Teaching pains

Had a very interesting teaching experience last week that I thought was worth sharing. I'll start by reminding everyone that my primary interest lies in surgery - particularly soft tissue surgery.

Last week, I took two of my little foster kitties in for a spay. I was on community practice rotation which is one of the rotations that the students have the opportunity to do spays and neuters. The usual clinician who handles the surgeries was out for a meeting thus making it so that the students assigned to surgery had nothing to do. I asked if they were interested and offered the kittens if they wanted - they were very enthusiastic!

So, I took them in and taught some common sense medicine. They got worried because one of the little ones had a temperature of 104 and a glucose of 88. "Should we postpone the surgery," was the question I was asked. My comment caused a slight gasp because I said, kitten sounds great and has felt great at home, eating / drinking / playing, etc. but had been fasted for the night so I voted to move forward.

As I told both students, it was their surgery and I was only scrubbed in to give advice and help if needed. The first student did a good job. She knew the concepts well, asked good questions, and followed directions / suggestions as I gave them. She was closing the skin with an intradermal pattern when life got interesting. Anesthesia called in to ask if I would be angry if we aborted the surgery on the second kitten because there was going to be a short power outage. Told them no problem but there wouldn't be another opportunity because if not done that day I had planned to take them home with me on my vacation time and spay them at home.

They wavered back and forth then decided to go ahead with it. The second student really did not have good soft tissue handling skills. I felt that I should tie my hands to keep from taking things away from him and finishing myself. It was then that I realized that I think I may be developing an ego - something that I hate in others!

The first student had asked how easy it was to actually tear the blood vessels and the second provided a teaching opportunity on that point. In cats, you don't really have to break down the suspensory ligament in order to ligate the ovarian vessels (they tend to be very stretchy). I usually do just because that is one less thing to ligate thus (in theory) giving better ligation of the vessels. The student didn't want to and I had told him that was fine but that it should be ligated with the vessel. He made a window cranial and caudal to the vessels and was struggling with getting the suture around and I told him either break down the ligament or ligate it. He ignored me and kept struggling. To make it worse, we were working with a time crunch because the power was going out shortly. I stopped him and said I would break down the ligament, then took a gauze sponge and started to do so. He was impatient and grabbed an instrument then used it (sort of like the proverbial bull in the china shop) to try to break the ligament.

The result was that the vessels tore beneath the instrument but the ligament was still intact. Good news was the the vessels tore above the clamp but boy was I aggravated. In my most sarcastic tone (after clamping the bleeding ovary) I turned to the first student and said, "In reference to your earlier question regarding how easily the vessels can tear, you will note that the ligament is intact and the vessels torn." So maybe sarcasm was inappropriate but it kept me from shaking the other student and taking away his instruments. I then personally tore the pesky little ligament.

It was very difficult for me to continue watching and instructing as he ligated the uterine body and started closing. He then tore his glove about 1/4 of the way through closing the linea. This was my second nagging feeling of developing an ego because, as I continued suturing backwards (because not only was I on the opposite side but he is also left-handed) while he changed gloves, I thought, "Man, I suture faster and better backwards than he does forwards." I allowed him to place skin sutures because it would be faster than intradermal and we were still awaiting the power outage. The other frustration (as insinuated earlier) was that he did not listen well. I kept loosening his sutures because skin sutures are not supposed to be tight and he kept tightening them again. The funny part was that the power went out for all of 45 seconds in the rest of the hospital but not in the surgery suite where we were. I wish anesthesia had told me and I would have made him go back and do intradermal sutures.

Both kittens are doing well despite the challenge (and stress) for their foster mother. I'm not the most compliant client and they were playing like little fools the day after.

The other outcome of this experience was to make me even more grateful for the wonderful surgery clinician with whom I worked in school. I feel huge empathy for the stress that must have been felt as he watched us students learning to do such basic things as suturing. I would like to think that I was not as much of a stressor but even the little ego that grows won't allow me to believe it;) Now I must find a way to squash this ego before it gets out of hand since that is one of my biggest pet peeves about specialists in general!