A year or two before beginning vet school I ran an "ascent only" trail race while living on the banks of the Atlantic. The deceptively named "Loon mountain 10K" is run in the mountains of New Hampshire - a few hours from the coast of Maine. I felt reasonably confident that the course was well within my abilities. After all, I routinely ran 7 - 10 miles, 5 miles being a "short" day for me. The morning of the race dawned grey, humid and overcast - typical of the great summers of New England. I roused my husband and drove the three hours to the race in the early dawn.
The race began mildly enough, in a river bed at the foot of the Loon Mountain ski hill. It was a small group, maybe a few hundred competitors - all jovial and at ease - until the gun sounded at which point they all rushed wildly down the rocky path, jockeying for position. This surprised me, most trail races don't start with a mad rush - but the reason for this became clear. The first 300 feet of this race is the ONLY level ground for the entire 6.1 miles.
I'm not sure which part of "ascent only" I didn't understand - I ran, I walked, I ran, I cursed, I tried running backwards. I passed people vomiting, people sitting, people crying. At one point the grade was so steep a gentleman in front of me began to crawl on hands and knees. As I neared the summit, and hopefully the end, I caught a glimpse of my husband clapping and offering encouragement to the finishers. My heart swelled with love and affection. But as I drew nearer I saw my ever supportive spouse was shaking his head and laughing - and the words that reached my ears as I crossed the finish line, spoken in his delicious, colonial, Zimbabwean accent were "You silly bitch, you did this to yourself!"
The fourth, and final, year of vet school is much different in design and composition then the preceding three years. As I may have mentioned we rotate through a variety of clinical settings - anesthesia, internal medicine, surgery, etc - each lasting roughly two weeks. Interspersed between these rotations are vacation weeks. Brief islands of time where we attempt to decompress, relax, recharge, do laundry, repair damaged relationships with loved one, study for the up coming national board exam, look for jobs, agonize over internships - you know - really just catch up on the little things.
I would maybe enjoy this time off more if I was less bitter about the rotation I just completed. I am still somewhat twitchy and gun shy after finishing a critical care rotation where I worked 90 hours in the last week - and in those 90 hours gained zero clinical skills while experiencing daily public shaming. (A two for one bonus type thing!) Just to add to the awesomeness of the entire situation, it dawned on me, that as an out of state student, I paid roughly $ 1000.00 for the pleasure of those 90 hours.
I have tried to reflect or put a positive spin on this time by making a list of things, that perhaps, I did learn and will benefit me as a practitioner in the coming years.
1. I performed my first ever physical exam on a bearded dragon. Actually I saw my first ever bearded dragon (a type of lizard kept as pets by certain people - usually 8 to 14 year old boys.) I blustered my way though the interaction - frantically thinking "what is the normal heart rate for these guys? 50 seams kind of low for an animal weighing 300 grams? Do you check capillary refill time? If so, how the hell do I get it to open its mouth?" And most importantly I kept repeating to my self "Don't scream if it bites you, don't scream if it bites you..."
2. "Huffling" is not a good sign in hedgehogs. DO NOT google the word "huffle" if you do, do not access the urban dictionary to further your understanding of the word.
3. If you cannot get said huffling hedgehog to unroll try putting it on its head and rubbing the spines on its butt. (I have found this skill useful in getting prickly husbands to unroll too!)
4. BDLD - In veterinary medicine this is not a kinky bedroom maneuver but stands for 'Big Dog/Little Dog' and refers to altercations between the two. Little dog usually gets the short end of the deal.
5. When asked by a client that just administered 15 times the dose of a certain medication if the overdose "could be fatal" the correct answer is "yes." In fact, remember enough of anything is fatal. Even water.
6. There are evidently 14 distinct features that can be assessed during a digital rectal exam of the dog - evidently being the key word in the sentence.
7. Tactfully asking a panicked client, at 4 AM, if there is any chance that their cat may have consumed marijuana is not as easy at it sounds.
8. Do not piss off the nurses - they are your best chance at getting out alive - and not killing anything else along the way.
I am sure there are other aspects to my education that have been enhanced. Perhaps I have greater compassion? A tougher work ethic? Better client communication skills?
Perhaps.... but the words that keep running though my mind on this mental "ascent only" slog are "You silly bitch, you did this to yourself."
Monday, August 22, 2011
Sunday, June 19, 2011
Because of fathers day..
When I was very small I used to crawl under my fathers tee-shirt, snuggle down on his chest, and view the world through the rich colors of (usually) tie-dyed cotton clothing. It was very comforting to fit under there, his voice rolling over me, his heart keeping time.... I was not the focus of his attention, yet I was within the circle of his strength and it was enough.
Many years later (but really not quite enough) when my father died, I found some of those old relics from the seventies. They were hidden in the back of his closet - reminders, perhaps, of a much kinder time in everyone's life. I kept two, one blue and one red that had faded to apricot, my nineteen year old self not quite brave enough to face the world without a blankie.
And?
I have now successfully navigated two (and a half) rotations of senior year. Equine surgery began with a bang, but then quickly became unbearably quiet due to an outbreak of Equine Herpes Virus-1. My next foray into the world of vet-med was on the Equine Field service. Now this was right up my alley - mano-a-mano repairing injuries incurred when an old mare and a T-post came to odds (old mare took the worst of it), floating the teeth of some 120 dude horses, castrating llamas (my husband feels some concern that I know how to remove the testicles of several distinct species) AND getting to perform my first ever nerve block on a real live HORSE.
Next on to Dermatology... a service I knew nothing about - but quickly realized I actually knew less than that. Everyone is particularly kind and helpful, but man if it ain't pertaining to derm - they don't want to know about it. One third year resident is so clearly sick of bumbling senior students that she could barely hide her scorn when we stuttered over words such as "hypotricosis" or confusing "erythematosus" with "erythematous." During my case presentations she commenced with such heated eye-rolling and facial contortions I nearly asked her if she needed to excuse herself to use the restroom. This show of disdain was so overt, that a fellow class mate (to whom I am not particularly close) apologized for the contempt directed my way.
Awesome!
