Diary of a Fourth-Year Vet Student: National Board Exam

I took my national board exam today. It was grueling, and I am still reeling.

It doesn't help that, in my current large animal clinical rotation, I am spending 14 hours or more each day at the teaching hospital taking care of patients and being disrespected by techs, house officers, and clinicians. Every day, I am exhausted, demoralized, insulted, infantilized, and frustrated, shit on, peed on, covered in oral meds and spit, dust, mud, hair, hay, stall bedding. I have yet managed to avoid injecting myself with anything untoward and kept most liquids out of my mouth and eyes, but I have stabbed myself more than once with a pristine needle--and those wounds bleed and bleed and bleed. None of these physical or emotional states are conducive to performing well on exams.

I managed to horse trade (species joke, haha) my evening hospital shift last night and my on-call shift tonight so I at least had a break for this very special day to take my national board exam.

The national veterinary medicine board exam consists of six 60-question modules. One of the modules is experimental, intended to evaluate new questions, and it doesn't count towards your final score. You don't know which module is experimental, but to be honest, you can kind of guess. The entire thing is computerized. You are allotted 55 minutes per module plus optional breaks in between. I chose to power through, taking only a 10-minute break at the halfway point to pee and eat some snacks. Even with that plan, I was at the testing center for over six hours...and it was an hour drive there and back on top of that (mysteriously, there are no testing centers in Corvallis).

I'd say that for about half of the questions, I could confidently answer them within a few seconds, and for about 1/3, I had to choose between two answer choices (and I am a shitty guesser), and with another 1/3, I had no fucking clue. Yeah, that's more than 100%. Just roll with it.

Let me assure you that after six hours of that nonsense, if you put a picture of some parasite egg found in the shit of some animal up on the screen, I will always choose to "treat it with ivermectin" or "fenbendazole" if ivermectin isn't an option because jesus christ, it's yet another parasite egg in the shit of some animal. Throw some ivermectin at it and be done with it. Unless it is a tapeworm. Then you treat it with praziquantal. Do you want to know how I remember that? Tapeworms come out the butt in segments, quanta if you will. So praziQUANTAL is the treatment of choice.

And if you have the option of treating some food mammal (cow, sheep, pig) with an antibiotic, and you are pretty sure it isn't a gram negative bacteria and it isn't a virus, then throw some fucking penicillin at it and be done with that too.

Dog ate a wild rabbit and now has swollen lymph nodes and a fever? Tularemia. Turtle with shitty swollen eyes? Vitamin D deficiency. Outdoor cat with open-mouth breathing, neck wound, and muffled heart sounds? Stick a needle in its chest, it's drowning in pus.

I could go on. For hours.

Let's not talk about the complete wild guesses. Sometimes I would read the question and simply have no fucking idea what it was about. Infectious? Parasite? Metabolic? Cancer? (It's always cancer in real life, usually lymphoma). Do I need to think about the drugs to treat it? Sequelae to the disease if it progresses?

Am I a bad vet if I select "euthanasia" as the answer for the dog who drank ethylene glycol 36 hours ago and presents to your clinic comatose. Irreversible kidney damage has already occurred by this time. You can give it fluids but you won't be able to save it. But what is the right answer? To give false hope to the clients and offer to give IV fluids, or to get to the reality of the situation and tell them euthanasia is the only option. Does the national board of examiners want me to give false hope or give reality? I suspected the former so went with IV fluids. In reality, the comatose dog cannot be saved with any intervention after 36 hours. But the board exams don't test reality. They are testing a sort of performative theater of the ideal vet and ideal patient and ideal client, none of which actually exist.

The results of this first round of board exams will be sent out in early January. If we fail, we get a second chance to take the exam in April. The percentage of students that fail the first time is a closely held secret in most vet schools. They only report the pass rate for each class which means the percentage of students who pass the board exams before they officially graduate, not the percentage who pass on the first try.

I have no idea if I passed. It is understood that you are supposed to feel as if you did not pass, then surprise, we pass you after all! The scoring system is arcane, mysterious, shrouded in smoke and glittery distracting bits. Questions have different point values. Your percentile is relative to the scores of your fellow vet students taking the test at the same time as you, meaning your "score" is curved based on various group statistics. If you are stupid and all the other students taking the test that fall are smart, you are screwed. If everyone is stupid and you all do mediocre, then you all pass.

