Wednesday, November 28, 2007

can i get a hell yeah?

i've come here again to ruminate. not in the fore-stomached ruminant sort of way, mind you. that would be far too literal for my tastes. at any rate, as everyone in the entire universe probably knows, i have been struggling for a good long while with a career decision. by january 18th, i have to decide whether or not to pursue further veterinary training as an intern or stop the madness and actually practice veterinary medicine.

of course, opinions on this subject are numerous and varied. i can't complain that i haven't had a good sampling of opinions from everyone i know. in fact, i was involved in a very heated debate amidst orthopedic surgery just yesterday. i was informed, in no uncertain terms, that without an internship, i would probably not be a good doctor. i - obviously - took huge offense to this assumption and argued quite aggressively with my antagonizer (a person i actually rather like and respect). but that's not why i came here to think aloud...

suffice to say that i have heard many, many negative remarks about private practice. granted, my population pool is skewed. i'm currently in an ivory tower of sorts - where "cutting edge" medicine is practiced (i use the term loosely). everyone in this bastion of intellect has obviously gone the route of further education. most have done it because they became disillusioned with private practice. many of my professors have worked with older doctors - out of vet school for 20 years or more, stuck in their ways, disinterested in continuing education or betterment of their practice, totally apathetic and/or burnt-out. indeed, that was my first experience with a veterinarian (at the tender age of 18). i worked for an embittered middle-aged man - stagnating - obviously - as evidenced by his rage any time an animal behaved in any way other than perfectly meekly. i watched him choke a 7 lb chihuahua once out of pure rage. he was obviously an unhappy person - someone who didn't really like animals anymore (who maybe never had). he didn't do any continuing education, didn't seem interested in improving the level of care he offered his patients, had no desire to upgrade his equipment or standard of care. in short, he was miserable at what he did - but he kept doing it - for whatever reason.

so, on the subject of disillusionment i come to discourse. my grandfather is one of my favorite people in the world. however, he is a self-professed cynic. it runs in the family, i must admit. over dinner with my family last week, he launched into a story of how his naivete with the world and the system of higher education was shattered within his first few years as a college professor. he was amazed and disgusted when grades were changed for athletes, cheaters caught and let off scott-free, and disheartened in general to see that the world, after all, isn't a very fair place. and i understand the feeling. i once sat in on a class my husband teaches. next to me and in front of me were 2 very well-known university athletes. before lecture, jim gave a quiz. i sat and watched as these 2 "students" cheated, brazenly. jim didn't see it until i indicated the problem with some not so subtle head nodding and pointing and coughing and such. and what happened? nothing. jim discussed it with his supervisor. and what it boils down to is that it doesn't matter. failing a student is much more hassle than its worth. besides they just need to pass so that they can become NFL or NBA stars. who cares anyway?

i used to get righteously angry about this sort of thing. hell, i've seen it happen in the vet school. it happens every day in every profession - just read the newspaper: drunk doctors killing patients, drunk pilots being kicked off planes, it happens everywhere.

i'm getting off track here, so i'll try to tie this up into one grand thought. actually, it's two separate thoughts that kind of come together. in regards to the cheaters, liars, thieves, and generally lazy in the world that get away with this - hell that will hold the same degree i hold -after 4 years of dedication, incredible sacrifice, and hard-work - and so what? life isn't fair. some who deserve nothing have everything and some who deserve everything have nothing. that's the way it is. life was never made to be fair. nature isn't fair. it just is. so instead of focusing on what everyone else is doing wrong and how i am working much harder, being much more dedicated, blah blah, and how we/i am getting gypped in the meantime, i can focus on myself - my career - my marriage - my situation - making it the best it can possibly be and leaving those cutting corners and practicing poor medicine to their own devices. self-righteous anger is really only detrimental to those with the feelings of anger, after all.