Actually it really was, because I have just discovered that I don't give a SH%$^&%$T any more. I'm totally used to getting things WRONG and man, I am just here to learn - putting my best foot forward.
Least I make it out to be more miserable than it really is - I am actually enjoying myself! Each day I am presented with yet another wonderfully quirky owner and their inevitably itchy dog (the doctor word for that is pruritic if you want to sound smart in some nerdy circles.) And once again, the things I end up learning don't really pertain to the biology of any particular disease (that's the easy part) but rather to the psychology of the individual that has just come through the door. I have learned that although we may have a medication to help this particular animal, that it is out of this owners reach financially, and that's OK.
I discovered that people feel guilty when you ask them questions such as "Are you still bathing Rufus once weekly?" because likely they are not - and that's OK too. I have leaned to preface these questions with a kindly "I'm just doing some information gathering, there are no right or wrong answers" or something to that effect.
I have run across folks that have researched madly on the medications that we prescribe (and that I still have trouble pronouncing) but don't understand that the side effects that they worry about aren't really seen in our veterinary patients. It has dawned on me that many people have suffered these side effects themselves, and they are afraid, and my job is to make them feel less alone. I have discovered that I like people and that has made any eye-rolling from a third year resident, eight years my junior, very unimportant.
Still...... some days I do give a sh(*@%&#t - and I just want someone to say "Wow! Good job - you're a rock-star" - and I flinch a bit when I stumble over "dermatophytosis." But it's usually just a moment, and if it gets too overpowering I can lay down on the floor with a faded old tee-shirt over my head, and if I angle my head just right I can hear a heart beat, that is my own, and it is enough.
Many years later (but really not quite enough) when my father died, I found some of those old relics from the seventies. They were hidden in the back of his closet - reminders, perhaps, of a much kinder time in everyone's life. I kept two, one blue and one red that had faded to apricot, my nineteen year old self not quite brave enough to face the world without a blankie.
And?
I have now successfully navigated two (and a half) rotations of senior year. Equine surgery began with a bang, but then quickly became unbearably quiet due to an outbreak of Equine Herpes Virus-1. My next foray into the world of vet-med was on the Equine Field service. Now this was right up my alley - mano-a-mano repairing injuries incurred when an old mare and a T-post came to odds (old mare took the worst of it), floating the teeth of some 120 dude horses, castrating llamas (my husband feels some concern that I know how to remove the testicles of several distinct species) AND getting to perform my first ever nerve block on a real live HORSE.
Next on to Dermatology... a service I knew nothing about - but quickly realized I actually knew less than that. Everyone is particularly kind and helpful, but man if it ain't pertaining to derm - they don't want to know about it. One third year resident is so clearly sick of bumbling senior students that she could barely hide her scorn when we stuttered over words such as "hypotricosis" or confusing "erythematosus" with "erythematous." During my case presentations she commenced with such heated eye-rolling and facial contortions I nearly asked her if she needed to excuse herself to use the restroom. This show of disdain was so overt, that a fellow class mate (to whom I am not particularly close) apologized for the contempt directed my way.
Awesome!
Actually it really was, because I have just discovered that I don't give a SH%$^&%$T any more. I'm totally used to getting things WRONG and man, I am just here to learn - putting my best foot forward.
Least I make it out to be more miserable than it really is - I am actually enjoying myself! Each day I am presented with yet another wonderfully quirky owner and their inevitably itchy dog (the doctor word for that is pruritic if you want to sound smart in some nerdy circles.) And once again, the things I end up learning don't really pertain to the biology of any particular disease (that's the easy part) but rather to the psychology of the individual that has just come through the door. I have learned that although we may have a medication to help this particular animal, that it is out of this owners reach financially, and that's OK.
I discovered that people feel guilty when you ask them questions such as "Are you still bathing Rufus once weekly?" because likely they are not - and that's OK too. I have leaned to preface these questions with a kindly "I'm just doing some information gathering, there are no right or wrong answers" or something to that effect.
I have run across folks that have researched madly on the medications that we prescribe (and that I still have trouble pronouncing) but don't understand that the side effects that they worry about aren't really seen in our veterinary patients. It has dawned on me that many people have suffered these side effects themselves, and they are afraid, and my job is to make them feel less alone. I have discovered that I like people and that has made any eye-rolling from a third year resident, eight years my junior, very unimportant.
Still...... some days I do give a sh(*@%&#t - and I just want someone to say "Wow! Good job - you're a rock-star" - and I flinch a bit when I stumble over "dermatophytosis." But it's usually just a moment, and if it gets too overpowering I can lay down on the floor with a faded old tee-shirt over my head, and if I angle my head just right I can hear a heart beat, that is my own, and it is enough.
Saturday, May 28, 2011
Ode to Gemma
For my daughters 7th birthday we (being grossly unprepared in the present department ) made a last minute purchase of a Guinea Pig from the local PetSmart.
She was a 3 month old, smooth-coated, piebald with a wicked cowlick and a penchant for cilantro. Abby christened her "Gemma Jane" and proudly displayed her on her dresser for many months.
Now, Guinea Pigs are not the most social of creatures, they are rodents that are prey to many, larger animals (humans include) and therefore, understandably shy. And although Gemma never asked to be picked up, she tolerated holding, brushing and the occasional bath without too much fuss.
I am not particularly interested in rodents, or any other small twitchy animals. No, give me something I can put in a chute, or through a saddle on. So, it came as a great surprise to me when I developed a soft spot for the little fur ball.
After a move to a new abode, Gemma's domicile ceased to be Abby's dresser and became the corner of the dining room - in the shade of dresser stuffed with old Halloween costumes, unfinished art projects and fuse beads. Although a caring "parent" my daughter now needed a gentle reminder to feed, water and check on our little "whistle pig" as my husband dubbed her.
Now, I tend to rise before my family, to run mountain trails in the dark of morning and Gemma and I developed a ritual.
After pouring coffee and letting the dogs out Gemma would emerge from her igloo and begin doing laps around her enclosure whistling her fool head off. This display of vim and vigor never ceased to amuse me and in return I would deposit green grass, or cilantro, in her little dish before heading on my way. My husband was equally fond of these antics - and protested that she needed a buddy for company, but in lieu of another pig would content himself by whistling back at her.
