O'Rourke's treatment has mixed rights and wrongs, but at least fasting is a good choice. Under normal circumstances, cholecystitis will slowly return to normal. But the patient's condition was not optimistic. According to the medical records, he had been suffering from high fever and abdominal pain for three days, with no sign of relief.
Nowadays, the diagnosis of cholecystitis can be basically clear, and the rest is about the degree of the disease.
The course of cholecystitis directly affects the choice of treatment, whether it is conservative, surgical, or conservative first and then surgery.
If an acute attack of cholecystitis is not relieved by the third day, you will basically need to go to the operating table. Of course, the prerequisite is to do a good job in diagnosis, that is, imaging examination. There is no imaging examination now, and the operating room of the temporary rescue center is not up to standard. It takes a lot of time to transport people backwards, and something may happen halfway.
Everything can only be judged through Kawei's experience.
He touched the patient's right upper abdomen again and once again confirmed that the location of the lesion was in the gallbladder: "Are you sure you want to operate now?"
"I...I'm sure." The patient nodded repeatedly, then tensed his muscles and turned sideways to avoid Kawei's palpation. "Stop pressing! I really can't stand it!"
"All right."
O'Rourke is a typical 19th-century physician. In his eyes, the quality of a doctor is basically judged by the speed of diagnosis and the accuracy of treatment measures. In particular, the speed of diagnosis can best reflect the amount of experience of a doctor.
A doctor who quickly diagnoses a condition may not be an excellent doctor, but a doctor who hesitates for a long time and cannot come up with a diagnosis is definitely a quack.
Although Carvey used considerable palpation, direct contact with the patient's body, and was also a dirty surgeon, his speed of diagnosis was excellent, even among the high-level experts of the Association of Physicians who are quick to diagnose. Get to the front of the line.
There are some suspicions of pretending to understand, but after the suturing just now, O'Rourke is more convinced that Kawei has really made a correct diagnosis.
It's just that the word "cholecystitis" seems strange to his mind.
“What does cholecystitis mean?”
"The most common cause of inflammation in the gallbladder is the presence of stones in the gallbladder." Kawei explained, "It can be seen from his body temperature and abdominal symptoms that the degree of inflammation is severe, and immediate surgery is indeed needed."
O'Rourke didn't understand surgery, but he couldn't help but ask: "How to remove inflammation with surgery?"
Kawei made a simple cutting action and said: "The principle of surgery is to cut out wherever it is harmful to the body. If the appendix is inflamed, cut out the appendix. If the gallbladder is inflamed, cut out the gallbladder."
"Will there be any impact on the body after gallbladder removal?"
"Yes, but not big," Kawei said. "Removing the gallbladder will not affect normal life, but it will have a slight impact on digestion. Personally, I feel that this impact should not cause him to refuse surgery."
"It doesn't matter, it's not a problem at all!" The patient said, holding his stomach, "I'm in so much pain now that I want to take a knife and cut open my stomach directly. I need to do the surgery quickly, I can't stand it anymore!
! "
"I need to make some preparations, and at the same time..." Kawei glanced at O'Rourke again, "Doesn't the deployment of the surgical operating room belong to Dr. O'Rourke?"
O'Rourke nodded: "I am only responsible for the logistics and medical treatment of the ambulance. I have no right to interfere with the surgery."
"It doesn't matter, the resistance to surgical intervention is much smaller." Kawei looked back at the guard captain behind him, "Go to Mr. Yingenatz and tell him that I need an operating room and hope that the surgeons here can cooperate. .”
"Dr. Ingnatz should have gone to the center of Gablenz."
Kawei was stunned and nodded slightly: "I forgot about this. It seems Lucius also went with him, right?"
"Yes, there are more patients there, and everyone else went with them except for your own first trauma team and two nurses."
"Okay, let Herman negotiate, and Damirgaon and Berget prepare for the most basic abdominal surgery as soon as possible." Kawei said, "Tell Amor that the operation time will be 1-2 hours, let's He figures it out by himself. Then he asks the nurse to open the patient's vein and first connect a bottle of saline."
"I see."
The guard captain left the internal medicine tent, and Kawei followed O'Rourke back to his office while others were preparing.
