Lessons in the Practice of Veterinary Medicine

The Chinook students were asked to write reflective pieces about their experiences as veterinarians in the North. Some of these pieces will be published, as blog posts, some without the names of the author. This one was written after the 2014 trip, by a student exploring the long journey of confidence and competence.

Patient in Sheshatshiu

Patient in Sheshatshiu

For me, learning always seems to be the hard way.  I’m the type to fumble a bit when trying something new, especially “in the presence of greatness”  It’s highly likely I’m always going to be less than content with my work.  As such, participating in the Chinook was both challenging and one of the most important experiences I’ve had as a newcomer in the veterinary profession.  What a wonderful and crazy combination of endurance testing, team-building exercises, and introduction to high-volume and high-quality spaying and neutering.  I still would not rate my surgical skills, spaying in particular, as excellent.

However I did learn a multitude of techniques I can apply as I perform surgeries in the future.  Maybe more importantly, I learned a lot about facing my biggest critic- myself.  I went in with the notion that after the limited number of surgeries I was already involved in, I should just know how to do them by now.  I worried about the disparity between where I wanted to be surgery-wise and reality.   Working as part of the Chinook team, everyone had the same common goal.  In that environment I could finally start coming to terms with my novice level of ability.

Even on the last spay of the trip, with a bit of physical and mental fatigue taking it’s toll, I still was struggling with more difficult spays.  I still felt I could benefit from more instruction. I had my most clear moment of realizing that asking for more help, seeking more chances to learn is actually ok, especially at this early stage of my career.  I saw all the wonderful instructors around me and I could see they really meant it when they said there was no shame in asking for help. Someday when I have to do a difficult surgery on my own I’m sure I will be glad I asked for the extra instruction when I had the chance.  For the larger dogs in heat, the postpartum dogs I am a little better than at the start of the trip.   I am still seeking further opportunities to build my abilities so that I don’t get stuck having to do only “easy” ones.

On this trip I learned that when I am mentally fatigued, and on top of that worrying about how I’m perceived- that the worrying just saps my ability to cope with the challenges that actually matter in the job.  When I just quit worrying, even if I am really tired, I can cope with stresses and challenges by remembering what I’ve been taught and keeping in mind the patient’s well being.

All this in addition to numerous technical skills I had a chance to practice:

Performing an intradermal suture calls for minimal and gentle tissue handling more than a truly beautiful cosmetic effect.    If you’re performing an ovariohysterectomy, there is a juncture where the broad ligament is torn to properly exteriorize the uterine body.  As with almost every other part of a spay, proper visualization is the key.  In the cat one tends to just tear until close enough.  In the dog, one can instead drape the broad ligament over their hand to see a transparent area that tells how close to try and get.  A window is made in that then the rest of the fat is gathered up and scrubbed at until reaching the round ligament which necessitates a good shredding action, with fingers preferably.

Dr. Ruffino helps prepare an animal for surgery

Dr. Ruffino helps prepare an animal for surgery

I feel more capable with lots of individual elements of surgery (breaking down suspensory ligaments in a spay or making a skin incision to exteriorize testicles that is not excessively big).  I gained greater comfort with using injectable anesthetics (getting a sense of when a patient is becoming light, learning through a bit of trial-and-error that ketamine-valium is a beautiful combination for animals being maintained on injectable whereas an agent like thiotal may be better if going to inhalant for maintenance).  I feel I can neuter on my own with relative ease (visualizing the median raphe and catching it to minimize dead space, trying a number of techniques).

Something I was “taught” (told) but I didn’t really get before Chinook: that these elective surgeries are definitely far from routine.  What am I still learning? How to put all the steps together for maximal efficiency.  The important thing about spaying and neutering is safely removing all the bits that are going to allow our animal friends to reproduce themselves in unsupportable numbers and leave themselves prone to poor health down the road.  From start to finish the priority ought to be hemostasis, sterility, and patient comfort.  Regarding a magic list of instructions to follow: there isn’t one!  More rewarding is that it’s the responsibility of each individual veterinarian to know what they are doing, to take what they have been taught and go a step further in applying that.

 

 

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