A: Only 5. As long as there is an equine medicine resident around to supervise.
Yes, at long last, I had my first adventure in the equine barn this morning!
Thanks to the fact that horses have eyes and I am on ophthalmology, I headed out with the platoon of other wary small animal trackers, led by one semi-confident mixed animal senior, to meet a beautiful black and white paint horse being dropped off for surgical removal of his ocular squamous cell carcinoma tomorrow.
I felt better once I found out that 2 of the 3 seniors in the group had never been to the barn, either -- and they're graduating in 2 weeks!
True, all we needed to do was pick a stall, put an ID card on the front, fill up the tub with water, and spread a bunch of straw on the ground. And yes, that's probably just as easy as it sounds. But I'm proud to say that the 5 of us banded together to git 'er done (as some of the equine medicine juniors and seniors looked on in amusement, and the expression on the equine resident's face plainly said "And how did you guys get into vet school?"). In our defense, breaking up a big bale of straw seems to be a lot more fun when you're not doing it alone.
In other ophtho news, I watched an enucleation (cutting out the eyeball) on an Airedale with chronic uveitis and a recently detached retina. I also saw an entropion correction (cutting out part of the eyelid that is causing the eyelid to roll in and the eyelashes to scrape on the eye) and watched a senior student tack a cherry eye.
Although all these surgeries have been cool to see (and I'm glad I got a chance to venture into the equine facilities), I do wish that they had appointments in the morning sometimes instead of surgery -- I thought I was signing up to help work up eye problems during this week of independent study, not just stand around in surgery on my tip toes trying to see a miniscule surgical field with 3 surgeons' heads blocking my view. Oh well!
Wednesday, April 27, 2011
Tuesday, April 26, 2011
COOL-slash-Ewwwwwww
During my independent study ophthalmology rotation this morning, I got to watch a cataract removal surgery called phacoemulsification.
In a nutshell, it involves cutting a hole in the cornea, inserting a probe into the diseased lens where the cataract has formed, using ultrasound waves to "chew" up the lens, and then placing an artificial lens.
And it was simultaneously just about the most awesome and the most horrifying surgery I've ever watched.
The 'ewwwww' factor was not helped by the fact that we were watching the surgical field magnified on a huge video screen, so the eyeball was about a foot and a half across.
And I absolutely had to turn away when they were starting on the first eye and you could see a huge-looking but actually very miniature scalpel blade slicing into the eye, with aqueous fluid gushing out around it.
But once you stop thinking of the eye as an actual eyeball attached to an actual living dog that ideally wants to be able to use its eyeball after it's been sliced-and-diced, then this surgery is so, SO cool to watch.
It's also so neat to think that after just 30-45 minutes per eye, this dog, who has been blind since becoming a diabetic a year ago, will have basically "good as new" vision. (Okay, there's also the $3000 the owners are coughing up for the phacoemulsification, but if I had a few thousand dollars to burn, this might be a good investment.)
However, I'm afraid the 'ew' factor prevails. I'll never be an ophthalmologist!
In a nutshell, it involves cutting a hole in the cornea, inserting a probe into the diseased lens where the cataract has formed, using ultrasound waves to "chew" up the lens, and then placing an artificial lens.
And it was simultaneously just about the most awesome and the most horrifying surgery I've ever watched.
The 'ewwwww' factor was not helped by the fact that we were watching the surgical field magnified on a huge video screen, so the eyeball was about a foot and a half across.
And I absolutely had to turn away when they were starting on the first eye and you could see a huge-looking but actually very miniature scalpel blade slicing into the eye, with aqueous fluid gushing out around it.
But once you stop thinking of the eye as an actual eyeball attached to an actual living dog that ideally wants to be able to use its eyeball after it's been sliced-and-diced, then this surgery is so, SO cool to watch.
It's also so neat to think that after just 30-45 minutes per eye, this dog, who has been blind since becoming a diabetic a year ago, will have basically "good as new" vision. (Okay, there's also the $3000 the owners are coughing up for the phacoemulsification, but if I had a few thousand dollars to burn, this might be a good investment.)
However, I'm afraid the 'ew' factor prevails. I'll never be an ophthalmologist!
Monday, April 25, 2011
Junioritis
I'd say just about every student in my class is afflicted with a serious case of Junioritis that can only be cured with 'tincture of time.'
What I mean is, we've gotten to the point of having a visceral reaction to the thought of sitting in class any more. Studying for exams now consists of a half hour skimming through the slides from the lectures you skipped, then just winging it. Papers are written by jotting down whatever thoughts you can pluck through the exhausted haze in your mind, then going back later to find references to support what you wrote.
We have two more weeks of junior year left. And in those 2 weeks, we have 3 midterm exams, a behavior final, and 12 hours of capstone. Plus regular rotations every morning this week and regular classes every afternoon this week and next week.
Capstone (affectionately dubbed "Crapstone") seems even more pointless this year than the previous two. Our freshman-year capstone exam was given the day before we started sophomore year; the sophomore capstone was given the day before starting junior year -- i.e. at the end of a long summer with (assuming proper motivation) plenty of time to brush up on material from the previous year. Although I didn't like the last 2 Capstones, I understood that they had at least some purpose.
Capstone III, coming up in 6.5 days, has lost all purpose. With a full schedule of rotations and classes, as well as ongoing exams (basically one every weekend) and homework assignments (one or two a week), there just isn't really any time to study for Capstone. They say that the other goal of Capstone is to prepare us for a cumulative, integrative exam like NAVLE? Well, the numbers are in, and this year's seniors (the first class to have taken any Capstone exams) did worse on the NAVLE than the last few graduating classes.
