Nineteenth Century Medical Guide

Chapter 478 474 Nothing is absolute in the world

Paris was getting hotter in July, and the slight coolness brought by the morning dew disappeared completely under the gradually rising sunlight.

Kavi turned over, his head feeling dizzy.

Last night, I returned to the hotel from the laboratory and went to bed hastily with the exhaustion of these days. Although I made up for the sleep time, some of it seemed to remain in my mind in the dream.

He opened his eyes and looked at the clock on the white wall. It was 9 o'clock.

Light shone through the gap in the curtains. It was daytime, which meant 9 o'clock in the morning, not at night. There were still more than four hours before the surgery.

Kavi anchored the time and synchronized his brain with reality, and only then did he wake up completely. His heart, which had been constantly worrying about the operation time, process, and prognosis, also relaxed a little.

He changed his sleeping position again, closed his eyes, and enjoyed the rare ten more minutes in bed.

Ten minutes later, Kavi got up, gently pulled open a corner of the curtain, and looked down at the hotel through the half-open window.

After the "special training" of the men in black, the reporters' poor disguises could hardly escape his eyes. These days, the coffee shop across the street had already become a temporary headquarters for reporters. Even Kavi had to spare a little space in his brain to remember these faces, which showed how high their attendance rate was.

This operation was two months in the making. From almost giving up, to carrying out animal experiments under pressure, to blood vessel cutting and the final operation, they must have gone crazy.

This was unimaginable for the surgical community in the 19th century, who would decide on surgical plans on a whim and then immediately operate once the plan was decided.

If it weren't for Holt's constant promotion of the operation, which occasionally released new information, people would have long forgotten that there was such an operation that could subvert everyone's assumptions. After all, in the past two years, Cavi has subverted too many medical perceptions, and everyone has long been accustomed to it.

But in his eyes, the pros and cons of publicity are mixed, so they become insignificant. What really matters is the operation itself.

The results of arterial blood vessel harvesting are quite good. Landreth's technology has grown rapidly in the past two months, and his efficiency has become increasingly higher. Now there is enough blood vessel material available, enough for matching and screening during surgery.

After working overtime until nine o'clock last night to complete the processing of the last batch of corpses, Kavi dismissed the surgical team, hoping that they could get a good night's sleep and recover their strength.

That was all they needed to do, and that was his order.

But as the surgeon, just recovering physical strength is far from enough.

After washing up and eating the breakfast sent by the hotel, Kavi stood by the table and used a knife and fork to simulate the surgical process. From laparotomy to vascular stripping, from clamping to incision, matching, anastomosis, and recanalization. Even if a lot of repeated processes were omitted, it still took more than half an hour.

After finishing, he did not forget to insert two unexpected situations.

Sudden tumor rupture and anastomosis failure are the most serious complications. The surgeon and the first assistant need to stop bleeding quickly, and the second and third assistants need to prepare for suction + autologous transfusion. The nurses also need to quickly replenish fluids and monitor vital signs.
Half a year ago, only the surgical team at Vienna General Hospital in the world had this level of cooperation.

Half a year later, the doctors and nurses of the main palace hospital were trained by Kawi. Their proficiency was not as high as those who had experienced the Austro-Prussian War, nor did they have their tacit understanding, but at least they would not hold Kawi back.

Although the hard conditions for the operation have been met, Kavi dare not be negligent. Any omission will lead to unpredictable consequences.

His hands moved faster and faster, and beads of sweat appeared on his forehead.

Ding, ding, ding. Eleven o'clock.

Kavi put down his tools, quickly put on his coat, held his hair down and put on a black hat, picked up his cane and suitcase and left the hotel.

While the reporters were still standing in the midday sun, wondering when he would go downstairs, Kavi avoided everyone's sight, quietly blended into the crowd, and boarded a public carriage to the hospital.

Compared to Kavi, Holt, who seemed to have little to do with the operation, seemed more nervous.

It was he who approved the animal experiments before the operation, the experimental funds and venues, and he was also the one who promoted the operation behind the scenes.

As the surgery date approached, he said calmly, but he felt increasingly uncomfortable in his heart, to the point where he couldn't work normally, fearing that Cavi's surgery would fail and trigger a chain of effects.

Kavi could return to Vienna to avoid the limelight, but with the title of "Father of Caesarean Section", even if he did nothing else, he would always be a leading surgical figure in historical records.

