Nineteenth Century Medical Guide

Chapter 504. A stroke of luck amidst misfortune?

Anders is a renowned swordsman and has accumulated a great deal of anatomical knowledge over the years.

Of course, most of them are on cows.

He knew the bones and muscles best, especially the bones. In the final thrust of the bullfight, he needed to aim at the gap between the bull's ribs from the jolting back of the horse and plunge the sword into its heart.

For aesthetic purposes, avoiding the cow bone is a mandatory skill for every successful swordsman.

Secondly, there are the limbs, sensory organs, and some internal organs, such as the liver, spleen, lungs, and kidneys. These solid organs are more susceptible to injury than hollow organs when they are impacted, trampled, or fall to the ground.

As the saying goes, "experience makes one a doctor," and sometimes, having gotten used to the feeling of being injured, Anders is more experienced than many young doctors who have only graduated for a couple of years, and is also better able to judge the location and extent of his own injury than many doctors.

From a certain perspective, he does have the potential to study medicine.

Of course, potential is one thing, and it's very different from actual learning. If you open an anatomy book, he might not even be able to figure out the definitions and locations of objects.

When anatomical terms are mixed together and appear in the same surgery, the situation becomes even more complicated.

"The kidneys have shifted upwards quite a bit, with the upper edge level with the shoulder blades, squeezing the lungs to one side."

"The visibility is poor, so let's extend the incision. Go to the sixth rib, and give me forceps and a scalpel."

"Prepare the rib retractor. You two must hold the frame steady and not let it move!"

"Ok."

"The bleeding is quite heavy. Can you see the diaphragm?"

"I see it, a V-shaped tear, it's ripped very badly."

"Having dissected so many corpses, this is the first time I've ever seen a ruptured diaphragm. The area below the rupture is..."

"It's the left lobe of the liver, and the pericardium is right next to it."

"First, drain the liquid completely, then prepare some clean water and rinse it several times to check for any ruptured blood vessels. The suction volume is almost 1000ml. Report the blood pressure and heart rate."

"Blood pressure one minute ago: 110/63, heart rate..."

The operating table was in the center of the theater, its platform slightly higher than the surrounding area. Anders lay on the bed, only able to see several people around him, passing instruments and bloodstained gauze back and forth.

Anders' nose reeked of blood, and for a moment he thought he had wandered into a slaughterhouse next to a bullring. After each bullfight, the butchers would gather there to butcher the dead bulls, selling the best cuts of beef to those who had pre-ordered at high prices.
At this moment, the nurse called two caregivers who carried a stretcher: "Mr. Anders, let's go back to the ward."

Andersen regained most of her senses immediately.

Whether it was because of the water rinsing his stomach or the coldness of the operating room, his body kept trembling.

It was as if a sticky chill crept in from all directions, wrapping around Anders' hands, feet, and torso, slowly increasing in pressure until he could hardly breathe.

"What are they doing?"

"He's having surgery."

Who will have the surgery?

"Probably," the caregiver was about to answer when she realized she had said too much, "we're not really sure either."

Anders wrapped the blanket tighter around himself, his eyes fixed on Kavi.

Although the Austrian kept saying that his injury was more serious and that he was the only one who needed surgery, Anders had a bad feeling: "Could it be Hugo?"

“Mr. Anders, you need to go back to your ward to rest as soon as possible.” The caregivers began to pull at the collar and trouser legs of his hospital gown. “We heard that your surgery was very successful. As long as you rest and recuperate, you will be able to return to the bullring soon.”

In Anders' mind, whether the surgery was successful or not had nothing to do with him.

Even now, he still feels that surgery is not a necessary part of treatment, but rather something that some doctors add out of thin air to increase their performance and reputation.

Anders has seen too much.

In order to increase their prestige, these doctors not only charge extremely high consultation fees and make many demands on patients, but they are also only willing to treat nobles.

She had no destiny to be a court physician, yet she acquired all their vices. Like a socialite lingering in high society, she appeared noble, but was actually nothing special.

Kave was the one the mayor's secretary paid a lot of money to specially invite to treat their bullfighters. Besides himself, only Hugo was qualified to be on his operating table!

"Kavi! If you have any conscience at all, tell me! Is that Hugo lying there???"

Anders pushed away the caregiver's hands, struggled to sit up on his elbows, and was about to turn around when he felt a sharp pain in his abdomen. Immediately afterward, two red lines appeared on his white hospital gown, right into Kavi's line of sight.

Before Cavi could even speak, Antonio couldn't hold back any longer: "What are you doing? Hold him down, don't let him move!"

Two caregivers quickly stepped in: "Mr. Matador, please don't make things difficult for us."

