Litokwa came from the outskirts of Graz. His father was an ordinary clerk in a government agency. His strong learning ability allowed him to enter the Medical School of the University of Graz. After graduation, he entered the largest hospital in the area and became a surgeon there.
From the perspective of the 19th century, his surgical ability should be above average.
Although not as good as Hills and Herman, he can also perform amputations and some common facial surgeries. After all, the medical level in Graz is a level lower than that in Vienna, and his teacher is not Ignatz, so his basic skills must be worse.
After a short training, he failed to pass Kawei's surgical examination and now became a military doctor.
Life in the Klavow Infantry Battalion was not only monotonous but also short. He was sent to the rear hospital less than two weeks after joining the army. But he was lucky. At least the shell on the morning of the 27th did not take away his hands and feet. Otherwise, he might have to say goodbye to medicine in this life.
The young military doctor was very aware of this and praised the surgical level of the Fortress General Hospital in his diary. 【1】
In today's surgical atmosphere, amputation is still the first choice for limb surgery, but the Fortress General Hospital often performs limb-sparing surgeries with a very high success rate. While praising this surgical method, Litokwa, as a surgeon, said that it was absolutely impossible for him not to be surprised or heartbroken.
Especially that night, Ronagne completely refreshed his understanding of surgery, and all of this was written in his diary:
[What an amazing rescue, it directly interrupted my description of the battlefield yesterday morning.
In order to accurately record the entire rescue process, I had to stop the diary on September 27 and start directly on September 28. It is now 11:48 pm on September 28, and Ronagne was admitted to my ward.
The hateful Prussians shot him directly through the head, cracking the skull and shattering the brain.
This is almost a fatal situation. Don't say I haven't seen this kind of trauma. Even if I had seen it, I wouldn't know how to deal with it. Cut off the broken parts? Perhaps the only way is to remove it. After all, this is how the medical professors at Graz Medical School teach surgery.
But can I live after the removal? There may be only one answer, but the operating room of the Fortress General Hospital rescued this guy from the hands of death.
Nowadays, part of Ronagne's head is missing, part of her brain may have been cut off, and her entire face is swollen and out of shape. Just now, less than an hour ago, Dr. Kawei solved his blood pressure problem again at his bedside and installed a tube on him.
To be honest, I can't imagine why a puncture tube should be placed in the waist for a traumatic brain injury. But this operation lowered his blood pressure very well. This heroic soldier who fought for the empire survived. Although he has not yet woken up, I know that his heart is still beating.
I have never seen such a surgical operation, and I don’t know what made him strong enough to survive?
Is it his strong and unyielding will to survive?
No, I have seen some traumatic brain injuries. Even ordinary trauma is difficult to survive. The brain has always been the most deadly part of the human body.
Is it those new medicines in the medicine cabinet? Or superb surgery?
I asked the nurse who was taking care of me, and she just said she didn't know. I asked the ward assistants here, and they also said they didn't know. The doctors who can go on stage to see the whole process of this operation are either sleeping or busy. No one can answer me!
hateful! It's really abominable!
Why didn't I pass that test? If I passed the exam, I might have learned it by now. No, I shouldn't be so brazen. At least I can see the operation!
I really want to go into the operating room and take a good look at how Dr. Carvey and his assistants operate! ]
This is what Litokwa wrote at 0:35 on September 29.
Not long after Ronagne's craniotomy and debridement surgery, severe cerebral edema occurred, and her blood pressure rose from 140/84 to 155/98. If nothing unexpected happened, Ronagne would definitely die of cerebral edema and brain herniation that night, just like other victims of traumatic brain injury.
But Carvey temporarily solved the problem with a lumbar puncture and lumbar drainage.
At that time, Litokwa couldn't see clearly what was going on in Ronane's hospital bed, surrounded by doctors and nurses. Even if he finally stood on his hospital bed, he could only barely see Ronane's bowed posture sleeping on his side and Kawei's back.
