All those years ago I entered my senior year of Veterinary Schooland and at my first class in clinical sciences the then head of large animal services Dr. Vernon Tharpe gave a lecture. He said, and I’m paraphrasing, that we were embarking on a career of art in medicine. When we graduate we will have a comparable education to our human counterparts but will have artistic skills that they cannot match. As an example, he said: who else would be able to enter a barn in the middle of the night with no light and be able to administer medications intravenously through the jugular vein to a downed dairy cow?
You need to do what to me, Doc?!
As large animal veterinarians calling on farms, and for that matter small animal veterinarians in Smalltown, USA, we would not have the diagnostic tools available at large learning institutions. Therefore, we would have to use our knowledge and newly developed diagnostic skills to develop and institute treatment and preventative medical plans all by ourselves.
Boy was he right!
When I graduated I went to work in a mixed animal practice in east central Appalachia in Ohio. The practice was mostly small animal, dairy, and equine. My boss had the attitude that I was licensed to practice and ‘threw me to the wolves.” This was scary, but in the long run it was what I needed to develop my skills. I had a steep and rapid learning curve because after two weeks the boss went on vacation and left me to run the show!
The first week there I was called out on an early Sunday morning to attend to cows caught in a barn fire. I basically had to make the decision as to which cows were salvageable and which had to be euthanized. That morning that 25 year boy-vet grew up really quick. Making decisions on someone’s livelihood can shake you to the bone.
Later that summer I was again called out to a dairy farm on a Sunday morning to find 5 cows laying dead around the barnyard, talk about pressure! Long story short, they had been electrocuted by faulty wiring around the watering trough. The first hint was thirsty cows staring at us but not going up to the trough.
During those first years I did c-sections on cows in barns and in the field, treated a multitude of colic horses, developed skills in correcting misrepresentations in vaginal deliveries of calves and foals, treated a many varying trauma cases in small and large animals, became adept in soft tissue and orthopedic surgeries, and developed preventative medical programs for farmers, horse barns, and small animal breeders. Those 3 years allowed me to develop and hone my skills in veterinary medicine. And, as all veterinarians know, we never stop learning. We know we have to be constantly fine tuned.
I recently had a case that brought these memories back. A close friend brought his female cat in for lethargy and frequent litter box visits while only producing very small amounts of urine. Examination revealed an over distended bladder. This is a relatively common problem in male cats, but female cats almost never have urinary blockages. Xrays showed two stones in the bladder, one in the middle of the bladder and a second probably lodged in the urethra, the tube where the urine exits the bladder. Surgery was the only option.
The first stone was easily retrieved. The second stone was found at the end of the urethra where it enters the vagina. The problem was that this location is inaccessible surgically without removing a portion of the pelvic bone. Also, the area of the urethra where the stone was lodged was severely traumatized and beyond repair. So, what to do? Call my friend and tell him it was hopeless and his only option was euthanasia?
I was not ready to give up. So, I developed a mental picture of what to do and proceeded. I cut the urethra in front of the stone where the tissue was still healthy. Then, I brought the end through the abdominal incision and sutured it in place and closed the incision around the opening. After some anxious days everything healed and she now happily sits on the litter box thinking she is urinating out the back while the urine is really passing between her legs.
Yay!
So, what’s this story really about? It relates back to the original definition of the art of veterinary medicine. I was in the cat’s abdomen facing a fatal problem and as far as I know, there is no description for a technique for translocating a female cats’ urethra. My decision was based on a combination of how we handle blockages in male dogs and cats. Surgically, I’ve made many blocked male cats ‘pee’ like females relieving them permanently of their obstruction. Likewise, I’ve opened the penile urethra of blocked male dogs allowing them to urinate freely between their legs.
My mind modified these procedures to create a technique to save my patient’s life. This is the art of veterinary medicine. We are creatures of creativity and are not locked in to “by the book” techniques. Even today many of our clients cannot take advantage of the specialization available to them due to financial constraints or personal preferences. That leaves us in general practice to develop care plans. Much more often than not we are successful and years of experience have helped me and all my colleagues to develop our art of veterinary medical skills.
Thank you, Dr. Tharpe, for that message. I have carried it with me all my career.