Nineteenth Century Medical Guide

Chapter 490, Section 486: The patient didn't arrive, but the doctor came first.
The San Mattia Foundation Hospital is less a hospital and more the “ruins” of a 16th-century monastery.

The renovations over a decade ago gave this place a fresh new look. Newly built brick walls enclosed a new ward building, and the once quiet courtyard now housed wards and an autopsy room. The arrival of new owners and guests made it crowded and noisy, filled with coughs and a suffocating, musty smell.
But no matter what it becomes, its soul remains stubbornly stuck in the past.

The afternoon sun struggled to penetrate the dusty windowpanes, cutting out a few beams of light. Dust swirled within these beams, while outside lay an unsettling gloom, barely dispelled by the presence of a few oil lamps mounted on the wall and the candle in Antonio's hand.

"His vision is severely obstructed, and there's blood smeared on the wound. How did he manage to solve the light problem? I can't see anything at all!"

After muttering to himself for a while, Antonio put down the candle, turned and walked to the operating table, picked up the already tattered surgical journal, and felt increasingly anxious:

"The process is written in a very formal and meticulous manner, full of surgical and anatomical details, completely detached from reality. Everyone says he's a genius who has performed countless surgeries, but has he never encountered any special cases outside of medicine?"

In the past six months, he has processed many corpses, specializing in external wound repair and internal organ removal, and has accumulated a lot of experience, especially in appendectomy.

Limited by the teaching standards of the University of Murcia's medical school, Antonio's surgical skills were not outstanding.
The reason he was able to learn to this level on his own was twofold: firstly, the appendectomy procedure is simple; and secondly, it was thanks to his hard work, time, and money. Of course, the most important reason, at least in his eyes, was the surgical journal he had in his hand.

Antonio had never seen such an expensive medical journal. The most expensive one in Spain, the Madrid Medical Bulletin, was a monthly publication, costing 50 pesetas per copy. The year-end issue, which contained papers and summary reports on disease diagnosis and treatment, was a bit more expensive, but still only a little over a hundred.

In comparison, medical journals that only publish surgical articles are cheaper.

The *Catalonia Surgical Journal* is also a monthly publication, priced at 20 pesetas for international customers but half price for domestic customers. Another example is the *Journal of the Seville Surgical Society*, published nine times a year, each issue costing only 15 pesetas.

Their prices are very conservative, because if they were any more expensive, no one would buy them. Sometimes, when sales are poor, attending doctors will receive a free copy.

But the magazine in his hand is published once a quarter, and each issue costs as much as 3000 francs. If you include the postage from Austria to Spain, you'll have to pay another 1000 francs when you receive it.

Of course, this isn't the only way to pay; publishers also offer various strange package deals.

In addition to regular subscriptions, you can choose an annual subscription, which will save you half the shipping cost; if you are interested in other Austrian surgical medical journals, you can choose a multi-journal subscription package, which will have certain discounts.

If you are interested in pharmaceuticals, you can order additional new drug trial reports from Swiss pharmaceutical companies for a small fee; if you are interested in surgical instruments, you can also obtain trial versions of the instruments for a small fee (additional shipping costs are the responsibility of the buyer).

You can even add a deluxe edition, a hardcover supplement, for an additional 2000 francs. This includes content related to the magazine author's recent surgeries, such as patient case files, surgical procedure records, and post-operative reports.
This magazine, which costs five or six thousand francs and has only a few hundred pages, is a complete rip-off in the eyes of outsiders, yet it was sold out before it was even officially released.

The book in Antonio's hand was not something he bought; rather, it was something he won in a bet.

Like most surgeons in the world, he had always lived in his own little world. He paid no attention to medical newspapers and journals outside of textbooks, and had no habit of reading them.

When Antonio first received the magazine, he wasn't interested either. He only flipped through a couple of pages absentmindedly before realizing he was wrong.

It is completely different from the outdated Spanish surgical textbooks. It does not spend time recording amputations, gouging out eyes, cutting away epidermal tumors, and other surgeries that have already been thoroughly studied. Nor does it contain those "surgeries" that disregard the patient's life and are performed without any theoretical basis for the sake of the surgery itself.

