Episode 3 Young Vets

Britain is a nation in love with its animals.

How are you doing?

We own 27 million pets...

..and 900 million farm animals

Very frisky one.

All of them...

..need vets.

Over the course of their final year,

ten students at the prestigious Royal Veterinary College

in Hertfordshire are taking what they've learned in the classroom...

..and putting it to the test...

..in practices,

-farms...

-This is all new territory for me.

..and state of the art animal hospitals.

It's a whirlwind of back-to-back work placements...

Sounds like an unhappy monkey!

..and they can't afford to fail...

a single one.

I need to do my job properly.

I need to do better.

It's the most challenging stretch...

Whoa!

..of a very long journey...

I have a serious problem with my hand shaking.

..to become...

-Gassy!

-..fully qualified young vets.

Saved a life today, which is good!

LAUGHTER

With several months of hands-on training still to come before

they graduate, our young vets are facing new challenges every week.

Honestly, I have no idea what I'm doing.

And for mature student Judy Puddifoot,

the challenges don't come any bigger than today's.

It's ridiculously early on Monday morning

and I am starting an anaesthesia rotation today.

This smile belies what I actually feel because I'm really frightened.

-Morning!

-Oh, you're back! Judy!

DOG BARKS

Anaesthesia is an essential skill,

which, like it or not, Judy has to pass.

So, what's gone on? Basically, your animal's stopped breathing?

-OK, so what do you need to do for it?

-Breathe for it.

Breathe for it. OK.

The rotation is very difficult in the anaesthesia process.

We'll be testing their knowledge to see how well they are versed

with the drugs they are using,

what is going on with their patient while it's been anaesthetised,

so at every point in time, we'll be testing them.

So that's all you're doing.

Just think of that as a door and if you don't close the door

the O2 is going to take the obvious route out.

-OK. How are you doing, all right?

-Yeah, good, you?

Despite already having two degrees before becoming a vet student,

Judy's had a rocky ride on this course.

Unfortunately, I failed third year by one single solitary percent.

So you go through this whole appeal process, you're trying to fight

your corner and, you know, luckily, I got back on the course.

They felt I was worth taking a punt on, so that's good.

As part of that whole appeal process,

I got a proper assessment for dyslexia

and, yeah, the assessor said that I was classically dyslexic.

I see, that's meant to go in there.

So, yeah, that was a bit of a shock.

Judy's hoping for a gentle start to her placement, but no such luck...

I get the noisy dog.

Hello, doggie!

Her first patient is a seriously ill Border collie called Megan,

who's having a major operation today.

Hello. Hello! Oh, you're lovely, aren't you? Good girl.

Not making that easy for me, are you?

Megan has a large tumour embedded in her ribcage

which needs to be removed.

Good girl. Just about here?

Yep.

-Good girl.

-Perfect. That's enough.

-Is that enough?

-Yes, that's perfect.

OK. Oh, you're such a good girl, aren't you?

Today, Judy's working with anaesthetist Diego Castineiras.

OK, sorry.

-Judy, this is Diego. Diego, this is Judy.

-Hello!

-Hello, Judy, how are you?

-Yeah, I'm good thanks. You?

I'm afraid you're stuck with me today.

Kennel 17, ICU.

-It's a thoracotomy for a mass removal tumour from her rib.

-OK.

Think about what you would use and why...

I picked up a case straightaway today so I guess the sooner

I get a case, the quicker I can learn how it all works but it's not

really been the slow introduction into, "How do we do this?" that I would have liked.

Megan!

We've given her her pre-med which is kind of a sedation drug

just to calm her down a bit,

but she's a little bit stressed and so we're just waiting for her

to calm down sufficiently for us to then induce her into anaesthesia.

We don't want her to be too distressed.

Removing Megan's tumour is a complicated procedure, which could take hours.

Judy's job is to keep a record of every drug administered.

So, what's that then? 12.45.

What we gave... Propofol was 20 milligrams in total.

Is she on four and a half there, or five?

Judy gets off to a good start.

But it soon becomes clear that it's a lot harder than it looks.

Maths is a big part of anaesthesia,

working out calculations of drugs quickly and I don't do maths quickly.

I just can't.

-So 2 micrograms dose Fentanyl.

-I think so.

Oh, God, right.

It gets me really frustrated that I can't just,

bang, work out maths in my head. A lot of people can.

I can tell jokes, other people can do maths.

Oh, my God! Fluids. I didn't write that down either.

What was that?

-Ketamine of 0.5mg per k.

-0.5...

'Initially, it is panic.

'And then the panic leads to frustration.'

And when you put panic and frustration together,

you get nothing.

Nothing inside your head. You just... I just go blank.

So you don't want that one, do you? You want...

No. No. Don't make a mess.

This has been given, I gave him all the Fentanyl,

give the dose of Ketamine, and then we'll do a CI of Fentanyl,

and a CI of Ketamine.

-OK?

-OK... God.

So... Oh, God, what do I do? Just re-write it?

Oh, God. This is ridiculous. This is the first time I've ever seen this sheet.

-I don't know where everything goes.

-That's fine.

But if I tell you this happened,

don't cross it out because it happened.

