If we look at infection from a macro perspective, it is an endless bloody battle between the human immune system and the army of microorganisms. Every immune cell and every complement protein is fighting for this war, and microorganisms will fight to the death to capture the human body.
As Kawei's first cesarean section mother and his first surgical patient, Nora enjoyed the benefits of preoperative disinfection. After the operation, her incision was very clean, with only a slight redness and swelling that was suppressed by her body's immunity.
There are many factors that influence the outcome of perioperative infection.
That Nola had such an ending was related to the surgical operation. The operation time was very short, and there was not much bleeding during the operation. There were twists and turns during the operation, but they were all under Kawei's control. The smooth operation + disinfection + Nola's body was healthy enough, which resulted in an infection-free incision.
In comparison, the peasant woman's situation was completely different.
First of all, the peasant woman gained weight after pregnancy and became obviously obese. The abdomen where the incision was made was the hardest hit area for fat accumulation. As long as there is a little bit of infection, fat liquefaction will definitely occur after this kind of abdominal surgery. 1】
Secondly, the trauma of this operation was much greater than that of Nora, the abdominal incision was large enough, and the operation time was also long. Not only was the ureter broken during the operation, the bladder was ruptured, and the fracture after hysterectomy was still connected to the yd.
The most important thing is that there is also a lot of bleeding.
Although the blood was re-entered into her body through the rubber tube, it could bring back some bacterial microorganisms after staying outside the body for a while.
Moreover, a large amount of blood loss is a real loss of immune cells, which can be refilled through manufacturing in the future. However, it is only the first day after the operation, and it happens to be stuck in the window period, and infection should appear.
Based on her chronic gynecological disease, even if there were preoperative disinfection and clean rubber gloves, and the cross-section was cleaned during the operation, the surgical incision should not be so clean. After all, this is a dirty surgical theater, and the doctors around the operating table are not wearing masks.
It's not that Kawei didn't believe Orgi's judgment, but he didn't believe his eyes. He couldn't even trust his own eyes 100%.
On the first day after surgery, it has been less than 24 hours since microorganisms invaded the body. If there is an infection, it has just begun and is not serious enough to be visible on the surface of the body. Maybe the infection is hidden in deeper tissues and just doesn't show up.
At this time, you need to gently squeeze the skin around the incision to see if there is any leakage under the tissue...
......Nothing at all.
Kawei pressed the skin, and his fingers only felt the negative pressure drainage tube hidden under the skin, and there was no soft feeling after infection.
What's going on? ? ?
"She urinates smoothly and there seems to be no sign of urine leakage from her abdominal cavity..."
Orji thought that Kavi came here because he was concerned about whether the ureter was being sutured smoothly. After all, there was a metal tube stuck in it, which would make anyone nervous for a while. But Kawei only thought about the incision, as if there was no chance of failure in ureteral suturing: "Dr. Kawei, what's wrong with you?"
"Oh, it's nothing." Kawei glanced at the peasant woman who was in good condition again and asked Orji, "I want to see her medical records."
"Medical records, go and get the medical records."
It was Kavi who saved him from serious injuries, and it was Kavi who saved him from the operation that was about to fail. Orji had no airs as a director in front of him. Publicly and privately, he hopes to find the key to success from Kawei: "Remember to bring her previous medical records from the gynecology department."
Kawei's judgment was not wrong. Three years ago, the peasant woman suffered from many symptoms of gynecological infection: lower abdominal distension, pain, itching, and increased secretions.
The doctor prescribed herbal medicine, vegetable juice and intermittent hydrotherapy2], but perhaps due to problems with the method of use or lack of religious faith, the peasant woman's inflammation was not cured.
Seeing this, Kawei couldn't help but sigh. It can be said that such a reproductive organ did not cause the fetus to abort. It can be said to be lucky, but it can be said to be a miracle that the fetal membranes did not even rupture before the operation. 3]
"Dr. Carvey, is there anything wrong with her medical records?"