It serves only surgical directors facing technical bottlenecks, with each page representing the most cutting-edge surgical techniques. Each technique is supported by relevant case studies, ensuring that the patients who underwent the surgery were still alive and the surgery achieved its preoperative objectives at least before publication in the journal.

Antonio has also questioned the surgery described in the magazine.

Because the concept, surgical approach, intraoperative procedures, and various solutions were all too incredible and almost impossible to complete.

However, the preoperative preparation, postoperative care, and precautions were all meticulously recorded and illustrated. If it were truly fabricated, the cost would be far too high. More importantly, a medical genius who pioneered the cesarean section and has already left a significant mark on medical history has no need to resort to fraud to gain fame.
Appendectomy is the most basic abdominal surgery and the most suitable procedure for newcomers to gain experience in abdominal surgery.
When Antonio first saw this sentence, the hairs on the back of his neck stood on end, and his entire body trembled uncontrollably, including his mind. Thanks to this, the sentence was deeply etched into Antonio's memory.

Looking back, he recalled that at the beginning, he couldn't even separate the septal tissues in the abdominal cavity, and it took him seven or eight hours to complete the final suturing step. Now, the entire process can be controlled within two hours, with almost no mistakes.

After having performed dozens of abdominal dissections on corpses, he could better understand the profound meaning of this statement.

But there is a fundamental difference between a corpse and a real person, and Antonio remained cautious, or rather, lacked confidence, feeling that he was still some distance from being able to perform a successful appendectomy.

The first thing that bothered him was the issue of the field of attack.

He didn't believe that a few oil lamps could solve the problem of limited surgical field, especially when the surgical incision was less than 10cm, where the shadow cast by a single hand could block most of the field of vision. If both hands were used in conjunction with an assistant, it might be impossible to even see the fingers.

Secondly, there's the ever-present topic of anesthesia.

Surgeons in San Sebastián had always been opposed to the use of ether, and even Anthony himself felt that pain during surgery was a very important indicator. Without anesthesia, patients would suffer unbearable pain, but with anesthesia, they might not even have the opportunity to undergo surgery.

Two months ago, there was a patient who, despite several days of attempts to persuade him before the procedure, died from one of the traditional side effects of ether: suffocation.

Perhaps due to a difference in opinion, he rejected ether from the bottom of his heart.

However, surgery has undergone a dramatic transformation. Surgical sites are increasingly deep, the tissue layers to be treated are more complex, and the procedures require greater precision. Stasis has become a necessity in advanced surgeries; anesthesia is essential to keep the patient still.
Antonio tried other methods, even imitating his past practice of hitting someone on the head with a stick, but unfortunately, none of them worked.

There are also issues like difficulty stopping bleeding, failed suturing, and wound ulceration. In short, if you want to get to the bottom of things, every detail is crucial in a one-hour surgical procedure. Although the four or five pages cover everything that needs to be said, it can still feel overwhelming in practice.

Having worked for so many years, and not just for the first time on stage, why am I getting nervous?
Antonio covered his face and rubbed his cheeks, trying to calm himself down: He had made so many preparations and practiced each step dozens of times, there wouldn't be any problems.

"Aha!!!"

He shouted at the glass dome of the theater, and the echo reverberated, seemingly restoring half of his confidence.

He closed the magazine and looked down at its plain, pale yellow cover. The standard font was so formal it was almost boring, and there wasn't even a single illustration. Antonio's fingers traced down to the author's name, his heart feeling empty.

I wish I could watch a surgery next to him, or even just sit in the theater and watch it.

Suddenly, the theater doors were opened. "Dr. Antonio, you've arrived so early." A nurse dressed as a nun walked in. "I need to do some pre-operative preparations. You don't mind, do you?"

Antonio turned to the page on appendectomy again, which featured a simple intraoperative diagram. The blank spaces next to the diagram were filled with his own interpretations of precautions and anatomical annotations omitted from the diagram: "Mind your own business, don't worry about me."

Compared to the bright sunshine outside, the air inside the theater was cold and heavy, with a faint alkaline smell of lime powder and the increasingly lingering stench of blood. As the nurses splashed wine vinegar outside and lit rosemary incense all around, the city's oldest monastery seemed to regain its solemnity.

