lesson learned...

one thing that is scary for the new graduate veterinarian is being faced with cases that are outside the scope of our experience. now - come on! you've just graduated from vet school, you're surely thinking - so you should be ready for anything, should have seen EVERYTHING - coming, as we do, from the ivory tower of vet school, with all the bells and whistles of diagnostics available to us. if you think about it though - you'll realize that we rarely see run-of-the-mill emergencies in vet school. that's because the vets out "in the trenches" see them all the time and handle them on a routine basis: snakebites, hit by cars, rodenticide poisoning, HGE...all of these things emergency and referring veterinarians handle on a daily basis. as a result, i have an idea (in the back of my head) how to treat these things. in practice - i don't always recognize them and have to consult my plunkett emergency book to get a handle on what i'm dealing with and how to treat it.

that's where technicians are crucial - good technicians. luckily, the practice in which i work has excellent techs who are self-motivated, competent, and comfortable starting triage treatments such as fluids and apomorphine (to induce vomiting).

i learned an important lesson on my second official day as an intern. i walked in to find 3 emergencies waiting for care. i opted for the seizuring cat with blood pouring from his mouth on the table. the technician looked at me and said, "the owner bought over-the-counter flea medicine and applied it. this is a pyrethrin toxicity. we've already administered robaxin and valium" (muscle relaxants and sedatives). naturally, in vet school we learned about these things, but i had never actually seen a case. the patient in front of me was completely obtunded, seizing. the owners had no idea how long he'd been seizing. based on his condition and the suspicion of long-term brain damage due to hypoxia, i discussed with the owners his poor prognosis. i did also tell them that sometimes animals (and people) make amazing recoveries and that treating him overnight would at least give him a shot. the owner was torn but elected to try therapy.

i was extremely skeptical about this cat's chances. he was blind - one eye was already clouded by what looked like anterior uveitis. the other eye was now blind - due to hypoxia, i could only surmise. but i tried very hard not to give the owners an indication one way or the other, besides saying that i thought there was absolutely nothing wrong with trying overnight and postponing a decision till the morning. in my head though - i thought the cat was toast.

pressing on, we treated this little kitty. by 3am, he was purring, throwing himself into my arms (valium makes kitties very affectionate), and generally making a pest of himself. it was nothing short of amazing (to me anyway).

my lesson: appearances can be deceiving. even the most hopeless looking case has a shot...

the real world part 1

i just deleted an entire post because it bored me to tears. yes to tears. i'm sitting here crying, i'm so bored.

i've been thinking - as of late - how different my life will be in 4 short months. just 4 months and my day-to-day life will become something entirely new. i'll be a professional, holding a doctorate degree, a real solid person in the world - no longer an ephemeral academic. i'm not good with change. at one time in my life massive changes could easily precipitate all-out panic attacks. this was back before i learned that i could control my panic attacks. or at least have the illusion of controlling them (without medication, thank you very much). i've been so immersed - so totally and completely submerged in my education that i don't know what i'm going to do when school ends. my education will never end, i hope to continue learning till the day i die. but my formal education - at the hands of professors - more than likely ends in may.

what am i going to do? i've decided that i'm going to explore the things i've wanted to do for a long time, but i've kept putting them off because vet school has been so all-consuming. in undergrad - for those of you who don't know this about me - i rode on the equestrian team (i rode english - equitation and jumping). in my spare time, i jaunted around large pastures on a friend's horses. very occasionally, i went foxhunting. now, i can't clearly remember the last time i rode. i sold my beautiful saddle ages ago - why let it gather dust in the closet?

i used to read voraciously. i still read - but not nearly as much now as i once did (my overfull bookcase points to this truth). i love music and going to shows. i've managed to attend concerts sporadically - but due to the drive involved with many, i see far fewer than i would like. (although i got to see the avett brothers again last night and DAMN are they amazing live).

i've always wanted to learn to ballroom dance. my grandparents were professional ballroom dancers, long before i was born. i've also always wanted to learn to play an instrument - the piano or violin. i've decided i will pursue one or both of those things post-graduation.

this smacks of a new years resolution post - but it isn't. this is a post-vet school graduation resolution. i'm going to stop wishing i'd done those things and do them. after all, time grows ever shorter, eh? also on the list: have a family of 2-4 children, finish reading all the "to-read" books on my shelves, own an off the track thoroughbred to take more riding lessons with, spend more time with my other family members and husband.

i'm so ready to have a real life.

would love some feedback - please!

greetings from sunny, balmy florida. christmas day was lovely but the day after was even more beautiful. blue skies, gentle breeze, a gorgeous early spring (winter?) day all around. if this is global warming - i LOVE it.

