Remote Restrictions -- Emily Shen
August 21, 2026
Emily Shen , AVC 2027, travelled to Port Hope Simpson as one of the student participants on the Chinook Project. As part of the experience, the students craft various pieces of writing.
I headed into this experience with the desire to fully embrace the concept of “spectrum of care”. In an academic and referral centre such as the Atlantic Veterinary College we are exposed to several advanced diagnostic tools, specialists, and educational resources for reference. They provide us with comprehensive information to guide differential diagnoses and treatment options. However, medicine does not just exist as a single path – and choosing a path that does not involve advanced medicine is not an indication of bad medicine. As senior students, although we have some independence to make medical decisions, we are largely familiar with having several avenues of input from our mentors. Medicine exists on a spectrum and is dictated by several parameters: ability to access advanced diagnostic tools, patient condition, client wishes and client considerations (i.e travelling to diagnostic centres, time restrictions, family dynamics, financial constraints). Understanding the needs of both patient and client is vital to designing a feasible and appropriate treatment plan to care for the patient.
At a remote clinic there are limitations – space within the clinic, equipment, medical supplies and personnel. As students, our confidence in our surgical and medicine skills are still forming and there is an inherent hesitancy to make decisions that will impact our patients. During my time with the medicine cases, I thoroughly enjoyed listening to the clients’ stories about their beloved pets while gaining a medical history to help their pets. With the cases that would require advanced diagnostics to differentiate between disease patterns, I would have transparent conversations about our limitations at the clinic but provide some treatment plans I could facilitate to help their pets to feel better.
I had an orthopedic case with a senior dog that was experiencing mobility issues and pain. An advanced medical path would include radiographs to specifically locate the problem or rule out other pathologies, bloodwork to assess systemic health and ensure safety of use for treatments based on health of the patient. However, that was not the goal of the consultation. The owners cared for this dog deeply and wanted pain control for him. I found that it is important to consider how you navigate a conversation where you know there are limitations; it needs to be judgement free and compassionate. I did not have access to an xray machine or bloodwork analyzers – that did not halt my decision to provide pain medication. I explained the reasons we would run bloodwork and take radiographs, and I explained that the NSAIDs I was prescribing to them could harm the kidneys and has the potential to exacerbate any existing renal dysfunctions. Informed consent is vital – owners need to understand the reasonings behind diagnostics and treatments to make the best decision for them. We generated a plan: I sent them home with 3 days’ worth of the NSAID for them to try at home to assess for pain improvement and side effects, with the plan for them to return to the clinic on our final day with an update. We wanted to provide several doses of medication for the owners to use when their dog was feeling sore but were limited in our supplies so we did not want to dispense too many doses initially. On the final day, we were able to send them home with several weeks’ worth of medication with the instructions to only give it for a few days when their dog is experiencing pain and mobility issues, to decrease the dog’s activity, and the recommendation to drive to Goose Bay for medical care if needed. The owners were so appreciative of our desire to help, and it made a lasting impact on me – we did not find the source of the issue, but we still provided care that would help the pain and bring ease to the owners.
From a surgical standpoint, I gained many skills and performed my first dog spay during this experience. It was nerve-wracking to perform a surgery for the first time in general, but it there were a few added pressures: Limited lighting sources, minimal anesthetic monitoring abilities, and clients were able to watch the procedure. I vividly remember how shaky my hands were when I made my first incision on day 1 of the clinic. My perspective is that learning skills in sparse conditions build strong problem-solving skills and ability to make quick decisions. Although I was nervous as a surgeon, each surgical patient was an incredible learning opportunity, and I appreciated the trust that the owners placed in us. I also experienced the gutwrenching feeling of a post-surgical complication. I was trying a different castration technique that was described in literature to decrease the chance of a hematoma forming post-surgery. The patient was an active and large dog with considerably sized testicles, so hematoma formation was a concern for me. Surgery was largely uneventful and several ligatures were tied around the spermatic cords to ensure hemostasis. We received an email later in the day regarding pronounced scrotal swelling – I saw the image and felt my heart sink and my stomach in knots. The scrotum was entirely filled with fluid and looked extremely bruised. My initial thoughts were that the knots must have slipped and the dog must be hemorrhaging. The confidence I was growing started to slip and I was both terrified and filled with anxiety. The patient was brought in and assessed by the clinicians and me. There were not too many options: medical management at home with the hopes of decreased swelling in a few days was what we could recommend. The next few days I was filled with bated breath – although I was assured that my technique was appropriate and I was supervised, I felt the responsibility on my shoulders. It was an important lesson for me: I cannot avoid every complication. When met with one, I need to approach it objectively without completely tearing down my confidence.
I left this experience as a changed person. I learned so much and I was able to experience the responsibility of a veterinarian for the first time. It is a responsibility that I feel honored to have and do not take lightly. All my learning from the Chinook Project has helped shaped me into the kind of veterinarian I hope to be when I graduate.
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