like that, but different

There’s no way to put this delicately: tomorrow ends my 32-year run of never having to put my arm up the back end of any large animal. That’s right, today I started  a Production Medicine rotation, and I can’t avoid it any longer.

To boot, I’m even doing it old-school style: I’m waking up at 4AM so that we can travel to a 5000-head dairy 3 hours away and spend the day palpating (checking for pregnancy) literally hundreds of cows. AWESOME. Hopefully my nose will be so stunned that it won’t be able to appreciate the good smells on the 3 hour trip home.

Exactly how I envisioned spending my days when I decided to go to vet school. Sort of.

surgery!

I’m on Soft Tissue Surgery now, and really, really enjoy it. The schedule is long, but reasonable: get in by 7:30 or so to take care of any inpatients, rounds at 8, and then, depending on the day, start gearing up for surgery or start taking appointments by 9 or 10. We work steadily all morning, take a break when and if we can for lunch, and keep going for a bit in the afternoon. By 3 or 4 we have more rounds about our patients and if possible, do another surgical topic. We’ve been dismissed by 5 every night so far, but during the week I had to get back to the hospital by 7:30 to do 8PM treatments and check on my patients.

There’s minimal standing around and waiting, which is a very refreshing change. Best of all, elective surgeries (neuters and spays especially) are largely left in the hands of us students: surgeons are standing nearby and ensure the integrity of our work at key points (making sure all gonadal tissue has been removed and closing the body wall), but they awesomely give us the time and space to think things through on our own and figure out what works best for us. And sometimes, with something like learning how to operate, that’s just what you need: quiet time to think things through, to develop your own best-practices, to freak-out that you’ve done something horribly wrong only to realize that you didn’t, at all.

Being given the opportunity to realize that you’re doing something new really well is wonderful. It’s only slightly less wonderful to find out that you’re doing something wrong, but to be swiftly corrected and assured that you aren’t the first person to make that mistake.

Getting better is the best thing of all, which I think is why I’m enjoying this year so much.

8 inches

That’s how much hair I got chopped off last night. And I know that it was at least 8 inches because while I went in planning on having it taken to just below my shoulders, once the stylist told me that if I took just a little bit more, I could donate it! Which was kind of cool. And I’m a sucker. But I’d have felt like a colossal jerk if I had said that an extra inch or two of hair was more important to me than a cancer victim. And plus, I was ready for a change. I kind of love it, and I kind of want my hair back. But change is always good.

that’s more like it!

I loved my Medicine rotation. Technically, it ended as I discharged my last patient around noon today.  I loved it the first week when it was strangely quiet and we hardly had any patients, so we spent the days on topic rounds and leaving early. And I loved it last week when it started to pick up and I had REAL, LIVE patients to work with. I even loved it this weekend when I had three patients and hardly any sleep and mysteries to diagnose. It was nice when it was quiet, but the busy-ness is totally what I expected.

A patient came in with a history of mild vomiting; by the end of the day his diagnosis is undisputable: Cancer, and he is hospitalized for IV fluids and the start of chemotherapy as his owner goes home with a fairly broken heart.  Another came in “diagnosed” by her local vet with cancer; by the end of the day we’ve found fungal organisms covering her intestinal mucosa, skin and forming nodules in her lungs (and of course, no hint of cancer): she gets hospitalized for monitoring and the start of a long course of anti-fungal treatments.  Her owner gets the lucky break: he’ll take a long and expensive cure over cancer any day, and is immensely relieved.

It’s completely fantastic, figuring out what is going on with these patients.  I love it, making a list of possibilities after you’ve done your physical exam and taken your history, and then plugging through diagnostics, getting closer and closer to the definitive cause of problems.

It’s not always so easy, of course. A third patient with vague neurologic deficits, respiratory difficulty and mild diarrhea; her owners, reluctant to put an old dog through too many tests, don’t want to go too far, so we’ll likely do what we can to get her appetite up to snuff and resolve the diarrhea, and send her home.

So there are ups and downs, quick fixes and cures, the inevitable euthanasias. But doing the best thing you can for every family is really, incredibly rewarding.

