Foreign bodies in the bladder have always had a place in emergency surgery. They are not uncommon, but cases are encountered from time to time.
The general treatment method is to use a transurethral cystoscope for exploration. If it can be removed, it can be removed. If it cannot be removed, the only way is to do a suprapubic cystotomy like Carvey is doing now. In principle, most foreign bodies that can enter through the urethral orifice can be removed in reverse. Modern urological instruments include forceps, small hooks and various dissolving solutions, which are sufficient to cope with most situations.
But there are always surprises. Patients can do whatever they want when inserting foreign objects, but doctors still have to follow the most basic anatomy of the human body when removing them. For items that are too large or difficult to pick up, the only option is to cut them open.
"The total length of the rat tail is 8.6cm." Kawei displayed it in front of everyone.
"Dr. Kawei is really knowledgeable. It seems he really needs a live rat to be effective."
"It's too exaggerated. Is this really something a human can do?"
"I guess he went in alive and was about to pull it out after using it. Suddenly he encountered an accident. He chose to cut off the tail directly. As a result, he didn't reserve the length to take it out, and it got deeper and deeper."
"Let's put aside his identity and messy life and just talk about the logic of the whole thing." A medical student asked, "Why do we need to dock the tail at this time? Isn't it better to just pull it out? What if the mouse escapes from the restraints? , wouldn’t it be faster to just pull it out?”
Another medical student followed the train of thought and said, "Isn't this the tail that was forced to be docked, but the one that he actively cut off and left inside?"
"Maybe, maybe, maybe I need to reflect on it?"
"No wonder I have to say it, it's so perverted!"
"Shame on the French!"
"Oh, don't throw dirty water on your own country. This person is probably a British guy." The medical student just described it with great disdain, "Look at his face, he looks dissatisfied with desire. I haven't seen him yet." I have never seen anyone who can enjoy it so much after inhaling ether."
"I can't imagine whether his purpose is to torture himself or not." Sedillo couldn't bear to look at the 100 francs he had paid, and just hoped to end the operation as soon as possible. "Forget it, Dr. Carvey, do the finishing sutures quickly, we still have to do it." To prepare for 13 beds of rectal cancer.”
Kavi's surgery was neat, and Ender's bladder was particularly wonderful, not just because of the decaying rat tail, but also for other things.
"Professor, I'm afraid this won't work." Kawei's tweezers encountered something else in his bladder. "This bag is not that simple."
"There won't be any more, right?"
As soon as he finished speaking, the tweezers picked out another thinner object: "It looks like a plant, with a soft texture. It should have been soaked for a long time."
"Looking at the shape, it should be the stem of a plant."
“Do you have to visit all the animals and plants?”
Kawei placed it on a metal plate, carefully unfolded it with tweezers, and explained: "I have to thank Professor Bertus from the Medical School of the University of Vienna. The botany he taught me is still fresh in my memory. At the same time, it also made me You can accurately recognize that this is a dog's tail grass."
"."
"Oh? Is it that fluffy dogtail grass?"
Someone suddenly mentioned it, causing the others who were still immersed in the shock of the live rat tail to take a breath: "It's plush. This is too exaggerated."
"Outrageous."
"Unbelievable! Absolutely disgusting!"
"When will the Cathedral Hospital get rid of this kind of patients? They are just discrediting this church hospital. Before the Renaissance, they would have been beaten to death!"
The reason why they took half a breath of cold air was because the remaining half breath had to be left for something, something that even Kawei, a surgeon who had been tempered by modern foreign objects for decades, could not distinguish it with the naked eye. .
He frowned and looked at the foreign object picked up by the tweezers. He repeatedly searched for items to compare with in his mind. After hesitating for a long time, he could only choose a similar object: "Is this cotton?"
"It's also possible that it's a growth on the bladder itself."
"No, I have never seen such a growth." Kawei shook his head and said, "My father took care of hundreds of cases of bladder stones and urinary retention patients in Italy. Whether it was what I saw with my own eyes or what he recorded, This has never been the case."
"What could that be?"
"The chances are low with cotton because it doesn't hold its shape when it goes into a small space."
"This is not a problem for people who are used to stuffing things." Kawei explained, "It only needs to be wrapped in a hard and slender wire to send it in."
