Another nearly 4-hour operation.
Kawei's health and energy were fine. When he left the bedroom, except for his legs being a little sore, he looked like a fine person. Hills is also relatively young, has done a lot of odd jobs, and has the physical strength to keep up.
The other three elderly people were not so relaxed.
When I stood on the stage, all I could think about was how to do my job well, and I didn't feel anything bad. But once they got off the operating table, the pressure disappeared instantly, and the fatigue they had forgotten swept over them instantly.
Standing for long periods of time and being highly concentrated, coupled with the lack of oxygen caused by masks, drained their energy.
When Kawei screwed all six screws into the grooves, inserted silver rods for fixation, and then spread a thin layer of bone for fusion fixation, Waterman was already a little exhausted [1].
The monocortical fixation of the vertebral body and the bicortical and tricortical fixation of the sacrum that Kawei mentioned just passed by his ears and did not enter his mind at all [2]. This is a drawback brought about by his gradual departure from the front line of surgery. Of course, the distance itself is also due to his increasingly unsatisfactory physical condition. The two complement each other.
Orgi, who was standing opposite, was even more tired.
He had suffered a gunshot wound to his abdomen. Although he was in good health and had recovered well, it would not show up during ordinary surgeries. But when faced with truly high-intensity surgery, the shortcomings are infinitely magnified.
The postoperative recovery greatly weakened his physical strength, and his strength and endurance for visual field exposure could not keep up. In the end, he relied on perseverance to hold on.
But compared to the two of them, the one who really suffered was Massimov.
He has not been injured, and his physical strength is actually pretty good. The only discomfort he has is cervical spondylosis and lumbar muscle strain. The difficulty of lowering his head, bending to exert force, and limited back movement have greatly restricted his surgical ability, which can also be regarded as an opportunity for him to retire early.
All three are old people standing on the edge of the retirement line, or have already stepped into the retirement zone. Now, in order to learn a new surgery, I endured the physical discomfort until the surgery was over.
Kawei has also been old, so he naturally knows how unpleasant it is.
This kind of blow is not only physical, but also mental. This feeling of powerlessness will make people lose their enthusiasm for work, forcing veteran doctors to leave the front line of their love step by step.
Because they are already at the forefront of today's surgery, as the difficulty of Kawei's surgery continues to increase, they will increasingly find themselves powerless.
In stark contrast to them is Hills.
In his thirties, he is at the peak of his physical energy. Although his basic skills are not as solid as Damirgaon's, he has enough experience in big scenes and has a very strong desire to learn. He even went to Kawi with his notes after the operation. Asked a lot of questions.
He was working on the whole process, so he didn't see many details, so much so that after entering the crest window, he couldn't even figure out the anatomical structure of the location. These are the three quality questions that newcomers to surgery often encounter when they first get into surgery:
What's in front of me?
What anatomical location have I wandered to?
What do I do next?
"These are all the problems you will encounter when you first get into ridge surgery." Kawei asked the three old people to go aside to rest, and finally explored the epidural space again to remove the remaining bone fragments. "Make a note of the surgery." Steps, and then practice more on corpses... If you don’t understand anything, you can come to me at any time.”
After a cesarean section and several successful abdominal surgeries, Hills slightly changed his position and relationship with Carvey.
Kawei is still a strong opponent in the competition among peers. He can only be considered a challenger. In fact, in most cases, he is not even a challenger. He still needs to continue to learn. But the tone of the challenge must not change. Even learning is for the sake of challenge. Once the tone changes, he may not be able to find the motivation to continue chasing.
"Okay, I hope Yingnatz...teacher won't get mad at me the next time I come to the Municipal General Hospital."
"He also made the decision out of anger." Kawei handed over the final steps to him. "During the operation just now, there was a lot of bleeding in the epidural space, and a drainage tube still had to be placed."
"good."
"Don't suture the paravertebral muscles. Just let them align after returning to their original positions. Suturing will aggravate the muscle edema, which will cause severe pain after the operation."
