Humans are not machines and will have many shortcomings. If the surgeon wants to have machine-like precision, he must make up for it with years of proficiency.
People are not machines, and they also have many advantages. There are quite a lot of emergencies encountered during surgery. In addition, every patient is different. The various critical treatments brought about by each indicator require the cooperation of the surgical team. and the surgeon’s decision-making ability.
Where did these things come from?
Of course, it is a result of continuous practice in surgery.
Modern surgical medicine has a relatively complete training system, starting from medical student internship, entering regular training, then specialized training, and then officially joining the surgical team, and finally becoming the real chief surgeon.
"First Evolution"
The actual results are definitely different, but the written regulations are the same, and each step has a set goal. When completing these plans, senior doctors will always be with you to help guide and teach. 【1】
This is just a single training line for the growth of a specialist surgeon, used to train existing or mature basic techniques and surgical procedures.
When a certain surgeon wants to try some new surgical methods on the same type of patients, he needs to learn through surgical videos and mutual communication before carrying out the surgery.
If he wants to enter this kind of experiment into a new field, watching videos and simple verbal communication alone may not be enough to give the doctor the confidence to operate. At this time, further study is often required to increase clinical experience.
Lower-level hospitals go to higher-level hospitals for further training, and higher-level hospitals go to hospitals that have developed these new surgical techniques and new fields for further training. Of course, there are also those who are bold enough to come to power without further study. They know all the theoretical knowledge and have sufficient professional titles, but the work they do is messy. This falls into the category of irresponsible messing up.
Orji certainly can't be called a loser. He came on stage just over half a month after being stabbed and shot, which already shows that his goal is to complete the cesarean section as soon as possible. Hills cannot be called a loser. Being able to get rid of Ignatz and start over in another hospital also shows that his goal is to prove his strength as an independent surgeon.
These are all primary causes, but the secondary causes cannot escape the word "name".
They need this "name" to rectify their reputation and at the same time attract a lot of business for the hospital, and patients are the tools for becoming famous. If it fails, sacrifice it and replace it with the next one.
This practice was common in the disorganized medical environment of the 19th century, and was actually what Ignatz and Waterman did. It's just that they had a slot behind them as assistants and the operation went smoothly, but the two at Graz Hospital didn't and the operation failed.
This time Kawei also imagined to follow the example and teach everyone he could.
But because of his "fame", Orgi could not put down his decades of experience and status and humbly go to Kawei for so-called "further training". Even if Kawei gave up his position as the surgeon, he still felt awkward having to follow the opponent's requirements for every step.
It took a lot of effort for Hills to get to his current position. If Kavi were to step in, he would be forced to the second assistant position again, which would be even more disgusting than turning back.
The above is the pressure from the hospital, and the bottom is the inner persistence of the two. It is not difficult to understand that such a result was obtained.
Kawei also knows the feeling of being inferior to others, and forcing him to persuade someone at this time will definitely have the opposite effect, and may even cause him to get angry. Since others were resolute, he could only sit in the audience and watch slowly, taking the opportunity to collect more operational errors.
After the operation is completed, they will be written into the surgical key points of cesarean section, thereby changing the current situation of high mortality rate of cesarean section.
...
Cesarean section is originally a very lucrative program. The process is complicated and dangerous. The operation process is fast in and out, and there is no sloppiness at all. After being set by Kawei as a benchmark, it could have brought more audiences, but the Municipal General Hospital suddenly came to drain the fire, and the theater had no choice but to let go.
I thought I could maintain the original market with confidence, but with this incoming and outgoing, not only the income is lost, but also the audience who come for cesarean section. It was also a cesarean section. The theater at the city's general hospital was packed with people, but it was much deserted here.
At four o'clock, the host arrived on time.
"Emmm... It seems that there are no ladies here. Good afternoon, gentlemen. The one who will be performing on the stage today is Vienna's extremely famous elite surgical team."
The host was still wearing a dark red coat, dressing the doctors who were about to appear in a glamorous manner: "The team members are all from Graz Hospital, and they are all chief surgeons who can handle complex surgeries on their own. Today they gathered in nearly a hundred lamps Under the oil lamp, I once again challenged myself to perform a cesarean section that could only be accomplished with the gift of God.
