Back to 8 a.m. on the 12th, when bed 97 began to suffer from unbearable abdominal pain, most doctors, including director of obstetrics and gynecology Hu Jier, began early rounds. But the surgery department on the other side had already finished its ward rounds, and 24 beds were pushed into the preparation room of the No. 2 surgical theater early.
The person who presided over this operation was Kawei, and it was considered his first operation during this trip to Paris.
Because the operation is not complicated, you only need to find out whether there is stricture in the urethra and whether there are stones in the bladder, and then choose between dilation, conservative treatment, lithotripsy, and stone removal. Therefore, the assistants allocated to Kawei were very limited, and even before the diagnosis and follow-up treatment were clear, there was not even anesthesia.
This is also a small part of the “cons” that come with free treatment.
The daily expenses of such a large hospital are tens of thousands, and it is not easy to maintain it. Some expenses can be saved as much as possible. Of course, doctors are willing to make treatment more comfortable if the patient requests it and pays the right amount of money.
It's a pity that the guy named End Wells in bed 24 has no money and can't afford a cent.
The surgery was unchallenging, even a little boring. As the benchmark for surgery in Paris, the Palais-Dieu Hospital has never been short of such patients, and urethral exploration and dilation are performed almost every day.
Normally, the number of people watching this type of surgery will never exceed 20, and they are mainly medical students. Kawei's appearance today did not bring any major exceptions. There were scattered students in the audience, and only three could really be considered doctors.
Sedillo, Guyon and another urologist from Sabot Hospital.
Giving himself such a bland operation would not make much waves, but since it was for display, Kawei still wanted to do something fancy.
"Today is my second day in Paris. I am fortunate to be appreciated by Professor Sedieu and let me deal with this patient who suffers from frequent urination, urgency and pain in urination."
Kawei signaled the nurse to send the patient into the theater and continued: "If I were in Vienna, I would choose the new endoscopic system originally invented by Dr. Bosini and modified by me. But unfortunately I left in a hurry and could not bring it. , the only option is these (old) expanders.”
He dropped the bait at the beginning and immediately attracted the attention of three doctors.
"Endoscopic system? Is it a urethral endoscope?"
"I remember someone used it before, saying that it can see the inside of the urethra, just like a vaginal speculum. But it is very troublesome to operate in practice, and the imaging effect is not good."
"The urethra is so thin, so there isn't enough light."
"It was really not enough at the time."
After a brief discussion, Cediyo asked the question they were most concerned about: "Dr. Kawi, it's not that we question your level of instrument improvement. After all, any surgeon who is praised by others should have this ability. We I’m curious, how did you solve the problem of the light source of the endoscope?”
"I changed the external candle to a built-in oil lamp. The specific structure will not be demonstrated until my assistant arrives in Paris." Carvey took out an expansion tube and continued, "Two weeks ago, I used it to observe To Mr. Edem's bladder. Although the field of view was limited and unable to rotate, the clarity was passable."
Edem, the patient who a month ago had all the urologists in Paris scratching their heads.
If it can't be cured in Paris, then it shouldn't be cured in the whole world. No one will believe that he has been properly treated in Vienna.
In particular, some doctors who were not optimistic about surgery firmly believed that Edem was only suffering from internal diseases and could recover with a little treatment. Performing random surgeries and wishfully claiming the surgery was successful after the surgery is no different than a liar.
Cedieu, Guyon and another doctor from Sabot Hospital also had this doubt.
But for Kawei, this is not a difficult problem to explain: "Mr. Edem's problem is hematuria. After the operation, his hematuria has basically ended."
The solution of one problem will always be accompanied by the emergence of more problems. If Edem's hematuria is really solved, the solution becomes what everyone is curious about: "Is it really the bladder cancer that the media said?"
"It's definitely bladder cancer."
"You chose to remove the tumor and then suture the bladder?" Juyong could only guess at the method of surgery based on his imagination.
"No, I don't think so! If the tumor is too big, it will be difficult to suture the bladder, and the volume of the bladder will be greatly reduced after suturing, which will still affect the urinary function."
"Should we just cut off the bladder? What to do with the urine? How to store it? I don't necessarily have to pee as much as the kidneys have taken out. I can't live in the toilet?"
