oh sweet verdant days of july

i "officially" start work tomorrow. translation: i have already worked 70+ hours unofficially. perhaps i should have waited for the orientation. it might have helped some in easing the transition into paperwork, speaking with referring veterinarians, protocols for certain emergencies - that sort of thing. but i don't regret starting early.

what am i looking forward to in july?

-working the 4th of july all day (NOT!!)
-the avett brothers concert july 12 in bristol
-new avett brothers EP: the gleam 2, july 22

sad, but that's about it. i have to work on the 4th, so no family time for me.

king kong on the stomach

after working 13 hours on sunday, i was ready to call it a night. but there were so many patients in the ER waiting room that i decided to take just one last case before calling it a night.

my patient was an 11 month old whippet, according to the card. in the flesh, he looked like a jack russell terrier mixed with something slightly larger but still very terrier-ish. his owner reported that she'd been out of town for 5 days at her father's funeral. she'd left the dog with her boyfriend. on the first day she was gone, the dog had eaten a tube of gorilla glue. FIVE DAYS previously. when the dog (heretofore max) began vomiting shortly thereafter - the boyfriend kicked max outside and left him there for five days. when the owner returned, max was covered in fleas, had not eaten anything in 5 days, and was still vomiting.

i ran preliminary bloodwork to find that max had a PCV of 70! to those not in the vet med world that's really really bad. PCV stands for packed cell volume and represents the percentage of blood that is made up of cells. normal should be between 35-45. 70% meant that this dog's blood was practically syrup. this was confirmed by a visual inspection of the tubes in which we spun the blood - it was chocolate brown and thick. a PCV of 70 represents severe dehydration. i talked to the owner about further diagnostics: bloodwork and xrays. she consented. as i waited for the bloodwork, we placed a catheter and started to slowly administer fluids to correct the severe dehydration. max developed head tremors. i stopped the fluids, the head tremors resolved. i started the fluids again, the head tremors returned. not a good sign by any stretch.

sighing at the impossibility of stabilizing him without causing neurological damage, i consulted my bloodwork. his electrolytes (sodium, potassium, and chloride) were so low as to be at the very end limit of the bottom of our scale. his potassium was 1.9 (life threatening is generally considered to be less than 2). his massive electrolyte imbalances explained the development of head tremors with fluids. then the xrays confirmed my worst fears. the stomach was completely filled with a mass of gorilla glue.

gorilla glue is an interesting substance. it's a poor glue for anything harder than wood. but wood it does well for because it fills in the gaps. it's not an epoxy glue, but a polyurethane adhesive. when it gets wet - it swells to approximately 10-15 times its original size. and that's what happened in max's belly. the good news is that it's not "sticky" per se inside the body. it forms a giant mass, but it doesn't adhere to anything. rather like a big rubber ball. there was a chance that - despite the duration of his illness - max's stomach was still ok. after all - stomachs are made to stretch. i checked his lactate (a measure of blood supply to organs) and it was within the normal limit, which gave me hope that the stomach wasn't dying due to obstruction and stretching.

i discussed all this with the owner - emphasizing first and foremost that stabilizing max would take hours and hours before we could even consider surgery. he was incredibly critical, his electrolytes so out of whack as to be life-threatening. the owner - distraught and confused and quite possibly under the influence of some sort of drug (based on her extremely pinpoint pupils and very erratic behavior, including yelling at the technicians) - elected to go ahead with stabilization and possible surgery, despite the $1600-2500 quote i gave her.

back i went to max, attempting to slowly re-hydrate him, despite the head tremors. and then the owner snapped, insisting on euthanasia. after talking with her some more, she signed the euthanasia form. i walked her to the front desk and returned to do my sad duty to the cute little puppy.

and the woman walked out without paying.

max went to heaven at my hands. after he passed, i opened his abdomen and exteriorized his incredibly massive, hard stomach. the stomach itself still looked viable, still had a good blood supply. i excised into it and removed the 1.5lb mass of rubbery gorilla glue. all in all - a sad end to a day that wound up being slightly in excess of 17 hours.

holy first two days, batman!

i walked in at 6:30 tuesday evening and was handed a file. "patient in room 4," i was informed, "chewed and swallowed LARGE pill-cutter, complete with 2 razor blades sometime 12 hours ago." i looked at the radiographs from the referring veterinarian. uh-oh. 2 blades in the massively distended stomach.

