A warning to those who may be squeamish, this is a discussion of an experience that includes the use of animals for laboratory animal surgery and surgical training. No images of surgery are included. However, at the end, I do include a video which you may choose to watch or not watch.
This was a particularly difficult article to write. We largely avoid talking about our embarrassing mistakes, regardless of how small they are. But I do think it’s important to reflect on and share the lessons we’ve learned. This is a story from my lab animal surgery course that illustrates an example in which my lab partner and I feel like we failed, even if it is purpose of the class — to provide an opportunity to make mistakes without any real consequences. It’s a chance to explore and learn. And I think this is worth sharing.
This was the first time where we were operating on living animals. We had several weeks of lectures before this, but now it was time to get some hands-on experience.
Before every surgery, we spent about half an hour just playing with the rats — holding them, petting them, comforting them. At first, they’re a little scared and hesitant, but they warm up to you really quickly. They really are just like dogs! Super curious and playful, often excited to see you, and comforted by your hands. If they had a more fluffy tail, people would probably want them as pets.
Not only is playing with them a nice and humane thing to do, but for the cynical minds, it can make or break a study of an implant design. A rat that is calm and at ease makes administering an anesthesia injection much easier and less fussy. Most importantly, surgical outcomes are far better and more consistent. If you’re life’s work depends on the success of a surgical device, it’s worth comforting the rats and playing with them before and after surgery. Each experience with a human should be a positive one.
When it came time to anesthetize them, I was surprised by how emotional it was. The anesthetic agent is delivered through an intraperitoneal injection into the lower left abdominal quadrant. The first time, it was the professor who did the injection, but later ones were done ourselves with the rat held safely in our hands.
The emotional part isn’t the actual injection. If done right, the rat feels a slight pinch, but generally doesn’t react all that much. After a minute or two of holding the rat, we put it back into the safety of its cage. They remain fairly active at first, but over the course of a few minutes become more woozy and disoriented. Eventually, they’re not able to remain coordinated and walk around. So they stumble a bit. They lie down and slowly become totally motionless.
Honestly, it is very hard to watch that. I felt an intense empathy for them and wondered what it was like from their perspective. I was on the verge of tearing up, thinking about that. I felt even more grateful afterwards, and incredibly appreciative for this opportunity to learn surgery from such an uncommon perspective. In this case, the rat will never wake up from anesthesia, so as to prevent any unnecessary pain or discomfort from our bumbling hands and surgical technique. The dose given is much higher than what would be given during major survival surgery, one in which an animal is expected to make a full recovery.
After preparing the rat by clipping the fur and setting up the surgical area, we began. An incision is made at the midline over the linea alba, a tough band of fibrous tissue. Gearing up for the final procedure, which is an ovarian hysterectomy, todays class was all about exploration. The professor had us explore the abdominal cavity to get a physical appreciation for the anatomy.
What a strange sensation to make a cut and see a slight trickle of blood come out from the skin. I had never done anything like this in the past. Of course, we had done dissections of various animals, but they were always dead and preserved. Here we were, cutting open an animal while it was still breathing right in front of us. The pressure required to actually cut through the tissue was quite a lot more than I expected. The skin, being incredibly thin and covering the soft abdominal organs, easily deflected into the abdomen, which made using a scalpel quite challenging. It seemed so incredibly easy when the professor did it!
My lab partner and I took turns to continue the incision. There are multiple layers that we have to go through. The thin skin on the top. Below it lies a thicker muscular layer. After making a relatively small incision with the scalpel, we switched over to using scissors. This allows us to protect the internal organs and not worry about stabbing through. Surgery is a very physical discipline after all! The scissors were a lot easier than the scalpel.
We extended the incision caudally without any issue. However, my lab partner met some serious resistance when extending the incision superiorly towards the head. After much struggling, we finally were able to look at what we did, only to be greeted by a bloody mess. We had breached the thoracic cavity. At first we had no idea what we were looking at. It was just all dark red. Only then did we realize what we had done. The lungs had collapsed due to the lack of pressure, essentially an induced pneumothorax.
We immediately called the professor over and explained what happened. He confirmed our suspicions. Importantly, he reassured us that this is what the class is all about. And today was only the first day.
He told us to hold the heart in our fingers and feel its beat. It is truly an emotional experience.
The professor came back and calmly explained the anatomy. The heart beat was becoming more labored. He injected the euthanizing agent directly into the heart, and we watched it slowly stop. Stillness. A moment of reflection.
To be honest, I was kind of shaken from that experience. But again the professor urged us to continue and learn. We continued the procedure, looking for the anatomy. We saw the two large kidneys, neatly tucked away behind the intestines. We gently pulled the intestines and ran them through our fingers, examining each fold. The uterus was way longer than I thought it would be! It makes sense, though, as rats carry litters rather than one baby at a time.
But it was truly an incredible learning experience. Just like in any endeavor, it’s worth sharing the lessons that we learned. This is certainly something I will remember for the rest of my life. The rest of the class was smooth sailing.
“Doctors make mistakes. Can we talk about that?” by Brian Goldman, November 2011. https://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that?language=en