I Have A Curse

Maybe it's "beginner's luck," but my cases all turn into wacky, that-never-happens, no-one-has-seen-anything-like-it sagas. I'm not complaining, but it's uncanny. I've had to research things that the other vets have hardly seen a handful of times in thirty years of practice. I've had straightforward cases develop bizarre crazyland complications. Last year, my boss told me I'd seen more weird stuff in two months than he'd seen in two years.

Here's a selection of the weird and wonderfuls I've seen...

• Great Dane with Lyme disease who came back a week later with a severe immune-mediated vasculitis (his leg was a water balloon).
• The same week, a cat came in for a recent "swollen foot." Sounds like a cat bite abscess, right? Nope. Huge elbow mass full of joint fluid. Maybe a synovial sarcoma?
• Also that week, a young cat brought in because he was having trouble breathing. Turns out he had acute anuric renal failure, for absolutely no reason we could figure out, and didn't respond to treatment. Died that day, nothing to do with the breathing.
• My first month in practice I encountered a dog with megaoesophagus, which is a rare condition.
• My first month, I also prescribed routine ear drops for an ear infection--a situation that happens on an almost daily basis. But this dog went death in both ears immediately after starting the drops. The owners were so mad at me I could barely talk to them. Has never happened before in this practice with any ear medication for any of the other vets.
• My boss saw a cat for a cat bite abscess and I ended up with the recheck the next week on his day off. He assured me it would be routine. Turned out to be in massive acute liver failure and spent the day on oxygen support because it could barely breathe.
• My first blocked bladder cat was a female with five struvite stones at least the size of your thumbnail. My boss has never seen as many large stones in a cat in his whole career.
• I saw a cat with nice owners a few times for small issues, then he came in a month later, on death's door, with a stomach full of blood. He was an indoor, only cat with no medications and no access to anything unsavory that we knew of.
• I had an ongoing saga with a cat that wouldn't really eat for weeks to months for no discernable reason. The owner is a little batty, and wouldn't let us do the full nine yards with regard to treatment, but still cicled around with this cat for ages. Weekly rechecks, repeat blood work and imaging, no response to any medication--and we must have tried the whole pharmacy.

I'm sure many more are on the horizon. They especially like coming in when I'm by myself, like Saturdays or in the evening on my late day. There have been a lot of panic texts to my boss these past six months.

HO HO Hypertrophic Osteopathy

Did you know that some lung tumours manifest as extra bone growth in the paws? That is, the first sign that we see is lameness and swelling of the legs, and when we go hunting, whoa hey there's a lung tumour. Some weird endocrine paraneoplastic response. It's called hypertrophic osteopathy.

  

It's still close enough to Christmas for me to use that in the title, right?
From google:

 

 

First Bird In-Patient - Patched Up A Macaw

Our first injured bird came in, and it went well! There is a nearby bird rescue, and one of their Military Macaws got attacked by his cage mate. He was missing a piece of his eyelid and all the feathers over his tail, plus had some various cuts and bruises. He was quite gentle to work with, however, and I daringly admitted him to the hospital. Our first avian admit!

I'm not great at wound management in general, even in dogs and cats. I tend to fumble through, with lots of direction from the other vets. For some reason I have a difficult time understanding the concepts, even though wound healing was drilled into me in vet school. Something about making the connection between lecture material and physically working with a wound right the hell in front of me has a hard time inside my brain. So, naturally, our first "sick bird" was a wound. But hey, could have been way worse!

I've read plenty about intranasal sedation, but when I was on Wildbase, I never saw it done. So I cruised VIN, checked my Avian textbooks, picked a dose, and went for it. Boom, midazolam and butorphanol right in the nostrils. No one else had seen it done before, either, so then we stood around with the lights dimmed waiting to see what happened. After about five minutes, we had a pretty snoozy parrot! The other vets were impressed.

I flushed out his wounds, applied some silver sulfadiazine and some Tegaderm, and that was pretty much it. It turned out I couldn't do much with the eyelid, though I wasn't sure until we sedated him (and the owner didn't care about cosmetics). Sent him home on antibiotics and meloxicam, and he's doing great.

Here's his good side.

My First Avian Clients Were A Piece Of Work

I decided I want to be an avian vet. In vet school, this idea was something like, "I want to be able to see a bird and not be afraid of it." So many vets out there refuse to see them, I figured, hey! There's a niche here waiting to be filled. So I studied our avian lectures very closely, I took avian electives, I got some experience at an aviary. When I realised how big a deal avian medicine can be, it hit home that I couldn't half-ass it--I had to know about birds, which is why vets who don't see a lot of birds often won't see any--so I also got my butt down to ExoticsCon, bought some textbooks, and started some focused studying.

The only thing left to do was, well, to actually start seeing birds. It's the only way to learn, really, especially skills like handling, physical exams, and blood draws. And answering the strange questions I never expected anyone to ask.