Anyway - I imagine you know where this is going, too many past tenths and all that.
This week, while Ali and the kids hit the road for a week in Utah, I stayed behind to log hours as a newbie fourth year on an equine surgery and lameness rotation.
During a brief conversation with my wandering spouse I head Abby say in the background "Tell mom to check on Gemma." "She's fine" I replied, but in that moment, as those words were leaving my mouth, I realized I hadn't actually heard from her lately and that the morning whistling had been ominously quiet.
Gemma was still alive, but clearly ill. Her fresh grass from that morning was untouched, a grave sign indeed. I took her to the veterinary teaching hospital, where we have board certified zoo medicine vets, and went over our options.
No many really - we could take radiographs and/or draw blood for a biochemistry profile, all of which would stress her greatly and perhaps worsen her condition. So, we did what is commonly done in this world of veterinary medicine - I was sent home with broad spectrum antibiotics and well wishes.
Gem went down hill, my force feeding, subcutaneous fluid administration and vitamin C shots did nothing to change the course of her illness.
The kids arrived home last night, Abby was devastated by the sad sight of her small girl, and guilt ridden that she hadn't spent much time with her lately.
This morning I woke early and went down to check again on the pig. She was gasping and limp but still with us. I forced more medicine down her throat and held her for a while before putting her back into her igloo.
Ali followed an hour later, saddened by her harsh breathing he held her in his arms while we drank coffee and planned our day.
In those minutes Gemma slipped quietly away, as unobtrusively as she had entered our life, so she was gone. The tiny little whistling light, despite our best efforts, sailed away.
I am inordinately sad - out of proportion really, with the event. I desperately wanted to make this one tiny, being better - and was unable to do so. And then there is my sobbing daughter, walking through that horrid, but unavoidable, first brush with mortality. I can hear my friend Nancy, a teacher and parent to two girls saying, "Parenting is really delivering disappointment in manageable doses."
And heartbreak, too, I would add.
So we make a box for Gemma, with her bell, and a sprig of spring lilac and some fresh grass. My husband digs an impressive hole, next to a bush of flowering purple iris - and we say goodbye. Everyone shares a story, or a thank you for Gemma, even the dogs give her a good snuffle (Abby interprets this as an affectionate gesture and I don't disabuse her of the notion.)
And so it goes. These funny little creatures come into our lives, and exit, teaching us such lessons along the way; lessons of compassion, and guilt and self recrimination and ultimately love - in all its varied and unique forms. So thank you Gemma, for bringing joy, and your whistles, into our family, and for delivering valuable heartbreak to us all along the way.
She was a 3 month old, smooth-coated, piebald with a wicked cowlick and a penchant for cilantro. Abby christened her "Gemma Jane" and proudly displayed her on her dresser for many months.
Now, Guinea Pigs are not the most social of creatures, they are rodents that are prey to many, larger animals (humans include) and therefore, understandably shy. And although Gemma never asked to be picked up, she tolerated holding, brushing and the occasional bath without too much fuss.
I am not particularly interested in rodents, or any other small twitchy animals. No, give me something I can put in a chute, or through a saddle on. So, it came as a great surprise to me when I developed a soft spot for the little fur ball.
After a move to a new abode, Gemma's domicile ceased to be Abby's dresser and became the corner of the dining room - in the shade of dresser stuffed with old Halloween costumes, unfinished art projects and fuse beads. Although a caring "parent" my daughter now needed a gentle reminder to feed, water and check on our little "whistle pig" as my husband dubbed her.
Now, I tend to rise before my family, to run mountain trails in the dark of morning and Gemma and I developed a ritual.
After pouring coffee and letting the dogs out Gemma would emerge from her igloo and begin doing laps around her enclosure whistling her fool head off. This display of vim and vigor never ceased to amuse me and in return I would deposit green grass, or cilantro, in her little dish before heading on my way. My husband was equally fond of these antics - and protested that she needed a buddy for company, but in lieu of another pig would content himself by whistling back at her.
Anyway - I imagine you know where this is going, too many past tenths and all that.
This week, while Ali and the kids hit the road for a week in Utah, I stayed behind to log hours as a newbie fourth year on an equine surgery and lameness rotation.
During a brief conversation with my wandering spouse I head Abby say in the background "Tell mom to check on Gemma." "She's fine" I replied, but in that moment, as those words were leaving my mouth, I realized I hadn't actually heard from her lately and that the morning whistling had been ominously quiet.
Gemma was still alive, but clearly ill. Her fresh grass from that morning was untouched, a grave sign indeed. I took her to the veterinary teaching hospital, where we have board certified zoo medicine vets, and went over our options.
No many really - we could take radiographs and/or draw blood for a biochemistry profile, all of which would stress her greatly and perhaps worsen her condition. So, we did what is commonly done in this world of veterinary medicine - I was sent home with broad spectrum antibiotics and well wishes.
Gem went down hill, my force feeding, subcutaneous fluid administration and vitamin C shots did nothing to change the course of her illness.
The kids arrived home last night, Abby was devastated by the sad sight of her small girl, and guilt ridden that she hadn't spent much time with her lately.
This morning I woke early and went down to check again on the pig. She was gasping and limp but still with us. I forced more medicine down her throat and held her for a while before putting her back into her igloo.
Ali followed an hour later, saddened by her harsh breathing he held her in his arms while we drank coffee and planned our day.
In those minutes Gemma slipped quietly away, as unobtrusively as she had entered our life, so she was gone. The tiny little whistling light, despite our best efforts, sailed away.
I am inordinately sad - out of proportion really, with the event. I desperately wanted to make this one tiny, being better - and was unable to do so. And then there is my sobbing daughter, walking through that horrid, but unavoidable, first brush with mortality. I can hear my friend Nancy, a teacher and parent to two girls saying, "Parenting is really delivering disappointment in manageable doses."
And heartbreak, too, I would add.
So we make a box for Gemma, with her bell, and a sprig of spring lilac and some fresh grass. My husband digs an impressive hole, next to a bush of flowering purple iris - and we say goodbye. Everyone shares a story, or a thank you for Gemma, even the dogs give her a good snuffle (Abby interprets this as an affectionate gesture and I don't disabuse her of the notion.)
