RAVS Trip Day Four

I figure a picture tells it all.

On the third day of clinics I started becoming delirious. I was reminded of my internship the first year out of vet school. At that time, a normal day was 9 hours long, but 2-3 days of the 6 day work week were 13 hours long. And every 6 weeks, I rotated into the emergency shift, which was a six day, 99 hour week. Or, when I was at home with newborn twins. Or newborn twins coupled with toddler twins. But I was much younger back then.

Back to the present. I was able to function and I didn't make any big mistakes, but I feel like I was a bit slow on the uptake and maybe even slurring my words on occasion. During the times between surgeries I would sometimes just sit there with my eyes closed. I did try to do some teaching rounds with the students and they seemed SO eager to learn. But that was challenging because many times we would get called away to do a surgery just as the discussion was getting good!

Every time we moved the clinic, it was a 2 hour process to pack up and another 2 hour process to set it up again. It was good to be in one place for 3 straight days - the community center at Eagle Butte, the largest town on the reservation (and only a 5 minute drive from our dorms!). But today we had to get there early in order to set up. The day started at around 6 am and ended with rounds at 10 pm - they let us off early so we could get some sleep!

I will take this paragraph to talk about some of my mishaps. There was the matted dog from day one who bled like crazy! She was in heat and probably had some tick-borne disease that affected her clotting ability. Then there was a Chihuahua spay the next day where, when I broke down the ovarian suspensory ligament, I also tore through a large vessel. Then there was a cat on the third day (today), who was bleeding from some unknown region (I think it ended up being from where we tied off the uterus), so I had to dink around trying to find the source. Oh, and the worst was the first clinical day when they had me neuter 2 cats and I didn't really know how to do the figure 8 self-tie! (I use suture material in my practice.) They would have been better off having a student doing them! In fact, after that I pretty much let every student do the entire cat neuter if we were assigned one.

So basically my days went like this - drink some pop, do a surgery, sit with my eyes closed, have a snack, drink some more pop, do a surgery....

RAVS Trip Day 3

Oh my freaking God!!!!!!!!!!!!! @$#%*&^ Noooooooooooooooo!!!!!!!!!!!! That was my internal reaction when my alarm went off at 4:45 am on Tuesday. 4:45!!!!! So not fair!!!! Remember, I am a sleep baby and I was already at a 6 hour sleep deficit and it was only day 3. How will I get through the day? My only remedy was soda. I couple of months ago I gave up soft drinks, but since I don't drink coffee and did not have any energy shots with me, Coke and Pepsi became my drug of choice for the week. However, while I had a bunch of cash, I had only $5s and $10s, which the vending machines did not accept. And no time to even walk across the street to the gas station to get change. Ever. So I became a sort of beggar that week, bumming change off of the other vets. I'm not ashamed.

After my cold water sponge bath and a small breakfast, we left the dorms at 5:30 am. The clinic started at 7:30 or 8 and we still had to set it up! The facilities in the new place were so much more awesome than the garage from the day before. This was a clean, spacious gymnasium. Look at all the room!

Since I was so eager to get the day started, I was given the first surgery, a young-ish, large-ish dog spay. And it must have gone well because I really don't remember it! Yay!!!

This was the second day of clinics, so I still looked pretty BAR (bright, alert, and responsive, for you non-medical types).

In addition to routine vaccines and surgeries, the group saw other interesting cases. Two dogs were hit by cars during the week (both ended up being euthanized), several were diagnosed with distemper or parvovirus (diseases that can be prevented by vaccination), tons of cases of mange, and a few dogs who had run-ins with porcupines. This poor dog also had puppies a week ago!

 

I was getting pretty confident with my surgeries, but again one of my spays decided to take forever to wake up and AGAIN they pulled out the ultrasound to make sure she wasn't bleeding internally after the surgery. I was beginning to get a complex! After getting the all-clear, we were able to break down the clinic to move to Eagle Butte. We ate dinner sitting on the floor of the community center, and were dismissed back to the dorms at about 10:30. But wait! I had a professional meeting to attend so I didn't get to bed until about 11:30.



RAVS Trip Day Two

5:45 am came way too soon. You see, I am a sleep baby. I do great with 8 hours. With 7 hours, I get a little testy. With 6 hours, I have a headache and some nausea. Anything less than that and I am pretty much a zombie. How I raised 4 infants is beyond me.

Anyway, the alarm went off and I stumbled to the bathroom for a cold sponge bath in the sink. That would become my morning routine - both to get sort of clean and to wake myself up. I think that there were hot showers through some tunnel in the dormitory building but that seemed to require too much effort. Still no working toilet.