Of course there are questions, lots of questions! Even in his eyes, this simple diagnosis and treatment record is not a medical record at all.
Kawei smiled and shook his head: "No problem."
"She is seeing a well-known gynecologist in our hospital." Orji explained. "Maybe the treatment methods prescribed will have certain differences in effectiveness, but his diagnostic ability is first-rate, and the conclusion will definitely not be wrong."
"So it was caused by her disorderly life?"
Orji nodded, and at the same time, he led Kaweila into the corridor and whispered: "Although the patient has always denied that this happened, who knows what the truth is. The newborn child is not very similar to her husband."
The label of "improper living" does carry a heavy weight and is a stain on any woman's chastity.
But Kawei had no intention or energy to change the diagnosis conclusion, because the gynecologist's judgment about "infection" was correct. It was indeed some "harmful substance" in the environment that invaded the peasant woman's body and produced these symptoms.
What he wants to know most now is the reason why the infection did not affect the surgical incision: "Her condition did not improve before the operation?"
"Always like this."
"Doesn't that mean these treatments are ineffective for her?"
"It can't be said to be ineffective." Orji explained, "At least she survived until she became pregnant and gave birth to a child. At least she survived until now without further deterioration. Based on my own experience, her body is recovering."
After listening to this, Kawei didn't know what to say, so he could only continue to move the topic to another surgical incision: "By the way, how are the sutures in the vagina?"
"The stump is pretty good too."
"Not even there..."
Kawei fell into deep thought and couldn't figure out why this happened.
Having handled so many cesarean sections, Kawei also had some understanding of the physical conditions of these poor women.
If the peasant woman, like Nora, had a good body and could fight infection, then the pelvic infection should not have persisted until now, and she would have returned to normal long ago. But if the body's resistance is worse than Nora's, then the surgical incision will not be so beautiful.
These two items are contradictory in themselves. What is the problem? ? ?
Kawei pointed to the signature on the medical record and said, "Dr. Orji, if possible, I would like to meet this gynecologist."
...
The infection cannot disappear for no reason. Kawei did not use any special means during the operation, and the preoperative disinfection was limited to the body surface, so the problem should have occurred before the operation. However, Kawei didn't see any problems in the medical records, so now he can only ask about the formula of those herbal medicines.
"Herbal medicine?" The gynecologist named Besim was making a special pessary for uterine prolapse in his office. "The one you asked about was bought from a medicine shop. It's nothing special."
"What specific drugs were put in?"
Seeing that he was a colleague and the person brought by Orgi, he was not shy about the effect of the herbal medicine itself: "I don't know how to make it, but the ingredients should be marigolds, burdock and some plantains, I remember That's probably it. As for whether they added any ingredients to it, I don't know.
Anyway, many patients find it effective after taking it, as long as the patients find it effective. "
"Can it really be effective?"
"Of course, some patients with lower abdominal pain can be cured by drinking three bottles, and some patients with increased secretions can also be cured..." Besim's affirmative tone was high and low, and soon softened, "But the medicine is Things still depend on the person, and for some patients it’s not so effective.”
Kawei looked at the small medicine bottle he handed over, which contained a slightly orange-red medicine. His intuition told him that the color was not simple: "Can I buy a bottle?"
"Just pay, 3 crowns a bottle." Besim suddenly thought of something, raised his head and asked, "By the way, where are you a doctor? Why are you so interested in gynecological drugs?"
"He is Dr. Carvey, Dr. Carvey Hines." Orji introduced with a smile, "The Department of Gynecology and Obstetrics is a family. You should have read the reports."
"Oh, it's Dr. Kawei." Besim put down the tools in his hands and stood up to shake hands. "People around you say you are very young. I didn't expect you to be so young when I saw you today. It's really good for you to be skilled in cesarean section at such a young age. It’s rare, in comparison, my student is far behind.”