And so it goes. These funny little creatures come into our lives, and exit, teaching us such lessons along the way; lessons of compassion, and guilt and self recrimination and ultimately love - in all its varied and unique forms. So thank you Gemma, for bringing joy, and your whistles, into our family, and for delivering valuable heartbreak to us all along the way.
Sunday, May 15, 2011
And so it begins!
Now a brief message......
For those not in the know (and why the heck would you be??) vet school takes four years - like all educations that stamp you with the word "doctor" upon completion. For the first two years of that, one is granted the usual summer/winter/spring breaks - but not between our third and fourth year - nope - the plan is devious, test the crap out of 'em, give a brief 12 hour respite then through them into senior year clinics.
During our fourth and final year as vet students we are the man power at the hospital (albeit rather ignorant and insecure manpower at the beginning.) So this is it -
May 2nd through the 6th.
Capstone exams. Cumulative exams that cover the last three years of our education. Two are practical exams, made up cases posted on cardboard. You must answer a series of questions about the case, step behind the screen and see how poorly you did on that particular set of questions. For example: there is a close up photograph of a tooth, in some sort of mouth, but it is so closely focused you can't tell what the hell species you are looking at. You answer "that is the 1st molar of a dog" go behind the screen and find out "Haha idiot, that's the 2nd premolar of a chinchilla!"
The third, and final exam,is a 161 multiple choice behemoth - the stacks of paper are so numerous that the ladies passing it out have to steal their children's red, Radio-flyer wagon to accommodate the pile. They drag it around the huge lecture hall dolling out bubble sheets and exams moaning - "bring out your dead!" - actually they don't say that, but it would have been appropriate if they had.
May 9th through the 11th
Final exams: more tests -I start drinking brandy in my coffee at 10:00AM - that's all there is to say about that.
8:00 AM May 12th 2011
Senior year - here it is. I stay up late organizing clipboard (you will remember from anesthesia how key they are in feeling professional) stethoscope, note cards, cheat sheets on lists of appropriate antibiotic choices in the horse. In the midst I forget to bring a blue/black pen and arrive with a red sharpie instead (a real no no for medical charts I am told later.) I arrive early for my first rotation which is equine surgery and lameness. Waiting alone in our "rounds" room a multitude of wide eyed, frantic fellow newbie fourth years trundle in, "Where do we meet for equine medicine? Equine ambulatory? Dermatology??"
My fellow rotation mates arrive, looking equally ashen and unprepared. Finally a technician takes pity on us and tries to "orient" us to the equine barn and the twisted, Machiavellian system of charts, medical records, charge sheets and innumerable other pertinent points of interest. Most of what she says bounces off our overly tested skulls and ricochets around the high gloss,medical grade paint walls.
11:00 AM May 12th 2011
I get my first case!!! (Due to the sensitive nature of this material, and maters of patient confidentiality I am unable to divulge the particulars.) During the history taking I become completely inarticulate - forget to ask basic questions such as "How is your horse housed? What do you feed?" and "What brings you in today?" Luckily the owners are lovely and understanding and don't hold my ineptitude against me.
One of my rotation mates stands in the background watching, he had become more grim and grey though out the process. I ask "how's it going" he responds "I think I'm going to have a cardiac event!!"
2:00 PM May 12th 2011
We are called into the food animal barn where our equine resident is scrubbing in on a surgery of a 3 week old calf with a suspected infected umbilicus. The room in filled with two surgeons, one gal running anesthesia, one of my class mates scrubbed in to assist and three on lookers clothed in surgical mask and cap (me being one of them.)
The procedure is rather straight forward, dissect abound the umbilicus (without cutting into the nasty, pus filled area) and remove all infected material. Now one of the deals with surgery is that when someone is scrubbed in, capped and gowned they are "sterile" and therefor a no-no to get near or touch if you are not in said condition. Never-you-mind that our patients are poop encrusted balls of gnarly bacteria, we have standards to keep. Well the sterile fourth year, who was evidently too anxiety stricken at the start of her clinical year to eat breakfast, stands up, brushes past me (in my very un-clean condition) slams into a stainless steal medical cabinet and promptly passes out at my feet.
The surgeon glances up causally from her procedure and says "someone call Dr. B and get some cold water on this girl." Then she goes back to her cutting. Yikes, I guess that tells you were we all stand, less important then the nasty, infected belly button of a dairy calf.
5:30 PM May 12th 2011
We are technically "on" from 8 AM to 5 PM. However....... if one has a patient in the hospital you are solely responsible foe that patients 7AM and 7PM treatments and physical exam. On top of that you must fill out screes of paper work so the likelihood that one will go off at 5 and be back by 7 is low to none. Navigating the counter-intuitive client software took me the grater part of two hours, at which point my 7PM treatments were due.
9:30 PM May 12th 2011
I arrive home to sleeping children and the blue light of the television humming softly from the back room. My stalwart husband smiles warmly and welcomes me home, at which point I burst into tears. I curl up on his shoulder with a glass of wine while he rubs my head and whispers sweet falsehoods in my ear, about how fabulous I'll be at the end of this and "what a star" I am. I'm not entirely sure what I did right in a past life to deserve such a man, but I'm thankful, entirely thankful for him.
I pass out from exhaustion (or possibly an overindulgence of Malbec) pondering the question
"what the hell was I thinking???"
But here I am, three years down and one to go, so I better "stay the course."
Goggles on mates!
For those not in the know (and why the heck would you be??) vet school takes four years - like all educations that stamp you with the word "doctor" upon completion. For the first two years of that, one is granted the usual summer/winter/spring breaks - but not between our third and fourth year - nope - the plan is devious, test the crap out of 'em, give a brief 12 hour respite then through them into senior year clinics.
During our fourth and final year as vet students we are the man power at the hospital (albeit rather ignorant and insecure manpower at the beginning.) So this is it -
May 2nd through the 6th.
