impending

I’m starting a new rotation today (Primary Care; one I’ve already taken once and really liked) and I feel totally dull. Maybe it’s that I’m coming off of two rotations, in fact THE first two rotations that I didn’t particularly like. Maybe I’m tired of studying and, more truthfully, worrying about boards (7 DAYS AWAY). Maybe I just didn’t sleep well enough.

For six months I loved my 4th year life and having something new to do every 2 weeks. And now, maybe I’m getting over that a little. Angst over passing boards and finding a job and actually being an independent vet are likely catching up to me, and I’m feeling more like being able to settle down would be really rather nice.

In just seven days, a huge chunk of that angst will be over when I’m done with boards. And everything else will fall into place. In the meantime, I just have to motivate myself to perk up a little.

 

7/8ths

I don’t know how it happened: my 4th year is more than half complete. It has all gone fast, but these last six months especially, have simply vanished into thin air. I remember it all, though some (like that month in May on ICU) is more blurry than others.

Before I had even got into vet school, when I was still in the miserable trenches, I remember saying to a then-1st year, somewhat jokingly: “tell me that it all just flies by and goes really, really fast”. For some reason I thought that it would be so difficult as to make me sufficiently miserable and make time feel like it was crawling. And she said “well, truthfully, it really does fly by”. I don’t know why I didn’t believe her.

These three and a half years have FLOWN. I still can’t really believe that I’m just six months from graduation, that I’m actually going to be a vet.

validation

I was on the phone this afternoon in the hospital hallway, talking to owners of a patient I had worked with a few weeks ago. The dog has been having some mild complications and so I’ve been checking in daily to see how he’s progressing and to monitor his need for re-hospitalization. The owners are an excellent lesson in very dedicated and at the same time, very non-compliant clients: they will do absolutely anything for their dog, so long as  that doesn’t mean with-holding table scraps or not letting him chase after rabbits or their farm cats. They can be a little chatty (in a good way), and this afternoon was no exception. As they explained in exquisite detail her bowel movements, respiratory effort, appetite, etc. one of the techs, who had already walked past several times, slowed down and whispered:

“You are going to be a really good vet.”

The comment was quite out of left field, and more likely than not it was just meant to be a nice little pick-me-up. And it was exactly that – totally made my day.

Probably the best non-veterinary thing I’ve learned during my 4th year is how fantastic appreciation is. From the flowers and a card to a hug and heartfelt thanks to a pat on the back from an unexpected source, it really is the little things that make me feel completely fantastic. It is a good reminder to be more grateful myself. And it’s good validation that my career switch was a wise one: I never got a hug for finishing a Web site on time.

the final, final stretch

Two weeks from today people, and it’ll all be over: I’ll be done with boards.

In the meantime though, I’m feeling like a stressed second year again, studying for a really hard exam that I HAVE to do well on in order to pass the class. I have not missed this feeling in the past six months, not at all, but I remember it very, very well, it having haunted me for the last three years.

But I keep this in mind: no matter how it has haunted me, it has all been fine. I did fine on the exams that I needed to do. And I will on this one too.

So this it is, the last major test before I get to be a freaking veterinarian. And I’m trying to prepare myself, just as I had leading up to previous major exams: my apartment is relatively clean, and I’ve vowed to finish dirty dishes every night before bed and clean the cat litter in the morning. I’m flossing every night. I baked a lasagna, and have a fridge full of veggies and dip for snacks. I’ll get to sleep at reasonable hours, and wake up a bit early. I have a schedule of what needs to be studied (EVERY THIN I’VE EVER LEARNED), and will hopefully cover everything before the big day. Time in school will be spent wisely, so that I can get most of my work done then and have the evenings and mornings to study exclusively for boards.

And most of all, I’ll remember: only two more weeks. I can bear anything for two little weeks.

and you’re going to do WHAT to that cow?!

Like it or not, I definitely had a wide range of experiences during my Production Animal rotation. I’ll have lots of good stories with which to bore my grandchildren. Some of these stories, by the way, are not for the faint-of-heart, so read on at your own risk.