Perhaps due to his misconceptions about gynecology, Besim still classified gynecology into the category of internal medicine, and diagnosis and treatment were still based on medication and some strange therapies.
On the contrary, the student he was talking about had already thought of using surgical methods to treat some gynecological diseases that could not be cured by medicine.
"This kid Denev likes to do some novel things. He has just graduated from medical school and has not learned any solid basic medical knowledge..."
Orji was impressed by this young gynecologist: "You mean that Belgian guy? I still remember him. A week ago, he came to me specifically to ask some questions about the anatomy of the uterus, saying that surgery was needed to remove it. Treating Uterine Prolapse.”
Besim sighed and shook his head: "When I heard this idea, I thought it was strange, so I didn't agree to it."
"Haha, no wonder he came to me for an opportunity to dissect the corpse, saying that he would only touch the uterus and not other organs." Orji had a good impression of him, "If he hadn't been preparing for a cesarean section, maybe I really gave the body to him."
"It made you laugh."
"I heard that his academic performance has always been good and he also loves gynecology. He will definitely become a good doctor."
"Well, I hope so. In fact, if no one wanted to do gynecology, I wouldn't have recruited him as a student..."
Strictly speaking, Denev and Berget are graduates of the same class. They have followed Bessim to study gynecology since their master's degree. The most studied topic during their doctoral stage is uterine prolapse. This may not be common in modern times, but it was a common disease in the 19th century. 4]
The solution is nothing more than to make a pessary to support the sagging uterus. The effect is limited, but at least it can prevent the cervix from being exposed.
Bessim was willing to comply with this concept of treatment, but in Deneve's eyes, it treated the symptoms rather than the cause. Looking at the women in the ward suffering from uterine prolapse, he was eager to find a good solution once and for all.
It must be said that he has a good surgical thinking. Since medication cannot cure it and the pessary can only delay the development of symptoms, let's start with the anatomy. He found that it might be the loosening of the broad ligaments on both sides of the uterus that caused uterine prolapse. If part of the loose broad ligaments were cut off, it might be possible to lift the sagging uterus up again.
After having this wild idea, Deneve was thinking about this operation.
This idea took shape during the doctoral stage and was opposed by almost all gynecologists, including my own teachers. But these objections failed to dispel his idea. Finally, after watching Kawei's cesarean section, he was determined to take action.
Besim raised his head and looked at the time: "It just so happens that you two are here today. Do you want to go and see his surgery together?"
"Surgery? What surgery?"
"Uterine Prolapse Repair."
"What? Doctor Besim, are you kidding? Did you really ask him to undergo surgery?" Orji smiled and praised, but at this moment he definitely felt inappropriate, "Surgery is not a joke. , every surgeon needs to undergo long-term and arduous training, not to mention that this is a complex laparotomy."
"I know......"
"Didn't you just say you didn't agree? Why did you agree again?"
"He has practiced it on sows more than a dozen times, and he has also had two opportunities to perform dissection operations on cadavers, and the results have been pretty good."
These are just Besim’s excuses. The real reason is that Denev’s determination also inspired his desire to cure the disease: “He has been discussing with me the possibility of surgical treatment of uterine prolapse since he graduated. Sex, and spending so much time practicing, as a teacher, there is no way I could dissuade him from his enthusiasm.”
"An anatomy is an anatomy and an operation is an operation. This is different."
When Orgi saw him looking at Kavi, he immediately said: "No, Dr. Bessim, Kavi is different. It will be difficult for the whole of Austria, and perhaps the whole of Europe, to have such a surgical genius again."
Besim has made up his mind. As the chief doctor of the gynecological ward, he has the right to make this decision.
He looked at Kawei and Orji and knew that the opportunity was rare: "Both doctors have successfully performed cesarean sections and are very familiar with the anatomy around the uterus and appendages. If possible, I would like to invite you two to watch this treatment." Broad ligament shortening for uterine prolapse.”
