Tuesday, August 01, 2017

Diary of a Third-Year Vet Student: The Clients In Front of Us

I'm doing a bit of shadowing this summer at the clinic I worked in a couple of summers ago. I've got my research project to finish up and it takes first priority, but I figured I could put in a bit of time to learn more about the kinds of vet things they never teach you in school. For example, I was observing a vet rinse out an abscess from the abdominal cavity of a rat. It was a rather spectacular operation because she ended up getting 46 g of pus out of that abscess (weight of rat before operation: 446 g, weight of rat after operation: 400 g). Pus fountains galore! 

I noticed she was using dilute betadine solution to rinse out the abscess, which was by this point completely walled off from the rest of the rat's abdominal cavity by fibrous tissue, as is normal for an advanced abscess like that one. I have seen other operations in which rinsing out wounds would be done with dilute chlorhex solution. Once she finally determined there was no more pus to be had and she had closed the incision (mainly done with skin glue since rats are known to self-harm and would pull any sutures out--no reliable e-collars for rats!), I asked her about her criteria to determine when she used betadine and when she used chlorhex for lavage. She told me that she uses betadine for anything involving serosal membranes in the gut (i.e., exposed visceral surfaces) or mucous membranes in the eye, vulva, prepuce, or mouth. Lacerations and things like that could be rinsed with either solution. That same night I also learned that for the purposes of anesthetic monitoring of heart rate, temperature, and blood pressure, ferrets can be treated as tubular cats. 

In just that one night I learned a handful of very useful things that I will never learn in school. Well worth a few hours of my time.

There are of course many aspects to being a good vet beyond knowing which suture to use (or not) or memorizing dosages of the erpy dog drug trifecta (maropitant, famoditidine, sedative or analgesic of choice). I am pretty sure that I posted a story on the blog about the Kale Vet who was recommending a raw bone-raw meat-kale diet to two homeless people to help their dogs who had some really itchy skin issues. She was not treating the client or the patient in front of her but some sort of Ideal Client. I was reminded of that again last weekend.

I spent most of my evening working with a couple, man and woman, who had brought their rat in for euthanasia. The rat was 2 1/2 years old, already pretty old for a rat. He was having seizures, hypersalivating, had become paralyzed in his hind legs and had lost bladder and anal sphincter control. The vet introduced me as a vet student and had me examine the rat. Our diagnosis was neurological, probably a tumor, probably pressing on the spinal cord or brain or both. It's a common thing to see in older rats.

The man was overweight, dressed in baggy, saggy, stained pants and wearing a stained white Tshirt, an undershirt really. The woman was overweight, had long, straggly blonde hair, angry, spotty skin, and was wearing a black miniskirt and a light blue top that was far too tight for her.

How easy it is to judge, isn't it? I fell right into that trap. I am ashamed to admit that, at first, I failed to interact with the client in front of me.

But they loved their rat deeply. They had watched him all day getting progressively worse and they knew that it was probably time to let him go, even though they had a tiny bit of hope that it might be treatable. The couple wanted to be there with the rat, so once we injected the pentobarbital (intraperitoneal injection), I took the rat back to them. And because I know it is not a good idea to leave clients alone in that situation, I gave them privacy but I checked in often. 

When I would go in and examine the rat, cradled in a towel in her arms, they would tell me stories about the rat, about the silly things he did, about his daily routines. I asked them questions about what rats eat and how he interacted with other animals. I learned that he had a specific type of coloring called "siamese" which gave this white rat with pink eyes a brown stripe on his nose and another above his tail (it's a real thing). As we talked, I began to see them, really see these clients and this patient in front of me. They were able to laugh even in their grief because their rat had had a pretty joyful life. They knew a lot about rat behavior and were willing to share that with me.

And I was reminded about how important it is to interact with the clients and patients I have right now, right in front of me. I never want to become the Kale Vet, oblivious to all but her own woo and her own agenda.

Before they left, when the vet was in the room, the woman turned to me and said, "I'm so glad you are going to be a vet. You will be a credit to the profession."

I did fall into the Kale Vet trap and I am ashamed that I did but I managed to correct my path before I failed those clients and that patient.

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