Nineteenth Century Medical Guide

Chapter 498, Question 494: What kind of chest do you think it has?

As a key assistant in the Cavill procedure, postoperative care and incision management are always part of Bergter's job. This includes meticulously recording the color, consistency, and amount of drainage fluid, as any abnormal changes indicate the progress of postoperative recovery and are important postoperative indicators.

Over the years, he has performed numerous abdominal surgeries alongside Kavi, and he has placed at least dozens, if not hundreds, of drainage tubes.

It can be said that abdominal drainage fluid is the most common thing he encounters in his daily work.

But he never expected that Kawi would open the cap of the drainage bottle and sniff it.

Does the drainage fluid have an odor?
It's just a mixture of ordinary blood and tissue exudate, what kind of smell could it have?
That's what he was thinking, but as the bottle neck moved toward him, Bergett instinctively took a half-step to the side: "Don't mess around, what if you knock this thing over?"

"It's just drainage fluid, what are you afraid of?"

"I'm not afraid."

Some long-sealed memories slowly gathered in Bergett's mind, and then, like snowballs that came out of nowhere during a snowball fight, they smacked him on the forehead.

Kavi was only in his early twenties. Although he was the head of surgery, held several honorary professorships at universities, and even had a higher rank in the military than him, he was still two years younger than him, and his habit of occasionally playing pranks on those around him had never changed.

Bergert silently grew wary and analyzed seriously, "Red drainage fluid indicates bleeding, but the color isn't dark, meaning the bleeding isn't significant. Ugo has a rib fracture, so bleeding is normal. Why did you bring it here specifically?"

Kavi persisted: "I'll let you guess what's inside."

“Blood and tissue fluid, and…” Bergette stopped what she was doing, looked up at him, “Wait, what do you mean?”

"The fact that I brought these things here means that it's not just these items."

Bergert's heart tightened; the soft snowball seemed to solidify even more: "What else could it be? Besides, how am I supposed to guess just by looking at this?"

"That's why I'm letting you smell it."

Having no other choice, Bergett put his nose close to it: "There's no smell."

Kavi also sniffed around: "The rosemary spray here is too strong, it masks the smell of blood and also covers the smell of this stuff."

After saying that, he briefly recounted what had just happened to Ugo, emphasizing the location of his injury: "You guessed it, didn't you?"

Bergett was completely confused: "This is the same situation as when we first saw him."

Are they the same?

"It's all just back pain."

"No, the location of the pain has shifted down by about two finger widths."

Bergert examined the drainage fluid carefully again, but couldn't find anything special. He then buried himself in sewing up the intestinal tube: "I really can't see anything special about it. It's just ordinary drainage fluid."

Seeing that he had lost interest, Kavi had no choice but to find someone else.

At the operating table, besides Bergett, Antonio was the highest-ranking surgeon, naturally becoming his target. However, his skill level was far below, so he had to change his question and not be too direct: "Dr. Antonio, you saw the drainage device I used before the surgery, right?"

Antonio was helping to close the intestinal slit with both hands when he was suddenly asked a question. He jumped up and said, "Ah? Ah, yes, yes, I see it. It's a very ingenious device."

Kavi ignored his flattery: "I put 10ml of water in the first bottle, right?"

“Yes.” Antonio nodded and continued, “In comparison, the second bottle contains significantly more water.”

Why should I add 10ml of water?

"In order to collect the drainage fluid."

"So how much did I collect?" Kavi asked Antonio, but handed the bottle to Bergett instead. "This is a 500ml wide-mouthed bottle. Look how much liquid is inside."

"About 200ml."

What was said in jest was taken seriously by Bergett, who finally realized that the problem was not simple: "How could there be so much? He only has a pneumothorax. If it were all bleeding from a fracture, that would be one thing, but it's not. The color is too light."

"so."

Kavi's repeated prompting showed that he genuinely hoped Kavi could find the answer.

As one of the younger generation of surgeons at the Municipal General Hospital, he spent the most time with Kavi, but he was also the least distinctive.

Compared to Hills, he lacked ambition. Compared to Herman, he was less composed and responsible. Compared to Damirgon, he acted solely out of curiosity and lacked any driving force.

Hills went to Gretz Hospital to serve as the chief of surgery at a young age.

Having gained management experience after the Austro-Prussian War, he smoothly rose to the position of vice president, with his ultimate goal naturally being to take complete control of the hospital. He acted arrogantly, but every step he took served his ambition.

