AWOL

Sorry, I've been AWOL since I came back from Hawaii. I went straight back to work the day after we returned, slightly jet-lagged, and of course, my presence brought the crazy. It never really slowed down after that. So, I'm very tired and very busy at work.

Some more pictures for your viewing pleasure.

Honolulu as we drive in to the city:

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Waimea Valley Falls (scene from Lost filmed here)



Me jumping off the big rock at Waimea Bay



Our first sunset, over Hawaii Kai (southeast Oahu)



"The Mokes" - 2 bird island sanctuaries off of Lanikai Beach

Aloha!

Hawaii was beyond anything I could have imagined. A fuller post later, but some pictures today. The highlight of the trip:

We visited a place known locally as "Electric Beach." It is located on the West side of Oahu at the base of an electrical plant. The outflow valve is underwater and pumps a ton of really warm water into the bay. A reef has sprung up along that pathway. If you go early enough in the morning (around 8-9am), spinner dolphins swim offshore. When we arrived, I was a little doubtful. It was sparsely populated, there was only a very small beach, and some very large waves and rocks against which to get dashed. I was a bit intimidated.

I'm not the world's strongest swimmer. But almost immediately, we could see the dolphins flashing into the air and then crashing back into the ocean. They were about 1/2 mile out to sea, in water easily 30-40 feet deep. I was with an experienced snorkeler and water baby whom I trusted completely (my friend Stacie) and 2 ex-lifeguards. I donned my flippers, snorkel, and mask, and prepared for the swim.

It was - bar none - the most amazing experience of my life. While we floated in crystal clear water 35 feet deep, we were surrounded by a pod of dolphins. There were babies and adults both. They clicked and squeaked. It was easy to hear them under the water. They did not seem disturbed at all by our presence, and we drifted with them for well over half an hour. No other snorkelers nearby, no tourists, no yelling, excited kids trying to touch or disturb the dolphins. Just the cool, deep ocean and dolphins all around. The swim (with flippers) was unstrenuous in the calm waters farther out.



Rocks on which to be dashed.


























































Another amazing experience was Hanauma Bay, a collapsed volcanic crater home to a warm, shallow reef. I wanted more than anything to see a sea turtle or an octopus. I was lucky enough to see BOTH. Going in the off-season is a great idea, as there are so many fewer people. The waters were calm, the animals plentiful. We swam with 2 green sea turtles (no pictures:( and one very curious octopus that darted away and then came back to check us out. He put himself in a hole in the reef, then would poke his head out to check on our whereabouts periodically. He changed colors in a heartbeat (as well as texture), from spiky and brown to match the reef to a brilliant pearl white with rippling grays bars to an unbelievably deep violet. He was magnificent and fascinating and obviously as interested in us as we were in him.































Then there was gorgeous Waimea Bay where the husband and I took the plunge from the famous giant rock (about 2.5 stories) into the warm waters and basked in the sun, stunning Waimea Valley botanical gardens, Waikiki, somber and beautiful Pearl Harbor, and just the entire experience of being saturated in an island lifestyle. I didn't wear makeup once, I let my hair get salty and tangled (it's ridiculously long), and I felt amazing. More to come....

Hawaii bound in less than 12 hours!!!!!!

Wowza

Did I earn my vacation last night...?

So, husband was out of town for the football game and his grandfather's surprise 90th birthday. I slept for 3 hours on Saturday night/Sunday morning at work, came home, laid down around 10am. Various animals conspired to keep me just barely awake for 3 hours. I finally conked out, then woke up an hour before I had to get up. So... I got maybe 3 hours of sleep before my last 16 hour shift.

The night started out slow for me as far as new patients. However, we had several very sick patients in the hospital that I had to attend to (2 abdominal ultrasounds, a hepatic lipidosis kitty, etc). I hoped the night would stay quiet. It twas not to be. Cue hit-by-car #1 around 9. Followed by hit-by-car #2 at 11. Followed by hit-by-car #3 at midnight. Then came the 2 week old kitten gravely injured that I foolishly took as a Good Samaritan, thinking that I could fix it.

Then one of my two technicians received a phone call informing her that her grandmother had just died suddenly (not ill or expected, though she was elderly). She dissolved into hysterics, understandably. We all cried.

In the midst, I had to euthanize a patient. Followed shortly afterwards by euthanizing the tiny kitten that made biscuits on my thumb. (Also made me cry)

Then the ICU quieted down around 3am. I thought "FINALLY, I can get my paperwork finished and lie down for a few hours." Nope. The phone rang announcing the imminent arrival of a dog in respiratory arrest. Shortly after, it rang again, letting us know that another likely hit-by-car was coming in.

2 massive cups of coffee and 5 Dove chocolate squares later, the exhaustion was somewhat at bay, and I finished what I needed to do. Charts, notes, and phone calls kept me busy until 8am. I fell asleep standing up in the ICU briefly.

When finally released, I came home and collapsed. It is 7pm, and I have just stirred from my coma. Time to pack...because come 9:40am tomorrow morning, I will be on a plane bound for San Francisco. Catch you on the flip side - hopefully rested, rejuvenated, and slightly tanner.

The art and the science

One of the myriad tasks a veterinarian is faced with is deciding when to try and fix a patient and when to offer euthanasia as an end to suffering. Since I am a doctor of veterinary medicine rather than a human doctor, I have the option (a blessing) of offering a humane end to pain. I rarely have to stand by and be party to endless, pointless treatment while a patient suffers. It's one of the reasons I am glad to be a DVM versus an MD. However, making this decision is an art and not a science. We're not always right. Sometimes we're very, very wrong.

