Old(er) in Vet School

Unofficial externship

2012-01-22T21:09:00.000-08:00

This week and next I'm on vacation, so I'm spending this week doing an externship at the practice where I worked before (and during, on breaks) veterinary school. We aren't allowed to do official 2-week externships for credit at places where we have worked before, hence the "unofficial" part.
I was SUPER nervous before going in today. After all, this is my chance to show them that I could be a good doctor (not just a good tech), and I would LOVE to work there after graduation.
It was great to see everyone again and I felt as though I could handle all of the cases that I shadowed today, which was encouraging.

And now for something completely different ...

2012-01-18T13:38:00.000-08:00

There was a really good deal on Groupon for Crossfit classes - 12 classes for $25. One of my very athletic friends swears up and down by Crossfit, so I figured why not give it a try?
If you haven't been before, it can be a little intimidating. I was really nervous the first time I went because there's all this unfamiliar equipment and terminology, plus people doing things like lifting heavy weights and doing handstand push-ups.
Um, yeah. I am (intermittently) the most incoordinated person I know, and although I do athletic things I am by no means a natural born athlete. This girl gotta work HARD to do things that come easily to many other people.
Anyway, I've been a few times now and it is actually fun! Yes, the workouts are crazy hard and make me sore, but the point (in my opinion) of attending coached workouts is to help you push yourself harder. Besides, you get to do cool things like climb up a rope, lift heavy things, and jump rope!
So yeah, now I REALLY need to get a job once I graduate so that I can feed this new addiction. Memberships are pretty expensive.

National boards

2012-01-13T20:35:00.001-08:00

Results from the national veterinary board exam are trickling in state by state - we got ours today.

I PASSED!

Off to have a few beers. More updates on derm craziness and state boards later!

Dermatology, week 1

2012-01-10T21:08:00.000-08:00

I started dermatology yesterday. Thought it would be confusing and boring and smelly.
It *is* (often) smelly - but actually interesting and kind of makes sense (most of the time). They are pretty methodical about taking diagnostics (impression smears, skin scrapings, etc.) in order to figure out what is going on because, let's face it - many skin diseases look alike. Then there are fairly clear-cut guidelines about what drugs and doses to use for which conditions.
The hours are very nice too - 8 to 5-ish with no on-call and rare inpatients.

I also realized the other day that I won't be in the main teaching hospital for the next 2-3 months and when I do come back it will be on anesthesia where I don't have to write records or have inpatients! My next few blocks are vacation or ancillary services (ophthalmology, community surgery, etc.) that operate out of different buildings. That realization made me incredibly happy.

ER, I missed you.

2012-01-08T14:03:00.000-08:00

I was the primary overnight student last night in the ER. It was SO nice to be back! (even with the many - um - colorful clients who came in)
As expected, I really enjoyed it. The nice (and unexpected) part was that my assessments and plans were more or less on target with what the attending would have done. They made a couple of minor changes (like adding dextrose to one patient's fluids because they were pediatric with a low-normal blood glucose) but the rest of my work was pretty solid, if I do say so myself. I've also noticed that my physical examination skills, problem assessment, and record writing have improved a lot over the past 7 months as well.
I need to remember this feeling the next time I'm on internal medicine and the clinician tries to make me feel like crap for not asking what the dog's favorite color and astrological sign are*.

*Ok, so they don't get this ludicrous with history-taking. But it's close!

Back to work

2012-01-02T21:00:00.000-08:00

After a busy start to the holiday weekend the rest was a whole lot of nothing. That was mildly annoying because you have to be within 15 minutes of the school while on call so I couldn't even really go for a proper run (especially when the gym was closed). All in all I spent a lot of time sitting in the apartment watching TV. Bor-ing!
I'm looking forward to going back in tomorrow but am also dreading it. There are still only 2 students on dentistry so we will be very busy again. I hate those days because my first instinct is to get caught up in the busyness and to work super hard. That should be a good thing, right? Actually, it's not the best idea. It only makes you exhausted at the end of the day; you don't learn more and you certainly don't get better grades from it. Better to pace yourself and keep your sanity (easier said than done).
A classmate pointed out today that we have finished 30 weeks and have 23 more weeks to go - over halfway there!

Back in the OR!

2011-12-30T17:14:00.000-08:00

Yesterday it was back to work. I'm on surgery for the next few days to cover the New Year's holiday. I was in on 3 procedures yesterday:
- Mastectomy on a dog with a small mammary tumor
- Bandage change under sedation of a dog with a horrific stifle (knee) wound
- Intestinal foreign body removal from a dog (YESSS!!! FINALLY an emergency surgery!!!)
Lest you think I'm a rock star when really I'm not, I didn't *do* these procedures. I got to scrub in and do little bitty pieces of the procedures (like making the skin incision and doing the skin sutures), and the rest of the time I just assisted but it was SOOOO nice to be back in the operating room again!
I realize that sounded really crazy to people who hate surgery but for those of you who feel like they'd rather stab themselves in the eyes than do surgery, just remember that is how I feel about internal medicine.

My pager is OFF.

2011-12-23T17:34:00.000-08:00

This almost makes me happier than the fact that I have 5 whole days off from school. I often fantasize about going Office Space on it, but school would probably make me get a new one. My school looooooves to use the student pagers for everything:
- Your appointment is here
- A client is calling with questions about their patient
- Rounds are starting
- There is a question about your ward orders
- A consulting service can see your patient now
and the ever-fun false alarm:
- Hmm - no one here at this number paged you
As you can imagine, our pagers go through batteries like it's nothing and we start to twitch when a pager tone the same as ours goes off (because the pagers only have like 5 tones to choose from).
Today we didn't have any appointments so I only came in for morning rounds and then went home for the rest of the day. I packed, cleaned the apartment (for the first time in almost a month), *and* took a nap! I'm headed back home shortly to see D and the cats there. I decided to leave the 2 other cats here at the apartment because one is very hard to corral into the carrier, both of them hate riding in the car, and mass chaos ensues when all 4 of them are together. Yes, I know they will have to sort things out amongst themselves once I graduate and move back home, but it's not worth stressing all of them out for a 5-day break.
Hope everyone is having a good holiday season!

Ewww.

2011-12-21T20:21:00.000-08:00

I'm still really enjoying dentistry. It's a good rotation for someone like me who is into semi-instant gratification. You scale the teeth and the calculus falls off. You extract the dead teeth and (sometimes) suture the sockets. Action, result. (Very different from internal medicine, but I digress).
The one thing that is a little hard to deal with are the cases of severe periodontal disease. I'm talking animals whose mouths smell like corpses, enema material, morning-coffee-cigarette breath, and so forth. One recent patient was so bad that I had to wear a mask while examining the oral cavity. Also, scooping pus out of the mouth is kind of nasty (same patient).
I had to keep swearing to the resident that I usually don't get grossed out so easily! Fortunately they told me that particular patient was the worst case they had ever seen.
2 more days until a desperately needed 5-day break!!!!!

Regressing?

2011-12-18T22:42:00.000-08:00

Lately I've been feeling fairly similar to how I felt in high school. It's a weird combination of anxiety and anger. Back then I think I was probably anxious (and angry) because my home life, well, sucked. Now I'm anxious about finding a job and angry about my grades.
I thought going into this year that my grades would remain roughly the same or possibly even improve because I feel more competent at clinical applications than theoretical ones. Not so. My GPA has dropped more than the ~0.1 that the administration said was the average change in last year's class.
The latest frustration? Internal medicine. I get all these great comments in my reviews, and yet my grade is average. It doesn't match what I was told, it doesn't match my perception of how I performed, and it doesn't match my classmates' perception of how I performed. Oh, and the kicker? It's worth twice the credits of other rotations because it was twice as long.
It is making me feel that same blend of insecurity and fury that I remember all too well from high school. I doubt my abilities now and I want to scream at these people "So what if I'm not kissing your ass, being all bubbly, bringing you baked goods, and promising to do an internship and residency just like you did? I did a damned good job and you can suck it."
It's funny because I've also been listening to some of the angsty music I liked back in the day. A particular favorite this week is "Fight" by The Cure. A sample of lyrics:

Fight fight fight
Just push it away
Fight fight fight
Just push until it breaks
Fight fight fight
Don't cry at the pain
Fight fight fight
Or watch yourself burn again
Fight fight fight
Don't howl like a dog
Fight fight
Just fill up the sky
Fight fight fight
Fight til you drop
Fight fight fight
And never never
Never stop

... I'm gonna keep fighting. Just need to make it through another 6 months.

p.s. I wonder if sometimes clinicians tear you down in order to scare you into doing an internship? Certainly fear is a main reason why most of the people I know are doing internships - not because they want to specialize!

Dentistry

2011-12-14T22:47:00.000-08:00

... is very busy. I'm learning a lot and am enjoying the instant gratification of extractions and cleaning disgusting calculus from teeth. I'm also enjoying having inpatients that can walk *and* don't need approximately 512 medications per day, all given at separate time intervals.
By the way, the second week of the exotics rotation was much better than the first - probably because I worked more with a different doctor.

Memory

2011-12-06T19:53:00.000-08:00

One skill I've had to develop this year (and perhaps the most important one) is my short-term memory. When you are performing a physical exam you need to remember everything you saw. Sure, you can write down some of it, but to write down everything would take a looooong time. Then there are the endless to-do lists: medications to order, records to write, clients to call ...
I carry around a small notebook for key things like vitals that I know won't stay in my brain for long. Each patient gets a page. So far that system has worked really well for me.
p.s. My current rotation is still driving me up the wall, but the end is in sight!

Breaking point

2011-12-02T22:25:00.000-08:00

Well, I just capped off week 1 of 2 on the exotics service by sitting at home and bawling for like 15 minutes. I am learning things, and most of the people are very nice and helpful. This unfortunately is another service with a Resident From Hell.
They are always smiling and they try hard to be nice but it always comes out wrong. They are completely disorganized and yet try to make you feel as though you're the one not getting things done. Hello? I seriously am not capable of being in 2-3 places at once. If I've taken one patient to go get radiographs, I have DEFINITELY not simultaneously drawn and submitted blood from a second patient *and* gone to the pharmacy for prescriptions for a third patient! They also practice what I think of as "popcorn" management. Whatever idea pops into their head, that's what they want done immediately. Problem is, it's totally random and often simultaneous. Makes me really appreciate the residents in small animal medicine who would sit down and really talk through a case with you.
Oh, and this person's "rounds" consists of asking you questions that you do not know the answer to (and cannot reason your way into - for example, what is the maintenance fluid requirement for birds). I tried to make a joke today saying something like "See? That's why I asked for rounds on that topic - because I know nothing about it!" and they said something like "Oh, but you learn much better this way vs. me just telling you the answer."
Really? Since when does everyone have YOUR learning style? I absolutely positively need to write things down or I do NOT remember them. Oh, and I remember exactly zero of what you "quizzed" me on this morning, asshole.
After talking with some other classmates I've since found out that I'm not the only one who has had problems with this Resident From Hell. The unfortunate thing is that this rotation is that I still feel quite alone dealing with this, and I'm afraid I'm not dealing with it very well. I can feel myself shutting down just like I did in cardiology and becoming silent and seething. The 16 hour days + on-call every 3 days is also making it pretty hard to meet up with friends to feel half normal again. The closest I came to actually being happy this week was being in pathology for a necropsy of a patient and getting to chat with a bunch of classmates.
At least dentistry (my next rotation) is supposed to be really cool.

Could we have nap time EVERY afternoon?

2011-11-27T11:30:00.000-08:00

Wednesday evening I finished my first block of small animal medicine.
Hallelujah!
I also started Thanksgiving break that night. Thanksgiving itself was low-key; D made turkey, mashed potatoes, and brussels sprouts with bacon. For dessert we had Trader Joe's pumpkin cheesecake. Friday I took one of my cats in for a dental. Saturday we ran a 5k race (which was tough considering I'd only run about 4-5 times in the past 6 weeks).
The best thing about this break has been catching up on sleep. I sleep 8-9 hours per night and have been taking 1-2 hour afternoon naps too. Amazing!
Tomorrow I start a 2 week rotation in the exotics department. I want to be able to treat small companion mammals (rabbits, ferrets, guinea pigs, rats, etc.) in practice and am hoping to get a decent amount of exposure to those. We'll see, though - the department sees a fair amount of wildlife, companion birds, and companion reptiles. Here's hoping that the other student on the rotation with me wants to take those creatures' cases!
In other news, I applied for a few jobs yesterday. They are at clinics with posted openings, which means there's nearly zero chance I will GET the job(s), but that's okay. I want clinics to keep me in mind for future openings and I needed to test out my resume and cover letter. I was also feeling a little left out since the match deadline is coming up soon and it feels like nearly my whole class is applying to internships.
I love professors' responses when I say that I want to get a job as a general practitioner:
"Oh." (short pause)
"Well, the world needs those too."
Sorry I don't want to become a world-renowned expert in a virus or whatever. That doesn't make me any less ambitious or intelligent.

