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.

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