As the chief physician of the Sixth Army, O'Rourke has a separate farmhouse as a rest room, and his treatment is much better than that of officers of the same rank. Having just left the smelly medical ward, and stepping here again, it was as if I had stepped directly across the human world, from hell to heaven.
This place is not as spacious as the Laming Command Post, but it is slightly more exquisite under the decoration of O'Rourke himself. It is hard to believe that this was an ordinary farmhouse two days ago.
"Dr. O'Rourke seems to like art very much." Carvey glanced at the small portrait on the wall, then glanced at the corner of the frame and said, "Is this a painting by Mr. Hans?"
"Yes, when I went to Vienna for a meeting two years ago, I took the time to commission him to paint it." O'Rourke changed out of his military uniform and hat and wore a more comfortable coat, "What? Dr. Carvey also likes Mr. Hans's works?" "
"It's not bad, I am also a friend of Mr. Hans." Kawei found a chair and sat down, "But I have never seen him paint such a small portrait. Today is an eye-opener."
"I spent a lot of money at that time." O'Rourke picked up the rag on the side and carefully wiped the frame. "Only this size can be carried with you, otherwise you can only keep it at home."
"I think you should consider using a camera."
"Although photography is amazing, the photos taken have no artistic flavor." O'Rourke said, "I still like the lines drawn by painters with brushes... What would you like to drink?"
"Oh, don't bother." Kawei quickly returned to the topic, "I'm here mainly for the cleaning of the ward."
After hearing this, O'Rourke came to his senses. The man in front of him was not only a surgeon, but also a deputy inspector of the Military Medical Department, responsible for the supervision of military hospitals and military ambulance stations.
Theoretically speaking, there will be a deputy inspector within each army group to uniformly supervise the work of medical staff. The Osa Allied Army and the Sixth Army are no exception. It's a pity that the deputy inspector who was originally on the Western Front disappeared inexplicably. Now that the position is vacant, it makes sense for Kavi to fill the vacancy with Archduke Brecht's message.
But O'Rourke still wanted to struggle: "Deputy Marshal Laming took over the position of deputy inspector. If you have any questions, you can go to him."
Kawei felt helpless after hearing this: "I have tried to find him, but I can't compete with him. So now I am not ordering you as a deputy inspector, but as a junior doctor who wants to discuss the issue of ward cleanliness with you. "
O'Rourke knew that the environment in the tents was very poor, but there was nothing he could do about it. The conditions in the army were like this, so he could only try to overcome them: "As for the environment, you have also seen that we do not have decent buildings in the area where we are stationed. We can only rely on tents to centrally manage those areas. Wounded and sick soldiers, otherwise it would take half a day just to do ward rounds.”
The suburbs are different from urban centers, and farmhouses are scattered widely, which also greatly limits the efficiency of temporary rescue services in using farmhouses.
"But this is not the reason why the tent is unclean," Kawei said. "The rats, bugs, fleas and lice on the soldiers' bodies should all be removed."
"Of course I also like to be clean. Please believe me, no one likes these things." O'Rourke explained, "Especially fleas and ticks. We don't have enough manpower. They are not dust on the ground and can be easily removed."
"That's why we have typhus..." Kawei muttered.
"What did you say?"
"I said that the latest research found that typhus may be related to fleas and lice." Kawei said, "I strictly eliminate rodents and pests in the Olmitz Fortress Hospital on the northern line, and so far I have only seen seven cases of typhus. , and there are no signs of transmission.”
"But we are in the wild here, and the conditions are limited." O'Rourke was a little excited, "You don't necessarily want me to light a pile of straw to fumigate the entire ward, right?"
"I know it's not easy to kill fleas and lice in an outdoor environment, but spraying carbolic acid, kerosene, creosote, and concentrated salt water can all be effective." Kawei said, "At the same time, we can also start from the patient's body. . Wash your body with dilute carbolic acid solution and soap every week, and frequently change clothes and bedding that are exposed to the sun..."
"We don't have creosote, and kerosene is rarely used for lighting. Carbolic acid is only used for surgery." O'Rourke said, "I would like to try concentrated salt water, but I don't know if it will work."
"It's important to wash your body and clothes with soap."
"let me try."