7.5 hours

2011-11-21T17:45:00.000-08:00

That's how long you get to take the NAVLE.
I'm not gonna lie, it was a tough exam. I felt like I got approximately 100 chicken questions out of 360 total questions, but whatever. It's over with, and hopefully I passed so that I don't have to take it again!
Back to medicine tomorrow - only 2 more days until break!

Hunkered down

2011-11-19T12:57:00.000-08:00

I take the national boards exam (NAVLE) on Monday and am spending most of the weekend doing some last-minute studying. I feel pretty well prepared but am still nervous. I've been through all of the VetPrep questions, took the online class from VIN, and went through the board review flashcards a number of times. Now I'm reading through a study guide that one of our professors gave to us.
Fortunately I sent my inpatient home last night and don't have to go to the hospital this weekend!
The exam is 360 questions, 60 of which don't count (but you don't know which ones). Most of the questions focus on the "Big 4" species - cattle, horses, dogs, and cats. Fortunately I'd already learned about 3 of the 4 from classes and just had to focus more on cattle. Nobody knows what percentage correct you need to pass, but historically it has varied between 55-65% (from what I've been told).
Unfortunately you don't find out if you passed until February-ish. If you don't pass, then you can re-take the exam in the spring.
In my state we also have to take a state board exam, which I'll probably do in the spring. Frankly I haven't done much about the state boards yet - am waiting until I finish the NAVLE first.
Deep breaths! After that, only 2 more days of internal medicine - until the next block I have in the spring.

People suck sometimes

2011-11-14T22:01:00.000-08:00

I need to rethink the whole helping people and pay it forward thing, or at least be more selective about who I choose to help 'cause some people just crap on you in the end. I'll write more later when I'm less livid and can better disguise names and specific incidents.

A weekend off!

2011-11-12T12:37:00.000-08:00

Well, I broke my streak of being in the hospital every day at 18 days. I figured I'd hit all 31 days in a row while I was on medicine, but we actually discharged my two inpatients Thursday. Yesterday there were no appointments due to Veterans' Day, and so I ended up with a 3-day weekend. How awesome is that? On top of that, one of my inpatient's owners got the doctor and me each a thank-you card and a bottle of champagne. My first ever client gift! :D
Yesterday I slept, caught up on records, and caught up with my favorite TV shows. Today I got groceries, cleaned the apartment, and went in to help others with their morning inpatient treatments (since so many people have helped me with mine, I wanted to pay it forward). D is coming later today and I need to figure out what to do while he's here.
Studying for boards is going reasonably well. I'm really glad I started this summer because I don't feel panicked right now. Sure I'll be nervous a week from Monday when I drive to the test center and sit down to take the exam, but I'm ready.
1.5 more weeks of medicine to go!

Internal medicine, week 3

2011-11-09T22:00:00.000-08:00

I hit the wall last weekend. For anyone who runs, it was like mile 17 (or thereabouts) in a marathon where all ~~you~~ I want to do is lie down on the sidewalk. Or bribe someone for a ride home.
Last Thursday was really busy with appointments and we ended up with a completely full "board" (listing of inpatients). Now having 2 inpatients and seeing appointments wouldn't be *that* bad if:
a. I didn't have to do all my inpatient treatments (ahh, the joy of being a student)
b. it didn't take literally twice as long to do or find things as it does in a private practice (mainly because of hospital policies)
c. I didn't have to write super-detailed records

Anyway, I was so exhausted Saturday morning that I had to fight the urge to vomit. Then one of my inpatient's conditions worsened so I had to do a crap-ton more diagnostics and treatments. Then D called me; his car had broken down 1/2 hour away from where I was and he needed me to come get him. I don't really remember the drive there and am grateful I made it there safely. Then I spent more quality time Saturday evening, Sunday morning, and Sunday evening trying to stabilize the aforementioned inpatient.

This week has eased a tiny bit. My inpatients are fairly stable and one (possibly two) is (are) going home tomorrow. It seems like the busy times come and go, similar to the midterm crunch times in previous years.

I'm still learning a lot but will happily move on to another rotation where maybe I can sleep and pee once in a while. Perhaps dentistry?

Internal medicine, week 2

2011-11-02T21:36:00.000-07:00

My review last Friday was very positive, which was a relief!
So far I've seen some really interesting cases. Some of them (like my dialysis patient) aren't things I will ever manage in real life, but I can take away good pieces of information from each of them that I WILL be able to use.
Rounds can be intense, as can presenting cases to my resident and/or faculty. There are definitely some subjects where I'm weak (like immune-mediated diseases - didn't take that elective!) but other areas where I feel fairly comfortable and knowledgeable.
The hours vary - a short day is 11 hours. I think my longest day so far was 16 hours. Weekends are tough because you often pick up a case from emergency and have to do a bunch of diagnostics and treatments. Time is definitely precious - I appreciate every bit of sleep, food, and time to go to the bathroom (no, seriously) that I can get.
Anyway, I'm pretty tired but I like being busy and learning things. Here's hoping I will have the endurance to make it to Thanksgiving!

I thought people were crazy, but ...

2011-10-27T21:23:00.000-07:00

Medicine is actually really interesting and not as horrible as I had anticipated. (I thought that some of my classmates who said they liked this rotation had a screw loose or were masochists.) In fact, the clinicians are REALLY good teachers. I already feel as though I have learned a ton in just 4 days!

It probably helps that we have plenty of students on the service to cover the appointments, as well as my having luck (so far) with not accumulating > 1 inpatient at a time.

I'm a little nervous because they give you verbal progress check evaluations on Fridays, which have made some people cry afterward. Hopefully I am not one of those people. I think I'm staying on top of things enough to avoid a verbal beat-down. Hopefully.

High anxiety

2011-10-23T11:38:00.000-07:00

Tomorrow I start 4.5 weeks of internal medicine (i.e. starvation, sleep deprivation, and being constantly told you're doing things wrong).
National boards are in 29 days.
I've no idea if I will get a job when I graduate, let alone a job that won't make me hate my life and regret the decision to go to vet school.
Maybe that's why I feel like I'm gonna vomit?

Clinical Pathology (and an update on my amputation patient)

2011-10-18T22:20:00.000-07:00

Got word that the dog from Sunday is doing well and the rescue is very happy. Yay!
It's funny, after every new surgical procedure I have trouble sleeping that night because I'm worried that I somehow screwed up.
Anyway, I'm on clin path this week. It's only a week long rotation. So far we've reviewed how to analyze blood chemistries and CBCs, and how to do smears of blood, bone marrow, and aspirates. Tomorrow we go through urinalysis, cytology, and microbiology (culture and sensitivity). Friday we have to present a case analysis based on data (usually a CBC & chemistry, sometimes more) given to us the day before.
I wish that we had this rotation before clinics started. It would have been helpful for:
- Knowing how and where to submit samples
- Reviewing how to analyze data before you get on tough rotations like medicine and emergency
Oh well. I'm enjoying these short days because next week my free time will disappear into the medicine abyss. On the up side, friends have told me they've all lost a few pounds while on medicine (which I wouldn't mind - I'm about 5 lb over what I'd like to be at).

Arterial bleeding scares me

2011-10-17T13:10:00.000-07:00

Yesterday I did my first-ever amputation surgery. It was the pelvic (rear) leg of an approximately 70 lb Lab.
Let me recommend something - don't have a big, well-muscled dog as your first-ever amputation patient because a) it will take FOREVER and b) they bleed a LOT.
I was most frightened about ligating the femoral artery (hello, ginormous vessel with lots of pressure!) but that went fine. What took the most time was dealing with the back-bleeding from muscles that I had already cut off and a couple of collateral arterioles that probably came from the spinal area (they were too caudal to be branches from the femoral artery and besides, that had been ligated already).
After all of that (including getting sprayed in the mask with one of those arterioles), I was finally able to close everything up. The closure looks very nice, if I do say so myself! I just hope he doesn't ooze too much from all those freaking muscles. Ordinarily if you need to amputate a non-functioning limb, the muscles are atrophied. Not this dog!
Today I'm pretty sore. Now I see why some vets refer those surgeries. It was a great learning experience, though!

Real World vs. Ivory Tower

2011-10-12T12:09:00.000-07:00

One of the most interesting things I'm learning while on externship is how different your plans may be in a teaching hospital vs. a private hospital.
At school, you have the luxury of recommending gold standard diagnostics and treatment plans - the ideal, money-is-no-object plan - and clients (for the most part) don't bat an eye.
Outside of school, your plans are constantly being adjusted or pared down due to money constraints. You really have to have your diagnostic and treatment plans prioritized into what will give you the most bang for the buck, so to speak. Sometimes you choose subcutaneous fluids at home when IV fluids in the hospital would be best. Sometimes you choose to monitor the animal with neurologic signs and provide supportive care vs. doing an MRI to find the exact root cause of the issue. Sometimes you euthanize an animal with extensive traumatic injuries that require expensive surgery and intensive care.
I can see where this would be frustrating to veterinarians, especially if it happens with every single client. You could start to feel as though you're not doing right by the animal. I'm not (yet?) frustrated by it, though. I figure if someone cares enough to bring their pet in to see a vet, even if they can't do everything I would want, it's still better than nothing and I can at least help a little.
We'll see how fast this idealism wears off once I graduate and start working :)

Externship 2

2011-10-09T11:18:00.000-07:00

Last week went well. The clinic is in a somewhat rough neighborhood about 25 miles from my house (which translates to a 30-90 minute commute on a freeway where there are often random pieced of furniture and broken-down cars in the lanes, much to my amusement).
I spent last week with the surgery and internal medicine departments. The case load isn't quite as high as I would like, but the cases I've seen have been good ones. It's nice to see cases that you actually might see in primary practice (vs. the odd-ball cases that present to a tertiary institution like a teaching hospital). Next week I have one day with surgery again and then I'm with emergency - yay!

3 weeks of (relative) freedom!

2011-10-02T09:36:00.001-07:00

I am DONE with cardiology! Just submitted my feedback. I wrote it more professionally than the draft in my previous post, but the key points remain.

Later today I'm traveling back home and will be starting an externship in that area. The clinic is an emergency and specialty clinic. I'll be spending most of the time in the surgery and emergency departments - yay! I love both of those areas (not that I want to spend another 4 years to specialize in one of them). It will be nice to see a "real" hospital again and not one with so many complicated rules and processes. It will also be VERY nice to not have any inpatients to attend to or records to write!

After that, I have a week in clinical pathology. It's 9-5, no dress code, no inpatients, and no records. All in all it should be a nice break before starting medicine.

One Person

2011-09-26T22:55:00.000-07:00

Week two of cardiology. One doctor is off the service while another is on. The rest of the doctors and techs remain the same.

Today was approximately 1,000,000,000,000,000,000 times better than even the best day last week.

Why is this? How can literally one different person make such a HUGE difference? Granted, the doctor who is now on the service is VERY nice and (gasp!) actually takes the time to explain things! But how is it that the other doctors and techs who were also extremely grumpy and un-helpful last week are suddenly much nicer and (gasp again!) actually helpful?

Weird, but I'll take it. It was nice to not come home today crying or wanting to punch someone.

My feedback for this rotation

2011-09-22T08:35:00.000-07:00

It's only day 4 of cardiology and here are my constructive comments so far. Obviously I will clean them up a little before submitting them in my evaluation, but you get the general idea. Also obviously, this has been my worst rotation so far.

Rounds
- Not reviewing basic concepts first. We haven't reviewed ECGs in 2 years! We don’t know what you’re looking at on echos in the different chamber views.
- Asking specialist-level questions or questions on things that weren’t taught, e.g. a resident had a question for the clinician, and the clinician turned it around to students asking what would YOU recommend; asking questions about DRVOTO which was never taught; asking questions about normal echo velocities and pressure gradients, which wasn't covered well in classes and is specialist-level knowledge; asking about ECG calculations (besides MEA), which we've never done before
- Letting students flail/keeping silent when they don’t know the answer. Please review basic concepts first, start with easier questions then work up to more difficult ones, and give us hints if we are struggling.
- Topics we need more info and/or a review on: what the echo views are, how to interpret ECGs, what drugs are used for which conditions from a disease perspective (not from a drug category perspective, e.g. for SAS, we typically use these drugs and here’s why. For HCM, use these…)

Procedures
- If time permits, allow students to try doing echo after “official” echo is over (similar to abdominal ultrasound). I don’t feel prepared to perform even a basic echo to look for a grossly enlarged chamber. Most other schools allow students to practice.

Organization/Flow
- The sign-up process for appointments isn’t working. In orientation, says to sign up ahead of time and put name in computer. However, appointments don’t show up in order and then we are constantly asked to pick up whatever comes in next. Either implement FIFO or let us actually stick to what we signed up for.
- Please give an orientation on things that are different in cardio. For example, the troponin blood test needs to be in a green-top tube on ice, you shouldn't use jugular or lateral saphenous veins for pacemaker patients, etc.