But he, a small president of a surgical association, is not enough to fill the gaps in public opinion.

After torturing himself for two days, he simply turned down all his work and focused on preparing for the operation.

Let’s start with the audience.

Unlike in the past, visitors this time underwent more stringent approval.

The initial requirements were a PhD degree from Paris Medical School + a Paris surgeon + at least one abdominal surgery. The six selected people were arranged in the nearest VIP seats.

For the following 1-3 rows, the condition was relaxed from "having performed one abdominal surgery as the main surgeon" to "having served as a chief surgeon for ten years."

4-6排属于参与过卡维解剖课的医生，7-9排由那些颇有潜力的年轻外科医生和顶尖内科医生组成，9排之后则留给了各大医学院最拔尖的医学生们。

Such a strict screening threshold naturally makes some people who want to take advantage of the situation give up. The random drawing of seat numbers after arrival also avoids private chats between old friends during the operation as much as possible, reducing interference to the minimum.

This approach immediately attracted criticism.

Since there are identity restrictions, their professional level should be recognized. The so-called private chats are also discussing surgery and should not be restricted.

The surgery was difficult and the hands were fast. If you were not careful, the details would slip away. Everyone's knowledge of anatomy was different, and when they encountered problems, they discussed with each other to find out the gaps.

"Excuses! All excuses!"

At this critical moment, he didn't give anyone face: "Knowing that it was an abdominal aorta surgery, didn't you prepare for it in advance? If you really encountered any difficulties, you can talk about it after the surgery is over, or during the operation? Can you keep up with his speed? Are you going to let Kavi wait there and wait for you to finish talking before you start?"

Everyone was speechless.

The few remaining troublemakers were about to speak out when Hott scolded them again: "If you have any objections, just refund your tickets. There are a lot of people at the door who want to come in and watch. Otherwise, I will ask them if they are willing to abide by the rules. It seems that we will have to give the ticket collectors a simple test in the future! If you are unwilling to learn and remember even the most basic anatomical knowledge, you are not qualified to enter at all!"

Having said that, it was like killing a chicken to scare the monkeys, and no one dared to act rashly anymore.

Before the operation even started, the atmosphere inside and outside the theater was tense. The audience on the sidelines were nervous, fearing that they would be driven away by Holt and miss the chance to witness Kavey's operation. The medical staff on the scene were also nervous, worried that they would make a mistake and ruin the entire operation, and even more afraid that they would be eliminated and would never be able to join the group to work with Kavey again.

Landreth is under the greatest pressure, not because he has a weak ability to withstand it, but because as long as he serves as Kavi's assistant doctor, the pressure will be infinitely magnified.

Standing in front of you is a flawless and constantly innovative surgical machine, which is always watching your every move. Any slight mistake will be pointed out and modified by it. Sometimes you have to be publicly executed in front of the audience. Just thinking about it makes my scalp tingle.

Others have their own troubles.

Albaran was afraid that he would be too slow to react and couldn't keep up with the pace; Holmes was standing in the center of such a magnificent theater for the first time, and he couldn't stop shaking all over; James and Wade held a small notebook, worried that they would mix up the names of the surgical instruments.

As Peon, Betha's bedside doctor, the heavy atmosphere made him feel suffocated.

It's not just the technical pressure, but also the pressure of the cumbersome preoperative preparation process.

Blood type matching, methylene blue rehydration dosage ratio, crystalloid preparation, 12-hour fasting and 4-hour water ban, the patient's sleep quality, whether the catheter is properly prepared, vital signs, 24-hour urine volume, whether there are bleeding spots on the skin and mucous membranes, etc.
These are all the preoperative preparations that Kawi required, and none of them can be missed.

What is more troublesome is people.

Bertha was young and had experience with the previous surgery, so she walked into the operating room alone without crying or making a fuss. But her mother, Veronica, who was always by her side, had a subtle change in her mood.

As time went by, her initial sadness, helplessness and gratitude slowly dissipated, replaced by confusion, worry and fear of surgical failure.

Bertha was going to perform the world's first abdominal aorta transplant surgery. She didn't know what the abdominal aorta was, and could only rely on the scar on her daughter's body that had just healed to guess the surgical process.

Open laparotomy is difficult in itself, and Bertha was still a child, so she had to undergo a second laparotomy. Even though Peon had always emphasized that the surgery was safe, Veronica was still worried.