So, yes. We are ready to be done with junior practicum. We are ready to be done with classes. We are ready to be done with homeworks and exams. And, most of all, we are ready to be done with Capstone.
Having seen how busy and fatigued the seniors are, I never thought that by the end of this semester I'd be just about longing for senior year to begin! Four weeks on Community Practice sounds like a veritable vacation compared to the final four weeks of spring semester. (I know -- check with me when I'm about 3 days into Community Practice, and see if that's still how I feel.)
I'm so ready to be done!
What I mean is, we've gotten to the point of having a visceral reaction to the thought of sitting in class any more. Studying for exams now consists of a half hour skimming through the slides from the lectures you skipped, then just winging it. Papers are written by jotting down whatever thoughts you can pluck through the exhausted haze in your mind, then going back later to find references to support what you wrote.
We have two more weeks of junior year left. And in those 2 weeks, we have 3 midterm exams, a behavior final, and 12 hours of capstone. Plus regular rotations every morning this week and regular classes every afternoon this week and next week.
Capstone (affectionately dubbed "Crapstone") seems even more pointless this year than the previous two. Our freshman-year capstone exam was given the day before we started sophomore year; the sophomore capstone was given the day before starting junior year -- i.e. at the end of a long summer with (assuming proper motivation) plenty of time to brush up on material from the previous year. Although I didn't like the last 2 Capstones, I understood that they had at least some purpose.
Capstone III, coming up in 6.5 days, has lost all purpose. With a full schedule of rotations and classes, as well as ongoing exams (basically one every weekend) and homework assignments (one or two a week), there just isn't really any time to study for Capstone. They say that the other goal of Capstone is to prepare us for a cumulative, integrative exam like NAVLE? Well, the numbers are in, and this year's seniors (the first class to have taken any Capstone exams) did worse on the NAVLE than the last few graduating classes.
So, yes. We are ready to be done with junior practicum. We are ready to be done with classes. We are ready to be done with homeworks and exams. And, most of all, we are ready to be done with Capstone.
Having seen how busy and fatigued the seniors are, I never thought that by the end of this semester I'd be just about longing for senior year to begin! Four weeks on Community Practice sounds like a veritable vacation compared to the final four weeks of spring semester. (I know -- check with me when I'm about 3 days into Community Practice, and see if that's still how I feel.)
I'm so ready to be done!
Glad that's over
I have successfully (at least I think) completed Week 2 of the dreaded junior-year Client Communication Skills!
As expected, the spring semester week was less fun and more stressful and depressing than the fall semester. Our discussions focused on how to talk about end-of-life decisions, the euthanasia process, delivering bad news like a terminal diagnosis, talking about medical errors, and addressing financial concerns with clients.
So, yeah, not a lot of fun.
The simulated client scenarios they gave us were, predictably, more of a challenge. Tuesday's cases included:
-- Explaining to a reptile fanatic that the geckos he brought in were not the species he thought they were and as a result he was housing them in a desert habitat instead of a tropical habitat which was making them sick
-- Meeting with the owner of a horse after you've done a pre-purchase exam on the horse for a potential buyer, meaning the results of the pre-purchase exam are part of your confidential veterinarian-client-patient relationship with the potential buyer so you can't discuss your findings with the actual owner (and what you found caused the potential buyer to decide not to buy the horse)
-- Handling a client who brought his dog in once 6 months ago for chronic skin, ear, and eye problems (probably allergies) and now is back with "I just want to get more antibiotics and leave" (this was the case I got)
-- Discussing a physical exam finding of a fractured tooth that needs to be removed under general anesthesia with the owner of an 18 year old, hyperthyroid, chronic renal failure kitty
Tuesday's case (the allergy dog) went well for me. Knowing a little more about what to expect from having the cases in the fall semester helped to decrease the nerves a little, as did having 6 months of practice dealing with real clients on clinics.
Thursday's cases were... pretty terrible. They were:
-- A panicked horse owner who is standing in the breezeway watching her horse thrash around violently from severe colic, which isn't responsive to sedation or pain medications; you have to get the owner to sign an estimate for surgical fees *with* informed consent, meaning she truly understands the risks
-- Explaining to an owner coming to pick up his cat from CCU that the cat's IV line had been switched with another patient so that the cat had received the wrong medications for 8 hours (although thankfully there would be no lasting ill effects)
-- Delivering the news of a rapidly terminal prognosis (splenic hemangiosarcoma in the process of bleeding out) to a distraught owner, and deciding whether to euthanize or pursue treatment
-- Discussing a dog with severe maggot infestation with your technician, who wants to report the owners for animal cruelty/neglect even though there were extenuating circumstances
-- A young, previously healthy dog with serious sepsis and less than a 5% chance of leaving the hospital alive, and owners who can in no way, shape, or form put down any part of the $1000 deposit required to initiate treatment beyond emergency stabilization
I had the splenic hemangiosarcoma dog, and was that ever a doozy. The added problem (besides just giving a terminal diagnosis) was that owners often have no idea their dog has this type of cancer because the dog just grows a blood-filled tumor in its abdomen and doesn't act very sick -- until one day the tumor breaks open and bleeds and bleeds and bleeds into the dog's abdomen -- and usually the dog gets very weak or collapses. So this dog's simulated owner had no idea that the dog was even sick, and now had to get the news that without surgery and other complicated treatments that might not even fix the problem, her dog would probably bleed out and die within the next few hours.
