Diary of a Fourth-Year Vet Student: The End is Nigh

Not that anyone is counting, but I only have 7 1/2 days of clinics left, including one evening ICU shift and one ICU on-call shift. The Class of 2019 will be released on Wednesday, June 12, at noon, and I heard a rumor that there is a plan for the group to decamp to the parking lot across the street for some public alcohol consumption. I'm up for that.

I just finished my RVP (Rural Vet Practice) rotation. That is one of the most highly rated rotations, even for small animal folks, because it is so hands-on, and the clinicians and techs are great. You spend one week doing horse dentals, and one week doing a lot of pregnancy checks on cows.

Let's break those two things down a bit. Horse dentals, at least when they are done according to recent standards of care, involve honking big power tools with scary grinding surfaces. The clinician shows you how to do it on the first patient, then lets you do all the work for the rest of the week. Horse teeth grow continuously, not like human teeth, and they can develop some really crazy points and sharp corners and waves and wonky bits that result in malocclusions and ulcers on oral mucosa and tongue. They also get fractures, abscesses, and other things that require tooth extraction. The extraction tools look just like the ones we use for dogs and cats except they are many times larger and enormously heavy. Think medieval torture implements except these are clean and shiny. Horse dentals are extremely satisfying because with just a bit of training and 20 minutes of work, you can make that horse so much more comfortable. But the actual procedures? The best metaphor I can come up with is thrash rock--lots of yelling and hammering and blood and spit flying around. When you are done, you are covered in tooth dust, spattered in blood and bits of feed, and sweating like a, well, a horse. It is exhilarating.

Preg checking cows takes a lot more practice to become proficient. It is done via rectal palpation. By feeling through the rectum, you have to find the cervix then pull the uterine horns up onto the pelvic rim and palpate along each horn to the ovaries. You often have to shovel poop out of the rectum before you can feel anything. As a bonus, the cows also pee, poop, and fart on you. The first dozen times you put your arm up a cow's butt, it feels like nothing more than a huge, very warm bag of gooey guts in there. For some people, that's true for the first hundred times they do a rectal palpation. But managing pregnancy, particularly for the dairy industry, is a critical component of that business. Misdiagnosing a pregnancy, saying a cow is pregnant when she is not and vice versa, is a costly mistake. It is quite challenging to work at this procedure and get better and better every time you do it.

The RVP rotation also offers plenty of other kinds of exciting opportunities for students to do procedures on large animals. For example, I did a field castration of two yearling horses...by myself. The only part that I did not do was tie them up once they were sedated and on the ground--that was a matter of safety for all personnel so the clinician did this part himself. Field castrations are not sterile, although they are done as cleanly as possible. We use devices called emasculators, which do exactly what you think they do based on that name: they crush the tissue of the spermatic cord and other bits in that area. One of the yearlings was an Arabian who was so nasty that his owner was covered in bruises from his hooves. It was super satisfying to cut his testicles off, let me assure you. 

And I got to help manage a bull who needed some serious hoof trimming. He was so large, weighing in at well over a ton, that he would not fit in our squeeze chutes. Although he was used for breeding, he was treated like a pet and was quite docile, so we walked him out to a horse paddock and did the procedure outside. Here's a picture of me keeping a hold of one of his legs so he didn't decide to wake up and kick the clinician working on his hooves:

The RVP service rarely has in-patients since most animals are treated during farm calls, but I happen to have one this weekend that I'm taking care of following a procedure we did on Thursday. A friend pointed out to me that this alpaca is the very last patient that I will ever have in vet school. So to honor that bittersweet milestone, here's a quick pic of me and Stefan:

We are getting so close, so very close, to being done.

Diary of a Fourth-Year Vet Student: No-Willy Willy

Sure, we vet students can succumb to the charms of cute puppies and lambs as much as the next person. But show us a truly broken little nugget and we can come to blows about who will hold that precious baby next.

Willy is an adult male chihuahua. He was found wandering in the desert, severely dehydrated, with his eyeballs hanging out of the sockets. Those were duly removed and the sockets sewn closed. He is mostly deaf. His jaw was broken some time in the past and the top and the bottom don't line up anymore. He's missing most of his teeth, so his tongue sticks out of his mouth all the time. He's got terrible allergies. And he had a mast cell tumor on his prepuce, so his prepuce and the distal part of his penis had to be removed. Our soft tissue surgery service did that procedure last week, i.e., they removed Willy's willy. He has a new pee hole a little farther back along his belly, closer to his anus. In short, Willy is a mess. But oh my, he is exactly the kind of mess that gets vet med people worked up.

Willy spent a couple of days in our regular wards for all of his pre-operative testing and imaging, and then a couple of days in ICU after his surgery to make sure he was recovering nicely. I wasn't kidding about people arguing who was going to hold him next. This dog never touched the ground except to pee or poop for four days. I repeatedly overhead people say "You've held him long enough. It's my turn."