The three of them further began to discuss the methods and possibilities of surgery, and the medical students around them were stunned. For these young people in their 20s, the amount of information for a tumor resection is still too much.
Seeing them like this, Kawei smiled and sat between the patient's legs, and began to flush the surgical area with the water that had been prepared yesterday: "I will talk about the surgical process later, but now let's focus on this 24-bed patient. From yesterday morning to now I have only urinated three times, and there are already urine pigs left.”
"It still feels like a stone."
"It shouldn't be large pieces, but small pieces accumulated together. It can't be touched by palpation, but it can also block the urethral opening and cause urination interruption."
"Indeed, there is such a possibility..."
Ende's situation is special, and he refuses to say anything. There are very few clues that can be used for diagnosis. Kawei is really not sure; "Doctor Albaran, help me fix it."
"kindness."
Kawei put on a mask and gloves, lifted the small thing with two fingers of his left hand, and then directly inserted the urethral probe as thick as half a finger. To everyone's surprise, the whole process went very easily. It didn't encounter much resistance when it went down to the prostate, and it entered the bladder with just a little force.
"The process was really smooth...but considering the age of the patient, it is normal that there is no prostate hyperplasia."
Kavi originally thought that the urethra would have adhesions due to inflammation, and Ende would definitely have to suffer a little before entering the bladder. But when the spies went in, he discovered something strange. Apart from the unobstructed urethra, Ende's patient didn't seem to react as violently to the spies as other patients.
"Dr. Carvey, how is the inside of the bladder? Are there any stones?"
Kawei came to his senses and began to rotate the silver rod in his hand, hoping to contact the surface of the stone by bending the swing of his head. However, contact is touching something, but it doesn't feel like a hard stone.
Soft or not, hard or not, what on earth is this?
Even Kawei was in trouble. He was not strong enough to judge the complicated conditions inside the bladder just by relying on the feel of the probe: "I did touch something, but I am sure it was not a stone."
"It's not a stone? What else could it be?"
"In addition to stones, there are other things growing in the bladder..." Guyon thought of Edem, "It's not another tumor, right?"
"No, it's impossible for tumors to be suspended in urine." Kawei didn't give up yet, still turning the silver rod in his hand repeatedly, feeling the touch of the front segment collision, "Wait a minute, this feels a bit strange."
"What's wrong?"
"It's not lumpy, but cord-shaped." Kawei described his judgment seriously, "Yes, it's cord-shaped!"
"What is a cord?"
"Dr. Kawei, you have to look carefully. Are you sure it's like a cord?"
"I..." Kawei was a little skeptical at first, but after repeated teasing, he said, "I'm sure."
This is a situation that no one has ever seen. Whether it is a bladder stone or a tumor, it should not be cord-shaped, and the possibility of a growth similar to a polyp is even smaller. They were confused about the nature and causes of the signs in the patient's body, but Carvey seemed to have made his own judgment.
In fact, this situation is very common in modern times, and many people have this habit. After working in the emergency department for so many years, he has seen everyone from boys as young as a few years old to elderly people who have been retired for many years.
As for why there were no patients in this area in the 19th century, it is not a human problem, but because they were unable to obtain soft and long props without conditions. It's not that hard objects can't be used, but it's because it's difficult for hard objects to completely enter the urethra when used, and it's much easier to pull them out.
If you replace it with a soft rubber tube or other slender props, it will be easy to "miss" during use, causing similar effects.
From the touch on his hand and the reaction when the probe penetrated, Kawei had no choice but to lean towards the foreign object in his urethra. Once you have a suspect, the first thing to do is to confirm it: "Mr. Ende, did you put some things in this that shouldn't be placed randomly?"
Everyone present, including Eun Tak who was lying on the operating table, showed incredulous expressions.
"No, I, I didn't..."
"No?" Kawei looked at him doubtfully and used another force on his hand, "But you don't seem to hate me stirring the stick."
"Hiss..." Ende felt the stimulation coming from below and struggled to control his facial expression, "You are a doctor. The doctor only needs to cure my disease. Why do you keep asking so many questions? "
"Considering the degree of dilation of the urethra, your reaction to the urethral probe, and the shape of the suspicious foreign object in the bladder, I have reason to suspect that this is not the first time you have encountered trouble." Kawei sighed: "This length and The shape requires surgery to remove it.”
