3]" Massimov simply drew A sketch said, "The removal of the right ovary soon turned into a bilateral removal, and the difficulty of the operation went up to a new level."
Kawei also had to admit that doctors who have the courage to enter the abdominal cavity in this era are worthy of admiration, but he still had to complain that the operation was too rough.
The vast majority of teratomas do not require ovarian incision at all, and the tumor body inside can be removed by simply peeling off the outer covering. And bilateral ovaries should not be removed, as this will directly cut off fertility.
At first, he thought that Massimov did not understand the anatomy of ovaries and teratomas, so during the time-limited ether anesthesia operation, for the sake of safety, he chose to perform a faster resection because there was no other way.
But later in his speech, he told Carvey that his guess was completely wrong.
Massimov did not understand the anatomy of ovaries and teratomas, but he even less understood the importance of ovaries to women.
This is not a matter of shallow understanding, but a bizarre misunderstanding based on male superiority: “I remember that Virchow, the father of pathology, once said the importance of the ovary to women [4], and it was also mentioned in textbooks. It should be made clear to students new to medicine that the ovaries are dangerous organs that men do not have.
Menstrual disorders, neurasthenia, and hysteria are all related to the ovaries. Removing the ovaries is physically harmful, but mentally she may be one step closer to men. 【5】
This inspired me to continue trying this surgery, but it was a pity that God did not give me too many opportunities. Because the two tumors were too large, I encountered a lot of bleeding when doing the right resection, and in a panic, I even scratched the tumor..." [6]
Kawei was not too surprised by the results of the operation. It would take a long time just to peel off the surrounding tissue of the bilateral teratomas. If it were successful, it would definitely be big news, and the ranking in the regular meeting would not be as bad as the subsequent failure. Cut lower.
What really made him feel strange was his previous understanding of ovaries.
It felt like a bunch of familiar German words came into my mind, but I made up a few words that I couldn't understand. He couldn't understand why Massimov thought that the ovaries played a role in determining gender, but seeing the doctors around him nodding in agreement, he had no choice but to give up.
Kawei has been here for more than half a month, and has experienced many strange theories during this period.
But those theories are just detours, or the theories behind them are not understood. None of them is so outrageous as to praise the removal of an entire set of organs.
"What's wrong?" Ignatz asked, realizing Kawei's confusion, "are you interested in ovaries?"
"Uh... Well, I don't quite understand what Mr. Massimov meant by what he just said." Kawei tried to ask, "Can removing the ovaries really have that effect?"
"Oh, it's normal that you don't understand. It's only found in the physiology and pathology textbooks in medical schools. We don't cover much in surgery." Ignatz didn't answer directly. He only mentioned one source and seemed to understand the problem. Wei's bottleneck, "You, a surgeon with a wild background, should go to medical school for further studies."
Wild road? ? ?
Kawei took a slight breath and said no more.
Compared with the teratoma removal process that Massimov vividly explained on the stage, he was more concerned about what was taught in medical schools in the 19th century. Although he is a small person standing on the shoulders of giants and is not qualified to criticize the forerunners, human curiosity cannot be stopped.
This made him look forward to the life of studying in the academy even more...
...
Judging from the time, not long after Massimov's bilateral oophorectomy failed, another failed cesarean section followed. Two blows took away the young lives of two girls and completely destroyed his confidence in surgery.
After many days of reflection, Massimov had to bring up the idea of a abdominal no-go zone.
Waterman took his views on abdominal surgery into account and put a lot of effort into arranging the meeting.
After three failed abdominal surgeries, he underwent an almost successful tracheostomy halfway through, which was the fifth letter of the original, addressed to a surgeon from a small clinic: Damirgaon.
Judging from the quality of the surgery alone, there is nothing outstanding about this surgery.
The operation was not successful, it failed very simply.
The introduction also says: It only takes three minutes for a patient to go from having difficulty breathing to suffocating to death. In the past, this kind of crappy operation could not be included in the regular meeting. After all, it was difficult to distinguish whether the surgeon was a serious surgeon or a barber.
"The Exotic Land Development of Vegetable-Growing Skeletons"
Waterman still added it in. The superficial reason should be that since December last year, apart from the emergency tracheotomy performed by Laszlo, this is the only clinic that has performed tracheostomy.