Breakfast was left for us in the kitchen. No complaint on that - bagels, cereal, toast, and Sunny D. Between that and the bologna sandwiches we got for lunch, I felt like I was time-warped back to the 70s.

We left the dorms at 6:30 and drove 30 miles back to the garage, which was set up for the day. The clinic started at 8, but there was already a line of patients at 7 am. The group was divided as follows: receiving (meeting the clients, examining the pets, vaccinating, treating, admitting if surgery was needed), anesthesia (they were with the pet from the time the pet was given pre-anesthetic medication until the time it was up and walking after surgery), and surgery. There were two receiving vets, three full-time surgery vets, and two vet employees, who did surgery and also dealt with logistical issues. I was in surgery the first four days.

As patients were admitted, their information was placed on the surgery boards, which looked like this:

Each patient was then assigned both a surgery and anesthesia student, and a surgeon. Doctor Paul (one of the in-charge vets) was nice enough to start me off easy, with a dog neuter. I was still nervous!!! In fact, I think my hands shook through that surgery. I had a student scrub in with me and let her do as much as she could with the time we had. Most of the students were between their 2nd and 3rd years of vet school and had some, but not much, surgical experience. They also had to pass a practical exam before they were allowed to scrub in. We were allowed 60 minutes for anesthesia or 20 minutes for a dog neuter/45 for a spay (dog or cat), whichever was less. So if an animal took a long time to prep for surgery, that cut into our surgery time. Often we would ask the surgery student what part of the surgery (incision, tying ligatures, closing the skin, etc.) they wanted to do for sure, and then the surgeon would do the rest. I was a little lax and sometimes went over a minute or two in order to let the student do a little more.

That first day, our team performed around 35 surgeries. My most memorable was a little pile of matted fur named "Princess". It took over 30 minutes to shave all of the mats off of her! She must have had 100 ticks on her, too. In fact, she had one engorged tick and at least 6 smaller ticks trying to eat out of the same hole! Gross! And she was in heat and I had only 30 minutes to spay her. It was a bit of a bloody mess, but my confidence was up. I had begun to use a new knot technique, which is sort of a game changer for me.


Princess Before


 
 
And after

 

 

 

Even though it was in a garage, the clinic was impressive!  Here is the line of 4 surgery tables. The anesthesia students have fancy orange duct tape badges and the surgery students have an individually color-coded duct tape badge. The vets only got plain grey duct tape.

 

 

 

The surgery packs. There were two large autoclaves going pretty much all the time to keep up with sterilizing the instruments.

 

 

 

Recovery. Note the screen tent in the background. Cats recovered in the tent so they could not escape!

 

 



 

Even though it was a no-cost clinic, no corners were cut. All surgical patients had an IV catheter and IV fluids, sterile packs, local anesthetic block when indicated, gas anesthesia (even cat neuters!), and pretty good monitoring. It was a great learning experience for the students.

 

It was a long day. I think we got lunch at about 3 pm (it came pretty erratically the entire week). Bologna sandwiches, watermelon, cold water. I will admit that week I fell off of my Pepsi wagon. Even on the first clinical day I was tired and needed caffeine. There was a grocery store 1/2 mile from the dorms but we never ever had time to even go there. So between the meals, I kept myself nourished with Pepsi from the vending machine and snacks that I had bought in Bismarck.

 

The surgeries were done at about 7 that night, but Princess was not waking up as fast as she should. Actually, she was awake but her body temp did not rise over 99. So one of the staff vets pulled out the ultrasound to make sure she wasn't bleeding internally from her spay (you know, the one I did). She was fine, but her recovery delayed the entire system. We could not break down all of the clinic until we were certain that we would not need to do anesthesia or surgery on any patients at all.

 

So after over 12 hours of clinics and surgery, we then got to take the entire clinic down and pack it back into the trailer. And drive 30 minutes to another town in the reservation, where we unloaded the trailer into a clean and spacious gymnasium.

 

Back to the dorms. We were so late that we almost didn't get dinner. Still no hot water. Still no working toilets. But I was too damned tired to even care.

 

RAVS Trip Day One

My last post was about my spay anxiety and upcoming trip with the Humane Society's Rural Area Veterinarian Services (RAVS), which performs free vet care to underserved communities in the US and abroad. I was hoping to learn some new surgical techniques, perform lots of surgeries in an environment where there was the support of other veterinarians, and give back my time to students and communities that needed help.

Enough of that. What was it really like? Well, the next post or two will describe MY experience. It may be different from the experiences others who were in the same place at the same time. Please remember that.