As for how he performed the lumbar puncture and drainage, Litokwa could not see it at all.
After closing the diary, he found that the first half of the night was quite difficult, and his mind repeatedly scrolled through the content of Kawei's teachings to the doctors around him:
[The exposure position requires the side-lying position of "holding the head and bending the knees", and the waist should be perpendicular to the bed surface]
[Maintaining the patient's body posture is very critical and will affect the success rate of the operation. For example, Ronane was lying on his back without a pillow just now. Now for the puncture, he must be given a pillow to prevent his body posture from being affected when his head is downward.]
[Be sure to pay attention to the scope of disinfection. The scope should be large to prevent one gap from being inaccessible. You can use another gap]
[When inserting the needle, pay attention to the sliding of the skin and fix it with your fingers. If the skin and soft tissue are not fixed well, the needle tip will go crooked. It’s not that your needle insertion posture is crooked, but that the internal structure is crooked, remember! ]
[If the first needle puncture is unsuccessful, you must not repeatedly test the surrounding area. There are other tissues and blood vessels around it, so doing so can easily cause damage. The correct way is to withdraw the needle under the skin, then position it accurately and insert the needle]
[There will be a sense of breakthrough after the needle is inserted, but you cannot rely solely on the sense of breakthrough, because some patients and injured people feel different. sometimes.]
Kawei talked about a lot during the operation, from preparation to needle insertion to final drainage, he went over all the key points. However, because Ronagne's situation was different from that of ordinary patients, and the doctors around her were also asking questions, there was not much that Litokwa could really write down.
These are only a small part of it, very detailed, but what Litokwa really wants to know is not these details.
It cannot be said that these details are not important. It can be seen from Kawei's wording and expression that details are very important for lumbar puncture. But before pursuing the details, he wanted to know one thing: where was the piercing?
Does it go through the ligaments and then into the spinal canal?
Litokwa heard the cerebrospinal fluid, and also heard the doctor at the bedside exclaiming after the puncture:
[Squirted out, cerebrospinal fluid spurted out! ]
[It’s so powerful that it can spurt out. The pressure is the same as the blood in the veins! ]
[This pressure may have exceeded 300mmHO. After releasing some, I will make a simple measurement. ]【2】
Litokvar knew about cerebrospinal fluid, a medical term that had been identified in the 19th century [3]. The relationship between the brain and cerebrospinal fluid is also taught in medical school anatomy courses, but after downplaying it, not many medical students can remember it.
After all, brain anatomy does not affect cranial surgery. No one would cut open the brain to study the cerebrospinal fluid of living people.
And the most critical thing is that Litokwa can't figure out why cerebrospinal fluid is released from the waist? He even didn't understand why the blood pressure dropped after the cerebrospinal fluid was released. Why did Kawi say that Ronagne is safe now, and Ronagne is indeed as safe as he said?
Why? ? ?
There is also a measurement method similar to a sphygmomanometer. Can the pressure of cerebrospinal fluid really indicate the severity of traumatic brain injury?
Although Litokwa memorized all these contents, it did not affect the pile of question marks in his mind. After experiencing the mental torment left by tossing and turning in the first half of the night and overthinking, he reluctantly fell asleep.
However, after six hours of sleep, when he woke up, the pile of question marks did not get any explanation, but became more.
Rogelini, who had just undergone surgery, was brought in by the nurses.
Originally, his bed number should be further back, but due to the shortage of beds, a slightly injured patient in this ward was allowed to be discharged, so he was able to stay.
This time the injury moved from the brain to the chest and heart, another place that the surgeons had no idea where to start. Litokwa still vaguely remembered how the chief of surgery at his hospital dealt with cardiac trauma: "Just do a simple bandage, try to stop the bleeding, and wait for the heart to heal on its own, if it really wants to."
This inherent processing model is common all over the world, at least in Europe.
He had never heard of a surgeon who dared to open the chest, let alone a surgeon who dared to repair the heart. Can the heart really be repaired? That heart that beats more than 100 times per minute beats twice per second. How to do this?
