Not quite what the surgeon ordered…

The procedure was a tie back surgery on a Thoroughbred with laryngeal hemiplasia. There are certain topics and specific points that get emphasized more than others during vet school.

1. don’t be the vet that misses foot and mouth disease
2. rabies is always a differential for patients with neurological disease
3. causes of hypercalcemia

And then there are certain topics that are species specific. “Roaring” in horses is one of these topics that we discuss thoroughly in the classroom because of the relative frequency that it is seen in practice. I was excited to see the corrective procedure, especially since it is likely one I’ll never perform as a mobile veterinarian. Atrophy of the cricoarytenoideus dorsalis muscle leads to decreased movement of one of the cartilage structures, which can lead to decreases airflow in times of strenuous exercise…a possible reason why a racehorse may exhibit exercise intolerance or otherwise go from winning to losing races. If corrected, the horse can return to the track without hindrance to future performance.

The Surgeon did not seem so thrilled as I was. “You can’t see anything. It’s a procedure mostly done through feel” he explained. He couldn’t have been more correct. All five of us students, currently on our Equine surgery rotation, hovered as close to the three-feet sterile cut-off as possible. In surgery, to protect the sterility of the site, surgeons and tables, anyone who is not considered “sterile” cannot come within three feet of these objects. Sterility would’ve required scrubbing, sterile gloves, sterile gowns, cap, mask and booties. Boots, cap and mask are always required in the surgical suites.

The surgeon worked from a small incision on the site of the neck below the mandible with an endoscope viewing the affected arytenoid cartilage. When visibility is minimal, I tend to phase out all else. The large ventilators make a rhythmic trance-inducing beat. It can be way too easy to space off. Wondering about recovery, after care, healing time. thinking about the possible complications since this surgery is located near various important structures like the internal and external carotid arteries, sympathetic trunk, trachea, esophagus etc. This question regarding complications is bound to pop up later.

“Get a towel.” It still takes me a minute to work through the muffled sounds when people speak through surgical masks. The Surgeon was sweating something terrible. ‘Get a towel to wipe this sweat.’ He wasn’t talking to anyone in particular.

My classmate asked loudly and quizzically. ‘Is he serious right now?’ I cringed in the awkward silence. I shook my head and  immediately began searching the walls for a paper towel dispenser. Yeah, right.  The other 4 students had the same instinct. There were jolted efforts and several students disappeared to find towels. The resident, in her infinite wisdom, pulled a surgery towel from the table and tossed it to my quizzical classmate.

The surgeon pulled away from the incision to carefully instruct how one folds a towel when wiping away sweat from another’s face… not something  we rehearsed in our first year course ‘Principals and techniques of Surgery.’ Unfortunately, the instructions on how to precisely fold the towel were muddled with frustration and it was multiple folding attempts later before this towel was folded appropriately.

The Surgeon turned his back to the student, and she reached around him to hold the towel in front of his face with her hands. It looked uncomfortable… He proceeded to wipe his head so vigorously that he knocked one end free. The towel almost hit his sterile gown. This would’ve been a surgical nightmare, broken sterility… requiring rescrubbing, regloving, and regowning…postponed the procedure, cost the client more money, put the patient at increased risk…bad juju.

To describe the atmosphere as suspenseful would be an understatement. it wasn’t until my classmate was done that I realized even I was holding my breath.
‘Stand by in case I need it again.” he said, while diligently and carefully continuing his work. I made eye contact with my classmate, who stood uncomfortably at her post. She gestured to the towel and made a face. I thought ‘hell, and we will be doctors in 5 months?’