Clinic in a Box

August 14, 2024

Grace Done, AVC 2025, travelled to Nain and Postville as one of the student participants on the Chinook Project.  As part of the experience, the students craft various pieces of writing.

How does one prepare to be unprepared?

   I had completed an anesthesia rotation at AVC before the trip. I had many notes on the importance of pre-surgical total protein and packed cell volume (PCV) on bloodwork, on interpreting electrocardiograms (ECGs), maintaining blood pressure, using a mechanical ventilator, and implementing multimodal pain management techniques. We made sure to use tables that could lower and elevate to raise big sedated dogs rather than lifting them from the floor, and I always jumped in to raise the operating room table if the surgeon’s back looked hunched. My job as an anesthesia student was to focus on my singular patient and not worry about the other cases going on nearby. 

   As we unboxed our little mobile clinic in the Nain hockey arena, the stark contrast to my previous anesthesia experience was glaringly obvious. We set up fold-out tables stacked on paint cans for surgery tables and positioned them so that one person could monitor two patients at once and also watch the patients recovering nearby. We often monitored one patient under TIVA (total intravenous anesthesia) and one patient under GA (general anesthesia) at the same time, occasionally dashing away to fetch more suture or prepare vaccines or injections for post-op. We set up a portable pulse oximeter/capnometer at each table. There would be no bloodwork, no ECG, no blood pressure and no ventilator. We would have only the particular drugs we could pack with us, and we had to make them last over two weeks filled with big dog surgeries. We would work as a team to lift big dogs onto tables safely, and I would find myself regularly assuming a “surgeon splits” position in an attempt to keep my back straight and lower myself to a comfortable surgical level. So, while I was feeling prepared in my understanding of anesthesia and the flow of surgeries walking into this trip, I quickly realized we couldn’t be prepared for all of the spontaneous adaptations and adjustments that would need to occur as the patients started flowing in. Not to mention that many of the patients were huskies, a breed which I am now fully convinced creates its own rules for anesthetic drugs.

Clinic setup in the Nain hockey arena

  After we completed around 50 surgeries in Nain, our team began to fall into more of a rhythm. We had patient paperwork packets compiled and ready to go the night before and started to anticipate issues before they would occur. We looked much less like chickens running around with our heads cut off as we became familiar with where things were and when we would need them. We still had moments of chaos, but overall things were moving smoothly - just in time to pack it all up and head to Postville! We carefully organized and re-packed everything as tightly as we could in our limited bins and prayed it would all fit back in the little Twin Otter plane. 

   When we arrived in Postville with our “clinic in a box”, I felt more prepared than before as to how things would go and what we would need to set up. We got to work unpacking everything and setting up a new clinic space… but this clinic was a little different than our arena set-up in Nain; this clinic was big and open concept with exterior windows (and biting flies!). We started to follow a similar setup to our previous clinic but had to try out some new arrangements to make it fit the space. We used tables placed sideways to create recovery pens and placed our surgery tables in line with the windows to make use of the extra light source. A microphone stand turned into an excellent intravenous fluid pole, and the trusty paint-can method of raising the tables worked like a charm. We had several dogs on our schedule that were not huskies! Finally, one big change that our previous week did not prepare me for was just how much of a difference this open-concept clinic could make.

Jen and Tim (owners) posing with their dog Biscuit and Chinook team members Grace, Emily, and Mackenzie (left to right).

   My first patient from Postville was a big goofy husky named Biscuit for his neuter surgery. Jen and Tim, Biscuit’s owners, were immediately ready to jump right in and help with his sedation, induction, and recovery. I was amazed at how many owners were interested in watching their pet’s surgery and asking us questions about the procedure while it happened. It was such a neat opportunity and privilege to help put owners’ minds at ease by showing them exactly what goes on behind the scenes when their pet comes for a surgery with us. There was no pressure for anyone to leave or go to another room if they wanted to stay with their pet. 

Tim (owner) watching Biscuit (dog) sleep peacefully during his neuter surgery.

  I thought I would feel extra nervous performing surgery on pets like Biscuit in front of their owners. It was a firm reminder of the intense responsibility we have to our patients and clients, and also of the seriousness of even small elective procedures such as spays and neuters. However, I found myself feeling calm and confident in my skills, and I made sure to show each pet parent that they could trust me because I trusted myself. It was of course an added comfort to know that I had skilled veterinarians nearby to help me out in the event of something unexpected, and rotation-mates ready to scrub in if I needed extra hands.

   After the procedure was over, we would find a private area for pets to recover. I was able to witness first-hand how comforting to our patients the presence of their owner could be as the sedation wore off and they woke up feeling disoriented and groggy in an unfamiliar environment. Seeing that familiar face made a huge difference for many of our patients. Owners were even ready and willing to sit and monitor their pet in recovery and ice their incision while we worked on other tasks. Seeing owners become more involved in their pet’s visit was inspiring and watching them go on to comfort and educate other owners whose pets were next in line was something that I truly could not experience anywhere else.

Biscuit enjoying an outdoor adventure a few days after his neuter surgery.

  At the end of our week in Postville, I also got the amazing opportunity to see my surgery patient Biscuit living his beautiful northern life to the fullest without a care in the world. He was back to his bouncy self and didn’t seem to hold any grudges against me for the whole ordeal. 

   I gained so much perspective over the course of the Chinook Project as a veterinarian in the north. I learned flexibility and adaptability, and I was able to develop and enhance my skills as a surgeon, a communicator, and an educator. I learned that we can do more than we think without fancy equipment and big hospital rooms. Our ‘clinic in a box’, with the support of the community and of each other, was enough to make a big difference in the lives of countless pets in Labrador this summer.