Such a patient who is highly suspected of breast cancer has persistent severe headaches. During hospitalization, he also suffered an upper limb fracture on the same side as the tumor and multiple epilepsy. Most doctors' diagnosis will be biased towards brain metastasis + bone metastasis from breast cancer. Also definitely do a head CT + fracture site radiograph as soon as possible.
The role of examination is nothing more than to confirm the diagnosis and provide an indication basis for subsequent treatment.
Once the diagnosis is made, the next step is to establish a more grueling treatment plan. Local surgery, systemic chemotherapy, localized radiotherapy, palliative care that only considers the quality of life, giving up completely after considering money, or deciding to take a gamble and find another way.
Although modern medicine is far from a perfect cure in the face of cancer, fortunately, every patient and family can make their own choices, and the risks they face, the money they spend, and the possible outcomes are all acceptable. foreseen in advance.
But in the 19th century, patients faced the unknown.
First, the condition is unknown.
Diagnosis in the 19th century did not have an objective standard or even a theoretical basis. It relied entirely on the doctor's experience. Regarding the king of diseases, tumor, medicine in ancient times only knew its harm and lacked vigilance against tumor metastasis.
Therefore, based on Massimov's decades of medical experience, the cause of Mrs. Santini's upper limb fracture was a simple fall. Based on Ed Nelson's decades of medical experience, such stubborn severe headaches should be caused by evil spirits.
Second, the treatment they need to face is unknown.
Patients can almost only passively accept the doctor's advice. They and their family members can only answer right and wrong questions, rather than multiple-choice questions after weighing the pros and cons like modern medicine. True or false questions determine not only the execution of treatment, but also the patient's stay and prognosis.
The pain in the early stage of breast cancer is tolerable, so the patient chooses to ignore it, and the result is spread + metastasis.
Because the headache is intolerable, the patient can only accept treatment unconditionally in order to relieve the pain. The result is that the more treatment is given, the more outrageous the treatment becomes.
Ultimately, the prognosis for all treatments is unknown.
The treatments chosen by doctors are, in their opinion, the most suitable for the patient's current condition, with no adverse reactions or complications. This is not an unintentional statement, because this is the kind of education they receive in class, and most doctors also believe it.
Of course, the above three points all require a foundation, which is the foundation for which medical theoretical knowledge is extremely lacking. If the ability is not enough, no matter how much we talk about the system, it will be in vain.
But when it comes to the heights of Massimov and Ed Nelson, years of experience will bring them some doubts after colliding with reality.
For example, Massimov once questioned whether his surgical ability could really solve Mrs. Santini's already swollen breast cancer. For example, now Ed Nelson has also begun to question whether Mariana's seances and exorcisms are really capable of eliminating diseases and evil spirits.
However, due to Mariana's identity and her own cultivation, his words were extremely restrained: "It's really rare for severe epilepsy to occur during magic treatment."
"There's definitely no problem with the enchantment, and there's no problem with the altar. I've arranged it according to standard "Biblical Magic."
Mariana sat in the physician's office, holding Buster in her arms: "It's even less likely that Buster will have a problem. His psychic ability is impeccable and has even been recognized by the Pope. Although the Pope himself Don't like cats, but Buster is special..."
At this point, Ed Nelson raised his eyebrows: "Judging from the symptoms, her epilepsy seems more like a backlash. Maybe our exorcism technique is too strong and stimulates it."
"Maybe."
Mariana was also startled by Mrs. Santini's strange reaction just now, and subconsciously stroked Buster's hair to relieve the pressure: "How is Mrs. Santini now? The reaction just now was really terrible."
"The convulsions are over, but the headache is still there."
"Well, if possible, I really hope that I can carry out the remaining exorcisms..."
If something like this happens halfway through exorcism, even if the patient has faith, he will still doubt the feasibility of exorcism, or at least question Marianne's level like Ed Nelson did. Mariana also knew that she had no chance, so these could only be self-comforts afterwards: "She will get better, right?"
