Soooooooo....
During our third year of vet school we are immersed in a two week rotation through the hospital's anesthesia department.
One can tell when a fellow student is on this particular service; they are dressed in scrubs, clutching a clip board, wide eyed and muttering mathematical equations for continuous rate infusions of fentanyl. It is wise to avoid these students until the rotation in finished as they may start spontaneous weeping if you show too much interest in their lives.
I, personally, have been dreading this rotation. In some wicked twist of fate I was scheduled for anesthesia my last two weeks of Jr. year, during the same time that I am meant to be studying for finals, as well as "capstones" which are cumulative tests from all our classes during the past year.
Nice.
So - my first week started on surgery C. We 3rd years run the anesthesia on shelter patients in for routine spays and neuters. The animals are usually young and healthy and the procedures (hopefully) don't require the animal to be anesthetized for long.
Day 1: I arrive at 6:45 AM ready to roll with my anesthesia handbook and clipboard. The night before I had done a physical exam on the overwhelmingly lick-y/jump-y/bark-y year old yellow lab that was assigned to me. I pre-medicate my nutty yellow girl and go in to set up the anesthesia machine. This is more time intensive and anxiety producing then it sounds, and the cost of doing something "wrong" is.... death (for your patient.)
I call one of the super technicians over to double check me and get the go ahead to induce my animal and continue. I place an IV catheter, intubate and hook her up to the innumerable wires and alarms to measure her vital signs - no problem.
Then the bells and whistles go off.
Due to my patients excitable nature I had chosen to give her acepromazine as one of her pre-medications. Unfortunately one of the side effects of this drug is that it causes hypotension and a corresponding drop in blood pressure. My patients mean arterial pressure is 40 mmHg (normally we like to keep it above 70) and at the same time she has decided to stop breathing.
Super tech starts issuing orders,I shut up and listen intently....for the entire surgery my dog continues to crash. I silently beg the fourth year surgeon to hurry up. In the midst of all this high adrenalin drama I am meant to fill out the official anesthesia medical record. There is a diabolically cryptic system of up-side-down v's, dashes, dots and numbers that correlate to pulse/oxygen saturation/heart rate/respiration etc. These tiny marks must be made every five min. I do the best I can - and am found lacking, but I'm getting used to that.
Day 2: The worlds tiniest dog is assigned to me. A 2 kg chihuahua with a heart rate of 200 beats per min. She is sweet but so high strung that three vet students are unable to restrain her for a blood draw. That's about 450 pounds against 4 - and the 4 pound-er wins. Yikes. I decide to use ace again.
Another super tech is at my side this morning. I pre-med my little darling and follow the steps for assembling and pressure checking my anesthesia machine. I am inordinately proud that I (a dyed in the wool large animal person) am able to place an IV catheter in this tiny animal. We intubate without a problem and start on the miasma of cords and monitoring equipment.
Last verse same as the first. Now I have a non-breathing chihuahua - with blood pressure in the toilet... fluids, atropine, breathing for her all works, works so well in fact that she starts to wake up on the table as the surgery begins.
"Stop cutting!" yells Amy - my super tech and new best friend - we get her under again and give the nod for the surgeon to continue. The rest of the blessedly short procedure continues like this. Our tiny Taco Bell spokesperson is either waking up or trying to die. Big doctors get called, a board certified anesthesiologist swoops in, issuing orders, I try to get out of everyone's way.
"Why do you think the CO2 is so high?" he asks me.
I stare blindly at my log of v's and dots and say the unforgivable "I'm a large animal person and haven't much experience with anesthesia....."
He cuts me off "That is no excuse, when you are a vet you will have a license to kill...."
Wow - I know we are meant to do a lot - but I didn't realize being an associate of 007 was part of the deal. (Although I do think that Sean Connery is one of the yummiest men alive - but I digress.)
So - goes the next two weeks.
The learning curve is steep, so much so that I begin to develop altitude sickness. The two overwhelming emotions I experience are terror or deep shame my gaping lack of knowledge.
I clutch my clip board and look around wildly for an understanding face, my fellow students avert their eyes and nod sagely, "She's on anesthesia this week isn't she."
Yes, yes I am, and I'll take my vodka martini medium dry, lemon peel, shaken not stirred.
HA! Fantastic! Keep charging!
ReplyDeleteThat sounds ridiculous! I love how you call the technicians "super techs!"
ReplyDeleteJust wanted to say Hi, I'm a pre vet student myself and have enjoyed reading your entries. I'm new to blogger, but if you would be willing to check in on my posts and provide guidance and feedback at times, I would greatly appreciate it.
Good luck with everything!