the owner, a kindly, late 40s man, grasped my hand and admonished me to save his dog. said dog was a 9 year old (friendly - believe it or not) cocker spaniel with the most disgusting skin that i have ever seen (which is saying a lot for a cocker spaniel - they all come complete with gross skin, ears, and eyes). pimples, yeast, pyoderma...in short - your average cocker. said cocker appeared to be feeling fine. i triaged - got her back to the techs to start getting in a catheter, drawing blood, and prepping for surgery.

i tried to find a quiet closet in which to hyperventilate. i was about to do an abdominal surgery. a REAL abdominal surgery. and that wasn't all. while that patient was being prepared, i was to see other patients. while she was in preparation, i took in a german shepherd with an extremely odd presentation (more on that later), a dog in respiratory distress with a heart murmur, a stepped-on puppy, a seizuring cat (definitely more on that later), a straining to urinate female cat, a humane society hit by car...and more.

meanwhile, the extremely talented technicians were battling to place a catheter in the disgusting, thick, mucoid skin of my cocker spaniel. surgery was supposed to be around 8pm. however - by the time the catheter was in, pre-anesthetic bloodwork was conducted, and we were ready to go, it was 11:30. my other patients were settled, and so in i went.

i was supervised by my attending clinician - but the surgery was up to me. and of course it couldn't be a simple foreign body removal. nope - not my first. it had to be spectacular. i exteriorized the stomach, gently palpating the bloated sac. i instructed an orogastric tube to be placed so that the material in the stomach could be removed. gentle palpation revealed masses of plastic. good - i knew where some of the pill-cutter was. i moved down the GI tract, softly squeezing and slipping the intestines through my hand. at the junction between the ileum and cecum (small intestine), i hit pay dirt. a huge wad of plastic - jagged and sharp - lodged there. i continued to palpate and to my immense dismay also found plastic in the colon. the colon is a nasty organ. surgery is absolutely avoided in that area whenever possible because of the poor healing associated with that part of the intestines.

sighing, i returned to the stomach. i made a small incision in the middle of the body and went to work removing the incredibly jagged plastic. but i couldn't find the razor blades. after suctioning and lavaging the stomach and feeling around more and having dr G feel around more, we decided they must have passed into the intestines. we closed the stomach and moved to the intestines. the mass located at the cecum was absolutely torturous. after incising the small bowel, i spent 20 minutes removing all of the plastic. the good news was that the bowel was healthy and pink - no sign of devitalized tissue. yet. and still.....no razor blades.

and then the colon. dr G suggested an ingenious idea. we used extremely long forceps (with an equally extremely long name that i have since forgotten) and had an unlucky extern remove the plastic rectally. and still.....no razor blades.

we were at a loss. it seemed unlikely the dog had passed the blades. the referring vet had taken the xrays a mere 1 hour before we saw the dog. the owner was very vigilant. so - by all appearances - the blades were still in the dog. dr G whipstitched the linea for me, and we took our patient to radiology. xrays revealed the razor blades.......................still sitting in the stomach. sighing with frustration - at hour 2 of surgery - back i went. i re-opened the linea, stared at the stomach for a moment, and then make an executive decision. my incision this time was 10cm. lavaging lavaging lavaging - and then - the razor blades made their much longed for appearance.

i closed the gastrotomy site and sighed with relief. 45 minutes later, the patient was recovering. and then...badness. her abdomen started to swell. i took a sample, and it was bloody fluid. ack. fearful that she had perforated a gut or that one of the enterotomy sites was leaking, i looked at the sample under the microscope. no bacteria. whew. over the last day and a half, she has been slowly improving. this morning, we offered her a tiny bit of bland stomach diet. and she wolfed it down. when i relayed this information to her extremely worried owner, i was engulfed in a minute and a half long, very soggy (as he was crying) hug.

and that - folks - was ONE of the myriad cases i handled on tuesday night - my first night as a veterinarian. more to come later on the other interesting cases i saw.

