Tuesday, 28 July 2009

To cut is to cure? Medicine vs Surgery

My wife and I are both vets, which makes for some very boring discussions most eveings. We do like to have our own area of expertise, however. For instance, I consider myself a medic. My wife considers herself a surgeon.

(Not that either of us have officially specialized - neither of us have quite got round to it, somehow. It was so nice not having exams after taking them every year for the first twenty-three years of our lives that we're not in a hurry to get started again, though we both have plans in that direction at some point in the future... though this may be in the same way that I have vague plans to get bitten by a radioactive spider and develop superpowers)

The difference between medicine and surgery is relatively easy to define. Basically, pretty much anything up to the point where use a scalpel blade, and after you use suture material, is medicine. The bit in the middle is surgery.

(Incidentally, why do we call our consultations 'surgeries'? Surgery is, literally, the one thing you're pretty much guaranteed not to be doing when you are consulting, and considering that's really the fun bit of the job, it's kind of rubbing your nose in it, isn't it?)

Now, I can really see the appeal of being a surgeon. Surgery doesn't involve a lot of talking to owners. and life wound be so, so much easier without talking to owners. Surgey also has a much higher, shall we say - satisfaction quotient - than medicine. What I mean by that is, if you see a surgical problem (a broken leg, a ruptured diaphragm, lingerie stuck in a dogs abdomen (no, really!)), you knock the animal out, fix the problem, the animal wakes up. Job done. Instant healing work. (Incindentally, this satisfaction sometimes doesn't matter whether the animal actually recovers or not. It has not been unknown from me to hear phrases from surgical colleagues along the lines of 'The operation was a complete success. Unfortunately the pateint did not survive.')

Medicine is never quite as simple as that. If you work out the animal has diabetes, or Cushing's disease, lymphoid leukaemia or renal secondary hypoparathyroidism, you can't just magically fix it with a swish of the blade. You're then commited to a lifetime (well, the animal's lifetime) of tablets, or injections, or of which can go wrong at any time and need fresh blood-sampling, fresh jiggling.

So why be a medic? There are times (including right now, when I'm writing this blog) when I wonder that very same question. Surgery is fascinating. There are times during operations, when I experience one of those 'self' moments - I take a step back and look at who I am, what I am doing. What I am doing is standing with my gloved hand inside another living, breathing animal, one that will recover (hopefully) and be absolutely normal. That is a strange experience, and quite a fulfilling one, too. Medicine has no comparitive Godlike moments to offer.

I think what I like about medicine is the puzzle - piecing together the history, and blood results, the symptoms. Working out the problem has a lower key buzz, but one present nevertheless, that makes me feel a bit like a veterinary Sherlock Holmes, eliminating the impossible until the truth, however unlikely, shines through.

Of course, these are romantisized views of both disciplines. There are many medical cases (surgical too - see my first blog) which defy explanation and the textbooks, are are exercises in pure frustration (we don't get to call on Hugh Laurie to come and sort it all out, either). On the surgical side, there is a horrible, creeping sweaty feeling that only surgeons know - the feeling that something has just gone very, very badly wrong with your surgery.

(Which reminds me - a classic surgical euphamism is 'He lost a lot of blood.' What a lovely phrase. Kind of makes it sound like the animal's fault, doesn't it? Like he dropped it behind the sofa. Well, what the surgeon really means is 'I fucked up, and cut something that I shouldn't have, which was followed by twenty minutes of swearing and a whole lot fresh swabs.')

Still, at least I gives me and the wife something different to talk about of an evening. One fine day, you might see the fabled letters CertSAM printed after my name.

And one day, you might see me climbing a brick wall, and doing whatever a spider can.

Tuesday, 21 July 2009

Happy Anniversary!

It was a momentous anniversary last week, as I'm sure you all know. No, not the forty years since mankind first walked on the moon. Something much more important. Well, to me at least.

It has been ten years since I became a Bachelor of Veterinary Science (decidely not hons) and a member of the Royal College of Veterinary Surgeons (which, I have just worked out, means that I have paid the Royal College so far roughly £3000 for the privelidge of being a vet. Yay.).

Ten years. Several ways of celebrating this anniversary spring to mind, but as I no longer have a firearms licence, and all the pentobarbitone is at the practice, I'll settle for a glass of beer and a Blog entry.

I've being trying to think today when the idea of being a vet first curdled it's way into the youthful cream that was my young mind. I'm fairly sure that I've narrowed it down to a holiday in Germany when I must have been about eight or nine. I always took several books to read with me, and one was a copy of 'Every Living Thing' by James Herriot...