The afterglow of Dr. Carvey has come to an end. Now the three doctors of Graze Hospital, Orji, Hills, and Lockard, will continue their glory. Let us invite three doctors to take the stage..."
The opening remarks were obviously designed, and not only did Carvey find them strange, but many viewers also found them strange. What does God’s gift mean? What is the end? What is continuation of glory?
It seems that every sentence says that Kawei got to where he is today by luck, but he has had 7 cesarean sections and none of them failed. According to what he said, doesn’t God have to live in his home every day?
Everyone came to see the surgery, and they didn't want to complain about a host because of Kawei. Besides, not many people in the audience remembered him.
The three doctors opened the door and walked into the venue one after another. Behind them was a small team of four people responsible for carrying surgical instruments and a lot of bottles and cans that needed to be used.
Orji walked to the audience and nodded slightly: "The patient undergoing surgery today is a 22-year-old peasant woman from the suburbs. She gave birth for the first time. Because she had obvious vaginal bleeding a month ago, we concluded that she had previa. The placenta requires surgery to remove the fetus.
Two days ago, her vaginal bleeding increased significantly, so the hospital sent a special car to bring her to Graz Hospital for surgery..."
While talking, two nurses from the theater pushed the mother into the theater.
Just like Kawei at that time, the mother had a hanging bottle on her hand, which had been filled with 500ml of normal saline. The operating table was also set by Orgi so that the head was high and the feet were low to prepare for possible heavy bleeding during the operation.
These were all done well, the only difference was the people gathered around the operating table.
For a country girl who came to the city for the first time, the spiraling surgical theater in front of her, more than thirty uniformly dressed gentlemen in black coats, and the smell of disinfectant on the tip of her nose made her quite nervous.
"The operation will be over soon." Olgi opened his mouth to attract her attention, and said to her with a smile, "It feels like I just slept for a while. When I wake up, I can see the child. There is nothing to be nervous about."
The woman touched her belly with one hand and held Orgi's hand with the other. She nodded slightly: "You promised me that you would be able to keep the child?!"
"I swear, I can definitely do it..."
Orji comforted her and began to introduce the preparations before the operation: "This time we still adhere to the disinfection standards advocated by Dr. Kawei. We first treated her abdominal skin with carbolic acid and alcohol, and used disinfectant to clean the rubber on our hands. Gloves before proceeding with the surgical procedure.”
Orgi looked at the nurse on the side. The black mask covered the peasant woman's mouth and nose. The slowly spreading ether vapor penetrated into the respiratory tract through the rubber tube, and then dispersed into the blood. The anesthesia soon began to react. First she coughed, then her saliva increased. The peasant woman began to swallow non-stop, and then she began to vomit slightly.
"Bring me a towel." Orgi tilted her head to the side. "These are all side effects of ether anesthesia. Just bear with it and it will be fine soon. It will be fine. It will be fine..."
The nurse patted the peasant woman's face gently: "The ether is working."
"The disinfection here has also been completed."
Orji glanced at Kawei in the audience and put on gloves: "The operation starts now, scalpel."
Considering that the peasant woman had placenta previa, the surgical incision was not the subabdominal incision that Kawei had been using for the next few games, but the earliest transrectus abdominis incision was used to enter the abdominal cavity. After all, Orji had decades of clinical experience and sophisticated techniques. Judging from the color of the gauze, there was not much bleeding into the abdominal cavity.
"By cutting open the peritoneum, we entered..."
Only half of the words were spoken when the scene in the abdominal cavity in front of Orgi forced him to swallow the last tail: "If I read correctly, this should be the placenta that Dr. Kawei encountered last time. Implant it.”
It was still the familiar large group of red and black blood vessels, intricately covered on the uterine wall.
"The range is 5*6, maybe even bigger than that day." Orji roughly measured the implantation range with his fingers, and then said, "Take the blocking tape."
A gauze strip 3cm wide and half a meter long was placed on the lower segment of the uterus, and the uterine blood flow was blocked by ligation and compression. But these are definitely not enough. For blood transfusion, preparations must be made to collect blood: "The aspirator and blood collecting basin are ready, the jar is opened, and the anticoagulant is ready."
Lockard and another assistant were already ready on both sides of the operating table. As soon as the order was given, they would step forward to deal with the surging blood. The midwife on the other end is standing a little further away. As soon as she enters the uterus, she will step forward to help remove the fetus.