Capstone exams. Cumulative exams that cover the last three years of our education. Two are practical exams, made up cases posted on cardboard. You must answer a series of questions about the case, step behind the screen and see how poorly you did on that particular set of questions. For example: there is a close up photograph of a tooth, in some sort of mouth, but it is so closely focused you can't tell what the hell species you are looking at. You answer "that is the 1st molar of a dog" go behind the screen and find out "Haha idiot, that's the 2nd premolar of a chinchilla!"
The third, and final exam,is a 161 multiple choice behemoth - the stacks of paper are so numerous that the ladies passing it out have to steal their children's red, Radio-flyer wagon to accommodate the pile. They drag it around the huge lecture hall dolling out bubble sheets and exams moaning - "bring out your dead!" - actually they don't say that, but it would have been appropriate if they had.
May 9th through the 11th
Final exams: more tests -I start drinking brandy in my coffee at 10:00AM - that's all there is to say about that.
8:00 AM May 12th 2011
Senior year - here it is. I stay up late organizing clipboard (you will remember from anesthesia how key they are in feeling professional) stethoscope, note cards, cheat sheets on lists of appropriate antibiotic choices in the horse. In the midst I forget to bring a blue/black pen and arrive with a red sharpie instead (a real no no for medical charts I am told later.) I arrive early for my first rotation which is equine surgery and lameness. Waiting alone in our "rounds" room a multitude of wide eyed, frantic fellow newbie fourth years trundle in, "Where do we meet for equine medicine? Equine ambulatory? Dermatology??"
My fellow rotation mates arrive, looking equally ashen and unprepared. Finally a technician takes pity on us and tries to "orient" us to the equine barn and the twisted, Machiavellian system of charts, medical records, charge sheets and innumerable other pertinent points of interest. Most of what she says bounces off our overly tested skulls and ricochets around the high gloss,medical grade paint walls.
11:00 AM May 12th 2011
I get my first case!!! (Due to the sensitive nature of this material, and maters of patient confidentiality I am unable to divulge the particulars.) During the history taking I become completely inarticulate - forget to ask basic questions such as "How is your horse housed? What do you feed?" and "What brings you in today?" Luckily the owners are lovely and understanding and don't hold my ineptitude against me.
One of my rotation mates stands in the background watching, he had become more grim and grey though out the process. I ask "how's it going" he responds "I think I'm going to have a cardiac event!!"
2:00 PM May 12th 2011
We are called into the food animal barn where our equine resident is scrubbing in on a surgery of a 3 week old calf with a suspected infected umbilicus. The room in filled with two surgeons, one gal running anesthesia, one of my class mates scrubbed in to assist and three on lookers clothed in surgical mask and cap (me being one of them.)
The procedure is rather straight forward, dissect abound the umbilicus (without cutting into the nasty, pus filled area) and remove all infected material. Now one of the deals with surgery is that when someone is scrubbed in, capped and gowned they are "sterile" and therefor a no-no to get near or touch if you are not in said condition. Never-you-mind that our patients are poop encrusted balls of gnarly bacteria, we have standards to keep. Well the sterile fourth year, who was evidently too anxiety stricken at the start of her clinical year to eat breakfast, stands up, brushes past me (in my very un-clean condition) slams into a stainless steal medical cabinet and promptly passes out at my feet.
The surgeon glances up causally from her procedure and says "someone call Dr. B and get some cold water on this girl." Then she goes back to her cutting. Yikes, I guess that tells you were we all stand, less important then the nasty, infected belly button of a dairy calf.
5:30 PM May 12th 2011
We are technically "on" from 8 AM to 5 PM. However....... if one has a patient in the hospital you are solely responsible foe that patients 7AM and 7PM treatments and physical exam. On top of that you must fill out screes of paper work so the likelihood that one will go off at 5 and be back by 7 is low to none. Navigating the counter-intuitive client software took me the grater part of two hours, at which point my 7PM treatments were due.
9:30 PM May 12th 2011
I arrive home to sleeping children and the blue light of the television humming softly from the back room. My stalwart husband smiles warmly and welcomes me home, at which point I burst into tears. I curl up on his shoulder with a glass of wine while he rubs my head and whispers sweet falsehoods in my ear, about how fabulous I'll be at the end of this and "what a star" I am. I'm not entirely sure what I did right in a past life to deserve such a man, but I'm thankful, entirely thankful for him.
I pass out from exhaustion (or possibly an overindulgence of Malbec) pondering the question
"what the hell was I thinking???"
But here I am, three years down and one to go, so I better "stay the course."
Goggles on mates!
Saturday, April 30, 2011
The agony and the anesthesia
Soooooooo....
During our third year of vet school we are immersed in a two week rotation through the hospital's anesthesia department.
One can tell when a fellow student is on this particular service; they are dressed in scrubs, clutching a clip board, wide eyed and muttering mathematical equations for continuous rate infusions of fentanyl. It is wise to avoid these students until the rotation in finished as they may start spontaneous weeping if you show too much interest in their lives.
I, personally, have been dreading this rotation. In some wicked twist of fate I was scheduled for anesthesia my last two weeks of Jr. year, during the same time that I am meant to be studying for finals, as well as "capstones" which are cumulative tests from all our classes during the past year.
Nice.
So - my first week started on surgery C. We 3rd years run the anesthesia on shelter patients in for routine spays and neuters. The animals are usually young and healthy and the procedures (hopefully) don't require the animal to be anesthetized for long.
Day 1: I arrive at 6:45 AM ready to roll with my anesthesia handbook and clipboard. The night before I had done a physical exam on the overwhelmingly lick-y/jump-y/bark-y year old yellow lab that was assigned to me. I pre-medicate my nutty yellow girl and go in to set up the anesthesia machine. This is more time intensive and anxiety producing then it sounds, and the cost of doing something "wrong" is.... death (for your patient.)
I call one of the super technicians over to double check me and get the go ahead to induce my animal and continue. I place an IV catheter, intubate and hook her up to the innumerable wires and alarms to measure her vital signs - no problem.
Then the bells and whistles go off.
Due to my patients excitable nature I had chosen to give her acepromazine as one of her pre-medications. Unfortunately one of the side effects of this drug is that it causes hypotension and a corresponding drop in blood pressure. My patients mean arterial pressure is 40 mmHg (normally we like to keep it above 70) and at the same time she has decided to stop breathing.