Yep, fun times. I was nervous enough about the complicated cases (and they didn't tell us which case we would get until right before each of us started). It made me feel sick to read some of the case descriptions earlier in the week and imagine myself (a) trying to deliver this news to a client or (b) being the client getting the news.
And the case description I was given implied that the dog's owner had been told what was going on (i.e. the diagnosis) and was given some time to sit with the dog and decide what she wanted to do, and I was supposed to go in and support her through the decision. One of my first questions to the owner was "What has the doctor told you is going on with Penny?" and the answer was "Nothing." Great. Have another obstacle.
Mostly the difficulty for me with this case came from having never delivered this kind of news before and having to do it with an owner that was very in shock and emotionally shut down. I'm not great with allowing spaces and pauses in my conversations with clients, and that was exactly what this owner needed -- time to process what I was saying. And before I had had a chance to explain anything other than "Penny has cancer," she was asking me questions like "What do we do?" and "So I can just take her home now and then in a few days it might be time to put her to sleep?" -- questions that I felt I couldn't answer adequately or fairly without even given her a little bit more of an idea about what was going on with the dog.
In the end, I was the "someone always cries" person among my group of five students. It was so intensely frustrating to feel so sorry for this owner and what she was going through; to want so badly to help her through this process and yet not be able to connect with her; and to struggle to answer her questions directly without deviating off along my own path of "what I think she should know" versus "what she's telling me she wants to know." (And don't forget -- I was being videotaped and watched by my 4 classmates, my coach, and my coach's coach. No pressure, though.)
So I held it together during the actual interaction with the client -- which I was thankful for. There are plenty of stories on VIN posted by vets who've ended up with a client comforting them during a euthanasia or tough conversation, rather than the other way around -- and I didn't want that to happen, at least not on my first try.
But once the "acting" part of it was over and it was time to debrief and discuss the interaction, I did lose it a little bit. Thankfully, there was already Kleenex right there in the room for the actors who were crying! I certainly didn't have a total meltdown or anything, but there were a few tears and shaky voice for the next 15 minutes or so.
In the end, although it was a thoroughly sucky experience, I'm so glad that I had it in a simulated setting. I can't imagine what it would be like to go through that for the first time with a real client -- not able to pause when you lose direction, not able to rewind when you mess up, not able to get direct feedback from the client about how your words and actions made them feel, and not able to get support and suggestions from a great group of classmates and a coach.
And I definitely learned a lot for next time!
(Now, I'm just hoping there won't be a "next time" other than the regular stuff we have to do during senior year... but the decision about who fails their video reflection paper at the end of the rotation seems completely arbitrary this semester, so who knows -- I may 'get' another shot
As expected, the spring semester week was less fun and more stressful and depressing than the fall semester. Our discussions focused on how to talk about end-of-life decisions, the euthanasia process, delivering bad news like a terminal diagnosis, talking about medical errors, and addressing financial concerns with clients.
So, yeah, not a lot of fun.
The simulated client scenarios they gave us were, predictably, more of a challenge. Tuesday's cases included:
-- Explaining to a reptile fanatic that the geckos he brought in were not the species he thought they were and as a result he was housing them in a desert habitat instead of a tropical habitat which was making them sick
-- Meeting with the owner of a horse after you've done a pre-purchase exam on the horse for a potential buyer, meaning the results of the pre-purchase exam are part of your confidential veterinarian-client-patient relationship with the potential buyer so you can't discuss your findings with the actual owner (and what you found caused the potential buyer to decide not to buy the horse)
-- Handling a client who brought his dog in once 6 months ago for chronic skin, ear, and eye problems (probably allergies) and now is back with "I just want to get more antibiotics and leave" (this was the case I got)
-- Discussing a physical exam finding of a fractured tooth that needs to be removed under general anesthesia with the owner of an 18 year old, hyperthyroid, chronic renal failure kitty
Tuesday's case (the allergy dog) went well for me. Knowing a little more about what to expect from having the cases in the fall semester helped to decrease the nerves a little, as did having 6 months of practice dealing with real clients on clinics.
Thursday's cases were... pretty terrible. They were:
-- A panicked horse owner who is standing in the breezeway watching her horse thrash around violently from severe colic, which isn't responsive to sedation or pain medications; you have to get the owner to sign an estimate for surgical fees *with* informed consent, meaning she truly understands the risks
-- Explaining to an owner coming to pick up his cat from CCU that the cat's IV line had been switched with another patient so that the cat had received the wrong medications for 8 hours (although thankfully there would be no lasting ill effects)
-- Delivering the news of a rapidly terminal prognosis (splenic hemangiosarcoma in the process of bleeding out) to a distraught owner, and deciding whether to euthanize or pursue treatment
-- Discussing a dog with severe maggot infestation with your technician, who wants to report the owners for animal cruelty/neglect even though there were extenuating circumstances
-- A young, previously healthy dog with serious sepsis and less than a 5% chance of leaving the hospital alive, and owners who can in no way, shape, or form put down any part of the $1000 deposit required to initiate treatment beyond emergency stabilization
I had the splenic hemangiosarcoma dog, and was that ever a doozy. The added problem (besides just giving a terminal diagnosis) was that owners often have no idea their dog has this type of cancer because the dog just grows a blood-filled tumor in its abdomen and doesn't act very sick -- until one day the tumor breaks open and bleeds and bleeds and bleeds into the dog's abdomen -- and usually the dog gets very weak or collapses. So this dog's simulated owner had no idea that the dog was even sick, and now had to get the news that without surgery and other complicated treatments that might not even fix the problem, her dog would probably bleed out and die within the next few hours.