My sparkly exciting future full of our feathered friends dimmed a little bit when I encountered my first bird clients. Okay, they're technically the second--the first was a necropsy on an endangered duck, which I will definitely write about one of these days. But they were my first companion bird clients, and companion birds is really what I do. And boy oh boy, I definitely had a moment of, "Is this what bird people are like? I don't want fifty clients like this."

They found me by searching the AAV website, of which I am a member. This was before the newspaper article for our clinic announcing I was seeing birds, and maybe even before we got it onto the clinic website. These people managed to get onto a website mainly used by vets and look up where I work. This was slightly alarming because they kept referring to me as being "boarded" by the AAV. Er, I paid the association a membership fee and they send me a journal. Being boarded is a huge, huge ordeal involving giant scary exams, after which you are a specialist.

Anyway, they have a whole bunch of birds. The first one they brought me was a macaw. Like, pretty much the biggest companion bird there is. For my very first avian exam in real life, ever. EVER. And with technicians who hadn't handled a bird in over a decade. To top it off, these are pushy, anxious people, so their birds are pushy, anxious birds, and there's nothing as much fun as having a huge macaw lunge at you any time you get close. The owners were not impressed that I seemed "intimidated" by the birds. I wasn't, but when you've only been in practice for about 5 minutes, you don't have the hardened steel to not flinch backwards when a beak the size of your hand is snapping at you.

Once we got past the introductions, one of the very first things these people said to me is how Harrison's bird seed is actually really bad for birds and vets shouldn't be recommending it. They read it online. Luckily, they said this about two seconds before I was about to tell them to try Harrison's bird seed, so I avoided that argument. They are very proud of how rich and varied their birds' diets are--lots of fresh fruit and veggies, and seeds, and rice, and quinoa, and pasta, and... wait what? I tried to explain that a likely reason the feathers are ratty, and the stool is loose, and the beaks are flaky, is because they have (wait for it) an imbalanced diet, and I firmly suggested they at least increase the percent of formulated pellets. This lasted for all of two seconds of course, because they've been in a second time, and again proudly explained their home-made diet to me, which has zero pellets now.

Okay, so I'll never convince them to change the diet. I won't bother arguing. They also wanted me to check the loose stools, like I mentioned. I did a full faecal exam and actually came up with a diagnosis. Put up some meds for them to try. Turns out they went home and researched the drug on the internet, decided it's too dangerous, and it was far riskier to give the really-good-for-diarrhoea antibiotic than to let the birds keep having diarrhoea forever.

I spent at least an hour with these people, maybe even an hour and a half. I gave the birds tons of time to get used to my presence, the sight of the towel, me patting them, before I even started the exam. I talked with the owners about all their crazy "I read such and such online" questions. I explained everything about diet, and gave them handouts with information from trusted veterinary sources, as well as a ton of free samples of pellets and diet conversion products. Then they bitched about the bill, saying that for someone so inexperienced it should have been a lot less. Maybe, oh, $30.

They said they'd go back to their other vet. Whose history, by the way, was two, two-word lines: "[Date] Sexed - male." and "[Date] Nail trim." I was secretly relieved, because I knew it would be a headache to ever get these clients to comply with any veterinary advice.

Alas, it didn't stick. They came back a month or so later, with some more birds. This time around, they wanted me to examine a new bird, so they wouldn't have to keep it in quarantine/isolation for the full 30 days. They didn't want to do any of the bloodwork or viral testing that is recommended, and balked at the price of a hundred or two hundred dollars. They wanted to know why I couldn't just give it a "clean bill of health." I explained about asymptomatic carriers of disease, but they decided that chlamydiosis is a severe illness (one of them had caught it from a bird before), so if the bird had it, they'd be super sick by now.

That bird was strikingly sweet, and had excellent feathering and body condition. Even the owners commented on how much more quiet and docile she was compared to all their other birds. Turns out they'd only had it a week. Sigh. Can't wait to watch it slowly get more aggressive and poorly every time I see it...

You Have A Cold? Time For GDV Dog To Come In When You're By Yourself.

Yesterday, when I left the house, I felt normal. By the time I got to work, I had one of those, "Oh, the air is a bit dry" sore throats. Then I proceeded to get sicker by the hour. Since I hadn't been sick in the morning, I wasn't prepared. At home I have a cornucopia of cold and flu remedies, but at work all I had was tea. Lots and lots of tea.

It figures this would happen on my late day, when the clinic closes at 8pm. Things went pretty well, considering. Most of my exams were new pets adopted from the shelter, getting their free exam. I speyed a shelter cat. Dental on a dog that didn't need any extractions. For the evening appointments, one showed up super early, one was just a booster with no exam, and we knocked it out of the park.

Yay, maybe I can get home somewhat early and then take some NyQuil and pass out!