I would take him without hesitation. I'd put him in a baby sling and carry him like that everywhere. One of the clinicians said "Cuddles CRI. That's what he needs. Cuddles CRI." Which has to be one of the funnier vet med jokes I've heard in a while. A continuous rate infusion or CRI is how we deliver certain drugs that get metabolized very quickly. With an IV catheter and pump, we can drip a continuous flow of these drugs, usually pain meds or sedatives, into an animal to keep them comfortable. Willy needed cuddles, stat.

I am utterly amazed and grateful that I go to school with and work with the kind of people that get emotional over dogs like Willy.

Diary of a Fourth-Year Vet Student: Doing Amazing Things

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.

Diary of a New Veterinarian

Nope, despite the title, I haven't graduated quite yet. I still have a couple of hideous rotations to slog through, and a couple of fun ones right at the end. And I have to pass them, of course. Then all the credits have to be counted up and the degree awarded.

But the worst parts are over. I have been kind of serially paralyzed by some pretty big stressors. I took the national board exam in November, but had to wait until mid-January to find out if I passed. I did. Then I started to apply for jobs. That's never fun but I kept slogging away at it. Many of my classmates already know where they will go after graduation in June. If they applied for residencies or internships, they were informed of those results in January. Some of them are going back to their hometown clinics--they knew that was their destination even before they started vet school. That left the rest of us scratching our heads, wondering where we would end up.

Last week I set off for a series of interviews. Typically for this sort of thing, some went very well, some were just duds. I got home, still wondering where I was going to end up. But by Monday of this week, I had three firm offers in hand. Written offers. Good offers. Great, right? A problem of privilege to be sure. But it was also a new kind of stress!

And the three offers could not have been more different. One was from the USDA. The offer was to be a supervisor inspector at a poultry plant in Georgia. Pros: good government benefits, very low cost of living, I'd come in at GS12 with a very good starting pay, and a very pretty place to live. Cons: I'd have to stick with a rather unstimulating job for a couple of years before I could move into something more exciting. Another offer was from a small animal clinic in Texas. They wanted to hire me to work overnights. Pros: excellent salary and benefits package, lots of new challenges and learning opportunities, schedule was four nights on, four off, leaving plenty of time for daytime activities. Cons: high cost of living in that area, and my heart was just not into being a small animal clinician. But I could name half a dozen of my classmates who would have given a digit or two to get that job offer.

The final offer was from the Arkansas Veterinary Diagnostic Laboratory in Little Rock, Arkansas. I wanted that job from the moment I read the job description. I did a phone interview in January then a site visit last week. I worked my ass off in that interview. And in a strategic move, I added a fourth reference to my usual three to provide additional depth and breadth. Pros: good salary, low cost of living, great work-life balance, interesting work. Cons: it would be picking nits to find some. Even better, that particular position can be eligible for a loan repayment program. Not guaranteed, I have to apply to the program, but there is a decent chance of getting at least some loan relief.

I gave all three offers a reasonable evaluation (more in depth than I have done here, of course). Then I accepted the Arkansas offer as I already knew in my head and my heart that I would.

And it should not be a surprise to anyone that I am now pre-approved for a home loan (that literally took only 20 minutes, the result of extremely clean financial living for the past few years--the banker guy and I laughed when he pulled my credit scores) and am working with a realtor to find a house. I may even fly out next weekend to look at some properties.

I'll be in Little Rock by the end of June, and I'll start my new job (more on that to come) in July. Exciting times.

Diary of a Fourth-Year Vet Student: Catching My Breath

I just completed the third of my "big four" clinical rotations: large animal medicine. I finished large animal surgery and small animal surgery back-to-back (that was it's own special kind of hell in a year of hell) in November-December. I've still got small animal medicine to get through, and start it in three weeks.

Large animal medicine, the clinical rotation, trips up just as many people as large animal medicine, the third-year lecture series. Two classmates failed at least one term of third-year lecture and will have to repeat that. And at least two of my classmates will have to repeat the rotation. All four weeks of it, not just a makeup day or two. I was holding 'bated breath all morning waiting for my evaluation to roll in. It was fair, quite fair, and I got a score of 86 out of 100. I am not perfect in my skills but I tried really hard. I also had some challenging patients.

Large animal medicine is for the most part an emergency service and that means we see lots of very sick animals. During my first two weeks, I euthanized 75% of my patients. During the second week, I (and my patients) had better luck, and my overall death rate for the four weeks ended up being 38%. And before you get hasty and wonder what kind of janky care we are providing, know that it's often not our care that makes the difference. Sometimes animals come in that are just too sick to save. The best option is euthanasia.