the real thoughts i wanted to express were on disillusionment. my grandfather thinks that when i venture out into the real world of veterinary medicine, i am going to realize that it sucks and that people suck. that every job i ever hold will end up being about the money, that i will lose the love and joy i find in veterinary medicine, because - in the end - it boils down to the money. i have thought about this a great deal - especially as of late, hearing so much unhappiness from my professors and colleagues in regards to the "real world" - and this is what i have surmised: you're going to be disappointed and disillusioned no matter where you go. no matter who you're friends with, no matter who you love, what you love, everything disappoints you. yeah, i'm going to see stuff done by colleagues and doctors that disgusts me, that i don't agree with, that i wouldn't do myself. i'm going to have to sacrifice some of my own stances on subjects because that's what happens. you can't be an idealist in an un-ideal world. what staves off the inevitable cynicism then? some would say nothing - that in the end, i will wind up exactly as my professors and colleagues and grandfather already are - cynical. but this is my staunch (and perhaps naive) attempt to take a stand. disillusionment and disappointment come if you allow them to do so - but you can make a choice. you can let the garbage flow by you - accepting that nothing is perfect, everything has its flaws - and focus on becoming the best you can be at what you do - not just your job but your marriage, your relationships, your hobbies - everything. forget the rest of the world and its imperfections. love what you have, love what you do, keep a keen and open mind, and let the rest go its way. if you can do that, i think cynicism can be kept at bay.

if i choose to go into private practice right away, i can let the things i see and disagree with embitter me. i can decide that veterinary medicine is all about money and that i will have to completely compromise myself to be successful. or i can do what i already plan to do no matter what - strive to be the best i can be at what i do. offer the highest quality medicine i am capable of offering and continue to be the person i am - someone who loves animals and loves vet med. i can accept those things that i can't change about the world - its essential unfairness namely - and not let it drag me down when i witness this. after all, it's not fair that people cheat and get by, people cut corners and never get caught. but what's really not fair is that people are murdered, raped, starve to death - every day - and the world moves on. it's life. get over it, cynics.

if i go into an internship, i'll bitch and moan (as i always do) about how hard it is. but i'll love it too. if i stay in academia, i'll love it, i'm sure. but just like anything and everything, i'll be disappointed in some way - and yes, probably disillusioned. but...i've already said it all. accept life as it comes to you, keep an open mind to it, advance yourself, your knowledge, your relationships and loves, and the rest...well to hell with it.

then again, maybe i am terribly naive.

Monday, November 26, 2007

second verse, same as the first.

the nex week is going to be fantastic. and by fantastic, i mean AWFUL.

the wedding this past weekend was fabulous. everything was gorgeous, it went off with only a minor hitch or two (AWOL hair dresser, last minute hair scramble, etc). we had a great time, and i got to see my family - both of them. a little anyway. there was much to do and a very short time in which to do it all. schlepping back and forth between the families proved difficult, and i didn't get to see much of my blood relatives. hopefully that will be remedied over christmas...but we'll see. money money money - always money.

and our football team won - in a spectacular 4 OT game - and they're off to the division championship! whoo. i didn't get to watch the game - as it coincided with the wedding, however - i did have a handheld radio which i kept at close hand throughout (including the reception) so that i might hear the results of the game. since pretty much every native in our state is a football fan, it was no surprise that when we erupted into cheers during the reception over our precarious win that the DJ broke into our rousing and well-known (and despised) fight song.

the 2 black furballs went to live with my parents. mom and dad lost their 8 year old cat to acute renal failure a few months ago and have been lonely ever since. i had planned on giving them the male kitten, but when they saw the mittens together - they couldn't resist. so both kittens are now gone. i'm a little sad, i'd gotten used to my little shadows.

anesthesia ends in a week. i also take my board exam in 1 week. between now and then, i have 2 ICU duty nights. that means i arrive at school around 7:30am and stay till midnight. i hate ICU duty (as i might have previously mentioned). and i'm stressing a bit about my licensing exam - since i was at school very late this evening and will be again tomorrow and thursday. this month has been jam-packed - and i haven't prepared as much as i'd like. fortunately, i'm coming up on my 2 week "vacation." most of you will recall that i elected to end my externship early and come home from florida. so i'm making up those 2 weeks over vacation. however, i don't start until next tuesday, after i take my board exam. so i have a three day weekend during which to cram cram cram cram.

i'm excited about my externship. it's at a critical care/emergency/referral hospital about an hour and a half away. i think it's going to be a great experience. it's close enough that i can come home, if the need arises. after it's over, i have 2 weeks of christmas vacation. then it's january - and i have a mere four rotations left!

as for the internship vs. job front - i go back and forth every single day. i'm still officially in the matching program - as i've finished all of the application materials, had letters of rec sent, and have finally finished and sent my CV and letter of intent. now all that's left to do is determine if i actually want to go through with it or not. can i still be a good doctor without it? i cannot decide how much of my desire to do an internship is based on an actual need to do it versus an insane drive/competitiveness to prove that i can. argh. every single day brings a new twist and a new consideration and a new lack of decision-making. oh well. i have until jan 18.

i'm breaking the rule of my blog and posting pictures of the wedding. they'll come down in fairly short order, but in the meantime - enjoy.