Ten minutes to seven, phone call. Young dog that has been severely vomiting all day. May have eaten sewing fabric or needles. Hmm, doesn't really sound like something that I want to wait overnight.

I knew it was going to be a long haul as soon as they arrived, because this dog was a big labby thing that was going crazy. All over the place, jumping, panting, anxious, wouldn't sit still. There were only three of us in the whole clinic, and one of the technicians is recovering from broken ribs so can't handle any animals. So it was two tiny young women against big anxious dog. When we finally managed to get an xray... Oh shit, that looks like GDV.

I decided to call the emergency clinic to see what they recommended. I had the brilliant plan to email them the xrays. Turns out none of us knew how to actually log in to the email account.

Long story short, it wasn't actually GDV, gave it some meds, and the dog got better overnight. They canceled their recheck appointment today, along with the other... three or so appointments I had. So after the handful of morning appointments, everyone kind of shuffled me out the door to go home and rest.

ExoticsCon

 

When I was reading on VIN what people recommend for getting started in avian practice, the biggest answer was "Get yourself to the annual avian conference." So I did. And it was awesome.

ExoticsCon was in San Antonio this year, and it was a combination of the avian vet association, the reptile vet association, and the small mammal vet association. There were lectures for all three going on at once, so I could go to a half hour about avian viruses, then switch to a case study of cancer in a hamster, then check out research on reptilian pain perception, if I wanted. I was worried the experience would be too similar to school--flashbacks to 8 hour days of lecture--but it was SO much more fun. All the pressure of exams and assignments was gone, and I could pick what I wanted to learn and when. If I didnt want to go to anything for an hour, I didn't have to. But I had the opposite problem: I was usually choosing between two or even three simultaneous lectures that I wanted to see. And there were some big names there. I went to talks by people like Brian Speer and Thomas Tully--guys who wrote the textbooks on avian medicine.

My hotel. I was very important, being a 

doctor and all. 

I made some friends, too. Everyone was so easy to talk to, happy to give advice and interested to meet a new grad. I had my "first time attendee" badge and that made for a good icebreaker topic. Even before that, five minutes off the plane and standing in line for a taxi, I met a vet student on her way to the same place and we shared the cab. She was even going to intern at Wildbase in a few months--small world!

Being in San Antonio was something else, too. For a small town girl, it was like complete sensory overload. There was more stuff within a thousand feet of my hotel than there is in like my entire home town. I mean, there was an IMAX attached to my hotel, for crying out loud. There was also a spy exhibit, with lots of history about intelligence operatives, neat artifacts (like an enigma machine), and simulations of stuff like a laser maze or a room with a bunch of hidden cameras. If I wasn't so busy with the conference, I could have spent hours sightseeing or shopping (apart from the slight detail that Texas in August is like the surface of the sun, and I couldn't go outside for two seconds without melting). I simply had to take the boat tour down the river, which was amazingly gorgeous, but my poor old camera wasn't up to the challenge so I couldn't get a lot of worthwhile pictures.

Pigeon carrying spy cameras.

 

 

 Laser maze! I failed horribly.

A neat thing about the conference was how... sciencey everything was. There was a giant room set up with booths for vendors, including lots of free stuff (candy, free samples, stuffed animals), and tons of handouts. When trying to sell to vets, I guess, the thing to do is print out journal articles that support your product, and talk about all the studies and science that prove why I should by it. I also go try to some fun demos, like cutting a piece of meat with a radio-scalpel.

My favourite part was the keynote speaker, who is avet for NASA and has been in space a whole bunch of times. He had videos and photos of him actually in space and on the ISS. Most of his talk was about the physiological side effects of space travel, and the history of animals and space travel. Normally, my love of sci-fi is a completely separate part of my life to the work part, so this totally blew my mind. Completely starstruck. And it turns out, in a room full of hundreds of vets, there's really quite a high percent of sci-fi nerds!

The other exciting thing that happened was zoo day at the San Antonio zoo. Because in my profession, a professional conference can include zoo day.

 

 Left: Reptile house. Right: Feed prep area.

 

First Dropped Stump

The surgical emergency every new grad fears.

For the non-vets, a "dropped stump" is when a particular artery isn't well tied off when you let go of it (usually accidentally), so uh, blood starts pouring out of it into the abdomen. Pretty much every vet student's nightmare, and inevitable at some point in your career. I've spent years dreading it, being extra super paranoid in every surgery, and it finally happened in August.

Naturally, it was on a day when I was the only surgeon in. And naturally, they had booked a large, deep-chested dog spey for me. It was like looking down into the grand canyon and trying to work with a grappling hook attached to a helicopter. I managed to get my ligatures on, half-blind and up to my elbows in dog abdomen, and, ironically, I wasn't quite confident in them so I wanted to add a third. Just as I lifted the pedicle up to tie another knot, poof, the pedicle was gone. In my hand, securely in the clamp, were the two original ligatures, nice and secure... And attached to nothing.

