Decision Making - Kisa Storey

August 21, 2025

Kisa Storey, AVC 2026, travelled to Hopedale and Sheshatshiu as one of the student participants on the Chinook Project. As part of the experience, the students craft various pieces of writing.

Before participating in the chinook project, all of my clinical experience as a student included a very large safety net of clinicians and technicians. My ideas have always been discussed at length and approved or disapproved, so that the final result delivered to my patient was the correct choice or the right answer. But, as I continue getting closer to becoming independent in my practice, I started to ask myself, what if I don’t know the right answer? What if I need to make a spilt second decision, and there is no time to triple check with someone more experienced or a textbook chapter on the perfect way to manage a case? During my two weeks at the Chinook project, I felt myself begin to answer the questions and doubts I had about who I would become when the safety net of school was no longer there. 

I had completed a handful of surgeries prior to this rotation. All of them were cats- a few neuters and a few spays. During spays, I always had another student scrubbed in with me and a professor close by ready to jump in if things were to go sideways. I had never done a dog spay before, and from what I knew they were more technically challenging to complete. For one of my first surgeries in Hopedale, I was scrubbed in by myself with a veterinarian watching. The dog’s pedicles were much larger than a cat, and I knew I needed to modify the technique I had used on cats to make sure the vessels were tied off through all the fat surrounding them. I hesitantly relayed my plan to the vet supervising me, and she just nodded, telling me to go ahead. With minimal input from her, I cautiously ligated and transected both ovarian pedicles. Before moving onto the uterine body, I was checking the pedicles with a gauze. The broad ligament and fat within it had been oozing more than I was used to, and I was struggling to tell if this was due to an improper ligature or just because the dog was mature and recently had given birth. Eventually I was able to visualize them and watched for a moment to confirm to myself they weren’t bleeding. I moved onto the uterine body, which again required deviation from what I had gotten used to, as I didn’t trust the large blood vessels on either side of the uterus would be occluded with just a standard circumferential or strangle knot. Instead, I started with a strangle knot distally and chose a transfixing ligature on both sides to occlude each vessel as much as possible. Nothing bled as I transected the uterus and watched it disappear into the abdomen.  As I closed the abdomen, I realized the choices I had made, on my own, worked- and worked well. During that spay, I had doubted myself and my judgement. The entire surgery I was looking for confirmation that I was making a decision that was right, nervous there was something I was missing or that the techniques I had practiced on my own were wrong. I had only come to notice how much confidence I gained, when in Sheshatshiu I began what was to be yet another dog spay.

I entered the abdomen as I normally would- but instead of small intestine, a giant purple distended structure with bright red torturous vessels stared back up at me.  A giant, pregnant uterine horn, too big to fit out of the incision I made. There was no one to look up at for approval, and I didn’t have the same timid, unsureness about myself as I did the first time. I extended my incision, and heaved out both horns, hugely distended with puppies. The ovarian pedicles weren’t as big as I had anticipated- but it was the broad ligament vasculature, what I would normally tear with my hands, that had become very enlarged and exposed. I again had to modify my plan from what I had gotten used to doing in the dog spays, but this time I wasn’t caught up in worrying I had made the wrong choice. The broad ligament vessels were as big as a pedicle- so I decided to ligate them as I went along to avoid them bleeding. 

Even though I was performing this procedure in a way I had never done before, I felt confident and comfortable in my skills and clinical judgment. I realised I had been building this as I began to have more freedom in the clinic-  and more room to trust myself in the process.