Wednesday, November 21, 2007

here i am again

studying for a test. as per usual. it's a urinary exam this time, my 2nd test of 3 (the final being...well - the final). today was pretty mellow at school - only 2 lectures - and a lab. i'm feeling pretty good in general. we found a place to live, once school gets out. our previous landlord just bought a new house for a rental property - and it's about as perfect as you can get (for us). it's 2 bedrooms with a real dining room/breakfast nook. it also has a 'spare' room that's too oddly shaped to be a bedroom - but is perfect for bird cages. it has hardwood floors and plenty of space. only one bathroom, but i couldn't care less at this point. it's reasonably priced - and it's near enough to school. it's fairly close to rhiannon too (about a 5 min drive). it's also RIGHT NEXT to the farmer's market - so no more kroger for birdie veggies. i'm thrilled that the weight of finding a place to live that would accept all of our pets has so unexpectedly and expediantly been taken care of. it's more of a relief than even i realized it would be.

in other news...i can't believe how fast this semester has flown by. we only have 9 more days of class - and then finals are upon us. kind of a scary thought. but i'm cavalier right now. my grades are good - i've been able to relax a little lately - because i've worked so diligently throughout the semester. and i'm just generally in a good mood. my social neuroses seem to be calming themselves. i am realizing anew the value of my family and the friends i already have. i can get along with people at school - hang out with them and enjoy their company. but it doesn't have to extend beyond that. i don't feel so socially obvious, i guess. it's weird - i know. but i'm realizing that i enjoy my own company and that of my family and old friends. i think i expect too much - loads of friends and constant social activity. when i step back - i realize it's because i have a driving need to be accepted and fit in, not because i feel any personal lack of companionship and love in my life. i think i always felt like a misfit in high school - and to some extent - undergrad. and that feeling has carried over and created a need to feel liked by everyone i know. but in the end, is that really all that important?

in sad news, we won't be congregating at granny russells this year for thanksgiving. i had just finished telling my friends today about the amazing food and family togetherness that always goes on at the russells - and how much i was looking forward to it. but granny is getting older and the strain of feeding and entertaining 20 or 30 people has finally become too much. it makes me sad because i realize that all things - no matter how good and important - must come to an end. it makes me sad for jim, and it makes me sad for the day when it happens in my family too. it also makes me want to cherish the time and family i have all the more. we will still be gathering -but at a buffet instead of granny's house. time does pass too rapidly.

life is good.

Tuesday, November 20, 2007

busy turkey day

since i'm about to run off for a weekend, i thought i would go ahead and do my thanksgiving post.

i still feel like crapola. oh wait. i'm not giving thanks for that. i don't believe it's flu anymore. i'm not sick enough. yet. i feel like i need to say yet...just in case i jinx myself. vet school has made me superstitious.

so my sister-in-law is getting married on saturday. this happens to coincide with the few and hallowed days of fall - football saturdays. we're playing our last game of the season, which will determine if we get into the championship game. and i don't get to watch it. i'm so, so sad. don't get me wrong, i love weddings. especially when i get to wear a beautiful dress, have my hair done, dance, and look pretty. but saturday during the fall is a sacred time dammit. it's going to be hard to be discreet with a radio plugged into my ear from 1:30 until 5. especially since the wedding starts at 4:30. maybe i can just wear the earpiece in my left ear, that way the guests won't notice.

so, the wedding is an all day affair - bridesmaid breakfast in the morning, hair in the late morning, other stuff up until 4:30. and it's a baptist wedding. we all know what that means - lots of SOBER people NOT dancing. actually, there is dancing. just no alcohol. and all white people. *sigh* i'm not a drunk (despite my kitten/vomit story), but i really do enjoy alcohol at a wedding. it makes them all the more fun. sooooo....friday evening will be spent doing the traditional rehearsal dinner stuff. it leaves me some time on the actual turkey day to see my other, blood, extended family. most of the relatives from florida are coming up to visit. i can't complain about having actual time off from school and not being on call for emergency anesthesia, especially since i was on call july 4th when the family was here (for surgery). but...i won't have too much spare time to spend.

it's going to be a very, very busy 4 days. and i only have 1 week left on anesthesia. hard to believe that another rotation is almost finished. i have the following left: equine and farm animal med (1 month), radiology/pathology part II (1 month), avian/exotics and externship (1 month), small animal med/oncology (1 month), and equine surgery/overnight critical care (1 month). that means i have 5 months of my senior year left. it's going by really, really fast. as i might have mentioned.