Communication/mentoring
- I don't know if you realize this, but all of the residents and staff give annoyed looks when you ask for help with anything
- Please check in to see if we actually understand what’s happening (Dr. **** did this a couple of times during echos)

Overall
- I felt as though I was expected to know everything from day one and that clinicians were frustrated when I did not already know everything
- I was not encouraged to ask questions or admit weaknesses because not only did I not get ANY coaching or hints, I got annoyance
- I do not feel like I learned anything from the clinicians – all I learned were things that I frantically taught myself after hours from references in an attempt to make rounds less awkward

Cardiology

2011-09-19T19:18:00.000-07:00

Something about cardiology makes my brain stick its fingers in its ears and go "Lalalalalalalalala - I can't HEAR youuuu!!!"

You would think, as a former chemical engineering student, that I'd have this all figured out. You would be wrong.

I can hear and characterize murmurs. I can determine whether or not a patient is in heart failure. I know most of the basic medications and treatments for the big diseases - especially those that present on emergency.
That's about it, though. ECG calculations throw me (to be fair, I'd never done any besides heart rate and mean electrical axis before today). Obscure or non-pathologic conditions throw me (who cares if I'll never see it or if I'll never treat it?) Thinking through shunt loops continues to make my brain hurt a LOT.

This is what the 2 weeks is for, I suppose - to get more comfortable with the material. I just feel really really stupid, especially compared to the other students (both have been on for a week already, and one has been doing several cardiology externships throughout the country AND has their own calipers for ECG measurements!) It's just hard to not be able to come up with answers during rounds - especially since they pimp us constantly during rounds.

Maybe I'm losing my touch?

2011-09-11T12:41:00.000-07:00

The last few times I've been on call at school I didn't get called in. That's perfectly fine with me for now, although I hope if/when I'm an emergency vet I actually see some cases.

This weekend has been relaxing. I went for a run yesterday morning and this morning, got groceries today, and did laundry last night. D visited yesterday and we went to the Farmer's Market and out to lunch and dinner. Now I'm sitting watching football, and tonight I plan to try making this delicious-sounding pasta dish I found in this month's Runners World.

Week 2 of radiology starts tomorrow. It's been hard on my hip to sit (or stand) still all day, every day. Seems I do much better on services where I'm moving around a lot. I hope to get my bike back this week too - one of the brake cables is completely frozen. I need to get my bike riding in while I'm still on rotations with reasonable hours and decent weather!

Nerves

2011-09-07T21:22:00.000-07:00

Every Sunday night or Monday morning before starting a new clinical rotation, my GI tract rebels.
Every time I'm about to open a new rotation evaluation/grade, I feel like vomiting.

Stress much?

Not totally sure why I have put so much more pressure on myself this year. It's not like I'm planning to do an internship & need letters of recommendation.
It's probably because I (like most vet students I know) am terrified that I will be a crappy doctor when all is said and done, and that whole being-a-doctor thing is coming up FAST.
Just need to reframe my attitude and know that if I'm doing the best I can, then that's all I can do. It may not be enough some times, but should be enough most of the time.

Radiholiday

2011-09-06T20:26:00.000-07:00

... that's what radiology is called around here. Let's review some key points.

Start time: 9 am
End time: 5 pm (but they apologized to us in advance because sometimes we have to stay until 6 if it's busy)
Inpatients: none
Records to write: none

Let's compare this to a surgical or medicine rotation
Start time: 6 or 7 am, depending on the # of inpatients
End time: 9 or 10 pm (that's BEFORE you write records)
Inpatients: up to 3-ish
Records to write: all appointments seen, all inpatients

Now you see why it sort of feels like vacation. Of course I miss the adrenaline rushes from surgeries and emergencies, but this is still pretty nice.

I stand corrected

2011-09-02T18:30:00.000-07:00

Yesterday we had our first set of 1st-year students in the clinics. It was a surgery day on orthopedics, and I was really happy with the students we got. They were all very enthusiastic and even though they didn't all have a ton of clinical experience, seemed to pick things up very quickly. It was nice to have the help, and it was nice to realize how much I actually DO know - I could actually answer their questions! I was initially worried that having them around would be extra work, but it really wasn't at all. It probably helped that we got good students and that it wasn't outrageously busy.

Speaking of orthopedics, today was our last day. It was much busier this week. I had 3 surgeries on Tuesday and one yesterday. I think we had 6 total on Tuesday, 3 yesterday, and 1 today. I obviously did not DO the surgeries, although I did get to place a screw in my TPLO dog's plate and got to do a fair amount of skin suturing. I worked my ass off this week, but I learned a ton. Stark contrast to the last rotation where I worked my ass off and didn't learn much at all ... at any rate, I really enjoyed orthopedics and almost wish I could get another week or two on the service.

Next week I start radiology. Hours: 9-5, M-F. No inpatients, no record writing. I can sleep! Run! Cook! Watch TV! Yes!

Orthopedics

2011-08-23T20:13:00.001-07:00

Yesterday I started on orthopedic surgery. We see appointments 2 days per week and have surgery 3 days per week. Unfortunately none of our appointments yesterday converted into surgeries today so we had a lot of time to kill. We got to practice suturing, bandaging, and we also rounded a lot. It was a nice change of pace from the last 2 weeks!
Orthopedics is challenging because you have to be able to visualize the problem in 3D using your orthopedic exam and 2D images, then figure out a plan to correct it. The equipment such as the plates, screws, etc. are all specialized and you need to be able to think about mechanical forces on the bone and joints as you plan. I like it because it appeals to the engineer in me, but there is so much that I don't know ... plus I'm not sure I can ever get super-excited about ortho (as I do with emergency).
Apparently I might even get to do some skin sutures when we have surgeries. Yay - doing something!

About my last post - I think that I happened to get 2 craptacularly awful cases concurrently and that probably skewed my perception of the rotation. Don't get me wrong - the hours are still horrendous - but my level of frustration is probably higher than other students' with that particular rotation.

So. Over. This.

2011-08-20T11:42:00.000-07:00

As it turned out, I kept both crazy clients through this past week as well. Wednesday I had a mental breakdown when I got home, and this morning I had another one.

It would be one thing if I learned a lot during these 100-hour work weeks. However, I am actually not learning very much at all. Watching surgeries doesn't help me learn, especially when they are surgeries I will never actually do. Instead, I am doing treatments and paperwork. Treatments and paperwork. Ad nauseum. It just really pisses me off that I am paying $1,153 per week to be free scut labor and learning virtually nothing in return.

Sleep deprivation, crazy clients, and reprimands

2011-08-14T12:59:00.000-07:00

Remember how I mentioned that I still liked school? Today - not so much.

Last week was interesting. I really like the doctors and techs on soft tissue, and the surgeries themselves are interesting. I DON'T like:
- Not being able to actually do anything during surgery (except maybe cutting suture)
- Waiting around a lot of the time and yet still being at the hospital 15-16 hours per day
- Sleeping only 5 hours per night
- Dealing with 2 crazy clients in a row (I won't go into details, but let's just say that one client is neurotic & indecisive and another is an ignorant control freak)

Maybe I don't have the best attitude because I didn't want to take this rotation in the first place and it was suddenly made mandatory (taking away elective time that I had planned out). I don't know.

On the sleep issue - I know a lot of people can function just fine on 5 hours. I need 8 (which I consider an improvement because before vet school I needed 9 or 10). I was practically delirious toward the end of last week, just from exhaustion. Friday night I almost fell asleep while standing up. In the shower. The exhaustion made everything that much harder - it's tough to analyze lab results and come up with a plan when it takes all your brainpower to stay awake and upright.

I know that crazy time-sucking clients happen. 2 in a row (and trust me, they are in the top 1% of craziness I've seen) is exhausting.

The last thing making me grumpy is the constant "don't do this, don't do that" inherent in the teaching hospital. One person tells you one way to do something, another says it's the opposite. Net result - you literally get reprimanded for something (sometimes > 1 thing) every. single. day.

Very frustrating all in all. Hopefully this week goes better (although I still have to deal with crazy client #2).

Soft tissue surgery

2011-08-10T21:18:00.000-07:00

So far this rotation is going okay. We don't get to perform the surgery, which is what I expected (and why I was upset when they suddenly made this rotation mandatory last fall).
The doctors and techs all seem very nice and helpful. Since I got burned by that last resident, though, I hesitate to be enthusiastic about them just yet.
The cases? Interesting and varied - amputations, mass removals, various abdominal surgeries, and so forth. A lot of them are things I never plan to do (e.g. anything in the neck or dissecting any tumor off a great vessel) but that's ok I suppose.
My current inpatient is a very ill-behaved dog who peed on me, bled on me, drooled on me, and tried to bite me all before 8 am. I can't WAIT to discharge him!
The one key thing I've been learning (especially with my current inpatient) is to stop and take a short break when I feel overwhelmed and possibly about to cry. I duck into the bathroom or the stairwell and just collect myself before continuing.

We also got sent the schedule of first-year students who will be shadowing us. I will have 6 different days throughout the rest of the year where a first year will be in the clinic with me. It sounds like we are expected to help teach them various things. It sounds like a great opportunity for them. In theory it should help cement what I learn too - by teaching, you learn, right? The only problem is that when you already spend 15-16 hour days at school you don't want *any* extra work. Right now I don't have time to run, socialize, cook, keep my apartment clean, or even make any doctor or haircut appointments.
Some of the first year students on summer clinics already have a good base of clinical skills and/or medical knowledge, so they at least have an idea of what's going on. The problem is when a student doesn't have either medical knowledge or clinical skills and is basically lost. You just don't have that much time to teach them everything there is to know about a particular disease *and* teach them basic clinical skills *and* teach them the processes that the teaching hospital uses *and* teach them how to use the medical records system *and* see appointments *and* perform procedures *and* update records *and* call owners *and* do all the treatments for your inpatients.

Externship 1: Last Day

2011-08-06T12:07:00.000-07:00

Today is the last day of my externship - I'm on a swing shift again so I'm just hanging around waiting until it's time to head over there. I switched to a hostel over the weekend because it was too expensive to stay in a hotel for the whole 2 weeks. The hostel is in a really good location but it's hard when you room with people who basically sleep round the clock!

I'm feeling pretty homesick today for some reason and can't wait to get back. I miss D and the cats, I miss my friends, and I miss my normal routine. It would help if I could run, but a hill run earlier in the week was really tough on my knee so I have to take it easy for a couple of days.

Monday morning I start on soft tissue surgery. If I think about it too much I get really nervous. One, I'm not looking forward to coming back to the teaching hospital and all of its bureaucracy after being in the "real world" for a while. Two, I didn't take the soft tissue surgery elective and therefore already feel behind in subject knowledge. Three, I'm not a great surgeon. I'm okay, but definitely not gifted. Four, my confidence has been shaken from the previous evaluations.

Hopefully by the time I go back I'll be so busy that I won't have time to brood and make myself even more nervous.

Addendum to the grading thing

2011-07-31T01:28:00.000-07:00

I'm still pretty peeved at one of my rotation grades. I've tried to let it go, but here's the deal.

One of the residents said something like "I constantly had to remind you to update your cases and they weren't done when you left the hospital."

NOT TRUE.

I worked on exactly 4 cases with this person. One of them - they told me I didn't have to write anything because it was my first or second day on the rotation. The next two I **KNOW** I finished before I left for the day. The last one, again they specifically told me I didn't have to write, but then later sent an email asking me to fill out the physical exam part - which I did IMMEDIATELY.

If these residents are going to either confuse me with someone else on the rotation or flat out make shit up, why am I even trying so hard??

I could bring it up with this resident, but it doesn't seem worth it because I got a pretty decent grade on the rotation so that comment probably didn't affect my overall grade. Still - I'm going to run into this person again obviously and I have a crappy poker face. It will be hard to smile and make nice in the halls.

Resetting expectations

2011-07-27T13:54:00.000-07:00

I've finally received some evaluations from clinic rotations (still missing one of them), and my grades are indeed lower than they were during the past 3 years.

It's a little hard on the ego. I went out of rotations thinking I did "A" work and getting a B+, and other rotations thinking I did A-/B+ work and getting a B-.

The administration mentioned that our grades would drop a little this year. I just don't want to be one of those people who are book smart but not real-life-smart, you know? That isn't really the case - I got really positive feedback on one of the harder rotations - but I want to have good enough evaluations that I feel comfortable going straight into practice and not frightened into an internship.

I guess if I knew how to do everything already then I wouldn't need this year, right?

Anyway, I had my first externship shift last night. I got to see a blocked cat, an Addisonian dog, a couple of dogs with medication toxicities, a mangled leg, a food bloat, a couple of seizure patients, and some other cases that escape me right now. It was really busy and interesting, although it is hard to go from managing cases (with coaching) like I did in school to just watching and maybe helping once in a while. Back at it tonight!