Super tech starts issuing orders,I shut up and listen intently....for the entire surgery my dog continues to crash. I silently beg the fourth year surgeon to hurry up. In the midst of all this high adrenalin drama I am meant to fill out the official anesthesia medical record. There is a diabolically cryptic system of up-side-down v's, dashes, dots and numbers that correlate to pulse/oxygen saturation/heart rate/respiration etc. These tiny marks must be made every five min. I do the best I can - and am found lacking, but I'm getting used to that.
Day 2: The worlds tiniest dog is assigned to me. A 2 kg chihuahua with a heart rate of 200 beats per min. She is sweet but so high strung that three vet students are unable to restrain her for a blood draw. That's about 450 pounds against 4 - and the 4 pound-er wins. Yikes. I decide to use ace again.
Another super tech is at my side this morning. I pre-med my little darling and follow the steps for assembling and pressure checking my anesthesia machine. I am inordinately proud that I (a dyed in the wool large animal person) am able to place an IV catheter in this tiny animal. We intubate without a problem and start on the miasma of cords and monitoring equipment.
Last verse same as the first. Now I have a non-breathing chihuahua - with blood pressure in the toilet... fluids, atropine, breathing for her all works, works so well in fact that she starts to wake up on the table as the surgery begins.
"Stop cutting!" yells Amy - my super tech and new best friend - we get her under again and give the nod for the surgeon to continue. The rest of the blessedly short procedure continues like this. Our tiny Taco Bell spokesperson is either waking up or trying to die. Big doctors get called, a board certified anesthesiologist swoops in, issuing orders, I try to get out of everyone's way.
"Why do you think the CO2 is so high?" he asks me.
I stare blindly at my log of v's and dots and say the unforgivable "I'm a large animal person and haven't much experience with anesthesia....."
He cuts me off "That is no excuse, when you are a vet you will have a license to kill...."
Wow - I know we are meant to do a lot - but I didn't realize being an associate of 007 was part of the deal. (Although I do think that Sean Connery is one of the yummiest men alive - but I digress.)
So - goes the next two weeks.
The learning curve is steep, so much so that I begin to develop altitude sickness. The two overwhelming emotions I experience are terror or deep shame my gaping lack of knowledge.
I clutch my clip board and look around wildly for an understanding face, my fellow students avert their eyes and nod sagely, "She's on anesthesia this week isn't she."
Yes, yes I am, and I'll take my vodka martini medium dry, lemon peel, shaken not stirred.
During our third year of vet school we are immersed in a two week rotation through the hospital's anesthesia department.
One can tell when a fellow student is on this particular service; they are dressed in scrubs, clutching a clip board, wide eyed and muttering mathematical equations for continuous rate infusions of fentanyl. It is wise to avoid these students until the rotation in finished as they may start spontaneous weeping if you show too much interest in their lives.
I, personally, have been dreading this rotation. In some wicked twist of fate I was scheduled for anesthesia my last two weeks of Jr. year, during the same time that I am meant to be studying for finals, as well as "capstones" which are cumulative tests from all our classes during the past year.
Nice.
So - my first week started on surgery C. We 3rd years run the anesthesia on shelter patients in for routine spays and neuters. The animals are usually young and healthy and the procedures (hopefully) don't require the animal to be anesthetized for long.
Day 1: I arrive at 6:45 AM ready to roll with my anesthesia handbook and clipboard. The night before I had done a physical exam on the overwhelmingly lick-y/jump-y/bark-y year old yellow lab that was assigned to me. I pre-medicate my nutty yellow girl and go in to set up the anesthesia machine. This is more time intensive and anxiety producing then it sounds, and the cost of doing something "wrong" is.... death (for your patient.)
I call one of the super technicians over to double check me and get the go ahead to induce my animal and continue. I place an IV catheter, intubate and hook her up to the innumerable wires and alarms to measure her vital signs - no problem.
Then the bells and whistles go off.
Due to my patients excitable nature I had chosen to give her acepromazine as one of her pre-medications. Unfortunately one of the side effects of this drug is that it causes hypotension and a corresponding drop in blood pressure. My patients mean arterial pressure is 40 mmHg (normally we like to keep it above 70) and at the same time she has decided to stop breathing.
Super tech starts issuing orders,I shut up and listen intently....for the entire surgery my dog continues to crash. I silently beg the fourth year surgeon to hurry up. In the midst of all this high adrenalin drama I am meant to fill out the official anesthesia medical record. There is a diabolically cryptic system of up-side-down v's, dashes, dots and numbers that correlate to pulse/oxygen saturation/heart rate/respiration etc. These tiny marks must be made every five min. I do the best I can - and am found lacking, but I'm getting used to that.
Day 2: The worlds tiniest dog is assigned to me. A 2 kg chihuahua with a heart rate of 200 beats per min. She is sweet but so high strung that three vet students are unable to restrain her for a blood draw. That's about 450 pounds against 4 - and the 4 pound-er wins. Yikes. I decide to use ace again.
Another super tech is at my side this morning. I pre-med my little darling and follow the steps for assembling and pressure checking my anesthesia machine. I am inordinately proud that I (a dyed in the wool large animal person) am able to place an IV catheter in this tiny animal. We intubate without a problem and start on the miasma of cords and monitoring equipment.
Last verse same as the first. Now I have a non-breathing chihuahua - with blood pressure in the toilet... fluids, atropine, breathing for her all works, works so well in fact that she starts to wake up on the table as the surgery begins.
"Stop cutting!" yells Amy - my super tech and new best friend - we get her under again and give the nod for the surgeon to continue. The rest of the blessedly short procedure continues like this. Our tiny Taco Bell spokesperson is either waking up or trying to die. Big doctors get called, a board certified anesthesiologist swoops in, issuing orders, I try to get out of everyone's way.
"Why do you think the CO2 is so high?" he asks me.
I stare blindly at my log of v's and dots and say the unforgivable "I'm a large animal person and haven't much experience with anesthesia....."
He cuts me off "That is no excuse, when you are a vet you will have a license to kill...."