Sometimes in these situations, blood starts welling up in the abdomen like someone turned on the tap. Fortunately mine didn't bleed all that much, really. I still had to stand there for ten minutes with a fistfull of swabs pressed into the general area, while one of the other vets drove in to help.

At the discharge, I had to figure out how to explain to the client that surgery wasn't exactly routine, but the problem was resolved. I went with "there was more bleeding than usual." At the recheck a week or so later, she mentioned she'd heard a "sloshing sound" the first night. :S

Considering in the very next surgery I did, a cat spey, the clamp cut clean through the uterus and I had to go fishing for the severed end, I was put off surgery for a little while...

"I Was Worried, So I Threw Out The Meds"

"I'm so worried about my dog. She's just wasting away and not herself at all anymore. Hasn't changed at all since 2 weeks ago."

"Did you give the meds?"

"No. I didn't like them so I threw them out."

To paraphrase the rest of our conversation:

"She's got diarrhoea."
"Do you want a probiotic?"
"No, she doesn't have diarrhoea. She's really painful."
"Do you want pain meds?"
"No. Her skin is so bad."
"Do you want to try some oil supplements?"
"She's just wasting away and I'm so worried."
"That's what the pred is for."
"I really don't want to use the pred."

And around and around we went.

Freedom!

A client made an appointment to be seen because her cat is "emancipated."

Reception Borrowed My Dogs When I Wasn't Looking

My dogs came to work the other day. They periodically do, and spend the day in the doctors' office behind a baby gate, often with 1-3 other doctors' dogs, and my bird. They know their way around the clinic pretty well: break room = crumbs and table snacks, treatment area = needles, nail trims, and other scary things.

This time around, at lunch time, they wandered off while I took a phone call. Turns out they went up front, and the girls up there were trying to guess what tricks they know. (One of them is a dog behaviourist who runs training classes) The conversation went something like this:

"I think she taught them some things."

"Hm... Do you guys know spin?"

*Dogs spin*

"Oh! Uhhh, how about down?"

*Dogs do 'take a bow', which is their default since it's the most recent trick they learned*

"Wow! Look at that! What about 'touch'?"

*Dogs frantically paw at her outstretched hand, since several tricks (like shake, wave, high five) combined in their heads into "smack the human's hand"*

"You're really good at that! Sit pretty?"

*Perfect 'sit pretties' as she holds a treat over their noses.*

I show up to find out what they'd wanted to ask me while I was on the phone--which was, "Can I give them more treats?" After being impressed at how "well trained" they are (i.e. extremely food motivated), they'd started teaching them new tricks. In particular, they were trying to get Tempest to jump over Shakespeare. They were having an issue with Shakespeare standing up the same instant she jumped over him, so they learned to anchor him down by putting treats on his front paws (he's good at "leave it"... in this sort of situation, anyway. Not if he thinks he can get away with something naughty).

Another day in the office, really.

Still Bitter About This

Subjective evaluations can be a blessing or a curse. If you're personable and a good student, it's easy to win clinicians over, except for the staunch few who have very high standards--sometimes impossibly high. My feedback throughout final year was a rollercoaster of anxiety as I waited to find out how I did on each roster. The way it worked was that after the roster was over, a clinician or a committee would grade each student and post it to an online system. Your grades were generally 1-5 in a series of categories, including knowledge, professional conduct, and practical skills, accompanied by a comments box.

For the most part, my grades aren't worth talking about. I did well in some, average in others. I worked hard and sometimes it paid off and sometimes it didn't. But a year later, there's still one evaluation that I remember keenly. And it's not so much because I did poorly, but rather that concept that so often makes barbs stick in your memory: injustice.

You see, this was a clinic I had chosen to go visit, for an elective week. It was a small animal clinic right in town. I'd spent a week shadowing them in third year, and at the end of it, they'd welcomed me to come back in final year. So I did. I probably shouldn't have.

Firstly, it's not the greatest clinic. The facility was dark, cramped, and dreary, and the medical practices were... average. Anaesthetic monitoring was subpar, in-patient cages were lined only with newspaper, there were practically no in-house lab options. But hey, this is the point of clinical rotations: see what's done well and what isn't done well. The issues arose, I think, because I was bored out of my freaking mind.

Even though this clinic has a student almost every week of the year, they don't seem well adjusted to having students. There was literally nothing for me to do, ever, and there was also no place for me to sit or stand that wasn't in the way. I can understand that some clinics aren't comfortable allowing students to participate in procedures (even though every other place I spent time with was happy for a final year student to get as hands-on as possible), and I can understand that they don't exist with the aim of mentoring me and making my life better. But, really, when there's a slow schedule, and all I've been doing is standing next to a wall for hours, you can't expect me to not try to make better use of my time. Thing is, in fifth year, we had an absolutely obscene number of assignments, and if I wasn't learning anything, I honestly couldn't afford to stand around.