Pacific Northwest

2011-07-25T17:04:00.000-07:00

I start my externship tomorrow night at the emergency clinic out here. Today I've just been exploring the city. I haven't been to Portland in something like 18 years so it's been fun to walk around and shop/eat/browse. I bought a 2 week transit pass instead of hassling with a car, which is turning out to be a pretty good decision. The public transit system is pretty extensive and there appears to be no parking and tons of 4-way stops - a driving nightmare.
Today I went to Powell's Bookstore (it's HUGE and apparently has a shop cat who I did not see), VooDoo Doughnuts (delicious), and Pioneer Square. One thing that's really interesting and (I think) new are all the food trucks. The number and variety of them are ridiculous! Today I ate at one that specializes in making dumplings named, appropriately enough, "The Dump Truck." I also went for a 10-ish mile run in Forest Park, which reminded me how much of a trail runner I am NOT. It was pretty and all but I was huffing & puffing pretty hard and now my legs hurt!

Tomorrow I'm going to the zoo in the morning and then it's off to the externship in the afternoon!

Yes, I still like school. Ask me again in October.

2011-07-19T21:39:00.000-07:00

I've had some more interesting cases over the past few days, including a dog with pleural effusion (fluid in the chest space) which I got to tap by putting a catheter in the chest (scary!), and a dog with hemorrhagic gastroenteritis. I've also had a couple of euthanasias, which apparently make my nose run because I'm trying not to cry. It's really hard to see clients so upset about their pets, especially when it's a cat.

Next week I start my externship at an emergency clinic in Portland. Exciting!

So far I still really like clinics, but I've seen my friends on internal medicine and they don't look very happy most of the time. Mind you these are generally very upbeat and fun people, so let's just say I'm a little concerned. Guess I'll deal with that when it comes - I start my first 5 week block of medicine close to Halloween.

At home?

2011-07-13T20:42:00.000-07:00

I don't have a lot of time to write tonight but just wanted to say that I still (so far) love emergency.

Yes, some clients are challenging. Yes, it's heartbreaking when you euthanize a patient. But it is so freakin' interesting!

It probably also helps that we've had a lot of "real" emergencies (hit by car, respiratory distress, GDV, comatose patients, etc.) as opposed to pets coming in on emergency as a back-door into other services like orthopedics and such.

Plus I've gotten to do way cool things like direct the resuscitation of a patient in hypovolemic shock (with the clinician approving my decisions, of course) and placing a central line!

I just feel very at home on this service - like I fit in better or something (not that I've felt uncomfortable in other services - just that this one fits me better).

Jitters

2011-07-10T20:25:00.000-07:00

Every time we start a new clinical rotation it feels like I'm starting a brand-new job. That's essentially the case - new location (in the hospital), new people to work for and with, and so on.

I don't consciously feel nervous, but apparently I am nervous somewhere deep down because I keep having bizarre dreams the couple of nights just before. Last night I had another one (don't remember the details), so I must be nervous about tomorrow morning too.

I'm also freaking out a little about maybe not having a job when I graduate. That's a long way off, but still.

1 month of clinics: done

2011-07-09T13:22:00.001-07:00

I finished oncology yesterday. Overall, it was a really interesting and laid-back service and I enjoyed it a lot. I only had to manage 1 appointment per day, so I was usually done with everything by 2 and could study for boards before we had afternoon rounds. So far I'm averaging about 65-67% on practice questions, which isn't bad (you need 70% to pass).

Next week starts the emergency blitz - 2 weeks at the teaching hospital followed by a 2 week externship at an emergency clinic. Hopefully I still like emergency once it's all over with!

End neuro, start onco

2011-06-27T18:58:00.000-07:00

I was on call Saturday night for neurology and (like usual when I am on call) got paged to come in for an emergency. A small dog had neck pain and trouble walking. She had good voluntary movement and was stable enough to spend the night in the ICU under close observation, then get a myelogram and go to surgery first thing in the morning. Sure enough, the myelogram showed a compression on the spinal cord in her neck so she went to surgery. The resident performed a ventral slot procedure (similar to a hemilaminectomy but on the ventral surface of the vertebral bodies in the neck - easier to access) and I got to scrub in, which was cool. I was a zombie last night, though.

Today I started my oncology rotation. I have to confess my profound weakness for little old man and little old lady cats and dogs. (Remember I adopted the 18 year old cat a couple years back)?
Anyway, the pace and "feel" of oncology is radically different from neurology. It is primarily an outpatient service that does staging (figuring out how bad it is) of the animal's cancer and giving chemotherapy treatments. The animals have already been diagnosed with some sort of cancer, so you don't have to rack your brain thinking of differential diagnoses. The clinicians are all SUPER nice. The clinicians on neuro are nice too, it's just that a lot of neuro involves emergencies so people don't always have the time to be extra nice; for example, praising you when you do a good job at something. The hours are much better too - I was only at the hospital for 8.5 hours today as opposed to 16-ish. So far I really like it!

Neuro - week 2

2011-06-20T21:11:00.000-07:00

This week is shaping up to be much busier than last week. Unfortunately I didn't pick up any cases today (my appointment cancelled), but I got to send another patient home. So far I've seen a good representation of the really common dog neurological diseases:
- Intervertebral disc disease
- Seizures
- Inflammatory brain disease
- Vestibular disease
I've also gotten to scrub in and assist on 2 hemilaminectomy surgeries. This type of surgery is done when an intervertebral disc (or material that extruded from a disc) is compressing the spinal cord. The surgeon basically makes an incision along the dog's back, dissects down to the vertebrae, drills a window into the vertebrae to access the discs, and remove the compressive material. It's really hairy because the spinal cord is also RIGHT THERE. Obviously all I get to do as a student is hand over stuff like the suction and bone wax, cut suture, and staple the incision - NOT the drilling or cutting! It was pretty awesome though.
We don't seem to get a lot of cat cases, which is unfortunate with me being the cat lady and all.
Here's hoping this week goes well!

I feel like a big kid now

2011-06-13T20:52:00.000-07:00

First day of clinics - finally!

I spent much of yesterday and early this morning feeling like I wanted to vomit from nervousness. We had our big orientation for the first 1 1/2 hours of the day where they talked to all of us about things like infectious disease control, which wasn't terribly exciting. Then we traveled to the neurology ward for more orientation. Since the ACVIM meeting is this week, the service is on emergency hours only so there are no appointments to see. There were just a couple of inpatients left over from the weekend, and they assigned one to me and one to the other senior student. There are 5 other "summer clinics" students who are 2nd and 3rd years, so I imagine they will get any incoming emergency cases. It's nice to have a ton of people to spread the (potential) work among.

The thing that surprised me today was how much I actually remembered from my classes while we were talking during rounds. I didn't feel like an idiot!

My patient is a sweet little dog recovering from spinal surgery - she had a herniated disk - so I basically just have to take care of her daytime treatments, write the daily SOAP update, and call the clients twice per day with updates. With just one patient so far, the work is more than manageable. We'll see how it goes next week when the service is running full strength again!

... and done (with 3rd year)

2011-06-06T17:21:00.001-07:00

Took my last in-class exam and turned in my last 2 take-home exams today. I'm free for 6 whole days before clinics swallows up my life!

Weekend

2011-06-05T11:34:00.000-07:00

Friday we got the option to take our emergency/critical care final early, so I decided to get it over with. I think I did pretty well on it, or at least I easily came up with answers for most of the questions!

Tomorrow is our law & ethics final. It's mostly short answer with one essay. I don't think it will be too horrible (meaning: I'm pretty sure I'll pass the class). He gave us the scenarios ahead of time and I read all the regulations & laws he assigned, so I'm as ready as I can be. Note: if you ever want to knock yourself unconscious, read laws. Seriously.

Both of my take-home finals are done - I just need to check them over before turning them in. Then I get a few days off!

Yesterday I ran a 10k. The weather was pretty bad for early June in my area - cool, rainy, and windy. The race course was in a park on trails so the mud and puddles were fierce too. Oh, and the course was a little hilly. I ran it as fast as I could - my lungs were on fire the whole time, my shoes were soaked and squishing, I had to REALLY concentrate to keep my pace in the last mile, and at the end I felt a little nauseous. But ...

I WON MY AGE GROUP!

I about fell over when I read the race results. I usually am a solid mid-packer, so this was a total shock. It made my weekend!

No more classes!

2011-06-02T15:07:00.001-07:00

2 more take-home exams, 2 more in-class exams, and that's it for 3rd year.

I'm freaking out ... on the inside

2011-05-31T20:13:00.000-07:00

I only have 2 more days of classes, then a couple of finals, and then ...

CLINICS.

A lot of my classmates are talking about it, of course - it's only 12 days away now! Some people are visibly frightened, while others are excited. I think I will be excited once it starts, but for now my stomach hurts and I'm having weird dreams. Here's why I'm stressing:

- We get letter grades for each clinic. Yes, there are objectives that you should be able to demonstrate for a given rotation, but there is a LOT of room for subjectivity in grading. I expect my GPA to drop and that's going to make me feel dumb and sad.
- In addition to seeing appointments, doing treatments, and writing the medical record, starting this year we also have to go into a system and check off the competencies that we observed or performed (the equivalent of swiping our ID badges into labs, I suppose). Frankly I'm worried that I won't have any time to eat, pee, or sleep for the next year.
- If I can't eat, pee, or sleep, my quality of work will suffer. Bad grades, dead patients ... who knows what kind of chaos will result?
- Teaching hospitals run notoriously slowly, and that is going to be a constant exercise of the little bit of patience I possess.

There are probably other worries in the back of my mind, but those are the big ones. I know once I get into clinics I will be fine, but this in-between time is tough.

More dentistry

2011-05-25T20:49:00.000-07:00

We had a special exotic dentistry lab today - not part of our classes, just for a limited number of people who were interested in the topic. It was similar to the dog and cat ones we had before - there were cadaver heads and we got to practice oral exams, occlusal adjustments (basically the equivalent of "floating" horses' teeth), and extractions. It was a lot of fun, and I'm really glad I got picked to attend. Since I'm interested in treating small mammals, this was extremely helpful.

Skipping class

2011-05-24T19:45:00.000-07:00

I didn't go to class yesterday. It was intentional.

Believe it or not, it is ok to skip sometimes. Sure we have certain required sessions (like most labs) where we have to turn something in or swipe our student ID, but there are a fair number of lectures where, frankly, my time is better spent out of class. Some teachers just don't make any sense and frustrate me. Others spend the whole lecture period reading their slides verbatim. In cases like this where sitting there is a true waste of time AND (key point!) I can learn the material better on my own, I don't go.

It probably doesn't help that there are only 6 more days of classes to go. Ever.

Surgery final, doctoring, + more feral cats

2011-05-16T16:33:00.000-07:00

The surgery final last week was actually kind of fun. Don't laugh - since it was pass/fail, that took a lot of pressure off and there were a lot of hands-on stations like:
- Showing how to pressure check the cuff on an endotracheal tube
- Selecting what suture type (choose from 4) is best for a given closure layer in a given weight of patient
- Calculating how much water, dextrose, etc. to make an x% or y mg/mL solution (THANK YOU to my old hospital where the techs had to do this daily!)
- Greeting a client and giving post-spay discharge instructions
I really love when classes are modeled after what you will actually be doing as a doctor!

Orthopedics is also done - technically our take-home final isn't due until Friday but I turned it in last week.

So ... at this point I only have a few classes left (law, doctoring, small animal medicine, feline medicine, and emergency/critical care). I don't have any work left for doctoring either because our group presented our material last week. Yay!

Yesterday I volunteered at another feral cat clinic where I got to do the neuters. I practiced a different way of neutering that I had only done once or twice, and decided I liked it a lot better than the way I initially learned because this way has more knots and therefore is hopefully more secure. It was a little strange because the techs there treated me like I was a doctor even though they knew I'm still a student - they were like "close enough - you're almost in clinics." Weird. And cool.

Speaking of which, in 4 weeks I will actually be in clinics. I hope those of you who started already are enjoying it!

Awards

2011-05-10T19:53:00.000-07:00

I ended up getting 2 scholarships today! One was for all the work I've done with orphaned kittens, and another was a more general one dealing with small animal practice. That one requires that I do some volunteer veterinary work during my first year of practice, which is no big deal because
a. I'm already doing volunteer veterinary work, and
b. I enjoy it and plan to continue it anyway - regardless of the scholarship
I also got to meet the donor, which was really nice. Considering the rate at which my tuition has increased the past 4 years, it is HUGELY appreciated.

It was interesting to see which 4th years got awards. Most of their awards are obviously based on clinical skill. It seemed like a different subset of the class got these awards vs. the more academically-focused awards that were given out to that class last year. There were a couple of rock stars (my big sib included) who seemed to do well in both, but for the most part it seemed to prove the adage that those who do well academically often don't do as well clinically. I'll be interested to see what plays out next year. There are top people in my class who I think will also rock clinics, and others who I think will struggle with the accountability, decision-making, communication, and other "soft skills" needed in clinics.

