6th semester has a couple of intimidating hurdles in store for you and you tend to hear about them way before you even reach 6th semester because they are just that notorious. Since 1st semester you have been working on your surgical skills and getting your hands to recognize these new motor skills and perform them without even thinking. In 6th semester you finally get to put these skills together and you are tested via the ROSSie (a spay model). The ROSSie attempts to mimic all the layers of your patient's abdomen as well as the reproductive organs (although now that I've actually performed an OVH on a live patient I can honestly say that this model is nothing like live tissue but it will prepare you in regards to the ligatures/etc that you use during your OVH surgery). If you practice, practice, practice, and then practice some more...you will do really well with this. Along with your surgical skills being checked off by surgeons at RUSVM, you also will be tested on your working knowledge of various anesthesia topics. In my case, I did prepare probably more so than the rest of my classmates simply because I had taken an entire semester off from anesthesia and didn't want to struggle at the examination. The A-team (anesthesia team) was very straight forwards and the examination varied depending on which clinician you were paired with, but overall it was a very fair review of some key topics you should have a grip on prior to entering 7th semester when you will be entirely responsible for the anesthesia of your patient (being the sole anesthetist in many small and large animal surgeries).
Last but not least, BLOCK EXAMS. I have mixed feelings about blocks. The first two blocks for my semester were fair and I was told to do really well on them because the 3rd and 4th blocks could be rough. So I listened to the wise words of those that had come before me and did well on the first two blocks. I studied hard for both the 3rd and 4th block but still struggled. Going into finals I had one goal on my mind...to either maintain or increase my overall GPA. At the end of the semester I was able to actually increase my overall GPA and therefore still be able to apply to the schools I wanted to apply to for clinics (I'll talk about this later).
I was really happy with how my 6th semester went as well as the end results. It was the first semester that I was able to really focus on my studies because I had removed myself from being chair of Josh Project and taken on a less time demanding project (the mural painting project at the pediatric ward that I'll blog about in the near future). I have no regrets with how I submerged myself in all things Josh Project in previous semesters! I honestly am so happy I took the time and energy to focus on something outside of my coursework that would contribute to not only the RUSVM community but most importantly the St. Kitts community. But in realizing that my grades weren't necessarily the best reflection of my potential, I did decide to step away and really put all my effort into having a successful, on paper, semester.
ON TO TALKING ABOUT 7TH SEMESTER!!
Prior to the end of 6th, we actually gave preferences for our introduction to clinics rotations. You will have mandatory rotations (ie. equine, bovine, small animal clinic, clin path, emergency, etc.) and then you will have a choice of elective rotations (ie. anesthesia, therio, small animal surgery, ambulatory medicine, primate research, rehabilitation therapy, acupuncture, diagnostic imaging, etc). I am really thrilled about the rotations I was able to get (it's up to a computer system after you submit your rankings). For my elective rotations I received small animal surgery, anesthesia, dentistry, communications, and diagnostic imaging. Each week you are on a different rotation. Some are a day long, a couple days long, or the entire week. My first rotation was small animal surgery during my second week. I met my patient on Monday of the second week and did a complete physical exam as well as blood work and then completed all the paperwork that followed (ie. SOAP form, discharge instructions of findings from the PE and blood work, etc). My patient was an intact male cat that was less than a year old and presenting to us for a feline castration procedure. The procedure was then carried out by me as his sole surgeon on Thursday. The surgery went great and I am overall really thrilled about this rotation and how hands off the clinicians were. You were expected to treat it as YOUR patient, YOUR surgery, and YOUR paperwork. I prepped appropriately for this surgery by reading through the small animal surgery book as well as rounding with the overseeing clinician on the procedure. I had never performed a feline castration let alone been given the responsibility of an entire case. It was very exciting to have the opportunity to put my knowledge to the test and being as thorough as possible for the entire rotation. I decided to perform an open castration on my patient and use a figure 8 knot to tie the pampiniform plexus to both testicles.
During my first week, I received my surgery lab partners (4 of us total; 2 surgeons and 2 anesthetists) and also found out just prior to the start of the semester that I would be acting as one of the surgeons for a canine OVH procedure on the Friday of the second week. On the Wednesday of the first week, we received our patient and all four of us performed a thorough physical exam as well as drew blood for the blood work. We gave our patient a tentative diagnosis of Ehrlichia which is actually pretty common for the dogs living on the island. Ticks, that usually carry Ehrlichia, are very rampant with the island climate. She was sent home with the appropriate medication and we provided information to the owner. Our patient had to come back for a recheck blood draw at which time we had to evaluate other blood values that were out of the normal ranges. Our patient was approved for her OVH surgery for the Friday of the second week after the platelets had improved and met the surgical/anesthesia requirements. The surgery went really well and like I stated above, our ROSSie model did nothing to prepare us for how real live tissue is to work with. The good news is that you have the surgical skills to carry out the procedure and you have some amazing clinicians overseeing the entire procedure (as well as the technicians at the hospital...they are just awesome). My surgery partner and I began practicing together the moment that we found out we were going to be performing the procedure together (so that previous Wednesday). We even went to the anatomy lab and pulled out a specimen with intact female repro tract and structures. We reviewed the anatomy of the abdomen and the layers we would be cutting through. I mean we really prepared to the best of our ability for our OVH procedure. We were also given a bucket that was similar to the ROSSie but allowed us to practice the intradermal suture pattern (which we learned in a week).