Yep, fun times. I was nervous enough about the complicated cases (and they didn't tell us which case we would get until right before each of us started). It made me feel sick to read some of the case descriptions earlier in the week and imagine myself (a) trying to deliver this news to a client or (b) being the client getting the news.
And the case description I was given implied that the dog's owner had been told what was going on (i.e. the diagnosis) and was given some time to sit with the dog and decide what she wanted to do, and I was supposed to go in and support her through the decision. One of my first questions to the owner was "What has the doctor told you is going on with Penny?" and the answer was "Nothing." Great. Have another obstacle.
Mostly the difficulty for me with this case came from having never delivered this kind of news before and having to do it with an owner that was very in shock and emotionally shut down. I'm not great with allowing spaces and pauses in my conversations with clients, and that was exactly what this owner needed -- time to process what I was saying. And before I had had a chance to explain anything other than "Penny has cancer," she was asking me questions like "What do we do?" and "So I can just take her home now and then in a few days it might be time to put her to sleep?" -- questions that I felt I couldn't answer adequately or fairly without even given her a little bit more of an idea about what was going on with the dog.
In the end, I was the "someone always cries" person among my group of five students. It was so intensely frustrating to feel so sorry for this owner and what she was going through; to want so badly to help her through this process and yet not be able to connect with her; and to struggle to answer her questions directly without deviating off along my own path of "what I think she should know" versus "what she's telling me she wants to know." (And don't forget -- I was being videotaped and watched by my 4 classmates, my coach, and my coach's coach. No pressure, though.)
So I held it together during the actual interaction with the client -- which I was thankful for. There are plenty of stories on VIN posted by vets who've ended up with a client comforting them during a euthanasia or tough conversation, rather than the other way around -- and I didn't want that to happen, at least not on my first try.
But once the "acting" part of it was over and it was time to debrief and discuss the interaction, I did lose it a little bit. Thankfully, there was already Kleenex right there in the room for the actors who were crying! I certainly didn't have a total meltdown or anything, but there were a few tears and shaky voice for the next 15 minutes or so.
In the end, although it was a thoroughly sucky experience, I'm so glad that I had it in a simulated setting. I can't imagine what it would be like to go through that for the first time with a real client -- not able to pause when you lose direction, not able to rewind when you mess up, not able to get direct feedback from the client about how your words and actions made them feel, and not able to get support and suggestions from a great group of classmates and a coach.
And I definitely learned a lot for next time!
(Now, I'm just hoping there won't be a "next time" other than the regular stuff we have to do during senior year... but the decision about who fails their video reflection paper at the end of the rotation seems completely arbitrary this semester, so who knows -- I may 'get' another shot
Friday, April 15, 2011
Senior year countdown
We are frighteningly close to senior year, as we are reminded just about daily by the faculty who used to say "When you're in the clinics next year" and now say "When you're in the clinics in a few weeks." (At which we cringe in unison, cover our ears, and go to a happy place.)
Here are some numbers to give you an idea of what the rest of my semester looks like:
2 more weeks of junior practicum in the morning, including 5 mornings of client communications and 5 mornings of independent study in ophthalmology
2 papers to be written next week for client communications
3 more weeks of classes in the afternoon, including 30 more hours of lecture
4 more exams in Small Animal Med/Sx II
4 more "closed-book homework assignments" (= "quizzes") in Small Animal Med/Sx II
1 final in animal behavior
1 animal behavior case study paper to write
17 days(!) until our 12 hours of capstone exam begin (OK, I'm freaking out just a little bit)
125 lectures from last semester that I'd love to at least pretend to study before capstone (13 down -- gotta start somewhere)
27 days(!!!) until our first day in the clinics as seniors
Which for me means potentially 31-32 days until I start spaying and neutering dogs and cats all by my very lonesome. Yeek.
And a partridge in a pear tree.
Here are some numbers to give you an idea of what the rest of my semester looks like:
2 more weeks of junior practicum in the morning, including 5 mornings of client communications and 5 mornings of independent study in ophthalmology
2 papers to be written next week for client communications
3 more weeks of classes in the afternoon, including 30 more hours of lecture
4 more exams in Small Animal Med/Sx II
4 more "closed-book homework assignments" (= "quizzes") in Small Animal Med/Sx II
1 final in animal behavior
1 animal behavior case study paper to write
17 days(!) until our 12 hours of capstone exam begin (OK, I'm freaking out just a little bit)
125 lectures from last semester that I'd love to at least pretend to study before capstone (13 down -- gotta start somewhere)
27 days(!!!) until our first day in the clinics as seniors
Which for me means potentially 31-32 days until I start spaying and neutering dogs and cats all by my very lonesome. Yeek.
And a partridge in a pear tree.
Squeeee
I had the keeee-yoo-test little itty bitty baby puppy to anesthetize yesterday. Teensy "Molson," pictured here:
is a 9 week old, 4 1/2 lb sweet little German shepherd(?)-Husky(?) mix who came to the VTH in dire need of removal of his eensy-weensy testicles.
