I Came, I Saw, I Rectalled

21st Feb – 3rd March

“Wait, so… milk is just cow boob sweat?” the words came out before I’d given them permission, much to the amusement of my friends. This was the only piece of information I had retained from two consecutive hours of lectures on mammary glands. Although, in my defense, this is essentially true – the mammary gland is a modified apocrine sweat gland. Ergo milk is modified apocrine sweat. Gross, I know.

I had two hours to consolidate and memorise these lectures before I jumped on a minibus and took a trip to the school’s dairy farm for my afternoon practical, entitled on my timetable as: Rectal Examination of Cattle

My favourite.

Over the summer, I’d spent placements on both dairy and beef farms, many hours of which were spent shoving my hand repeatedly up more cows’ bumholes than I could keep count of. Bear in mind that this was before my courses on bovine anatomy and reproduction – in other words I had no idea what I was doing, and had to learn ‘on the job’.

Today’s session was a much more structured affair. Walking into the teaching barn, I was a bit disappointed to see that there were no cows in the stocks, just multiple metal tables covered in uteruses. We all gathered round, and selected a uterus. The tutor began by recapping the uterine anatomy, and produced an entire cow’s pelvis out of thin air, to help us orientate ourselves when we finally took the plunge.

She had us fold up our uteruses on our left hands as they would be in a non-pregnant heifer, had us shut our eyes, and then talked us through the process of palpating it with our right hands. As I stood in the middle of the barn with my colleagues, holding a defrosted vag aloft with one hand and squeezing it with the other, I felt a distinct sense of calm. It was like visualisation meditation, except instead of feeling the sensation of warm sand between my toes, I was instructed to “feel for the turkey neck”. Simply divine.

“There’s a reason we do this with you. This is exactly how it feels in the live animal.” the tutor asserted.

My eyes flew open. Is it heck as like.

I quite distinctly recall spending my summer groping around in a cow’s rectum for very protracted lengths of time, and coming across nothing of this clarity. The cervix is the most distinctive landmark, and on many occasions I couldn’t even find that. Those in my class who had never rectalled before (yes, that is a real verb once you get to vet school) seemed reassured that they would now be able to reach in and rearrange the contents of their cow’s pelvic cavity with one swift tug. I, on the other hand, began to question my own recollection of my previous rectalling experiences.

We then discussed the reasons for rectalling, and the risks, and then followed the tutor to a different corner of the barn.

“These are our rectalling simulators, and you’re going to practice on these before attempting it on a live animal.”

I looked at the simulator, and its giant rubber anus stared right back at me. When my turn came, I can honestly say it felt more perverse to put my arm through the rubber anus than it did a real one. On the other side, I was met by a vaguely uterus-shaped sandbag, which I obediently palpated the length of, and pulled it into the pelvis via the intercornual ligament.

With that strange and unhelpful experience out of the way, it was time to strip down to our t-shirts in the freezing barn and suit up. Wearing full-length plastic gowns and arm-length plastic gloves, a group of us entered the cow barn, where a long row of real-life anuses stood to attention. I was assigned the fifth anus from the end, which belonged to a tall black and white Holstein-Friesian. Just like all the others, her head was restrained at the front, and she was sandwiched at either side between two other cows. Poor lass.

A dedicated rectalling coach gave us a final pep-talk on the rectalling rules, and set us off.

Unlike the first time I entered this alien world, which you can read about here, I knew the drill. With my hand generously lubed, and her tail pulled to one side, I formed the classical torpedo shape with my fingers and began introducing them into the centre of the pucker. Right on cue, the anus reflexively squeezed shut, and she tried to clamp her tail back down. Feeling guilty but determined, I continued with firm pressure. It’s a bit of a squeeze at first, but once your knuckles are through there seems to be a sudden vacuum that sucks in the rest of your wrist quite suddenly.

I was put out to find her rectum filled to bursting with uncommonly sludgy manure. The rectal coach had specified no more than a minute scooping, and so once I’d scooped out everything that I could within my 60 seconds, I figured I’d just have to swim through what remained. The first job was locating the cervix, which after so many beef cows was not a problem for me in this skinny dairy cow. But when I went searching for the uterine horns, the intercornual ligament, the ovaries, the left kidney, and the rumen, I came up completely blank.

Just trying to move through the manure became tiring, and my hand started to cramp up. None of this was made any easier by the fact that my cow kept arching her back and straining to push me out. I mean, not that I blame her. I soon realised that the reason I couldn’t find the left kidney was that my cow was so long it was basically out of reach.

The student to my left was having some difficulties, and pulled out to ask the coach for some advice. He was by her side immediately, and I was about to be impressed by his attentiveness when he opened fire on her, “Why did you pull out? Under absolutely no circumstances should anyone pull out if they intend to go back in. If you keep pulling out and going back in, you’ll introduce air into the rectum and you could cause a rectal perforation. The welfare of the animals is our first priority, if I see you doing that again I will end your session.”

