This past Monday I began my second veterinary school rotation, Soft Tissue Surgery. This was also my first rotation in the hospital. Coming off of a laid-back three weeks in molecular biology, I was scared of every aspect of this rotation, The long hours, memorizing surgical techniques, coming up with treatment plans, filling out paperwork; you name it and it was giving me an ulcer. This culminated in me nearly having a panic attack Monday morning. But after a 55-hour week at Michigan State University’s small animal hospital, I actually feel like this is something I can handle. So if you’re interested in going into veterinary medicine or just want to what us vets go through, allow me to share what one of the vet school rotations is like.
MONDAYS & WEDNESDAYS – Patient Intake
Mondays and Wednesdays in this rotation are the days we take in new patents for surgery. On Mondays the day starts at 8:00 a.m.; on Wednesday it starts around 7:15 because you have to come in early to check up on your patients from the previous day. This means you’ve got to check all their vitals, administer their medications, take them out to urinate or defecate, and call the owner. Once you’re settled in, you take a look at the clipboard of appointments for the day. This clipboard lists the patient and a quick two or three word explanation of why they are coming in (ex: laryngeal paralysis; urinary obstruction; etc.). Then you go up front to the reception area and wait for your patient to come in.
Once they do, you bring them into an exam room. You’ve got to get a thorough history of the pet as well as do a complete physical exam. After you’ve got all the details you need, you go into the consultation room and find the first available doctor. You give them a rundown of your case and explain your thoughts on what tests to run, what treatments to give, and what the diagnosis is. The clinician will help guide you and then you both go back into the room and to let the owners know what’s going on.
Then the owner gives you the patient and you’re in charge of it until it goes home. Now you’ve got to spend the rest of the day figuring out exactly what’s wrong and preparing it for surgery the next day. You’ll do such things as getting blood and running it up to the pathology lab, filling out an anesthesia request form for tomorrow’s surgery, and bringing the patient to radiology for imaging. There’s also “Topics Rounds” on these afternoons. For about an hour and a half, the whole rotation meets up with the doctors and they’ll give an interactive lecture on whatever topic they decide. For example one day this week we discussed everything possible about removing foreign bodies from dogs’ GI tracts.
Once all this is done and your patient is all set for surgery the next day, you can call the owner and fill them in on your progress. Wednesday is busier because you’ll probably be working on discharging your surgical patient from Tuesday. This means you’ve got to keep in contact with the owner to see when they come in to pick up their pet. You’ve also got to write a discharge form. This is a roughly two page document that explains all the tests you ran, their results, a summary of the patient’s surgery, and everything the owner needs to know about taking care of their pet after their surgery. Depending on how long the wait is to get all your tests done and how long your discharge takes, you’ll get out of the hospital anywhere from 5 – 7 at night.
TUESDAY & THURSDAY – Surgery
This is the day where the rotation lives up to its name. You’ll come in at 7:15 in the morning to check on your patient. There’s not usually new appointments on these days, so figure out when your pet is going to surgery, make sure everything is set for it, and research everything there is to know about the procedure.
At some point anesthesia will come and pre-medicate your patient. This gets the animal sedated and gives you a roughly twenty-minute warning that your surgery is coming. Grab a quick bite to eat and change into your scrubs. Once anesthesia brings your patient into the prep room, you’ve got to clip and scrub the surgical site. Once the patient is ready for surgery you can scrub in, gown up, and take your place beside the surgeon.
We don’t do the actual surgeries in this rotation. Instead, we serve as surgical assistants. We hand the doctors tools, blot any hemorrhage, manipulate tissues and sutures, and have to know every aspect of the surgery to answer any questions they might have. If the surgeon feels you’re prepared, they will often let you handle minor tasks like doing the final sutures to close the patient.
Once the surgery is complete, you help anesthesia bring the animal to recovery. You’ll want to stay with your patient until they’re stable. Then you need to come up with a post-operative treatment plan. This includes every detail of what care the patient needs. Usually this includes some combination of fluids, pain meds, antibiotics, and various other medicines that the animal needs. Once this is all set up and approved by the doctor, you can call the owner and then settle down to write your surgery report.
An example of a surgery report. This one was very short because the procedure was just draining an abscess.