One really annoying thing was that they had no internet. Not just no wireless, there was no internet on the computers at all, except for the practice owner's office. If you wanted to look up a drug or a disease, forget it. This added to the whole "dark ages" feel of the place. Fortunately, I had a few things I could work on without internet, so during slow periods when there were no consults or surgeries, I opened a separate window on one of the computers and got to work. No one ever said anything to me, but in my evaluation after the fact, they wrote that at one point, I started working when the billing on that computer hadn't been finished. Mind you, I only sat down when there was no one around and nothing going on. Did anyone ever ask me to move, or to use the computer briefly? No. But they got irritated enough by my presence to complain and have it put down in my evaluation.

The other comment that really stands out in my memory is that apparently I was asking questions at inappropriate times. They said it was good of me to show enthusiasm, but I really needed to be more appropriate about when and where I asked questions. I've wondered and wondered, and I still have no idea what triggered that comment. I do always ask questions, and I asked plenty there, because--like I mentioned--I had nothing else to do and no one was engaging me in anything. So I'd chat with the surgeons during surgery, and I'd ask case-related questions between consults. Where was the transgression? Did they feel I was holding them up between consults? Again, no one ever said anything to me.

What really makes getting a bad grade on that rotation hurt is how polite they were to my face. They welcomed me to come back to their clinic, knowing who I was and what I was like, and they let me wander around trying to find things to do to keep busy without comment. They said kind things to me and wished me well, and then graded me lower than almost any other rotation of final year.

It doesn't matter in the slightest, because I got an A in clinics, good references, and a good job. I know that particular clinic is a miserable work environment with poor medical practices, and having students around must have been too much extra stress for them. But you know what? I'm still bitter about those comments.

Sure, I'm Sure

I need to be more careful about what I say. I've always known this, but I had a reminder today.

I saw a 9 week old puppy, who had been in a week ago for a UTI. This appointment doubled as her originally scheduled puppy exam and first shots, as well as a recheck for the UTI. I had already made a poor impression on these people, because last week, I was about to send her home on Baytril, when I remembered--whoops, we don't want to give that to a puppy of that age. So I quickly caught them, said, "Wait, I changed my mind, take this antibiotic instead," and tried to explain the brain fart with a tangle of poorly articulated blabbering. Turns out this totally confused them (big surprise), and they'd been giving the cephalexin once a day instead of twice a day.

So anyway, he comes in today, and I had a hard time getting history out of him. I asked how the UTI is going, and if she's having any of the same symptoms. For some reason, this completely baffles him. "Any of the same symptoms???" I could practically see the question marks floating around his head. Since she's a puppy, she's still being housebroken, but eventually I figured out that she stopped squatting repeatedly outside and was now passing normal amounts of urine at a time. He asked about the antibiotics, and I told him to finish it up, at the twice daily dose. He asked me the first time while I was still trying to figure out what was going on--I couldn't tell if we needed to re-treat, or if she was better, or what. He then asked me again after we were finished talking about it, and again after the tech had joined us and helped me give her vaccines.

Afterwards, he complained to the front desk:

Him: Is she new?
Them: Since May.
Him: I asked if I should finish the antibiotics, and she said "Sure." She must be new.

He also added that he usually sees "a man." (My boss)

I actually have no idea what I said the first time. I was too busy trying to get the history out of him. I may have said "Sure," but I don't think I did--then again, I wasn't listening to myself. I do have a habit of agreeing to things when I'm not listening. (I'll be writing in a chart, someone asks me something, I say yes... A minute later think, wait, what? Tell me again, I wasn't listening). But I know FOR SURE, I told him all three times to finish the antibiotic and give it twice daily. The tech told me I definitely, definitively, for surely said "YES FINISH THE ANTIBIOTICS."

I know in my heart of hearts that he will forever remember only the "Sure." I'm now terribly paranoid about what other slip-ups have escaped my mouth. 

Interviewing

Acquiring a job was an interesting venture. I went to a lot of clinics in person to drop off resumes, and joined all the websites (AVMA, AAHA, MVMA, you know, all those four letter things). There were two main categories of people who wanted to hire me.

1. Large "chain" clinics in random states, with a generic email inviting me to fly out across the country to work for them, most likely sent to everybody who sticks a resume up on those sites.

2. Clinics out in the boondocks who can't get anyone to work for them, so are like, "New grad? Sure! Heck, we'd hire a vampire at this point."

There was also the one who didn't read my resume past the first line, and offered me a job as a vet tech.