Anders had just gotten rid of the ether and was so dizzy that he felt like he had been in the sea all day. His whole body was weak and he couldn't withstand the force of their four hands.

But his lips and tongue were perfectly normal, and the opening in his mouth was still open: "Tell me quickly, is it Ugo? Kavi! You said Ugo's body was fine, why are you performing surgery on him now?"

Kavi simply kept his head down, making incisions, without replying.

On one side was the incredibly skilled Cavie, and on the other was the well-established bullfighter. Antonio found it very difficult: "The condition is not fixed and can change at any time."

Anders was restrained by the caregiver and could only stare blankly at the ceiling. After struggling for a while, he managed to slam his hand on the bed frame: "Only two hours? What could possibly change in two hours???"

As soon as the surgery was over, Kavi didn't want to have anything to do with this madman. He ignored everything the man said.

After Bergett secured the rib retractor, he turned to his side and slowly inserted his left hand fingers into the incision to begin probing the upper edge of the kidney.

Seeing that Antonio didn't react, Cavie casually picked up a pair of hemostats with his right hand and slapped them hard on the back of Antonio's hand: "Didn't you hear him howling?"

Antonio frowned and glanced back twice: "Make him shut up!"

It's not that he doesn't want to manage it, it's that he simply doesn't know how.

Moreover, at this point in the surgery, he didn't want to waste such a good opportunity to chat with someone mentally unstable: "What are you all standing there for? Hurry up and take Mr. Matador back to his ward!"

Upon hearing this, Anders twisted his body even more enthusiastically.

Kavi buried his head and found the left kidney, and also felt the renal pelvis. While instructing Berget to prepare methylene blue, he said earnestly, "You stitched up his incision yourself. It was a relatively rare intestinal suture, and the surgery was considered successful. It would have been bad if it had burst open."

Antonio then realized what was happening.

Secondary suturing inevitably increases skin damage and greatly increases the severity of infection. This 17cm long incision may well be the "perfect" end to the second half of his professional career.

He quickly stepped off the operating table: "Shh~ be quiet! This isn't a bullring!" Anders twisted his body violently: "I'm going to sue him in court, no, I'm going to see the mayor!"

"Why would I sue him?" Antonio gave up on reasoning with him and changed tactics. "Are you trying to go back to bed and have your stomach stitched up again by pulling on the incision like that?!"

"Sew it up," Anders looked down at his stomach. "Sew it up then!"

“We need to trim the broken skin and then suture the incision back together. If the suturing fails, you’ll just have to watch it rot and stink, and you might have to live with a gaping hole for the rest of your life, Mr. Anders?”

Anders had fallen silent, and his anger had subsided considerably.

Antonio crossed his arms, hiding his hands under his armpits to avoid contact with contamination. He then asked the nurse to lift his clothes, his face beaming with undisguised joy—a mixture of relief and a touch of pride.

"Fortunately, it was just a little bleeding."

"Does it need to be addressed?"

"Don't move around for now, and please keep your voice down. Speaking loudly can strain your muscles and is a major cause of the incision reopening."

“Okay, okay, no problem, Dr. Antonio, you’re Spanish, I trust you.”

Anders lowered his voice and slowed his speech, but the facial muscles he used to speak remained tense: "Is Ugo in danger? Why did he need surgery? What exactly does that guy named Kavi want?!"

After saying just a few words, he squeezed every last drop out of his lungs before taking a deep, slow, and restrained breath.

If he was a live fish that had just jumped out of the water a moment ago, able to hop around on the ground, now he can only weakly flick his tail in protest.

"The incision is starting to hurt, isn't it?"

"I only care about my deputy!"

“His condition is very dangerous, even more dangerous than yours just now.” Antonio didn’t know how to explain it to him. “Your staying here will only affect our work. Go back to your ward and wait for news.”

"No, you have to tell me, what, what happened to him?!"

“The cow’s hoof trampled his diaphragm and kidneys, and urine and blood got into his lungs.” Antonio tried to summarize the condition using the vocabulary he knew. “We need to clean his chest cavity, suture his kidneys, then put the kidneys back into his abdominal cavity, and then suture the diaphragm back up.”

Anders could already guess how long Hugo's incision was, since his own incision was right in front of him, making the comparison easy.

"From the sixth rib to the second lumbar vertebra." Antonio gestured simply with his fingers. "The incision length is beyond my comprehension. Will there be any issues after the surgery?"

As he went on and on, Kavi grew impatient: "My dear Director, could you please put away your overflowing sympathy and put it where it belongs?"

Antonio's expression changed; he realized he had said too much and turned to leave.