"We will do our best." Ed Nelson nodded and leaned forward and said, "Countess, I need to see my patient now..."
Mariana said straight away: "Go ahead, I won't disturb you anymore."
"Let me call you a carriage."
"No need to bother, Nora is here." Mariana carried Buster and walked to the door. "If possible, please tell me the follow-up situation when the treatment is over."
"must."
...
At this time, Kavi and Massimov were standing in the internal medicine ward, in front of them were busy physicians and nurses.
The internal medicine department was still confused about Mrs. Santini's illness, and everyone thought it was the spirit of an octopus in the deep dark sea that was causing trouble. But as surgeons who believe more in the reality before them, the views of the old man and the young man next to the door are basically consistent.
It's just that this "consistency" contains too many traces of Kawei's guidance.
"The tumor metastasis you are talking about...is it metastasis along the lymphatic channels?"
"In addition to lymphatic channels, there are also blood vessels in the body," Kawei said.
Massimov took a breath, lowered his head and thought deeply for a moment: "Tumors need blood supply to begin with. If you think about it this way, it is not impossible, but can such a huge tumor really metastasize to such a distant place?"
"Breast cancer on the left side, fracture of the left upper limb, and the location of the headache is also close to the left side. This can't be considered far away."
"What? The fracture site is also a tumor?" This surprised Massimov. "I checked, and the symptoms look like ordinary fractures."
"The patient is only in his 30s, and he just fell on the ground, so the probability of fracture is not high." Kawei explained, "Even if there is a fracture, it should be in the thinner forearm, not the thicker back arm. Unless it is normal. The bones have been damaged to a certain extent, and this damage increases the fragility of the bones, eventually leading to fractures."
Overall, Massimov still trusts Kavi.
But trust is more based on surgery. For example, in abdominal surgery and breast surgery, Kawei has made a big name in the Austrian surgical community. Massimov almost looks at the young man in front of him as an equal. people.
But in terms of medical theory, the old man was very cautious.
If he really wanted to believe Kawei, his attitude toward intracranial and skeletal tumors should be the same as breast cancer, requiring active surgical treatment. But now Massimov just stood by the door, looking at Mrs. Santini lying on the bed in the distance, saying nothing.
"Teacher, do you think my opinion is flawed?"
Massimov shook his head: "On the contrary, the theory you mentioned is logically consistent."
"The tumor has developed to this point, and we can't delay it any longer." Carvey suggested. "The patient should be sent to the surgical ward immediately, and the surgery should take over with full authority, and then formulate a surgical plan suitable for the patient. Even if it cannot be completely removed, The tumor should also make Mrs. Santini’s life easier.”
"I only say that the logic is self-consistent, but there is still no theoretical proof."
"Do we have to wait until Mrs. Santini's death to do an autopsy and then compare the cell structure under the microscope to prove the theory?" Kawei shook his head repeatedly, "How can surgical treatment be restricted by such a thing?"
"But the patient is not mine." Massimov said the key point, "You can't even convince me, how can you convince Ed Nelson?"
Kawei realized that the root of the problem still lay in the insufficient foundation of medical theory. Nowadays, the knowledge of cell biology, physiology, and pathology is still too shallow and has no systematic structure. Even if you learn them all, it will give people a hazy feeling.
In order to get the old man in front of him to agree to ask Ed Nelson for an operation, he had to explain his "theory" more thoroughly.
"Actually, this is the same as the colonization of certain robber countries, such as France, which prides itself on being romantic, and Britain, where the streets are full of gentlemen." Kawei said, "They send colonial troops all over the world, and only a small number of people can do it. After a few years a large colony developed.”
The explanation was so straightforward that it was impossible for Massimov not to understand: "You mean that after a small part of the tumor tissue fell off, it went along the pipeline and re-grew a new tumor elsewhere... ..”
After the theory is updated, clinical thinking always needs to do some adaptation work.
