For the surgeon, the use of drugs means the anesthesia is complete.
But for anesthesiologists, the use of drugs means the beginning of anesthesia.
"Anesthesia" has been an accessory to surgery since its birth. It was not until the end of the 19th century that Britain began to divide medicine into disciplines. Anesthesia became an independent discipline, and there was a matching London Society of Anesthesiology.
But before that, anesthesia was a small component used during surgery to put patients to sleep.
In modern times, the anesthesiology department has developed rapidly (it is still quite miserable in China). Anesthesia has changed from pain relief at the beginning to intraoperative maintenance. The decision-making power of critical surgery has gently slipped from the palm of the surgeon's hand into the hands of the anesthesiologist. .
Surgery cannot be performed as long as anesthesia does not allow it.
But in the 19th century, when there were not so many things to pay attention to, anesthesia in people's minds had little to do with people. The key was the bottle of ether. As for who put the ether into the patient's body, it seems to make no difference.
Naturally, the surgeon cannot do such unskilled work.
As a result, anesthesia fell into the hands of assistants, nurses, and intern medical students. Amor, who works as assistant to Hills today, graduated from Innsbruck University Medical School and was asked to anesthetize a patient just two weeks after working.
[Here, give you ether and let Mr. Edward have a good sleep. ]
This is the "anesthesia instruction" that Amor received. There is no dosage, no duration, no need to monitor any vital signs, and no need to consider the patient's underlying disease. He only needs to adhere to one principle: falling asleep means the anesthesia is successful.
The anesthesia before the operation was completed beautifully. Edward felt a little nauseated and fell asleep immediately.
Ether works quickly but also loses its effectiveness quickly, and the patient wakes up in less than an hour.
The second anesthesia during the operation was inherently risky. Coupled with Amor's panic, the anesthesia did not go smoothly. But no one could say he didn't do a good job, because Edward did fall asleep again, and that was a success in their eyes.
"Teacher Hills..."
"Pull the hook. If you don't understand anything, wait until I close your belly."
Hills was immersed in the operation. After the initial stumbling, he felt that he had mastered the trick of cutting the meso omentum. The mesangial tissue at hand does not bleed much, and suturing and knotting are getting easier and easier. Sure enough, leaving the comfort zone is the right choice. Surgeons need to face crises independently in order to grow.
It may not have been a perfect operation, but it was enough to establish himself as Glaze's chief surgeon.
At least that's what Hills thinks now.
"But teacher, the patient..." Armor's words reached his throat, and he really didn't know how to describe Edward's current state.
"What's up with him?"
"His pulse seemed, like, gone."
"Gone?"
Hills finally put down the knife, looked away from the cut belly, and re-examined the patient's body.
Edward's face was sallow, his eyelids were closed tightly, and there was a trace of purple on his cheeks and lips. Except for the blood stains and pink foam remaining at the corner of the mouth, it was just like falling asleep after anesthesia before, and no other difference could be seen.
Hills glanced at his assistant, asked the nurse for a single-tube stethoscope and put it on his chest.
"————"
There was silence in my ears, not to mention my heartbeat, I couldn't even hear my breathing. Hills had realized the seriousness of the problem and carefully chose a new position to listen. There was still silence.
"————"
In the next half minute, the receiver was moved several times, and there was nothing in my ears except the sound of the receiver rubbing against my skin.
Only then did he accept the reality and had to walk to the side of the audience and said to everyone: "I have to announce to everyone an extremely sad news. Just now, my patient Edward Bracha Mr. Soder passed away."
There were a few more sighs at the scene.
"I survived the most complicated first hour of the operation and it was almost over, but I died in the final sprint."
"What a pity."
Hills was just a little depressed, obviously used to seeing patients who died suddenly on the operating table: "Mr. Edward had severe pulmonary symptoms, and the hemoptysis just now may be the straw that broke the camel's back. Unfortunately, we have lost him forever. An excellent tailor.”
The audience also bowed their heads to express their condolences symbolically.
