In the eyes of outsiders, surgery may be a discipline that can easily cure diseases, but only after you truly enter this field can you realize the powerlessness involved.
Even in modern times, with a large number of medical equipment and drugs, there are not many surgeries that can truly make patients feel rejuvenated.
Many surgical options will bring inconvenience to patients' lives, and some will cause many complications, such as infection, bleeding, organ perforation, weakened function, etc... The reason why they are called complications means that This is a postoperative condition that has little to do with the surgeon.
Perhaps superb surgical techniques can reduce the chance of occurrence, but they cannot really reduce it to 0.
All the doctor can do is try to avoid risks before or during the operation. The ventriculoperitoneal shunt that needs to be done now is the choice made by Carvey after weighing the pros and cons. Perhaps this choice is not good in modern times, but the options in the 19th century were really limited.
Ventriculoperitoneal shunt is not actually a modern surgery. Looking back at the history, it is closer to the 19th century [1].
However, in the modern diagnosis and treatment of craniocerebral trauma, it is still a commonly used treatment method for intracranial hypertension. This treatment method is a typical treatment of symptoms but not the root cause, because it does not remove the cause of cerebral edema, but simply reduces intracranial hypertension.
But for Mrs. Santini, that was enough. The reason why neurosurgery prefers palliative care is largely because nerve tissue is different from other organs. Excessive touch can cause nerve damage.
Even a small amount of bleeding can endanger the patient's life. To cause more trouble for a palliative disease is obviously not worth the gain.
Medicine is not only about removing pain, but also about allowing patients to live like human beings. This was especially true in the 19th century when there was a lack of technology and no means of survival.
From a purely surgical perspective, the operation of ventriculoperitoneal shunt is not difficult and the process is not complicated if it is left to a senior doctor who specializes in neurosurgery.
But now that the main surgeon is in the hands of Kawei, the difficulty will definitely go up a level. It’s not like the emergency surgery department has never performed extra-neurological surgeries. When encountering traumatic brain injuries, especially when the neurosurgery department doesn’t have too many manpower, Kawei also has to take the stage.
But there is no knife. Compared with other surgeries, the error tolerance rate here is very low. What matters is not only surgical proficiency and the ability to avoid risks, but also extremely precise operating techniques.
The former can be compensated for by accumulating experience, but the latter requires a lot of practice. There will naturally be no problem with Kavi's technique and proficiency, but it's a pity that he has been away from high-intensity emergency medicine for a long time, and his hands will definitely be rusty, so his current pressure is no less than that of Massimov.
This kind of pressure will naturally be reflected in his expression, behavior and language. Coupled with the rare silent operating room environment, he will once again return to his original appearance in emergency surgery, the self-centered emperor of the operating room.
"All surgical instruments must be strictly sterilized, as well as the catheter. I will use this tube later, and the other end must be inserted into the patient's abdominal cavity."
"..."
"No! All tube cavities must be disinfected, not only the surface, but also the inside, everything must be disinfected in place!!" Although Kawei's voice was not loud, his temper was even stinker than the usual Massimov's, and he looked at everything. Not pleasing to the eye: "Don't even expose the gaps in your gloves, wrap them tightly... Wear the mask... There is also disinfectant, this is not enough, bring two more bottles! It's only after ten o'clock , cheer me up!" Since entering the operating room, Massimov felt something was wrong.
Not only Kawei's temper, but also the bizarre brain surgery that is about to begin. If cesarean section and breast cancer are the product of a flash of inspiration based on the experience of our fathers, appendicitis is the result of persistence, and hysterectomy + repair of surrounding organs is a collection of superb surgical skills, then today's cranial drilling seems very... Mysterious.
Because cranial trepanation is almost invisible in Vienna, in fact there are not many surgeons in Europe who are skilled in using trepanation, because it requires a lot of patients who need trepanation to practice for the doctor. In fact, it is almost impossible. It's possible.
If he still learned it from his father, then his father was too powerful and too invisible. Why had he never heard of such a person before?
Massimov had also discussed this issue with Ingnatz, Orji, and Waterman before. There are indeed many famous surgeons in Lombardy, but I have never heard of anyone who is so proficient in abdominal surgery.
