Nineteenth Century Medical Guide

Chapter 492, Chapter 488: Helping me is helping him.
It's less about Antonio being interested in Kavi and more about the surgical skills Kavi possessed. As for Kavi himself, stripped of his medical and surgical expertise, he was probably just an ordinary young man, like his assistants.

As for Dean Alvaro, Kavi is most likely a fraud, or perhaps even a madman. Of course, it doesn't matter if he's a genius, as Antonio said. Who Kavi is is unimportant; what matters is not harming his or the hospital's interests.

But when the person actually appeared in front of them, their original impressions completely changed.

After asking the questions, Cavie walked into the ward naturally and arrived at Antonio's desk in no time. Like a senior official inspecting work, he casually picked up a medical record and began to read it.

Compared to Bergett, he was used to doing this kind of thing, so his movements were smoother, and he didn't treat himself as an outsider at all.

Ian stood in the corner, somewhat helplessly: "Dr. Kavi, I'm really sorry, but I'm afraid you'll have to go to another hospital. That clinic also has a surgical area. It's a bit small, but it's clean enough, the equipment is complete, and there are suitable assistants. It shouldn't be a problem to handle two surgeries."

Seeing that he had no other choice, Alvaro smiled and once again gave him the order to leave: "Yes, go to that clinic then, you're not welcome here."

Ian put on his hat, ready to leave, but Kavi didn't move. He just looked at the medical record, and then, under Antonio's strange gaze, he replied, "I'm quite curious, what makes the secretary think that there won't be any problems with handling it this way?"

Ian's hand, which was straightening his shirt, stopped at the collar. He stared at the Austrian doctor, a bunch of question marks on his forehead.

Kavi didn't look at him, but instead looked at Antonio, who was standing not far away.

After a brief exchange of glances, Kavi recognized the man as the director and also got a basic understanding of his professional competence.

The medical record writing is not standardized but it is meticulous. The surgeon is very cautious and patient and has a strong drive to learn. Unfortunately, when it comes to the actual practice stage, the surgeon lacks ambition and is too protective of his reputation.

Moreover, he doesn't seem to be very good at teaching students; at least, the two assistants in the ward are quite incompetent.

This should be a busy afternoon, a time to work on medical records, review anatomy books, or prepare for surgery. But they've been so affected by this incident that they can't work at all.
Kavi returned the appendectomy record to Antonio and continued to ask Ian, "Is there a medical basis for it? Or is there some other reason?"

Ian was a little confused by the question.

He had no concept of surgery; he just thought the size of the venue shouldn't affect the operation, and that as long as there was a place to stand, it would be fine. So he said it offhand, without any real reason.

If you had to give a reason, it would probably be that he wanted to resolve this matter as soon as possible to avoid affecting the city's image and subsequent planning.

However, being used to his work habits, he didn't slack off and still wanted to cooperate actively: "I'm sorry, Dr. Kavi, I overstepped my authority. I'll do whatever you say. As long as you can perform the surgery, that's fine."

"But that won't work. The more instruments you have, the higher the requirements for the surgical space."

Nineteenth-century surgical theaters may appear to occupy a large area, but the actual space available for surgery was very small; the surgeon and two or three assistants were enough to fill the space. If you add the busy nurses and other assistants on the outer perimeter, as well as spare instruments and medications, the surgical area would only become more crowded.

Over the years, Kavi has seen many surgical procedures, but the only ones he truly felt were the Municipal General Hospital and the Palace Hospital.

If Vienna and Paris were like this, little Saint-Sebastián was even more uncomfortable. He didn't want to turn the operating table into a restaurant kitchen, so crowded that you couldn't even plug in an oil lamp.

“I just went to the theater, and it’s barely adequate.” Kavi walked up to Alvaro. “Are you the director?”

"Yes, it's me."

Alvaro looked him up and down, and he couldn't believe that such a young man could have such a powerful aura.

Kavi was unaware of their complicated relationship and didn't care to know, even skipping the self-introduction. His only concern was how to secure the venue and assistant: "Is the director refusing to lend the theater a matter of money, or something else?"

"All."

Kavi glanced back at Ugo, the Spurs player lying outside the door, who was experiencing significant chest pain and shortness of breath; his pneumothorax was worse than before. Looking at Alvaro's expression, he knew Alvaro was far from being easily persuaded: "Is there any room for negotiation?"