I had heard about RAVS from a veterinary listserve to which I belong. It took me about a year to actually decide to apply for a position as a volunteer veterinarian on one of the trips. I think I applied in December and had a phone interview in January. I was pretty honest with my experience and abilities, as well as my crazy phobia. Ahne, the lead vet who interviewed me, was very encouraging. I received my acceptance onto a trip some time in March. At that time, I had to supply proof of my veterinary license and that I did in fact graduate from a vet school, and I underwent a background check. I then gave them 3 possible weeks that I was available and they put me on the Cheyenne River Indian Reservation in north-central Sought Dakota.

What I was only vaguely aware of was that 95% of the people on my trip were just coming off a week together at another reservation. I think only two of us joined mid-shift. I knew nobody and had no expectations. It was definitely out of my comfort zone and a couple of weeks beforehand I started to get a little nervous.

In the group there were 2 staff veterinarians, 4 contract veterinarians, one volunteer veterinarian (me), one staff technician, a few other contract or volunteer technicians, a contract photographer, the South Dakota representative for the Humane Society, and about 25 veterinary students (who, by the way, actually PAY $200 to be part of a trip!).

The day (July 13) arrived. I hate driving so I flew in to Bismarck, North Dakota, stayed by myself in a hotel room that night, and met the group the following morning. I am too cheap (and principled) to pay to check my luggage so I packed everything (including the mandatory mess kit and sleeping bag) into a carry on! I was impressed with myself. There were introductions (for the 2 newbies) and then we caravanned 4 hours south to the reservation. I was expecting less-than-ideal conditions, but our first stop was sort of appalling. We had to set up a clinic in a garage. Fine. But the garage had not been cleaned out in the least! Our group had to move tractors, sweep and mop the area, and set up a huge clinic/surgical area, all on Sunday afternoon. No help from the community at all. I am not sure about this, but I think the RAVS group comes here every year. And I think that we are liked and appreciated (and, by the way, provide tens of thousands of dollars of FREE vet care per day!). So why nobody could step up to the plate and make sure we had a useable space is beyond me. I don't think that is asking for much.

I think it took 4-5 hours to get the garage ready for the clinic the following day. The system is actually quite impressive. There is a huge trailer filled with many labeled boxes of supplies and equipment. The trailer is systematically unloaded and the clinic is set up. Everyone helps out. We were all exhausted by the end, and then had to drive 30 minutes to our home base, in another town on the reservation. We were finally able to sit down to eat (Indian tacos in a church) at about 9 or 10 Sunday night. Then we checked into our dorm rooms. OMG! Most of the rooms were missing beds, or mattresses, or both. The toilets did not work. There was no hot water for showers. I stayed up until about midnight with one of the staff vets going over some of the things I was responsible for the next day. Which was due to start at about 6 am.


The RAVS trailer

 

 

The garage - site of the first clinic

 

My dorm room. My spartan bed is on the right.

Dog Spays Revisited

Two years ago I posted about my newly acquired dog spay phobia. Since outing myself to the veterinary community, I have had quite a few vets from all around the country contacting me with the same problem. So I know that I am not alone. I have received many descriptions of the techniques (surgical and mental) that vets have used to cope with spay problems. Many get stressed out weeks in advance if they see a dog spay on the appointment schedule. Some (and I think these are the smart people) just stopped doing them. Life is too short - give the job to someone who actually enjoys it.

I tell you, I am almost to that point. But I am not quite ready to let the measly dog spay win over my psyche. I am a very confident surgeon. In fact, I didn't bat an eye yesterday while removing a 3.5 pound cancerous spleen from a 100 pound dog who had 3 LITERS of blood in his abdomen and was hemorrhaging through most of the surgery. Why can't I take out a little uterus without having a panic attack?

What have I done to combat the problem? Well, I have slowed down and become very VERY diligent when doing a dog spay. Every ligature gets triple checked. I don't break down any connective tissue that might have even the tiniest of vessels, because they are the ones that sneak up on you a few minutes later when you're staring at an abdomen pooling with blood and you have to go find the source. I meditate to calm myself. I visualize success. And I take drugs. Yes, I have a prescription of clonazepam that I use for situations like this. It works great. But still... isn't there something wrong with continuing to do a procedure for which I have to medicate away my anxiety?

I am trying one last thing. On Saturday, I leave for a six day stint volunteering with the Humane Society's Rural Area Veterinary Service program, where I will be part of a team of 6-7 vets and 20 or so support staff and vet students who provide free veterinary care on a reservation in South Dakota. I have been promised long work days, second world country medical conditions and facilities, a comfy dorm room at night, and lots and lots of spays. Yes, I am going to flood this anxiety away. Or die of a heart attack trying.

More to come as I go through this adventure over the next week. Assuming I have internet access.