Surgery! Permalink |
Sophomore surgery lab started out with a bit of a surprise when we discovered that the humane society did not have enough dogs in need of spaying to supply all of the surgery groups. So instead of performing a dog spay, I would be performing a cat spay. I was a bit disappointed at first in that I had done a cat spay a few months before and was looking forward to doing a dog spay. But in the end, it doesn’t really make that much of a difference - same procedure, just with smaller “parts.”
The patients arrived on Monday and our surgery was scheduled for Thursday. Our cat was an unnamaed gray girl about 1 year old. She was a real sweatheart - very friendly and unfazed by just about anything. Our first task was to give her a complete physical and get started on the seemingly endless paperwork (yes, they strive to make this as realistic as possible). Also included in the effort to make the surgery similar to what we’ll find in real practice was a simulated “owner” that we had to call and discuss the surgery with.
Being the surgeon, my collegues decided that it was my responsibility for communicating with the client. Lucky me. I wasn’t quite sure what to expect with the client - nobody knew what they were told, if they were coached on what to say/ask, etc. As it turned out, they were pretty much left on their own as far as their interpretation of “playing” client, and my client apparently felt it was her duty to grill me with questions. At one point, when I was trying to provide a bit of background in answer to one of her questions, she cut me off and angrily exclaimed “you’re not answering my question!” Ah, yes, the difficult client. Eventually we found common ground and our conversations were generally civilized. In retropsect, performing the surgery was a lot easier than dealing wiht the client. Again, they had managed to successfully mimic real life!
Surgery day was tucked in-between three tests that week, so to say that the stress level was high was an understatement. My surgery group showed up at 7 a.m. on surgery day to go over everything one last time before our 9 a.m. surgery. Between surgery, anesthesia, and paperwork, there was a mind-boggling array of things to remember. I made up a check-off list beforehand, which was helpful but proved ultimately incomplete.
After giving “Ashley” (we couldn’t leave her unnamed) one last physical exam, we got the go-ahead for surgery. We premedicated her with a drug cocktail of acepromazine, atropine, morphine, and ketamine. After about 15 minutes, she was in a semi-conscious daze and we proceeded with the rest of the surgical preparation procedures. Placing a cateher in a small cat with small veins turned out to be a very difficult undertaking, and when Dionne, who was serving as the anesthetist, didn’t quite make it happen after several tries, we had to call in an experienced vet tech to make it happen. Next, I shaved the cat’s belly for surgery, we gave her an injection of carprofen (an NSAID for pain) and put an endotracheal tube down her throat. We then have her an induction drug (thiopental) and took her to the surgery table, where we hooked her up to the aneshtesia machine and started her on fluids through her IV catheter. At last it was time for me to go scrub in and get the surgery started.
They are very anal about scrubbing at the vet school, perhaps because they know that once you get out into practice you won’t spend anywhere near the amount of time scrubbing that they teach you, so they figure they’d better teach the “best” practice and let you devolve from there. After scrubbing I returned to the surgery table, put on my gown and gloves, and went about placing the sterile drapings around the patient. Meanwhile, my surgical assistant, Heidi, went to scrub in.
I then proceeded to lay out my surgical instruments and, upon Heidi’s return, placed scalpel to kitty abdomen and commenced with the surgery.
All in all, things went very smoothly. I was able to get in and find one of the uterine horns fairly quickly - probably one of the more difficult parts of the surgery - and from there it was a matter of methodically tying ligatures to cut off blood supplies to the things I was going to cut off. When I got to the point of tying off the uterine body, we discovered one of the things we had left off of the checklist - expressing the bladder prior to surgery. The bladder was full, making it difficult to find the uterine body and maneuver things. But we weren’t the first ones to ever forget to do that, and with many things in surgery, there is more than one way to get things done. Heidi used a hypodermic needle to penetrate the bladder and extract a good portion of the urine. Of course, this meant that we had to spend the rest of the surgery smelling cat pee, but I guess that’s the price you pay for making mistakes.
There are approximately sixteen surgery groups working at a time, and a group of roaming surgeons and anesthesiologists move from table to table to see how things are going. They also have to approve your procedures at certain steps, so we spent a bit of time waiting for a roaming surgeon to give us the go-ahead. But better safe than sorry and it’s not a race - the patient takes precedence over everything.
After successful removal of the ovaries and uterus, it was time to sew up and get out of there. There are three “layers” of suturing to close the incision. The first, and most critical, is sewing up the abdominal wall. If for some reason any of those sutures do not hold, you can cause internal bleeding and major complications. Then next layer is the subcutaneous layer - a layer between the abdominal wall and skin that is mostly fatty tissue. Lastly, you close the skin. Normally, the skin closures are done in a way such that the sutures are “buried” and you can barely tell where the incision was. However, with shelter animals, they insist that we put in externalized sutures that must later be removed because they use it as a means for encouraging whomever adopts the animal to take it to a vet.
Once the last stitch was in, it was time to turn off the anesthesia and work on recovery. It took about five minutes for the cat to start “coming around”, at which time we removed the endotracheal tube and whisked her out to the recovery room were Dionne sat with her under a heat lamp. Cats have an especially difficult time keeping their body temperature up while under anesthesia (even though they are on a heating pad during surgery), so it is critical that their temperature is brought back up to normal after surgery.
Ashley recovered from the surgery and anesthesia perfectly, and the next morning, she and the rest of the animals were taken back to the humane society for adoption. I tried convincing my wife that we should adopt her if she still wasn’t taken after a week, but it turns out that conversation didn’t have to go to far - Ashley was adopted almost immediately.
Afterwards, we all agreed that surgery was a million times better than sitting through lectures. But alas, reality was quick to set in - shortly after seeing our animals off on Friday morning, we had to zip over to the classroom for our 8 a.m. clinical pathology final. Fortunately, there would be two more surgeries to come in the next few weeks.
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