The two had a lot of discussions about the patient's high body temperature, and they had completely opposite philosophies on cooling down.
Kawei clearly prefers salicylic acid, which, although it has quite annoying side effects, can still be used by doctors as long as the dosage is controlled. O'Rourke still insists on shelving salicylic acid. He prefers his own method to this dangerous drug: "If the hen's blood cannot reduce the fever, I will choose to use aniline."
"Aniline...what is aniline???"
"A pharmacist friend recommended it to me and said it was useful for reducing fever."
Kawei couldn't react for a while: "Has it been tested?"
"He should have tried it already, otherwise he wouldn't be so confident."
Kawei felt strange, but just as he was about to say something more, he was interrupted by a knock on the door outside the house. The one who came was the captain of the escort team who had just gone out to deliver a message: "Doctor Kawei, I have brought all the news, but..."
"Just what?"
“There are only two farmhouses that serve as operating theatres, and they are all full.”
Kawei had already been prepared to wait: "It doesn't matter. Traumatized soldiers are more important. I can wait."
"But they said that the operation has been scheduled until noon tomorrow, and you have to wait for more than 20 hours if you want to use it."
Kawei frowned, not because the other party was deliberately targeting him, but because he was considering whether the soldier could survive until that time: "No, he won't be able to bear it for such a long time, and he will need surgery tonight at the latest."
"But......"
Kawei stood up: "What is the name of the surgeon in charge? Where is he now?"
"The name is Donilson. He should be undergoing surgery now."
...
Donelson objected not only to the use of the operating room, but also to the procedure that Carvey described. After Kawei found him, the two had a "intense" discussion about the operating room, the patient's diagnosis, surgical methods and treatment rights.
"As you can see, the operating room is very busy." Donilson only stared at the operating table without even looking at Kawei.
"The operating rooms are all temporarily set up. I can do the surgery anywhere I want." What Kawei really wants is the medicines and equipment here. "I have brought all the emergency medicines and the stock of ether is enough. The main reason is to Disinfect with some carbolic acid."
"The amount of carbolic acid is very small, so I can't give it to you."
Donilson's refusal was quite blunt, with the difficulty written almost on his face: "I think Dr. Carvey should give up this operation. Internal medicine patients will naturally be handled by internists. There is no need for us in the surgery department to wade into troubled waters."
"He has cholecystitis, which has been developing for three days. He won't survive long without surgery."
"What cholecystitis? The gallbladder can also be inflamed? You are just talking nonsense there. I think he just has ordinary abdominal pain." Donelson took the scalpel and cut the skin of the soldier's calf. "Just take some medicine and give him an enema." ”
Kavi was not in the mood to discuss disease diagnosis with him, and just said: "As a deputy inspector of the Military Medical Department, I am requisitioning the use of surgical supplies from you."
"I don't agree." Donilson didn't pay attention to Kawei's rank and title at all. "Don't ask for the reason. It's very simple. This is the Sixth Army, not the Third Army on the Northern Front. You also Don't say I'm being presumptuous, each army's inspectors are different, this is the rule set by the Military Medical Department."
"Even if I can't take over the temporary rescue center, I still have the power to supervise your medical practice."
"No, Deputy Marshal Laming has the final say here." Donilson's hand speed was not slow at all, and the scalpel in his hand has been replaced by a bone saw. "As for whether you listen or not, that is your business. Without Deputy Marshal Laming's order, I would not allow others to interfere with the medical work of the Sixth Army's temporary rescue center, let alone sell any medical supplies to outsiders."
"I have a message from Archduke Brecht in my hand. I am here to support the work."
"Oh? Deputy Marshal Laming agreed to your intervention?"
Deputy Marshal Laming was walking around. Kawei sighed: "Forget it, I don't want surgical supplies, and I won't use your operating room. I will take the soldiers away."
"You don't have the power!" Donilson finally turned back to look at Kavi. The young man in front of him ignited the anger in his heart. "Soldiers of the Sixth Army must die in the temporary rescue center of the Sixth Army. Who can We don’t even have the right to take him away.”
"Of course I have the power." Kawei said, "A lieutenant general always has the power to promote a soldier to become his own bodyguard, and I will go to Garbrentz next, and he will follow him as a bodyguard. I'll go with you."