caveat

ok people - after talking to my mother and reading the comment left on "oh heavenly day" - i see that i have hurt some people's delicate feelings. there's nothing wrong with reading romance novels and christian books. i wasn't insinuating that there was. i was merely stating that i'm afraid that i'll mellow too much with age and lose the person i am in favor of becoming someone i feel obligated to be (but don't really want to be). it's not a criticism of anyone that i don't want to read romance novels or christian books or watch G or PG movies. so stop taking it that way.

psychosomatically ill

i feel queasy. last night, i didn't want my dinner. i only ate half of my homemade turkey breast salad with macaroni and nuts before i threw the rest down the garbage disposal. today, i cooked tuna melts and fries. and i couldn't eat a whole (small) sandwich. my entire GI tract feels loose and watery. it's been 2.5 months since i did any small animal medicine. and tonight - oh tonight - i'm on emergency medicine.

ugh. and i dreamt of tornadoes the other night. when i was younger, i had a deathly fear of tornadoes (we were in one when i was 8 or so). i've somewhat overcome that fear, although storms still frighten me more than the average person. at any rate, whenever i'm truly worried about something - i dream of tornadoes. the proximity of the tornado is always directly proportional to how close the worrisome event is. in my dream on sunday, the tornado was right on top of me.

**blech** i need to vomit.

we now return you to our regularly scheduled broadcasting...

i called my new boss last night and told her that i was 1) suicidally bored now that moving in was accomplished and 2) that veterinary knowledge was leaking out of my head daily.

thus, i start my internship tomorrow evening at 6:30pm. i'm working the overnight emergency shift.

oh heavenly day

i'm not even sure that anyone reads this blog anymore, but hey -- it's really all about me anyway, right?

so - after living here a week, jim and i ventured forth into the heart of our new city. and i love it! downtown chattanooga is a beautiful place. there are 2 downtowns - in a way - one on our side of the tennessee river, one on the other side. the river is spanned by 2 large driving bridges and one very large walking bridge. it's a trestle bridge with a sunken middle, so i suspect it was once a railroad bridge. the view is lovely - you can see the hunter museum hanging off of the bluffs, coolidge park on the banks, and the island in the middle.

i can't get over the art scene in chattanooga. it has one! the beautiful hunter museum hangs on the edges of the limestone bluff overlooking the chattanooga river. surrounding it are many more smaller galleries, cafes, and inns. there is also a sculpture garden positioned on the top of one of the bluffs. most of it was modern art - and therefore not my taste - but there was one quite arresting sculpture of icarus. it's icarus, on his tiptoes, straining upwards, hands secured to his foolish wings. the sculpture is almost parallel with the ground, and it's positioned at the very edge of the bluff - as if - at any moment - it might take flight. i must say i was quite enamored of it.

we ate a local pizza joint called lupi's and were quite happy with the quality of our food. we also cruised around the famous tennessee aquarium. we didn't go in - but the landscaping outside is like a tour in itself. it's beautifully done - streams are built into the sidewalk. they're incorporated to look like part of the sidewalk itself was washed away by the stream's exuberance. in one area, a fountain spurts straight out of the ground. at that point, the pavement is pushed up and fractured, as if the fountain blew straight through it. there were kids in bathing suits everywhere, playing in the fountain. the whole air was one of festivity and joy in the summer day. not to mention that it was a truly gorgeous mid-june day. hot but not too hot, humidity within a tolerable range, and a hard, blue sky. there was a strong breeze off the river - and it was just ... lovely.

after eating, we roamed some of downtown on our side of the river -visiting art galleries and eclectic shops full of locally crafted jewelry, artwork, and the like. we found a great used bookstore - and it was there that the thrill of my day occurred. carol and barbara. barbara was in her 60s, carol in her 50s. they were funny, interesting, and they liked the sorts of movie and books and music that i do. "there will be blood" "no country for old men" - they discussed these movies with vivacity and genuine interest. and they told me about their book club - which is currently reading cormac mccarthy's "the road." i'll be joining them on the last monday of this month - and i couldn't be more excited. people with my interests! people who like the books and movies i do! people i can relate to in chattanooga. it was also heartening to see older women whose interest in independent films and culture and books and art hadn't slackened with age. i'm always afraid - on some level - that when i'm 60, i'll take to reading books like romance novels and christian stuff, and watching G and PG rated movies. it seems that taste must age like everything else and that i'll lose mine as i grow older. these women gave me new hope for myself.

all in all, it was a lovely day.