How do you know you are a fourth-year vet student?
1. You don't have time to eat the lunch you packed for the day, and after 15 hours on your feet in the hospital, you are too tired to eat it for dinner when you get home that night. You are in fact too tired to eat anything for dinner and choose to fall into bed instead. So you take that same lunch back to school the next day.
2. You are offered a half-sandwich by your clinician and your first thought is, there must be strings attached to this, it can't be free. Then your second thought is, don't be stupid, never turn down free food. You grab it, say thanks, and shove it under your white coat because you are in a treatment area and shouldn't have food in that space. Well, you will definitely get yelled at for having food there, the clinician won't. You scurry out into a hallway, find a quiet corner, and began to literally cram the sandwich into your mouth. A classmate walks by and sees you tucked into the corner and says, hey, how's it going. You slowly look over your shoulder, your mouth full of sweet, sweet calories, and you mumble, "...small animal surgery". She nods knowingly, and leaves you to your two minutes of peace and food.
3. You have 50 competing priorities and you are literally running to another part of the hospital to try to take care of at least one or two of them when you round a corner and bump into a crying classmate. You immediately stop--because at that moment, her problems are far, far larger than whatever your problems are, and because tomorrow that could very likely be you sobbing into a bowl of canned dog food--and you give her a hug and say, tell me what's up. You listen, you give advice if you can, you listen some more, you hug her again then look her in the eyes and say, you can do this thing. Then you rush off again.
My classmate was crying because she thought her patient wasn't getting appropriate pain medications and that he was painful, and the clinician and resident weren't listening to her suggestions. I told her to go back and keep advocating for her patient. I told her that she was a good vet and what she was suggesting seemed appropriate. She told me later that day that she did go back and make her argument again, and they listened and changed the dog's pain meds. She was so happy with her patient's changed demeanor now that he wasn't so painful.
4. You get fired by a client.
This is a fairly common thing across the board in vet med, but it is more surreal in this particular tertiary teaching hospital in which all of the small animal patients are referrals only. You can't just call and make an appointment. Your vet has to contact us. The firings I've witnessed have all involved students so it seems like somebody isn't thinking these things through very well. Here is my own story.
The woman brought in a pitbull mix who, like ever so many pitbulls and their cousins, had horrible joints and terrible skin. Elbows, wrists, knees, hips--all degenerating, all arthritic and painful. We had performed an operation on one of his knees earlier in the year and she was returning so we could perform the same operation on his other knee. The dog was obese and he was so painful that he could barely walk. The problem was that this dog also had horrible dermatitis. In his inguinal area (his crotch area) and the area of his belly in front of his prepuce, the skin had open, weeping sores. The skin between his toes was so darkly stained with saliva from licking that it was not the usual red-brown but nearly black. Overall his skin was thickened and scaly. Pretty much a normal Tuesday for a pitbull. She tried to blow smoke up our ass about how he just had a reaction to being bathed at PetsMart two days before (yep, she was trying to throw some minimum wage worker at PetsMart under the bus). It actually took much longer than that for his skin to get this bad. I called the regular veterinarian and discovered that the dog had a multi-year history of chronic bacterial dermatitis that would respond to a short course of antibiotics then come raging back again. (Don't get me started on how fucked up that is--they are creating drug-resistant bacteria by treating this problem in this manner.) This was most certainly not in his history. I relayed all this to the clinician, and showed her the dog's skin. She agreed with my assessment--doing surgery on an animal with an obvious skin infection greatly increases the risk of post-surgical infection, and doing joint surgery in that case could potentially lead to a septic joint and even loss of the limb. Joint infections are not to be trifled with. So we decided to send the dog back home to see if his dermatitis could be cleared up with our recommendation of chlorhex baths and a better diet. The clinician and I went over every line in the discharge instructions before she sent me into the room with the client to talk to her about this plan.
When I told the client that we weren't going to do surgery at this time, she got quite angry. She continued to trot out the PetsMart bath nonsense. I told her that the dog's skin had been that bad for days, even weeks, and she got even more angry. True, that was a mistake on my part because if my tone was even a little bit off, that would make it sound like it was her fault, and in fact that is how I think she was taking it, but jesus, the dog's skin was frighteningly nasty. She interrupted me and said, "I am tired of this middleman business. I am tired of this. I am tired of talking to students."
I paused and said, "You do know that this is a teaching hospital?" (I am already going to hell, so in for a penny, in for a pound, right?)
She looked at me and said, "I am tired of talking to students and I am tired of talking to YOU!"
I dropped the discharge instructions on the empty chair next to her and walked out of the room without another word. Honestly, I was a bit hurt in that brief moment but it quickly turned to hilarity when a teammate asked me what was wrong (my face must have had one of those priceless expressions), and I relayed what had happened. I contacted the clinician, told her that I was really sorry but that I made a mess that only she could sort out. NINETY MINUTES later she emerged from the exam room shaking her head. She looked at me and said, "That woman is insane. You did nothing wrong."
5. You get told by a client whose pet is a frequent flyer with multiple, inches-thick folders containing his medical history, that you are the best student she has ever worked with.
I have been told that by three different clients in the past two weeks.
6. You spend four weeks working with two other students on the same very difficult rotation. You become such a smoothly functioning team that, by the fourth week, clinicians and techs can't tell which student has which patient because the three of you begin to work like Borgs, speaking with one voice and one purpose. That might sound creepy but it actually results in excellent patient care.
Nothing gets overlooked when you reach this kind of teamwork. If I was scrubbed in for a surgery, I didn't even have to ask, I just knew that Lani would be setting up my ICU treatment sheets and Sushil would be in the OR taking notes for my surgery report. If they were in surgery, I would be doing the treatments for their other patients or trotting tissue samples down to the diagnostic lab. I was lucky to be part of such a strong team.
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