Читать книгу Tales from a Young Vet: Part 2 of 3: Mad cows, crazy kittens, and all creatures big and small - Jo Hardy, Jo Hardy - Страница 6

We’d been told that the anaesthesia rotation would make even the toughest vet student cry. Rumour had it that the clinicians were merciless, the drugs impossible to figure out and the operations interminable. So I arrived at the Queen Mother Hospital at eight o’clock on a morning in late August feeling extremely nervous. I felt sure that I knew absolutely nothing and was going to fall flat on my face.

To make matters worse, the TV crew were coming to film me at work for the first time. After the slapstick carry-on of our holiday shoots, I could only hope that this wouldn’t be a disaster, too.

Thankfully, two of the other students were also being filmed. Grace was by now a bit of an old hand in front of the cameras, and so was Charlie. He was in our sister rotation group, the one that was doing more or less the same order of rotations and had been with us in Wales. They joined us again for anaesthesia and it was good to see them – especially Charlie, who was one of those guys that everyone got on with. Quite a posh country chap, he wore his checked shirts, chinos and gilet as standard wear rather than just as vet ‘uniform’. With blond, floppy hair and a huge grin on his face, Charlie was always in a good mood, always jokey and easygoing, no matter how stressful the moment. And he was brave; he would give anything a go, even if he knew he was probably going to get it wrong.

I enjoyed bumping into Charlie in the student tea room, where we’d regularly congregate to have a moan. He’d be the one who would come and put his arms around you and say, ‘How’s it going? What’s going on?’

That first week the crew concentrated on Charlie and Grace, and I was grateful for the chance to find my feet with anaesthesia without cameras there to highlight my every mistake. I like to get things right, which I was quickly coming to realise was unrealistic in rotations. This was the time to get things wrong and learn from those mistakes so that they wouldn’t be made once we were out in the world on our own.

My first case was a sleek black cat called Archie, who had a mass in one of his lungs. He needed to have a third of the lung removed, which required a sternotomy, for which the whole sternum would need to be opened. When you do this the animal can’t breathe alone, so it has to be attached to a ventilator that will effectively breathe for it. But ventilating has a major impact on blood pressure; if you over-ventilate it affects the blood flowing around the thorax and around the heart, and because of this you must take the blood pressure every five minutes. This is in addition to the information on the anaesthetic machine that must be closely monitored throughout the operation; the heart rate, oxygen saturation level (the amount of oxygen in the blood), the breathing rate, the end tidal CO2 (which is the amount of carbon dioxide being breathed out), and finally the isoflurane concentration (which indicates the concentration of anaesthesia you are using).

As the operation is carried out you sit to one side with a chart in front of you, regularly noting the levels of all these different functions.

Adding blood pressure into the mix means putting a cuff around the animal’s front leg, with a small probe positioned around the back of the paw. The probe is attached to a machine that lets you hear the pulse as a kind of puffing sound. You inflate the cuff until you can’t hear the pulse, and deflate the cuff until it comes back, then you read the machine to see what the pressure is.

All of this was a lot to be doing on my first case, and the operation went on for a gruelling five hours, which is an extremely long time in which to stay clear and focused. When it goes on for that long you can usually find someone to take over for a few minutes so that you can stretch, go to the loo and eat something sustaining and quick, like a banana, but other than that you are expected to stay with your case for the whole time.

What makes it even harder is that the operating theatres are kept very warm. When an animal is under anaesthesia it can’t control its body temperature and can become too cold and even hypothermic. The room is kept warm to counter that, but it has the unfortunate effect of making you feel extremely sleepy. By four hours in you’re hungry, sleepy and praying it isn’t going to take much longer.

The reason an operation like this takes so long is because to reach the lungs you must cut open the sternum with bone-cutters, and then wire it back together again at the end. It’s a big procedure and fascinating to watch.

There are usually six or seven people in any operation; the anaesthetist clinician, the anaesthesia student (in this case, me), the head surgeon, resident surgeon (a vet training to be specialist surgeon) and two veterinary nurses. There is often also a student who isn’t scrubbed in, who scribes, or writes up the operation notes.

Because it’s a long time and everyone is concentrating, very little is said, which is perhaps why the students get quizzed so much; it keeps everyone alert.

At the end of every day, between 5 and 6pm, we students would sit around a table and discuss our current cases and the ones to come the next day. We’d be asked why we’d chosen certain drugs, what the dosage was, what the alternatives were, how the drugs would affect the heart and a dozen other questions. A senior anaesthetist was a formidable chap called Haidar, who had a reputation for being fierce and utterly relentless in his questioning. And he lived up to this. At the evening round-up he would sometimes grill one of us for half an hour at a time, before moving on to someone else.

We did discover, though, that there was another side to Haidar. Although his natural expression was rather grumpy and our first impression of him was terrifying (an impression he rather liked to cultivate, I suspect), he was often very funny, clowning around, joking and making us all laugh.

