First-time Surgery
When I had a phone call asking whether I’d like to do a locum job in southern Cornwall for a week, I jumped at the chance. I love Cornwall and I thought it would be fun to drive down there and have a week in a practice somewhere completely different.
It was only after I said yes that I realised it was, by pure chance, the vet practice where my cousin Kate worked as a senior vet. Kate – actually my dad’s second cousin but slightly nearer to my age than Dad’s – had married a Cornish guy and they had settled there.
‘Come on down,’ she told me when I rang. ‘It’s a lovely practice, I’m sure you’ll enjoy a week here.’
So one Sunday evening in early October I packed my bags and set off on the six-hour drive. The practice had booked me into a little coastal hotel nearby, but this time I didn’t feel quite as lost as I had during my first week as a locum two months earlier. I was getting the hang of it and enjoying the variety that the job offered, although my staple hotel diet still seemed to be Pot Noodles. My car didn’t like being by the sea, though, as with every gust of ocean wind the alarm would go off, so I spent much of my evenings looking up how to turn off a car alarm on the painstakingly slow hotel internet, while repeatedly leaning out of my bedroom window to turn off the alarm, which just kept activating.
On my first day I was down in the diary to operate in the morning and consult in the afternoon. I was looking forward to the challenge of operating, and hoping for something reasonably straightforward.
I arrived bright and early to find that I wasn’t the only newly graduated locum who’d been hired.
‘Jo! Fancy seeing you here!’
‘Oh my goodness, Lizzie, I didn’t know you’d been hired too!’
It was a nice coincidence. Lizzie had been in my year at the Royal Veterinary College and during our final year she’d been in the sister rotation group to mine, which meant we had a number of placements together in hospitals, practices and farms as we ploughed our way through the long, long list of rotations on our journey towards finals. And now here we were, the other side of it all, working together.
Lizzie was bold and outgoing, the sort of person who fitted straight into the team and who, after hellos and introductions, was confident enough to say, ‘Who wants a cuppa?’ and find her way to the kitchen to make tea for the whole team before we started work.
The practice, like many across the UK, consisted of a large number of part-time staff, both vets and nurses. There were four vets and six nurses, plus two receptionists, but rarely were there more than three vets, three nurses and one receptionist in at once.
Lizzie and I had been hired to replace one of the practice partners who had hurt his back – the theory seemed to be that two graduate locums made up for one senior vet. In fact, we soon realised that the practice was overstaffed, and since the surgical suite was about to be refurbished, Lizzie got to work cleaning up and moving items into storage, joking that she was happy to be paid a locum salary to do housework.
Meanwhile I cracked on with the operation list for the morning. Since we didn’t have a super-clean operating suite, we could only do what were known as ‘minor ops’ – those that were less risky and didn’t involve going deep into the body – in the prep room out the back.
First on my list that morning was an entropion correction on a cat. Entropion is when the eyelid rolls inwards so that the lashes rub continuously on the cornea of the eye. Very uncomfortable for the poor cat, who gets inflamed and sore eyes. Entropion surgery isn’t all that common and I had never seen one performed, although I knew the theory. It involves making a crescent-shaped incision like a new moon beneath the eye, removing the skin in the crescent and stitching the remaining skin together, thus pulling the eyelid back into the correct position. But there were details I wasn’t sure about. What thickness of skin should I remove, for instance?
Lizzie stuck her head round the door. ‘All OK?’
‘Lizzie, have you ever done entropion surgery?’
‘Um, no, actually. But Fossum is on the shelf behind reception if you need it.’
‘Fossum’ is every vet’s best friend. It’s an instruction manual called Small Animal Surgery by Theresa Welch Fossum and it gives step-by-step instructions on how to do every operation you can think of on a cat or a dog.
Every surgery has a Fossum. I took it down off the shelf and pored over it, checking the details of the operation. It looked straightforward enough.
‘Nothing to do but have a go,’ I muttered to myself as, with the cat anaesthetised and Fossum open in front of me, I followed the steps, peering across the recumbent cat every now and then to check that I was on course, with a helpful nurse watching the anaesthetic and occasionally turning a page for me.
By the time I’d finished I was cautiously pleased – the cat’s eyelids were now in the right place and I’d done a pretty neat job. I asked Kate to have a look, just to check a senior member of staff was happy with my work; she peered over my shoulder, said I’d done well and gave the nurse a thumbs-up to wake the cat. Once I’d made sure that the cat was fine, I closed Fossum, put it back on the shelf with a pat to say thanks, and went to get myself a cup of tea.
My second op was removing two rotten teeth from a greyhound. I was actually more nervous about this than I had been about the entropion correction, despite having done dental surgery before. There had been a difficult practical at university, which became known as the ‘dead dog head practical’ and which still made me shudder every time I remembered it. During our training we had practised, under supervision, removing teeth from the heads of dead dogs. The first time I did this I had really struggled. The beagle head I had been given – one of many donated to the university from pounds, labs, racing kennels and owners kind enough to leave their dogs for us to learn on – had been used for several practicals before mine, so all the easy incisor teeth had been taken out already. I was left with the outer incisors, which are much bigger than the front ones.
The technique involves pressing all around the edge of the tooth with an instrument called an elevator, which has a sharp curved end and a handle that fits perfectly in the palm of your hand. The pressing weakens the periodontal ligament which holds the root of the tooth in the socket. When the tooth is wobbly, you can wiggle it with forceps to weaken it further and carry on rotating between the two until the tooth is wobbly enough to pull it out.
After 10 minutes of applying pressure, then wiggling, the tooth was still very firmly in place, so I decided I would apply a little more pressure with the elevator, but at that moment it slipped and I sliced all the way up the gum. The clinician in charge came over to take a look.
‘Just as well this dog is dead, or you’d be doing some stitching right now. At least you didn’t take out its eye. Believe me, that’s happened. Now try again, with more patience this time,’ he said.
Remembering this, I took a deep breath as I looked down at the very much alive dog that was anaesthetised on the table in front of me. I had scaled its teeth to remove the tartar and now I needed to remove two rotten wobbly teeth before polishing all its teeth to finish. ‘Patience,’ I reminded myself as I leaned in to begin pressing with the elevator around one of the rotten teeth. I was wearing a mask to avoid inhaling bacteria from the dog’s mouth and it was hot and uncomfortable, but half an hour later the teeth were out and the greyhound had a squeaky clean polished mouth.
Two
