Here we go

(Blogger was down all day yesterday, so here's my post from yesterday evening.)

Day 1 of senior year started out pretty gently. They eased us into what will soon become a demanding schedule with a laidback 3 hour orientation starting at 9 am. From there we hung around, chatted, ate lunch, etc. until our appointments began at 1 pm. With 9 appointments and 8 seniors, the work was evenly distributed and I ended up with just a single appointment at 2:20 pm.

First I got over the initial shock of introducing myself as, "Hi, I'm ____, I'm a senior vet student"(!!!) and noticed with great relief that my client seemed to have no idea that, had he made an appointment for yesterday rather than today, his dog would have been cared for by a student with 364 days more experience than me.

On my way up to meet the client in the lobby, I developed this paranoia that this client would be exactly like my first actor-client in communications rotation this spring -- i.e. antsy, impatient, and eager to get in and out with a minimum of talking and money spent. Fortunately my real client was completely the opposite -- he had a sense of humor, gave the impression of having all the time in the world to sit and wait for me to get things done, readily accepted all of my vaccination and preventive health recommendations, and was an all-around nice guy.

My patient was a huge fluffy black-and-white teddy bear of a dog (possibly a Newfie/border collie cross, or at least that was the best guess from the rescue that adopted him out as a puppy). Not quite two years old, he was in need of some vaccines and some serious weight loss. We enrolled him on the VTH's adult dog wellness program; vaccinated him for rabies, distemper/parvo, lepto, and bordetella; ran a heartworm test (negative); sent home 6 months of heartworm prevention; and threw in a lovely fecal sample cup to bring back a fresh "deposit" for parasite testing, given that this sweet doggie has a revolting habit of ingesting raccoon feces (and probably any other feces he can find -- I doubt he discriminates). He'll be back for a lepto booster and deworming in 3-4 weeks.

Each of us new seniors set several goals today for our time on Community Practice. One of mine was to improve my proficiency and confidence with jugular vein blood draws -- something I've always found difficult and that I'll use any excuse to avoid, even though it's something I really need to get good at. Unfortunately, a terribly obese and long-haired dog who didn't feel like sitting still turned out not to be the greatest candidate for a needle poke in the neck. But at least I gave it a shot!

Following the appointment (which took me 75 minutes from door-to-door -- which I consider respectable in light of the goal of 60 minute appointments, given that it was my first day and we got a ton of stuff done), it was time to sit down with the paperwork. Throughout his appointment, my teddy bear dog accumulated: a treatment consent form signed by the owner; a medical discharge summary; a heartworm test form; a vaccination reaction information sheet; 3 carbon copies of his rabies certificate; a history/physical exam form; a prescription for his heartworm meds; 2 pages of patient ID stickers; 2 patient ID cards; 2 fee sheets; and all of the electronic records forms I had to fill out in the computer system. I know it'll get a lot easier and faster the more appointments I do, but yeesh. No wonder last year's seniors griped constantly about paperwork.

Speaking of last year's seniors, the hospital feels empty without them. I saw one of the graduating-tomorrow seniors walking through the hall showing his family around, and he just seemed out of place. As I traipsed back and forth from the lobby to Community Practice (which is the farthest department from the reception area and exam rooms), it was so strange to see my classmates sitting in all of the rounds rooms. Yes, I'm used to seeing them in there during junior rotations, but we juniors are usually relegated to a chair in the corner or perching on a desk along the wall, rather than sitting at the rounds tables. Now it's just us.

I'm terribly thankful that we new seniors get three entire months to learn the ways of the hospital before we have new juniors tagging along with us. I remember thinking last fall, "I wonder how it is that we inexperienced juniors will magically become these total rockstar seniors" -- I now know that at least part of the answer is that we'll have 90+ days to mess up, get lost, fill out forms incorrectly, and fail 4 times in a row to dial a long-distance number (true story -- laugh all you want) before we have eager juniors sticking to us like glue.