Overall the experience was amazing. It was scary and intimidating working on a live patient but very exciting to be allowed to have this learning experience. I can honestly say that I think this is one of those scenarios this semester that it really is a group effort. My partner was just as driven and determined as I was to be as prepared as possible. Our chemistry as a duo has really made all the difference as well. Prior to this team up, I had not interacted with her because I was still a fairly new addition to orange semester. We worked extremely well together and our anesthetists did a great job preparing for our procedure as well as keeping our patient on a perfect plane of anesthesia the entire procedure.
I'm also very thankful for having a case/patient that presented with some health issues that required me to really put my thinking cap on to work it all up and record the findings appropriately. My feline castration was healthy as he could be and so I was really thankful that my OVH patient came with a few lessons to teach me as I put my 6 semesters of knowledge to the test. I know that I will probably never forget my OVH patient and the lessons she taught me.
This week is my diagnostic imaging rotation which was only from 1p-4p today (Monday). We did an ultrasound on a healthy kennel dog and all of us took turns locating the right and left kidneys, the spleen, the liver and gallbladder, the urinary bladder and prostate, and noting the stomach and intestinal tract. We also observed a cardiac ultrasound on a young cat with a heart murmur. Loved seeing the heart and all the different views and areas that we really focus on to diagnose cardiac diseases! Dr. Du Plessis also joined us to echo a young cat and it was really a great opportunity to watch her in her element and have her share her insights on the case. We were also able to check out a digital radiograph of a femoral fracture repair via plate and cerclage wire on a young dog that had just been in surgery for this repair and discuss the case briefly with the surgeon.
So as I stated above you have an OVH surgery that you work with three other classmates on (2 will do the surgery and 2 will do the anesthesia). You have two OVH procedures and act as a surgeon for one and an anesthetist on the other. I also have a SOAP group that consists of myself and two other classmates. This group is in charge of SOAPing a donkey (Spanky) and sheep (Thor) that we have been assigned. In the SOAP group you also get to perform some large animal procedures. We will be doing an arthrocentesis on our donkey and I will act as the primary surgeon in this procedure. Then we do an epididectomy surgery on our sheep and I will act as the sole anesthetist. We will do a nerve identification procedure on our donkey and I will also be the sole anesthetist for this procedure. I will be the assisting surgeon for two incision procedures (once with my group and then volunteer for another group). I will also act as an assisting surgeon on our casting procedure. And then last but not least, I will be the primary surgeon on our sheep celiotomy and typhlotomy.
Aside from these two groups that I'm working with, I'm also in a different group of six others that will be presenting on the topic of the interpretation of fractional excretion of sodium during one of the scheduled grand rounds days this semester (7th semester students present a variety of topics to 6th, 7th, and other semester students). We met the other day and got our outline for our presentation on paper and the topics are divvied up as well. Our goal is to collaborate with some of the professors that may have some cases or information that will help us to make our presentation as exceptional as possible. I'm actually really excited about this topic because it's not one that I know a great amount about so I will get a chance to teach others at this presentation all that I've learned from researching this topic and hopefully provide them with valuable and useful information to use not only in school but beyond.
So that's it for now! My feet literally hit the ground running when 7th started, but it has been right up my alley. I love being busy. I love feeling a little chaos at times. And I love putting my organizational, problem solving, and veterinary skills to use! I will attempt to update my blog as the weeks roll by. I'm really excited about all the amazing opportunities that this semester has in store as well as the countdown (85 days!!!) until I say good-bye to my island home (I will miss it dearly) and begin the next chapter of vet school. I will be finding out this coming Friday where I will be spending my clinical year ("4th year") of veterinary school. No matter where that may be, I know that I will make the best of it. I did submit my top three preferences and provided a personal explanation for my top preference, but the process is not clear cut and you don't always get your top preference let alone any of your top three preferences. I'm keeping my fingers crossed but remaining realistic about the process. I know that where ever I end up is all a part of my plan and I have to trust that.
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