Wow - I know we are meant to do a lot - but I didn't realize being an associate of 007 was part of the deal. (Although I do think that Sean Connery is one of the yummiest men alive - but I digress.)
So - goes the next two weeks.
The learning curve is steep, so much so that I begin to develop altitude sickness. The two overwhelming emotions I experience are terror or deep shame my gaping lack of knowledge.
I clutch my clip board and look around wildly for an understanding face, my fellow students avert their eyes and nod sagely, "She's on anesthesia this week isn't she."
Yes, yes I am, and I'll take my vodka martini medium dry, lemon peel, shaken not stirred.
Monday, April 11, 2011
The unmentionable
In Zimbabwe, where I lived for a few short years, there are many species of poisonous snakes. Fat and lazy puff adders that sun themselves in the middle of foot paths, Mozambique spitting cobras, the ubiquitous boomslang and that lightening-quick merchant of death, the black mamba.
The dread of these creatures has produced a curious habit in the population of this nation. One does not say the word "snake" rather they are referred to as nyoka which, when roughly translated from Ndebele, means "unmentionable one." It is felt that to name the creature out loud will, in fact, call it into being - so this trick of the tongue gives the speaker a sense that there is a choice in the matter when meeting something terrifying.
In veterinary medicine we deliver death, daily. There are the animals brought in too ill or hurt to treat, ones that are dangerous, lame, terminally ill or just guilty of not having a home. These latter ones pass by in unmentionable numbers.
I admit that I can be guilty of a cavalier attitude. We see death everyday, each rotation, it becomes the norm. If you can not compartmentalize this part of your life - keep it moat-bound in logic - then feelings of despair can creep in.
To combat this inertia I try to remember the first time mine was the hand to deliver deadly medication.
For me it came while gaining experience at a mixed animal practice. A stray cat was brought in hypothermic, emaciated - in the process of leaving this life. The doctor on duty allowed me to euthanize him - but this poor guy was so dehydrated that putting in a catheter was a bleak prospect. The good doctor showed me how to palpate the heart, through the too thin chest - to trace the landmarks for my cardiac stick. It is surprisingly easy - I felt the heartbeat vibrating up though the syringe, pulling back the plunger - deep red blood rushes in, mixing with the potassium chloride. I give the injection and it is over. We wait, listen for breathing, or beating but there is none.
Later that day a beloved horse comes in. After attempting medical treatment of a progressively worse colic the owner decides to try surgery. Her big gelding is in relentless pain, we can't keep him standing and I worry that his petite, distraught owner will be crushed before we can get her horse into surgery.
I am running the anesthesia - listening to his heart when they open him up, only to find feet of necrotic bowel, too much to repair.
Dr. X hands me the euthanasia solution and for a moment I think "no, I don't want to be the one!" But this too is my job, to know how to do correctly this most important thing. I push his forelock away from his eyes and say "Good bye Merlin"- I'm glad he isn't hurting anymore.
Dr. X looks at me, nods - says "It's never easy."
I hope he's right - that it wont be - that my heart always hurts a bit. I hope that, as I did with the first horse, that I will place my hand, say good-bye and that, in the end, I am brave enough to call them by name.
The dread of these creatures has produced a curious habit in the population of this nation. One does not say the word "snake" rather they are referred to as nyoka which, when roughly translated from Ndebele, means "unmentionable one." It is felt that to name the creature out loud will, in fact, call it into being - so this trick of the tongue gives the speaker a sense that there is a choice in the matter when meeting something terrifying.
In veterinary medicine we deliver death, daily. There are the animals brought in too ill or hurt to treat, ones that are dangerous, lame, terminally ill or just guilty of not having a home. These latter ones pass by in unmentionable numbers.
I admit that I can be guilty of a cavalier attitude. We see death everyday, each rotation, it becomes the norm. If you can not compartmentalize this part of your life - keep it moat-bound in logic - then feelings of despair can creep in.
To combat this inertia I try to remember the first time mine was the hand to deliver deadly medication.
For me it came while gaining experience at a mixed animal practice. A stray cat was brought in hypothermic, emaciated - in the process of leaving this life. The doctor on duty allowed me to euthanize him - but this poor guy was so dehydrated that putting in a catheter was a bleak prospect. The good doctor showed me how to palpate the heart, through the too thin chest - to trace the landmarks for my cardiac stick. It is surprisingly easy - I felt the heartbeat vibrating up though the syringe, pulling back the plunger - deep red blood rushes in, mixing with the potassium chloride. I give the injection and it is over. We wait, listen for breathing, or beating but there is none.
Later that day a beloved horse comes in. After attempting medical treatment of a progressively worse colic the owner decides to try surgery. Her big gelding is in relentless pain, we can't keep him standing and I worry that his petite, distraught owner will be crushed before we can get her horse into surgery.
I am running the anesthesia - listening to his heart when they open him up, only to find feet of necrotic bowel, too much to repair.
Dr. X hands me the euthanasia solution and for a moment I think "no, I don't want to be the one!" But this too is my job, to know how to do correctly this most important thing. I push his forelock away from his eyes and say "Good bye Merlin"- I'm glad he isn't hurting anymore.
Dr. X looks at me, nods - says "It's never easy."
I hope he's right - that it wont be - that my heart always hurts a bit. I hope that, as I did with the first horse, that I will place my hand, say good-bye and that, in the end, I am brave enough to call them by name.
Wednesday, March 30, 2011
Perspectives
My daughter, Abigail, turned nine on Monday. Somewhere between being an infant in arms and now, she grew, became big and courageous and has learned to fight her own battles. In another nine years she will legally be an an adult.
Yikes.
In the first semester of our first year of vet school - when we one is still dewy-eyed with the wonder of being accepted into this elite program - we took a class called 'Perspectives in Veterinary Medicine."
This innocuous sounding title did not prepare us for the curriculum which was largely comprised of presentations by vets that had battled drug addiction, alcoholism and failed relationships.
I like to call this class the 'disclaimer course' so when we are burnt out, divorced and chain smoking they can say "Don't blame us! We warned you, you need work life balance."
So what does this have to do with my daughter turning nine? Perhaps nothing.