During the surgery, Megan needs antibiotics to prevent serious infection.

And Judy is given the job of measuring up the next dose.

Which, unfortunately for Judy, involves maths.

Calculate 20 milligrams per kilo for that.

20 milligrams per kilo.

100mg per k... 100mg per mil, even.

OK, thank you very much.

Darn it. Darn it. Darn it.

It's time to call on a student's best friend -

a veterinary nurse.

I need to draw up some Zinacef.

And, one, I've never done it before,

and it's in a dilution like that.

-So, she's 20.1, right?

-Yeah.

-Times... He wants a 20mg.

-Yep.

Fine. Then divide it by a concentration of 100.

-4. OK, so just write 100?

-Yep, that's fine.

-Done.

-So then everybody knows.

Fine. OK. Great. Done.

Although it's very frustrating and it's very scary,

I want to face it head on, you know, I can't walk away from it,

it's something that I'm going to need to do,

and so I want to stay in that situation and work it out.

Antibiotic in hand, it's back to Megan's surgery.

So...yes. So, it's 400ml.

And back to the paperwork.

Give another 5ml per kilo.

After a gruelling three and a half hours in theatre,

Megan's tumour has been successfully removed.

But, for Judy, her first day in anaesthesia

has been a real struggle.

It's just so many balls to juggle and try and keep them

all in the air, and it just wears you down, eventually,

and I'm rapidly getting to burn out.

I need to just stop, take a break.

But you can't take a break so we'll see how it goes.

Yeah, difficult. Stop because I'm going to cry!

God!

SHE CRIES

It's probably not the best case to have on the first day.

In critical moments, there are a lot of things that are happening

and it's difficult to keep up to speed.

I mean, she did OK. Especially it being the first day.

Hello, what's this?

After a much needed night's rest,

both Judy and Megan are feeling a lot better.

Are you going to get up? Do you want to get up?

She's doing very well. She's doing fine.

She's not in pain.

She's doing much better than I was expecting more quickly, so, good.

Anaesthesia.

It's a really scary rotation because the pressure is quite a lot on you

to know the stuff, to pass the rotation generally.

Yeah, so it was horrible but, you know,

you have to take the rough with the smooth, so...

I find, even now, that people will say, "Judy, can you do so and so?"

And I'll go, "Yeah, I'll do that," and I'll get halfway across the room and go,

I don't actually know how to do that.

You have to subtly ask a nurse!

"Sorry, can you just explain to me what that was?" It's ridiculous!

The worst thing is when they say something really quickly

and you don't hear, so you ask again, and they say it again,

and so you're sort of, like, OK, I'm going to ask one more time,

so they say it, you still don't hear it, and you're like, "Yep,

"I'll get right on that," and then you just go and try and think about what it was they asked you to do.

What is the most likely thing they'd want?

I think he said PCV so I'm probably just going to go and do that.

Yeah. Yeah. That is frightening.

HE PANTS

Hey!

You know when you're running late and you're just like, "Crap!"

Student Amy Clithero is running late.

She's midway through a placement in emergency and critical care.

After years in the classroom,

Amy's relieved to be finally hands-on with real animal patients.

Sorry.

Hiya. Hello.

'The last few months of third year, I was really struggling.

'I just lost all my motivation.'

It was, like, I'm learning all this stuff,

I'm not getting to do any hands-on things,

what's the point of being here? Why do I want to be a vet?

And then when you start rotations, you're just like,

"This is why I want to be a vet."

Today, she will be supervised by vet Myfanwy Hill.

A lot of the animals we see in here are quite sick

so a lot of the time they're emergency patients.

What's the normal thing to precipitate a ketoacidotic crisis?

Erm...

We'll be pushing her to make sure she can get the most out of

her time today on a busy shift.

Amy's patient is a critically ill cocker spaniel called Tyler.

He's been admitted to the emergency room after collapsing.

Her first job is to run through Tyler's medical history

with his owner, Linda.

Shall we just work through one at a time what he's got?

Of course. Hip dysplasia.

Cataracts, both eyes.

Okey dokes.

He's on insulin twice a day.

The lady who does his beauty treatment

found a suspicious lump

in his anal gland, and she says to me,

"I think you ought to get it checked out."

And it turned out to be cancer, unfortunately.

He had the... Yes, he had the lump removed from the back passage

and then they found cancer...

In his lymph nodes?

Lymph nodes, that's it. Lymph nodes.

Right, OK, and is he on chemotherapy at the moment for that?

He's just finished his chemotherapy.

This Friday, he's going back to see if the cancer's gone.

Eight-and-a-half-year-old male neutered cocker spaniel,

he's got a little bit of history, if I'm honest.

A left anal gland...

anal sack adenocarcinoma which has spread to lymph nodes,

he's had five lots of chemo treatment every three weeks,

and he finished that back in April,

and he's due to go for a check up on Friday.

So, his blood glucose is 1.7.

That's a bit low, isn't it? So is he hydrated OK?

-Touch the skin to tell. Yeah, that's fine.

-Yeah.

Tyler's seriously ill and all Amy and vet Neil Smith can do is

stabilise his blood sugar level

while Linda waits nervously for news.

So, we've done some blood tests...

Yep.