so, i'm in a dilemma - and i'm asking for opinions. i have a few regular readers - some in the vet scene, some not - but i want to know what others think. within 20ish days, i have to decide whether to stay in the match or withdraw. if i stay in, i will rank 6 places: 4 academic internships, 2 private. these will be 6-7 day work weeks, long hours, low ($25,000) pay without possibility of a 2nd job as a relief vet elsewhere, and no real vacation. due to lack of funds and my senior year being diabolically busy (boards, matching, plus my rotations) - i haven't visited ANY of these places and thus have no idea how or if i'll fit in or even like the place. BUT these internships will be incredible learning opportunities, i will really develop as a diagnostician - as well as refine my ability to treat and manage diseases in both acute and more long-term situations. i will be able to pursue a residency if i want to do so after one of these internships - but i can also work for a while. doing a competitive, top-notch, structured internship will make me a better doctor right off the bat. all are a 5 hour drive away from home, which means my long-suffering but patient and wonderful husband will have to commute 2 days a week to teach classes so that he can keep his stipend. thus, he will spend tues, wed, and thursday of every week away from me. lastly - and least importantly, i'm competitive and driven as hell and want to prove to myself that i'm good enough to capture one of these positions and excel.

my other opportunity is taking the internship offered to me already (outside of the match). it pays $30,000, i work a week then take a week off which means i can work as a relief vet nearby and make an "extra" $30,000-45,000 per year. it's only an hour and a half drive from our current home - only 3.5 hours from our real home, so husband can keep his stipend and assitanceship, have an easy commute, and come home to me at the end of the day instead of staying away (although mostly, i won't be at home because i'll be slaving away as an intern). i'm also not so far from my family - either of them. i love the place, i love the staff, i felt welcomed - i felt like a part of the team. it was a fantastic place for me - and the clinic is beautiful. it pays well, it's a good fit for me personally, but it's not competitive for residencies and may require that i do another one later if i decide to pursue that course. further, it's not structured at all - so teaching opportunities outside of being a real doctor are few. there are no structured case rounds, no journal club, no rounds of any sort - yet. the organization is a bit lacking at times, but it's something i can live with - i think.

so...i'm opening the floor to my few but faithful readers. what do you think - whether you're a fellow vet student or not?? i'm torn still. my heart seems to know the answer - but my head is trying to be stubborn and pragmatic...i'd like to hear how others feel.

christmas thanks

i didn't do a real thanksgiving post. i think i just bitched about being tired and upcoming boards and being sick. so i'm going to take a moment and actually list the gifts life has given me.

1) my husband - patient, forgiving, loyal, and supportive through 4 years that have sorely taxed us both in many ways (ahem- vet school). after almost 9 years of marriage (yes, nine!) - i am still sad when i'm the first one home. i am still happy when i hear a car door slam and know it's him coming home. i still like to surprise him at school and take him to lunch. he's still my best friend and the person that gets me through the rough patches.

2) my family - flaws yes. outweighed by what they give me? most definitely. without my family, i wouldn't be who i am today - the good and the bad. i feel incredibly lucky to know that if i ever needed anything, if i was ever in trouble - whether of my own making or otherwise - i have not one but TWO families to whom i could turn. not only was i born with an incredibly close family - but i married into one that over the years (11 of them all told!) has become a part of me. they are as much a part of me as the family to which i was born.

3) my friends - those that i would call my close friends are numbered in single digits (family members excluded). but those people that i do call true friends are as dear to me as family. i know - in a moment - they would be with me, should i need them. miles separate me from some of them - but our hearts are never separated.

4) the opportunity to be a veterinarian - i am blessed with enough motivation and intelligence to pursue a rigorous degree in a rigorous program in a country with only 27 vet schools. despite having to take out a massive amount of financial aid to pave the way, in 4.5 short months, i will be walking across a stage to receive my DVM degree. i never imagined i could or would do it, but with the support of my husband and family, i'm almost there.

5) my country - despite its shortcomings, i wouldn't choose to live anywhere else in the world. i'm proud of my country and all that it stands for - i think we are - as someone once said - "like a shining city on a hill."

enough maudlin ramblings for the evening?

i'm going to do it

i'm going to tempt the black fates that mock human arrogance. i'm going to utter a phrase that no one with any common sense would utter for fear of jinxing themselves.

i have not YET been bitten. i've had close calls with animals - dogs and cats that is. i've been gnawed on by plenty of parrots - big and small. it hurts, but it's something to which i'm accustomed. parrot beaks don't frighten me much. but as for dogs and cats - not one has sunk its fangs into me. YET. but i know it' s coming. i try not to worry about it too much. and on a day to day basis, i rarely think about it. i've absentmindedly palpated a large dog's abdomen before while discussing disease processes with an owner - and nearly had my arm removed - but i dodged the bullet. i've examined a painful, glaucomatous eye and pulled my hand back fast enough to evade the quick, sharp teeth of an annoyed blue heeler. i've yanked my hand back just barely fast enough to avoid needle sharp cat teeth on more than one occasion - though the teeth skimmed me and ripped my glove open. yet, the actual teeth sinking into flesh hasn't happened.

