Something that is said a lot by surgeons is that unless you do something then you will never understand just what it takes. I realised today that this feeling depends on what you are doing. For routine stuff such as castrations where the goal is to remove some organs through a small tidy incision with no impact on function I am confident. I know what I am doing, how to do it, and that everything is going fit back together afterwards.
Today however I was put into a new situation, I assisted on an amputation after a car accident, and was left with a big hole on the side of the chest to cover with skin. I was basically doing reconstructive plastic surgery for the first time – and I started to feel the pressure. I had to make sure that the skin came together without tension without any dead space and with good opposition. I started walking the top flap down across the open space suturing it to the underlying muscles as I went. Once I had reduced the space here I realised that the edges did not line up – it was my responsibility now to cut the skin so that it fit together. For the wound to be straight with no dead space as if I left space underneath the skin it would form a seroma and fill with fluid. This has always looked so easy when someone else is doing it, however now it was me and it was not so easy. This was the easy wound as there was not going be much movement here yet I was still not sure just how much I could or should take.
I did the only thing I could that made sense and did it in stages as I brought the skin back together and it worked. Nothing like the results in the textbooks – however tonight I am going sleep fine with confidence that it was a good job and will heal.
The next part of the surgery was to repair a wound on the back leg as well – the skin had been peeled back either side of the thigh from the front with dirt inside with really dirty edges. This time it was more difficult to judge – this wound was going have movement across it with every single step. Every step was going change the tension on this wound, and it was big from the top of the thigh all the way until just above the top of the knee. Normally the length is not a consideration (wounds heal side to side not front to back!) – however the closeness to the knee meant that different tension patterns were going apply to different parts of the wound.
I made my plan; I picked up the scalpel, placed it against the skin roughly 3mm from the torn edge and started my cut. My cut was long and went around the entire wound taking in a random hole at the lower end as well. It was slow, and I was petrified that I was going take too much, or worse go too deep and cut something I shouldn’t. As I cut there was bleeding – I’m lucky I know more about bleeding now than most – and seeing this blood I was concerned but not alarmed as it was only a little. I clamped it off whilst I finished my cut – clamping it applied pressure and gave it time to clot so that by the time I was going suture the wound it would have stopped bleeding.
I then set about cleaning the surface of the open wound that had been contaminated with a curette (like sharp edged spoon) so that I had a clean wound bed that would stick to the skin I was going place over it. I took my now relatively cleaner wound and then flushed it with sterile saline to hopefully remove as many germs as possible that I may have missed and started suturing it back together. Firstly bringing the edges of the skin close to each other, and then suturing the edges of the skin together.
Finally it was time to head to recovery – which went extremely smoothly with the dog up on its 3 good legs within 30 minutes of the end of surgery. I just hope now the dog finds an amazing home.
One of the greatest responsibilities of a vet is to be an advocate for a voiceless animal, to be able to speak for the animal and push for what it is best for that animal. With all the technology and medicine available it is not a case of keeping the animal alive, but one of trying to balance the quality of life. Every vet student wonders how they are going to have that conversation, if they are going to get it right, and if they are going be able to do it. There is no exact science here, experience – which vet students lack – does help however it is still a guessing game, one where the doubts of if it is the right time find their way into the mind.
Euthanasia… The word actually is from the Greek language and means good death. Being able to relieve suffering is one of the vets greatest tools, yet is the one I feel that has most responsibility. Here you are not just a voice for the animal, you are a counsellor for the client who is saying goodbye to their best friend. This isn’t always easy, especially if it is an animal that you liked or a friend or family.
Over the weekend I gave a voice to a friends cat who had deteriorated again, its wasn’t a easy decision to make to raise this option. Not only because I knew how much the cat meant to her, but because I was not sure it was the right time. Clinically it was possible to keep him alive, it wouldn’t have been a good life though as I suspected he had entered end stage renal failure with the toxins in the blood attacking the digestive tract. I took a chance and spoke through this with her, not an easy conversation but one that was essential for my other friend, her cat Masik.
Taking Masik to the vets it was confirmed as renal disease, the kidneys not working, now clinical signs of renal disease do not appear until 75% of the kidney is diseased. Talking with her family my friend decided that it was time and today took Masik to the vets for the last time. Before the final euthanasia drug is administered it is common to administer a sedative and painkiller to ensure a comfortable passing. One of the side effects of this drug is vomiting, and this Masik did showing my friend how it contained blood, his last gift to her saying that it really was the right time.
Rest In Peace Masik my friend.
Sometimes when you look back on something you start thinking about other things you could have done. Tonight if I had kept my original flight I would have been in Slovakia, I would be £200 poorer, and I would have failed to sell all my stuff. Its also sad as there is a festival on currently in Slovakia which if I had made it over today I would have been able to attend with my new classmates. However I believe that I made the right choice, I am not as stressed as I was about getting everything done, and tommorow should be selling the last of my stuff.
Anyways in talking to vets the common decision is that of where to draw the line. With pets it is possible to treat many diseases aggresively, however it comes down to a vet to help a owner decide when or if there is no quality of life. The biggest ethical dillemma facing animals is that it is impossible to communicate to them that they are going get better. Whilst the owner and vet may know this, the animal (which in some cases may be in extreme pain) doesn’t. With more and more advanced (and more agressive) treatment being developed sometimes its difficult to see where the line is.
If you contrast these decisions you can see that decisions made that affect yourself tend to be easier than those that affect others. I believe that it is important to understand the responsibility I am taking on in becoming a vet, firstly to animals, and then to clients. Within veterinary medicine they say you do not really start learning until you are in practice, and as such I both look forward to graduating in 4 years time, whilst also dread the mistakes I am bound to make…