..and that shows low glucose and high calcium.

And the high calcium

is most likely due to the type of cancer that he's got.

Oh, that's down to the cancer?

So, together that makes him feel a little bit weak.

What we want to do is we want to keep him in

and monitor his glucose to make sure he doesn't go low again.

I have to explain about some of the risks.

There's always a risk of infection whenever you come to a hospital.

And, unfortunately, I have to mention the risk of death.

Linda's desperate to help her beloved pet,

but treatments for Tyler's illnesses

have already cost her thousands of pounds.

All this extra expense has been down to me

because the insurance has run out.

These operations are very, very expensive.

Thousands, I would think.

It's horrible having to make a decision on treatment

based on money, especially when it is almost a life and death one.

Some owners just, they want a pet treated no matter what.

You don't want to see any animal suffer and I will go on

as long as they can make him well.

But if I see him really, really in distress,

then, you know...

You know it's time to say goodbye.

Elly Berry is determined to pass her final year with flying colours.

I don't like getting things wrong, as a terrible perfectionist.

It's something I try to keep under wraps

cos it's not a nice quality to have.

I have got my parents' voices in my head, you know,

"You can't be right the whole time."

But I could try. I really could try.

My dad IS right all the time

and if he can do it, I can try and do it.

This week, Elly is in Dorset where the Royal Veterinary College

trains its vets in farm work.

With almost two million dairy cows in the UK,

farmers depend on vets to keep their livestock healthy.

-I presume they've finished milking, haven't they?

-Yes.

On top of Elly's workload,

she's opted to take this difficult placement

as she has a passion for farming.

I'm a country girl at heart.

Ideally, I'd love be to move back towards home

and that area is perfect. It's on the edge of the Cotswolds.

You've got a wonderful amount of beef and dairy.

It may not be as romantic as Elly thinks

getting to grips with 300 dairy cows and 80 calves.

What if we come across, maybe, just a general infection?

Maybe like a navel infection?

Checking calves for signs of disease

is a skill expected of all farm vets.

Elly will be assessed by course supervisor Susannah Dyson.

Like we discussed, we want to check the navel.

Absolutely.

We want to check the joints for swellings.

Then we've got our respiratory scores, so temperature, cough,

nose discharge, eye discharge.

-Are you happy with all of those?

-Yes.

Generally cows are very calm and quiet animals,

but when they've just had a newborn calf,

you just need to be... Need to be careful around them.

COW MOOS

Aw, calfy. Hello.

Elly's first patient was born this morning.

Hydration, fine. No discharge, nasally or ocularly.

Go to your mummy.

One calf has had the all clear, but there are 79 more to go.

Right. Go for it.

Ow. My foot. You're on my foot.

If I could be a farmer, I would. It's a bit like Sophie from Dick King-Smith.

I want to be a lady farmer, but I'll be a lady vet instead so that's fine.

Did you ever read those books? No? Just me.

Hello! I'm not milk. No, I'm not.

80... 92 heart rate.

That's quite high.

Smaller animals tend to have faster heart rates,

so what do we think the normal heart rate for a calf would be?

Have a guess. I am going to tell you the right answer.

-Don't know, 60 to 100, 150?

-A little bit higher.

Normal heart rate can be sort of 100 to 120 in a calf

-so her heart rate, 92, is fine.

-Normal? Oh good.

93.

'The only reason I did get to grips with the calf checks was'

because there were so many of them.

99.2.

'I think I can comfortably say I can go up to a calf'

and assess its health right now.

I...I have those skills.

Kisses, yeah. Lovely.

Very happy calf. Happy. Happy.

Come on, then.

With calf checks barely over,

Elly's called to an emergency with farm manager Andy Matthews.

Calf's upside down, backwards, feet first,

and he's dug in so it's in distress, and going to assist it now,

and pull him out, hopefully alive.

If Andy doesn't act quickly, the calf could easily suffocate.

Ideally, you want them to dive out like that, on their nose,

and onto the front of their hooves.

The fact that the hooves are upside down, you can tell it's backwards.

RATCHETING

It may look brutal, but, thanks to their prompt action,

the new calf is delivered alive and well.

Look, she's licking straightaway.

She's a good mother.

That's really good. Happy days!

The fact that it came out and she's licking straightaway,

often, especially heifers, they don't really know what's occurred

something's come out, and they're a bit, like, "Oh! What is this?"

But the fact that she's licking it straightaway,

that releases a lot of hormones, both for mother and calf.

A lot of maternal bonding goes on.

Look at that!

SHE MOOS

CAT GENTLY PURRS

CAT MEOWS

At the Queen Mother Hospital for Animals,

Amy Clithero is still in emergency and critical care,

where cocker spaniel Tyler has spent the night receiving treatment.

It's... When I know what I'm doing, it's fine. Sometimes I'm just...

I don't have a clue what I'm doing and it gets a little bit worrying

especially when I'm not on top of paperwork at the end of the day.

Tyler's blood sugar levels are back to normal

and his owner has arrived hoping to take him home.

Just want to see him walk in standing up cos, like I said before,

he kept collapsing so see how it goes.

I'm going to be upset now.

-There we go.

-Hello!

Hello, darling!

