My Soft Tissue Surgery rotation is done. It’s been a rough, long, but exciting 3 weeks, but it’s all behind me now. That means I should have more time to write since my next rotation is capped at 40 hours per week. I thought I’d celebrate this new found temporal wealth by writing about my recent spay and neuter day.
This past Tuesday myself and two other students from my rotation drove an hour and a half to the Michigan Humane Society to complete five surgeries. It was one of the scariest yet rewarding days of my life. I haven’t done an actual surgery by myself since last semester, when I did a dog neuter. Since then I’ve only assisted on surgeries. But on Tuesday I had to do five surgeries on my own. There was a doctor on hand if I had questions or an emergency rose up, but I didn’t have an assistant and otherwise had to do everything myself.
So without further ado, here’s how the day went.
NOTE: I took some photos for this blog while I was there, but I obviously couldn’t take pictures during a surgery. So I have decided to use my incredible artistic skills to recreate these moments using Microsoft Paint. The photos that I did take are horrible quality because my camera sucks incredibly hard. If you would like to see better quality photos in this blog in the future, then please buy me a new camera.
The Beginning – INTRIGUE
I’d spent the past Sunday reviewing the surgical techniques and watching videos for the four different surgeries we would be expected to do: dog spay, dog neuter, cat spay, and cat neuter. The morning of this adventure, I felt prepared and excited as I stepped into my friend’s car at 6:30.
Me on the way there. I really can’t express how much I hate this camera. It doesn’t even have a flash; it just has a flashlight. Seriously.
I tried to review some notes on the drive there, but mostly just enjoyed the ride sipping a NOS energy drink. (Side note: NOS has excellent flavor and a mild, unobtrusive, yet helpful buzz.)
NOS energy drink gets a 9 / 10 – Amazing.
Once I arrived at the facility we were given a quick tour. I assumed that this would be a rundown facility, but instead it was a massive and pristine complex with an adoption center and large veterinary clinic. I spent most of the tour thinking not about the surgeries I would be performing, but how I’d one day love to work in a place like this. I spoke to the man giving us the tour, Dr. Fisher, about working for the Humane Society. He said that he really enjoyed it and that the salary was comparable to private practice. I’m definitely going to look into this as a possible career path; I think it would be really interesting and rewarding to help the most at-risk animals.
After a tour we had to do very quick physical exams on our patients. These weren’t the five to ten minute exams we do in the hospital. All we did was spend one minute on each animal making sure they were the recorded sex, didn’t have signs of infection, and that their heart & lungs sounded normal. Then we switched into our scrubs and got ready for surgery.
Surgery One: Dog Spay – FEAR
My mind was still caught up in how much I liked the facility when my first patient was slid onto my table. As I grabbed my scalpel and looked down at the dog, everything suddenly hit me. Oh shit, you actually have to do surgery now. I started to feel the fear bubble up, but managed to control it by reminding myself that spays are relatively easy surgeries and that I’d been preparing for this. So I made my incision.
So what exactly does this surgery entail? A spay, or ovariohysterectomy, involves removing a female animal’s uterus and ovaries. What we do is cut our way into the abdomen and locate one of the two uterine horns and ovaries. We clamp off the blood supply and cut the ovary away from this “pedicle” (artery and vein). Then we find the opposite ovary and do the same thing. After that we just need to cut off the uterus and stitch the animal closed.
Things went very well initially but rapidly fell apart once I was inside the abdomen. It took five minutes of searching for me to find the first uterine horn. Whenever I used my spay hook to find the uterus I’d just end up getting intestines. As I’ve noted in previous posts, I’ve started getting anxiety attacks recently. At this point I felt another one coming on. My face started burning up and I got incredibly nauseous. This subsided a bit once I finally found the first uterine horn and cut off the ovary’s blood supply. I started to think that I was handling things, but while working on the opposite ovary I noticed there was blood in the dog’s abdomen. A lot of blood.
An accurate rendition.
After I realized that this hemorrhage was becoming a literal pool the organs were floating in, I called over Dr. Fisher. He put on some gloves and took a look around, but declared that I hadn’t severed anything and that the blood wasn’t life-threatening. This was a big dog and it was just dribbling down into the abdomen from the ovary I’d already cut and had rested on the outside of the abdomen. I forced myself to keep working and got through the surgery as fast as I was able, considering that I needed to stop every five minutes to keep from throwing up.
The worst part came when I closed the abdomen. I’ve always been nervous about my suturing abilities, but what made it worse was having to bend over the table. I don’t have the world’s best back and this table was set incredibly low. I’m sure I could have handled that on a normal day, but I was already fighting off nausea. The added back pain made me feel completely on the verge of passing out and I strongly considered telling Dr. Fisher that I wouldn’t be able to do the next surgery. But my previous panic attacks had usually subsided after this amount of time, so I forced myself to power through it and sutured the dog closed. Dr. Fisher declared my suturing adequate and the techs carried away my patient as I took a deep breath and realized I’d finally done a spay.
One out of five done.
