We are getting so close, so very close, to being done with our fourth year of vet school. Most of us have obvious clinical signs of advanced senioritis. I have a countdown timer on my phone--39 days and 1.25 hours, not that I'm keeping close track or anything.
I only have a couple of rotations left. I started my Small Animal Medicine rotation two weeks ago with quite a bit of trepidation. I felt that my clinical and diagnostic skills were weak and that I would be struggling in this rotation. I certainly have had some extremely challenging cases so far, and a couple have brought me to tears. I've had patients in the ICU for most of the two weeks, which means I have to be at school by 6am every morning, including weekends, to do morning treatments and take care of paperwork.
But to my surprise, I am really enjoying this rotation. The techs are great, the clinicians that I'm working with are incredibly patient teachers, and to be honest, I have been surprised to learn that I'm actually pretty good at internal medicine. I think it helps that this rotation is coming at the end of my fourth year when I've actually managed to learn some things, including how to think about complicated disease cases. Also, I came into this rotation without worrying about all the stupid quotidian stuff you worry about in your first rotations, such as where to find things in the hospital, how to create proper medical records, who to ask for help--chasing down these things takes time away from working out cases and treating patients. I've got all that stuff sorted out now so I can focus a lot of time and effort on my cases.
Yesterday, in a quiet moment in our rounds room, I told the clinician in charge of internal medicine about my concerns coming into this rotation, but then told her how much I am enjoying it, and how much I am learning from my many challenging cases. She looked at me with a moment of disbelief, and said, "Really? You felt you were weak? You are doing absolutely amazing." And I can't tell you how good that made me feel.
One thing that I've learned is how to find the balance between what the patient needs and what the client wants. That balance may not always fall the way you think it should. I had a kitty with bloody mucus coming from her nostrils for a couple of months. Two bad signs already: chronic and bloody. Turns out kitty has a very large tumor in her nasal passages and sinus cavities that has metastasized to her brain. I diagnosed it myself by staining a slide that we made by smearing a bit of the tumor across the glass (it was of course definitively confirmed by our clinical pathologist, nobody was going to rely on just my say-so). Kitty has a very poor prognosis, maybe just a few more weeks at best.
Making this case even more complicated and emotionally fraught, when she was recovering from anesthesia, she went into respiratory arrest then cardiac arrest. Basically, she died. The alert anesthesia student on the case was watching her recovery closely, and against all odds, they restored respiration and heartbeat in this cat. But kitty continued to struggle to breathe, and I was convinced she would not make it. We put her in an oxygen cage in the ICU and I sat in front of it for two hours waiting for the owners to show up because I didn't want her to die alone. I think every single student on the small animal side of the hospital drifted by during those two hours to check on me and the cat.
Her owners eventually decided they wanted us to try to stabilize her overnight so they could take her home the next day. I was convinced this was the wrong plan. But that wasn't the balance this case needed. My clinician agreed to try to meet the owner's wishes. We came up with an overnight treatment plan, and to the amazement of all, kitty survived the night. We weaned her off oxygen the next morning and by noon she was breathing room air. Her owners took her home that afternoon. I've spoken with them a couple of times since. They are sad about her prognosis because of course we didn't cure her (no treatment would be effective at this point). But we gave them something very important: a few more good days with their beloved kitty. I would have taken that away from them if I had advocated for euthanasia that night. Medically complex and emotionally and ethically challenging--that's small animal internal medicine. I am really grateful that I have clinicians willing to help me learn how to work with these amazing cases.
