Every Case Is a Classroom

Amy Winemiller looked at the X-ray and didn't need a medical degree to know something was wrong.

“I'm not a doctor, but it was immediately clear that his organs weren't where they were supposed to be," she said. 

Nothing about Copper that evening had suggested an emergency. The Winemillers' year-old mixed breed — normally goofy and carefree — had escaped from the backyard and come back quiet. He wasn't limping, but he had a few scrapes and wouldn't leave their side, so they looked closer. His gums weren't the lively pink they should have been.

So late that night, Amy and her wife, Caitlyn Winemiller, drove Copper to the Veterinary Teaching Hospital at the Virginia-Maryland College of Veterinary Medicine. 

“We knew that if surgery was necessary, Virginia Tech was where we wanted to be," Caitlyn Winemiller said.

The emergency team examined him. He was stable and not in obvious distress, but something didn't add up. They recommended X-rays, and that's when everything changed. Copper had a diaphragmatic hernia — a tear in the muscle that separates the chest from the abdomen. His organs had shifted into his chest cavity. 

"He could still breathe reasonably well," said Bobbi Conner, clinical professor of emergency and critical care medicine. "But a lot of his abdominal organs were where they don't belong."

Copper needed surgery. But for Conner, how the team got there — and who learned along the way — mattered just as much as the outcome. 

"These are not always clinical lessons," she said. "A lot of them are the art of medicine."

Learning at Every Step

The team discussed whether a CT scan was needed before surgery to get a clearer picture of the damage. Copper was stable, the hernia was clear, and the surgeons could address any additional injuries once they were in the operating room. 

"We talked through the pros and cons," Conner said. "It didn't seem like it was going to change the short-term plan."

The family agreed — go straight to surgery. It was the kind of clinical decision-making Conner wants students to see up close. 

"We've spent a lot of time and effort training our students to be good at their physical exam, their history, assessing these things," Conner said. "Building that confidence is really important."

A resident on the case scrubbed into the procedure — her first diaphragmatic hernia repair.

"I remember asking her: ‘Could you do this on your own now?’ " Conner said. "Probably, she could. And that could potentially be life-saving someday — when she's the only person there."

Fourth-year students worked through the triage and stabilization. ICU students monitored Copper's recovery, learning to read changes in his breathing without panicking. And for students on the anesthesia team, Copper's case carried a particular lesson: Animals with a diaphragmatic hernia can appear stable — until they're sedated.

"They'll be super stable until you anesthetize them, and then things can change," Conner said.  

Under anesthesia, patients lose the conscious drive to breathe — and with a compromised diaphragm, the body can't make up the difference. 

Even a veterinarian who never plans to perform this surgery could encounter an undiagnosed hernia in a trauma patient.

 "You're going to sedate them for X-rays, and then suddenly they're going to decompensate,” Conner said. “Having students be part of that — learning what to anticipate — is huge."

"His breathing is fast. Why do you think it's fast?" Conner said. "Well, maybe because he's got organs in his chest. Sure. But why else? It could be pain. Why else? Let's slow down and think through this."

For Amy Winemiller, the teaching environment was part of what gave her family confidence. Between students, residents, and licensed veterinary technicians, she knew someone was always watching him.

"If you're teaching others how to do it, that means you've mastered it yourself," Caitlyn Winemiller said. 

"It was comforting to know that this surgery would give student vets something they could carry forward to help future patients," Amy Winemiller said.

Back to His Goofy Self

Copper had no interest in a careful recovery. He was ready to run the moment surgery was over. Keeping him separated from his littermate Maeve was its own challenge.

His birthday happened to fall during his hospital stay. The staff hung a sign on his crate and checked in on him even after he was discharged.

"They were so good with him, and they were all so sweet," Caitlyn Winemiller said. 

He's fully recovered now — still goofy, still living for attention, though a little more cautious than before. For Conner, his case is a reminder of what a teaching hospital makes possible.

"Because we're in a teaching hospital, this case not only helped Copper," she said, "but it will help pets next year, and 15 years from now."