Litokwa had never even seen the beating of the heart. He could not imagine the scene of the operation. He could only focus on a piece of bread on the table with his eyes, and use simple body movements to quickly move up and down to simulate what he might see.
No, my mind is even more confused!
"What on earth are you asking?" The person in charge of this ward is Goram, and both Rogelini and Ronagne are the subjects of his focus.
Litokwa was originally a doctor with the army, and his military rank was not much different from that of Goram, but he was very careful when asking questions: "Can you tell me, how did Dr. Kawe treat Ronane's traumatic brain injury?"
"have no idea."
Gorham wrote the medical records carefully and answered simply: "Without the arrangement of the surgeon, I couldn't enter the operating room at all. I didn't even see the lumbar puncture that night. I still want to ask others."
"So." Litokwa looked at Rogerini, who was not yet awake, "What about him? How did his heart repair be done?"
"Just open the chest, find the pericardium, and cut it open." Golam pointed to his left chest and said very simply, "Then find the hole in the heart and sew it up with sutures."
"Are you on the operating table?"
"Yes, I got it." Golam was a little proud. "I'm really happy to be an assistant next to Dr. Kawei."
Litokwa was very curious about how outstanding a young surgeon was that even the 30-year-old Golam praised him so much: "How to evaluate his operating skills?"
"The technology is very impressive. I definitely can't compare with it. Even Dr. Bill Rotter, the deputy dean of the College of Surgery, can't compare with him." Golam said very straightforwardly, "But I think the difference between him and us is The difference is not just technical.”
"Oh? What level are you still on?"
"Surgical thinking." Gorram said while writing medical records. "Dr. Kavey's surgical thinking is different from ordinary people and is not bound by traditional surgery and anatomy at all."
This is an extremely abstract statement, and Litokva knows the meaning of this statement very well, but what he wants to hear is more specific content: "The constraints of traditional anatomy and surgery? How to understand this statement?"
"This can be understood to mean that he can do what we think is impossible, he can do what we think is difficult, but he is strongly opposed to what we think should be done." Goram said nonsense. , "That's probably what it means."
Litokwa knew that there was no point in asking these questions, so he tried to dig deeper into the specific process of this heart repair surgery: "Can you explain the process in detail?"
"Process? What process?"
"Heart repair, how is it done? Does the heart really need to be repaired?"
"Didn't I just talk about the process?"
"But that's too simple. Can you give me more details?"
It seems that Goram has told the whole process, but in Litokwa's perception, these words are the same as not saying anything: "How on earth do you open the chest? The distance between the ribs is so narrow, it can really be exposed Is there enough surgical field? Also, what to do with the bleeding from the rupture after entering the chest cavity? Can it be stopped? That's the heart, isn't it?"
"Okay, okay." Gorram was not in the mood to answer these questions, "You are a wounded person. Wounded people should do what they should do. Go back and rest."
"I know I'm a wounded person, but so am I."
"Of course I know you are a doctor." Golam smiled and sent him to the bedside and said, "Even a doctor has to heal his injury first. The infected area has just improved. You can ask again after the wound has healed. It’s not too late for these things.”
If it were Goram from two days ago, he might have a good chat with Litokwa now.
But he saw the exchange between Delvaux and Sarson, the competitive landscape in the general hospital and the possibility of his own promotion. At this time, exchanging surgical details with a military doctor was setting up a new competitor for himself.
Goram is not that stupid. He finally got the opportunity to come to power, so why should he share the experience with others.
However, he was not so heartless. After seeing Litokwa's disappointed look, he comforted him: "Dr. Kawei will continue to make rounds in the afternoon. This is a key ward, and he will definitely come. Then you can ask him again. Well. I am a second assistant, and I am doing cleaning and retracting almost the whole process, so I really can’t explain the details.”
[On duty, this chapter will be supplemented in the middle of the night]
(End of chapter)