- Just moving cows around and trying to get them on to a tilt-table. For those of you who are cow-naive, it goes something like this: get them to move forward in a narrow chute with a combination of whistling/hissing/yelling/tail twisting/prodding/begging; once they’ve gotten to be in front of a table try to get a halter on them, and secure the other end to the back of  the table. Use a swinging door to smoosh them so they can’t kick out laterally. Pull wide straps down around their belly (one just behind their front legs, the other just in front of their back legs or udder) and up around the table, secured tightly, but don’t expect cows to just position their feet properly. Instead be prepared to crawl around under the cow positioning it just so, fearing for your life and getting covered with manure. Now tie the bottom legs down securely, again, must be willing to kneel down under the cow to loop the leg and get the rope through a hole in the table. Raise the table until the cow is horizontal, and now secure her top feet down, as you did for the bottom. Actually, the system works pretty well, and isn’t particularly dangerous as long as you are cognizant of the cow’s temperament and your own body’s positioning.

- The trip out to the huge, 6000-head dairy. I’ll never be the same. In retrospect, maybe it wasn’t soooooo bad after all? But then, maybe it was. I’ll have nightmares of cows running down the alley, their hooves throwing poop in my face, for years to come.

- Tapping and flushing joints  on a lame cow.

- Trans-tracheal washing a cow with respiratory disease. The little calf took the tube and saline down her nose into her lungs like a little champ.

- Collecting fecal samples, blood samples and nasal swabs on a group of beef calves. That was actually fun, probably because it was fairly warm out, and I got to get somewhat good at drawing blood from cows.

- Penile translocations on a bull. Yep, you read that right. So, a way to detect estrus (breedability) in a cow is to see if she is “receptive” to a male, i.e. to see if she will allow a bull to mount her. However, if you want to breed her artificially, you can’t just allow a fertile bull to test her out, if you will. And so, what some producers will do is surgically alter a bull into a “gomer” or “teaser” bull. To do this, the penis, which normally lies along the ventral midline, is dissected out and re-routed so that it comes out more closer to his hip – way lateral on his side. This way, he is still sexually intact so he still has the desire to mount a cow, but can’t actually impregnant anything. Apparantly, they can still ejaculate though I would guess that it would be a genearlly frustrating existance. So yeah, I watched as a few of these surgeries were performed. And honestly, I didn’t like it – it was the first time I felt, as a vet-like person, that I was doing an animal more harm than good. Boo.

- I got to scrub in on a C-section for an absolutely enormous cow. Palpating a cow from her SIDE, rather than from her rectum, is pretty cool, you can actually…feel organs! Well, I could at least. It kind of reminded me of that kids gameshow DoubleDare where they’d have to find an apple in a big vat of goup, or something. Just all warm and squishing…but with a fetus! Unfortunately, the fetus had already died when we got to him (and we pretty much knew that going in).  Between pulling it up and out of her abdomen, and then suturing closed the uterus, peritoneum, muscles, fascia and skin while kneeling over her (C-sections are ideally performed with the cow standing, but this ornery one decided to lay down mid-procedure: AWESOME.)… it ranks in between climbing Mt. Katahdin and running a half-marathon as far as most exhausting things I’ve ever done. It was also amazing seeing how much bleeding there was (I felt like Carrie at the prom, it was craaazy), and also how she just stood up, walked into her cage and had a completely uneventful recovery once we were finished with her sutures. Animals are resilient.

- Breeding soundness exams on bulls. Icky, but actually not as icky as I had feared. First do you a general health check – vitals, respiratory sounds, rumen sounds, etc. Then you measure and palpate the testicles, make sure they have normal morphology and symmetry. THEN you collect semen, take a look at it under the microscope, and are done. See how I glossed over that last part? Yep, trying to just erase it from my memory. Moving on!

- Bull calf castration. It was actually very much like castrating kittens – incise the scrotum, yank out the testicles…and you’re done. Like that, but different since the testicles were about 100x larger on the calves, of course, and power tools were involved. It was shocking how well the calves tolerated the procedure though – we just used a local anesthetic, and they pretty much just stood there for it.