"I cannot endure the humiliation from the other party while accepting patients who should have been sent to other hospitals for treatment."

Alvaro slowed his speech, trying to make each syllable clear and powerful:

"He neither gives us money nor acknowledges our rights. When things were spiraling out of control, he suddenly thought of us and asked us to take over the mess. Dr. Kavi, I believe you are a true gentleman and should be able to empathize with this."

"Money is not a problem; I can give you all the consultation fees Mr. Ian promised me. As for the rights you mentioned..."

Alvaro laughed: "How much is the consultation fee? What I want is the treatment cost for the matadors' injuries over the next five years. Of course, compared to the total cost of building this hospital, this kind of subsidy is still insignificant. But it represents integrity and respect for us."

Kavi frowned, because just recently he had learned that the matadors' medical treatment and surgeries were all out-of-pocket, while the hospitals still required subsidies from the city government. He had a sense of déjà vu; it was very likely that the promises made earlier had not been fulfilled.

He can manage medical skills, but he can't manage policy.

Kavi then shifted the pressure onto Ian: "Mr. Secretary, if we can't resolve the venue and assistant issues, I'll have to abandon the surgery."

"Without surgery"

"The Spurs player lying outside should be fine, but Mr. Anders, who has been taken to the operating room, is probably in a more difficult situation."

Hugo wasn't very popular; viewers unfamiliar with him might not even remember his name or face. He was a minor character in the bullfighting team who could be replaced at any time. But Anders was different. Not only in Madrid and Seville, but even in this small town, many people admired his bullfighting skills.

The large crowds attracted by this performance are the best proof of that.

Ian panicked: "No, Dr. Cavill, this isn't what we agreed on. Anders absolutely cannot die here; he must return to Madrid alive."

"It's not up to me to decide."

Kavi turned and stepped out the door: "I'll give you ten more minutes. Please resolve this as soon as possible. If you can't resolve it, I won't make things difficult for you, but I won't accept the 5000 franc consultation fee."

Ian looked troubled. It was indeed a matter of money, but it wasn't entirely about money. There were too many details involved, and as a newcomer, he could only follow the mayor's advice.

But the expressions on Alvaro and Antonio's faces were quite interesting.

5000 francs was a considerable sum for the two of them, equivalent to more than half a year's income. Even with their previous investment in the hospital, Alvaro had only spent 40,000 francs, which had essentially depleted his savings.

The fact that this figure is now linked to consultation fees not only surprised them, but also brought about a significant shift in their mindset. "5000 francs? How can that be so much?" Alvaro was very dissatisfied. "Ian, didn't you say before that the municipality was short of money?"

"What can I do if the new mayor doesn't honor the subsidy that the old mayor promised? Besides, I only arrived two years ago."

Before he could finish speaking, Antonio, who was standing to the side, interrupted, his previous hesitation suddenly turning into unwavering determination: "Dean, you must agree to this surgery, or I'll resign!"

"Well, you traitor! Who got you out of the Seville police station? It was me!!!"

“This is too important to me. I can’t let this only opportunity slip away right under my nose.” Antonio stood next to Ian. “Besides, you’re not even willing to lend me your operating room for two surgeries for 5000 francs?”

“I’m the dean, but I’m also an employee,” Alvaro retorted. “Does the boss need this little bit of money?”

"Yes, it's not about money. But look at these empty beds, there are fewer and fewer patients. If this continues, the hospital will go out of business and close down sooner or later."

"If it goes bankrupt, it goes bankrupt. Just consider it a loss of investment money."

"But now the opportunity is right in front of us, Dean! Just think about Dr. Kavi's reputation!"

Ian turned to find Kavi, wanting to explain to him what made this surgical genius so extraordinary. But Kavi had already left the ward, temporarily detached from their complicated situation. Ultimately, all he wanted to do was treat the two bullfighters' injuries.

"How are the preparations going?"

Berget was squatting beside the stretcher, preparing negative pressure drainage for Ugo: "The rubber tubing and syringe are ready, but we're short of bottles. I don't want to have to change his negative pressure syringe every few minutes; that would be exhausting, and the effect wouldn't be that good."

Previously, Kavi had developed a simple negative pressure device to keep the oozing wound dry. However, in the case of pneumothorax, the syringe used to maintain negative pressure was insufficient.