"Surgery?" Ende shook his head, "Can I not have surgery?"
“If you don’t do it, you’ll just have to stay in it.”
"Just keep it, but I feel so uncomfortable when I go to the toilet. Can you solve it?"
"So you have to take it out!"
Ende glanced back and forth in the surgical theater and saw that they were all discussing the feasibility of a layman inserting a foreign object through the urethra. His heart was still wavering and he immediately made a decision: "I don't want to have surgery."
Ende looked like he was willing to die to keep the secret, which made Kawei shake his head, but it also aroused his curiosity to know what was in the bladder: "If I don't do surgery, I'm afraid he won't survive a month." .”
"No, don't be joking." Ende said with a smile, "It's not like I haven't experienced it before."
"Oh? Have you ever experienced it?"
Ende didn't bother to explain to him: "I don't do surgery anyway."
After saying that, his cooperation began to decline, and his legs that were originally on the stand began to become restless, as if he was ready to leave the operating table at any time.
The spies are still inside at this time, and any tampering will definitely cause damage. But Kawei believes that a person who dares to stuff messy things into his urethra can definitely do such a thing.
Nowadays, doctors no longer have the absolute dominant position between doctors and patients. Whether or not to treat a patient depends entirely on the patient's own wishes, not the doctor. What's more, the main hospital is free of charge, and there is no financial exchange between patients and the hospital. If Eun-tak insists on not treating him, not to mention Kawei, there will be nothing he can do to him, and even the chief director Sediyo on the stage will be unable to do anything.
Although foreign bodies in the bladder may not have much impact at first, they will definitely cause secondary infections over time. Local infections may lead to stones or more serious systemic infections.
It can range from reoperation to death.
After careful consideration, Kawei decided to stabilize him and persuade him to stay for surgery. Firstly, it was for my own curiosity, secondly, to save his life, and thirdly, I still hoped to get a good start and let the three people on the stage see my skills.
"Don't worry, just listen to what I have to say."
Kawei didn't say much, but calmly exchanged something that the other party could not refuse: "I will give you 100 francs and keep it for the operation."
Eun Tak was stunned.
All the medical students and the three doctors in the audience were also stunned. They had only seen hospitals free of charge, but never seen doctors giving money to patients in return.
"What did you just say? You gave me 100 francs?"
"Yes, it's quite a lot." Kawi turned back to look at Sedieu who was sitting in the audience with a surprised face, "But I don't have any money with me. I will have someone bring it to you after the operation is over. Of course. , if you are afraid of being cheated, you can first ask Director Cediyo to get the money."
】
"Hey, Dr. Kawei, you..." Cediyo was stunned.
"This is a good case." Kawei asked, "Don't you have any interest in his bladder? Don't you want to see what is hidden in the bladder?"
Guyon was the first to stand up: "Teacher, I think 100 francs is worth it. Teacher Kaushik, what do you think?"
"He's the one paying for it anyway, so of course I have no problem with it."
Cediyo had no choice but to take out a hundred-dollar bill from his pocket and have it delivered to Ende: "It's getting late, find someone to pour some ether into him, and then start quickly."
...
The operation itself is still not difficult, but the surgical method chosen by Kawei is different from the mainstream vaginal incision for stone removal, but a suprapubic incision.
In the first step, after finding the bladder inwards, use silk thread to sew two needles for traction on both sides, make an incision in the middle, and insert a suction device into the bladder to drain out the urine. 【1】
In the second step, use your fingers to probe into the bladder to find the location of the foreign body, and then use the stone forceps to pinch out the foreign body under the guidance of your fingers. 【2】
The shape of the foreign object in Ende's bladder meant that it would not be difficult to retrieve. Soon a dark rope-like thing was pulled out of the body by Kawei. Everyone was excited and began to guess what it was.
"What's this?"
"Cloth?"
"A rope? Or some kind of metal?"
"It could also be wood, it looks soaked."
"No, none of them." Kawei frowned and looked at the thing carefully, and a strange but reasonable idea suddenly popped into his mind, "This should be the tail of an animal. If I guessed correctly, It probably came from a very fat rat."
"Why did he put the tail of a dead rat into his urethra? Is he a pervert?"
Kawei smiled: "How can you be sure that the mouse is dead?"