It's done now. I'm off to bed.

Diary of a Fourth-Year Vet Student: Absurd

So we are standing around a stall, looking at a horse we performed surgery on two days earlier. He had dozens of stones in his bladder that we removed. There are several procedures that can be used on horses to remove these kinds of stones, and none of them are all that great. The surgeon presented these options to the horse's owner and she opted for a perineal urethrotomy. In short, we got into his urethra via an incision that we made just below his anus.

Back to the five of us standing around the stall. The burning question was, how do we know which hole the horse was peeing from? There was indirect evidence that he was urinating (areas of wet bedding) but that wasn't sufficient. The surgeon was not willing to clear this horse to go home until we were sure he was peeing from his penis, not the hole we made in his urethra way upstream.

Even though the student had asked that techs look in on the horse every hour since the day before, nobody had actually seen the horse pee. Our discussion was lively but we had no solution to our problem.

Until the horse suddenly started peeing right in front of us! From his penis!

We (four men, one woman, three different countries of origin, mostly areligious) exclaimed as one "Praise Jesus!" Then we collapsed in a heap of laughter.

You know you are in fourth-year vet med clinical rotations when....the absurd becomes normal.

Here is a picture of all the food I made this afternoon. No matter how tired you are, if you come home from the hospital and sleep, you are wasting precious minutes and seconds. You need to prep meals for days in advance whenever you have a chance. And have plenty of pocket-friendly snacks on hand because you might not have the five minutes you need to heat up then eat that nice food during the 14 hours you are in the hospital every day.

Diary of a Fourth-Year Vet Student: Choices

You know you are a fourth-year vet student deep into your clinical rotations and lost to human norms of behavior when you take your pellas off to pee and your pen falls out of your pocket and into the toilet, and you think, "eh, it's been dropped into worse things three times already this morning and I kind of like that pen"... so you fish it out.

I had a dozen exam gloves stuffed into another pocket. No, I didn't use one. Yes, I washed my pen when I washed my hands. I'm not that far gone yet.

This cute goat, my patient for four days, says "hi!" 

Diary of a Fourth-Year Vet Student: Dealing With the Bodies

All vet students at my school, regardless of their chosen track, spend two weeks with pathologists and pathology residents in the necropsy unit. I just finished this rotation during which I performed necropsies on barn owls, rabbits, dogs, a cat, a sheep, a goat, horses, cows, and a sea lion. We had three sea lions last week and another one this week. I spent two weeks cutting up dead animals, handling their entrails in a modern version of augury.

Necropsies are a systematic examination of the tissues of a dead animal. We are looking for changes in the tissues that might be associated with disease, that might give us a hint as to the cause of death. Sometimes there are no gross lesions (gross meaning we can see them with our naked eye). Sometimes the problems are impossible to miss. But you can't just find the obvious things and call it a day--you have to carefully and systematically examine (look at and often finely dissect) all the tissues to make sure there isn't something else going on that is even more important but less spectacularly obvious. You also have to collect tissue samples for different purposes (bacterial culture, or tissue placed in fixative that will be used to make slides for histopathology).

I did a solo necropsy on a 6-week-old Angus calf this week. Poor thing had severe suppurative pneumonia--his lungs were nearly completely replaced with abscesses filled with thick, greenish pus. After systematically examining all of his tissues and collecting the necessary samples (took me about 45 minutes but I didn't have to collect his brain), I had to dismember him to make it easier to move his remains. And I am here to tell you that even with minimal training and working alone with a single sharp knife, removing the calf's head and four legs completely from his body took me maybe 15 minutes. Someone with slaughter plant experience could have done it in 5 minutes.

Why am I sharing this gruesome information? You may have heard about the terrible ending of the Saudi journalist Jamal Khashoggi in the Saudi embassy in Istanbul, Turkey. You may have heard he was tortured and dismembered by a large group of Saudis, recordings of which events the Turks likely have, and which they likely have shared with our morally corrupt government officials. It is entirely in the realm of possibility for a single man, let alone 15 men, to kill a man and cut him into smaller pieces in a matter of minutes.

The politics of Jamal's horrific story are beyond my ability or desire to write about in this particular venue. Instead, I want to underscore the physical brutality of what happened to a man who dared to criticize his own morally corrupt government.