The fact that I have some avian experience and was interested in seeing exotics made me particularly prized by that second group. Bosses who are like, "I don't know anything about that stuff, but there's an untapped market there, so you'll have tons of business!" My current boss was among those who said he'd buy me anything I need for seeing birds. Sadly, I didn't realise how much you can/should go out of your way if you want your avian practice to be really effective, and the scary thing is, I doubt most of those bosses do either. It's not enough to throw birds into the mix and treat them like cats and dogs.

I ended up interviewing at three places. There were a few others I was in contact with, who bailed on me--and probably a good thing, too, because I heard later that they are awful places for new grads. No support, no time in the day to get things done, yet expected to stay as late as necessary to finish up all paperwork and everything, for no extra pay.

There was a common theme among clinics that a lot of places didn't have much in the way of support staff. The one I'm at now is one of the only clinics that has a technician with each doctor at all times. In fact, it's the only one that had 3 other doctors. Most were one or two doctor practices. Also, most were dungeons. Cramped, cluttered, old buildings in desperate need of a redesign. Workplaces with no real break room, just a shelf with a coffee machine and microwave (where does everyone eat lunch??). Dark treatment areas, tiny surgeries, consult rooms with no logical flow between them, ugly waiting areas. The kind of place that starts out depressing and stressful before you've even said hello to anyone.

One of the places that wanted to hire me actually talked smack about their previous new grad. Apparently they hire new grads all the time, because they can't get anyone else to work for them, being in the middle of absolutely nowhere. And most new grads move on after a year or two, so this was one of their selling points: "We've successfully mentored numerous new graduates." But when I started asking questions about the person who'd left, opening up the position, they had some not so stellar things to say. Essentially how she seemed overly needy, wanting advice on every case, asking too many questions all the time. And I'm thinking... I will be wanting advice on every case and asking questions all the time. Seriously?

Then there's the matter of on call. Clinics in civilised parts of the state are within reasonable distance of a 24-hour emergency facility, so on call has become a thing of the past. Unless your clinic is, you know, in the middle of absolutely nowhere. I would have had a 40 minute commute to that particular clinic, and I was required to be within 20 minutes when on call, so I would have had to stay at the clinic one weekend every month. Then they had the gall to say, "We don't want the on call to be a reason someone declines the job." Well, guess what, I have an offer that's almost exactly the same as yours, with no after hours, and no living at the goddamn clinic. Hate to say it, but that's kind of a big deal.

The job I did get was definitely the best choice. :)

Double Trouble

Client brought her cat in to be seen. When she got to the clinic, she realised the other cat had been sleeping inside the carrier when she stuffed cat #1 in. "I thought it seemed awfully heavy!"

My First Day On The Job Involved A Proptosed Eye

One of the reasons I took the job that I did was that they were interested in hiring a new grad, and willing to give me training wheels for my transition from vet student to actual vet. For my first month, I was never alone in the clinic, so no evenings or weekends, and I was paired with the most experienced senior vet techs. My appointments were all scheduled for 30 minutes instead of twenty, and I was given extra "block off" time for work-ins. My first few days, I didn't have any scheduled appointments at all. I was meant to observe, familiarise myself with where everything is, and maybe jump in on work-ins or walk-ins.

As life would have it, there was a work-in at 8am that first Monday. A dog that had gotten into a fight with its larger friend, and may have gotten a laceration above one eye. "Redness" above the eye, they said. Perfect first case for the new grad, they said.

So in I go and as soon as I lay eyes on the dog, I know exactly what happened, and that I have no idea what to do about it. It wasn't a laceration. It was a proptosed eye.

Small, buggy-eyed dogs like pugs and shih-tzus already have their eyes halfway out of their heads. Therefore, it's pretty easy to pop them the rest of the way out. A solid squeeze or bang on the head could do it. If you catch them straightaway, you can push them right back in. Naturally, this happened the previous afternoon, so the eye had been bulging out exposed to the world for more than 12 hours.

In typical new grad fashion, I gave an excuse to bring the dog out back ("have a look at it under the bright lamp in treatment"), found my boss, and promptly went, "What do I do, what do I do!"

Long story short, we admitted her to the hospital for mini surgery to put the eye back in and suture the eyelids together to hold it. All went well, and I saw her every week for a month or two. The eye retained some function to it and time will tell what happens to it in the long run.

It turns out this was a prelude to the theme of my career. Nothing normal happens to me. It's only the wacky, you-don't-see-that-every-day cases, time and time again.

What It Feels Like Being A New Grad

I think I could be a finalist for "Most Awkward Phone Message Leaver in the World." That, and we could also create a drinking game for every time I say or think "They didn't teach me how to do that in vet school."

Vet school led me to believe advanced orthopaedic and ophthalmic procedures would be a common occurrence, and I would be sending out advanced endocrine panels on a daily basis, and chemotherapy is just another day in the office. Nevermind that I still barely know how to bandage a splint.