"I wasn't able to save his life, but the surgery itself didn't fail."
Hills had no intention of leaving the operating table, nor did he announce the termination of the operation. The assistants still stood by his side: "Now I need to continue to complete this operation and leave something worth learning for those who come after me. I think Edward If Sir, if his soul has knowledge, he would also agree to what I do...Give me the scalpel."
Faced with these on-the-spot remarks, the audience still gave some sporadic applause. The patient's death does affect his mood, but this should not be a reason to blame Hills. At least he is still working hard to perform the operation.
Of course, there are quite a few people who are not so easy to fool, such as Varela, who cannot afford the front row fee and can only watch from a distance in the last row.
Having just watched a boring amputation, watching Hills' open abdominal exploration should have ignited some excitement. But after the operation started, he always felt that something was wrong. Anyway, he felt very uncomfortable.
After a while, he discovered that it was actually because he saw two surgeries in succession that he subconsciously compared them together.
Although Kawei's amputation is boring, the process is smooth and the blood vessels and muscles are handled neatly. After watching "quick suturing and ligation, suturing and ligation" for more than half an hour, when you look at Hills' surgery, your eyes will feel that there is disharmony everywhere.
Of course, he can't criticize everyone. Kawei's new genre is against surgical performance and must be stopped.
In his opinion, Hills' surgery was just like that, with nothing to praise or criticize. But now that the patient died suddenly, Varela seemed to have found a point of attack again: "Dr. Hills, your knife is indeed fast enough, but it's a pity that the suture and ligation speed is too slow."
Hills disagreed with this statement: "My speed is indeed incomparable to Professor Ignatz, but it should never be described as 'slow'."
Judging from the objective facts, Hills' speed is indeed not slow. The fact that he has performed abdominal "surgery" to this point already illustrates his ability. Although many of the treatments looked very rough, and there was almost no separation of blood vessels, which made Kawei want to curse when he saw it, but at least the result of the cutting was passable.
Of course, these comments are limited to pure surgical techniques, not surgery, because Kawei never considered it an operation from beginning to end.
Looking at the many doctors on the stage, not all of them could do what Hills did. Many of them did not even dare to open the patient's abdominal cavity. If we only look at technology, Hills can already reach the mid-level level of Vienna Surgery.
But Varela just wanted to say something to him: "Since it can't be described as 'slow', let me put it another way. It should be that the operation time was too long."
Hills clearly felt his malice and put down the scalpel again: "Mr. Varela, if there is really a problem with my operation, so many fellow doctors on the stage will definitely raise questions immediately. You don't need to say it." .”
"I remember what Dr. Carvey said just now."
"But after I explained, he stopped talking immediately."
"I'm just expressing my feelings from the perspective of an audience." Varela was unmoved and continued to turn on his poisonous tongue mode, "If Dr. Hills' hands can be faster, he can do it before the patient wakes up. After the operation is completed, I think Mr. Edward will not die on the operating table."
Hills made a prompt defense: "The patient's health condition is very poor, and sudden death is inevitable."
"What if there is no second anesthesia?"
"Anesthesia is safe, and ether is also safe. These have been proven through hundreds of operations. I don't need to say more."
Hills looked at the assistant in front of him and comforted: "Amor, don't listen to the rumors of some non-medical people. You don't need to be responsible for this. The patient's physical foundation is too poor and he will die at any time. This This is also the main reason why I want to actively undergo surgery.”
"So, it's still your problem."
Hills took a long breath and turned to follow the voice: "Please be careful with your words, Mr. Varela. Although the theater did not explicitly stipulate that no questions could be asked during the operation, it gave the surgeon the power to clear the theater. If I remember correctly, you had a taste of this not long ago.”
Varela immediately thought of the reason for his current downfall, couldn't help but glance at Kawei at the table, and finally closed his mouth.