Haidar liked to sit in the hallway between the anaesthesia induction room and surgical theatres, ordering people around from his chair. He continually grumbled about the hot weather. We were all revelling in a rare sunny spell, but it brought no joy for Haidar. To everyone’s surprise, though, what distracted him from his daily grumbles was the film crew. He rather liked having the cameras around when a scene was being filmed.

Towards the end of the first week it was Jacques’ twenty-eitgth birthday, so I raced home after work to talk to him on Skype. Only ten more days and I would be flying out to South Africa again. I was starting the trip with two weeks’ work experience alongside some wildlife vets in the north of the country and I would see Jacques after that, when I would be spending a whole month with him, writing my research project and doing some more work experience with a vet friend of his. I couldn’t wait. For his birthday I’d bought him a GoPro camcorder, which I was going to take out with me. I was looking forward to giving it to him, but for the moment all I could do was tell him how much I was missing him.

The week passed in a blur of operations, equipment trays, intubation and recording of vital signs, all the while struggling to stay focused in operations and being grilled by clinicians. The longest operation I was involved in was six hours on a retriever with a ruptured diaphragm, and the saddest was an operation on a boxer with an advanced mast cell tumour that could not be completely removed.

By Friday afternoon I was ready for a break, but before we went home we were called together by Haidar for what he referred to as a ‘lucky dip’, which was actually anything but lucky, since it involved him choosing us at random to answer questions. I was picked first and he asked me about anaesthetic plans for a pyometra, or infected womb. As I struggled through my answers he followed one question with another until I had been in the firing line for half of the hour-long lucky dip session. By the end I felt as though I’d been under interrogation, but at least I’d survived.

‘Rather you than me,’ Lucy remarked as we were leaving the room. ‘You did pretty well. I couldn’t have answered some of those questions.’

‘Thanks,’ I said grimly. ‘That was horrible. He picked on me for so long. I just kept thinking surely he would ask someone else a question soon. But it’s amazing how much suddenly comes back to you when you’re put under extreme duress. At least I know now that the information is in my brain somewhere. Maybe I’m like Sherlock Holmes with his mind palace.’

Lucy laughed. ‘Just hope we all are. We’re all going to be put on the spot like that at some point. And that’s just the clinicians; after that we’ve got the exams.’

‘Don’t remind me,’ I sighed. ‘Can’t even think about that yet.’

I went back to the house to catch up with James and John over a glass of wine. I would have loved to have gone home that weekend to see my parents and my horses, but I was on call on the Saturday and at three in the afternoon I was called in for an operation on a dachshund with a prolapsed disc. He was a lovely little dog, a black long-haired little chap called Butch, which I assumed was ironic. Poor Butch had lost the use of his hind legs and was incontinent, so he needed help.

A lot of dachshunds have genetic problems with their spines. Not surprising, perhaps, given their short legs and very long backs. A prolapsed or ruptured disc is quite common in the breed and very painful but it can be helped with surgery. It was a long and intricate operation, but by the time I left for home at nine o’clock that night Butch was fast asleep in a comfortable kennel in the ICU department and on his way to recovery.

At the start of my second week we had an equine seminar in which we were taught how to anaesthetise horses. I asked Haidar if I could do an equine case and the following day he sent me over to the Equine Centre to help with a stifle arthroscopy – keyhole surgery on the stifle joint in the horse’s hind leg. Keyhole surgery with an arthroscope, performed under general anaesthetic, is becoming more common for horses with joint problems and the success rate is good.

I arrived early in the morning and had the chance to place my first venous catheter in a horse (a catheter or tube placed into the jugular vein in the horse’s neck). I did it first time and was really pleased with myself. The catheter is used to attach the horse to plenty of fluids during surgery to keep its blood pressure up and to provide immediate intravenous access should we need to administer any emergency drugs.

It was a busy morning. I had to record even more information for the horse under anaesthetic than I had for smaller animals. I also had to take blood gases to measure the horse’s heart function, but I felt awful because I spilt some blood into the blood gas analyser, a very delicate machine, and broke it. I apologised profusely, but there wasn’t time to deal with it because the horse was still under.

The operation was a success, the horse was soon back on its feet and I was told not to worry about the machine – though I did, of course. But there wasn’t a lot of time to feel bad about it because I had to rush back to the QMH to help with the complicated case of a Russian terrier, a huge dog a bit like a black bear, which had potentially fatal arrhythmia, or irregular heart beat. The clinicians were concerned that he had a mass, or possibly a clot, in his heart. It was a high-stress situation – no one was sure that the dog would pull through or what they were going to find, so we had plenty of crash drugs on hand and a portable defibrillator in case his heart stopped. But, almost miraculously, it went well. There was a clot, not a mass, it was removed and the dog recovered well. This was great news for the owners as things could have been far worse – the clot could easily have dislodged at any time and formed an embolism in the lungs, or blocked a large vessel. Or it could have been a cancerous mass in his heart.