She was worried that once Bertha got on the operating table she would never get off, so it would be better to do nothing.

Aren’t you living a good life now?

"The surgery time has been set long ago, and the theater is full of people. You say you don't agree to the surgery now?" Peon took out the medical record board and flipped through the surgery consent form she signed a month ago. "You agreed to Dr. Kavi's advice and signed it!"

"That was two months ago, and now I don't agree!"

"What about the expenses? Hospitalization fees, surgery fees, nutrition fees?" Peon pointed outside the door. "That long stone bench in the small garden outside the theater, what did you promise Dr. Kavi? How did he help you? Have you forgotten everything?"

"No, that's different! I will pay you back, seriously!"

"You probably don't know the effort and time that Dr. Kavi spent on this operation. The tens of thousands of francs are secondary."

".I really don't want to lose Bertha!"

The more they talked, the more Veronica understood the dilemma she was in. Tens of thousands of francs were already an astronomical sum, and she couldn't even pay the interest. She could only protect Bertha like a lioness, not letting anyone get close to her: "She looked good in the past two months, she was able to eat and sleep, and she even gained weight. She's healthier than ever!"

Payon continued to explain: "The hemangioma in her body will only get bigger and bigger. There is no possibility of improvement without surgery to remove it."

"It doesn't matter if it doesn't get better, as long as you can stay alive."

Peon spread his hands and looked up at the ceiling, not knowing how to explain: "Veronica, I told you last time that even if the hemangioma does not worsen, she needs to maintain a low heart rate and blood pressure for life. Once the heart rate and blood pressure rise, even if it is just an occasional fluctuation, the hemangioma will be impacted! Once it ruptures, how can you let her live?"

"I really don't have the courage, really. I'm really afraid of losing her. Please, don't do the surgery, okay?" Veronica put her hands together, bent over and kept talking to Peon, "If it really doesn't work, wait a few days and let me think about it again."

"But most of the surgical profession in Paris is here."

At this time, Kavi walked into the temporary ward in the operating theater.

After handing his hat and cane to the nurse, he walked forward under everyone's gaze and took the medical history book in Peon's hand, which was as thick as a medical textbook. "What happened?"

"Doctor Kavi, the family members don't want to have surgery." Peon briefly explained the situation. "I tried to persuade them, but it was useless."

Kavi looked up and glanced at Veronica, then turned his attention to Bertha, greeted her, and then lowered his head to check the medical history and preoperative preparation items he had just recorded this morning.

He did not mention the documents signed, nor did he mention the content of his several conversations with Veronica. He simply talked about Betha's current situation: "I know you are under a lot of pressure, but how is a little girl who can't do any labor and even has to be careful when walking a few hundred meters to survive in the future?"

"I'll take care of her."

"But does she agree?" Kavi looked at Betha on the bed and asked with a smile, "Do you want to have surgery?"

"I don't want to. The operating table is cold and scary, the wound hurts, and changing the dressing hurts even more. It takes a long time before I can get out of bed and walk, and I hate lying in bed to pee and poop." Bertha clutched the bed sheet tightly with both hands and said, "But Dr. Kavi, you said you could cure me, right? I remember."

"of course."

Bertha looked at her tearful mother and hesitated for a moment before asking, "After the operation is successful, can I sing and dance like before?"

"Of course." Kavi said with a smile, "I said before, you can do whatever you want."

"Then go for the surgery. I can bear it for a while."

Veronica knew her daughter's wish and had guessed the answer before she heard this, shaking her head. After hearing Bertha's answer, she sank and threw herself at her daughter, crying even harder.

The stuck preoperative work started again.

Compared to Vienna, the operating theater at the Hôtel-Dieu in Paris is more like a modern operating room. The performance element is completely diluted, and there are not so many complicated details for entry. Everything is aligned with preoperative preparation.

Of course, Kawi prefers this kind of working environment.

But things are not absolute.

He changed his mind temporarily and took over Holt's role as host, directing everyone's attention to the gate:
"You all probably know a lot about abdominal aortic aneurysm and this operation that has been in the works for two months, but you know very little about the patient. Before the operation begins, please allow me to solemnly introduce today's protagonist, young Bertha, a girl who is brave enough to accept unknown challenges and is willing to create history with us."

(End of this chapter)