As for me, I think I will do well in clinics. Probably not rock star caliber, but solid. (I hope.)

Last clinical skills lab

2011-05-09T19:20:00.000-07:00

Today I learned how to take bone marrow aspirates from 2 different locations in a dog, how to perform a tracheal wash 2 ways (through the mouth and through the neck/tracheal wall), how to do a chest tap, and how to place a chest tube. It was pretty fun, although one of the faculty there gets cranky and impatient if you don't nail something immediately. Um, it's a lab. On cadavers. Let's not instill MORE fear into people facing down clinics, ok? Needless to say I'm very glad that person is not on duty during any of my rotations in their service!

Tomorrow is our annual awards ceremony, and I got a scholarship - yay! They don't tell us what we get until we show up. I don't care, though - it's still exciting! Then Wednesday we have our final exam in surgery lab. The course leader says as long as we know how to do things that we did DURING our surgery labs, we should be fine. I studied a little bit for it but am taking tonight off. I'll do a little more studying again tomorrow night. The only thing I'm not sure about is hand ties. We never used them during labs but were tested on them at the beginning of the year. I've totally forgotten how to do them and learning them is a bear because I'm left-handed and the instructions/photos are all right-handed. Oh, and we had to turn in our knot-tying kits so that next year's class has them, so I've nothing to practice with. Did I mention it's pass-fail?

Last surgery lab

2011-05-02T18:56:00.000-07:00

I had the honor (?) of performing the last surgery in our little class group of 3. Our dog was a roughly 6-month-old pit bull puppy - very sweet and very energetic!

For some reason I was super nervous yesterday about today's lab. I guess it's because they are extremely picky about how we do things at school and I always come out of the labs feeling stupid. Anyway, as usual (at school, it doesn't happen at spay/neuter clinics elsewhere) I was so nervous making the skin incision that my hand shook a little. Sigh. She also didn't have a lot of fat under the skin so I cut a little bit off center on some abdominal muscle - had to then make my abdominal incision off center there and try to correct it headed toward the other end of the incision.

Overall it went fairly well. Her right ovary was pretty deep in her abdomen so I had to release the suspensory ligament a lot more than I usually do. The super-scary thing was that her ureters (which connect the kidney to the bladder) were RIGHT UNDER the uterus - even as far up as the ovaries! Usually you can see them right under the bladder but then they dive downward close to there. Nope, not this girl! Even though I could totally see them, know what they were, etc. it still freaked me out a little - especially on the right ovary where I didn't have a lot of space to work with.

The thing that I messed up and am still kind of beating myself up over is that I forgot to put the top layer of skin sutures (the kind that need to be removed) in. Our past few patients didn't need them and the spay/neuter clinics never use them, so I spaced and forgot. I don't feel horrible - the instructor said it was ok and my assistant had forgotten about it too - but I don't want to get docked points for that. Oh well - at least I didn't cut her ureter, right?

Money. And orthopedics.

2011-04-29T18:14:00.000-07:00

My current debt load is nearly $80,000. That is excluding 4th year loans, which I have yet to get/accept/etc. They are estimating our total cost of attendance to be $60,000 for the year.

$60,000. For the year.

I'm pretty lucky because I had a fair amount of money saved up before school and haven't maxed out my loans every year. Some of my friends are well into six figures of debt.

Our state is in very rough economic shape and (IMHO) our education system is very poorly managed. Example: top administrators make $2 million EACH IN PENSIONS PER YEAR AFTER THEY RETIRE.

Anyway, when I started our cost of attendance was around $35,000-40,000 per year and it has increased every single year since.

Honestly, I totally love veterinary medicine but I don't know if I would be willing to go to vet school if I had to start today. Who knows what it will cost 4 years from now?

Also, I am leaning against doing an internship now - this blog post got me thinking. If I am not planning to do a residency (and I'm not), then that is a LOT of money to pay to just delay my fear of becoming a bona fide practitioner!

(change topic)

I discovered that I REALLY like orthopedics. It probably helps that the clinicians on the service rock, but there's something about analyzing the lameness or fracture and then fixing it that is - well, cool. I like the physics part of it. Don't vomit - hear me out. I was never any good at calculating force vectors or whatever, but I can *see* what's happening qualitatively - which is perfect for orthopedics! I can't wait to do that rotation this summer!

6 more weeks until clinics.

Whirlwind week

2011-04-21T17:03:00.000-07:00

This week has been very busy! Monday we had our dental extraction lab. It is very, very difficult to extract teeth - requires a lot of strength and patience. Our cadaver head also apparently had ankylosed teeth per the resident, which apparently means the tooth was starting to fuse to the bone itself instead of having soft tissue between them. This in turn means it's a lot harder to extract the tooth. The whole experience was pretty tiring and frustrating. Hopefully when I'm on dentistry next year I will have a better time of it.
Tuesday our emergency/critical care take-home midterm was due. It was interesting and sort of fun to do, but tiring because you had to think a lot about how to approach the problems.
Yesterday we had another surgery. Unfortunately our dog had already been spayed - probably early in life because we literally saw no external spay scar, and the scar in her linea alba (the connective tissue that you cut to get into the abdominal cavity) was only about 1 cm long! Anyway, I was the anesthetist and it went fine.
Our dentistry exam (an online exam that is open-note but you can't work with classmates) is due Monday so I've been working on that too.
Today is my birthday, so in honor of that (and since yesterday was very tiring) I slept in and skipped my 8 am class! My awesome friends took me out to lunch and got me cards, a gift card to Sephora (yay!) and made a donation to a dog rescue in my name. D and I are going out to dinner this weekend to celebrate as well.
Tomorrow I'm going to see "Water for Elephants" because I LOVED that book. Hopefully they do it justice.

< 2 months until clinics

2011-04-14T14:44:00.000-07:00

That's a simultaneously exciting and frightening thought.

Anyway, classes are still pretty interesting but without the fear of looming exams, I have to admit I'm not spending a lot of time studying. There are a lot more labs and case discussions, which are really helpful to cement ideas in my mind.
This week we had 2 dentistry labs - one where we practiced performing dental exams and cleaning, and another where we took and interpreted dental radiographs. The labs are done on cadaver heads from animals that had been euthanized for other reasons (e.g. shelter animals who failed behavior testing). Today we had a lab where we learned to do a full orthopedic exam on a dog. It was really interesting too! Next week we learn to extract teeth (on the same cadaver heads), and we have another spay surgery (I will be anesthetist).

I also signed up to run the same half-marathon I ran last October. I'm pretty sure I can do the full training schedule because my super-hard rotations are before the training period and after the race itself. I figured I need to keep doing things besides vet med whenever possible.

3-day weekend!

2011-04-04T17:21:00.000-07:00

Have I mentioned lately that I love 3rd year?

Since I'm taking a light load this quarter, I didn't have any classes today. It was sooo nice - I went shopping and got a couple of dresses and a pair of shoes for clinics, ran, lifted weights, and went horseback riding. I even have time to clean the apartment tonight!

Classes are interesting, for the most part. Law is still pretty boring, but my other classes are fun. I especially love the emergency/critical care class because the professor has a great deadpan sense of humor and makes things really interesting!

Our first surgery of the quarter is done. She was a big super-sweet pit bull who looked like she'd recently had pups. The surgery was EXTREMELY bloody, which takes some getting used to. She went through it like a champ, though!

Clinics schedule

2011-03-26T11:47:00.001-07:00

Here it is - all of my clinics are small animal, not large animal.

Weeks 1 and 2 - Neurology (a real @ss-kicker from what I understand, so I'm glad to get it over with!)
Weeks 3 and 4 - Oncology
Weeks 5 and 6 - Emergency (they switched me from night shift to day shift, which was a little bit of a bummer but oh well)
Weeks 7 and 8 - Externship at an emergency clinic in Portland
Weeks 9 and 10 - Soft tissue surgery
Weeks 11 and 12 - Orthopedic surgery
Weeks 13 and 14 - Radiology
Weeks 15 and 16 - Cardiology
Weeks 17 and 18 - Externship at an emergency clinic near Oakland
Week 19 - Clinical pathology
Weeks 20 through 24 - Medicine (another tough one)
Weeks 25 and 26 - Companion avian & pet exotic service (can be tough if there are only 2 students on)
Weeks 27 and 28 - Dentistry
Week 29 - Holiday (I get the few days between Christmas and New Year's off)
Week 30 - Dentistry
Weeks 31 and 32 - Dermatology
Weeks 33 and 34 - Vacation (These are the last 2 weeks in January, so I'm hoping to take a week-long ski trip!)
Weeks 35 and 36 - Community practice (i.e. primary care)
Weeks 37 and 38 - Ophthalmology
Weeks 39 and 40 - Community surgery (supposed to be a great rotation; you do mainly spays & neuters with other random surgeries as needed)
Weeks 41 and 42 - Anesthesia & critical care
Week 43 - Vacation
Weeks 44 and 45 - Community surgery
Weeks 46 and 47 - ICU
Weeks 48 through 50 - Medicine
Weeks 51 through 53 - Pathology

Spring quarter

2011-03-26T11:45:00.000-07:00

New York was great, as I expected. I totally brought the wrong shoes for walking, though. I love my Dansko clogs for school and work and figured those would be great for walking. WRONG! I ended up with a huge blister on the ball of my left foot and bought a pair of walking shoes from Clark's for the rest of the trip. It was fun to see all the famous sights - Times Square, Central Park, etc. *and* the weather there was better than it was at home!

Speaking of weather, it is STILL raining here. The roads to the mountains have been closed most of the time this week, so no snowboarding. Hopefully I can go one last day in the next couple of weeks (with about 10 feet of fresh snow, it hopefully won't melt for a while).

Ok, so Monday we start our LAST QUARTER OF CLASSES! I have a light load because I took a lot of electives early. Here's what I'm taking:

Core classes
Doctoring - this quarter we have to do a business-focused project in small groups. I believe mine is a hiring/HR scenario, while other groups deal with other issues (finance, marketing, legal, etc.)
Surgery - we each do a dog spay, assist with one, and anesthetize one. Hopefully no biggie since I've been going to the spay/neuter clinics regularly and have done somewhere between 7-10 spays there.
Clinical skills - I think we just have 1 lab to learn more procedures on cadavers (like placing chest tubes)
Law and ethics - the rumor is that this class is better and more interesting than the freshman class, but I'm skeptical. At least it fulfills a requirement so that we don't have to take a separate legal test to be licensed in this state.
Dentistry - there were too many people in the class and they didn't get everyone's labs done last quarter, so my 3 labs are this quarter

Electives
Advanced small animal medicine - case discussions! Yay!
Feline medicine - kitties! Yay!
Emergency and critical care - emergency! Yay!
Small animal orthopedics - more in-depth than the class last fall, and includes a couple of labs on lameness and bandaging

I also signed up for a TRX class at the school gym. My friend takes a class at home and says it kicks her butt, so I'm looking forward to it. There are quite a few spring races I'd like to run as well; so far I've signed up for a 10k in April.

It should be a somewhat relaxing and - dare I say it - fun quarter.

Oh, and they finalized our clinics schedule. More about that later!

Done, done, and on to the next one

2011-03-14T17:11:00.000-07:00

Our last small animal medicine exam was today. There were a few questions I wasn't sure about and probably got wrong, but I had a really good grade going into this so I'm sure I passed the class.

Most of the other small animal-focused people are done now, but I still have a presentation for avian medicine tomorrow and an exam in equine medicine on Thursday. I'm kind of jealous of the people who are finished and have almost 2 whole weeks off, but that's ok.

There was another spay/neuter clinic on Saturday. I got to do 2 dog neuters, which was cool. It seems like I'm getting better and faster at it - yay!

Here's the spring break plan:
Thursday (red eye flight) through Monday - New York City
Tuesday - make study notes for dentistry class (I have to take the exam next month)
Wednesday - donate platelets & plasma
Thursday - hopefully get more spay/neuter practice
Friday - hair appointment
Saturday - run the adoption event for the foster kittens
Sunday - feral cat spay/neuter clinic
Monday - back to school for the LAST QUARTER OF CLASSES!

I brought my cat and foster kitten back home over the weekend so it's deathly quiet in my apartment. How do people live alone without pets? I get soooo bored and lonely without them!

Advice for scheduling senior clinics

2011-03-11T12:58:00.000-08:00

We accidentally got a sneak preview of our clinic schedules yesterday. They are not finalized (for example, I had 4 weeks of soft tissue surgery instead of 2 and 0 weeks of radiology instead of 2).
At any rate, a large number of people in my class freaked out about various things. Here are some suggestions to help you avoid these situations:

1. Request vacation when you think you'll need a break. If your school allows you to request vacation weeks, try to space it out so that you don't have all your vacation at the beginning or the end of the year! If you leave it to the school to schedule for you, I can almost guarantee that is what will happen.
At our school we allow 1st and 2nd year students to go do certain clinic rotations over the summer. What almost invariably happens if you don't request a week or 2 OUTSIDE of summer is that they will schedule your vacation during the summer when they have the extra help! Then you end up going 8-9 months with no vacation save a couple of holidays.