So there’s a snapshot of my last two weeks. As I sit here, freshly showered, not smelling the least bit of manure, I can’t help but wonder if I’ll actually miss it next week. Kind of doubt it though.

introducing: my bad attitude!

I used to entertain the thought of being a mixed-animal vet. Not because it’s something I’m all that interested in, but because it would be a useful thing to be: there’s a severe shortage of large animal vets in the country, and it’d be good to be useful. Right? Right.

But the fact is, that it is an almost completely different job from being a small animal vet.  There is an oceans difference between working with someone’s pet/family member and working with someone’s, well, work.  And yeah, blah blah blah, there are grey areas, pet goats and horses, etc., and sure to some extent medicine is medicine, but just bear with me, please.  Theoretically I’ve always understood that, but it’s really taken this rotation to drive the point home.

There has been a lot to really enjoy about this rotation: primarily the people. I love the large animal vets, and generally I like talking to the farmers who either bring their animals to us or invite us to come out to them.  I love the gentle souls of our professors, who know how to manipulate the 1500lbs animals to do what we need them to do without causing undue stress or pain, and who can make a diagnosis over the phone but still pretend to give us the credit for it, after an hours-long discussion.

All the same, this is the first rotation that I really haven’t enjoyed.  On all previous rotations, I have tried to stop just short of being obnoxious to jump on any opportunity I get: I’ll take any case, do any task, etc., etc. It’s a learning opportunity, it’s usually fun and interesting, and if nothing else, it passes the time faster.  And it’s hard to explain, but with cows…I’m just not that into them.  90% of our “exam” time is spent just trying to get them in the stantions, or on the table, etc. It’s like every cow is a big huge, poorly behaved dog that you have to wrestle with to get anything accomplished.

With small animals, our concern is for the pet and the owner, of course: you can’t push a $4000 surgery on a poor owner. But all the same, desicions are always made with love. With food animals, decisions can’t be made of love, or else farmers would lose their livelihood. You can’t always do what’s in the best interest of the cow; often that option is actually fairly laughable. So sure the decisions are still made with compassion, but fundamentally they are business-driven, out of necessity.  And that is just not of interest to me.

It’d be like if you really didn’t like football, didn’t know the rules, etc., but were forced to go to football camp. It’s not like football will have a huge impact on the rest of your life, and sure it’d be a good thing to learn but really…is it necessary?  I don’t mind it SO much, really, but certainly, I’ll be glad when it’s over.

At the same time I can appreciate some of the insane experiences I’ve had, and will be sharing more of them soon!

Eh. I feel like a slacker with all these confessions, but I can’t love everything.

board review

I take the board exams in about 26 days, the first day that the testing window is open.  I’ve been studying fairly regularly since mid-August: my goal has been an hour a day, and over all I suppose it has averaged out to be about that. Some days (weeks, even) I have skipped entirely, but today I’ve done at least four hours since it’s been slow. Having ready access to the internet during down time on rotations has been essential – I’m able to get some studying done during the day and not totally kill my life outside of school.

Mostly I’ve been doing VetPrep, an online site that asks you questions, remembers which ones you got wrong, repeats them as necessary, etc. And actually, I’ve been doing pretty well. I can tell I’m getting better and better at it – the first practice exam I took I had just about no idea on 75% of the questions, and now it’s more like 10%. Better yet, I haven’t gotten worse than a 68% since early September, and that’s probably about close to what you have to get to pass boards.

Even so, while I’m feeling prepared and actually much better than I ever thought I would (four weeks prior, no less), I can’t imagine not feeling a bit nervous and panicky when the actual day comes. Here’s hoping it will just go well and I’ll feel good enough about it so that I don’t have to be a neurotic mess until I find out if I passed.

now, about those cows

Leading up to my two week stint on Production Animal Medicine (which I am now halfway thru), I heard the same thing from just about everyone who had already had it: You’ll love it. The large animal people and small animal people alike hailed it as being very hands on, very laid back, very dirty, sure, but very fun.  And so even though I was going to miss the familiarity of the small animal hospital, I was feeling pretty optimistic when I plodded down the long hallway in the new large animal hospital to report for duty on Monday morning.