They have practiced this hundreds of times, and everyone is confident that they can do their job well.
But the patient's body is ever-changing, and the situation at the surgery site is also ever-changing. What they can really rely on, in addition to practice, is the decision-making power of the surgeon.
Orji's scalpel, just like Carvey's then, avoided the implantation area. In order to facilitate the removal of the fetus, he made a long vertical incision on the uterus, which reached directly to the fundus of the uterus and was more than 10cm long.
This was the first time for Kawei to watch someone else's cesarean section surgery from an audience's perspective.
Olgi was considered "obedient" and the disinfection and preparation work before entering the abdomen was done well, but the selection of the entry point into the uterus was a bit far-fetched. Kawei knew that he wanted to increase the error-tolerance rate of fetal removal, and he could also use this longitudinal incision to avoid the placenta being covered, or at least touch the edge of the placenta. Just peel it off to create enough space, without the need for direct incision. placenta.
This kind of long longitudinal incision also has disadvantages. The recovery is inherently poor, and there will be considerable risks if another pregnancy occurs in the future.
But what really makes Kawei feel strange is the peasant woman's placenta implantation.
The incidence of placenta accreta is not high, but two women with placenta accreta appeared one after another in just one month, which reminded Kawei of Brenda who had just been discharged from the hospital.
"It's bleeding, get the blood quickly!" A loud roar pulled Kawei out of his thoughts.
At this time Orgi's scalpel had cut open the uterus, and a large amount of amniotic fluid mixed with meconium and blood poured out of the uterus. Immediately after the fetal head was exposed, the midwife came forward, dug into the uterus with one hand, raised her head, and gently pulled with both hands: "The baby is out!"
There was a lot of applause on the field, which was an affirmation of the success of the first half of the operation.
What comes next is the truly thrilling time.
"I don't need this basin with amniotic fluid. Just change it to another basin to collect the blood." Olgi began to explore the inner wall of the uterus in his hand. "Here, give me gauze first. I want to do some compression."
"Give."
The yellow and white strip of cloth turned red soon after entering: "...Give me more gauze."
"..."
"Give me a little more, a little more!"
"..."
The gauze was continuously stuffed into the peasant woman's uterus, but the bleeding was still going on and showed no sign of abating.
Orgi knew that this was the limit, so he asked Lockard to find the oxytocin that had just been customized from the pharmaceutical factory: "A bottle of 50 kronor, a real life-saving drug that is more effective than the panacea in the drug store..." .Punch it all into the uterine muscle layer.”
One tube, two tubes, three tubes, oxytocin was continuously injected into the peasant woman's body, but the uterus remained motionless.
"placenta!"
Suddenly a voice suddenly sounded on the stage, and then quickly disappeared from everyone's ears. Orji realized that he had forgotten the important process of cesarean section. No matter what the situation was, the first step was to remove the fetus and the second was to remove the placenta. The next step to stop the bleeding could not be done until it was completely removed, because it could not be stopped at all.
"...To remove the placenta!"
Orji suppressed his competitiveness and relied on what was said on the stage just now: "How about swapping the positions of the operating table and collecting the blood from the blood basin?"
"Already almost 700ml."
Orgi slowly peeled off the placenta tissue implanted in the uterus with his hands, and said at the same time: "Get ready to start autologous blood transfusion."
There was no need for Orgi to explain the blood transfusion process. The two nurses had already performed blood anticoagulation and filtration according to the most standard methods. The infusion bottle on the side was also removed, ready to replace the original saline with fresh non-coagulable blood.
Perhaps Orji's handling was still a little rough, and perhaps the cooperation between the teams needed to be strengthened, but the operations on site seemed to be proceeding according to Kawi's previous pace.
Kavi also hopes that the operation will go smoothly, so that Vienna will have one more surgeon to handle cesarean sections, so that he will not become an "obstetrics master." I had so many cesarean sections that I actually vomited.
But the great God seems to be joking with everyone.
The work of removing the placenta has just come to an end and is about to enter the final sprint stage. Maybe Orgi was too excited, or maybe he was too focused on the peasant woman's blood loss. He used too much force on his fingers, and with a pop, he directly penetrated the uterine wall where the placenta was implanted too deeply.