Now on to surgery, and tomorrow I operate on my first client-owned patients!!!

a rant, in parts

Rant subject: The favorite saying of a medical director at a place where I did an externship had a favorite saying, which I heard at least three times as he made the case for doing an internship after one graduates. That statement was: “Vet school simply does not prepare you to become a clinician.”

Exhibit A: At the same hospital, I watched as an intern, who had graduated that May from a vet school that I am not going to, did her very first dog neuter (IN LATE SUMMER…AFTER SHE GRADUATED FROM VET SCHOOL). I double-checked with another student who goes to that school, and sure enough: students were allowed to graduate with no surgical experience other than two dog spays. No cats, no neuters, and certainly no advanced surgery. [Students at this school can do extra surgeries if they go out of their way to.]

Exhibit B: I (and I’m pretty representative of my classmates) have done two major intra-abdominal surgeries (including gastropexy, gastrotomy, splenectomy, nephrectomy, liver and renal biopsies, gastropexies and resection and anastomosis), spayed a dog and neutered both a dog and cat, in addition to spaying four additional cats during feral cat clinics.

Exhibit Ba: A classmate who just came back from an externship with a shelter (I’m doing the same thing in March) completed 56 spays and neuters during her two weeks there. FIFTY-SIX!!!

Exhibit C: On most of my small animal rotations, the students job is to take a complete history from the owner, perform a complete physical exam, formulate a plan, interpret diagnostics, adjust plans, prescribe medications, etc. OF COURSE there are clinicians there who back us up, correct us and guide us, but the responsibility is real, the expectations are real, and we do, OF COURSE, learn an absolute shitload.

So why, then, will I be SO unprepared to be a good clinician when I graduate? What better preparation is there, than three years of very directed education followed by a year working with people who’s job is to make you a good clinician? Is it the fault of some schools, who maybe have more of an academic focus and not enough of a practical/clinical one?

And is there not something in the MD’s line about not being prepared that smacks of scare-tactic? Wouldn’t it be more encouraging and more accurate to say “do an internship if you want to be an excellent clinician, right off the bat? do an internship if you want more training, and want to better yourself in that way”?

I’m still on the fence about doing an internship, and leaning more and more away from it. As the disparities between veterinary education and experience show, everything is exactly what you make of it. So if, for lifestyle reasons, I don’t feel like an internship would be right for me, I’m still not going to doubt my abilities to excel as a new vet.

job search: begins now (with a poll!)

Despite the stress of impending board exams and grand rounds presentations, I recently got clued into the fact that…well…the job market…is not so hot these days. It’s not a disaster. There’s hope, of course. But for someone who is interested in practicing in a relatively saturated area (me!), the time to start looking for a job has arrived. If I want to be employed by next summer.

And yes, it seems crazy to be looking for a job eight months in advance, but, c’est la vie. I’ll be a much happier person jumping on this now rather than waiting until I have to really be crunched for time.

So my first step is cleaning up my resume. I have one that is as recent as two years ago, but some things have changed since then so there is work to be done. I spoke with a wonderful, wonderful, experienced professor about the best practices to investigate and how to go about contacting them, and once I have a perfect resume, I’ll be sending it out. And hopefully, hopefully, I’ll be hearing some good things back!

one-two punch

Fall has arrived! But really, it’s not as bad as I feared. I’m pumped up. I’m preparing well. And generally I’m happy, which helps immensely.

In LESS THAN A MONTH now, on October 16, I will give my Grand Rounds presentation. This is a ritual which some vet schools put their seniors through (others just require it of interns, or not at all…lame!) in which each student has to give a 10-20 minute presentation on the veterinary case or topic of their choosing to an audience of faculty, staff, and some assortment of students (for us, that would be all 150 3rd years and probably a third of our own class). I’m generally okay with public speaking, but it’s still nerve-wracking…there’s always a professor or two seemingly trying to trip you up with a random question.

I have yet to choose my topic, but I have one in mind; it was one of the very first cases I took this year, when I was on ICU. It’s an topic that is interesting to me, and I think the case was convoluted enough to be interesting but not confusing. I’m going to hold out for another week before making that my final answer, just in case something better comes along for my next week in medicine.

