1 pm.
Kawei stayed alone in a cafe not far from the hospital, holding a newly bought newspaper in his hand and drinking coffee absentmindedly.
Since leaving the war front, it had been a long time since he had performed two surgeries in one morning. The body is definitely not tired. Compared with the original high-intensity working environment, this place is simply paradise. However, this does not bring any benefits, but makes Kawei feel tired.
Surgery in Paris is much more difficult than in Vienna. It doesn't matter what you need. Even the normal saline to maintain the total body fluid cannot be prepared in advance. The ectopic pregnancy surgery just now consumed all the pituitary gland extract and sodium citrate, so he had to recommend that the surgery be postponed.
Kawhi certainly has his reasons.
The location of rectal cancer itself is awkward, and the tumor in bed 13 is close to the dentate line, making it even more troublesome to deal with. Coupled with the lymph node dissection during the operation, the large number of blood vessels and complex tissue structure anatomy of the pelvic floor, this operation looks "big" no matter how it is done.
There is no preoperative examination, stable intraoperative anesthesia, physical sign monitoring, or decent drug support. If the sodium citrate used for blood reinfusion and the pituitary gland extract used to stop bleeding during the operation are lost at this time, the operation will lose the final protective barrier and the fault tolerance rate will be zero.
Perhaps the rules of modern surgery are too thorough, and Kawei would not perform this kind of surgery unless it was absolutely necessary.
"Professor Sedieu, the last resort I'm talking about is the girl in bed 97." Kawei put down the newspaper and coffee cup and waved to the waiter, "Can you give me another piece of paper?"
The waiter looked at the three pieces of paper with sketches of anatomy and surgery on the table, and said in his heart: "Okay, please wait a moment."
"I admit that the abdominal approach you mentioned requires a lot of surgical steps, involving surrounding lymph nodes and blood vessels." Cedieu turned over the back of the densely drawn paper at hand and drew another picture, "I chose the sacrum. Caudal approach, cut off the tailbone, and then do the resection directly facing the rectum.”
“What to do about the sphincter?”
"Avoid the sphincter and only remove the tumor," Cediyo said. "The digital examination has already identified the location, so there should be no impact."
Regardless of whether the sphincter can be saved, Kawei first mentioned the common complications of the sacrococcygeal approach to him: "It is a good method, but I think that although the anatomical structure of the approach is simpler, it can easily cause intestinal fistulas."
"Intestinal fistula?" Cedieu frowned, and soon his mind was filled with all the negative effects of this word. "Intestinal fistula...is it because of the infection you mentioned before?"
"right."
Kavi took the fourth piece of white paper from the waiter, picked up the pen and started writing something of his own: "French surgeons don't seem to care about 'infection', which is the excessive bacterial growth in the wound advocated by Mr. Pasteur. The harm caused by growth.”
"I have indeed heard of it, but is this statement really reliable?" Cediyo glanced at Kawei's paper, "You are writing..."
"The surgical records will be sent to Professor Hugill later."
Kavey continued to explain: "The concept of 'infection' is very new and has a wide scope, but Mr. Pasteur is not the only one who proposed this point of view. Dr. Semmelweis proposed it more than 10 years ago, and now including Lister The doctor and I firmly believe that the culprit of ulcerated surgical wounds is bacteria.
And I personally even feel that as long as surgery exists, infections will be with it. After all, the world is full of those little things. "
Compared with those die-hards who cling to the old principles, the also stubborn Sediyo appears to be more rational. What Kawei just said has a close logical relationship and cannot be dismissed casually with just a guess.
In the process of "surgical incision - incision infection - tissue swelling and inability to grow - increased leakage - incision ulceration - further infection", adding bacteria as a medium can work perfectly...
But in fact, if you don’t understand the operating mode, it would make sense to put other things in it.
"So we all tried 'disinfection,' which means cleaning anything that comes into contact with the incision surface, even the air and all the doctors' hands," Kavey explained. "I went a step further and even did it on the nose and mouth. blocked."