-Oh.

-That's one happy doggy. There's your insulin for you.

Oh. Yeah, I need that.

Most owners I actually really enjoy...just enjoy getting

to know them and just speaking to them

cos you've all got a common interest.

You're interested in animals. You want to make their animal better.

The owners and their reactions when they're taking them home

can make the job really good.

It's been very quiet at home without you.

DOG YELPS EXCITEDLY

Tyler's feeling better for now.

But, with more chemotherapy to come, he has a difficult road ahead.

Be a good boy.

CAT MEOWS

THEY CHAT

In Potters Bar, student vets Matt Wilkinson

and Dani Willey have been housemates since their first year.

-He's very clean, actually, for a boy.

-You're very dirty for a girl.

-Oh, thank you very much.

-You wee on the seat...

-"Oh, my God! I can't believe you said that on the camera!"

-I do not! I do not!

-She doesn't wee on the seat. It's only a little bit true.

-Oh, my God! Shut up.

I hope it's a really easy Monday. That'll be nice.

Dani's about to start her placement on small animal medicine.

This is so stressful.

I think everyone's really apprehensive about small animal medicine

cos everyone talks about it being like the big scary one,

they expect you to know everything...

Yeah, it's mainly they expect you to have a lot of knowledge for it.

Based at the college's main campus,

Dani needs to have a working knowledge of all small animals

because any pet with any disease could walk through the door.

And Dani's first case is definitely a mystery.

Three-and-a-half-year-old cat Peppi is having trouble breathing.

Hi, I'm Daniele. Hiya. Nice to meet you.

-Nice to meet you.

-So, this is Peppi?

Under the supervision of vet Katarina Hazuchova,

Dani needs to take Peppi's medical history.

And what seems to be the problem with her?

Well, she's had a lot of breathing problems

because her nose... I've actually taken picture of it,

she actually had... Her nose was just dripping.

-Right, OK.

-It did sound like she was drowning, didn't it?

-Yes.

It was really bubbly.

-It's quite a good picture of it.

-Oh, yeah.

Cool. Will it be OK if I just have a quick look at her?

-Yeah. Of course, yeah.

-Thanks.

'Nasal discharge can either be something to do with

'a mass maybe in the head, or it can be something maybe

'lower down in the lungs.'

Let's see if there's airflow out of it.

'It's been going on for a while'

and if the referring vets can't seems to work out

what's wrong with it, then maybe it's something

a bit more serious going on.

-We're just going to take a look.

-Thanks.

Peppi, who is a three year, nine-month-old female

spayed domestic short-haired cat,

they've got a picture from their phone of it

kind of literally dripping from the right nostril.

Right. How does it look like? Is it mucus?

It's kinda of browny... Yeah, mucusy.

There's no... They said they haven't seen any blood in it.

But she said it smells of, like, rotting flesh.

-So it's probably virulent.

-Yeah.

So, in Peppi's case, because of the amount of discharge

and the amount of respiratory noise she had, I think me and Katerina are

most worried it's probably something quite sinister like cancer.

Katerina takes the decision to admit Peppi to the hospital.

I mean, she's a young cat, so just wait for the CT, the biopsies,

and then we can talk about the treatment, if it's cancer.

Today, Matt Wilkinson is starting at a general practice

in Eastbourne, on the south coast.

It's always nice to be back in Eastbourne.

The placements in Eastbourne are really close to me

so I can get up a bit later

so it's nice to have a bit of a longer lie-in.

Matt's on familiar territory this week.

I've been coming here since I was in Year 11,

just doing all my pre-university work experience here,

so they've all watched me grow up from yea high.

It's quite nice actually to have him back as a vet student

and he's been great. Fantastic.

One of the first things I learnt when I came here was that if you treat your nurses right,

-you'll have a happier time.

-Absolutely.

-There we go. Lesson learned.

I still boss him around.

-Obviously.

-We're a nurse. Nurses boss them around.

It's your job. Exactly.

Keen to make the move from tea boy to graduate,

Matt is hoping for more hands-on experience this time.

-0.5.

-Yes. That's right, isn't it?

-That's 0.05.

-OK. A bit more?

This is what we'll be doing fundamentally for the rest

of our lives so this year is incredibly important to get right.

Matt's about to assist on a particularly challenging patient...

-Are we ready?

-I'm ready.

..who's arrived in a gravy carton.

Hello, Cracker. Come on.

Cracker has a huge tumour on the side of her body

that needs to be removed.

Senior vet Ian Mcgill will be performing the fiddly operation.

The owners of the mouse, Mrs Moore,

said that they're very, very caring.

They have a lot of mice, and she's quite prepared to spend

£100 to have the surgery done on a mouse.

Not always easy to get a mouse through an operation like that

cos it's very major.

Quite a large lump there.

We don't really often see much surgery on mice.

So it's fairly interesting when one does come in.

It may be rare to operate on these tiny rodents,

but the owner is certain it's the right decision.

What she needs she gets. Whatever she needs,

treatment wise, she'll get. Same with the other at home.

INTERVIEWER: And why is that?

She's a person so you do it for a human child.

Why wouldn't you do it for your animal?

Oh, no, you're coming out the other side!

