Anaesthesia was both awesome and terrifying. Most of the terrifying part was due to the first day, and after that I slowly but surely gained confidence in what I was doing.
Rounds helped a lot: every day we had quite a thorough discussion on aspects of anaesthesia, and what to do when things go wrong. It made the days super long, though.
Our roster leader was an amazingly nice, friendly, smiley vet, who had unending patience for our complete inexperience in the hospital and working with real patients. We got to do lots of hands-on stuff, which is a huge change from fourth year. Probably the coolest part about the roster was that we made up our own drug protocols. She would give us the cases, and we would pick which drugs we wanted to use, at what dose, and what fluids to give, and so on. Every time, we were encouraged to use either a premed we hadn't tried before, or an induction agent we hadn't used, so we could see the differences in their effects. For instance, I tried a propofol/ketamine combination for induction, and that did not go so well: my dog twitched all during the surgery and recovery, due to the drug reaction on the muscles (we think). My roster-mate tried medetomidine for a premed, and her dog, who happened to be massive, ended up so zonked it turned into quite the ordeal to get it down to anaesthesia for induction.
We had a few really crazy cases. I did this one dog that had liver damage, so there were tons of potential anaesthetic complications. It turned out to have a local peritonitis around the bile ducts, and any time the surgeons tugged on it, the heart rate and blood pressure went through the roof. As soon as they let go, everything plummeted! This stressed everyone out. Except me, who had no clue what was going on because it was day 2, and was just diligently writing down everything they told me to into the anaesthetic record. It involved lots of fiddling with constant rate infusions of drugs; increase the dose of dopamine, now decrease it, now stop it, now increase it, now increase the fentanyl, on and on.
By the end of the week, though, I knew what I was doing. I knew how to set up all the machines, and what to do about every reading (though sometimes the answer is "get the anaesthesiologist"). The roster leader said that she would be comfortable with any of us anaesthetising her own pet, which, if sincere, is just extravagantly generous of a compliment!
Another fun thing about the roster was that we'd run into the other "teams" in the hospital. The students on surgery would be gowned up on the other side of the table. Several times, patients had to be anaesthetised for imaging, so we would march in their and handle that stuff, while our classmates on the imaging roster worked around us to take the xrays. The awkward part about that was when you're in the middle of taking your set of readings, and everyone has to keep clearing the room for the xray. Come back in, get a blood pressure while they readjust the positioning, everyone out again. It got a bit silly.
It was a full-on week, but very rewarding. The same thing that made it off the deep end overwhelming on day one is what made it so fun and exciting on day 5: responsibility.
The main thing I didn't like was the lack of contact with the patient. Well, the awake patient. I got to tap their eyelids and push their jaws up and down a thousand times, but I didn't get to see the happy little animal in the consult room. Also, a lot of the time, I had a very limited understanding of what was happening medically or surgically. So while it was a very exciting and enjoyable roster, I don't think I need to become an anaesthesiologist.
Saturday 30 November 2013
Thursday 28 November 2013
Roster Leader Reads Minds
While waiting around for a patient to get a CT scan, I got to chatting with our roster leader. At one point, she asked me if I want to specialise. I said I don't know, because residencies are a lot of work.
She told me she could see me in internal medicine.
Guess what my favourite and best class was for fourth year? Medicine.
I asked her what gave it away, and all she said was "You're a thinker. I can see you thinking through things." She then went on to explain that during her residency, she got to see all the other residents and what personality types they tended to attract. For instance, some students you just know are going to be surgeons.
Apparently she does this regularly. She told a student last year that she could really picture that student doing a nutrition residency (of all things??). The student's response? "You know, I've always considered doing that!"
She told me she could see me in internal medicine.
Guess what my favourite and best class was for fourth year? Medicine.
I asked her what gave it away, and all she said was "You're a thinker. I can see you thinking through things." She then went on to explain that during her residency, she got to see all the other residents and what personality types they tended to attract. For instance, some students you just know are going to be surgeons.
Apparently she does this regularly. She told a student last year that she could really picture that student doing a nutrition residency (of all things??). The student's response? "You know, I've always considered doing that!"
Monday 25 November 2013
Responsibility Time
Today was the first day of my first roster of fifth year. I am one of three unlucky bastards whose first roster is anaesthesia.
Now, the first roster is bound to be pretty intimidating. Despite four years of wandering around the vet tower, we haven't actually been in the hospital part more than one or two times. We basically have no idea where anything is, what anything's called, or where anything goes. We also have no clue how to use the computer system. Oh, and we have next to no practical skills.
I thought the first day might ease us into it. Boy was I wrong.
The reason I thought that was because we didn't start until 8:30, and had an hour tutorial. Sounds like a cruisy morning, right? Well, I guess that part was. The tutorial was pretty much what I expected: here's a reference list for this and that, here's how to check the cuff on your ET tubes. Okay, I got this.
Then at 9:45 (because the tutorial went over time, of course), we get given a list of patients for the day. A list which spans 3 sticky notes, and has four patients circled for us to do as soon as possible. And by that I mean, the surgeons want the 3 dentals to be ready to go by 10:30. We're told to go "work up the cases." At this point I haven't really figured out what that means.