Monday, November 19, 2007

my last exciting day in the neuro ward

this is how NOT to hold a canine speculum.

i spent my last night on emergency duty. i arrived at 7:30 in the morning and left shortly after 11:30pm. it was a loooooong day. and not a very good one. as usual, i spent most of it feeling like i was in the way. i tried to volunteer myself for jobs - and to be helpful. but to no real avail. this whole week was a disappointment. i worked as a vet tech essentially - cleaning cages, giving meds. other than 1 exciting activity, i did nothing 'vet-like' this entire week.

the final night was what got to me. on emergency duty, we received a very elderly dog in acute renal failure. we stabilized the dog (gave it fluids, some minor pain meds, etc). the emergency doctor decided to catheterize the dog. a good decision, as when the kidneys are failing - it's crucial to monitor urine output. i held an oxygen mask on the dog's face while the doctor prepared a sterile catheter and set to work. catheterizing a female dog is not easy. of male and female dogs and cats, female dogs are the hardest. this dog was elderly. it was very, very ill and dyspneic (in extreme respiratory distress). it was also evidently in some pain. at any rate, the best thing for this patient (in my humble opinion) would be to stabilize her with fluids, catheterize her quickly and painlessly and get her into an oxygen cage. that was not to be. the doctor spent over AN HOUR trying to insert the catheter. at one point, blood was on the tip of the catheter and he jokingly said, 'if this dog didn't have a urinary tract infection to begin with, it does now!' an hour and 10 minutes into trying to catheterize this poor, poor dog that was struggling to stay alive and breathe, i gently suggested that he turn the speculum right side up. he was holding it upside down. i did not say it was upside down but tried to tactfully offer a better solution for visualizing the urethral tubercle. after all, we're all 'colleagues' here, right? i also offered to try the catheterization- because my fingers are tiny compared to his (this was a 12 pound dog). he couldn't get his pinkie all the way into the vulva to expose the urethral opening. he ignored me. at some point (an hour and 20 mins?), he gave up - and we were able to put the dog in an oxygen cage.

at that point, the evening was more or less done. it was 10:30. we were scheduled to be on till 11pm, but seeing as how we're 2nd years - and apparently fairly useless - i asked our overseeing students (4th years) if we might call it a night. they all readily agreed. however, the doctor looked at me - and in a snide voice informed me that we needed to stay until the students left. to get the whole experience of 4th year. i knew - without a doubt - that his frustration at his inability to catheterize the dog was bearing down on me. i turned around and walked out of ICU and went to find the other students (to see if there was something i could do to burn the next 30 mins). when i left, he turned to the 4th year overseeing me - and said "i didn't appreciate her smart-ass comments. if she'd been more helpful, i would have let her go home." this -- after all week -- i have been everywhere - offering to do ANYTHING i could to help the students - even bringing them lunch or running stupid, un-vet related errands. this doctor worked with me for 2 hours and said this about me.

now, i understand completely that he was frustrated and felt embarrassed about the catheter thing. i would too. and i understand completely that sometimes there are things that have to be done that are extremely difficult - for whatever reason. and i understand that everyone makes mistakes - and that sometimes people can't do something that should be relatively accomplishable. i understood all that. what i don't understand is how some people can be so petty. i was truly interested in the health and well-being of this dog. yes, i was impatient after standing still holding an oxygen mask for an hour on a dog's face. but seeing the dog struggle to breathe - and seeing the obvious distress (though mildly sedated, she was still conscious) that this procedure was putting her through - made me impatient to help her. i was under the false notion that our first concern was the patient's health, followed by learning (as this is a teaching hospital). i was also operating under the assumption that we're all colleagues. and - despite the fact that i'm just a vet student - i could maybe offer some thoughts on the subject. ESPECIALLY considering the fact that we had our catheterization lab in renal systems a mere 3 weeks ago. doing this exact thing (albeit on cadavers - which are MUCH harder to work with). i'm a silly girl.

