Vet school versus The Real World

After 3 days back working for the Giant Veterinary Corporation hospital in Northglenn where I worked last summer, it's interesting to compare my experiences in vet school during the last 11 months to what it's like to be back in an actual functioning hospital environment.

In school, when you're sitting in lectures and going to labs all day long, you know in the back of your mind that every case example you're discussing would in theory represent an actual physical animal with owners and finances attached. But when the instructors just keep tossing CBC or biochemistry data at you, with no pet's name or breed or age attached, or you're working through some aspect of case management from a very isolated point of view that just pertains to that one class that you're in at the moment, it's easy to forgot how complicated practicing veterinary medicine can be.

In the real world, every dog or cat has an owner (or multiple owners). Every owner has a checking account with a certain balance or a Visa card with a limit. If you want to get an accurate history on a patient, you may be hindered by a screaming toddler in the room with you, or an inability to understand English. If you want bloodwork data on a pet, you first have to make up an estimate, call the client, explain the need for the testing, get approval, get somebody to help you hold the pet (+/- a muzzle and a third person to restrain), draw the blood (a lot harder than it looks), wait 10-20 minutes for it to clot, 10 minutes to spin off the serum, warm up the chemistry machine, thaw your 12 slides from the freezer, and wait for the machine to run the test. And sometimes it doesn't work on the first try. And sometimes the machine is broken. And sometimes it turns out you didn't draw enough blood so you have to get the dog out again. And sometimes you did draw enough blood, but someone accidentally throws it away before you run it. Etc. Etc.

You don't always do the "gold standard." Looks like the dog has a toenail infection and a lump on its side? Owner's finances are limited? Fine, instead of doing a complete list of preventive services (heartworm test, 4 vaccines, fecal exam, deworm) plus treating the toenail and diagnosing the lump, you just give the rabies vaccine, skip the cytology or any other diagnostics on the lump, and send the dog home with a steroid injection, two weeks of antibiotics scripted out to a pharmacy, and an e-collar to keep him from licking. See him again in 2 weeks, and hope for the best.

Five month old puppy in to be spayed? Doctor notices on pre-surgical exam that she has two retained puppy teeth that should be extracted? You try to call the owner at the phone number they left as "number where we will be able to reach you during surgery." No answer. Leave a message. They never call back, so the teeth stay in for now.

18 month old dog has been "sick" for a month. Started with acute vomiting, then nausea, and now has progressed to diarrhea, although the vomiting is gone. Dog's physical exam is fine, fecal exam is normal, owner okays bloodwork (chem, CBC, venous blood gas, lytes, and pancreatitis test). All bloodwork normal. No idea what's wrong with the dog. In vet school world, you pursue additional and more invasive diagnostics (at least theoretically) until you have your answer. Real world? Send the dog home with an antibacterial/antiprotozoal medication and a bland diet.

In the last 3 days I've cleaned up pee, poop, vomit, and diarrhea. I've been peed on (right onto my hand, also down my leg). I've had an abscessed anal gland exploded on the side of my shirt. I've been scratched and had dogs try to bite me. I've failed miserably at drawing blood (at least jugular sticks; I'm still okay with cephalics). I successfully placed one IV catheter on the first try, then horribly mangled a second (in my defense, the second dog was a Basset hound puppy) - but did manage to salvage the vein and get a catheter in that same leg after all. I've relearned the CBC machine, chemistry machine, centrifuges, blood gas/lytes machine, and entire computerized medical records system. I've reminded myself how to express anal glands and am practicing palpating bladders for cystocentesis. I watched an aural hematoma repair surgery on an old Dalmatian and observed the extraction of a maxillary carnassial tooth on a large middle-aged dog. I've done a heck of a lot of laundry. I've stayed past the end of my shift twice and gotten to go home early once. I now remember how boring the commute is (although it's shorter than I remembered - only about 45 minutes) and I got myself a book on CD to entertain me.

It's going to be a long 5.5 weeks!