2. Remember that internship letters of recommendation can come from many different services. Some people in my class were FURIOUS that they didn't have medicine before the internship application deadline next fall.
Most internships are ROTATING. You could get a LOR from surgery or internal medicine specialties like oncology or cardiology and probably do just fine (as long as they're from faculty and not residents). Sure, a LOR from medicine would be nice - but given the high #s of people in every class gunning for internships, there is no way everyone can get all their medicine done by fall. Also, who's to say that you'll even do well enough in a particular clinic to merit a strong LOR? My personal strategy is to ask on those services where I KNOW I'm doing well (i.e. probably not neurology).

3. Time your externships appropriately, if possible. If you are worried about developing a particular skill prior to an externship, then schedule your externships later in the year when you've had more clinical rotations! Also, some externships can be quasi-vacations (see #1 above).

Bottom line - don't expect the administration to be looking out for only YOU and giving YOU the best possible schedule. They have MANY other people to schedule too, and you need to take as much responsibility as the system allows to ensure that your schedule is what's best for you.

On a side note, I've been noticing a pattern of certain people in our class getting very, um, huffy when things don't go their way. I guess the world has been good to them up until now? They also seem to be people who have been in school their whole lives.
I am NOT saying that people who come straight out of undergrad or grad school are all like this! A great number of them are not. However, I AM noticing that the people who are struggling more with roadblocks all share that in common.

Coming soon!

2011-03-09T18:46:00.000-08:00

We got an email today that our senior clinics schedules may be ready as early as next Friday. (For your reference, the class of 2011 got their schedules around Memorial Day; approximately 2 weeks before clinics started.)

I'm really excited to see my schedule! I've been waiting to schedule visits to hospitals until I know when my vacation will be. Since small animal track people pretty much only have time to do 2 externships and since we aren't allowed to extern at places where we've teched, I need time to make the rounds (and hopefully interview?)

I'm trying not to think too far ahead, but it's in my nature as a former project manager. The economy and job prospects are concerning. As a prospective GP, I don't want to do an internship unless (a) it would give me awesome experience, or (b) I can't find an associate position. Gotta put that out of my mind for now and focus on classes for the time being!

Mental health days

2011-03-03T17:39:00.000-08:00

Yesterday I only had 1 class - an 8 am equine medicine lecture. Same thing tomorrow. I decided to catch up on some sleep instead and podcast the lectures later.

It was great! I had time to run and to do circuit training, to put together my study notes for Monday's exam (on equine medicine), and even to watch a movie (Resident Evil: Afterlife - which I don't recommend).

We only have 1 more week of lectures and then it's finals week. Then we get a week off for Spring Break, then it's my last quarter of didactic learning!

A lot of people are going to the SAVMA symposium over spring break. I'm going to New York instead - want to spend my break doing non-vet-med-related things. Like shopping and eating.

Repetition

2011-02-24T21:14:00.000-08:00

It's getting to the point where our classes are repeating themselves. Yesterday in ultrasound we reviewed echo findings of common cardiac diseases (which we covered last year in medicine). Today we covered tetanus and botulism in small animal medicine (which we covered in neuro and in equine medicine). Most of my classes are like that now.

Sometimes I think I might just be ready for clinics. Maybe.

In other news, I've reached my goal of running 15 miles per week for the past 2 weeks. I'm hoping to keep it up through the spring (and possibly increase it). I also started a circuit training DVD program that is deceptive. It feels easy at the time (except for the push-ups), but I am SORE the next day! Guess that means it's working.

We only have a few more weeks left in the quarter. Coming up:
2 more small animal medicine exams (the next one is Monday)
2 more equine medicine exams
Finish the group project in avian medicine (we have to put together client-focused information on common bird problems)
1 more surgery (and I'm assistant - the easy job!)

Then it's off to New York for part of Spring Break. I've never been there before and am really excited!

Down

2011-02-18T18:31:00.000-08:00

This week has been tough. School has been fine - few classes, only one exam (equine medicine today, which was also fine).

No, the problem has been my mood. I've felt like those commercials where people talk about having to wind themselves up to get through the day. It has been pretty much taking all my effort to get up in the morning and go through the motions of the day.

This frightens me because I'm familiar with this feeling, and when it persists it spells major depression.

I've been trying to figure out why I feel so crappy. Perhaps it's because the weather is foul. A more likely explanation involves a couple of nasty little habits I have:
- Shouldering responsibility for pretty much everyone and everything
- Constantly comparing myself to others

Both of these can be good things in the right context, I suppose. Being responsible can be a good thing, but somehow I frequently end up in situations where I'm the "mom" figure. I am the only one who has brought a stethoscope or has read the lab guide. I'm the one to talk someone down from their anxiety or fear. Couple that with a lot of extracurricular responsibility this month and I'm feeling like the weight of the world is on my shoulders.
As far as comparing myself to others? Again, this can be good if kept in check - like when I'm running a race and I can surge at the end because I want to beat someone. However, I'm having trouble keeping it in check lately. I want to be thinner. I want my hair to not be graying so quickly(!) I'm jealous of all the girls in my class who go on Facebook bragging about how great their significant others are and how they cook dinner/clean house/do-so-very-much-for-them AND are romantic to boot when I don't live with D AND he forgot Valentine's Day. I'm jealous of the people who are getting better grades.

It has been getting better, though. I've made sure to exercise more than usual and to force myself to go to school and interact with people. I AM looking forward to another spay/neuter clinic tomorrow. I get good enough grades that I could probably get an internship if I wanted. D is a really good guy and I remind myself of all the things he HAS done for me. I've been focusing on doing what I need to do and trying not to feel the weight of everyone else's problems.

Hopefully this too shall pass. If not, fortunately our school has a counseling service that I will make use of!

It's like 2nd year again, but with surgery

2011-02-10T18:37:00.001-08:00

This week's schedule was unusually intense for most of our class. Here was mine (I say "was" because the worst is now over for me):
Monday - small animal medicine exam
Tuesday - avian medicine exam
Wednesday - surgery (which you have to study for too!)

The small animal medicine exam was fine. They didn't ask us anything outrageous, and the lecturers did a good job emphasizing important testable points while they were presenting.
The avian medicine exam, however, was rough. I literally had no idea what the answer was for about 15 of the 50 questions. I must have guessed correctly on some of them, though, because I didn't get that many wrong. Frankly I'm happy that I passed, but am not sure why there was such a disconnect between my lecture notes and what was asked on the exam.
Surgery wasn't super smooth either. I was the surgeon again - this time for a dog castration. There were a lot of problems getting a catheter placed (small dog, veins kept blowing), then he was apparently hypotensive. The drape almost fell and I broke sterility with my left glove trying to rescue it, so I had to re-glove that hand. The dog's skin was super thin, kept bleeding, and I really struggled to not go all the way through on my subcuticular. About half-way through, the surgeon faculty comes by and says "Wow, that needle is WAY too big for that dog! I'd offer to get you a new pack, but you've already started so keep going." Needless to say he had swelling and redness last night and this morning. Fortunately it didn't seem painful - he didn't react when it was palpated.

Other people in my class had an exam today in food animal medicine, and others have an exam tomorrow in one of the large animal repro courses. The zoo track people ended up with 3 exams in 1 week.

As a side note, it's interesting how different faculty and surgical supervisors give off different vibes. Some are really nice but still correct you when appropriate, while others give the impression that they're just waiting for you to eff up. The latter definitely rattles my confidence.

Busy, tired, happy

2011-02-05T20:41:00.000-08:00

Today was the first spay/neuter clinic of several that I'm organizing student volunteer surgeons for. We had all cats today and I got to do a couple of spays and a neuter. It was great - the doctor supervising us is an excellent teacher and I learned how to do a spay like you would in private practice. In school they make us use a huge incision, pull the bladder out of the way (no spay hook), and do a 4-layer closure including a simple interrupted pattern on the body wall. I totally understand the rationale - for your first spay you should really be able to see what you're doing and make a super-secure closure. However, it makes the closure take FOREVER. So today was exciting because I got to make a smaller incision, learn how to use the spay hook, and improve my suturing technique on a 3-layer closure instead. It's nice to have that repetition and I'm really looking forward to going back next week!

However, now I'm exhausted. I've been studying for Monday's small animal (dermatology) medicine exam, but I still need to make some more progress toward Tuesday's avian medicine exam. Tomorrow morning I'm running a 10k race - considering my current energy state and training level, my goal is just to finish it without walking. Oh, and I'm neutering a dog at school on Wednesday which seems a lot less scary after today. I decided that being the surgeon is WAY less stressful than running anesthesia.

Hopefully I can squeeze in a little time to watch the Superbowl. D is out of town doing a ski race, so at least I don't feel bad about spending so much time studying and doing other things.

Busy outside of school, not so much in school

2011-01-31T12:27:00.000-08:00

I am now fostering our last surgery kitten. Turns out she was from a county shelter with a high euthanasia rate, and since she had some abnormalities in her pre-op blood tests I was worried that she wouldn't make it if she went back there. She immediately fit in with my cat and my other foster kitten and is recovering nicely. I'm having her blood values rechecked this week - hopefully they are normal!

Last Friday we had another clinical skills lab for birds and reptiles. I learned how to do physical exams on and how to draw blood from 2 types of birds (lovebirds and quail) as well as bearded dragons. It was really interesting and I feel a tiny bit less apprehensive about dealing with birds now. (I still feel apprehensive because they often die in the hospital - as a prey species, by the time they are visibly sick they often have one foot in the grave already.)

The weekend was nice too. I ran a 3.5-mile race back home and got 5th place in my age group (out of 55), which is awesome considering I have ZERO natural athletic capability. I also attended the feline medicine annual symposium at school, which was interesting.

This week should be fairly low-key school-wise. Saturday I'm going to the first of 4 spay/neuter clinics that I organized student volunteers for, and we actually get to do (supervised, of course) surgeries. I'm excited but I always get a little nervous when it's something I'm responsible for - I want it to go well!

Good mojo day

2011-01-24T20:05:00.000-08:00

Sometimes (and rarely while I've been in veterinary school) things just seem to go well. (Knock wood in case I am jinxing myself - more later.)

Today we had our first surgery of the quarter, and I was the anesthetist. It was a cat spay. All this quarter and last, our anesthesia faculty have gone on and on about:
- How hard it is to intubate a cat (their larynxes are very sensitive and snap shut easily; if you force the tube you can create swelling later which keeps them from breathing, which is obviously bad)
- How important it is to properly inflate the cuff on the endotracheal tube of a cat lest you rupture its trachea (also obviously bad)
- How notorious cats are for having hypotension (low blood pressure) under anesthesia

Then *I* started remembering the last cat spay prep I participated in.

I was DREADING today.

However, so far things have gone really well! Our cat is a very sweet little 6-8 month-old tortoiseshell lady who defies all of the stereotypes about torties. She is one of the sweetest kittens I've ever met. She purred throughout her physical exam and even while I was drawing blood from her! I decided to draw blood from her jugular vein because I need more practice with that. I learned to draw blood from animals' legs first, and so the neck is a little harder for me. Got the blood, no problem.

Next we had to premedicate her and get her prepped for surgery. I turned on the clippers near her to see if she would flip out like the last cat - nope. She was looking around and purring. Got the catheter in no problem and gave her the induction drugs. Intubating was also very straightforward - I waited until her laryngeal opening was at its widest opening and gently passed the tube down. Inflating the cuff also went well.

During the surgery itself I had to adjust the amount of gas inhalant she got a couple of times depending on what the surgeon was doing but all in all that went well too. She woke up woozy and purring.

Tonight I have to go back in and check on her, feed her, and give her more pain medication. That's why I don't want to jinx myself, but so far so good.

All I can say is thank you universe for making this one easier than the last cat!

1st exam of the quarter

2011-01-17T22:02:00.001-08:00

We have a combined small animal & equine medicine exam tomorrow morning covering dermatology. It should be ok, I think. Derm isn't my favorite subject in the world (I don't hate it) but it's really important. I also know ringworm inside and out after having immunosuppressed cats and orphan kittens so hopefully that part of the test will be easy.

Speaking of really important, it seems like endocrine diseases are really important to know too - diabetes, Cushing's disease, hyperthyroidism, and so on. Pretty common topics in general practice, right? Unfortunately, the way that it is taught in my school isn't helping me learn it AT ALL. The professor buries the key points between a lot of babbling so it's extremely confusing. They also don't put things into context (e.g. talking about abnormal test results for a test that can be used for > 1 disease without mentioning what disease these abnormal results would indicate!) Finally, it is a short course with pop quizzes and the quizzes are nearly as confusing as the lectures themselves. I gave up and bought a book on veterinary endocrinology. It's from the "Made Easy" series, if you want to know - and it's pretty decent. I'm trying not to get frustrated at the fact that I'm basically teaching myself something that I will probably USE. EVERY. DAY. once I'm out of school.div>

Why it's good to do non-vet-school things!