One of the interesting aspects of large animal medicine is the sheer variety of species we see: goats, sheep, pigs (lots and lots of pigs), camelids, horses, bovines, mini donkeys...and they have an amazing array of ailments that range from the mundane (bacterial ear infection in a goat) to the dire (chronic liver failure in a horse, prognosis of days to live). The diagnostic tools and the pharmacopia used in large animal medicine are quite diverse as well. Dogs and cats will look pretty boring after this past month!

The other thing about the large animal medicine rotation is the hours. I put in around 63 to 78 hours per week at the hospital (I know, I had to track it). It is exhausting.

We had a bit of a scare two weeks ago when a calf one of my classmates was treating came up positive for the protozoa cryptosporidium. Very infectious, very contagious, very zoonotic. The rate of handwashing jumped up exponentially as soon as we got the news! This week is about the time when we will start showing symptoms if we got infected so there's been a bit of texting amongst the group to make sure everyone is still okay.

I now have a bit of time off from clinical rotations. I'd like to spend it sleeping but tomorrow I get on a plane and head off for three job interviews. I had yet another phone interview just this morning that was encouraging so there may be more site visits in the future. I'd really just like to settle the matter, get an offer and a contract, think about it for a few days, then sign it and be done. Knowing where I will end up when June rolls around would reduce my stress significantly.

Diary of a Fourth-Year Vet Student: The Last Hoop

I am in Atlanta at one of the largest food expos in the world: IPPE, the International Production and Processing Expo. Over 30,000 people involved in all aspects of food production attended last year. That's a really huge meeting! People involved in production of poultry, beef, and pork are here. People involved in growing grain and other feed ingredients are here. People who make machines that process meat parts are here. People who make feed supplements (for health and growth promotion) are here. Animal pharma is here. The exhibit halls (yes, halls plural; there are three of them) are jaw dropping. Entire semi-trucks, enormous machines that pellet feed, robots shifting egg crates around a knot of conveyer belts, even functional devices that bread and cook real meat. There's a lot of fake meat parts used in the displays too, which never fail to attract my attention. I just have to give them a poke to see what they feel like.

So what am I doing here? I am working my butt off looking for a job. I don't like cold contacts but I absolutely can walk up to someone, introduce myself, chat them up a bit, then say, so, are you hiring veterinarians? It's quite surprising how few companies advertise open positions. Some exclusively staff their professional positions via recruiters. Others rely on personal recommendations. I've gotten some good leads (and some good advice) and will be sending out a lot of follow-up emails when I get home later this week.

I completed a fourth preceptorship last week and have been traveling for two weeks. Two weeks of rental cars and public transport and hotels--it's exhausting and expensive. I will be very happy to get back home. I'll be even happier if I can get a job! That's the last piece of this long journey. I passed the national board exams. I'll shortly be licensed to practice in Georgia (that story is another blog post). I have more rotations to complete although the end of my time at OSU is in sight. The last step, the biggest one in fact, is to get a good job and start putting all my new skills to work.

Diary of a Fourth-Year Vet Student: That'll Do, Pig, That'll Do

I have spent this week in a preceptorship that really put me on the spot in a lot of ways. I was constantly grilled with thought problems based on real-life scenarios that this person had experienced. I had to use a leg hook to catch feisty chickens--much harder than it looks, you have to be committed once you grab one. I had to get blood from many different types of chicken, and under time pressure. Sure, the basic anatomy is the same but some were so small I could barely tuck them under my arm (in this world, you hold your own bird to collect blood). Apparently I was only the second student in 10 years who had managed to bleed one particular strain, and even better, I pulled about 40% of the needed samples in that barn, which was not shabby at all.

And today, I got to do postings (the word used in the poultry world for field necropsies) on guinea fowl. They were not reaching target weight. Based on observation in the house and discussions with Clemente, the farm manager (who spoke only Spanish), we suspected coccidia, a type of intestinal parasite. It is such a problem in chickens that we vaccinate for coccidia, but guinea fowl do not get this vaccine. So the farm manager grabbed a transport crate and turned it on end, and we euthanized five birds who were not doing well. And I did the necropsies right there. I like to talk when I necropsy, probably annoying to some, but it is helpful if people who have never seen a necropsy before are watching you: "Hmm, the trachea and larynx are clean. Look, there is no feed in the crop. The liver looks great, smooth, no lesions. Oh, look at that gall bladder--a bit bigger than it should be, but then the bird hasn't been eating for a few days." And so on.

When I was done, the guy I am working with this week suggested a picture. There is only one commercial guinea fowl producer in the US and we were not only standing in one of his barns, we were doing field necropsies on the birds. Not many vet students get that opportunity. A picture! Great idea! Suddenly, the farm manager jumped over and put his arm around me.

And that photo is priceless to me. It says a lot that I could walk in and get the confidence of that guy in a couple of hours. Those are his birds in the sense that he takes care of them every single day. He wants to do what it takes to help them get better.

My mentor told me in the car afterwards that I had done an excellent job with the necropsies, and with Clemente.