The Nightmare That Was Boards

After the harrowing experience that was final finals, I had the pleasure of sitting the licensing exam. NAVLE, it's called: the North American Veterinary Licensing Exam. As if three weeks of written and oral exams weren't enough, I had to study for another two weeks, make the six hour drive to Auckland, and then take the most difficult and frustrating test of my life. Unfortunately, the reason it was so awful had a lot more to do with the climate control than the material.

I took the test in December, which means hot, humid, muggy weather in Auckland. We stayed in a cheapish-but-central hotel, in a room the size of a closet, with no fan, no air conditioning, and no internet. The only thing to do in that room was lay on the bed with all the windows open and try not to stick to everything, because outside was just as muggy and breeze-less as inside. There was a tiny tv with six channels, and then me with my stack of notes that I'd read over a hundred times in the past month.

Okay, so miserable hotel, whatever. I've traveled, I can deal. But what really got me was the testing centre. I'm surprised I made it out alive.

The instructions were to show up half an hour early, so we could get all registered and set up. The elevators were weird and broken, so I had to go to the floor below and take the stairs up, then wander around to find a registry desk--which was dark and empty. One by one several of my classmates arrived, and we all stood around awkwardly, waiting for someone to show up. There was a dark, empty, locked room labeled as the testing centre, and literally no other soul in sight. The half hour elapsed, and then another.

Eventually someone did show up, and then we were taken into another room, sat down, and told to wait some more. One by one, we were called up to give ID, get scanned for cell phones or devices, and handed official scratch paper for notes. The actual testing chamber was a row of eight computers divided into cubicles, each with a set of ancient, uncomfortable, noise-blocking headphones. And no climate control.

In the crisp wee hours of the morning, all went well. I worked my way through the old-fashioned UI and got to test-taking. It's a multiple choice exam with six modules of 60 or so questions. They are timed so you have an hour for each module, but no specific timing on individual questions. There were a whole lot of details to this process, but it's all a blur in my memory--which is wont to happen when you take a seven hour exam in a room like an oven. I realise my math doesn't add up right... I think the extra time comes from the hour or so of allotted break time. You can take your breaks whenever and however you want, between modules. So like, if you start a module, you're stuck until you finish it, but if you want a 10 minute break after each one, you can, or you can power through half and take a long lunch, etc etc.

As time wore on, with eight people in this cramped, sound-proofed room (read: oven), my physical and mental state deteriorated. Even though I took as many breaks as I could, as soon as I got back in the room, I started getting lightheaded and having a hard time concentrating. I was so sure I would faint. I had to start taking breaks specifically to go to the bathroom and lay wet toilet paper over my forehead and neck. Oh yeah, the bathrooms were on another level, had a security code on them, and no paper towels. And the cold water was lukewarm.

The material on the test was irritating, too. I knew going into it that there would be a certain percent of questions where I had no clue, had never heard of the disease/diagnostic test before, and would have to guess at random. I didn't expect all the other annoying questions. For instance, at least 50% of the small animal questions were on cat respiratory disease. There was supposed to be a large section of pig questions, and only a rare deer question, but instead, there were no pig questions and lots of deer questions (guess what I studied). And the most annoying of all were the questions that asked what step would you take next, and then list 5 tests or procedures that are absolutely appropriate for that clinical situation, and I had to try and hazard which really-important-helpful-thing they wanted me to do arbitrarily first.

I was the first one out of there. I've always been a fast test-taker, but after a point I was just like, "I need to get out of here before I pass out." I believe I started at 9am and finished at 3:30pm, so 6.5 hours total. On my evaluation form, I wrote angry comments about the climate control. My husband traveled with me, and I found out he, too, had laid around dying of heat and humidity, with the original intention of exploring the city.

We went out to eat at the rotating restaurant on top of Auckland's Sky Tower, and he'd put the reservation under my name as "Dr" and we had wine and lamb and dessert. Then we went to the ice bar and stayed there a good long while.

Funny Quotes From Boards Practice Questions And Lectures

Toxic plants have a tendency to show up inside animals’ stomachs and therefore, toxic plants also have a tendency to show up on veterinary board exams.

The contents of the cecum are dry and cheesy (much like board review study material)

Ok, admittedly this is a tough question, but we do not want to make them too easy.

"Ok ladies and gents, it is time to beat to DEATH the cranial. cruciate. ligament. rupture. All right this lecture might go a little longer than others, but it's going to be worth it, it's going to be glorious."*
 
"So at this point you're probably on the verge of tears, and you no longer want to ever think about neurology again, and you're probably considering a career as a baker."

Suture material can be very exciting if you let it be.

"In this PowerLecture we are going to KILL patellar luxations." 

Remember: with hypothyroidism dogs become fat, lazy, heat seeking missiles of skin disease.
 
"Okay everyone, let's conquer pelvic fractures once and for all." 

UV light is not thought to play a significant role in development of these tumors as they tend to occur in the area where the sun does not shine.