Except that:
The demographics of veterinary medicine are changing. 75% of vet students at my university are female - some schools have all female entering classes. Many of these young women want to begin a family someday.
So back the the 'Perspectives" class.
One notable speaker, a mother of three, came to class bearing so much of her self that it was painful to witness. She cataloged the years spent working toward her DVM, then on to a post doc and board certification. She was before her time, in an era where the masculine paradigm of long hours and no family time held sway.
During these years she also had three children. Children that went immediately into day care.
She showed us a PowerPoint presentation, with bulleted pros and cons of her life decisions.
On the plus side: Professional recognition, good money, meeting interesting people.
On the down side: Not spending enough time with her family, sending sick children to day care, missing important milestones such as kids big sporting events, growing apart from her husband, divorce.
Ouch.
There she stood, in front of all 134 of us bright eyed and bushy tailed vet students - with her most painful moments bulleted before us. My heart hurt, for her, for her kids, for us, for the young women in the room being told that this was their only option.
Another speaker that day addressed the same topic; being both a father of three and a working vet - yet his choices were no different than the previous speakers. His wife (also a vet) and he had three children, one an infant, all in daycare. He joked with the first speaker about the joys of dropping them off and heading to work. I winced at his cavalier attitude.
Our class turned out to offer only one view - rather than discussing options for parenthood and "work life balance" - the message of "Career First, kids second" rang loudly through the lecture hall.
It appears the "masculine paradigm" still rules in veterinary medicine.
The point that is lost in all of this is, that not that the kids will be damaged (I myself am the product of daycare from my third day of life onward) but rather how damaged the parent is. Those years with your children are lost. My daughter does not remember her first smile, tooth, steps, word - but I do. I was privileged enough to be home with my young ones, not everyone has that option.
The most challenging thing I have ever done (more terrifying than backpacking through East Africa, or caring for my dieing father) was being a stay-at-home mom. It is a job that is never done, nor done well enough. Those years were also the most rewarding and ones I wouldn't give up.
Parenting is challenging enough. The last thing we need is to feel bad about our choices. But if we are going to offer 'perspectives' to this next generation of veterinarians perhaps the entire spectrum of choices should be given?
So, Abby is nine. She went to her school for her birthday, I went to mine. She tells me about her friends, how she hates Latin and loves music. She says I smell like "horse poop."
I tell her about the mares I palpated, explain the magic of assisted reproduction, show her pictures of the foals born that week and lament the parasitology test I failed.
It's good. I am happy to be pursuing two wonderfully challenging careers. Veterinary medicine, marriage, parenting can all be woven together.
So to all you vet student hopefuls out there; Go your own way, have kids, don't have kids - whatever - just know that it is possible to have a career and be the parent you want to be. You don't have to follow in the foot steps of those that went before. Be big and courageous and fight your own battles.
And happy birthday Abby.
Yikes.
In the first semester of our first year of vet school - when we one is still dewy-eyed with the wonder of being accepted into this elite program - we took a class called 'Perspectives in Veterinary Medicine."
This innocuous sounding title did not prepare us for the curriculum which was largely comprised of presentations by vets that had battled drug addiction, alcoholism and failed relationships.
I like to call this class the 'disclaimer course' so when we are burnt out, divorced and chain smoking they can say "Don't blame us! We warned you, you need work life balance."
So what does this have to do with my daughter turning nine? Perhaps nothing.
Except that:
The demographics of veterinary medicine are changing. 75% of vet students at my university are female - some schools have all female entering classes. Many of these young women want to begin a family someday.
So back the the 'Perspectives" class.
One notable speaker, a mother of three, came to class bearing so much of her self that it was painful to witness. She cataloged the years spent working toward her DVM, then on to a post doc and board certification. She was before her time, in an era where the masculine paradigm of long hours and no family time held sway.
During these years she also had three children. Children that went immediately into day care.
She showed us a PowerPoint presentation, with bulleted pros and cons of her life decisions.
On the plus side: Professional recognition, good money, meeting interesting people.
On the down side: Not spending enough time with her family, sending sick children to day care, missing important milestones such as kids big sporting events, growing apart from her husband, divorce.
Ouch.
There she stood, in front of all 134 of us bright eyed and bushy tailed vet students - with her most painful moments bulleted before us. My heart hurt, for her, for her kids, for us, for the young women in the room being told that this was their only option.
Another speaker that day addressed the same topic; being both a father of three and a working vet - yet his choices were no different than the previous speakers. His wife (also a vet) and he had three children, one an infant, all in daycare. He joked with the first speaker about the joys of dropping them off and heading to work. I winced at his cavalier attitude.
Our class turned out to offer only one view - rather than discussing options for parenthood and "work life balance" - the message of "Career First, kids second" rang loudly through the lecture hall.
It appears the "masculine paradigm" still rules in veterinary medicine.
The point that is lost in all of this is, that not that the kids will be damaged (I myself am the product of daycare from my third day of life onward) but rather how damaged the parent is. Those years with your children are lost. My daughter does not remember her first smile, tooth, steps, word - but I do. I was privileged enough to be home with my young ones, not everyone has that option.
The most challenging thing I have ever done (more terrifying than backpacking through East Africa, or caring for my dieing father) was being a stay-at-home mom. It is a job that is never done, nor done well enough. Those years were also the most rewarding and ones I wouldn't give up.
Parenting is challenging enough. The last thing we need is to feel bad about our choices. But if we are going to offer 'perspectives' to this next generation of veterinarians perhaps the entire spectrum of choices should be given?
So, Abby is nine. She went to her school for her birthday, I went to mine. She tells me about her friends, how she hates Latin and loves music. She says I smell like "horse poop."
I tell her about the mares I palpated, explain the magic of assisted reproduction, show her pictures of the foals born that week and lament the parasitology test I failed.
It's good. I am happy to be pursuing two wonderfully challenging careers. Veterinary medicine, marriage, parenting can all be woven together.
So to all you vet student hopefuls out there; Go your own way, have kids, don't have kids - whatever - just know that it is possible to have a career and be the parent you want to be. You don't have to follow in the foot steps of those that went before. Be big and courageous and fight your own battles.
And happy birthday Abby.
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