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A Bloody Mess
Feb. 5th, 2004 04:28 pmThe first thing I learned, in the daily practice of veterinary medicine, was that textbooks are your best friends. More than anything, medicine means knowing where to look things up. All of the information you might ever need is in a textbook, somewhere. Unfortunately, the second thing I am rapidly learning is that textbooks lie.
For example, surgery textbooks describe forelimb amputation as a simple and excellent procedure. The drawings demonstrating the procedure are simple, clear, and black and white - tiny, irrelevant things like blood vessels are just glossed over, and each individual muscle is outlined in bold, so you can clearly see where one ends and the next begins. Nowhere does it describe what a broken humerus looks like after the dog has walked on it for two weeks, shoving bits of bone into random places and generally turning the involved muscle into hamburger. I'm also very tempted to increase the reality factor in my orthopedic surgery textbook by liberally smearing the pristine, bloodless diagrams with ketchup until the images are obscured to uselessness.
Fossum's 'Small Animal Surgery' describes the procedure thusly: 'Make a skin incision from the dorsal border of the scapula, over the scapular spine, to the proximal third of the humerus.... Transect the trapezius and omotransversarius muscles at their insertions on the scapular spine.' It goes along in that vein for most of a page.
A more honest rendition would read something like: 'Make a skin incision starting at the dorsal border of the scapula. Find the proximal third of the humerus. Realize that what you thought was the humerus is, in fact, the point of the fracture. Reposition the skin and try to make it straight. Try to stop the bleeding. Transect the trapezius. Try to stop the bleeding. Find the next muscle, if it hasn't already been minced by the bones. Try to stop the bleeding. Holler for your technician to bring you another pack of arterial clamps. Run out of gauze. Holler again. Realize that the drape you have is too small, and spend ten minutes trying to twist it around to expose your entire incision. Replace the clamp that fell off in the process, endeavoring not to splatter blood onto your surgical partner. Try to compare the reality in front of you to the tidy image in the book. Give up, and start filleting. Try not to squirt the other surgeon in the face with lidocaine.'
It's done, finally, and the dog is fine. The textbook has survived my post-operative abuse, and I think I've finally gotten the last flakes of blood out from under my fingernails and off my face and out of my clothes. However, I think that from now on I will make the professional choice to stick to small, glamorous, blood-free soft tissue surgery. Or, better yet, I'll just draw pictures....
For example, surgery textbooks describe forelimb amputation as a simple and excellent procedure. The drawings demonstrating the procedure are simple, clear, and black and white - tiny, irrelevant things like blood vessels are just glossed over, and each individual muscle is outlined in bold, so you can clearly see where one ends and the next begins. Nowhere does it describe what a broken humerus looks like after the dog has walked on it for two weeks, shoving bits of bone into random places and generally turning the involved muscle into hamburger. I'm also very tempted to increase the reality factor in my orthopedic surgery textbook by liberally smearing the pristine, bloodless diagrams with ketchup until the images are obscured to uselessness.
Fossum's 'Small Animal Surgery' describes the procedure thusly: 'Make a skin incision from the dorsal border of the scapula, over the scapular spine, to the proximal third of the humerus.... Transect the trapezius and omotransversarius muscles at their insertions on the scapular spine.' It goes along in that vein for most of a page.
A more honest rendition would read something like: 'Make a skin incision starting at the dorsal border of the scapula. Find the proximal third of the humerus. Realize that what you thought was the humerus is, in fact, the point of the fracture. Reposition the skin and try to make it straight. Try to stop the bleeding. Transect the trapezius. Try to stop the bleeding. Find the next muscle, if it hasn't already been minced by the bones. Try to stop the bleeding. Holler for your technician to bring you another pack of arterial clamps. Run out of gauze. Holler again. Realize that the drape you have is too small, and spend ten minutes trying to twist it around to expose your entire incision. Replace the clamp that fell off in the process, endeavoring not to splatter blood onto your surgical partner. Try to compare the reality in front of you to the tidy image in the book. Give up, and start filleting. Try not to squirt the other surgeon in the face with lidocaine.'
It's done, finally, and the dog is fine. The textbook has survived my post-operative abuse, and I think I've finally gotten the last flakes of blood out from under my fingernails and off my face and out of my clothes. However, I think that from now on I will make the professional choice to stick to small, glamorous, blood-free soft tissue surgery. Or, better yet, I'll just draw pictures....