Holy mother of sin. She looked at me sideways, and I sort of shrugged apologetically, arm still in-rectum. Focusing back on my cow, I was having real trouble finding the bony outline of the pelvic rim, a problem I’ve never had before, and something that should have been easy to do. I took a short break to let my hand stop cramping, because she was straining really hard and there was no point fighting it. And so I stood, one arm up the cow’s clacker, and the other leaning on her rump, waiting for her to relax.

Catching me completely off-guard, fluid suddenly began gushing down my front. My first instinct was to jump back, but the fear of accidentally pulling out kept me anchored so that I just stood and let the cow empty her entire bladder down me. All I could do was look away and keep my eyes and mouth shut until it ended.

When finally it did end, I opened my eyes to see the coach standing right beside me. For a split second I was terrified that he was going to lecture me about how irresponsible it was that I didn’t pull out, and how I could have caught a disease from the aerosolised urine. Instead, he said cheerfully, “I’ll bet you couldn’t feel anything in there with that enormous bladder in the way. Everything should be much easier to find now!”

And sure enough, he was right. So I still couldn’t reach the kidney, and I’d be making it up if I said I could find the ovaries, but boy was there so much more space in there now. Having violated my cow enough, I pulled out with a great slurp and went to peel off my urine-soaked plastic gown.

The following day, I had a practical for the gross anatomy of the placenta. Before the repro module, placentas were a bit of a mystery to me. Now that we’ve pored over them from the entire organ to the microscopic structures and physiological functions, I cannot hear the word without conjuring images of aliens from some weird Ridley Scott movie. Pregnancy is not a symbiosis, it is parasitism.

Having said that, the foetuses of most mammals are absolutely adorable. After having learnt the theory, I entered the practical to see these structures for myself. Even within domestic species, there’s a huge variation in placental attachment. Interestingly, humans and rodents have far more in common reproductively than we do with the oft-used human medical model, pigs. Primates and rodents have discoid placentas, where the materno-foetal connection occurs in a dinnerplate-like structure. In cats, dogs, and most other carnivores, we see a ‘zonary’ placenta, which encircles the foetus like a napkin ring. Pigs and horses have diffuse placentas, where materno-foetal contact is made all around the foetus, and ruminants like cows and sheep have cotyledonary placentas, where the maternal and foetal tissues connect at discrete interlocking points like pop-studs. But it’s not just the gross structure that’s different. Each of the above groups also have different histological structures within the placenta, which affects how it functions. One interesting example is the primate and rodent haemochorial placenta, where the blood of the mother and foetus has the least separation, and these are the only placentas that allow maternal antibodies into the foetus. All other species are born without antibodies until they drink colostrum. Pretty cool.

And so I had a great time looking at this wonderful array of placentas and foetal animals with everything in perfect miniature. Tiny hooves, ears and tails, and all their internal organs so astonishingly complete.

I wasn’t so besotted the following day, when the realities of having chosen veterinary medicine over human medicine really hit home. On that single Thursday, across multiple lectures, we covered the management of reproduction in the cow, pig, sheep, goat, and birds. By the fourth consecutive hour sitting listening to it, I could tell that I wasn’t the only one who had been unable to maintain concentration and had switched off almost entirely. That evening, I was so intimidated by the volume of new information that I chose to deny it completely and work on other topics instead – a fantastic maladaptive coping strategy.

On Friday, I made time to deal with Thursday’s sex-ed tsunami by deliberately avoiding a few hours of cattle husbandry lectures because the lecturer’s slide notes are 41 pages long and look like this:

cattle_notes

Avoidance: another effective maladaptive coping strategy

When I started vet school as a fresher, we were warned about people who deliberately avoided lecturers and sidelined ‘less important’ subjects, and being naive and eager I swore never to be that person. Well, ladies and gents, let me introduce you to a changed version of me. I can’t name one vet student who hasn’t strategically avoided the odd lecture, or who hasn’t crammed ALFS because they’ve been buried eyeballs deep in Animal Body. But unlike most students, who often avoid lectures to watch Netflix, vet students are in a constant highly-strung state of time juggling; using avoided lectures to try and get on top of the ever growing workload, and then sacrificing sleep to make up for the avoided lectures. Behind the humour of the practicals and the professional calmness of the school lies hundreds of students budgeting thousands of hours, each with a different strategy, and each repeatedly recalculating, reprioritising, and taking careful gambles. Whatever gets the job done.

I also made use of that weekend to write up more lectures and gain some ground on revision, because by this point, there were only two weeks to go before the Animal Body 3 exam week. Every second is valuable at this stage, because trying to revise previous material whilst simultaneously trying to process all the new material being delivered is a nightmare.