I'm also grateful that the Community Practice clinicians and technical staff seem truly excited to have us there. After hearing many comments over the last few weeks from clinicians and interns about how much they're going to miss the old seniors, along with the occasional only-semi-joking exclamation of "Look out! The juniors are coming!", I really feel like we former juniors can offer, if not extraordinary technical competence and thorough knowledge of the inner workings of the VTH, then at least a bright-eyed and bushy-tailed enthusiasm for being out of the classroom and working full-time with real animals and clients -- an eagerness to participate in twice-daily rounds -- a positive attitude toward teamwork and stepping in to lend a hand to a classmate whenever needed. It can't be entirely fun to start basically from scratch with a group of students, but the clinicians seem to recognize that our ineptitude isn't entirely our fault, and that our ability to learn has not been totally damaged by the past 3 years of classroom teaching.

Now, I'll admit that I'm pretty tired after today, which was only an 8 hour day with plenty of downtime and merely a single appointment of my own. So I certainly can't blame the former seniors for the apathy and sullenness that reared its head starting a couple months ago. I hope, though, that we new seniors can maintain our energy and good spirit for awhile. (I say that now, when I don't have to come in until 10(!) am tomorrow -- but check back at the end of next week when I've been at the hospital 12 hours a day caring for my surgery patients and seeing appointments.)

Speaking of which: surgery. My first "goal" I mentioned during orientation today went something like this: "I'd like to be able to just think about doing surgery without wanting to throw up." And that's pretty much how I feel. I was a little panicked last week as I started to realize that senior year was so close, and it occurred to me that Community Practice isn't just medicine appointments (which I love), but also that pesky little thing called surgery. Fortunately, I've been spared from too much anxiety by knowing that I won't have a surgery of my own until at least Tuesday.

Surgery, surgery, surgery. Yes, I'm going to do it. Yes, I'll probably even do a good job. Yes, there will be plenty of people around to help me if I freeze or get confused or make a mistake. And yes, I'm sure my patients will survive and go home to their happy owners (or to happy adopters at one of the shelters). But I'm still not at the point where I can psychologically handle the idea that I will soon be cutting open the abdomen of a living, breathing creature (which I would like to stay that way), removing organs, and sewing everything back up as good as new. It just seems like a lot of power that I don't feel ready for (but I'd better be soon!).

Last thing to mention -- I got to file my first incident report today! Incident reports are the hospital's way of keeping track of any mistakes, errors, complaints, or malfunctions that occur in any way or shape in the hospital. You file incident reports for everything from a client complaining about having to wait too long, to the fluoroscope settings not working correctly, to the wrong dose of medication being sent home with a patient, etc.

Each of us new seniors got "callbacks" to do today (every case seen in Community Practice gets a follow-up call the next day, so we got all the cases seen by the old seniors yesterday). Mine was a puppy who came in on Monday for vaccines and follow-up from a rectal prolapse a few weeks earlier, likely caused by its heavy parasite load that was diagnosed and treated at the prior visit. The owners were instructed to bring in a stool sample, which they did on Tuesday, and the results from the lab on Wedneday showed a persistent Giardia infection. The senior student wrote a prescription for fenbendazole, which was picked up by the owner on Wednesday afternoon.

My follow-up call found the puppy feeling great after vaccines and deworming, but the owner was a little confused about the deworming instructions. Her prescription label for her 5 doses of dewormer indicated to give one dose every 5 days. After speaking with her, I investigated a little, having not much personal experience with fenbendazole, and learned that it is usually given 5 days in a row, one dose a day. I then called the Pharmacy, who looked up the handwritten prescription that was turned in yesterday and found out that the pharmacy technician had written the wrong instructions in the computer, which were then printed incorrectly on the Rx label. This was an innocuous mistake to have happen -- but had the owner not asked me to clarify the instructions for administering the fenbendazole, and had I not followed up on it, the puppy would have gotten possibly an ineffective course of dewormer. I'm glad it wasn't something more serious -- it's scary to think about how tiny things like that can potentially have a huge effect on a patient's health.