It's difficult to anaesthetise a mouse because they're very small.

Oh, starting to go.

ELECTRIC RAZOR BUZZES

So you can see from the surface of the tumour that it's quite nasty

and aggressive. It's quite purple and angry looking.

So if we didn't do anything,

it would ulcerate and that would be the end of Cracker.

You can't check the heart rate because it's too fast.

Have you managed to work it out?

It's so difficult to count.

'Usually with dogs and cats,'

you assess their eye reflex, you assess their jaw tone, you know,

none of which are very easy in a mouse.

Everything's a lot more fiddly.

You can't exactly take a heart rate very well.

You need a tiny little stethoscope. I mean, I think...

I was using my massive stethoscope!

So you can't really...

There's no way you can get a rate, really.

-OK.

-Let's do it.

I've operated on two siblings of this mouse

so we don't know the history of this mouse but it may well be

they've come from a lab population at some point so they might be

little bit inbred so that's why they're getting so many tumours.

-Can I get some 3-0 catgut, please?

-Mm-hm.

Where have you kept that...

Everything's changed!

I'm going to remove as much of the mess as I possibly can.

We've managed to get all the tumour out.

The skin has come together well.

I am just giving some fluids under the skin.

All right, Cracker's back with us.

That surgery may have prolonged Cracker's life for three to four months.

You know mice don't live very long. That's maybe saving a human 20 years of their life.

Cracker may have had major surgery,

but in no time she is back on her feet and trying to escape.

There we go.

Matt and surgeon Ian are not the only ones who are relieved Cracker's

operation is a success.

It's always worth it. It's never not worth it.

She is going to get good quality of life from it.

Well, I can't have children so she is the children.

Brilliant to have you back, isn't it, little one?

BARKING

Thank you.

Back in Dorset, perfectionist Elly is on day two of her farm placement.

Follow me.

Cow's hooves are constantly growing

and foot trimming is a skill which all farm vets must master.

Yeah, yeah, these are to protect your arms.

Gloves to keep us as clean as possible per cow

so as not to give an infection to her.

And then this, which is awesome, and obviously the hat which is key.

Sorry, no, it is key. It's very important.

This placement is particularly tough as Kelly's supervisor today

is Nick Bell, the senior tutor of the course.

Foot trimming is one of the most challenging tasks for Elly.

'She's got to know how to handle the cow and then she's got to'

execute something that's practically quite challenging.

So it brings together some really core skills for Elly that will

stand her in good stead when she's in her first job in practice.

Foot trimming may be a simple procedure, but it's easy to get wrong.

Is that bit there OK?

Don't go too deep.

No, remember wider, flatter.

-Can I stop you there?

-Please do.

We don't want to go too deep that we create a new problem for her.

-So...

-You make it look so smooth and amazing.

It's practice!

'With anything at vet school, there's usually about four or five

'people at least watching you and so the pressure was on and then I also'

felt quite a lot of pressure cos I didn't really know what I was doing

and I was just trying to remember, which hand do I hold it in and how much do I take off,

'and how sharp is this? And, "Oh, I actually can't do this."

'I was trying to lop off the end of one of those toes.'

No, it keeps slipping off and I am not strong enough.

-How are you getting on?

-Any advice?

-No...

-It's just speed. It takes practice.

Once you've trimmed a few...

-Thousand feet.

-..thousand feet, you will be confident.

It's very easy for people to think it's like peeling a potato

and that we want to pare away...

To take all the nasty...

But we actually want to leave a lot of the functional horn there.

I don't think I did very well. I am not happy with that.

I think I could have done better.

I feel bad - coming to the other side, you see the angle

that you've been cutting away at... That's not good.

Practice makes perfect.

Why are you not happy?

Because I mean, it's silly, you are only new to it, aren't you?

Yeah. If I just... If I had taken it a bit slower, maybe.

Generally today happy and I am quite good at hiding when something's

wrong, but I think just in that moment I was just genuinely

disappointed and it was just, for my shame, a bit of a low moment.

'But I think better to have them now while I'm learning as opposed to when I get there'

and it's a real farmer, so better to get all this out of the way now.

'It's quite natural in those high pressured situations that

'emotions do sometimes overflow

'and we've seen this on numerous occasions with other people.'

It's part of being a little bit perfectionist which

a lot of the students that come here are.

MOOING

MEOW

With a traumatic time in anaesthesia behind her,

Judy is beginning her next placement in intensive care.

The unit looks after the Queen Mother Hospital's most

seriously ill pets who need round-the-clock monitoring.

We have a cat over there that was crashing

so Ros had to run over there and help,

'but I have never seen so many people around one table.'

'The students are actually...'

It's sometimes eye-opening

in the things they are exposed to, what they're expected to be doing.

What we ask them is to learn from every experience.

'Get the most they can from every patient

'no matter how complicated it may be.'

There's always lessons to be learned about being a good vet.

-Steady. Steady. Steady.

-Stop it!

All patients on the unit have either been admitted as emergencies or have been through major surgery.

Megan... Here's Megan!

The first patient Judy spots is Megan, the Border collie,

recovering after her operation to remove a tumour.

You're a good girl.