My other 5 cases on clinical anesthesia and Surgery C were all basically adult animals ranging from 12-180 lb, so I was a little nervous about anesthetizing such a tiny pediatric.
Fortunately, Molson did great with an atropine/hydromorphone pre-med, ketamine/valium induction, lidocaine intratesticular block, and some meloxicam and more hydro post-op. I got a 22g IV catheter into him after a couple tries (he got ferocious when I swabbed his leg with alcohol! What a tough puppy!) and successfully intubated him with a wee little 4.5 ET tube. He stayed pretty warm (thanks to a warm water blanket and a handy dandy heat lamp) and kept his heart rate up between 130 and 170. His blood pressure even stayed in a decent range, which can be an issue with pediatric patients. He was lounging in a pile of blankets and towels, basking in the glow of another heat lamp when I left him in the humane society ward. He's going to find an awesome home and grow up to be a fantastic doggie, I just know it!
is a 9 week old, 4 1/2 lb sweet little German shepherd(?)-Husky(?) mix who came to the VTH in dire need of removal of his eensy-weensy testicles.
My other 5 cases on clinical anesthesia and Surgery C were all basically adult animals ranging from 12-180 lb, so I was a little nervous about anesthetizing such a tiny pediatric.
Fortunately, Molson did great with an atropine/hydromorphone pre-med, ketamine/valium induction, lidocaine intratesticular block, and some meloxicam and more hydro post-op. I got a 22g IV catheter into him after a couple tries (he got ferocious when I swabbed his leg with alcohol! What a tough puppy!) and successfully intubated him with a wee little 4.5 ET tube. He stayed pretty warm (thanks to a warm water blanket and a handy dandy heat lamp) and kept his heart rate up between 130 and 170. His blood pressure even stayed in a decent range, which can be an issue with pediatric patients. He was lounging in a pile of blankets and towels, basking in the glow of another heat lamp when I left him in the humane society ward. He's going to find an awesome home and grow up to be a fantastic doggie, I just know it!
Of course he's cute!
Bullwinkle, my sweet little anesthesia case from Tuesday, is now up for adoption and looking ever so darling (OK, maybe "darling" is a matter of opinion) in his adoption photo:
He's cute, I swear! I know he'll find a great family who appreciates his one-of-a-kind looks.
He's cute, I swear! I know he'll find a great family who appreciates his one-of-a-kind looks.
Monday, April 11, 2011
Bullwinkle!
I'm on surgery C for anesthesia this week, meaning I'm assigned to my very own humane society anesthetic case tomorrow and Thursday, and my very own client-owned spay/neuter patient on Wednesday.
Tomorrow's patient, "Bullwinkle," is a scruffy little mutt dog, about 12 pounds, mostly black with a little white on his chest, with long wiry hair and two very large testicles. He's about a year old -- estimated only, because he was left overnight at one of the local humane societies. :(
I have to say: Bullwinkle's only chance at upcoming adoption is for someone to fall in love with his "quirky" appearance. I say "quirky," because it doesn't seem very politically correct to say what my anesthesia rotation-mate said when she saw him: "Oh my god! Your dog looks like a retard!"
True, Bullwinkle must have come from a motley line of cross-bred dogs, with nary a purebred ancestor in sight. True, his eyes do bug out of his head, one more than the other. And yes, he has one ear that stands straight up and one ear that flops over. And I'll admit that when he looks directly at you, you can't avoid a shiver of crazy running down your spine.
But he's sweet! Okay, he's really scared and doesn't want to look at you, or come near you. And if you put a leash or collar on him, he melts to the floor and magically weighs 80 pounds. But he let me pick him up and put him on my lap, and didn't try to get away. He's one of those "I'm so freaked out I can't move but I don't think I'm going to bite you" dogs. So I'm not sure anyone will fall in love with him based on his personality, unless he really warms up once he gets de-testicled.
I have a sterling anesthetic management plan worked out for him, including some acepromazine, atropine, and morphine as pre-meds; ketamine/diazepam for induction; isoflurane maintenance; an intratesticular lidocaine block; and carprofen/morphine injections post-op with his senior Community Practice student choosing what oral NSAIDs he'll take home with him. Doses and rates are calculated out for oxygen flow, IV fluids, and atropine/dobutamine/ephedrine if needed to help with his heart rate or blood pressure. He'll get a pulse oximeter, capnograph, EKG, Doppler blood pressure, and temperature probe to make sure he's doing well while asleep.
Here's hoping Bullwinkle's surgery goes well tomorrow, and that he doesn't try to give me a heart attack while I'm managing his anesthesia! Despite his "unique" looks, I'm starting to like him...
Tomorrow's patient, "Bullwinkle," is a scruffy little mutt dog, about 12 pounds, mostly black with a little white on his chest, with long wiry hair and two very large testicles. He's about a year old -- estimated only, because he was left overnight at one of the local humane societies. :(
I have to say: Bullwinkle's only chance at upcoming adoption is for someone to fall in love with his "quirky" appearance. I say "quirky," because it doesn't seem very politically correct to say what my anesthesia rotation-mate said when she saw him: "Oh my god! Your dog looks like a retard!"
True, Bullwinkle must have come from a motley line of cross-bred dogs, with nary a purebred ancestor in sight. True, his eyes do bug out of his head, one more than the other. And yes, he has one ear that stands straight up and one ear that flops over. And I'll admit that when he looks directly at you, you can't avoid a shiver of crazy running down your spine.