I am required to cut up animals as part of my training and practice of the veterinary profession. Every day in necropsy, it was just as difficult to make the first cut as it was to make the last one. Think how morally empty a person has to be to think it is okay to do this to a human being, not done for any justifiable purpose but to remove a political problem.

The house is burning down around us--all we have to do is raise our heads up and look.

Diary of a Fourth-Year Vet Student: Let's Get It On

During my anesthesia rotation, I got the opportunity to put catheters into veins and arteries of dogs, cats, horses, and a sheep who did something stupid (oxymoron) and needed surgery to fix it.

As in any profession, anesthesia has its own set of entertaining "old wive's tales" that often have a tiny grain of truth in them. For example, here's one: little white dogs bleed more than other dogs. That's not actually true--little white dogs bleed no more or less than any other animal. You can be super careful but collecting blood for analysis and inserting catheters is a messy activity, and blood is going to get somewhere awkward or inconvenient. Even a tiny, stray drop or smear of blood on the fur of a little white dog shows up like it was painted in neon.


Another interesting one is "pitbull skin." This is in fact a real thing. Pit bulls (and bulldogs and related breeds) often have skin issues, with dry scales, bumps, and thickened skin that is not elastic like normal skin. When you push a catheter into them, their skin drags on the plastic catheter and bunches up around it. The drag makes it really hard to tell where you are, and whether you have hit the vein or not (if you have a good touch, you can feel a small change in resistance when the needle tip enters a vein but that is almost impossible to detect when you are pushing through pit bull skin). When you get a bunched up roll of skin in front of the needle, it makes it all that much harder to even advance the catheter. The thickened skin also makes it hard to see the veins which do not pop up like they do in normal skin. I poked the front leg of a pit bull completely blind--conceptually, I knew where the vein should be, but I could not see it at all. Even pit bull puppies, who shouldn't have had time to develop such bad skin, have pit bull skin.

In addition to placing venous catheters to use for fluids and drugs, vet students also place arterial catheters for use in a specific type of blood pressure monitoring setup. You've probably seen blood pressure cuffs. They are not very sensitive but are easy to use, and are not invasive. But if you place a catheter in an artery and run a line filled with fluid from the artery to an electronic sensor, you can measure blood pressure directly. Large animals (horses, ruminants) always get arterial lines because cuffs don't work well on them. But sometimes small animals got arterial lines too when it was critical that we monitored their blood pressure very accurately during a procedure.

During my three weeks of anesthesia rotation, I placed lots of catheters, and I didn't miss a single one. Only two or three required more than a single poke. I had some particular successes amongst all the successes. I placed an arterial line in the lingual facial artery of a horse in a dark surgical suite when the surgeons needed the lights off to see their monitors for the laparoscopic procedure. I could only feel the artery, not see it at all. It's a miracle that I didn't poke myself in the dark. While placing a catheter in the front leg of a cat, the cat twitched as I was preparing to tape, and the plastic catheter bent and blood began spurting out. Sure that I had just buggered that up, I pushed it back in, and looked up at the tech helping me. She said, was the blood coming from the catheter or from around the catheter? I said, um, from around it. Okay, she said, tape that sucker in there. That catheter remained patent for over 24 hours--it got the cat through surgery and a day of aftercare in ICU.

I am also proud of the catheter pictured below. Sometimes, for various reasons, we have to use rear legs or the jugular vein to place catheters. This particular dog had already had many procedures done and the veins in his front legs were total shit--collapsed, full of clots and hematomas. He was a mess. On top of that, he was a pit bull and had the aforementioned shitty skin! I had to push that long, long catheter into his lateral saphenous vein with that crummy thick skin dragging all the way. He was having surgery done on both of his elbows, but the surgeon wanted to take a look at his knees for grins and giggles. When the radiographs were made and I saw my handiwork, I immediately snapped a picture of it. Beautiful!

I got much better with my taping too. Taping catheters is its own arcane art, and everyone has their preferred way. The best way is the way that keeps the catheter in the vein as long as you need it to be in there. At the teaching hospital, the first piece of tape is not supposed to be pretty or perfect--it is supposed to hold the darned thing in place while you put the pretty and perfect tape pieces on. The anesthesia techs encourage us to be less tentative with that first piece and to just get it taped on there by singing Marvin Gaye's "Let's Get It On" to us while we work. It is effective because we all end up humming it by the end of the first couple of days.