(... and yes, I'm very aware that it's a massive cliche that I decided to be a vet because of James Herriot. What do you want me to do, lie? In retrospect, it's a shame I didn't base my career choice on one of the other books I took with me - Deathwing over Veynaa by Douglas Hill. I could have ended up as an intergalatic Legionnairy of Moros with an adamantium skeleton! Now that wold have been a fun job)

...and I loved that book. It all sounded som much fun, and the guy was helping animals! For a living! When I was a child, I loved animals (Not in that way, before you start, okay), and I loved Biology. When I read that book, it just made perfect sense to combine the two. Plus, it sounded really funny when James Herriot wrote about gruff Yorkshireman having to explain that their dog 'had a problem with his...with his pencil, Mr 'Erriot).

So I was very fortunate - from that time on, I had a sense of purpose. I knew exactly what I was going to do for the rest of my life. That nagging, insistent voice at the back of my mind, that was always telling me that I should try and make the world a better place, would be silenced! I would be making the world a better place with my day job! I could even spend my evenings playing rolepaying games and computer games, and not feel guilty about it!

The determination lasted through all the teachers, and all the careers advisors who told me that it was a waste of time (seriously, has anyone -ever- recieved one useful scrap of advice from a careers 'advisor'? My wife's told her she should be a florist. Though, considering my current feelings towards the profession, maybe we should have listened back then), it lasted through my GSCE's, through my A Levels, and right up to that final glowing day when I recieved my one (and only) offer to go to Bristol, to study being a vet.

I have now been a vet for twice as long as I studied to be one. I am older, arguably wiser, and a whole lot tireder. That nagging voice, the one that I hoped would finally shut up when I was doing good deeds and getting paid for them, is not fooled, and though it has grown quieter over the years, it has never been silenced. My job does not consist of doing good deeds, all day, every day, as I imagined it would. And though I may relieve some suffering, I also help to perpetuate it in the form of helping dog and cat breeders continue to spawn the various mutants that they seem to consider 'cute'. The best thing I do, the honest-to-goodness kindest act I generally perform, is euthanasia, and with the best will in the world, it's hard to feel good about oneself for repeatedly killing small animals.

Ten years gone. My attitude to my job is, and I suspect, always will be, mixed, but it has brought me the greatest thing in my life so far - my wife - and for all the wonderful years we've had together, I actually feel it was worth it all!

There are many more things I could write about, but I'll leave them for another time. For now, sit with me and raise a glass, for years gone by, and to absent friends.


Saturday, 18 July 2009

IV - or not IV?

I've been on call today and given six intravenous injections. I haven't missed a vein once.

Not that impressed? Well, I am here to tell, young reader, that you should, because giving an IV injection is not quite a simple as they make it look on the telly. It always really bugs me on some programme or other, when someone needs to be sedated really quickly, the hero/heroine just grabs an arm and fires away. Yeah, good luck with that buddy/buddess - you've just given a subcutaneous. Or an intramuscular if you pushed hard enough.

Okay, maybe I'm getting too worked up about this - but I've seen it too many times not to feel peeved that a skill which I acutally possess is so undersold by mass media. I am, in real life, what you might call a doofus. You might call me that, if you were being polite and didn't want to call me a clumsy idiot. No mug of coffee is safe from me. If you have red wine and white carpets, I would advise you never to let me into your house.

However, somehow, when I am in vet mode, I am pretty goshdarn good at getting an injection to go where I want it do go. To get an IV, you need a steady hand, and a gentle touch. A client of mine who was a nurse told me that they practiced their IV on cats - because if you can get a cat's vein, you can get anything.

Now imagine that cat would like to eat your eyeballs. Now further imagine that said Corinthian-cat's owner would not allow you to clip any fur from its leg, because 'it's going to a show at the weekend' (For some reason, show judges, who actively encourage producing animals which look they have repeatedly been hit in the face with a cricket bat, and are so deformed that if they sneeze hard their eyes can prolapse, feel that a clipped patch on a foreleg looks unsightly) and perhaps you will understand why I'm a little proud of the fact that I can hit a vein fairly often.

I am, of course, not on my own amongst the veterinary profession at being able to perform this particular task, but I must fight against my natural modesty and immense charm to bring you the news that I am actually better than quite a few others I have worked with. It is not unusual for other vets to ask me to come and try and get blood/fit an IV catheter for them. As you can imagine, when I get that lovely flush of blood back in my syringe, I make no fuss about it. There may be a little dancing involved. There may be some asking of the nurses 'Who's the Daddy?' (They never seem to know who the Daddy is, though.)

You might call it my super-power. I could be Vein Man! (Though now I think about it I'd have to spell it prominently on my mighty chest or people might think I just really loved myself)

(NB - I may have near-legendary vein-hitting skills, but a chimpanzee with no arms and a stitched up mouth could bandage an IV catheter better than me. Hey, a guy's got to have some limits to his power, hasn't he? I've got to leave some jobs for other people)

So, the next time you see someone stabbed in the arm aimlessly with a syringe, and thereupon fall instantly to the ground in sedated stupor, stand up and shout at your television set 'We demand realism! Don't devalue a skill that people are proud to attain!'

Go on. Please. At least think it a bit? Thank you.