There are very few people who can do cesarean section. He still needs to know how to remove the appendix, hysterectomy, repair of bladder and ureter, and remove breast cancer... Now he also needs to know how to perform cranial trepanation.
Because I was preoccupied with Mrs. Santini's surgical plan, the feeling was not strong enough. But after confirming the surgical plan and following Kawei into the surgical theater, watching him direct his assistants there like a doctor with decades of surgical experience, the indescribable sense of separation became more and more intense. It's obvious.
Who is his father? ? ? A surgeon who specializes in abdominal surgery can still think of shunting after cranial drilling. Are there really such powerful guys in Italy?
? ? The last neurologist whom Massimov was familiar with was Dr. Charl of France, but his research was limited to peripheral nerves.
For example, hysteria, muscle atrophy, multiple sclerosis, paralysis tremens, etc. do not reach the level of the brain.
【2】If it has something to do with the brain, is it that Broca? He was of the right age, he was also a surgeon, and he had dissected many brains, but the other person was an authentic Frenchman who graduated from the University of Paris.
Moreover, the range of surgeries he is proficient in are actually similar to Waterman's, and are limited to the maxillofacial region. He may also touch on some gynecological surgeries, but Massimov knows very well that he does not know how to perform abdominal surgeries at all... [3] No, it’s Italy, his father is Italian!
Judging from the fact that Kawei is so familiar with the brain, he can rely on many anatomists. After all, he is an adoptive father, and it is normal for his age to fluctuate.
The Lombardy region of Italy was indeed the first to study and establish psychiatry and neurophysiology, and insane asylums were built in Milan, Naples and some surrounding areas.
【4】Is it Lombroso? 【5】It is true that he has cut many brains, and his research on the brain is indeed very in-depth, but I remember that he is only 30 years old.
He may look quite young now, but 17 years ago he was only 13 years old and still in middle school. How could he adopt Kawi?
? ? etc! The razor in Massimov's hand became slower and slower. Why don’t I think about Lombroso’s teacher?
Anyone...Morselli? People are in Naples. Biffy? The last time I saw him was in Pavia, he probably wouldn't go to Milan.
Bellinger? Alas, poor Bellingeri, died 18 years ago... who else?
? ? By the way, what was the name of the person who proposed the ventricles? He seems to have done some research on the stomach... Massimov knows a lot of Italian surgeons, but there are so many of them that he may not be able to remember some of the names. .
Among these people, there seems to be no one who not only studies the brain but is also proficient in abdominal surgery.
But that's not the strangest thing. The most unacceptable thing for Massimov was that he read many medical books related to the brain. No matter whose book it was, there was basically only one step in the surgical treatment of headaches, which was to drill holes to release the pressure.
He didn't know why a tube was used to shunt the blood after drilling, let alone why the shunt had to enter the abdominal cavity.
There is indeed some fluid in the ventricles of the brain, and removing this fluid can indeed reduce intracranial pressure, but is surgery necessary to this extent?
And can this kind of fluid diversion operation really be done through surgery? He had a headache thinking about it, and felt that if he continued to pursue the operation and the name of Kawei's adoptive father, he would become crazy.
"Teacher Massimov, what's wrong with you?" Only when facing Massimov could Kawei realize that he was still an ordinary surgeon, not the original director of emergency surgery: "We are almost ready for the operation, let's start. Bar."
"Oh." Massimov carefully shaved off the last strand of Mrs. Santini's hair.
"Is it okay to just shave it all off?"
"Hmm..." Kawei glanced at the bald scalp and soon discovered the temporal bone on the left side. It was visible to the naked eye that the bone under the scalp was different from the skull in other locations.
The tumor is not only squeezing the brain tissue inward, but also eroding the outer layer of the temporal bone outward. Massimov also saw Kavi's prompt and found the place: "Is it here?" Kavi nodded, but did not say a word. Instead, he came to Mrs. Santini with a smile and comforted: "Mrs. , the operation will be completed soon, and the headache should be better by then."
"Really???" Santini has been suffering from headaches for a week and is already on the verge of mental collapse.