Although Massimov felt that Carvey's theory was worthy of belief, he was still struggling with the name and origin of the tumor because the location and symptoms of the tumor were different. Intracranial tumors present with headaches and seizures, tumors on the bones present with increased bone fragility, and breast cancer itself is just swelling and stinging.
Is it inappropriate to use the same name to represent three tumors?
"Teacher should look at the other side of the ocean. The Americas that were originally occupied by Britain and France have developed into the United States after driving out the indigenous people who originally lived there."
Massimov's thoughts suddenly became clear: "So that's it..."
At this time, Ed Nelson's voice came from the distance. After sending Mariana away, he went straight to the ward, hoping to see Mrs. Santini's condition: "The seance is over, why haven't you two left yet?" ?”
"We were discussing the condition."
"Such a stubborn and severe headache is really troublesome." Ed Nelson said helplessly. "Coupled with the failure to exorcise the evil just now, I am afraid it is impossible to completely cure it."
"Have the teacher considered changing the treatment method?"
"I have tried many different methods, but the results are all average." Ed Nelson did not lose confidence in treatment, and vaguely demonstrated his right to treat the patient, "But don't worry, I already have a treatment strategy that matches his symptoms. "
"What treatment?"
"At first we applied to the hospital to purchase an electric current bathtub to treat some refractory skin diseases, muscle pain and mental disorders," Ed Nelson said. "But later the application was shelved due to funding reasons."
Massimov sneered at this: "Come on, do you think that the life of a shoemaker's wife can make the dean spend a lot of money to purchase this expensive machine?"
"Of course I won't buy it."
Ed Nelson knows the dean very well: "But if the treatment is really effective, then Mrs. Santini can be strong evidence. Even if the dean continues to refuse, he owes me a favor and can apply for other devices later." When the time comes, he might allow it to pass out of consideration."
"But the question is, how do you subject her to an electric bath?"
"There is a resort in the suburbs. There are two machines there, and the business is quite good." Ed Nelson said with a smile, "I will take the patient there for treatment tomorrow. If nothing else happens, Mrs. Santini will recover that night." Home."
Seeing that the patient was about to fall into his palm again, Kawei wanted to struggle again: "But the patient has already received electric shock treatment, and the effect is not good."
"That's just a local electric shock. It doesn't stimulate the whole body like a current bathtub." Ed Nelson explained, "It's a weak electric current that can relax the whole body. Compared with ordinary electric shocks,"
At this point, there seems to be no room for further suggestions.
But Kawei did not choose to give up like Massimov, but wanted to struggle again: "Judging from the reaction just now, the evil spirit in the patient's skull seems to have been stimulated by exorcism, and this overreaction caused Epilepsy."
Massimov: Why did the tumor we just mentioned turn into an evil spirit again? ? ?
Ed Nelson: You actually have the same opinion as me? ? ?
Facing different people, Kawei chose completely different explanation routes in order to achieve the purpose of surgical treatment. Massimov can still take the orthodox medical route, but for Ed Nelson, he can only choose theology: "I think the evil spirit just wants to come out and breathe."
"...It's interesting, keep talking!"
"The skull is closed and filled with soft and waxy brain tissue. There is no room for it to survive."
Kawei tried to conflate the theology and medicine that had been separated again: "It's like a small room without doors or windows. Not only is the space small, but there is no light. If you stay in it for a long time, you will definitely go crazy. If you go inside again at this time, If you pour some messy things into it, people will resist. It is this repeated resistance that causes headaches."
Massimov: What are you talking about? ? ?
Ed Nelson: That makes sense!
!
"This is similar to the idea of ancient Roman medicine." Ed Nelson pondered for a moment and asked, "Do you think the electric bath will continue to stimulate it and cause more severe headaches?"
"This is indeed the case based on the previous course of the disease."
"Then what do you think should be done?"
"As the teacher just said, according to the ancient practice, Mrs. Santini's head should be drilled open to open a window for ventilation in the room that has been closed for a long time." Kawei said, "But the original skull drilling technique is too crude. , my plan will go further than the original one.”
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