But he's sweet! Okay, he's really scared and doesn't want to look at you, or come near you. And if you put a leash or collar on him, he melts to the floor and magically weighs 80 pounds. But he let me pick him up and put him on my lap, and didn't try to get away. He's one of those "I'm so freaked out I can't move but I don't think I'm going to bite you" dogs. So I'm not sure anyone will fall in love with him based on his personality, unless he really warms up once he gets de-testicled.
I have a sterling anesthetic management plan worked out for him, including some acepromazine, atropine, and morphine as pre-meds; ketamine/diazepam for induction; isoflurane maintenance; an intratesticular lidocaine block; and carprofen/morphine injections post-op with his senior Community Practice student choosing what oral NSAIDs he'll take home with him. Doses and rates are calculated out for oxygen flow, IV fluids, and atropine/dobutamine/ephedrine if needed to help with his heart rate or blood pressure. He'll get a pulse oximeter, capnograph, EKG, Doppler blood pressure, and temperature probe to make sure he's doing well while asleep.
Here's hoping Bullwinkle's surgery goes well tomorrow, and that he doesn't try to give me a heart attack while I'm managing his anesthesia! Despite his "unique" looks, I'm starting to like him...
Why yes, I WOULD like a scholarship!
After last year's traumatic non-scholarship-experience detailed here, and an even-more-pathetic-than-usual essay submitted with my scholarship application last November, I finally got a scholarship!
OK, now that you're done cheering, the relevant details are: $2200 (yes! would have been happy with $50!), 9 other people got the same scholarship as me (holy rich people), it's only for junior students, and the criteria were "superior scholarship, initiative, perseverance, potential for leadership, and financial need." I'm going to pretend that I qualified for more of that than just "financial need."
So I joined many of my fellow junior, sophomore, and freshman classmates, as well as some biomedical sciences undergrads, to nosh on a pretty display of fruit, cheese, crackers, and cookies, accompanied by "golden punch" (which I'm 97% sure was straight orange juice) and listen to a 25-second congratulatory speech by the dean of the vet school.
Interesting statistic: apparently there are 440-some scholarships given out every year to vet students and biomed undergrads, totally some $1.6 million dollars annually. Wow. (And also, why haven't I seen some of this money before?? That comes out to about $2700/year per student!)
Anyway, I'm thoroughly satisfied by my scholarshippiness and look forward to the receipt of $2200 to help offset my upcoming tuition bill of $51,000 for senior year.
OK, now that you're done cheering, the relevant details are: $2200 (yes! would have been happy with $50!), 9 other people got the same scholarship as me (holy rich people), it's only for junior students, and the criteria were "superior scholarship, initiative, perseverance, potential for leadership, and financial need." I'm going to pretend that I qualified for more of that than just "financial need."
So I joined many of my fellow junior, sophomore, and freshman classmates, as well as some biomedical sciences undergrads, to nosh on a pretty display of fruit, cheese, crackers, and cookies, accompanied by "golden punch" (which I'm 97% sure was straight orange juice) and listen to a 25-second congratulatory speech by the dean of the vet school.
Interesting statistic: apparently there are 440-some scholarships given out every year to vet students and biomed undergrads, totally some $1.6 million dollars annually. Wow. (And also, why haven't I seen some of this money before?? That comes out to about $2700/year per student!)
Anyway, I'm thoroughly satisfied by my scholarshippiness and look forward to the receipt of $2200 to help offset my upcoming tuition bill of $51,000 for senior year.
Sunday, April 10, 2011
Welcome to anesthesia
I'm in between my 2 consecutive weeks of junior anesthesia rotation -- our only junior practicum rotation other than client communications that comprises more than a single week during the year.
Anesthesia is reputed to be one of the more challenging, time-consuming, and stressful, yet thought-provoking, interesting, and rewarding rotations we get to have during junior year. My 2-week block is the second-to-last of the academic year, meaning I've heard feedback from almost all of my classmates up to this point.
The dozen of us who started anesthesia last week showed up outside of room D107D shortly before 8 am, as instructed by the first page of our orientation packet that was delivered to our mailboxes the previous week, with "8 am on Monday, room D107D" highlighted for us in bright yellow.
Unfortunately, by 8 am, no instructor had arrived to unlock the door to the room we were supposed to be in, much less give us an actual orientation. Being good little vet students and understanding that clinicians and support staff can be very busy and the hospital has a priority to patient care as well as student learning, we sat patiently in the hallway for another 15 minutes.
At 8:15, I walked across the hospital to the anesthesia induction/recovery area to see if anyone might know what we were supposed to be doing. I found the anesthesia prep room as well as the rounds room completely unoccupied, so went to rejoin my classmates in our continuing exercise in patience.
At 8:30, nothing had changed, so I made the rounds again, and again found the prep room and rounds room with nary an anesthesia clinician or nurse in sight. Back I went to room D107D.
At 8:50 am, the surgical instructor who works with the spay/neuter cases seen on Community Practice came walking down our hallway, and we pretty much pounced on her to help us. Being a helpful person, she first let us into the room we were waiting in front of, and then paged the nurse who was supposed to be leading our orientation. The news she found out was that said orientation nurse had called in sick and advised whomever she talked to that she would be unable to lead junior orientation and they would have to find someone else to do it. Seems that message never got conveyed to anyone who might actually be interested in leading our orientation.