2011-01-13T20:32:00.000-08:00

You would think that a doctor of virtually any variety (veterinary, MD, dentist, PhD) would just need problem-solving and medical/scientific skills, right?

WRONG. You need strong leadership and communication skills too.

Who does the talking for your patients? Either your patient themselves (if you're lucky), or your client or patient's caregiver/family member/advocate does it for them. If your communication skills suck, you won't get a good history. If you don't get a good history, chances are pretty high that your diagnosis will suck too.

Who looks to you for recommendations on treatment plans? Again, it's a human being of some sort. You are the medical expert and you need to provide a plan and a rationale behind it, hopefully to convince them to follow your plan. Without sounding like a pompous jackass. You also need to be able to answer questions and adapt your plan if it isn't feasible for whatever reason.

I am mentioning this to stress the importance of working on those skills throughout vet (or medical, etc.) school and beyond as part of your life-long learning. Unfortunately there isn't much time in a veterinary or medical curriculum to teach those things in a structured way. Here are some ideas for self-directed learning while you're in school (don't laugh - if you get good at prioritizing your time and are ok with not getting straight As, it is possible):

- Join a club and take a role where you need to organize volunteers, plan an event, lead meetings, or all of the above
- Join Toastmasters
- Look for books on leadership and read them (I like The Leadership Challenge by Kouzes and Posner, but there are many other good ones out there)
- Do something (anything!) that isn't medically or scientifically-related to remind yourself that you aren't a differential diagnosis-generating-machine
- Look for presentations and discussions on communication, leadership, and even business skills

You don't have to do all of these. Pick something - ideally something that pushes you, or maybe even scares you a little bit. That's how you grow.

I'm by no means the be-all end-all expert or perfect in these areas, but I'd like to think I learned *something* in the 10 years I spent working and getting my MBA. Trust me, developing these skills helps a LOT. We're no longer in an era where doctors can use leadership-by-force with their patients or clients, no matter how much of a smarty-pants you might be.

New year, new quarter

2011-01-07T19:49:00.000-08:00

appy New Year everyone!

This week was a busy one. Here's a summary of my initial thoughts about the classes:

Dentistry - more interesting than I thought it would be. It's at 8 am every day in a dark lecture hall (need to see the pictures on the screen) so that is kind of rough.
Ultrasound - haven't had the first lab yet, but lecture was an easy review.
Doctoring - done for the quarter! We had a couple of lectures and another role-playing exercise with actors that I did well in (I think).
Small animal medicine + equine medicine (combined the next 2 weeks) - covering dermatology, which isn't my most favorite thing but it's important for me as a future GP.
Small animal anesthesia - the class isn't hard, but now I'm worried about surgery labs and clinics. So many drugs! So many side effects! So many different protocols! I just plain can't remember them all and I get terribly confused.*
Companion avian medicine - it's ok. I'm not sure it will stoke a big passion for birds (I still hate how easily they die) but I'd like to be able to at least see birds if they come in the door.
Endocrinology - disorganized, rambling lectures. Thank goodness a lot of it has been covered in other classes already!

Overall it seems like it will be MUCH less draining than winter quarters were the past 2 years. So far having an 8 am class every day has been very tiring. It looks good on paper - hey, I'm done at 3 pm today! Wait, I've been in class for 7 hours. Hopefully I will adjust to the schedule again soon.

*I realize that once I get into practice the protocols and number of anesthetic drugs used will decrease a LOT and I'll get more familiar with them. Until then, I'm kind of freaking out.

Gratuitous kitten picture

2011-01-02T15:57:00.001-08:00

Finally relaxing

2010-12-27T11:48:00.001-08:00

I think I hit that magic point in a vacation where I no longer feel the need to move at 100 miles per hour all the time. I'm content to sleep (a LOT), read, watch TV, and take care of a few things at a time. It's nice. What's not nice, however, is the weight I seem to be gaining. Stupid candy and holiday food!
We go back to school in a week. This quarter is looking like it won't be nearly as hard as previous ones - but I could be wrong. Here's what I'm taking:
Core classes
- Surgery (continued; our team has 3 more surgeries this quarter)
- Doctoring (continued; more role-playing labs)
- Clinical skills (continued; I just have 1 lab with birds and reptiles)
- Endocrinology
Electives
- Dentistry
- Bird medicine
- Small animal medicine
- Equine medicine
- Diagnostic ophtho
- Advanced small animal ultrasound
- Small animal anesthesia

I know it looks like a lot of classes, but many of them are 2 credits or less. In addition, only 3 of the classes have in-class exams. The rest have quizzes, take-home exams, or are pass/fail based on participation.

Nothin' doin'

2010-12-21T12:23:00.000-08:00

So far I haven't accomplished very much during this break, which is disconcerting. I feel like I should be productive - cleaning, cooking, organizing, taking care of all the things I don't have time for during school ...

Oh well.

I guess I have done some things - took a lot of items to Goodwill, made a coconut cake, started my scholarship application, finished my course evaluations, had my annual viewing of "Love Actually" (my favorite Christmas movie), and so on. I've also gone snowboarding (once - this past Sunday, and conditions were slushy/yucky).
Today I'm attempting to make one of my grandma's Christmas cookie recipes. If that goes well, I'll try another recipe later in the week.
Saturday we're headed to the mountains (that's right, on Christmas) to go skiing/snowboarding at my favorite resort - looking forward to that!

Some day I will hopefully be able to make peace with downtime like this. For now I'm totally antsy and would *almost* rather be at school.

The verdict

2010-12-09T10:44:00.000-08:00

My foster kitten does indeed have a corneal ulcer. Apparently despite my shuddering at all of the disgusting pictures in the ophtho lectures, I might have learned something in that class. (Or I'm a really good guesser.)

Now I get to put antibiotic drops in her eye twice per day - yippee.

Break time

2010-12-08T11:48:00.001-08:00

I'm back home with 3 1/2 school-less weeks ahead of me.

Right now I have 5 (yes, 5) new foster kittens that I'm working with. The 2 oldest are the most social and don't really need anything other than food and some attention. The next oldest one is an extremely frightened girl. I got her spayed and treated for ear mites yesterday, and tomorrow she goes to the vet to have her eye examined. Her right eye looks a little cloudy and she squints. Without the right ophtho stains and tools I can't be very sure what the problem is, but a corneal ulcer seems like a good bet. Hopefully if I can get that treated she will relax a little, because it probably hurts. The 2 youngest ones just need extra socialization and don't seem to have any major health issues.

Saturday I'm doing the feral cat spay/neuter clinic again. There are 4 3rd-years going this time, so I don't get to do all of the neuters but that's ok - I'm pretty comfortable doing them now, even with minor complications. That night D's company has its holiday party at a super-nice hotel on the coast with delicious, delicious food.

Next week I have jury duty. I deferred it from mid-November when they originally wanted me to come in. Hopefully my group doesn't get called. I suppose I should put another book on my Nook just in case, though.

Other than that, my plans include running, swimming, snowboarding, catching up on TV, and resting as much as possible. We get another week off in late March and then that's it until clinics - which means I might not get vacation again until January 2012. Hopefully they give me my 3rd week BEFORE then!*

*We can request a specific week or block of 2 weeks for vacation, but all other vacation gets assigned by the administration in order to make sure services are covered and that we get enough time on each service.

< 24 hours left in my last fall quarter!

2010-12-06T21:22:00.000-08:00

I did adopt out my foster kitten, and as predicted I did cry afterward. Less than a week later (today), I now have 5 new foster kittens from 3 different litters.
Our clinical skills lab last week was really interesting. We learned how to place urinary catheters (which I already knew from working as a tech) as well as how to perform joint taps to sample joint fluid. In case any of you are wondering, we don't do invasive labs like these on live animals - we use fresh-frozen cadavers. It's a little daunting to know that the next time I do a joint tap it will be on a real-live patient. Come to think of it, our school isn't all that great at giving us a lot of technical clinical experience. We briefly go over something once and then are expected to have it mastered. Here are some examples besides the latest lab:
- IV catheters
- Intubation
- Anesthesia monitoring
- Spays and neuters
Oh, and we don't do any cat neuters as part of classroom work - if you don't participate in extracurricular spay/neuter clinics the first time you get a cat neuter might be 4th year.

Anyway, my last exam is tomorrow morning (small animal medicine). There are some details that I can't seem to pound into my head despite 3 trips through the material, so I'm taking a break for the rest of tonight and will look at it again in the morning. I'm really looking forward to having some more time off - there's a lot of snow in the mountains calling my name!

Slow(ish) week

2010-11-29T16:51:00.000-08:00

This morning was our equine medicine exam. It involved a LOT of writing but wasn't tricky or anything. I also finished my ophtho take-home exam today.

Tomorrow - no school-related events; just have to study neuro. My remaining foster kitten has an appointment with potential adopters. I've really grown attached to him over the past few months and will probably cry if he gets adopted. In addition, my cats are at home (not at school) so if he gets adopted I'll be alone in the apartment for the first time.

Wednesday - clinical skills lab, study neuro

Thursday - neuro exam. This one has me kind of scared because a) it's neuro, which I struggle with and b) it's a lot of material. Oh, and there's a small animal medicine lecture.

Friday - SA medicine lecture

It's kind of nice to have such a light schedule for once!

What I'm doing with my week off

2010-11-24T16:23:00.000-08:00

1. Running (mainly on the treadmill because it's been cold and rainy)
2. Swimming (indoor pool, see above)
3. Studying (equine medicine final is the Monday after break - great planning, school)
4. Sleeping 9 hours per night instead of 5 or 6
5. Eating good food and drinking good wine
6. (Hopefully Friday) snowboarding
7. (Saturday) neutering feral and stray cats at a clinic
8. More studying (neuro final is a week from Thursday but it looks like a BEAST)

Relief!

2010-11-19T21:48:00.001-08:00

Finally, FINALLY, it's Thanksgiving break. I even made it through today's opthto lab (surgical techniques on cadaver heads) without vomiting or fainting, although I had to stop about halfway through an enucleation because I got a severe case of the heebie-jeebies.

I skipped equine medicine the past 2 mornings in order to get more sleep, which was a good life decision. I no longer feel like I could cry at the drop of the hat, and I even had energy to go for a run today. Win!

No juice left

2010-11-17T16:29:00.000-08:00

The TV interview went well, I think (I haven't watched it and don't plan to because I hate the sound of my recorded voice). The small animal exam went well too.

This week, so far, has sucked the last bit of life out of me.

First up, Monday's cat spay. I was supposed to be the assistant, however our cat bit me after being shaved for her catheter. She was basically tripping on her premeds and freaked out (imagine a feral cat under restraint and you get the picture.) Unfortunately our lab is not set up to handle fractious animals and the only restraining device I had for her was a potty pad. Seriously. And no one came over to help me. Awesome.
So I decided to let the cat go in order to save my hands, but on her way out she nailed me. I bled onto the floor in the 10 feet it took to get to the sink to scrub my hand out, and had to leave to go to the doctor. I was hysterical afterward. Now let me be clear - I've been bitten before, but it was my own fault (trying to restrain an animal past the point of common sense). What was so upsetting this time was that
a. I didn't have the equipment to be safe, and
b. NOBODY helped me until it was too late!
It made me feel very alone and like no one gives a shit about me. The reality is that they were either busy dealing with their own cats or incorrectly assumed I had the situation under control. It's really hard for me to not withdraw (socially) after something like that happens and I'm still struggling with that.
At least in future labs they are going to make sure that each cat has their own carrier - if I had one available that day I could have just put her into it and let her finish her freak-out in peace.

Next was yesterday's written exam for surgery. It was LONG (like 15 pages? I lost count) and really difficult. I think I passed, but I was making up a lot of answers.

I just want to get this week over with so that I can go home and rest. (We have next week off for Thanksgiving break.)

TV and ear tags and exams

2010-11-09T15:55:00.001-08:00

It's been a busy week-and-a-half, which isn't surprising given that Thanksgiving break is coming right up. Last week I had back-to-back exams in equine medicine and neurology. I don't know how I did in equine yet. I thought I had done well in neuro (especially compared to how crappy I felt coming out of it) until I found out that almost half the class got As. WTH? Oh well. I honestly don't really like neuro anyway so it doesn't upset me too much.
We also had a required regulatory lab where we learned how to tattoo and ear tag cattle for brucellosis vaccination, how to fill out USDA and state forms, and how to perform TB tests in cattle. It's kind of strange because the USDA is changing their certification into 2 levels - level 1 is basically cats & dogs, and level 2 is all animals. When you're certified you can do things like write official health certificates for animals that are moving interstate or out of country. Anyway, I'm 99.999% sure I will never work with cattle professionally, so this lab wasn't very interesting. In addition I always feel dumb when large animal faculty (excluding equine) ask me questions because I haven't taken any of the classes and have NO idea what the answers are. Then they say things like "well you need to know this for boards." That's great, but I won't be studying for boards until NEXT YEAR.
This week we have an exam in small animal medicine (tomorrow) and we get Thursday off for Veteran's Day. I'm also going on community TV tonight to talk about the school's foster kitten program that I help manage - wish me luck!

