Wednesday, June 11, 2014

I'm fine.

John Bridger: How do you feel?
Charlie Croker: [shrugging] I'm fine.
John Bridger: Fine? You know what "fine" stands for, don't you?
Charlie Croker: Yeah, unfortunately.
John Bridger: Freaked out...
Charlie Croker: Insecure...
John Bridger: Neurotic...
Charlie Croker: And Emotional. 
 - The Italian Job
With the above definition, I have mostly been "fine" on this rotation. I'm either freaked out about a procedure I have to do (often with the client watching me), insecure about my answers at morning rounds, neurotic about over-analyzing my patient exams (is this normal? ooh, that's up a little, do I need to worry about that? why is his AST down??!), and emotional because either something fantastic has just happened or something horrible. 

Large animal medicine is almost over. Which means almost six weeks of my fourth year is over. This is has been substantially different from my first three weeks on fish health.

Namely, patients die.

Okay, fish die too. But it's just less emotional. From a welfare/lab animal perspective, fish suffering is no different from any other animal suffering. But whether it's societal conditioning, or just the difference in management (after all, I wasn't setting up IV lines and doing ultrasounds on the fish and the fish didn't have humans attached and names and stories),  for me it's just plain sadder when a non-fish dies. (Your mileage may vary.)

People often comment to me, "Oh, I don't know how you can stand it! I just couldn't put an animal to sleep." To be honest, that's not the part that bothers me. Sure, it's sad. I screamed like a baby when my dogs were put down. I am moved seeing a clients' animal euthanized. It's a goodbye, of course it's sad. But 9 times out of 10, it's in the animal's best interest. In vet med, we can do what (most) human doctors can't. We can end suffering once and for all. We can take the pain away.

What gets me are the ones we just can't save.

Maybe we just don't know what they have. Maybe we know what they have, but we just get them too late. Maybe they just go overnight. I can't go into specifics on this blog, but we've had a rough couple days in large animal medicine with a few deaths; things that just couldn't be helped. When I came in this morning, I asked a classmate about a patient who came in yesterday. He told me he died overnight. It turned out to be a fluke thing that no one could have anticipated and even if they had, there was nothing that could have beeen done about it. But it didn't change the fact that I got irrationally angry at the universe and stood in that stall and cried. Not long, but I did. Then there was stuff to do. There's always stuff to do, but sometimes, you just need that five minutes in a dark stall to let it pass, so you can get on with the patients that are still alive and still need you.

Saturday, June 7, 2014

An Open Letter From A Senior Student On Rotations

Hello clients!

A teaching hospital is a bit of a weird environment compared with your neighbourhood vet clinic. It's a world of extremes. We have general vaccine and well puppy/kitten checks, and the most dire of chemotherapy and complicated surgery. We have tiny birds and huge draft horses. And it's the most experienced knowledgeable specialists combined with the larval forms known as senior students.

The senior student may be the first person you meet after reception. They may seem like they're reading off a script while they ask for a history because they are determined not to miss a detail. They will probably take copious notes and ask you to repeat things so everything is correct. Please be patient with us. We are learning. We haven't developed that sixth sense and intuition yet. Your regular vet may take 10 minutes to do a physical, but the senior student might take three times that. It's because we're double and triple checking in our own heads. As I am examining your animal, this is what's going through my head: Is that a crackle in that lung? Are those gut sounds increased? Are these gums pink or a little pale? Is that a murmur or just the hair on the stethoscope?  Oh crap, forgot to check the joints. Temperature is 38.1, what's normal in this species? 37.2 to 38.5? Something like that? Wait, but it's a neonate, what's normal in them?

You might think we're inept. And we kind of are. But I promise you, that doesn't mean we're stupid or uncaring. Once we have consulted with our rotation clinician, 99% of us will rush off to read EVERYTHING we can get our hands on about that disease. Its mechanisms, the drugs that treat it, the side effects of those drugs, management of the disease, diagnostic tests, prognosis and complications. We'll look up differentials for that disease. We will spend hours pouring over your animal's tests results. So don't worry, and try not to be too critical of us to our faces; we may pee our pants in terror.

On the first day of this rotation, the senior clinician asked if anyone was afraid of dealing with clients. I said I was. I probably won't ever forget her advice to me: "Clients just want to know that you care." And we do. We are pet owners too. We will spend our free time grooming your animal. We will come in when we don't have to to see how they're doing. We fret about them when they aren't doing well, and we celebrate when they improve. Every morning on my large animal medicine rotation, the greeting between students isn't, "Morning, how're you?" Instead, it's, "Morning, how's your patient?" If it's a food animal or a new foal and it comes in without a name, we will give it one because we just feel connected to them (there are usually long drawn out conversations of, "Does this calf look like a Jenny or a Phoebe to you?"). If it has a name, it'll get a cutesy nickname. We treat them like they're our own.

So next time a senior student is in front of you and stumbling through the history and pestering you about vaccine history and what dewormer you used last, take a breath and be patient with them. They won't let you (or your animal) down.