Surgery Two: Cat Spay – CONFIDENCE (also Nausea)
As the techs carried in my next patient, a female cat, I took a few deep breaths and forced myself to be confident. If the bloody mess that was my last dog was still breathing, there was no way I could manage to kill this cat. So I cut open the abdomen and, to my amazement, found the uterus on my first try.
This is when things hit a turning point. My anxiety began to fade as I forced myself to focus on the positives. I started to think about how much I enjoyed doing this surgery in spite of my fear, of how much I loved working with animals every day. I began to realize what a good decision it had been to pursue veterinary medicine and how I had already successfully spayed one animal. I started to feel like a real doctor and be proud of myself.
Much less blood this time.
It also finally occurred to me that I could simply ask the techs to raise the table. They complied, but told me that this table didn’t go as high as the others because of course it doesn’t, this is me we’re talking about. So while I was emotionally much better, my back kept hurting and prevented my nausea from fully dissipating. I would spend the rest of the day fighting the urge to vomit because of this stupid table.
But in spite of that this surgery went much more smoothly. Soon I was closing up my patient and then they carried her away, leaving me with a tiny uterus and two small ovaries.
Tiny gonads from a tiny adorable kitty.
Since we each had four types of surgeries to complete and five patients, some of us would need to do another spay before lunch. Spays take much longer to do than a neuter and my back was nearly unbearable at this point, so I basically ripped off my gown before they could tell me to stay scrubbed in. Luckily, they’d decided I would do a cat neuter next, which is essentially the fastest surgery possible. I stepped out to the prep room, where this simple procedure would be done.
Surgery Three: Cat Neuter: – RELIEF
I’d always heard that a cat neuter is barely considered surgery, but had been hesitant to believe this. After all, you’re still removing organs from a living thing. How simple could it really be? As it turns out, very. Even for someone who’d never done it before, the whole process took about five minutes. A real vet could do it in one.
Basically, an incision is made on one side of the scrotum with a scalpel blade. You pull the testicle out, tie its spermatic cord in a knot, cut the testicle away, and repeat on the other side. That’s it. You don’t even have to suture the wounds closed; you just leave them open.
The only semi-difficult part of this procedure was tying the spermatic cord in a knot. It takes me a very long time to learn how to do knots. That part of my brain just doesn’t work right; I can’t learn by watching a video or watching someone. I have to actually do it a ton of times slowly to learn how. Dr. Fisher was very understanding even as my efforts to follow his instructions made me seem like a complete idiot.
Everyone laughed as I died a little inside.
Eventually I figured out how to tie the knot and managed to cut away the first testicle. I managed to tie the second spermatic cord after only a couple tries and breathed a sigh of relief as we broke for lunch and I would finally get a chance to sit down.
End result: two testicles removed. Each was smaller than my pinky’s fingernail.
Surgeries Four & Five: Dog Neuters – CONFIDENCE (again)
After lunch I quickly did my last two surgeries. These were both dog neuters, the only operation I had done on my own before. Considering all of my previous patients were still breathing and I’d gotten a chance to rest my back, I was actually looking forward to these last two operations.
Dog neuters are harder than cat neuters, but they’re still pretty simple. Instead of slicing the skin over the scrotum, you push each testicle forward into the pre-scrotal area. Then you incise over the testicle. Simply pull out the testicle, clamp and ligate the spermatic cord, and cut the testicle off. Repeat with the opposite testicle, suture the animal closed, and you’re done.
Considering how simple this procedure is and how I’d done it before, I basically went through these on autopilot. I really like doing dog neuters; there’s something so relaxing about stripping away the spermatic fascia and yanking the testicle as far out of the body as you can. One thing that kept crossing my mind while doing these last two surgeries is I do not feel old enough to be doing this.
I’m 24 years old; many of my classmates from high school have full on careers, are married, and have kids by now. But I’m one of the younger people in my veterinary class; it seems that most people take at least a year off between undergrad and vet school to get some hands on experience. Plus, it’s me. I spend most of my spare time daydreaming about Jimmy Neutron, how to create my kids’ TV show, and video games. Even though I’ve grown up a lot over the past few years, I still think of myself as having a very prominent inner child. Yet there I was, covered with a mask, gown, and surgical gloves, doing surgery on a living animal. I was handling the surgery, but I just did not feel old or wise enough to do this.
Thankfully, these thoughts were mere curious musings, not the beginning of another panic attack. I finished my two surgeries quickly enough, took off my gloves, and sat down utterly exhausted.
An incredibly poor quality photo of puppy testicles.
That stupid freaking table after my last surgery.
A fully utilized surgery pack after my last neuter.
At the end of the day we all drove home completely exhausted. We’d spent six hours in the operating room and about ten hours at the facility. Even though I just wanted to get home and crash onto my bed, I couldn’t help but be proud of myself and relieved that I’d finally done each of the four major surgeries I’d be performing daily as a veterinarian. For the first time I began to really think I could handle this job and looked forward to doing this stuff on a daily basis. I’m taking this same rotation next spring for more experience, and I can’t wait to go back and kick that table’s ass during my next batch of surgeries.