Chapter 298: The Second Time

The church crowd cheerfully saw Brother Wading off with the patient, voluntarily provided a carriage for transport, and stated they would patiently wait here for the patient's family to arrive and inform them of the destination.

They were not actually that concerned with the follow-up; the point was that the church had already entrusted the injured person's treatment to a doctor of considerable reputation.

As for what specific treatment the patient would receive, that was the doctor's business and had nothing to do with the church.

Symbolically, they still dispatched a cultivator to ensure participation.

Brother Wading volunteered to take this spot; he was a bit worried, or rather, very certain that once others knew the treatment method about to be carried out, they would not be willing to let the patient be taken away.

Even that cultivator who had unfortunately fallen from his horse during the rainy night attack and received treatment from Kraft would, afterwards, feel a pang of heart palpitations when touching the small triangular dent on the top of his head.

That piece of bone was collected and carved into a double-winged protective amulet as a memento of surviving a great disaster and proof of being favored, hoping this divine favor would continue to accompany his life.

Regarding the patient's practice of attributing part of the credit to the Heavenly Father, Kraft expressed no objection and did not feel it was a slight against his work.

In a sense, he even agreed with this view.

Under the current equipment and sterile conditions, successfully completing a craniotomy without infection or excessive bleeding and fluid seepage, saying "blessed by the Heavenly Father" was conservative; one could fully consider competing for the title of Heavenly Father's Chosen, at least passing the preliminary round.

Therefore, unless it was a case that absolutely had to be done, Kraft was actually quite reluctant to get involved in such surgeries.

After investigating via special means, he excluded patients with non-severe compression, stopped active bleeding, and stable vital signs.

These could be left for continued observation. If all went well, small hematomas would slowly absorb over the coming long period; there might be some sequelae, but it was better than gambling one's life on the operating table.

The rest were patients who had to be treated.

While preparing for the surgery, a pre-drafted informed consent form had already been filled out, waiting for the arriving family to be informed of the condition, obtain consent, and then begin work.

Fortunately, the family of the patient with Cheyne-Stokes respiration arrived first.

Unfortunately, the patient's brother, who was of similar age, did not quite understand the doctor's meaning.

Although Kraft used the most vivid analogies possible to describe the patient's current condition, the dangers, and why surgical treatment was the best choice, the family member still asked in confusion when his brother would wake up.

"He may never wake up again," the doctor had to adopt a more blunt phrasing. "Even with my method, he will most likely die within the next few days or simply die during the treatment process; the chances are extremely slim."

"You can choose to let him suffer less and leave in a more dignified manner; or gamble on a one-in-ten or one-in-twelve survival probability."

"You said you need to open the head... but isn't that death?" This man, who ran a small business, knew nothing about medicine, could see his brother's condition was wrong, but if someone on the street said such a thing to him, he would surely get a beating.

"As long as we don't hurt what's inside, he's just missing a piece of skull; we need an opening to clear out the blood clot." Kraft repeated the surgical principle again, not hesitating to bring up bloodletting therapy.

"Just like doctors usually let out your stagnant blood to cure illness, only this time it's from inside the brain."

"Can it only be treated this way?" The patient's brother still held some hope.

"You could also expect a miracle to happen." To be honest, the thought of "it would be best to just give up" had already started appearing in his mind.

This procedure currently had high difficulty, the benefits gained were relatively limited, it was easily misunderstood leading to a series of troubles, and was purely a loss-making operation, but providing the theoretically highest-reward option for selection was his profession.

"Think it over, and preferably do it quickly." After saying this, he left; the family could consider it for a while, but he had to go to the back to start preparations, and as soon as the other party signed, they could start immediately.

When Kraft had washed his hands, set up the last instrument, and felt in the waiting period that he might not need to operate, Kup came to inform him that the family had agreed and signed.

Now things were much simpler; the only thing to worry about was the operation itself.

The patient was lifted onto the table by Dai Wei and his assistant, and the range of the hematoma had already been marked.

Compared to the first craniotomy subject, this person's condition was clearly more severe; the instability of vital signs was caused by a rather serious brain hernia.