Herman, on the other hand, remained at the Municipal General Hospital.

With Wattman's retirement, Ignaz became the new president, and he could have challenged Sedillo for the director's position. After all, the latter had only been there a short time, his skills weren't much better than Hermann's, and he also had some language barriers. But Hermann gave up, choosing to face his personality and return to his original position, continuing to improve his skills step by step.

Damirgan, on the other hand, had a clear objective from the beginning.

The year after returning to France from Paris, he borrowed several surgical atlases from Kavier and invested heavily to start from scratch, beginning with a basic surgical clinic and establishing his own practice.

Perhaps due to his noble status, Bergett acts without pressure, and his previous anxiety about his abilities has dissipated due to his progress over the years. This is one of the important reasons why he has been able to stay by Kavi's side.

Kavi doesn't deny his growth and passion for medicine, but he always felt that Kavi lacked a sense of urgency.

So he declined all the surgeries that were permissible, and when problems arose, he didn't rush to deal with them, letting Bergert handle them himself. Since the diagnosis was unclear, he simply presented the problem to Bergert, letting him solve it and broadening the diagnostic approach as much as possible.

If you can also follow the diagnostic approach, then you're not far from officially becoming a master.

Unfortunately, diagnosing difficult and complicated diseases requires access to a vast amount of medical theoretical knowledge, which was far beyond the capabilities of 19th-century doctors, including Bergett, who had followed Cavite for three years.

"No, I can't guess."

Where in the body is the most water?

Bergert's theoretical knowledge was limited, and he had the task of suturing the intestines to finish, so he really didn't have the mind to think about the answer: "I have to finish suturing and closing the abdomen as soon as possible. Just tell me the answer. If this guy is not sensitive to anesthesia due to physical reasons and wakes up halfway and sits up and causes trouble, I can't do anything about it."

Kavi was somewhat disappointed.

"How about I give it a try?" Antonio was more interested.

“Alright, everyone gets a share, you can all try.” Kavi carried the bottle and came to him and his other assistants. “Hey, just bring your face close, don’t get your body too close. I haven’t disinfected myself yet, and if your skirts touch me, you’ll have to change them again, which is too much trouble.”

Antonio sniffed carefully, taking a few deep breaths, and seemed to detect a different smell: "Emmm, it smells a bit bad, like..."

"Like what?"

“Let’s all talk about the illness together, what are you afraid of?” Kavi returned to the control panel in the distance. “Just say whatever comes to mind, don’t waste time, the same goes for the rest of you.”

"Like urine."

Upon hearing this answer, Kavi nodded thoughtfully, then suddenly said, "It seems my nose is fine. Mr. Ugo is a very rare case of urinary tract infection."

Bergette was surprised: "Wait, what did you say, breasts?"

"He urinated into his chest cavity."

He paused, glanced at Kavi, then continued his suturing: "His injury is in his back, the upper edge of his kidney just touching the twelfth rib, which is quite a distance. Even if his kidney is really injured, the urine should go into the abdominal cavity, how could it go into the chest cavity?"

The thoracic and abdominal cavities are independent of each other, separated by several anatomical structures. However, external injuries are unpredictable, and anything can happen.

The criteria for establishing urinary thorax are very strict, and in my experience, I have only seen a few cases.

The surgery itself isn't complicated; the challenge lies in making a definitive diagnosis, that is, confirming the presence of urine in the drainage fluid. Urine has a distinctive odor, and the presence of blood can interfere with the diagnosis, making it a highly subjective judgment that cannot be used for a formal diagnosis.

He put the drainage bottle aside and flipped through the slides on the operating table: "Are you sure?"

"This"

"Hard to say."

"The smell is too faint; you can only say it's somewhat similar."

Compared to blood, urine has a much wider pH range, and the reagents that can be used for identification are only available in modern times. Apart from smell, the only way to determine its presence is through microscopic examination. If you can see the distinctive casts or crystals in urine under a microscope, you can confirm that urine is present.

However, it is very difficult to find crystals and casts in normal urine; it is entirely a matter of luck.

Fortunately, there were very few truly normal people in the 19th century, and bladder stones were widespread. Even seemingly normal people's urine often contained a lot of crystals.

The most common type is calcium oxalate crystals, which are also the most common substance for stone formation, and they are now lying brightly under the microscope lens.

"It really is urine."