Saturday night was one of those awful nights where I was faced with trying to make the best recommendation for a horrifically injured animal. "Smidge" was an 18 pound mixed breed poodle dog. He'd been used as a tug-of-war rope between 2 much larger (>60 pound) dogs. When he presented to me, a loop of intestines was hanging out of his side. He had an extremely large, palpable hernia running down his body wall. I couldn't quite tell the extent of it, but I knew it was bad.



Surprisingly, despite his grave injuries, he was fairly stable. Other than a mild blood loss anemia, his bloodwork was shockingly normal. His white blood cell count had not dropped yet, his kidneys were hanging in, and his liver and pancreas seemed to be doing ok. The loop of intestine that was hanging outside the body was still pink and actually contracting. I had high hopes for being able to save him.

I counseled his owner at length about the severity of his injuries and the need for immediate surgery. I reiterated his critical condition. They were torn. Spend $2500-3500 on emergency surgery and critical care with a 50/50 chance? Euthanize? They asked me what I would do, and I told them truthfully that I would do surgery on my pet in their situation. I was careful to explain though that I would do so knowing that death in 1-3 days after surgery was a very real possibility due to systemic inflammatory response syndrome, sepsis, acute respiratory distress syndrome, and multiple organ failure. After much discussion, they elected to proceed.

In surgery, I started by going in through the belly and enlarged the first hole I came through (the one through which the intestines were sticking). I pulled them through and looked at them. Unfortunately, they'd started to turn purple and had stopped moving. As a result, I resected (removed) about 6 inches of bowel and sewed my ends together. I then closed the part of the hernia I could get to with the dog on his back. Everything else in the abdomen looked ok. BUT...I couldn't find the right kidney. I dug and dug. I couldn't find severe hemorrhage anywhere to indicate that the kidney was avulsed. I knew it must be herniated near the dog's back. So we flushed the abdomen, and we sewed him up. Then we rolled him over to approach the rest of the hernia from the back. And that was there things went downhill.

I took my scalpel and opened up the puncture wounds on his back. My jaw nearly hit the floor. He was ripped open from his spine all the way down his body wall to the abdomen almost. How I had not seen that from inside the belly, I'm not sure. He looked like he'd been torn literally in half. The right kidney was poking up through the hole, as were the intestines. There was NOTHING left of the body wall.



I knew then that it was bad and that my patient stood less than a 5% chance of survival. Still, I gave it my best - sewing torn muscle bellies and fascia together, and poking the kidney and intestines back into the body. To orient in that picture - the dog's head is to the left. The purply thing at the top of the hole is the kidney, and next to it are loops of intestine. You're seeing basically a hole in the dog lying on its stomach/side.

In the end, he survived 2 hours post-operatively until he went in acute respiratory distress and died. The owner wisely elected not to perform CPR.

I felt terrible and moped around work the rest of the night. I felt I had wasted $2800 of the owner's money, put their dog through misery and pain, when I should have recommended euthanasia from the start. The surgery was way above my head - although, truth be told, it was far above anyone's head. There was nothing to fix. The dog had been crushed into unidentifiable fragments of meat. It was horrible.

Hindsight is always 20/20, but somehow, that is no consolation.

I told you so...

So, I did a good deed and yet again, it was proven to me (via my colleague) that doing good things for people only gives them a sense of entitlement.

Remember this woman?

She showed up at our clinic a few days ago with a sick puppy. She agreed to pay for a physical exam and xrays. The puppy had a fixable but not cheap medical problem. My colleague elected to take the puppy on as a Good Samaritan, because the problem WAS so fixable. At the front desk, the woman became belligerent because she didn't think she had to pay the bill RIGHT THEN. She thought we could bill her.

I know that's a lie because I spent several hours with this woman helping her find financial options, discussing our payment policy (pay up front or leave). I guess she figured since we did it once, we'd always do it. That's the problem with good deeds.

Responsibilities.

So, for various reasons that I won't go into on this blog (personal family history), I am a freak about money. Constant fretter would better describe me. I'm pretty sure I fretted less when I made no money as an intern than now when I make way more than I ever dreamed I would. Dealing with finances always makes me feel stressed, worried, and overwhelmed.

Back when I started at my current job, I went to the see the financial planner that administers our office's Simple IRA. My question to him was fairly straightforward - tell me how to take charge of my money and what to do with it. He gave me some advice that I found extremely useful: first - start a savings fund with 6 months' worth of expenses. Second: get life insurance and private disability insurance (none offered through my job). Lastly: start paying off debt, starting with unsecured (my student loans) and moving to secured (the house).

A year later, I can say happily that we have a) established an emergency fund (only 3 months worth of expenses yet...but still growing), b) purchased private disability insurance, and c) bought life insurance for both myself and my husband. On top of that, I am contributing a small chunk every 2 weeks to my IRA. Both of our cars are paid off (well, the Mercedes was free), and we don't have any credit card debt.

Today, we met with our financial advisor to sign papers, and he said that we are in a great position for our age and education level - and it will only improve as my husband finishes his PhD and starts working.

I cannot reiterate to my readers that are vet students or other students or just anyone how important it is to take control of your money. I know it's probably easier for me to say that, because I am making a lot of money. But as my grandparents and aunt always said, "if you can't handle a little money, you can't handle a lot of money." Take control NOW.

I'm feeling un-frettery today for the first time in a long time. I'm also pleased to say that I can now spontaneously combust if I so choose - we are covered for that eventuality.

Ah, adult life. So dull and yet so exciting.