There's only one of me!

So today, I felt that I needed to be cut into a minimum of 25 pieces. The two internists were fighting over my help (I'm on internal medicine rotation right now) and the oncologist was calling me a traitor for no longer being on his service. I was told to "spread the love." I'm spreading as thin as I can, folks, but am only one person. Believe me, if I could be everywhere at once I'd be at home right now in addition to doing my internship and working at multiple places; might actually be able to afford something that way - like the new car I really need;)

That could be entertaining, though. Imagine, multiple me's...I'm positive that those readers who know me personally and well are thinking how frightening that image is to them. Even one of my intern-mates turned a little pale when the idea was propositioned today - he doesn't even know me very well either. It's kinda fun to know that I inspire fear in so many while doing so little - just by being me. It would be even better than having that third or fourth hand I'm always joking about.

One of our cases today was a young Pit bull who got into his owners' bottle of Midol. Midol contains tylenol and caffeine as well as a diuretic. Both tylenol and caffeine are toxic to pets. Tylenol, unlike most of the other pain medications, primarily affects the liver rather than the gastrointestinal system and kidneys. We use N-acetylcysteine as a glutathione donor to help protect the liver and prevent oxidative damage to red blood cells. We also give cimetidine which inhibits cytochrome p450, an enzyme in the liver, thus inhibiting the toxic effects of tylenol to the liver. Caffeine causes heart arrhythmias, fast and slow heart rate, coma, seizures, restlessness, anxiety, and even death at certain levels. Fortunately, this dog did not ingest a high enough dose of caffeine to cause severe signs. We're treating him to safeguard his liver. In contrast, we had a dog a few months ago that ingested an unknown amount of a diet shake mix that contained high amounts of caffeine and subsequently died in the face of aggressive treatment. It's amazing how many things are laying around the house that could potentially kill our best friends. Remember, they don't know better and you must "pet proof" your home just as you would take precautions for children. The Pit bull will most likely be fine but he's lucky.

Before I leave this area, I must make time to see some of the sights since who knows when or if I may ever return. One of the good techs at work has offered to show me around, which is great since I want to go to the museum in the city but am reluctant to go alone. She and I are able to coordinate a couple of days off in the coming weeks and I look forward to the adventure. I love museums and would hate to miss the opportunity. Will keep you posted...

Scrambled eggs anyone?

It never ceases to amaze me the many and varied ways that people can find to annoy one; especially when working with them! The personalities at the clinic where I'm doing my internship are "unique" to put it nicely (coming from me that's typically complimentary but not meant that way in this instance.) Some of them are not completely bad eggs but they are all frustrating in the very least. I'll give a quick rundown and should also remind you readers that I'm a Southern girl in the Northeast...

First there's "The Empress," fondly called because of her tendency to shoot the messenger. A terrible temper, short fuse, and quick explosion characterize this brilliant internist. I do not shortchange; she is very smart and an excellent doctor but God forbid you be the one to deliver any bad news, no matter how trivial. You can never do anything right, nothing satisfies her, and it is always your fault!

Second, "The Hawk," who is characterized by her ultrasonic hearing and nosiness. She always must micromanage and have a talon on the pulse of everyone's business; even when it's none of hers. She chides for not "owning a case" but gets angry when you make "Dr. decisions" without consulting her. It's always a no-win situation with the Hawk.

Third, "The Drama Queen," who has no filter and says out loud (very loud!) exactly what she's thinking or feeling at any given moment. She is very devoted to her patients but the rest of life she believes revolves completely around her. She also has no sense of time management so a day spent working with her rarely ends before 8 or 9 p.m. even when there is only one patient.

Fourth, "Master Non-communication." He thinks alot of things but fails to share them with his support staff. Result?? No one has a clue what is going on with any of his patients on any given day. From the opposite perspective, he never listens unless you beat him with the information repeatedly. He is also really good at derailing those around him from accomplishing their task making simple things take hours. No matter what decision you make i.e. consult him prior to doing or do something and inform him afterwards, it is always wrong.