But tracheotomy is not a major operation after all. Death caused by failed tracheotomy is often not due to surgical errors but to the cause - suffocation.
Therefore, it is always a bit novel that a failed gas cutter can be ranked in this position.
Damirgaon is a young man, even younger than Herman. After graduating from medical school with a master's degree, he did not choose to continue his studies and went directly to work in a small clinic. Because of the shortage of people, he went directly to the operating table as a chief surgeon as soon as he graduated, mainly doing work such as amputations and epidermal abscesses.
Last year, I finally completed five years as an surgeon, so I entered the College of Surgery on the recommendation of two teachers at the medical school.
It was a tentative submission, but unexpectedly, I received a reply from the dean of the college himself and was selected.
He was very excited and nervous. After hearing the host call his name, he quickly came on stage. He couldn't say a sentence clearly and incoherently: "I'm sorry, I really... I went a little too far. I’m so excited. I didn’t expect to be able to talk about this surgery for teachers, some of whom are my teachers’ teachers.”
The duration of the operation was really short, but under Damirgaon’s intermittent description, the three minutes was stretched to twenty minutes: “The patient came to my clinic in early February, emm, probably in mid-to-early February. A A very small clinic, left by my father, just east of the city."
The patient was a young man of about 20 years old, a leatherworker, who was very ill.
Before going to the clinic, I had been suffering from fever for nearly a week, with cough and sputum production. I had been prescribed medicine before but it had no effect. As a result, my cough worsened three days ago and I began to have difficulty breathing, which became more and more serious.
Based on Damirgaon's description of the symptoms, Kavi guessed that this was a case of severe pneumonia. In the era before antibiotics, once the body could not suppress the infection, death was imminent.
"It was very difficult for him to breathe, and in the end he couldn't even cough." Damirgaon shook his head helplessly, "I prescribed him a large amount of crow's tincture mixed with honey, but there was no improvement. "My breathing is getting worse and worse, and I can tell without using a stethoscope."
The audience had been waiting for the key points of the report, but the lengthy prelude made them lose patience.
However, just when they thought this was just a grounding operation without much nutrition, Kawei kept nodding. Because compared to others, Damirgaon may not have very good skills and may seem verbose in his speech, but he is very careful in describing the medical history. At least there is a complete logical chain to explain the patient's onset and the reason why he finally chose to have a tracheostomy. .
Poor breathing is an opportunity for tracheotomy, and the cause of poor breathing should be thick phlegm and scab blocking the throat and trachea.
According to modern medical procedures, a basic diagnosis should be made by taking a radiograph first, and then using a fiberoptic bronchoscope to check the condition of the trachea and bronchi.
If there is phlegm scab and blood stasis, the phlegm scab must be sucked out. If you still have difficulty breathing after suctioning, you can consider that there is obstruction in the throat or phlegm. After consulting with the ear, nose and throat, decide whether to use tracheotomy, an invasive relief method.
But he didn’t have any of the above instruments, and he didn’t know enough about sputum. Medical thinking, examination and treatment plans were still a long straight line without any branches in Damirgang’s mind.
Since the patient cannot breathe, it is very simple to cut the trachea first.
Naturally, the surgery was a mess. Even though he spent a lot of time describing the details, the audience was really not interested. If the result was only the death of the patient, then these surgeons, who had long been used to life and death, would have waited for Ignatz's inguinal hernia without any trouble.
"After I made the incision, I separated the subcutaneous tissue, and I encountered some trouble when I stabbed it down with the knife. Maybe I couldn't control the strength of the blade, and I couldn't hold back when the feeling of failure occurred." Damirgang smiled awkwardly. He smiled and said, "It seems that the knife cut the back wall of the trachea, and also cut the esophagus afterwards."
"Okay, we all know the result."
The host looked at the time and politely asked him to step down, but the development of the matter was not that simple.
What really needs to be shown to the public about this failed tracheostomy is not the cause of the patient's illness, nor Damirgaon's surgical skills, nor a discussion of the patient's cause of death, but the next sentence:
"I knew the tracheotomy must have failed after this incision, but what shocked me even more was that the patient, who was originally very thin, suddenly swelled up. Especially his face and neck, which were as swollen as a pig's head."
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