Hernia can be simply understood as tissue squeezing through some gaps into places it shouldn't go.

This situation was not formed by direct injury, but rather a hematoma of excessive volume broke the intracranial pressure balance, causing brain tissue to be compressed and displaced; if this compression were uniform, it would be fine.

But the problem is that the brain is not a homogeneous blob of slime; it is actually interconnected chambers separated by the tentorium cerebelli and falx cerebri structures, which can be imagined as a room divided into several small compartments by partitions.

Under pressure, contents in one compartment are squeezed toward another; since the exit size is limited, only part of the tissue gets squeezed through, and this small piece protrudes and presses on other parts.

When luck is particularly bad, this part is the medulla oblongata controlling life activities, manifesting as respiratory inhibition in the form of Cheyne-Stokes respiration.

To achieve a better decompression effect, besides clearing the hematoma, this time a larger surgical area is needed to remove a larger bone flap, which of course also means a higher probability of infection.

Fortunately, the clinic, even if it didn't use ether in large quantities often, still regularly updated its ether reserves, enough to support the surgery under general anesthesia.

Kup watched the blade carve an elliptical arc on the smooth scalp, like cutting open sturdy fur stretched over the back of a bowl; this thing must have good toughness, because one could see the metacarpals protruding on the back of Kraft's hand as he exerted force.

Next was literally flipping open this skin flap along with the thin muscle underneath.

Thanks to the Higo family's instrument improvements, one could now use a flat-headed small clamp to press the scalp incision edge, combined with pressing the superficial temporal artery to stop bleeding, instead of crudely burning the bleeding point with a heated thick needle.

The hand pressing to stop bleeding was provided by Dai Wei as a favor; Kup was responsible for holding the vascular clamp securing the scalp, while his other hand held up the reflecting mirror to provide illumination for Kraft.

Next came the sterile version of carpentry work; without a surgical drill, trying to knock off a large piece of skull with a small chisel was too time-pressured, requiring boldness, carefulness, fast hands, and steadiness.

First time is a learning experience, second time is familiarity. With last time's experience, Kraft felt he adapted quite well to this operation, finding a rhythm amidst the clanging knocking sounds.

Of course, it would be even better if a genius could make a drill in an era without electricity. Early dentistry saw foot-powered dental drills; sacrificing some craftsmen's brain cells, perhaps this was not an insurmountable technical hurdle.

About half an hour into the surgery, he had chiseled out two-thirds of the expected opening circumference; barring unexpected events, the decompression and clot-clearing steps should be performed within ten-odd minutes, closing the wound as soon as possible.

Dai Wei seemed numb; in over thirty years, the most blood these eyes had seen was the seepage from a chest puncture needle hole. Now he was hesitating whether to turn his head away; such a rare viewing opportunity was too hard to come by.

Despite compression hemostasis, a small amount of red still seeped from the edges toward the exposed, stark white bone shell surface, needing to be wiped away repeatedly with cotton balls. The highly impactful sight made him start to tremble unconsciously.

Kraft initially didn't pay special attention to this until he noticed the surgical field suddenly started shaking; he raised his head slightly to ask Kup and Dai Wei, who had better arm strength, to switch hands.

However, before the words left his mouth, he realized it seemed not just this small patch in front that was shaking.

Flat objects weren't very obvious, but the taller glass bottles seemed to be swaying left and right with a slight amplitude. Kup beside him increased the force stabilizing his arm; it seemed he also felt the change but thought he just hadn't held it steady.

"Don't move!" Kraft suddenly stopped his work, quickly tearing open a piece of sterile cotton cloth to block above the surgical area. "Don't panic; we only have two floors, it won't collapse!"

The two were completely confused when a obvious dizziness and visual shaking swept over them.

Long bottles, high shelves, even wooden pillars swayed; outside, the sound of vessels falling and shattering and delayed screams came, followed by chaotic footsteps and more crowd screaming.

"Don't move!" Kraft's roar drowned out the noise, pulling the startled consciousness back to the front.

He kept both hands holding the cotton cloth flat, blocking the little falling dust drifting down during the tremor, until the power coming from underground subsided.

"Call someone else in to hold this cloth; we continue."