Welcome to anesthesia

I'm in between my 2 consecutive weeks of junior anesthesia rotation -- our only junior practicum rotation other than client communications that comprises more than a single week during the year.

Anesthesia is reputed to be one of the more challenging, time-consuming, and stressful, yet thought-provoking, interesting, and rewarding rotations we get to have during junior year. My 2-week block is the second-to-last of the academic year, meaning I've heard feedback from almost all of my classmates up to this point.

The dozen of us who started anesthesia last week showed up outside of room D107D shortly before 8 am, as instructed by the first page of our orientation packet that was delivered to our mailboxes the previous week, with "8 am on Monday, room D107D" highlighted for us in bright yellow.

Unfortunately, by 8 am, no instructor had arrived to unlock the door to the room we were supposed to be in, much less give us an actual orientation. Being good little vet students and understanding that clinicians and support staff can be very busy and the hospital has a priority to patient care as well as student learning, we sat patiently in the hallway for another 15 minutes.

At 8:15, I walked across the hospital to the anesthesia induction/recovery area to see if anyone might know what we were supposed to be doing. I found the anesthesia prep room as well as the rounds room completely unoccupied, so went to rejoin my classmates in our continuing exercise in patience.

At 8:30, nothing had changed, so I made the rounds again, and again found the prep room and rounds room with nary an anesthesia clinician or nurse in sight. Back I went to room D107D.

At 8:50 am, the surgical instructor who works with the spay/neuter cases seen on Community Practice came walking down our hallway, and we pretty much pounced on her to help us. Being a helpful person, she first let us into the room we were waiting in front of, and then paged the nurse who was supposed to be leading our orientation. The news she found out was that said orientation nurse had called in sick and advised whomever she talked to that she would be unable to lead junior orientation and they would have to find someone else to do it. Seems that message never got conveyed to anyone who might actually be interested in leading our orientation.

The kindly surgical instructor marched upstairs to where she knew all of the anesthesia faculty and nurses were listening to a guest lecturer give a presentation, hoping to snag one of them to come give us a hand. However, she returned at 9 am with the news that, despite having interrupted their meeting and advised them that a dozen juniors had been waiting for over an hour for the anesthesia orientation they had been commanded to appear for by an annoyingly highlighted orientation packet, the meeting was apparently so important and/or interesting that not a single person would be able to break away from it to come orient us. Word was that the meeting would be over at 9:30 am and orientation would commence at that point.

Fast forward after killing time for half an hour. We dozen students again await an instructor at 9:30 am. Finally, at 9:50 am (bearing in mind that we all showed up roughly 2 hours before this point), a couple of anesthesia nurses walked in nonchalantly with no apologies and proceeded to give us their version of "orientation" ("Keep in mind that we've never done an orientation before and we don't really know what they tell you... but we can show you where the equipment is"). An hour and 15 minutes later (including a 30 minute antiquated video of how to place an IV catheter and induce anesthesia, using protocols that probably haven't been used at the teaching hospital in the last 15 years), we had apparently received all of the orientation we needed.

The nurses asked if there were any questions, and we proceeded to spend another 30 minutes asking them about tons of relevant information they had neglected to mention during "orientation." We then went on our merry way, thoroughly confused about anesthesia rotation.

In discussing with some of my other classmates over lunch, almost all of them said their orientation was very thorough and had taken the full 4 hours allotted, sometimes even spilling over into the lunch hour, and leaving the juniors confident in how the following two weeks would go. Haha. I'm sure we didn't miss anything in our 75 minute "we don't know how to do orientation" orientation. Good thing it's not like anesthesia is a department in which patients' lives are at risk and juniors are expected to devise their own anesthetic protocols and run anesthesia on their own. Oh wait.

Long story short, we clinical juniors (6 of us, including me, spent the past week shadowing seniors on more complicated cases, while the other 6 were on 'surgery C' -- the humane society spay/neuter cases) figured out what we were doing after sort of muddling our way through it on the first day.

On Tuesday I had a 50kg female great Dane undergoing a laparoscopy-assisted gastropexy (preventative surgery for bloat/GDV). She was totally anxious and freaked out when her owner dropped her off (sexually intact because "I want to show her and breed her" -- good luck getting her into a show ring without biting anyone). She fortunately sedated well with her pre-meds, and went down easily at induction. The surgery and anesthesia were uneventful, but she totally flipped out in recovery, 110 lb of panicked, disoriented dog flailing around and trying to bite. Hooray for alpha2 agonists that knocked her right out again.

On Wednesday my case was another great Dane -- this time 80kg (176 lb) -- in through Community Practice for the removal of a couple of probably benign but totally gnarly-looking skin masses growing on stalks off of his elbows. He was somewhat friendlier than the previous day's Dane, but still nervous, and didn't sedate as well before induction. However, he went under smoothly and recovered smoothly, which was a huge relief after seeing the previous day's recovery.

On Thursday I followed along with a 9 year old Australian cattle dog cross undergoing surgical repair for an acutely ruptured ACL. She had a TPLO (a procedure in which the bone of the tibia is cut and a steel plate is put on it) as well as a lateral suture to add stability to her knee. Those are potentially very painful procedures, so it was lovely that she received a femoral and sciatic nerve block on the affected leg, which kept her from feeling anything at all during surgery and kept her anesthesia very smooth. Like Wednesday's Dane, this dog didn't sedate especially well with pre-meds, but did induce smoothly. Her surgery went on for a long time so I didn't get to see her recovery.

This week I'm heading into my surgery C cases. Monday and Friday will be case discussions and rounds all morning, and I'll manage my own cases (with no assistance from a senior student) on Tues-Wed-Thurs. Tuesday and Thursday are humane society animals that go back to be adopted; Wednesday is client owned animals. They should all be spays or neuters on relatively young, healthy patients, which can theoretically make the anesthesia more straightforward, but we're still learning and there are always plenty of things that can go wrong in any anesthetic case, so it will be a challenging but hopefully rewarding experience (and I'm trying to put out of my mind my classmate whose very first surgery C case last fall died under anesthesia and couldn't be recovered... la la la, I can't hear you!). The downside is that on surgery days, I'll have to have my anesthetic plan approved BY 7 am (which means I have to get to school in time to put away my stuff, change into scrubs, get my clinic smock/thermometer/stethoscope/watch/etc., and get downstairs to have the nurse look over my anesthetic plan by 7 am). Sleep is overrated. Or so I keep telling myself.