And then, IN LESS THAN TWO MONTHS, on November 16, I’ll be taking my boards, the test that will hopefully give me a green light to become a licensed veterinarian and finish the rest of my veterinary school education in a happy little state of bliss. I’m taking it the first day that it’s offered, which is perfect for me – I’ll be very happy to get it over with. It stresses me out a little, but increasingly less so (thank GOD). I’m doing VetPrep pretty consistently and am actually getting better at it, so I think there may be hope for me after all.

So ‘m taking it in stride, and hoping for the best. No matter what, in two months, almost all of the stress of vet school will be behind me*, and that is really remarkable.

*I’m assuming that I’ll pass the boards. Because I will pass the boards.

firsts

I received my first thank-you note this week, and it made me about as proud as my first-grade self might have been bringing home an A+ on a spelling test. Which, since those sorts of things really mattered to me when I was a first-grader, is to say that I beamed, I skipped, and it made me feel really freaking fantastic.

It was from my first patient from my medicine rotation, earlier this week, an adorable and sweet little creature suffering serious urinary issues and was able to go home wednesday much improved, though not yet fully healed.

And sure, I’ve been on the receiving end of  ”Thanks to everyone” notes as a nurse, which was always really nice, but this one was just for me, and appreciative of my efforts as an almost-vet.

I might frame it.

home again

I’m back, and nearly deliroiusly happy about it. Perhaps it’s proof that I’ve become a homebody, but coming back to my little apartment, and being in my own space again, my own life again, has filled me with a warm contentment I wish I could bottle to preserve forever.

Iowa, of course, has changed: the soy fields are turning yellow and the corn fields a less-than-vibrant brown. My cats I think have gotten fatter (if that’s even possible), but it might just be a trick of my memory as I haven’t actually weighed them yet. Our vegetable garden apparently took steroids when we weren’t watching, because the vegetables are plentiful and in some instances, ENORMOUS – we pulled three zucchinis that were as long as my forearm and twice as thick; the tomato plants are heavy with tomatoes, giant pumpkins are too big for me to pick up, even the peppers came from behind and just need to turn red.

I start internal medicine tomorrow, which I’m excited for. It should be a somewhat difficult rotation, but good subject matter and a lot of learning, which is a good thing to do two months before boards.

And speaking of, I’m officially registered for the NAVLE (national board exam that I have to pass if I want to practice as a vet): I’ll be spending November 16, the first day the testing window opens, in front of a computer for 7.5 hours.

Seven more months!

cataracts, cloacas and cysts

Things have been going relatively really well at the new externship. It helps that I’ve come to realize that externships just aren’t the best thing for me generally: I’m not seriously evaluating these places as possible internships, and I do best when I have a defined role, a defined purpose and know how I can spend downtime best, as opposed to externships where I really am following people around and hoping to get taught and not get into anyone’s way.

But really, this place has been great. It’s a very busy general, emergency and specialty practice. My schedule this week has me on emergency for two days, surgery for two days and medicine for one, which keeps me on my toes. My schedule for next week will be determined by myself, which is lovely.  The quality of the medicine they practice is high, the doctors are very happy to teach and the technicians very happy to relinquish their roles and let me doing some of the dirty work (my first ultrasound-guided cystocentesis (drawing urine out through a needle through the abdominal wall into the bladder) happened today – and actually, that was my first time ever using an ultrasound as well.)

There is a lot going on, too. When surgeries wrapped up a bit early yesterday, the ophthalmologist was happy to let me sit in on his bilateral cataract surgery. And today between medicine appointments the exotics doc was happy to have me watch over his shoulder as he performed a very new surgery on a white bird (ugh, have no idea what kind of bird it was) with a prolapsed cloaca. So I’m seeing a lot, and I’m seeing a lot of stuff that probably won’t be seen in Iowa.

And another nice thing: I have Labor Day off! Which is fantastic. Of course I’m spending today getting caught up on e-mails, paying bills, and studying for boards. Not that exciting, but it’s good to be productive. Just another week, and I’ll be on my way back to Iowa!