"The problem is, how did the urine get into the chest cavity?" Bergett asked. "Did his kidneys rupture? The pleura, peritoneum, and diaphragm would also have to be damaged. But in that case, it should have entered the abdominal cavity first. He was sitting the whole time and never lay down, so how could it have flowed back into the chest cavity?"

"Take your time to think about it."

Kavi, looking like he couldn't be bothered to say anything more, put down the microscope, got up and walked towards the door: "Finish this surgery as soon as possible, there's another major surgery waiting tonight."

As Bergette received the last injection, she quickly tied her hands in a knot: "Aren't you going to leave this place?"

Seeing his condition, Kavi stepped forward and briefly checked his sutures: "The alignment is fine, there is no bleeding or leakage, the blood supply is good, there is no problem."

"I know I can suture properly."

“Mr. Anders is in stable condition. Please examine his abdomen carefully again. If anything happens, come to the ward and call me.” Kavi was already planning the surgical procedure for Ugo. “If everything is fine, close the abdomen.”

The surgery was nearing its end, and barring any unforeseen circumstances, Bergert had found the only opening.

Even if there are other ruptures, the intestinal tract will be treated in the same way. Exploration of the abdominal cavity and prolonged anesthesia are not difficult for Bergett at this point, and as long as Anders' vital signs are stable, there is no need to intervene.

In fact, from the moment it was discovered that there were no problems with the liver and spleen, the surgery was already over in Kavi's eyes.

All he could think about now was Hugo's thorax and how to explain the condition to the Spurs player and persuade him to have surgery as soon as possible.

He had already considered the surgical approach and the possible changes that might occur in Ugo's body after the skin was cut open.

Even the choice of camera angles for drawing surgical diagrams, the surgical steps to be recorded in the magazine, the potential for unexpected situations during surgery, and the key points of postoperative care all came to mind.

When I stepped back into the ward, the surgical plan was almost finalized.

"Huh? What are you doing standing at the door?" Kavi spotted Hermana immediately. "Didn't I tell you to stay by Mr. Ugo's side and not leave?"

"I," Hermana said with a hint of helplessness.

"what happened?"

Kavi looked into the ward. White curtains had been drawn around Ugo's bed, and he could vaguely hear people talking. He quickly stepped forward and pulled back the curtains: "I'm so sorry, Mr. Ugo is a seriously ill patient and needs to rest absolutely."

There was another person beside Ugo's hospital bed: "Dr. Kavi."

“You are…” Kavi’s face blindness kicked in, and it took him a while to recognize him. “Oh, Mr. Olney, what brings you here? I thought you were going to see Galado.”

“Anders and Mr. Hugo are also good friends of mine.” Olni smiled and took off his police cap. “I heard that you brought them here, so I rushed over to see them. Thank God you’re in Spain, otherwise I can’t imagine how much suffering they would have endured.”

Kavi didn't say much: "You have so many friends."

“Yes, you are my friend too.” Olney maintained his smile and took his leave before he could ask him to leave. “I trust my friends, and I trust your professional abilities even more. I heard what you just said, and I’ll be leaving now.”

Seeing that he was so sensible, Kavi was willing to share the progress of the treatment: "Mr. Anders' surgery went very smoothly, and my assistant is finishing up. If you don't have anything else to do, you can wait in the rest area for half an hour, and you'll see him once the anesthesia wears off."

That's wonderful.

Olney was extremely excited: "I thought those reporters liked to use exaggerated words to create a media frenzy, but now it seems they were being conservative. Who would have thought that they would be out of danger in just two hours?"

Kavi carefully considered his words: "Mr. Anders should be out of danger, but Mr. Ugo is not."

Ugo was taken aback, thinking he had misheard.

"Huh? No?"

“He didn’t originally need surgery, but the situation has changed, and now he does.”

Since things had come to this point, Kavi figured he might as well explain the surgical plan to Olni in front of him. If Ugo disagreed, his friend could try to persuade him.

Just as he was about to speak, a middle-aged man strode in from outside and whispered a few words to Orni before Kavi could speak.

Orni's expression changed instantly: "Why is she here?"

The middle-aged man shook his head.

At this critical juncture, Ornido had no time to think and immediately took his leave of the two men: "I'm so sorry, I have urgent business to attend to. Mr. Ugo, please be sure to follow Dr. Kavi's instructions and give my regards to Mr. Anders when he wakes up."