Once everyone in the rotation is done with all their surgeries, you all go on cage rounds. For around a half hour the doctors take the group to all of the day’s surgical patients. Each student goes over their case including the history, surgery performed, treatment, and further plans. You’ve also got to be ready to answer any questions the doctors have.
When the doctor asks, “How will you continue to combat this dog’s infection?”, answering, “Drugs” is only cute the first time. After that the yelling ensues.
Once rounds and the surgery report is done, you can go home. This is usually between six and seven o’clock.
FRIDAY & ON CALL DAYS
Friday is just a catch-up day. If there were too many surgeries on Thursday or an emergency came in, it will get handled on Friday. You may also have to come in on Saturday if you have a patient from Friday that stayed the night; I just had to go to the hospital for 2 hours this morning to handle his morning treatments and discharge him. There’s also on call nights. We each have to pick 2 – 3 nights to be on call. For weeknights, this just means we have to come in during the night if an emergency comes in and they call us. For the weekends, we have to come in once in the afternoon and once at night to treat all of the soft tissue surgery patients. If an emergency comes in and they call us, we of course have to come in as well.
WHAT I LEARNED
- Technicians are basically the only thing keeping the place running. The doctors can answer your medical questions, but they’re too busy to help you with anything else. If you need help with restraining an animal, filing paperwork, finding something, or just generally figuring out what you’re supposed to be doing, you need to find a tech. Luckily there are tons of them and all of them I’ve talked to are happy to help you out.
- There is so much paperwork. It takes a while to figure out what you need a form for and how to fill it out; I got a call Wednesday night because one of my patients didn’t have the medicine I wrote that he needed. I had no idea I actually had to fill out a form for that; I guess I thought it just kind of appeared in front of their cage. Here’s just some of the forms we have to deal with every day: prescription forms, histology submission forms, blood analysis forms, client communication sheets, discharge sheets, surgical reports, treatment flow charts, anesthesia request forms, transfer forms, history forms, & SOAP (morning check-up) forms. The first day of the rotation basically consisted of us third-year students running around with a clipboard desperately searching for someone to tell us what forms we needed and a doctor to sign them.
- Things will die. Most of our cases are rather easy surgical fixes; no one died on the table in our department this week. But one of my peers’ patients, a fourteen year-old dog, coded overnight and died. There was also a tiny 2-month old long-haired Dachsund in NCU (non-critical unit), which is the ward where many of our surgical patients are housed after surgery. Since we’re all always rushing through NCU to check on our patients, we fell in love with this puppy. He was small for his age and loved to just lumber across his cage, roll over, and lick our faces. He was the cutest puppy I’ve ever seen. We thought he had a persistent right aortic arch, which can be cured surgically. Instead, he had congenital megaesophagus. There’s no way to fix this and it predisposes the animal to aspiration pneumonia. He got to go home, but the odds are good that he’ll be dead within a couple years. Hopefully he’ll be one of the success stories and live a long life, but there’s just as much chance he won’t. This is something you just have to get used to in vet medicine.
- It’s long hours and a lot of work, but it flies by. I was so used to having 6 – 8 hour days in my last rotation that I had no idea how I would handle 10 – 12 hour ones. After all, after 6 hours at Wal-mart I wanted to die. But things are much better in the hospital. You’re so busy that you never have a chance to think about what time it is. And in spite of all the chaos of this rotation, it really is a lot of fun. When you get to give a client their newly healthy pet back or watch an animal’s open abdomen move while they breathe, you really do feel lucky to be in veterinary medicine. At the end of the day you’ll be exhausted and just want to sleep, but it’s a good type of fatigue. And at least we’ve got weekends off (mostly). Better than emergency, which someone in my rotation had last. She hasn’t had a day off in over two weeks. I’m not letting myself think about that yet. But for now, things are good.
- You’ll be terrified but then get confident. Like I said earlier, everything about this rotation overwhelmed me at first. But after just a week I feel like I’ve got a good handle on things. I know where all the paperwork is and how to complete it, I’ve gotten through several surgeries without compromising sterility, and I’ve been able to answer most of the doctors’ questions correctly. I’ve still got a ton to learn (especially drugs!), but I feel like over the next year and a half I can get there. That’s a heck of a lot better than nearly throwing up and passing out from anxiety during orientation.