The kindly surgical instructor marched upstairs to where she knew all of the anesthesia faculty and nurses were listening to a guest lecturer give a presentation, hoping to snag one of them to come give us a hand. However, she returned at 9 am with the news that, despite having interrupted their meeting and advised them that a dozen juniors had been waiting for over an hour for the anesthesia orientation they had been commanded to appear for by an annoyingly highlighted orientation packet, the meeting was apparently so important and/or interesting that not a single person would be able to break away from it to come orient us. Word was that the meeting would be over at 9:30 am and orientation would commence at that point.
Fast forward after killing time for half an hour. We dozen students again await an instructor at 9:30 am. Finally, at 9:50 am (bearing in mind that we all showed up roughly 2 hours before this point), a couple of anesthesia nurses walked in nonchalantly with no apologies and proceeded to give us their version of "orientation" ("Keep in mind that we've never done an orientation before and we don't really know what they tell you... but we can show you where the equipment is"). An hour and 15 minutes later (including a 30 minute antiquated video of how to place an IV catheter and induce anesthesia, using protocols that probably haven't been used at the teaching hospital in the last 15 years), we had apparently received all of the orientation we needed.
The nurses asked if there were any questions, and we proceeded to spend another 30 minutes asking them about tons of relevant information they had neglected to mention during "orientation." We then went on our merry way, thoroughly confused about anesthesia rotation.
In discussing with some of my other classmates over lunch, almost all of them said their orientation was very thorough and had taken the full 4 hours allotted, sometimes even spilling over into the lunch hour, and leaving the juniors confident in how the following two weeks would go. Haha. I'm sure we didn't miss anything in our 75 minute "we don't know how to do orientation" orientation. Good thing it's not like anesthesia is a department in which patients' lives are at risk and juniors are expected to devise their own anesthetic protocols and run anesthesia on their own. Oh wait.
Long story short, we clinical juniors (6 of us, including me, spent the past week shadowing seniors on more complicated cases, while the other 6 were on 'surgery C' -- the humane society spay/neuter cases) figured out what we were doing after sort of muddling our way through it on the first day.
On Tuesday I had a 50kg female great Dane undergoing a laparoscopy-assisted gastropexy (preventative surgery for bloat/GDV). She was totally anxious and freaked out when her owner dropped her off (sexually intact because "I want to show her and breed her" -- good luck getting her into a show ring without biting anyone). She fortunately sedated well with her pre-meds, and went down easily at induction. The surgery and anesthesia were uneventful, but she totally flipped out in recovery, 110 lb of panicked, disoriented dog flailing around and trying to bite. Hooray for alpha2 agonists that knocked her right out again.
On Wednesday my case was another great Dane -- this time 80kg (176 lb) -- in through Community Practice for the removal of a couple of probably benign but totally gnarly-looking skin masses growing on stalks off of his elbows. He was somewhat friendlier than the previous day's Dane, but still nervous, and didn't sedate as well before induction. However, he went under smoothly and recovered smoothly, which was a huge relief after seeing the previous day's recovery.
On Thursday I followed along with a 9 year old Australian cattle dog cross undergoing surgical repair for an acutely ruptured ACL. She had a TPLO (a procedure in which the bone of the tibia is cut and a steel plate is put on it) as well as a lateral suture to add stability to her knee. Those are potentially very painful procedures, so it was lovely that she received a femoral and sciatic nerve block on the affected leg, which kept her from feeling anything at all during surgery and kept her anesthesia very smooth. Like Wednesday's Dane, this dog didn't sedate especially well with pre-meds, but did induce smoothly. Her surgery went on for a long time so I didn't get to see her recovery.
This week I'm heading into my surgery C cases. Monday and Friday will be case discussions and rounds all morning, and I'll manage my own cases (with no assistance from a senior student) on Tues-Wed-Thurs. Tuesday and Thursday are humane society animals that go back to be adopted; Wednesday is client owned animals. They should all be spays or neuters on relatively young, healthy patients, which can theoretically make the anesthesia more straightforward, but we're still learning and there are always plenty of things that can go wrong in any anesthetic case, so it will be a challenging but hopefully rewarding experience (and I'm trying to put out of my mind my classmate whose very first surgery C case last fall died under anesthesia and couldn't be recovered... la la la, I can't hear you!). The downside is that on surgery days, I'll have to have my anesthetic plan approved BY 7 am (which means I have to get to school in time to put away my stuff, change into scrubs, get my clinic smock/thermometer/stethoscope/watch/etc., and get downstairs to have the nurse look over my anesthetic plan by 7 am). Sleep is overrated. Or so I keep telling myself.
Anesthesia is reputed to be one of the more challenging, time-consuming, and stressful, yet thought-provoking, interesting, and rewarding rotations we get to have during junior year. My 2-week block is the second-to-last of the academic year, meaning I've heard feedback from almost all of my classmates up to this point.
The dozen of us who started anesthesia last week showed up outside of room D107D shortly before 8 am, as instructed by the first page of our orientation packet that was delivered to our mailboxes the previous week, with "8 am on Monday, room D107D" highlighted for us in bright yellow.
Unfortunately, by 8 am, no instructor had arrived to unlock the door to the room we were supposed to be in, much less give us an actual orientation. Being good little vet students and understanding that clinicians and support staff can be very busy and the hospital has a priority to patient care as well as student learning, we sat patiently in the hallway for another 15 minutes.