"So thorough?"
"Everyone has a microscope, so why wouldn't they do a culture similar to the wound environment? It won't take long."
Kawei shrugged his shoulders and continued: "Besides, we are all doctors, and the patient's health is our only pursuit. As long as it is beneficial to the patient, no matter how outrageous the new theory is, you can still give it a try. In fact, this The new theory has already gone through a large number of clinical trials, and the mortality rate has dropped significantly."
Cediyo was willing to listen to what Kawi said so much simply because he could not deal with intestinal fistulas after incisional ulceration. This was also a key factor in the fact that surgery had never truly entered the abdominal cavity.
Cediyo is very afraid of intestinal fistulas. To be fair, without Kawi, who has proven that he can stably handle the abdominal cavity, he may not dare to use the sacrococcygeal approach: "In this case, I think it is better to choose local resection through the ganglia."
"After all...there's another issue to consider," Kawei said, "the expansion of the tumor."
"Are you afraid that I won't be able to cut it cleanly?"
This is what Kawei meant, but he still chose a more modest statement: "Professor, who can say now with a pat on the chest that he will be able to remove the tumor completely? Look at breast cancer, I am doing breast cancer for Countess Giustina It took a lot of effort to remove the cancer.”
Although Cediyo has dabbled in breast cancer, he doesn’t know much about it.
Justina had approached him at the beginning, but they ended up unhappy because he could only perform resections, but he could not perform reconstruction, and he could not guarantee that it would never relapse.
After hearing that Kawei chose such a typical example, he seemed to be aroused with some kind of self-esteem: "I also heard that Dr. Kawei used two operations to not only remove the countess' tumor, but also reconstructed her Your house. I am a little curious. I wonder how the countess is doing now? After all, she may not have been back to Paris for a long time. "
"It's good," Kawei said. "If everything goes well, she will be back soon."
"oh?"
"Didn't the professor read today's newspaper?"
"No."
Kawei handed over the newspaper: "Read this report." [1]
"I'm really coming back..."
Sedillo thought that in four days, Carvey's breast cancer surgery would be news spread to every corner of France, and he felt bad. This is not because of jealousy, he is indeed jealous, but now it is more because of his pride as the director of surgery at the Main Palace Hospital.
This kind of self-esteem will break through the seemingly solid defense line in an instant, causing the original judgment to suddenly change: "Let's go back to the 13th bed."
"Oh, yes." Kawei also regained his train of thought, "I suggest you wait a little longer and wait until this train pulls into the Paris train station. I promise to take them to the operating table of the Palais-Dieu Hospital within two hours."
"...I still can't see it." Cedieu packed up his things, Qi Qi also put the three pieces of paper into his backpack, "I will still choose today."
Cediyo's disapproval was beyond Kavi's expectation, but the doctor in front of him, who was over sixty years old, had a simple idea in his mind, which was to create a bigger news. In his opinion, complex rectal cancer surgery fully qualifies for this.
"Okay then." Kawei did not choose to cater to him, but gave him a head-on approach. "Then I wish the professor a smooth operation."
Cediyo looked confused: "What does Dr. Kawi mean?"
"After all, you are a patient of the Main Palace Hospital, and the surgical plan is all made by you. I am just giving suggestions." Kawei finished the operation record, and then signed his name, "Replacement is more suitable. An assistant you are used to operating with will definitely make the surgery go more smoothly.”
This is not the result Sediyo wanted.
Although he had studied the surgical procedures for rectal cancer and discussed the possible risks of various approaches with Kawei, he was unsure. This is a state that results from thin technical practice and is impossible to overcome on your own.
There was a fork in the road before him now.
On the left is a local resection of rectal cancer performed by gang. The operation is simple and requires few operations. Although the amount of bleeding is large, it is within a controllable range. Cediyo is confident that he can do it well, but the smaller the risk, the smaller the benefit. The "benefits" brought by the gang operation are difficult to convince him.