Ugo's condition was caused by a rib fracture followed by displacement of the fractured bone ends, which punctured the surface of the lung, resulting in a closed pneumothorax. Air could then enter the space between the visceral and parietal pleura through the ruptured opening, compressing the lung space and hindering lung expansion.

In fact, closed pneumothorax can heal on its own as long as the lung shrinkage is not significant. However, since there is no X-ray available, and internal bleeding can occur even with a fracture, Kavi still needs to undergo a puncture to assess the situation.

If the puncture is not effective, there is excessive bleeding, or the rupture in the lung continues to enlarge and develop into tension pneumothorax, then closed drainage must be performed.

This type of drainage requires a lot of space, while the simple negative pressure device made from a syringe is very small. If we still use that kind of thing, it will be very troublesome, as Bergette said.

Kavi leaned back and poked his head out of the doorway, then suddenly said, "Mr. Dean, would it be alright to borrow a wooden frame and a few wide-mouthed bottles?"

Alvaro pretended not to hear and continued arguing with Ian. Antonio came out and called his two assistants to help: "Dr. Cavill, ignore him, he's just like that. What you need will be here soon, and the operating room is ready; we can start surgery anytime."

"Ready?"

"Don't worry, give me half an hour, and I can definitely get it ready." After saying that, he repeated what Bergett had just said, "If there's too much bleeding, will we need to do a blood type test and give Mr. Anders a transfusion?"

"We could make some preparations."

If Kavey's rating for him was between 5 and 6 points just now, he might pass now. This is the theoretical component; the practical surgical component is a separate matter. However, passing the theoretical component means he is qualified to stand on the operating table as a second assistant.

The wide-mouthed bottle was delivered quickly. After connecting it to the needle, glass tube, and rubber tube, it formed a two-bottle water seal drainage device.

Anyone who has ever worked with chemistry has seen this kind of thing, and Antonio was no exception. But he didn't understand how the two bottles and some tubes could solve a pneumothorax: "How do you remove the air from the pleural cavity?"

"No need to draw air out. Just place the bottle in a low position. When you exhale and cough, the pressure in your chest cavity will be greater than the pressure of the water column, which will force out the trapped air inside."

Bergert explained, "So the liquid in the water-seal bottle can't be too little or too much. Too much will require the air to overcome more pressure to escape, while too little could cause the chest cavity to connect with the atmosphere, resulting in an open pneumothorax."

“If it were just a simple pneumothorax, only one bottle would be needed, but Mr. Ugo had an external injury and there was a high possibility of bleeding, so we used two bottles to achieve gas-fluid separation.”

Kavi continued, "Firstly, the blood is too viscous; once it enters the water-seal bottle, it increases the viscosity and volume of the liquid, increasing the pressure of the escaping air. Secondly, it allows for a clearer view of the amount of bleeding."

"If the two-bottle drainage method is ineffective, a third bottle will be needed, and an additional negative pressure system will also be required."

Thinking about this, he suddenly realized another problem: "Do you have a suction pump here?"

Antonio shook his head.

"What about a hand-cranked suction device?"

Antonio's face was filled with embarrassment and helplessness: "."

“If it’s just a regular pneumothorax, that’s fine, but if it gets worse, it’ll be very difficult to manage without negative pressure.” Bergett realized the seriousness of the problem. “I don’t want to be there with a rubber ball pressing on it.”

It's obviously impossible to keep someone staring at the drainage bottle all the time; no one can stay focused forever.

“It seems necessary to have a backup plan.” After a moment’s thought, Kavi instructed, “Director, find him a hospital bed to rest properly and try two bottles of water seal drainage. If that’s not enough, I’ll think of something else.”

"it is good."

After finishing his business here, Kavi turned around and went back into the ward.

Ugo's negative pressure drainage could be barely completed in the ward. The reason for the constant emphasis on the surgical theater was the fear of complications such as pleural reaction, bleeding, and organ damage.

But Anders' situation is more complicated. A surgical site is essential, and Kavi doesn't want to go through another outdoor surgery experience.

"How did your discussion go?"

Kavi glanced at Ian's face and knew it was hopeless. He hadn't wanted to be so high-profile, but he had no choice but to pull out the letter and hand it to Alvaro: "Duke Austa is my friend. Helping me is helping him. The Dean won't object, will he?"

(End of this chapter)