The tech says "Today is probably going to be a little stressful, we have a lot going on today." Isn't that a great thing to hear, when you have no clue what you're doing?
We then get sent to the wards to start "working up" our patients. We manage to locate one of the three animals, get a lead on him, and then stand around looking lost in the middle of the ICU. Techs are all around us, but they're rather busy doing ICU stuff. We know we're supposed to use the computer system to look up a bunch of history stuff, but we don't even know how to log in. We're capable enough to take the vital signs and listen to the lungs, but from there, well... there was a lot of "Can you help us?"
Eventually they figured out that we were floundering on our own, and proper people stuck with us to help us out. This wasn't until after we'd already floundered around with 2 animals. The morning was a bit of a blur, a lot of "we need this dog ready right away" and "here's the blood, go run a PCV/TP." It's not that PVC/TP is a difficult thing to do, it's just that it's a bit of an obstacle when you've only done one in your life, forgotten how to do it entirely, and also have no clue where the machines are in this place.
Once the cases were worked up, the proper anaesthesia started. Somehow I didn't quite have a case all to myself. The other two students got their animals induced and into surgery, and I had the delightfully stressful job of tag-teaming them out for lunch breaks. This involved getting thrown into a surgical theatre, given a rundown of the readings, and then left on my own to monitor. A live animal. Getting a real surgery on its knee. I'm still trying to remember what all the numbers mean, let alone what to do when one goes bad.
Fortunately they were super easy, and all I did was write down the numbers and Xs and Os on the chart for twenty minutes (you draw a little graph over time of the heart rate and respiratory rate and blood pressure). The stressful part was mainly in the "holy crap I'm just alone in front of all these machines, with complete responsibility for this patient."
In the afternoon, we had rounds. They're basically a tutorial, with the vet running the roster teaching us students. We went over all the classes of drugs and their side effects, all the monitoring equipment and appropriate values, and fluids. It was basically a crash course of everything we've learned about anaesthesia over the past few years, in the last 3 or so hours of the most hectic, overwhelming day of vet school.
When I finally got home, what better could have completed my day than to find out I got in trouble for writing a snarky comment on one of my exams. To be fair, even the course coordinator knows it was a stupid question.
Now, the first roster is bound to be pretty intimidating. Despite four years of wandering around the vet tower, we haven't actually been in the hospital part more than one or two times. We basically have no idea where anything is, what anything's called, or where anything goes. We also have no clue how to use the computer system. Oh, and we have next to no practical skills.
I thought the first day might ease us into it. Boy was I wrong.
The reason I thought that was because we didn't start until 8:30, and had an hour tutorial. Sounds like a cruisy morning, right? Well, I guess that part was. The tutorial was pretty much what I expected: here's a reference list for this and that, here's how to check the cuff on your ET tubes. Okay, I got this.
Then at 9:45 (because the tutorial went over time, of course), we get given a list of patients for the day. A list which spans 3 sticky notes, and has four patients circled for us to do as soon as possible. And by that I mean, the surgeons want the 3 dentals to be ready to go by 10:30. We're told to go "work up the cases." At this point I haven't really figured out what that means.
The tech says "Today is probably going to be a little stressful, we have a lot going on today." Isn't that a great thing to hear, when you have no clue what you're doing?
We then get sent to the wards to start "working up" our patients. We manage to locate one of the three animals, get a lead on him, and then stand around looking lost in the middle of the ICU. Techs are all around us, but they're rather busy doing ICU stuff. We know we're supposed to use the computer system to look up a bunch of history stuff, but we don't even know how to log in. We're capable enough to take the vital signs and listen to the lungs, but from there, well... there was a lot of "Can you help us?"
Eventually they figured out that we were floundering on our own, and proper people stuck with us to help us out. This wasn't until after we'd already floundered around with 2 animals. The morning was a bit of a blur, a lot of "we need this dog ready right away" and "here's the blood, go run a PCV/TP." It's not that PVC/TP is a difficult thing to do, it's just that it's a bit of an obstacle when you've only done one in your life, forgotten how to do it entirely, and also have no clue where the machines are in this place.
Once the cases were worked up, the proper anaesthesia started. Somehow I didn't quite have a case all to myself. The other two students got their animals induced and into surgery, and I had the delightfully stressful job of tag-teaming them out for lunch breaks. This involved getting thrown into a surgical theatre, given a rundown of the readings, and then left on my own to monitor. A live animal. Getting a real surgery on its knee. I'm still trying to remember what all the numbers mean, let alone what to do when one goes bad.
Fortunately they were super easy, and all I did was write down the numbers and Xs and Os on the chart for twenty minutes (you draw a little graph over time of the heart rate and respiratory rate and blood pressure). The stressful part was mainly in the "holy crap I'm just alone in front of all these machines, with complete responsibility for this patient."
In the afternoon, we had rounds. They're basically a tutorial, with the vet running the roster teaching us students. We went over all the classes of drugs and their side effects, all the monitoring equipment and appropriate values, and fluids. It was basically a crash course of everything we've learned about anaesthesia over the past few years, in the last 3 or so hours of the most hectic, overwhelming day of vet school.
When I finally got home, what better could have completed my day than to find out I got in trouble for writing a snarky comment on one of my exams. To be fair, even the course coordinator knows it was a stupid question.
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