This is the first anaesthesia case that

I got thrown into. Look at her, she is doing fantastic.

She is looking really good.

-Right... Go, go, go, go.

-I don't think he's breathing.

Judy and her fellow students have been given their first emergency of the day.

Core supervisor Duana McBride will be assessing their skills throughout.

-Are we seeing anything different with ECG then?

-No.

Is that going to help?

Is there spontaneous breathing yet?

All right, do you want to stop there?

LAUGHTER

Unfortunately the patient didn't make it,

but fortunately for Judy, this particular dog is just for practice.

No. I think you guys did really well and I think when I turned that on,

you felt a little bit out of your comfort zone.

Didn't manage to save the animal, Gerry, in our practical, but never mind.

We did learn a lot.

I feel a lot more comfortable doing CPR on animals after that so that's

good, but I don't think Gerry was a very good candidate to be honest.

I mean he looked pretty flat before we started

so I need to get a new patient!

This one down here, this is Biscuit, he's six and a half, Labrador.

Now he had surgery. He was in surgery for about nine hours yesterday.

Her next patient, Biscuit, is alive, but critically ill

after a serious operation to repair his badly damaged spine.

It was a major disc extrusions with a lot of haemorrhaging involved.

The main focus when he came back from surgery was the fact that this

dog could...respiratory arrest because of the nerves impinged.

This is an MRI of Biscuit's cervical and cranial thoracic spine.

Neurologist Tom Cardy is showing Judy and her fellow students the extent of the damage.

-What do you absolutely notice?

-That it's missing in this area.

It's missing in a huge, huge chunk of his spinal cord.

One of Biscuits' discs had popped and exploded

and it has just disappeared.

It's obliterated.

This is potentially a catastrophic event

so what we were left with was, unfortunately, a paralysed dog.

'If you've said to anyone, this dog has got this injury,

'they would say, "Well, he's not going to walk ever again."'

He's going to be for all intents and purposes,

a paraplegic dog, which is not good.

The operation to relieve pressure on Biscuit's spinal cord was a success,

but has left him with severe breathing problems.

His owners have limited insurance,

but have agreed to keep him on a ventilator for up to 24 hours

in the hope that Biscuit can start to breathe for himself.

Biscuit's owners have given us today to see major progress.

They don't have a lot of disposable income

and so they are watching very closely, but we're really hoping that he will pull through.

That's the goal.

I have heard a rumour it's about £1,000 a day. We will try to wean him off the machine

and if he does start struggling again, we can put him straight

back on the machine, but obviously you can't go on doing that forever.

There comes a point where he's going to have to breathe for himself.

Yeah, and when they get to that bridge, they will have to make that decision.

It will be hard, but hopefully Biscuit will make the right choice.

Do the right thing. So...

What we should try to do is see if he can have periods where he's doing all the work,

the work of breathing.

All they can do is wait and watch.

'You do feel quite protective over this dog

'because he's on a ventilator. You feel sorry for him. It's like

'he's in an induced coma, this dog, so you want to do things for him.'

I felt like it did make me bond with Biscuit even if he didn't know.

We got close.

How is he doing?

His tongue is... Put your tongue back in.

Oh, we are going to have to extubate.

But then nearly five hours later it looks like there could be hope...

Extubate him, he's awake.

..as Biscuit has started to breathe independently.

We knew obviously the time had come to turn the ventilator off

and wake him up and see what was going to happen, and everybody

wanted to see what was going to happen because it was touch and go. We didn't know.

Nobody could predict whether he was going to be fine or whether it was going to go downhill again.

-Biscuit is back in the room.

-Yes! Exactly that.

Ssh, ssh.

-The next hour is going to be...

-Crucial.

-..absolutely terrifying,

so we need to make sure he is kept nice and calm.

Nice and sedated keep his oxygen prongs in,

definitely pay careful attention to his rate.

I do want someone literally to be watching him for the next hour.

BISCUIT WHINES FAINTLY

You can hear, he is trying to whine now.

BISCUIT GRUNTS

We have to watch him like a hawk because if he needs to

have the tube put down again quickly, we need to be on it

straightaway, so hence we are all stood here watching him like hawks.

I do get quite envious of the medics in the fact that humans can

just stay still. Like when you are trying to sort of just do

a clinical exam for example, you've got this crazy dog running around

and you are like, "I just need to listen to your heart beat

"and your respiratory..." And I can't even see it let alone...

It's true.

When I had that Labrador puppy this morning,

I had saliva in my ear, I had it in my eyes,

I had it in my mouth and I was just like, "This is so much love

"all at once, but I just want a heart rate."

So we are just going to go and see Peppi.

I think she is going to be induced for anaesthesia soon so...

Dani's patient, Peppi, was brought into the hospital yesterday

with breathing problems and nasal discharge.

The vets are concerned that Peppi could be suffering from cancer.

So Peppi is going for a CT of her head and thorax today.

Peppi needs a CT scan to reveal the source of the problem.

If the scan reveals a cancerous mass it could be fatal for Peppi.

When you are looking at the CT, you are just looking for the bone destruction?

Yeah, because if there is some bone destruction, then this would be more suggestive

of a tumour, of some cancer.

