Road Trip Part 2: Starting to Settle In

I still haven't put my bed together although I hauled the futon upstairs to the bedroom. The space is slowly starting to come together. Unloading the trailer didn't take long, but it took me two days before I was able to get the kitchen clean enough, and before I was able to find all of the requisite equipment to make some coffee.

I've been getting the place cleaned and organized before the PODS arrive on Monday. I've got a week to unload them, plus another week after that to at least partially unpack before I start my new job.

This cheerful space will be my office. I finally got internet set up last night. 

I think you can tell that one of my priorities was dog beds!

The cat has finally starting showing up regularly for meal times, and is sleeping with the rest of us upstairs at night. The fence is not completed, so the dogs have to potty in the front yard on leash, and they are none too happy about that. They are all still a bit jumpy--the trip was hard on them too, and they are just starting to get used to the new environment. It will take time for all of us to settle in.

Road Trip Part 1: "It Was Fairly Horrible"

So exactly how does one get three dogs and a cat from Oregon to Arkansas? Driving was the best option but it came with some unique risks and problems. That's a long trip for just one driver. Plus I was going to pull a 5x8 foot trailer. And my plan wasn't too clear on lodging options. I figured that I would just pack it all up, hit the road, and figure things out on the way.

Taken in Utah.

It was a marathon event. I drove 2350 miles in three days. I did a bit less than 600 miles the first day, just under 900 miles the second day, and around 850 miles the third day. It was fairly horrible.

The cat was not doing well. He was in a large crate with room for a small bed, litter box, and bowl of food, but he was by no means happy or comfortable. He wasn't eating, drinking, or using the litter box, and that can be a big problem for cats. I was worried about him, and decided the sooner we reached Arkansas, the better. I was going to spend the same number of hours on the road, and whether we pushed through in three days or four wasn't going to change that.

And about those sketchy lodging plans? After wasting an hour or more trying to sort out a hotel on the first night (when I was already exhausted), I gave up and slept in the van in an interstate rest stop, buried in a pile of dog blankets and the two terriers. With four crates in the van, there was just enough room for me to sort of stretch out along one side. I could only let the terriers out--no way would I have been able to lie flat and let Azza out too. I did the same thing the second night too. In a way, it was easier. I could feed the dogs in their crates and didn't have to shuffle a hundred bits of crap in and out of a hotel room. Sure, I didn't shower for three days. And it was really cold both nights, around 45F. But I have plenty of dog blankets and the terriers are used to sleeping right next to me. So it worked out.

I stuck to major interstates for 99% of the trip. It was a good plan because I was able to stop often, let the dogs out and stretch my legs.

Here are some random observations from the trip:

• There is a lot of empty country out there. 
• Wyoming is fucking enormous. And empty. But amazingly beautiful. 
• Even after three days, I would look up at the rearview mirror and think, damn, that car behind me is too close, before realizing it was the trailer. I packed the shit out of that trailer. It was about the same size as the van and didn't move an inch even in high winds. 

Dogs along the driver side, cat in the dark red crate. 

• Kansas has the best rest stops I have ever seen. Large grassy areas surrounded by trees, places to pull the van and trailer into the shade, clean bathrooms. 

Enjoying some early morning Kansas sunshine.

• Oklahoma doesn't even bother with interstate rest stops. Disappointing. 
• It takes a pile of five thick fleece dog blankets to muffle the seat attachment brackets on the floor of the van but once they were in place, and I was wrapped in another king-size fleece blanket with two terriers snuggled in with me, I slept pretty comfortably. 

There was snow on the ground at the rest stop outside of Laramie, WY. Mimi is not amused by the cold winter wind. 

• I can't come up with a good reason for this, but with respect to traffic, the east-west corridors were the most empty and the north-south corridors the most crowded. 
• While I can confirm that the coffee culture of the Pacific Northwest has not fully penetrated The Big Empty of the western US, decent coffee can be found. 

So after three days, we arrived at the new house. My bed was in the trailer, but after that trip, I was too exhausted to even contemplate trying to unload anything. Plus we rolled in close to midnight and that's no time to be toting boxes and bales. So I slept on the floor of the house for yet a third night in the same pile of dog blankets, although this time Azza was able to join us.

Diary of a New Veterinarian: We Did It!

The Oregon State University College of Veterinary Medicine Class of 2019 graduated yesterday. I'm glad I went to the ceremony--it was just the right amount of emotion and tradition. I think we were all quite surprised at how nervous we were. The important part was walking across the stage, being hooded by two faculty members that our class voted on to do this task, then being handed a fancy diploma by the dean. Once that was done, the rest was downhill. I suppose that my perspective is skewed since I am at the start of the alphabet and was the second of our class to cross the stage. The last person had to watch the other 53 of us cross before it was her turn--I'm sure she was far more wrung out by that point than I was.

I was fine until it was all over and I was saying goodbye to my pocket pet, my best friend in our class. She started her internship this morning. I'm still packing, planning to head out this weekend. When we realized that we might not see each other again for months, maybe longer, things got a bit teary. I will miss her fiercely.

This photo was taken before the ceremony when we were all nerves and smiles.

Over the past four years, I got to know most of my classmates, particularly those in my surgery groups and in my fourth-year clinical rotations. As we now scatter to all kinds of interesting jobs and internships, I hope that I can keep up with all the exciting things they are doing and learning.

Diary of a Fourth-Year Student: "Stefan and His Bestie"

One of my classmates is going to do a presentation on Stefan, the alpaca with perplexing skin issues. He and I visited Stefan's stall so I could show him the nodules, and he took this pic and sent it to me with the title "Stefan and His Bestie."

Stefan was recently sheared so the weird carpet-like texture of his coat is the result of that. Nothing to do with his skin nodules.

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.