Wednesday, January 14, 2009

What's up there, Doc?

Meet Chi-Chi.

Chi-Chi is a four-year-old dachshund given to us several years ago by owners who no longer wanted her. Like many small dogs, she has issues with her hind legs. It’s called a luxating patella, and it’s caused by a too-shallow groove in the femur in which the kneecap rests. As a result of this conformation flaw, the joint and ligament slide out of place, sometimes locking or causing pain. If left uncorrected, the condition can worsen and cause permanent lameness.

Yesterday Chi-Chi had surgery to correct this problem. I was excited to see the procedure, because I’m interested in any sort of hands-on work related to veterinary medicine. I have seen a few surgeries in the past: a dozen or so dog and cat spays, a neuter, canine eye surgery, lots of dental work on various animals, a stillborn calf C-section, and hernia repair on a young filly, as well as dozens of smaller procedures. None of this has ever bothered me a bit—I’ve just found it all quite interesting. I didn’t think this would be any different.

And it started out fine. Doc talked me through what he was about to do, then started making the incisions through layers of skin, flesh, muscle, and synovial tissue. He exposed whiteness of bone and showed me just how utterly shallow the femur’s groove was—worse than a typical case, even. I bent over the operating table, asked questions, and was quite thrilled about the whole learning experience.

Then he pulled out the bone saw. By bone saw, I mean a two-dollar, five-inch long serrated blade from the hardware store. That’s exactly what it was, as Doc explained to me, and that’s what veterinary textbooks recommend. He then proceeded to take said extra-sharp dinner knife, place it against the femur, and start sawin’ away. The problem here was although the blade was five inches long, the actual incision was only three inches long, so there was a fair amount of overlap. This meant that as he scraped back and forth, metal against bone, either end of the saw grated against and ripped into muscle and skin. Ugh. The serrated edge was doing a number on what had been a clean scalpel cut. I hadn’t counted on it being so….messy.

Still, although MY leg started hurting out of sympathy, I was quite cool with the whole deal. I watched as he removed a good-sized chunk of bone, wrapped it in gauze, and set it aside to save for its cartilage. Fascinating. He then continued making the groove deeper, removing another piece and discarding it. As he went in for round three (back and forth, back and forth, back and forth, grate, grind, splatter) I think I allowed the rhythmic motion to hypnotize me. My mind wandered. I stared at the bloody opening, which only a minute before had seemed like an interesting science experiment. It came over me instantly. Suddenly I felt extremely ill. I couldn’t breathe. “I’m going to step outside for a moment,” I said, always one to explain myself calmly, even in moments of crisis. “That’s OK,” said Doc, and then, “Uh-oh,” and then, “Bend your knees and go straight down!” and then “Crack!”

Only that last crack, apparently, was me hitting the floor. I looked up sheepishly, immediately recovered save for my extreme embarrassment. I still felt a little queasy (probably due to my rapid descent to the floor), but as I wiped the cold sweat from my face and pulled myself up on my elbows, all I could think about was how much I would give to switch places with the dog, if just to rescue myself from my shame. How utterly humiliating.

Doc is a third generation vet, and his dad was there, too. Both of them were very nice about the whole ordeal, and they assured me that fainting is an extremely common occurrence, even among big brawny men and students already in vet school. It has to do with the unfamiliar smells, the confined quarters, the overheated operating room, and the sight of gore, they assured me. I looked it up myself, because I was curious what would cause me to lose all control like that.

I didn’t know what search terms to use, so my findings may or may not be correct. It appears as though the vagus nerve (which connects the brain to the digestive system) gets overexcited and pulls too much blood down too rapidly. This is a response to some sort of stressful stimulus, which can vary greatly and often does include the sight of blood or surgical procedures. Other things I have read suggest that this is a self-preservation mechanism—the brain purposefully shuts down in order to bring the body to a horizontal position, thereby allowing blood to reenter its cells and consciousness to be regained. Makes sense, I guess, though I wonder how this is tied into adrenaline and the fight-or-flight response. How is fainting in a time of crisis a remotely useful adaptation to survival?

The issue now is that it’s not exactly a mind-over-matter sort of thing. Even keeping a cool, clear composure won’t necessarily prevent a recurrence, I’m afraid. So it looks like I’m just going to have to keep working on desensitizing my body….and it’s quite possible I’ll end up embarrassing myself a few more times before I can handle situations like this. I actually ended up talking to another vet yesterday. This is a woman who has been through vet school and has had her own practice for years. She told me that even she can’t watch orthopedic surgery without passing out or at least feeling queasy. Odd. So at least I’m not alone, I guess, although it doesn’t make me feel all that better. Damn, it sure sucks to have the mind betrayed by involuntary instinct.

I did return to the operating room once I felt completely sober again. Doc was just beginning to put the first of four layers of sutures in. “I finished deepening the groove and replaced the cartilage on top. I got really aggressive with it while you were gone.” Don’t tell me that. “Here, I don’t really want to take out this stitch, but let me pull this tissue out of the way and I’ll show you what I did.” That’s OK, thanks, I’ll take your word for it. The rest of the surgery continued without incident, and both veterinarians repeatedly told me not to worry about it, that they’d seen it happen countless times in their careers, that it didn’t mean a thing about my future suitability as an animal doctor, etc. I know they’re right, and I’m most certainly not having second thoughts about my career choice.

But still. I just laughed the whole thing off, because if you can’t laugh at yourself, who can you laugh at?

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