Sorry, it's a human health question, but it is a potential biochemical warfare agent and the public expects veterinarians like you to know this.  

Of note, all Clostridia are categorized as gram positive organisms with the exception of Clostridium piliforme, which is gram negative (yes, Microbiology is confusing). 

Cryptococcus is also not a contagious disease (do NOT confuse this with cryptosporidium, which is very contagious and zoonotic as several of my colleagues can attest to profusely). 

This is the perfect random question. The fun fact to remember is that Cornish rex, British short hair, and Devon rex cats are predisposed to having Type B blood type. 

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*In  case you are wondering, the ones I put quotations around are verbal quotes from recorded lectures, while the others are copy-pasted from the answer pages of multiple choice questions.

To All The Unsung Blog Posts - Part 2

More not-quite-stories from final year!

- Imaging roster was known as "radi-holiday" and "radiation vacation." It was supposed to be a total laid-back easy peasy week. Totally not the case. The surgeon most notorious out of all surgeons for making students cry and break had recently decided to forget about surgery and do a radiology residency. Also, there was nothing more boring in all of final year than standing around for three hours in a dark room with 5 other students, no sitting room, watching the two residents painstakingly repeat and record every step of an abdominal ultrasound that should have taken twenty minutes.

- During equine rotation, some of our days were very slow, and one of the vets had a horse competing in a race, so the residents actually took us on an outing to a day at the races. We went out in one of the university's minivans, bought fried food, watched them show the horses, cheered for ours, talked about polo, and huddled together from the cold, miserable, windy weather.

- I planned to use for a blog post title: "And Today's Wardrobe Options Are Scrubs or Scrubs."

- I can't remember specifically what the issue was, but I believe it was regarding the horrible hours and work conditions in the small animal hospital. I have a paragraph from a started-and-abandoned blog post that goes: "I of course being the confrontational go-getter that I am, made sure something got done about it by writing a mildly worded email to our class rep... after her prompting me to do so."

-  My very last day of surgery rotation ever, a Friday, saw a dog come in at 3:30pm that had been hit by a car. I did the initial exam, and then stayed with the dog as he was stabilised and transferred to anaesthesia. Surgery started at 7pm. I got home and had dinner at 10:30pm.

- One of my last rosters was the SPCA. Most people had this earlier in the year, which would have been much more valuable, because you cover some surgery basics and get to try a few speys and neuters. During my week, they were doing a "desexathon." Free or low-cost (can't remember) desexing for pet cats in the area, to help control stray populations. Which is very worthwhile, because at least half of them were pregnant, and with 30-50 speys in a day, that's a lot of unwanted kittens. The sucky part is that because these were owned pets, the shelter wouldn't let us do anything. So I spent the entire week standing in a corner watching them do speys. Bear in mind this is a month before I qualified as a vet.

To All The Unsung Blog Posts - Part 1

I had many interesting ideas for posts that never got written. Here's a slew of the most interesting snippets that never made it to the light.

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- At a small animal clinic, during one exam there was this very cute little kid who was really into learning about everything that was going on. The vet had a kiddie stethoscope to give him, and he spent the rest of the exam listening to everything--the dog, his parents, himself, the table. The first time he put it on, he put it in his ears backwards, and after being corrected, was very concerned about getting it right every time after that. He kept interrupting to ask "Is it on right?" before listening to another inanimate object.

- One of my classmates fostered a paralysed dachshund that came through the hospital. The dog had a little mini wheelchair, and hung out with us in the student lounge. She was very friendly and would wheel around and get stuck on things.

- While on emergency rotation, a dog came in critically ill. I spent several hours with the team, participating in a small part of monitoring while they performed lots of dramatic procedures. At one point, I got sent to run down the hall to the lab, to see if we had results back on clotting times. They weren't back, and in the 5 minutes I was gone, the dog died.

- We toured a deer farm and a pig farm, which were really cool, but don't make for interesting stories. Though one of the techniques at the pig farm to tell if the feed mixer is doing a good job, is to drop in a bunch of sprinkles and look at their distribution in the final product.

- To prepare us for dealing with clients, we had to break into groups with an actor assigned to each group. We had several scenarios, and had to practice things like delivering bad news or dealing with an angry client. Some of the actors were apparently quite difficult! All of this was recorded so we could study it later. My group was a bunch of pansies and nobody would volunteer, so I ended up going twice.

- On our public health roster, we took tours of several meatworks--beef, lamb, and poultry facilities. While much of my class hated this, I actually found it fascinating. Everything was so clean and orderly. Plus we got to walk through the chiller, where the stripped carcasses hang on slow conveyor belts like we were in a horror movie.

- I'm not sure I ever talked about our naked calendar, one of the fundraisers for Halfway Day. I'm not sure what I did with the photos from my group, but you can check out the current Barely There calendar website for general photos, and maybe even support the current third years! Updated every year by the new class.