The first day was pretty good, too. There was already one inpatient, a sick prize ram who appeared to be improving. That afternoon we had a few cows come in, I think for lameness-related issues. There was downtime, which I spent working on my Grand Rounds presentation.  And that evening, when the professor in charge said that each Tuesday, half of us (there are five on the rotation) would get to go to a 6000-head dairy, 2 hours away, to do a herd check and preg-check a significant subset of cows, I was psyched for it. Bring it on, I thought.

And so Tuesday morning my alarm dinged at 4AM, and I was at school, bag full of granola bars, climbing in to the vet truck by 4:45. It was a cold morning, somewhere in the low 30s, and the sun hadn’t even risen when we reached our destination just before 7. We geared up: took off our warmer, long-sleeved outer layers to put on the short-sleeved coveralls and boots, along with shoulder-length plastic gloves we secured with clips to our shoulders.  Thankfully, I remembered to don my hat before we walked out to the absolutely ENORMOUS main holding area for the cows.

So imagine an enormous, rectangular buildings, divided in half the short way, and then with about 10 long rows. It is indoors, but there are ginormous open windows on each end, as cows are generally healthier at cooler temperatures.  Each row held several hundred cows: on one side of the row are head gates that hold the cows still and side-to-side so that we can do rectals and vaccinations or other injections, and on the other side are larger stalls where the cows can lie down and rest, or chew cud, or do whatever cows do. Our group was in charge of one half of the building. Mind you, we didn’t have to check every last cow, but only the ones estimated to be at 40, 90 or 220ish days of gestation.

And the place was really brilliantly run. If you consider the logistics of having 6000 cows, almost all of them at varying degrees of pregnancy, almost all who will get milked three times a day, and having to move them around, feed them, keep the place clean: it’s crazy.

But when I say keep the place, clean, keep in mind that that is a relative term. If you have say 1000 cows standing in one area for an hour, you’ll have approximately 1000 piles of cow shit within the first 10 minutes. But relatively, the place was very clean.

Pregnancy checks are done rectally, not vaginally: for one you definitely do NOT want to contaminate the vagina of a pregnant animal, and two, the rectum is a fairly movable structure, so you can almost use it like a glove and reach around and find other structures, like the cervix and uterus. At least, an experienced practitioner will be able to insert his/her arm into the rectum and tell, within 30 seconds and based on various and often extremely subtle signs, pretty exactly how pregnant a cow is. Inexperienced veterinary students, on the other hand, should expect to insert their arm into the rectum of a pregnant cow and feel…a big old sack of warm poo.

And so it was, no later than 7AM that morning that I was rectal-ing my first cow. And truth be told…it really wasn’t that gross, at all. I know it sounds silly to those of  you unfamiliar with cows, but they eat grass and hay. Their poop is really pretty unoffensive. Admittedly, once I was really getting shoulder-deep and so my whole side was covered with shit, and those 29 times a cow would run by me and inadvertently fling poop at my face, it got a little icky. But the grossness I could really handle.

There were two problems that I could tell. First, never having done rectals on cows, I could recognize almost no structures. About three hours in, I patted the head of a little cow fetus, and that was awesome, but prior to that I was stuck identifying the descending aorta (an easy-to-feel pulse at 12-o-clock), and occasionally uterine artery fremitus. I didn’t feel a single damn cotyledon (the area of blood exchange between the placenta and uterus), even though I should have been able to feel them in almost every single cow. And so, it was really frustrating.

Second, once you’ve palpated a cow, you pull your arm out, and it is, of course, wet. And when you are standing in a cold building and really can’t cover your arms and hands in anything other than a plastic glove, and you are wet to boot, your skin becomes ICY. And if you’re wimpy like me, it doesn’t make for a very fun time. I was mostly palpating with my left arm, and it got to be that I couldn’t even palpate with my right because my fingers were so numb I couldn’t coordinate them to squeeze together so that I could get pass the rectal sphincter.