First spay surgery!

2010-10-30T10:02:00.000-07:00

Wednesday was the big day. I had to get up early and go to school to perform a physical exam and draw blood from our patient. She was very good for everything except taking her temperature (rectally - can you blame her?)
Her bloodwork and physical exam were normal, so she was cleared for surgery. I was SO nervous that my gut hurt and I was sweating buckets. It took a while to get her intubated (thank goodness I didn't have to do that job - had that, um, fun last week with the puppy), and then we clipped and prepped her abdomen and took her into the OR.

First hurdle - would I remember how to scrub, gown, and glove since it had been over a month?
Yes
Second hurdle - would I make the skin incision smoothly and at the right depth?
Yes
After that, I started to feel a little better. There was a faculty surgeon that was rotating between my table and my neighbor's to make sure we were doing things right, which helped. It didn't take too long to get her tiny little uterus and ovaries out. Instead of using a spay hook, they had us make a bigger incision and look under the bladder for the uterus (next year we use the spay hook and a smaller incision).
It did take forever, though, to close her up. Normally a spay incision is closed in 2 or 3 layers, but we had to do 4. In addition, we had to close the body wall in a suture pattern that is much more fail-safe but takes a lot longer to do. Oh, and the incision was like 3 times as long as the incisions I've seen veterinarians make.

Anyway, she recovered pretty well and when my teammates checked on her that night she was back to normal and eating/drinking/urinating well. I woke up before my alarm the next morning praying she didn't hemorrhage in the night, that I didn't accidentally tie off her ureter, and all the other possible complications they teach you about (ah, vet school - how many gray hairs have you given me?)
When I checked on her, though, she was doing great! Her incision wasn't red or swollen and she was purring and kneading her little fleece blanket. Yay!

p.s. It's a really good thing that she had already been adopted because I would have been sorely tempted to take her!

Denial?

2010-10-26T19:52:00.001-07:00

Most of the time I don't consciously feel stressed out. However, I always know when I am in fact stressed because I have nightmares. They all have the same theme - someone is chasing me and trying to kill me.

Anyway, I woke up at 5 this morning after one such nightmare and then remembered why I'm probably stressed:
- My dad is in the hospital for his heart disease and has to have another bypass next week
- One of my cats (one that lives with D) is sick with a respiratory infection and possible hyperthyroidism (waiting on blood results)
- I am doing my first spay surgery tomorrow (Wait, didn't I go on a RAVS trip? Yes I did. However, I basically only did *parts* of each surgery because I was slow, and I never did any parts of a cat spay - just dogs.)

My patient is a 4-6 month old sweet little tortoiseshell lady. I hope I do right by her tomorrow. I hope my dad makes it through the surgery ok. I hope my cat gets better and that this isn't the start of her downhill slide (she's an old lady too).

First surgery lab done!

2010-10-20T17:39:00.000-07:00

Today I was the anesthetist in our group; the surgery was a castration (neuter) of a pretty darn cute puppy.
For our labs we have to be at school at 7 am to perform physical exams and to draw blood for pre-op profiles. Then we give premedication around 12:30 or 1 pm, induce around 1:30 or 2 pm, and then have surgery and recovery. The animals are usually recovered by 5 or 6 pm, which makes for a very long day.

Puppies are harder than you-know-what to induce anesthesia on. This boy did NOT want to go to sleep. At all. To be fair, I had decided to go with the adult anesthesia protocol since he was on the cusp of the age limit (4 months), and the puppy protocol specifies twice the propofol dose for induction. That was about what I ended up using. Lesson learned.

Anyway, after the goat rodeo that was induction and intubation, he did fine throughout the surgery. I didn't really need to adjust the inhalant anesthetic at all.

Most important - the patient is now resting quietly in his run and I passed the lab.

I have to go back in tonight to check his pain assessment, feed him, and give him more pain meds if needed.

Next week I'm the surgeon on a cat spay. I'm a LOT more nervous for that one. Definitely looking forward to the surgery after that where I'm the assistant!

Reasons why 3rd year is WAY better than 2nd year (at my school)

2010-10-15T21:17:00.000-07:00

1. Medicine classes. They integrate things we've learned the first 2 years and are generally taught by clinicians, with a focus on clinically relevant information! For example, our small animal medicine exam today had many questions that began with a brief signalment (breed, species, gender, intact or spayed/neutered) and history that we then had to answer questions about. LOVE it!
2. Our teachers seem more easy-going so far this year. It's almost as if we've proven ourselves and they treat us with more respect. Example - our ophtho professor announced that instead of an in-class exam, he is changing it to an open-resource online do-at-home exam. None of our earlier classes would have done that!
3. Labs. Clinical skills labs have gone beyond the "halter the horse" and "scruff the cat" from previous years, and we're learning to do physical exams and minor procedures. This quarter alone I have learned or will learn physical exams on small mammals (rabbits, ferrets, rats, hamsters, guinea pigs), joint taps/chest tubes/some other stuff on dogs (fresh-frozen cadavers - not live ones!), and CPR on a high-tech dog model complete with all the monitoring equipment you could wish for. Labs finally rock!
4. Surgery class! Our labs have started, and that is really exciting. We work in groups of 3; one person is the surgeon, one is the assistant, and one is the anesthetist. We take turns so that we perform all 3 roles for all 3 types of surgeries (dog neuter, cat spay, dog spay). The animals come from local shelters and we can adopt them afterward too. Our group's lab is next Wednesday and I'm the anesthetist.

Don't get me wrong, it is still a huge amount of work and it is by no means easy, but I'm enjoying it SO much more than previous years (last year in particular)!

Crunch week

2010-10-12T17:23:00.000-07:00

Fortunately I haven't had time to sit around and feel sorry for myself much -

Today we had our orthopedics final. It's a short class (only 10 lectures) and is only 1 credit, so I didn't kill myself studying for it. The exam wasn't super easy, but I think I did fine.

Tomorrow we have a discussion in doctoring class. Friday we have another exam in small animal medicine. Next Tuesday we have a midterm in ophthalmology. Next Wednesday we have our first surgery. It's a dog castration - I am the anesthetist, which is more frightening to me than being the surgeon because all the drugs get jumbled in my mind.

Other people in my class have it much worse than me this week - some have 3 exams and surgery! This year is still 1,000,000 times better than last year was though. We have fewer exams and MUCH more interesting classes!

Sad

2010-10-09T18:21:00.000-07:00

Last night, my old lady cat with lymphoma (above) had another seizure. She had one in June and had been doing relatively well since then, with the exception of a couple of GI upset episodes. This seizure lasted a full minute and she took 10-15 minutes to come out of it. During that recovery time she was blind and circling to the left.

Ok, I thought. 1 seizure can be an anomaly, but 2 is a pattern. I'll make an appointment in the morning for her to see a doctor since she's stable now. I'm obviously worried that the lymphoma has reached her brain (especially since she's had intermittent head tremors and intermittent anisocoria, or unequal pupils, for almost the past year).

Just before 5 am today, she had another seizure. This one lasted between 1 and 2 minutes, and it took her 15-20 minutes to come out of it. Again she was blind and circling to the left, and her back legs seemed weak.

Crap. It certainly looked like the lymphoma is in her brain, and if not that, then something else was seriously wrong in her brain. Then I thought about pursuing treatment for it. The only problem? Working up a brain mass requires an MRI, which requires anesthesia. She almost didn't make it through the anesthesia last spring for her GI explore, so that was a no go. Increasing her current chemo dose? Well, considering I've had to stop her a couple of times because it caused such severe GI signs, that didn't make sense either.

Ultimately we decided to take her in to be euthanized. It sucked.

I've realized one thing from having so many pets grow old and have terminal illnesses:
There is no best time to make the euthanasia decision. I'm always second-guessing myself - did I string them out too long and make them suffer (happened with previous pets)? Did I not give them enough of a chance to pull through (in this case)?

At some point I will make peace with this as I have with the others, but for now I'm just sad and overthinking things.

Delivering bad news

2010-10-07T20:21:00.000-07:00

Yesterday I got an email from a family who adopted one of my foster kittens last year. He was diagnosed with FIP. He had been getting more and more sick over the past few weeks, and their vet said he probably has FIP but offered to do an ultrasound just in case it is a liver problem. They wanted to know if there was anything else they could do.

FIP is a horrible disease - I actually had a foster kitten with it last year. This cat, however, had no health problems when I had him as a foster kitten.

I wrote back and told them how sorry I was that this happened, explained that there is no good way to predict or to treat FIP, told them it was up to them whether or not they wanted to pursue the ultrasound to rule out liver disease, and told them they did everything they could.

There is absolutely no easy way to tell someone that their pet is screwed. This is going to be the first of many, many times I'll have to do it, though. I hope it gets at least a little bit earlier because it bothered me the rest of the day.

Race

2010-10-03T21:12:00.001-07:00

I managed to hang in with the pace group until mile 8, when an urgent bathroom stop derailed me. My finishing time was 7 minutes behind that stretch goal, which was still a respectable time (for me).

No class until 10 tomorrow! That's a special treat since equine medicine has been at 8 am nearly every. single. day. this quarter. (I'm not a morning person).

2 done

2010-10-01T21:03:00.000-07:00

The neuro exam was tricky, but I did pretty well on it. Small animal medicine wasn't easy and wasn't hard - just kind of in-between. No grades back for that yet. Next up: equine medicine on Wednesday.

I'm looking forward to the race. I decided to push into the slightly faster pace group (thanks Life in Vet School!) and to see what happens.

Oh, and I switched laptops because mine was SUPER slow and dying. It was a tablet PC, so I decided to get a MacBook with some of my summer income because none of the people in my class with them seemed to have problems. I LOVE it!

Easier in one way, harder in another

2010-09-26T22:19:00.001-07:00

This week should be much lighter in terms of class time. We only have 1 afternoon lab, which means I'm done by noon or 2 the rest of the days!

However ... we also have 2 exams. Neuro is tomorrow. I feel like I actually know the material really well at this point, so that's good. Thursday we have small animal medicine, covering renal diseases. The lecturer was very confusing and overcomplicated things, so I'm concerned that the test will be poorly written. That's something I can't do anything about, though. I feel like that material is coming together for me too (with a LOT of effort to decipher his confusing slides and notes).

Today I finished my last long training run (12 miles) before the half-marathon in a week. My knees hurt quite a bit at the end. I think that riding my bike to school actually strains my right hip and knee a lot (not sure why), so I'm planning to drive to school this week and take it easy during the tapering period.

For the half marathon, I'm giving some thought to joining a pace group that should finish about 5-10 minutes faster than my last half-marathon time 5 years ago. I think it would be doable, especially given my running and racing times earlier this year, but I'm still worried I won't be able to keep up.

Planning ahead

2010-09-24T09:04:00.000-07:00

We had a class meeting yesterday to discuss our senior (clinical) year. Our school has tracks, so you need to decide on a track (small, equine, food, zoo, or some combination thereof) and that determines what clinical rotations you have to take, how much elective time you have, etc.
I had decided to track small animal, even though I REALLY like equine, for a couple of reasons -
1. When I'm looking for a job (in a small animal clinic in a major metropolitan area) I don't want prospective employers to question my dedication to small animal medicine and pass me over for jobs
2. There are some equine or equine/small track rotations I just don't wanna do (like repro)
3. If I tracked small/equine I would miss some really cool small animal rotations

Ok, so that was all set and I had scheduled 2 externships. I had also planned to do a rotation in the exotics department and to repeat the rotation in equine ambulatory. Until yesterday.

Yesterday the administration informed us that small animal track people would only get 9 weeks of electives instead of 11. They made soft tissue surgery a mandatory rotation. We already have 4 weeks of community surgery (where we actually get to DO surgery) and 2 weeks of orthopedic surgery. In soft tissue, you *might* get to suture if you're lucky. Whoopee.

I had scheduled 8 of those 11 weeks already, planning for the other 3 to be vacation. So here were my options:
1. Drop an externship (one was totally non-negotiable because it's an excellent externship and close to home, the other I REALLY didn't want to drop because it's a prominent emergency clinic in a large city)
2. Drop the exotics rotation (given that one of my key selling points when looking for a job will be that "I don't just see cats and dogs - I'll see small mammals too," this wasn't an option)
3. Take only 1 week of vacation instead of 3 (thought about it, but can you say BURNOUT?)
4. Drop the equine rotation - what I ultimately decided to do

I am still pretty ticked off. They should have told us about this LAST SPRING. They knew they had hired a bunch of ST surgery faculty and MUST have been thinking about it at that time. Now those of us who actually planned ahead are being punished.