It's not a mass because there is not any bony destruction that we

can see on the CT so it's good news.

Luckily for Peppi she hasn't got cancer,

but the vets have spotted something else at the back of her nose.

We had some findings from the images.

It looks like a polyp.

It's a polyp so it's actually something

we could remove potentially, so that's very good.

How to explain this in English? I don't know.

-They said like a mass on a stalk.

-Exactly.

The decision is made to try and remove the suspected polyp to help

Peppi breathe normally again, but it's a tricky procedure.

I've never done this so I don't know.

I think it will bleed quite a lot.

First the vets use a fibre optic camera to try to find it.

Just so we can discuss...

A bulge in Peppi's soft palate tells Katharina that the polyp is right at the back of Peppi's nose.

-Yeah.

-I would suggest...

Now all they have to do is pull it out.

The hook is for pulling the soft palate forward,

-so you want to... You need to get that over the soft palate.

-Mm hm.

Is that large for a polyp or is that kind of normal sized?

They are always unfeasibly large for the space they're occupying.

Now what Katharina is going to do is to grab it and pull.

OK.

-There you go!

-Yes!

That's gross!

Thank you.

That was good to get involved in. It was quite, like, brutal like,

seeing how they tug on it, cos you are just like, "Oh."

But as soon as it came out, how big it was was amazing.

It's kind of a case like you want to get in practice cos it's kind of a nice ending.

So do you think you could do one of those in practice?

I'd be a bit scared doing it, especially the pulling bit,

but it'd be pretty cool to do it.

MOOING

This job is anything if glamorous.

In Dorset, Elly is coming to the end of her two-week farm placement.

I'm just feeling now for the right ovaries.

Local vet Tom will be assessing Elly giving pregnancy checks to

a batch of heifers.

-And there will be a little...

-Nubbin?

Knobbly bit on the end there, which signifies whether she ovulated.

So, I have never felt a pregnant uterus before.

The majority of what I have seen on farm placement has been pregnancy diagnosis.

It's something I know you have to be able to do and it's been worrying me that I don't know how to do it yet.

Tom's concerned about one of the cows and he wants Elly to examine her.

There is another one here on the end.

She's been calved about a week. Dave's not happy that she's milking that well,

-so do you want to have a listen?

-OK.

It's called pinging. If you flick... and you hear a sound a bit like

if you flick terracotta, that kind of "ping, ping".

It means there is collection of air in there and you've

got a bit of stomach that probably shouldn't be where it should be...

Tom?

Elly thinks the cow's stomach has become twisted into the wrong position after giving birth.

Yes, so it is a twisted stomach so we'll,

after we've finished here, we will probably do an operation

just to make sure - pull that round in the right place.

Sweet. Thank you. That's brilliant.

Poor girl.

This is a serious condition which needs immediate attention or the cow will die.

But rather than whisk the cow off to a state-of-the-art hospital

she's going to be operated on right here in the barn and Elly has the opportunity to get involved.

Situation with this cow is that at the moment, she has had her

pre-surgical pain relief and antibiotic injections.

Cut the first layer and then split the second layer with my fingers.

So you're going in, curtain there, going round the back

of that and sort of feel the edge of it and sort of work your hand

around there, there's a kidney sort of hard knobbly thing.

-Yep.

-Are you with me so far?

-Yep.

-Below you is gooey intestines, straight ahead, doughy rumen.

-Yep.

-So go over the top of the doughy rumen and touch the far body wall.

-Yep.

-And then move sort of cranial to that...

-There it is!

-..and that's your...

-Whoopee cushion!

-Yes!

-Awesome.

-Now, what I'll do with this, I'll just pull it back underneath

so the gas can escape back along the intestines...

When Tom said, "Get in there. Stick your hand in there." That was...

I wasn't really expecting that at all, but that was great.

And literally we were right up to your shoulder...in a cow

hugging the rumen. Crazy.

With the cow's stomach back where it belongs, it's Elly's job to stitch her up.

-Just starting to...

-Enter student!

Well done.

-Snappy snaps.

-Yeah, yeah.

-Ow!

-Steady, girl.

You little madam!

She did very well. Yes.

The stitches... a little bit wobbly,

but it will hold together. That's the main thing.

So yep she's passed!

Leaving behind a happy cow, Elly is meeting supervisor Nick Bell

for the results of her placement, but she isn't feeling confident.

It is silly. I know. I know I can't be good at everything first time and I do just

need to practise and that's pure perfectionism coming out basically.

-What things do you think could have gone better for you?

-Foot trimming!

-Really?

-Yeah.

I wasn't... I felt... I just felt a bit cack handed and useless.

Don't feel bad at all because it's very much about practice

so that's nothing to worry about.

We are confident you are on track and, yeah, good.

-Brilliant. That's great.

-OK.

-Thank you.

-So, well done.

'I don't have any concerns about her performance'

from her knowledge and professionalism point of view.

There are some areas that she still needs to work on from the practical perspective,

but we'd expect that for a student at this stage of their training.

A glowing assessment from Nick means Elly is one step closer to her dream.

It feels very real when you are out there and you are getting

covered in poo and I know that's a very basic thing to say,

but it makes it seem closer to the reality that one day I'll live.