An hour or so in, I watched as the doctor in charge of us would walk by a pooping cow and put his hand under the stream of shit and hold the deposit in both hands. And for a while, I thought he was likely somewhat disturbed.  Eventually he took some fresh poop and slapped in it my hands, telling me it was the best way to keep warm. And he was right: fresh warm cow poop held between hands was better than any of those hand warmers you could buy at ski places. And so I ended up searching, silently beseeching the cows near me to just freaking poop already.

Another slight downside, probably relating to me generally being out of shape, was that some of those cows did not take so kindly to having someone’s arm up their rectum, and so fought back. Not with kicks, but just with good old fashioned squeezing. And so my elbow soon started to ache, and continued to, mildly, for the next few days.

By the grace of God, our professor had a class to teach back in Ames at 2, so we finished up and were out the door by 11:30 or so.  It took me a terrifically long time to warm up – my hands and wrists were throbbing as the blood started to circulate again. And I really wish that I could have gotten more out of the day – probably if I had had just five cows to palpate and practice on the day before, in an unrushed environment, I might have done better.

But, c’est la vie. It was definitely an interesting experience, and once I can look back on and think “eh, that wasn’t soo bad, really.” I’m glad I did it, though not for certain I ever need to do it again. Ever.

grand rounds

I finalized my presentation, and practiced my talk three times Thursday night, once with the other two girls who would be presenting the next morning, and twice on my own. My voice kept getting tight and shaky – even when I was alone in my apartment – and it was driving me batty. Finally I gave up and went to bed.

I woke up early Friday, inadvertently. Around 5AM, I was bright-eyed and not going back to sleep. Eventually I got out of bed, showered and got dressed in slacks and a blouse, packing away the t-shirt and jeans I’d need for my day working with cows. I had enough time to go through it one more time, and I did…and this time: it was fine. No shaking, no nervousness. I was psyched.

By the time I got to school, I actually felt much better and more confident about things. By 8, I was downright excited: in an hour, another obstacle would be completed.

Grand Rounds is a sort of tradition in veterinary/medical schools: fourth year students have to prepare a presentation ideally on a case they have seen.  If there is no such case (especially for students who present early in the year), generally they’ll just pick some subject of interest. My goal for Grand Rounds had always been to find a subject that I was really interested in, with a really well-developed case. Up until late September, I had a back-up case in mind that involved NSAID toxicity, but it didn’t thrill me that much. Finally, the last week in September, I got the perfect case: a really wonderful dog who had been mis-diagnosed with liver cancer by her referring vet; we were able to definitively diagnose her with Histoplasmosis, a fungal disease fairly common in the midwest.

I was the second student to present, and I could feel my nerves growing as my classmate before me started to wrap up her talk. And of course, she ended; the professor in charge that day introduced me, I thanked him and launched into my talk. And it went really well. I didn’t have notes with me, but had rehearsed enough that it was fairly well memorized. All the same, I was able to ad-lib enough for it not to sound canned. I made all the major points I wanted, and I got the reactions I was hoping for from the audience as well, including a few laughs. When the last slides finally rolled around, I could feel the tension leave me completely.

Another hurdle, another milestone. And in a month minus a day, I’ll pass the last one: national board exams.

me = nervous wreck

I’d really like to talk about my morning in the freezing wind rectally palpating several hundred dairy cows and how I never really imagined myself using a cow’s rectum as a warm, welcome glove (but oh, YES I DID), but I can’t because tomorrow morning is my Grand Rounds presentation and for no good reason whatsoever, I am a nervous wreck.

I have a great topic and a great case to talk about; I’ve taken public speaking classes; public speaking USED to be a big part of my job back when I had a job and I never at all minded it, so I’m not exactly sure why I’m so nerved up for it. But I am.

But really.  It’s 15 minutes of my life.  It will be fine.  Most of my audience will be 3rd years who are secretly studying their Pharmacology notes and not paying me any attention whatsoever. I know my topic well, and actually enjoy talking about it. So it will be fine.

I’m going to go repeat my mantras and chill out with some wine. Stories of me spending my days covered (COVERED) in cow shit to come.