"You haven't finished yet. What will happen to him after the surgery?"

From Antonio's perspective, the infection rate of surgical incisions is almost 100%, the only difference being the degree.

Redness and swelling of the incision seem to be an inevitable step on the road to healing, but compared to the surgeries he performed two years ago, the chances of patients' incisions becoming infected and ulcerated have decreased significantly.

The use of handwashing, clean gloves, and water, as well as the "disinfection" of the surgical area before surgery, were all learned from Kavi's papers and surgical journals.

Antonio summarized these into a completely new surgical standard, known as the "Cavill model".

He was a pioneer in Spain who was among the first to accept and practice the Kavi model. Even though many of the procedures were not exactly standard, they were still able to block out a lot of bacteria and greatly reduce the risks of surgery.

Of course, he currently performs minor surgeries such as lithotomy and tumor removal, with very small incisions.

Sometimes when amputation is performed, the suture incision length is only about 10cm, similar to Anders' abdominal surgery.

The incision made by Ugo in the lower back, passing through the chest and abdominal cavities, wasn't even in a straight line. Nearly 30cm long—even autopsies don't involve such an exaggerated incision; it's practically unheard of.
He couldn't imagine what the incision would look like after it healed, so he accidentally said something inappropriate just now.

Anders was eventually sent away.

Even if he didn't want to, he didn't have the time to talk or cause trouble. For the next 48 hours, he would drink large amounts of steroids and quietly fight the pain.

The surgery continued.

The previous abdominal surgery performed on Anders surprised Cavie.

By the high standards of Vienna City General Hospital, Antonio and his two assistants are all qualified surgeons. Antonio, in particular, possesses solid fundamental skills and a good understanding of surgical advancements, making him truly outstanding.

The nurses in charge of the operating room were also highly skilled; they could at least see the flow of the surgery and understand and learn how to measure blood pressure and heart rate. They were also very experienced in surgical preparation, indicating that they frequently rehearsed the procedures.

Unfortunately, San Sebastián is a small place with limited surgical education, unlike major cities like Paris and Vienna.

When it came to the real-world, hands-on stage, the intensity of the surgery increased several levels. Just being able to keep up with Kavi's thinking was already the limit, let alone his hands.

The brain can crash, theories can become disconnected, and original composure can gradually disappear, turning into panic.

So when Bergette had to handle a lot of assistant work on his own, Cavie didn't let Antonio and the others share much of the pressure, but instead chose to work alone.

From cutting the latissimus dorsi and serratus posterior inferior muscles, to cutting the lumbar fascia, and then bluntly dissecting the lateral edge of the sacrospinalis muscle, the subcostal vessels and costovertebral ligaments are exposed.

Then, after cutting the ligaments, the quadratus lumborum muscle was pulled apart, avoiding the subcostal nerve and iliohypogastric nerve. Finally, the two layers of fascia were cut open, and the perirenal fat was finally visible.

While dissecting, Cavie quickly applied wet gauze to stop the bleeding. Only after discovering that the perirenal fat that was fixing the kidney was only a thin layer left and the entire left kidney was completely embedded in the chest cavity did he turn back to let Antonio ligate the bleeding points at the incision site.

Is there a perforation in the renal pelvis?

“Yes, and not just in one place.” Bergett looked at the blue seepage from the renal pelvis and immediately found the rupture location. “Here, and here, it must have torn when it was squeezed into the chest cavity.”

The reason Kavi wanted to have surgery as soon as possible was because he was worried about whether there was any damage to the renal artery and vein.

With such a large displacement of the kidney, the arteries and veins will naturally be affected. If the arteries and veins rupture, it will result in extremely serious bleeding.

So he chose to quickly enter the retroperitoneum to observe the location of the kidneys. Now that he can personally feel the kidneys and renal pedicles, he can immediately confirm the condition of the blood vessels: "Thank goodness, the blood vessels are fine."

"Then let's put the kidneys back in first. We can put the renal pelvis aside for now, no rush."

Bergert quickly rinsed the diaphragm twice with clean water and assessed its condition: "The major blood vessels in the diaphragm were not affected, which is fortunate."

As Kavi slowly cradled the kidney, preparing to insert it into the diaphragm opening, he suddenly stopped: "No!"

Bergert didn't know what had happened, but if Kavi said something was wrong, it must be something serious, and his heart skipped a beat: "What's wrong?"

"What about your heart rate and blood pressure? Report them all!!!"

Heart rate.

The nurse was stunned for a moment, and only dared to look up at Antonio, who was equally bewildered, not daring to look at Cavie: "His, his heart rate is so weak, I can't feel it."