Something wondrous happened during Large Animal Surgery lab on Wednesday. It was the last surgery of the term and the last surgery we will perform as third-year vet students. I've mentioned before that we are grouped into teams of three for our surgery labs and rotate through the positions of surgeon, assistant, and anesthesiologist for the big procedures. It's an excellent way to learn how to perform those roles and how to communicate effectively with each other. For this term, I was grouped with two guys that I'd not worked with before on other class projects. I've now spent a lot of time with them in close quarters in highly stressful conditions, and I'd have to say that I got really damned lucky to be their teammate.
Speaking of close quarters, vet med usually involves teams of people working in sometimes less than ideal spaces. Forget the blood and poop and pus fountains. If you are sensitive about touching other people or being touched, vet med is not for you. It can get pretty cozy at times.
Anyway, for this last surgery, I was the surgeon, having picked this procedure at the beginning of the term thinking it would be relatively straightforward. Well, that happy delusion persisted until we got the notes from the instructor on the surgery protocol...and everyone who had unhappily chosen to be surgeon for this one started freaking out. Not just the usual grumbling, but freaking out. This was by far the most complex surgical procedure we had yet performed, involving incision and then closure of multiple layers of different tissues (I ended up going through 9 packs of suture material before we were done). The procedure itself was quite complex with some new techniques of tissue handling that we had not done before either. And on top of all of that, the instructor wanted us to close one of the organs using a suture pattern we had never even heard of, much less knew how to do. Yikes!
I scurried off to Dr. Google but couldn't find a good picture of this suture pattern. The instructor's notes included a written description of the pattern, but as you know, a picture is worth a thousand words. Plus the written description didn't make a lot of sense. I finally decided to sketch a couple of possibilities of how the pattern might look in Powerpoint and emailed the instructor. Close, but not quite right, she said. I tried again--and bingo! On the third try, I managed to draw a correct picture of the pattern. Once she said, yep, that's it, I emailed it to the class. We surgeons were all still freaking out but that was one less unknown going into the lab.
The procedure that we performed on our sheep is called a left paralumbar fossa exploratory celiotomy and rumenotomy. Not to worry, I am not going to go into all the details. The point of the exploratory celiotomy part is to be able to examine the abdomen of ruminants like our sheep for abnormalities; ceasarians and ovariectomies can also be done with this approach. With sterile sleeves over our sterile gowns and gloves, my assistant and I had our hands in our sheep nearly up to our armpits, identifying organs solely by feel. It was utterly amazing. The rumenotomy part involves opening the rumen of the animal to look for abscesses and metal bits that might be a source of disease. The rumen of ruminants like sheep and cows are enormous fermentation bags. Since these animals aren't terribly discriminating eaters, they sometimes swallow nails and wire. These sharp things can get lodged in a specific location and sometimes poke all the way through their guts, sometimes even to their hearts. A rumenotomy is the procedure one performs to get access to the inside of the rumen so you can feel around for sharp bits and get them out of there. Normally, one would not do this procedure unless you had verified using radiography or ultrasound that there was something in there, or if the labwork suggested the presence of abscesses. Once again, we had to stick our hands in there and feel around, this time inside the fermentation bag.
Now all of that long-winded intro is to get us all up to the amazing thing that happened. The incision in the rumen was the one that had to be closed using the new pattern. It was an oversew, meaning I had to close the incision with the pattern then sew over my first closure with the same pattern again. Oversewing is a common method for closing hollow organs like the rumen. I placed my first knot then got sort of fuddled and had to talk the pattern through with my team (they were awesome). Lots of stressors were gathering at this point: new pattern to be placed in tissue I had never handled before, clinician and resident lurking behind my shoulder watching, the rumen is quite vascular so the surgical field was extremely bloody with 3 or 4 little vessels jetting blood into the air and adding to the chaos (I was told to ignore those, keep going), and pressure to keep up a steady pace (surgery is not a race but you shouldn't dawdle).
I placed the first layer of closure in the rumen and my assistant and I were cleaning up the surgical field in preparation for the next layer of closure (the little bleeders were now tucked inside the first closure). The resident drifted over and said, hey, that's a really nice closure. Then she drifted off to the next station. I looked up at my team with tears in my eyes and said, I have never before been told by any surgery lab instructor that I did anything right or good.
Yeah, I know, that's really sad, isn't it? But suddenly, there it was, an amazing little thing that was actually an enormous thing for me.
And it was indeed a fabulous closure. I totally nailed that new pattern. My assistant and I went on to complete all of the required tissue closures and wrapped up that lab in good time and good spirits. The instructor later complimented our group in particular on our ability to think through problems and not just stand around waiting to be told what to do next. I credit my teammates. Both of them like to talk a lot during procedures which is precisely how we learn from each other.
Given the horror of my Small Animal Surgery labs, it's a miracle that I'd even want to do any surgery again. But I can think of no better ending than completing this difficult surgery on such a high note. It made me think that this vet thing might be happening after all.
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