Matt is still working in Eastbourne but this time he's in a different practice.

Set inside a large pet store, Companion Care Vet sees up to 40 animals a day.

If I end up going into small animal practice this is the stuff

I will be doing day in day out and it's the kind of stuff you

really need to get used to doing.

Good boy. Well done.

-Puppies at this age, they generally bounce, they are quite bendy.

-Yeah.

The practice is run by former Royal Veterinary College student Warwick Payne.

-All right, do you want to do the castrate?

-Yeah.

We could race. One at a time.

Yeah, we can have a castrate race if you want.

The race will have to wait as his first patient is six-month-old female kitten Gizmo

who's here to be spayed.

Tiny cat! You're going to have a tiny vein.

-Now that's not going to help if you wriggle.

-Can I have a towel please?

Today Warwick is allowing Matt to perform surgery on his own.

Neutering is an operation which every vet must master and Warwick will be observing Matt's every move.

I am just here to make sure everything is OK.

If he gets into any trouble, I'll help out.

Right, so make your triangle. Yeah. A bit further down.

So you've got your equilateral triangle.

Your incision is going to be about there and she is quite fat so, yeah, that's all right.

'Pressure is always a difficult one because you want to get things right.'

You don't want to get things wrong. You don't want to look like an idiot in front of the clinicians.

You want to prove to them that you know what you're talking about.

This is the bit where a lot of supervising vets get a little twitchy.

And to try and pass rotations and prove to them

the last four years have actually been useful to me,

I do know, kind of, I am starting to know what I am kind of talking about.

The bottom line is, this is someone's pet, you know,

Gizmo's got to go home at the end of the day

looking as well, hopefully, as she did when she came in.

We make a mistake, that puts an end to it.

I try not to think about it too much.

-So that was really helpful then, wasn't it?

-Yeah, no.

If I start feeling too much pressure,

then I start feeling scared and I don't really want to feel that

so I try not to think about it really.

I used to watch surgeons doing their ties thinking, "Whoa."

They were so quick and fancy and I just thought it was amazing.

And then you go back into surgery and you're doing the ties

that you used to watch thinking, "Wow, that's really amazing."

Just, you know, you go such a long way from work experience days.

-Yeah, all done.

-So how would you say Matt did on that?

Very well, yeah.

You know, like I said, I've watched Matt do a few procedures now

and I'm very confident in his ability to do the job.

He's actually, for the stage he's at,

he's actually a very good surgeon

and it's something that takes a lot of practice but

he is confident and competent enough to be doing a good job already.

OK, are we going to stay still?

6.5.

Yes, she's just got a tiny little wound there,

probably about that long.

If she isn't eating, then she'll need to come back.

Super brave! Well done. There we go.

For Matt, it's been a successful few weeks

and it looks like he's made a good impression

on a possible future employer.

This time next year, we may be needing another vet.

We've had a little discussion the other day about whether Matthew

would be interested should a position arise

so, yeah, we shall see.

I was elated when he said, "How would you consider coming to work for me?"

Because I thought, you know, "This is great."

Inside it was like fireworks were going off or something

but, you know, on the outside, cool, calm exterior, sort of,

"Yeah, that's something to consider."

Judy's coming to the end of her placement in intensive care.

She's been looking after her patient Biscuit.

-How much does it say on the side there?

-Over a litre.

Are you thirsty?

Oops!

He's recovering from his surgery to fix a catastrophic spinal injury.

Right, shall we?

And 24 hours after coming off the ventilator,

it's clear Biscuit is beating all the odds.

You're bored now, aren't you? He's had enough of this cot.

I glanced over at him, saw him

and he was up and he had his head around.

I'm like, "Oh, my God! He's up!" It was amazing. He's a different dog.

The dog with that level of damage to his spinal cord,

we weren't that convinced that he would recover.

The progress in the last 24 hours has been quite frankly astonishing.

Aw. We don't get you any more.

Aw.

They thought he was not going to be able to use his back legs ever

or for a long time

but he proved us all wrong.

That's better. Don't over do it.

Don't over do it.

Stay. Behave yourself, Biscuit.

Biscuit will finally be heading home to recover with his owners.

He's not walking yet but it's a good start

and it's been a good week for Judy too.

I probably went from my worst week ever on anaesthesia

to my best week ever on ICU.

Just the way it is. Welcome to rotations.

You all right, Biscuit?

Don't do that.

Four weeks later, Biscuit's back with his owners for a check up.

How's your paralysis?

THEY LAUGH

No, no, no, no.

When he came back, unbelievable.

He was walking.

This dog that looked like somebody had dropped a skip on his neck

was walking into the QMH.

Good boy.

How did you feel when you got the phone call

to say that he could actually stand?

I burst into tears.

-Yeah, I was amazed I think. Definitely.

-Good boy!

Before the surgery, we didn't know whether he'd be able to walk again

at all but it was worth a shot and even if he was happy and pain free,

we were happy with that but to have him back to normal is amazing.

Brilliant. Take care. Take care. Take care, Biscuit.

Closest thing to a miracle I've ever seen. It was just amazing.

We were all in awe of that dog.

He's up there on a pedestal for us.

Brilliant.