Do you have phenol here?

Antonio abruptly asked the nun, only to be met with the sour smell of vinegar in the air and the nurse's "Huh?"

"It's carbolic acid."

"I don't know, what is it?" The nun shook her head, as if she had never heard of the term before. "If you need it urgently, go to the warehouse and ask when I'm done here."

"Never mind, it's not necessary." Antonio didn't want to waste time. "Bring the patient here and perform the surgery as soon as possible so I can go back and rest earlier."

“Okay. By the way, Dr. Antonio, you're a native of Seville, why didn't you go to the bullfight today?” The nurse, oblivious to his change in mood, continued walking up the stone steps, her footsteps worn into the ground. “You must have heard of the bullring that Mr. Anders belongs to, right?”

"heard about it."

From the moment the nurse entered, Antonio's thoughts were scattered: "I need to clarify that not all Sevilleers enjoy bullfighting."

The nun paused, then laughed awkwardly twice, "I'm sorry, I didn't know."

“No, it’s not your fault.” Antonio stuffed the magazine into his suitcase and explained, “Many people have this misconception, just like us, who always think that all Parisians are talented artists.”

"Oh? So that's not how it is?" The nun seemed even more embarrassed.

Just as Antonio was wondering what to say, the door opened again, and a young man in his early twenties, wearing only a white shirt and looking rather clumsy, entered: "Anthony, Mr. Neo."

"Speak slowly, what's wrong?"

"Come on, a new patient has arrived!"

Antonio had been worried that something had happened to the surgical patient, and his heart tightened instantly. He only breathed a sigh of relief after asking, "You're here, just take her to the ward. What are you so nervous about?"

No, that's not how it is.

"Take a breath and get to the point!"

The young assistant loosened his shirt collar, took a couple of sips of water, and then said, "The patient hasn't arrived yet. A doctor has come. He said the patient will be here soon and hopes we can cooperate."

"They didn't come? They want our cooperation?" Antonio's mind was a bit confused. He frowned. "Wait, you said a doctor came? Which doctor? If they're doctors, why are they coming here to ask for our cooperation instead of treating their own patients?"

“Um, he’s not Spanish, he was just passing through. And then…” The assistant tried to recall the conversation, “or rather, the patient, he was a bullfighter, the Spurs player who’s performing bullfights in Constitution Square right now.”

Antonio was still completely confused, but since he was involved in bullfighting, he couldn't escape the consequences: "Where is he?"

"Right in the hospital ward."

"Where's the patient? That bullfighter!"

"Oh, it's still on its way. It should be delivered together with Mr. Anders."

"Anders? Anders is injured too?" Unpleasant memories flooded Antonio's mind. "Postpone the appendectomy; deal with them first. You hurry and get things ready."

Before he could finish speaking, his assistant interrupted him hesitantly: "They want us to vacate the operating room for their use; they don't need our involvement."

At this point, Antonio finally realized what the so-called cooperation meant.

He had met many colleagues—some arrogant, some extreme, some greedy, some selfish, some who liked to gossip behind people's backs, and of course, some who were petty and scheming. But he had never seen anyone so domineering. Anyone who didn't know better would think that the president of the National Surgical Association had personally led the entire surgical team to the scene.

"Anyway, that guy said they would handle the bullfighters themselves and didn't need our help. That's how it was."

The young assistant tilted his head back in a serious manner, one hand in his pocket and the other as if carrying a box, his eyes scanning the surgical theater around him, but not looking at anyone: "...His appearance and tone are just like mine now."

Antonio got angry, put the magazine aside, jumped off the podium and ran out the door, cursing as he went: "This is our hospital, why should we prepare a surgical theater for him?"

"He guessed it just as I expected."

"You guessed it? Guessed what?"

“He said you would definitely say the same thing after hearing these words,” the assistant followed behind him. “He said you shouldn’t rush to refuse, because…”

Antonio's eyes blazed with anger: "Why? Just say it all at once!!"

The assistant hesitated for a moment, biting his dry lips repeatedly, before finally saying as if he had made up his mind, "He said this is a rare learning opportunity for you, and you will definitely agree."