"good."
Hills simply sewed up the fascial layer with needle and thread, then closed the incision on the old marshal's lower back, and then disinfected, covered, and bandaged it again.
Until here, the surgery can't be called over. For Kawei and Ludwig themselves, the surgery itself was over, and the truly difficult post-operative recovery had just begun.
First, the paravertebral muscles above the spine were stretched for more than three hours, and then you will definitely encounter stubborn back pain. Pain relief must be available at all times. If it becomes unbearable, Kawei will choose to inject methylene blue to temporarily demyelinate the pain nerves.
Get rid of the pain, and then come the infection.
Although the routine use of antibiotics after surgery cannot reduce the risk of postoperative infection during ridge surgery, in principle, the more beautiful the surgery, the lower the chance of postoperative infection [3]. Kawei is confident in his technology.
But that’s only at the technical level, and technology alone is completely insufficient to prevent infection.
Kawei was not using a sterile operating room, but the bedroom of a 60-year-old retired marshal. The physiological saline used is freshly boiled and cooled water + table salt. Without the blessing of modern sterile technology, it is only better than drinking water.
The disinfection of the instruments was not complete, especially the leather skirts they used during the surgery, which were simply steam fumigated and sprayed with alcohol. Even if the ground is disinfected with alcohol and the air is sprayed with low-concentration carbolic acid, there will still be a huge risk of infection.
Therefore, within two days after the operation, methylene blue must be used daily to fight infections in the body.
After these two days, we will evaluate the drainage effect and the recovery of the incision and make changes. The best case is that the incision is normal, and the worst case is that it becomes infected and splits.
Kawei also doesn’t know whether the old marshal can avoid postoperative infection, because there are many factors to prevent infection that could not be developed in the 19th century [4]. He can only be as perfect as possible in terms of instrument materials, surgical techniques and drug selection.
"Enhanced nutrition. Don't touch the bandages and gauze on the incision. I will come here every day to check." Kawei said to the housekeeper.
After knowing that his master had gone through a long operation, the old housekeeper finally showed a smile on his face: "I have written it down. Do you have any other instructions?"
"Don't touch the incision with water. Observe the liquid in the drainage syringe and record the amount of liquid at any time." Kawei taught him how to use the drainage syringe. "Be careful to protect the mouth of the drainage tube and avoid touching dirty things." ..."
The housekeeper looked at the series of operations and was confused: "This thing is a bit complicated, I can't do it."
Kawei put down the syringe and support frame in his hand: "Forget it, I will call a nurse to come over to help in the evening. I will tell her all the key points of postoperative care. She has very high requirements for details like me. , I hope you can try your best to cooperate with her work."
"Don't worry, Doctor Kawei." The housekeeper put away the paper and pen for recording and said respectfully, "As long as it helps the master's health, we will fully cooperate."
Kawei stretched out and picked up the organized equipment box: "Okay, I will come again tomorrow."
"Are you going back?"
"Yeah, the operation is over, and there's no point in keeping me here." Kawei thought he was asking about anesthesia and recovery, and explained, "The anesthesia time should be less than half an hour, and the vital signs are all stable now. And Hills is watching, there won’t be any problem.”
The housekeeper quickly explained: "No, no, no, that's not what I meant."
"What happened?"
"There are many people in the living room downstairs, and some of them want to see you immediately." The housekeeper pointed to the stairs and said with a smile, "And it's getting late. It will take time to go to the city from here, so it might as well be Have lunch here before leaving."
...
Clinical medicine has nothing to do with military affairs, and the military medical office has little to do with Kawei, so he doesn't want to stay here for a long time. As for lunch, he always eats very sparingly, so he only needs to find something from the kitchen that he can eat on the way.
But when he heard that Franz was coming, Kawei could only change his original plan and choose to stay.
Franz no longer sat and chatted with Kawei as before, but stood up and showed respect as soon as he saw Kawei coming down the stairs. When Kawei walked up to him, he smiled and said, "Congratulations to Dr. Kawei, the operation seems to have been successful again."