it's not something i'm thinking about and worrying about daily - it certainly doesn't prevent me from doing thorough physical exams or being hand's on with my patients - but every now and then, i suddenly think - "hey, i'm gonna get bitten. probably more than once in my life. and it's gonna hurt like hell."

that scares me a little.

goings on and what-have-you

i'm at the in-laws for "christmas" - since all but 1 of husband's four siblings are married - getting together all on one day becomes more and more difficult. this year we elected to all get together on dec 22nd and have christmas. my MIL decided that since it wasn't really christmas then no traditional christmas dinner (turkey, stuffing, etc). instead, she made filet mignon, twice baked potatoes, hot rolls, and all the rest. i can't say i missed the turkey too terribly much. but then again, i am having it on tuesday when we head down to florida to see my side o'the family. my filet mignon was sooooo delicious.

in other, definitely not-christmasy news, i ran my new 3-legged pal (norman) by school to have him looked at by my favorite professor so that she could prescribe him some pain meds. she did a brief physical on him (something i had never done, apparently) and pointed out that he had a raging heart murmur (4/6). chyeah. seriously. i slotted him for an echocardiogram and it turns out that norman has early-onset hypertrophic cardiomyopathy with systolic anterior motion of the mitral valve. i know, i know - you're thinking -- WHA?!

hypertrophic CM is a fancy way of saying that his heart, for some obscure reason, has decided to asymmetrically thicken (no, it had nothing to do with the trauma that broke his leg). no one knows what causes this disease, but it's much more common in older cats. the thickening causes the valves in the heart to stretch apart and open so that regurgitation through the valves occurs. on top of that, for some reason, the valves that separate his left atria from his left ventricle get sucked into the aorta when his heart contracts. so yeah, he's on heart medication now and will live a truncated life that will probably end 1 of 2 ways : with heart failure or with a thromboemoblism that will paralyze his rear legs. oops. i meant rear leg. luckily, atenolol is cheap. not great news. but he's happy and healthy now and going to live with my BF, her husband (my brother in law), and their other 2 animals.

i suppose that it's for now.

angels of death

angels of death
as my friend over at all but 1 has noted, veterinary medicine can be a bit sad sometimes. you fight hard for your patients. sometimes you win those battles, but in emergency medicine (and oncology) - often you lose those battles. yet in that inevitable truth lies a great beauty. veterinarians can offer dignified, painless death to our patients. human doctors can (legally) not. this post is not meant to be an argument for or against human euthanasia. (sidenote: when i was young, i remember hearing my parents talking about the big debate over euthanasia and the elderly. and all i could wonder was why did people care about youth in asia? end of sidenote). to discuss human euthanasia would require navigating tricky emotional and political waters - and i don't dare tread there (mainly because i believe there are multiple "right" answers to that debate - kevorkian NOT being one of them). anyhoo, as i was saying...

one thing i got to do multiple times on my externships was offer the merciful sleep of euthanasia. i also performed quite a few - considering i've only done 1 that i can remember as a vet student that actually involved an owned animal. it was a new experience for me - being the only person present as the owners said goodbye to a beloved family member. and while it was heartwrenching, it also made me profoundly thankful that i don't have to navigate the channels and trenches of human euthanasia. few people question the job that so often falls to us as animal doctors. animal euthanasia is an accepted - dare i say - embraced tradition with which few disagree (although there are dissenters). and i'm grateful for that.

there is nothing (in the animal world, that is) quite as sad as seeing a 17 year old cat with multiple diseases stop eating or drinking but still drag on and on, somehow clinging to a shred of life. or worse, to see a young, otherwise healthy animal in agony with a broken spine . it is sad to have to end the lives of these loved ones, but it is a gift too - however much (as vets and as pet owners) - we struggle with it.

i euthanized one of my patients while on externship, and i cried with the owners as if he was my own. he was a 15 year old cat - a big, black ex-tom cat, previously healthy, with sudden onset of diabetes. it was secondary to some other disease - possibly pancreatitis, portal triad syndrome, hepatic lipidosis, or all 3. he was a very, very sick kitty. despite insulin therapy, antibiotics, and fluids, he did not get better. his owners made the difficult decision after 2 days to stop treatment. i cried when i carried his lifeless body back to make him a little coffin. but the owners thanked me for my obvious caring, my involvement with them, my calm and confident nature...and in the end, they thanked me for ending their kitty's suffering.

as much as it sucks to lose one, i'm so thankful that i have the option -that owners have the option - to stop the suffering of a their animal. so while we sometimes (especially in emergency medicine) feel like the black hooded figure with the scythe - i prefer to think of us as the benevolent angels of death - guiding animals to the afterlife (whatever that may be).