i'm not angry with the doctor that was on emergency that night, though he didn't exactly ingratiate himself to me. i'm just frustrated about school in general. the whole week was more or less a waste. i didn't learn much or get any hand's on experience. i spent most of the week trying to help out and stay out of the way of the doctors and 4th years. i'm also frustrated at my inability to keep my mouth shut when it seems that i should. i shouldn't give advice to my superiors. or should i? the procedure wasn't going to kill the dog (though the stress might've) - and whether he held the speculum right-side up or not seemed to make no difference in the end. why couldn't i have just kept my mouth shut?? what prompts me to say the things that other people wisely choose not to? it's a rather frustrating trait.

at any rate, the week is over- and i go back to classes. we have a test in urinary coming up on wednesday, which i need to be preparing more for. i tried to study over this past week. i often got home at 7 or so - and wound up sleeping really early. it was a hard week. i'm actually glad to be going back to class. where i can learn more stuff that i'll promptly forget and have to relearn when i'm actually a fourth year student.

Thursday, November 15, 2007

can you say hemilaminectomy?

today was my 2nd day in the neuro ward. it was a longish day, starting at 6:45 and ending at around 6:00p. i got to see 2 surgeries today - a dorsal laminectomy and a hemilaminectomy. i hope i'm spelling those right! these surgeries exist to treat herniated discs in what we like to call 'back dogs.' back dogs are dogs that become paraplegic, quadriplegic, ataxic, or otherwise severely incoordinated in their limbs due to a neurological problem. it usually happens because the little 'disc' inside the vertebrae starts to bulge out of its snug little spot and press upwards on the spinal cord. this causes pain and pressure, as well as a loss of function. so - a laminectomy is when the surgeon goes into the back from above, cuts open everything, exposing the vertebral spines. they then cut a little window into the bone (in a hemi, this is done on one half the vertebrae, in a dorsal -the window penetrates both sides of the vertebrae) and pull the disc out. this fixes the pressure - effectively decompressing the nerves.

i observed both a dorsal and a hemi today. the dorsal went as expected. the hemi was much more exciting. the doctor opened up the dog, cauterized vessels, etc - and got to the offending vertebrae. BUT - there was no bulging disc. instead - there was a purplish streak ascending the spinal cord, under the dura mater (protective covering of spinal cord). this was utterly baffling to the resident surgeon, as well as the surgeon on staff. ther were many hmmms...and ahhhs...and ... WTFs? they then performed a durotomy, which is opening up the dura. the purple material was removed and sent off to pathology. at this point, they (i should capitalize the they) suspect either trauma leading to a hematoma or a mass of some sort. apparently the dog tried to fly from the front porch- and failed. it was really neat to watch (the surgery, not the dog flying off the porch). i was also relatively useless. the only function i served was to run out of the surgery suite looking for vet techs to retrieve important instruments - like the oddly named Gelpi. the other thing i did was push the doctor's magnifying/microscope lenses back up everytime they slid down his nose. he was in a rush and forgot to screw the thing on tight. i almost offered to get the screwdriver and do it myself - but when the words "i can screw" almost came out of my mouth, i recanted of the notion. probably a good thing.

standing for 2-3 hours is hard on the knees and legs. i'm always amazed by surgeons and the stamina it takes to do these kinds of things. the technology at school seemed impressive to me as well - but then - i have no real exposure to this sort of thing. i do know that i saw 2 surgeries today, both costing the owners in excess of $2500. and these are fairly common at school.

i feel like i asked too many questions today though. i was extremely inquisitive. i feel - on the one hand - that it was annoying. but on the other hand i figure - i'm paying a lot to get this DVM/education. i sure as hell better be able to ask questions. i feel like i'm learning a lot in some ways. i also feel like a big fat nuisance that's in the way of all the 4th years, residents, and attendings. it's making me feel excited about being a 4th year - and less apprehensive about it then i thought. but interacting with so many people all day is also making me slightly neurotic about my personality, mannerisms, and social skills. i'll either have to just get over that or start medicating myself. does everyone have this kind of social anxiety? or only freaks like me?

my vocabulary seems to be degenerating. i used the word feel in that paragraph 4 times. as if vet school is making me more feel-y. i feel things very deeply. yes...

i question everything i say, every joke i make, every facial expression. and i know that's excessive. i realized that i asked some things i shouldn't have today - but that's good, because i won't ask them tomorrow. but it seems that i'm more prone to making verbal mistakes than most. why couldn't i have just kept my mouth shut in the first place? i feel like god should have given me a verbal delay so that my brain has time to think it through before my mouth falls open and a question plops out (did i use the word FEEL again?) ahh, the neuroses.

my final grade in anesthesiology was a B+.