At 8:15, I walked across the hospital to the anesthesia induction/recovery area to see if anyone might know what we were supposed to be doing. I found the anesthesia prep room as well as the rounds room completely unoccupied, so went to rejoin my classmates in our continuing exercise in patience.
At 8:30, nothing had changed, so I made the rounds again, and again found the prep room and rounds room with nary an anesthesia clinician or nurse in sight. Back I went to room D107D.
At 8:50 am, the surgical instructor who works with the spay/neuter cases seen on Community Practice came walking down our hallway, and we pretty much pounced on her to help us. Being a helpful person, she first let us into the room we were waiting in front of, and then paged the nurse who was supposed to be leading our orientation. The news she found out was that said orientation nurse had called in sick and advised whomever she talked to that she would be unable to lead junior orientation and they would have to find someone else to do it. Seems that message never got conveyed to anyone who might actually be interested in leading our orientation.
The kindly surgical instructor marched upstairs to where she knew all of the anesthesia faculty and nurses were listening to a guest lecturer give a presentation, hoping to snag one of them to come give us a hand. However, she returned at 9 am with the news that, despite having interrupted their meeting and advised them that a dozen juniors had been waiting for over an hour for the anesthesia orientation they had been commanded to appear for by an annoyingly highlighted orientation packet, the meeting was apparently so important and/or interesting that not a single person would be able to break away from it to come orient us. Word was that the meeting would be over at 9:30 am and orientation would commence at that point.
Fast forward after killing time for half an hour. We dozen students again await an instructor at 9:30 am. Finally, at 9:50 am (bearing in mind that we all showed up roughly 2 hours before this point), a couple of anesthesia nurses walked in nonchalantly with no apologies and proceeded to give us their version of "orientation" ("Keep in mind that we've never done an orientation before and we don't really know what they tell you... but we can show you where the equipment is"). An hour and 15 minutes later (including a 30 minute antiquated video of how to place an IV catheter and induce anesthesia, using protocols that probably haven't been used at the teaching hospital in the last 15 years), we had apparently received all of the orientation we needed.
The nurses asked if there were any questions, and we proceeded to spend another 30 minutes asking them about tons of relevant information they had neglected to mention during "orientation." We then went on our merry way, thoroughly confused about anesthesia rotation.
In discussing with some of my other classmates over lunch, almost all of them said their orientation was very thorough and had taken the full 4 hours allotted, sometimes even spilling over into the lunch hour, and leaving the juniors confident in how the following two weeks would go. Haha. I'm sure we didn't miss anything in our 75 minute "we don't know how to do orientation" orientation. Good thing it's not like anesthesia is a department in which patients' lives are at risk and juniors are expected to devise their own anesthetic protocols and run anesthesia on their own. Oh wait.
Long story short, we clinical juniors (6 of us, including me, spent the past week shadowing seniors on more complicated cases, while the other 6 were on 'surgery C' -- the humane society spay/neuter cases) figured out what we were doing after sort of muddling our way through it on the first day.
On Tuesday I had a 50kg female great Dane undergoing a laparoscopy-assisted gastropexy (preventative surgery for bloat/GDV). She was totally anxious and freaked out when her owner dropped her off (sexually intact because "I want to show her and breed her" -- good luck getting her into a show ring without biting anyone). She fortunately sedated well with her pre-meds, and went down easily at induction. The surgery and anesthesia were uneventful, but she totally flipped out in recovery, 110 lb of panicked, disoriented dog flailing around and trying to bite. Hooray for alpha2 agonists that knocked her right out again.
On Wednesday my case was another great Dane -- this time 80kg (176 lb) -- in through Community Practice for the removal of a couple of probably benign but totally gnarly-looking skin masses growing on stalks off of his elbows. He was somewhat friendlier than the previous day's Dane, but still nervous, and didn't sedate as well before induction. However, he went under smoothly and recovered smoothly, which was a huge relief after seeing the previous day's recovery.
On Thursday I followed along with a 9 year old Australian cattle dog cross undergoing surgical repair for an acutely ruptured ACL. She had a TPLO (a procedure in which the bone of the tibia is cut and a steel plate is put on it) as well as a lateral suture to add stability to her knee. Those are potentially very painful procedures, so it was lovely that she received a femoral and sciatic nerve block on the affected leg, which kept her from feeling anything at all during surgery and kept her anesthesia very smooth. Like Wednesday's Dane, this dog didn't sedate especially well with pre-meds, but did induce smoothly. Her surgery went on for a long time so I didn't get to see her recovery.
This week I'm heading into my surgery C cases. Monday and Friday will be case discussions and rounds all morning, and I'll manage my own cases (with no assistance from a senior student) on Tues-Wed-Thurs. Tuesday and Thursday are humane society animals that go back to be adopted; Wednesday is client owned animals. They should all be spays or neuters on relatively young, healthy patients, which can theoretically make the anesthesia more straightforward, but we're still learning and there are always plenty of things that can go wrong in any anesthetic case, so it will be a challenging but hopefully rewarding experience (and I'm trying to put out of my mind my classmate whose very first surgery C case last fall died under anesthesia and couldn't be recovered... la la la, I can't hear you!). The downside is that on surgery days, I'll have to have my anesthetic plan approved BY 7 am (which means I have to get to school in time to put away my stuff, change into scrubs, get my clinic smock/thermometer/stethoscope/watch/etc., and get downstairs to have the nurse look over my anesthetic plan by 7 am). Sleep is overrated. Or so I keep telling myself.
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