What tortured her even more was the fear of mental hospitals hidden deep in her mind: "They all said I was crazy. I really couldn't control myself. I didn't want to go to the Lunatic Tower."[6]
"Don't worry, I won't send you there."
"If it doesn't work, tell me earlier, I, I really don't want to live anymore, it's really too painful and uncomfortable!"
"It's okay." Kawei knew that this feeling was uncomfortable.
"Give me one hour, and it'll be over in one hour."
"Okay..." Amor was not around, and Kawei was worried about the nurses and assistants here, so he had to do it himself: "Including anesthesia time, the operation may take more than an hour. Everyone, cheer up, come early You can go home and rest early after you finish." Kawei has always been a surgical director who loves teaching. Facing this group of people in front of him,
"Student", although his attitude is not very good, but he still hopes to make these people gain more knowledge and learn more about brain surgery.
"First of all, before the operation officially begins, we still need to understand the basic anatomical structure of the brain." [7] Kawei asked them to prepare anatomical diagrams in advance, hung a blackboard in front of the operating table, and said while doing anesthesia: " The inside of the skull is not entirely solid, but there are certain cavities. This has been confirmed and named by many anatomists, which are the ventricles. The ventricles are cerebral fluid, and they are also the targets we need to shunt this time." In the process, Mrs. Santini had fallen asleep
"Give me carbolic acid and alcohol. I need to disinfect Madam's body." Kawei took the sterilizing basin and wiped her head with the soaked cotton ball.
"The scope of this operation is very wide. The scope of disinfection must be fully covered from the head to the abdomen..." [8] In addition to disinfection, surgical preparations also include draping. Unfortunately, St. Mary's Hospital does not have the sterilized sheets from the Municipal General Hospital. , in order to prevent infection, Kawei could only operate directly on Mrs. Santini’s head after disinfection.
However, before the operation, the patient's eyes and ears need to be protected as necessary to prevent eye and ear damage caused by drill bit slippage, bleeding, splashing bone powder or other accidents.
"Here, a scalpel." Massimov took a box of drill bits and acted as Kavi's assistant [9], and asked at the same time,
"In the past, we only opened the skull. Why do we have to go through so much trouble and do so many steps this time?"
"The headache is due to intracranial high pressure. The method is to open a hole to release the intracranial pressure." Carvey took the scalpel and first used a quill to mark the back corner of Mrs. Santini's occipital bone [10].
"But after drilling the head, you will encounter many problems, such as the most common infection, and the brain tissue that bulges outward due to pressure." Although Massimov is skeptical about infection, Corey has already begun to try many surgeries. Comprehensive disinfection.
What does it mean to just have bulging brain tissue?
"This is actually easy to understand." Kawei put down the quill, used a blade to cut an incision of about 3cm, then placed the drill head on the marked position, and began to choose the drilling angle: "The brain tissue is like very loose meat. Mud, originally it was wrapped in a cloth bag, which was fine. But now the pressure of the cloth bag has increased. Once a gap is opened in the bag, what will be the consequences?"
"...The pulp will be squeezed out by this pressure."
"That's right." Carvey held the skull drill in one hand and carefully placed it on Mrs. Santini's head with the other. He began to hold his breath and exert force as if he were drilling a hole in a coconut: "Once the outward movement is restricted, the brain tissue will naturally press outward. , the patient's neurological function will definitely be damaged by then." This is actually an unintentional statement, because in this era, no one knows what functions the brain has.
The first doctor to clarify the functional divisions of the brain was the German neurologist Brodmann in 1909, also known as Brodmann's division.
Kawei certainly knew about this zoning law, which is the foundation of foundations, but he did not know about time. Earlier in the mid-to-late 19th century, the divisions of the brain were replaced by the 42 divisions of the skull, also known as phrenology.
[11] However, Brodmann’s brain division was not achieved overnight. His achievements were based on the brain theories of many anatomists and surgeons.
Among these people, one person's name suddenly jumped into Massimov's mouth.
"This is what your adoptive father taught you, right?" Kawei was stunned for a moment, but did not take these words seriously. He nodded without much thought: "Yes, he has experience in drilling skulls, and he also tried... ..." Massimov suddenly interrupted him and asked: "Isn't your adoptive father Verga?" [12]