Monday of the next week started with a Large Animal Surface & Topographical Anatomy MCQ exam, which meant that over the weekend I had tried to split myself three ways: revising previous material, processing new material, and preparing for the LASTA exam. Suffice to say, when you do that, everything gets less attention than it deserves.

The exam was much like a spot, where you take your paper from station to station around the dissection room under the control of a stopwatch. Each station contains a dissected specimen, microscope photographs, or data charts, and you have 5 minutes to answer all the questions at the station. There are 15 stations in total. That hour and a half goes very quickly indeed. By halfway through, I had allowed myself to slip into a bad situation, where I was finishing the last station’s questions at the current station, which meant I had less time to answer the current station’s questions, and had to finish those at the next station. This backsliding is usually initiated by a station you struggle to answer, and it can be very difficult to get out of. My opportunity to break the cycle came when I sat down in front of a horned cow’s head, which had been dissected and a few of the nerves tied off with coloured string.

The station asked a series of questions which included naming the nerves. I sat there panicking a little bit, because I had thought regional anaesthesia belonged to neurology and so hadn’t revised it for this LASTA exam. Clearly I was mistaken. I answered the questions about nerve blocks for dehorning as best I could, and then literally invented names for the nerves.

Because I went about that station guessing, I finished it very quickly, and was back on track. I suppose my cluelessness was a blessing in disguise. I left feeling terrible about the whole thing, as did most students; it had been a guess-fest from start to finish. But incredibly, it later transpired that my result was 90%, and I had in fact invented the correct names for many of the nerves. I’ll be damned. Perhaps I should trust my brain to provide the correct answer a bit more instead of accusing it of guessing.

But there was no time for dwelling, because Monday finished with another practical on the dead horse. When I entered the dissection room this time, not only were there tables filled with the usual specimens, and the horse hanging in his frame, a space had been cleared for a huge blue tarpaulin with the fresh guts of a horse on top. Naturally, I beelined straight for the enormous guts, and stood around looking with a bunch of others.

The tutor appeared through the door, “These are from a horse that was euthanised in the hospital just a few hours ago. He wasn’t a colic case, so what you’re seeing here is a normal tract, including his stomach, through to his rectum. Feel free to put on some gloves and shoe covers and have a closer look.”

Thinking that this specimen would be quite busy for the next half hour or so, I left to look at the preserved ones. But ten minutes later, nobody had ventured onto the tarp. Suit yourselves. I pulled on some protective gear and got the ball rolling. The guts were colossal, as they are in a horse, but these were particularly big due to the gas that was accumulating inside them. The some lengths of colon were so wide I reckon I could have comfortably fit my head inside, although I wasn’t really keen to test that hypothesis.

Eventually, a bunch of us were on the tarp touching and moving it all about – there was plenty to go round! Identifying the different parts can be tricky, because a lot of it all looks the same, and things are adhered to other things by ligaments, so you can’t stretch it out. Eventually I got tired of trying to name all the structures and settled for messing with them and exploring their texture – in the end, young and old, we all learn through play! I then joined a small group to watch the tutor scooping armfuls of intestine out of the preserved horse, and then trying to put them all back, which was as entertaining as it sounds.

The rest of that week, with the exception of Wednesday, was particularly slow. We covered rabbit, rodent, and reptilian reproduction, the process of parturition and diseases of the mother after birth, evidence-based veterinary medicine (essentially statistics), a kidney review, and a reproduction MCQ exam to round off the week.

But Wednesday changed things up with the exotics reproduction practical. I never get tired of seeing new species, and when I entered this practical, the tables were covered with all different kinds. There were dissected ducks, geese, quails, buzzards, snakes, iguanas, tortoises, rats, and rabbits – it was like a potion making class. I can’t really say I understood exotic reproduction any better for it, but I didn’t understand it very well in the first place.

After spending a good hour examining the great variety of organs, I saw people gathering around the large reticulated python. The dead constrictor was at least six feet in length, and a specialist reptile vet from the exotics hospital had arrived to talk about it. He then proceeded to demonstrate how he would determine the sex of the snake. I knew from the lectures that you insert a probe into one of the two holes at the base of the tail, and measure how deep it goes in; it should go further in males than females.

Rolling the dead snake onto its back, the vet wiggled the probe into a hole and began advancing it carefully. It went roughly twelve scale-lengths in, and so he determined it was male. “Let’s give this a go on the smaller snakes we’ve got here, they’re a little trickier.”

He turned his back on us to walk towards another table, and the group of around ten students turned to follow him. I hung back with the python to get a better look. But he must have introduce some air into the snake’s vent during the probing, because as I gripped the tail and lifted its weight off the table, it escaped as a loud, wet fart.

Everyone turned to look at me.

I just stood there, holding a loop of snake, beetroot red and absolutely mortified.

“It was the snake.”

I knew for a fact nobody believed me, why on earth would they? But it’s okay, because soon enough I’ll be working with live patients and the tables will turn – I can blame mine on them! See you in the next post!

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