"I'd like to reiterate again that anesthesia is safe, surgery is also safe, and most intraoperative deaths are caused by diseases." Hills continued to emphasize, "If you still have any objections, we can wait until the surgery is over to discuss it. Please ask now." Let me get this surgery done as quickly as possible."
The audience stopped talking. For the next 10 minutes, Hills focused entirely on the surgery, rarely opening his mouth to explain.
It wasn't until he removed all the mesentery and omentum that he announced the result of the operation: "After 1 hour and 23 minutes, this large and small omentum + mesentery + partial peritoneal resection operation was finally successful. But Mr. Edward couldn't help it. Enjoy this body no more, may his soul rest in peace." [1]
There is nothing wrong with these two sentences as a concluding statement after the operation.
But the word "success" is too harsh.
Kawei didn’t understand why the operation could be judged as a success even if the patient died. Where was the success?
Doesn't surgery depend on whether the patient lives or dies?
And what is the point of cutting off these tissues?
Failure to explore the intestinal tubes did not solve the patient's intestinal obstruction problem. Because without the mesenteric omentum, intestinal obstruction caused by mutual adhesion between the intestinal tubes after surgery will only become more serious...
Looking at the entire operation, there are flaws everywhere, and I can't even find any single redeeming feature.
"What's wrong with you?" Ignatz noticed something strange about Kawei.
"Well, it's nothing." Kawei smiled and said, "I just feel a little uncomfortable."
Everyone is a doctor, so Ignatz didn't have much to ask: "You've been really busy recently, why don't you go back and take a rest?"
Kawei nodded: "It is indeed time to take a rest. I would like to take half a day off to check on Mr. Liben first. Then I will take Savarin's experimental report and go to Mr. Laszlo's home."
"I'll let you go home and rest."
"Don't worry, I'll go home after delivering the report."
...
The modern surgical process is a carefully planned hunt.
The launch time of the operation, the location of the battle, and the hunting target all need to be clear. How to conduct a frontal charge during the operation, how to cut off the enemy's retreat on the flanks, how to prevent fish from slipping through the net, and how to clean the battlefield are all planned before the war begins.
All aspects must be considered during the entire process, and corresponding remedial measures must be prepared. Any uncertain factors that may cause accidents should be nipped in the bud. To deal with each disease, surgery has its own treatment routines, and these routines are summarized by thousands of surgeons over decades.
With such complete preoperative preparation, as long as the doctor in front of the operating table has qualified skills and memorized all the routines, all that is left to do is to do everything in his power and obey fate.
However, this era lacks medical theory, practice, and surgical instruments, and surgeons can do very little.
Kawei really wanted to scold Hills in the audience. Even if he was kicked out, he would at least feel calm.
But he didn't do this because he knew that doing so would have no benefit except to offend Hills and lower the audience's favorability.
No one can prove that tuberculous peritonitis should be treated according to Carvey's method, and no one can prove that the patient died of double aspiration after vomiting under anesthesia and hemoptysis, and no one can prove that this disease with a stomach full of white nodules is It's called tuberculous peritonitis.
Sitting in the carriage, Kawei was still thinking about the surgery just now: "The technique and purpose of the surgery are secondary. The most important thing is to propose the concept of anti-infection. We must publish the paper on incision infection in our hands as soon as possible." When you go out, Quan can be used as a stepping stone."
This paper uses body temperature as the main perspective and introduces the infection conditions of several patients in detail. Among them, Li Ben is listed as the main research subject.
Infection is a very broad concept, which needs to be closely linked to three basic themes: symptoms, causes, and prevention and treatment.
The symptoms are very common tissue inflammation and ulceration. This has been described in detail in medical books, but it is not linked to microorganisms. But doctors often forget about another symptom, elevated body temperature.
After satisfying the two symptoms of inflammation and body temperature, Kawei decided to focus on explaining the cause, that is, microorganisms, and then used disinfection during surgery to explain how to prevent infection.
As for treatment…
At this time, the coachman's voice came from the window: "Mr. Carvey, Laszlo Manor has arrived."