On the right hand side is the sacrococcygeal approach just mentioned. The operation is simpler than that of the abdominal cavity, but it still faces the huge risk of intestinal fistula. But this is the first case in the world of rectal cancer resection using the sacrococcygeal approach. As long as it is done, the patient will not die on the operating table, which will earn him fame. 【2】
If complications are avoided, his reputation will have to go up at least one level.
Therefore, he had selfish motives in asking Kawei to be his assistant, because only in this way could he safely perform the sacrococcygeal approach.
Now this auxiliary external force suddenly disappeared, and Cediyo suddenly retreated to this fork in the road.
Once you have the expectation of success, it will be very difficult to change the surgical plan. He didn't know if he could withstand the pressure of the operation, but in any case, out of the character that an old gentleman should have, he did not force Kavi to stay, but he just felt it was a pity:
"Okay, externally I will say that you have had two surgeries in a row and you are tired."
"Thanks."
"No, you have blocked two big thunderstorms for our hospital, and we have to thank you." Cediyo stood up and put on his hat, "It's getting late, I'll go back now."
Upon seeing this, Kawei also stood up and handed over the surgical record [3] in his hand: "Professor, please hand it over to me. I want to walk around today and won't go back to the hospital."
"No reply?" Cediyo took the record sheet, looked at it twice, and asked, "What about the previous 24 beds? I have never seen such patients."
Kawei thought of the pathology results given by Albaran after the previous ectopic pregnancy surgery [4]. Even he could not have imagined that someone would spend time and energy to specially process ingredients in order to get "enjoyment"...
But no matter what, this is just a hobby, and it is not to the point where outsiders cannot tolerate it: "What else can I do? Just disinfect the incision."
"That's not what I meant," Cedillo asked. "I mean, shouldn't he be sent to a mental hospital?"
Kavey knew what a 19th-century mental hospital meant, and it was almost impossible to get out of there alive. But mental illness is not within the scope of his treatment, and all he can do is make suggestions: "I don't know much about mental patients, but mental hospitals are not a good place. From a surgical perspective, I still recommend treating them as normal people. "
"why is that?"
"It's just a behavior similar to self-mutilation and does not harm others." Kawei said, "Besides, the development of surgical technology is closely related to the number of patients..."
Foreign bodies in the bladder are very rare, and Sedieu also understands it well: "In order to maintain the number of sources of disease...Okay, I will talk to Guyon."
...
This was just a simple chat in the coffee shop, but Kawei could feel some unusual sights.
He knew that it was Mick who was protecting him. The task was urgent and heavy. Maybe the people were hired temporarily. They had limited experience and insufficient acting skills, and the glances they glanced at from time to time made him very uncomfortable.
Of course, Kawei didn't mean to question Mick's work, if it was just the awkward sight, forget it.
But now there was a note in his coat pocket, which only said the time and place, and nothing else.
The time was very late, and the location was far away from the hotel and the main hospital. He couldn't make a judgment, but he already had a tendency in his heart. Paris is unfamiliar with the place, at least until the other party actually shows up, he will never take risks.
After Cediyo left, Kawei called the waiter over again: "Excuse me, can you give this note to the two gentlemen sitting at the table near the door."
"The table near the door..." The waiter looked up and couldn't help but murmured, "Oh, it turns out it's them. They ordered a cup of coffee after sitting there for more than two hours."
Kavi wrote a sentence on the note and casually put the note and a 10-franc tip into his hand: "Trouble."
The waiter immediately changed his previous attitude, and the smile on his face became much more genuine: "Sir, do you have any other instructions?"
"The rest..." Kawei suddenly changed his mind, took back the note, pointed to the place name and asked, "I want to ask, what kind of place is this?"
"Well, it should be a small road in the Pigalle district. I don't remember where it is." The waiter looked down and suddenly laughed, "Actually, as a guest, going to Pigalle is very cheap. It’s better to go to the theater.”
Kawei didn't understand what he meant, but his smile said a lot: "Okay, I understand."
"The note..."
"Well, let's give it to them."