"I can only say that the operation process went smoothly." Kawei did not dare to speak too fully, "but the recovery after the operation still needs to rely on the old marshal himself and some luck."
"Another 4-hour operation." Franz glanced at the wall clock and was very satisfied with Kavi's performance. "You should know that no surgeon in the world has performed such a complicated operation."
Kawei knew that now was not the time to be overly modest, but he could not be too high-profile, so he could only change the topic during the conversation: "I heard from the old housekeeper, His Majesty the King wants to see me?"
"Yes, there are some matters about the Military and Administrative Office." Franz did not answer, but handed over the right to speak to Ambassador Edward who was standing aside. He sat back down in the posture that a king should have before, "Before these things, we should solve it first. Let’s talk about Mr. Edward’s problem.”
When he saw Edward's face, Kawei had already guessed his purpose of coming here, which was to get rid of Fernand's trouble.
But what he couldn't guess was that when Edward reached his current position, he still avoided some dirty tricks and showed no sense of being an assassin: "If I want to solve the problem you raised, it seems that this is the only way to solve it now." Walk."
"This road..." Edward hesitated for a moment and asked, "Who will take care of it? You don't have to let me go, right?"
Archduke Brecht on the side patted him on the shoulder and said with a smile: "This is easy to handle. I have people in the police station and the court. Mr. Edward just tell me and I will make arrangements."
Edward was still hesitant, hoping to get a clear answer from Kawei: "He really can't die?"
"I've seen him before and checked him out." Kawei shook his head, with a particularly complicated expression on his face. "The cardiopulmonary function is a bit worse, but the infection has gone away and the incision is growing well. The drainage fluid from the past three days There was quite a bit, and there was still some bleeding, but after two days there was only clear ascites left, and the drainage strip should be removed today.”
Edward didn't understand these professional terms, but it was easy to hear Kawei's "helplessness" from his expression and tone: "It seems he really survived."
"If nothing else happens, he can live for at least another year and a half. After all, his liver is not very good."
How could Edward wait until that time: "Okay, just do it the way you said."
? ? ?
Everyone suddenly shut up and looked at him: "..."
Edward realized that he had said the wrong thing, sighed, and changed his words: "I said it wrong just now. You did it my way."
Only then did they all agree, and at the same time they began to care about another thing: "What is Mr. Ambassador going to use? Arsenic?"
"This should be the most commonly used and best-used one. Are there any other options?" This is what Edward is struggling with. "But I remember that if I eat this thing, I will be found out after death, right?"
"Of course, today's technology can already detect arsenic." Brecht replied, "But don't worry, Mr. Ambassador. After all, he is a death row prisoner. The prison will not investigate. Even the prison will not investigate, and the police will No one will mind such nosy matters."
"If possible, can Dr. Carvey come to the scene to check?" Edward said, "The main reason is to use your mouth to announce the cause of death."
"You want me to admit that my operation failed?" Kawei laughed angrily, "Although you have a respected position and I shouldn't refuse, this has had a very negative impact on my work. As far as I know, Mr. Ambassador There is also a surgeon nearby who should be able to take care of it.”
"this......"
The more Edward listened, the more he felt that these people did not want to wade into troubled waters.
From a rational point of view, no one would investigate the cause of death of a condemned prisoner, but the direction of public opinion was unclear, Kawei refused to tell the truth, and Franz was too lazy to care about it, so he really didn't dare to take a gamble.
"The situation is so special now. Many people already want to release Fernand. At this time, the person died suddenly. Could it be..." Edward looked at Kawei, "So this time I came to Dr. Kawei. , I also want to ask if there is any other way to replace arsenic? It would be better to use something else whose source cannot be traced."
There are certainly alternatives to the death penalty, and there are many, but Kawei is unwilling to say: "I have no interest in killing people, so I don't know much about them, and I'm really sorry."