"Oh yes, there is another way"
The foreign body is surrounded by cotton wool, and the end is still somewhat adherent to the bladder wall. After a simple separation, Kawei laid it flat on a metal plate, rinsed it briefly with water, and began to calculate its length:
"The size of the foreign body was about 3*4*1cm when it was taken out. After unfolding, it was in the shape of a 12*1cm long strip, similar to cotton cloth. It may not be cotton cloth! Dr. Albaran, please take it for a biopsy and pathological examination."
"OK."
The three large objects left the bladder, eclipsing the two iron nails that were salvaged next. Finally, the suturing of the bladder and lower abdominal incision, which all medical students should learn, was also submerged in the saliva discussing the weirdness of foreign objects.
In fact, even Guyon and Sediyo were attracted by Ende's bladder. The only one who noticed the difference in Kawi was Kaushik sitting next to them: "Doctor Kawi's technique is really special."
"Huh?" Cediyo finally came back to his senses, "What's so special about it?"
"Didn't you see? His suturing was not just done with his hands, but with the help of a pair of short-nose pliers to tie the knots. The artistic perception may be a bit inferior, and it is not as ornamental as knotting with both hands. But if you consider The patient, his movements are quicker, his hands are more stable, and the knots are less likely to slip."
Kaushik stood up, put on his hat, lifted the cane leaning on the side, and said with satisfaction: "It seems that I did not come in vain this time."
"you are leaving?"
"The surgery is over, of course I have to go back."
"I will have my rectal cancer surgery in the afternoon, and he will also participate."
Kaushik smiled and said: "There are specialties in surgery. There are many things worthy of study in urology alone. Why bother to torture yourself with complex rectal cancer. I have something to do in the hospital, so I will leave first. Oh, by the way, I hope Professor Sediyo can send a message to me."
Cediyo's eyes were still looking for the so-called short-nose pliers, but Ende's incision had already been sutured. After two back and forths, he still chose to give up: "Can't you just say it yourself?"
"You know I'm not good at sociability." Kaushik looked at Kavi who was doing the aftermath work in the audience and said, "Please tell Dr. Kavi, I will definitely prepare several suitable cases for him to choose from."
The operation has ended, and there is really nothing to see. Cediyo also stood up and prepared to leave: "Although I want to say that missing the rectal cancer operation is a big loss for you, but... forget it."
At this moment, the door of the operating theater was rudely opened.
The person who rushed in quickly was Dr. Peang, who had been doing the rounds with him last night, but his face had long lost the calmness that should be expected from the top surgical department of the Palace Hospital: "Doctor Kawei, something big happened to Dr. Kawei!"
Just one sentence kept everyone in the venue.
"What's wrong?" Kawei had already guessed most of it, but still wanted to confirm, "It's not the girl in bed 97, is it?"
"Yes, that's her!"
"You can't be fainting from abdominal pain, right?"
"Yes! You guessed it right!!!"
Kaushik, who was about to leave on stage, did not expect that there would be an after-show. After listening to the conversation between the two, he became interested. He turned around and looked at Sediyo: "What's wrong with your bed 97? They all look nervous. "
"Severe abdominal pain, mild vomiting, and no diarrhea." Cediyo briefly stated the main complaint. "Originally, we gave a diagnosis of enteritis and appendicitis, and planned to perform a resection today. Later, Dr. Kawei thought it was an obstetrics and gynecology problem. , called that stubborn old man. The result..."
"Haha, someone was robbed."
Kaushik also knows Hugier. The three of them are all students who graduated from the University of Paris Medical School. They are only one or two years apart from each other. They know the basics: "Why is that guy so domineering now? He doesn't care if something happens to the person he robbed." ?”
"I don't know that."
Although the girl's symptoms were vague, in modern times further examination is needed. However, considering the basic concept of acute abdomen and the current lack of imaging for diagnosis, it is necessary to appropriately expand the indications for laparotomy.
Regardless of whether the previous diagnosis of ectopic pregnancy was right or wrong, laparotomy is now necessary.
"Where's Professor Hugill?"
"He is already undergoing treatment, but the effect is not good. The girl is not responding. I think he is also hesitant and doesn't know what to do next." Peang wiped it out, "He asked people to come to you and Teacher Sediyo. , but I didn’t say I needed surgery, I just wanted you to go and have a look.”
"People are like this, what are they waiting for?"
Kawei took off his leather skirt and followed Payon out of the surgical theater before he could wash his hands. Seeing the change in the situation, everyone else in the venue stayed, including Kaushik, who wanted to leave just now: "I feel like there will be another surgery next."
"Don't you think abdominal surgery is too complicated and you want to leave?"
"This is different." Kaushik sat directly back to his previous seat, "What I mainly watch is not the surgery, but the conflict between this young man and the old stubborn. Of course, it would be more fun if the two of them can do the surgery together. .”
"You still have such a bad taste." Cediyo sighed, "It's too immoral."
"What's wrong? Don't you feel happy seeing him being slapped in the face?" Kaushik took out his pipe from his pocket, pressed a handful of tobacco leaves on it, and asked Guyon to bring a candle over and light it lightly. "He was the one who denied it first. Surgery, break away from surgery, belittle surgery, say surgery is barbaric. Why, you are not allowed to watch the show after being slapped in the face? "
"What if he wins?"
Cediyo looked at his old friend's face and asked: "The development of the obstetrics department of the Palace Hospital is all due to him. After so many years, if he had not always advocated not to have cesarean section, I don't know if there would be any How many women are dying on the operating table.”
Kaushik blew out two puffs of smoke rings and said nonchalantly: "I'm not a woman, it's none of my business!"
Cediyo knew that his old habit had happened again, and his face turned cold: "Be careful, old classmate, I am different from you. I have a wife and a daughter."
"That's really embarrassing." Kaushik took a deep breath of cigarette and continued his sexual intercourse, "But I have to remind you that when a man was suffocated to death by urine because of his prostate, no one came out to stop it. Operation."
The two started talking about old friends and ended up talking about men and women. Although their ideas were different, their enthusiasm for surgery was the same.
Things developed in the direction Kaushik had just guessed. Fifteen minutes later, Kavi and Hujir appeared in the surgical theater together. Kawei and Peang, who came to the theater with him, prepared surgical instruments, and the opening remarks were personally hosted by the director of obstetrics and gynecology Hujir.
But just as he was about to speak, he saw Kaushik smiling and waving to him, and his mouth felt as if he had eaten a fly.
When things got to this point, it was impossible to go back on his word. He would never allow others to take away the girl from his department, nor would he allow her to die in his hands due to obstetric problems.
Of course, Hugill was not always stubborn. In order to respect his self-esteem and avoid unnecessary embarrassment, he still made some modifications to his rhetoric:
"Next was a temporary additional surgery, which was first performed by Professor Sediyo, the director of surgery. Because the diagnosis was unclear, I was found for a follow-up visit last night. At that time, it was considered that the patient had already lived a sexual life and had no obvious indications for abdominal surgery. It has symptoms, so it is temporarily placed under the management of the maternity ward."
In just two ordinary sentences, the responsibility was inexplicably pushed onto Cediyo's shoulders. This made Cediyo, who had been speaking for him, intolerable: "Old man, didn't you steal this patient?"
"Professor Sedieu, we are in the surgical theater now, not your surgical ward. Please respect yourself."
"If you hadn't blocked her, she would have undergone surgery last night!"
"Stop joking, you dare to do surgery without clear indications of appendicitis? What if there is nothing in the stomach after the operation?" Hujier argued with reason and retorted, "In the end, will you really stand up and be the surgeon? ? I’m afraid he will use the excuse that he had a less than successful gastrectomy operation in the afternoon to throw the blame to Dr. Carvey, who has just arrived in Paris not long ago."
"You!" Cedieu directly broke through the defense and asked, "You haven't had an operation for more than ten years, can you still use a scalpel now?"
"It's none of your business, at least I dare to go on stage!"
"Go on stage and kill the patient?"
"You killed one yesterday afternoon."
"."
The theater was filled with the two's mutual criticisms and Kaushik's hearty laughter.
This is not the first time the directors have quarreled. In the eyes of the surrounding medical students, the two people's scolding battle seems to be more exciting than the new opera at the Paris Theater. It is thrilling and at the same time satisfies their desire to peek into the privacy of their superiors. .
However, this kind of excitement is short-lived, and no matter how bad the relationship is, it is impossible to bring it to the operating table. When Kawei prepared the ether and equipment, the two people's mouths stopped at the same time.
Hujier took two deep breaths to calm down his excitement and his nervousness after not being on stage for a long time.
He explained in detail the necessity of the operation: "The patient's abdominal pain worsened an hour ago, and he soon progressed to a syncope state. Considering the previous appendicitis and obstetric-related diagnoses, an exploratory laparotomy was performed with the consent of his family. I did it together with Dr. Kawei from the Austrian Municipal General Hospital.”
"Give me the scalpel."
The opinions in this chapter belong only to the characters themselves and have nothing to do with the author.