Fifth, "The Colonel," who runs his department with military efficiency and expects other departments to do the same. The problem? They don't and then he becomes upset and his department gets off kilter because the top is now unstable.

Sixth, "Two Face." She is quite fun when not working with her and has a good sense of humor. When on the job, though, she becomes a know-it-all who can do no wrong and criticizes every move someone else makes. There is no consideration for the other side of the story.

Seventh, "Mr. Ego," an oncologist who always believes in a cure and cannot admit he is ever wrong. Jumping to conclusions is his specialty and not listening to anyone else his hobby.

There are more but those are the key players without mentioning "Gigi, the hooker" who is also the top administrator since the clinic was sold to a group of business investors... The common denominator is that they all have huge remarkably fragile egos. Imagine spending every day walking around with a bunch of eggs surrounding you on every front. That's how this internship feels!!! 68 days left and I just hope I'm not jumping into a worse frying pan for next year. Now there's an idea; perhaps I should scramble the eggs...

Cat attitude

We have a cat boarding right now who is a real personality. We'll call her "Fluffy" to protect her privacy. Fluffy started talking to me the minute I walked in the door this morning. We always board Fluffy up front so she can see what's going on in the world. If she's in back, she gets mean. We also open the back door for her so she can see out into the world through the screen door. So, Fluffy started talking the instant I walked into the door. I walked over to her and started scratching her head through the cage door. She purred a lot, and walked back and fourth, and generally enjoyed herself but still talking. As I walked away she got louder, like "Hey, where are you going, I didn't give you permission to leave yet!!!" A few minutes later my kennel assistant was cleaning her cage. "Hey, Dr. Can'tSpell, can you hold Fluffy for me while I clean her cage?"

I go over and pet Fluffy while her cage was cleaned. My assistant takes out a soaking wet litterbox and replaces it with a clean one. I put Fluffy back into her cage and close the door. And then Fluffy goes right to the litterbox and promptly urinates into it. I guess earlier she was complaining about the service and telling me she was out of toilet paper!

Something sucked every day of this week

Well, let's see.

Lots of emotional-ridden family issues going on right now. In addition to these three or four separate issues, at work...

Euthanized a long-time patient on Monday that I'd been treating extensively for months.
Euthanized a patient on Tuesday that had very angst-ridden family. I cried a lot (again).
Euthanized a patient on Wednesday.

On Thursday I did something else that they always tell you you're going to do in school that I've managed to avoid doing so far. Which is, a pedicle broke while I was ligating a dog spay and I had to go fishing for it. I located it just fine and tied it off just fine, but boy, what anxiety! The patient did well, and recovered with no problems.

This type of thing is an accident and happens all the time. The tissue was really friable since the dog was in heat and it just happened. However, I sweated bullets as soon as that thing was found! I was proud of myself and didn't freak out while doing it, but I kinda sweated it afterwards!

So today, nothing bad has happened (yet, knock on wood). However, I have to drive 1 1/2 hours as soon as I get off work. Hopefully, my car will work fine and I won't hit anything on the way there or back. But the way my luck is running this week, I really wouldn't be surprised. Keep your fingers crossed for me.

My Monday Sucked

When you are surrounded with death and destruction before 11 am on Monday morning it's NOT going to be a good week.

Also, note for all of you medical types out there... this post made me glad I'm not in human medicine.

Squish, squish

I had a lot of fun today. I spayed an in-heat small dog. This usually fills me with trepidation (any dog spay does- it's a long storey) but this one went ok. But the fun part came later. I removed a big marble sized sebaceous cyst from a dog's back. I got to so some cool wound closing stuff, like walking sutures and vertical mattress sutures (I haven't done these since vet school and was happy I remembered how) and afterwards, I sliced open the cyst and shelled out a perfect little white ball of hair and sebum and oil from the cyst! It was extremely cool!!!!! I find weird stuff cool.

Circling the drain

The chart said the dog was vomiting. When I got in the room I found a very large German Shepard who was laying on the floor panting at me. Turns out he hadn't been quite right ever since they got back from their winter place in Arizona. Immediately all those odd things that occur only in the Southwest flash through my mind. Plague. Coccidiomycosis. (I think). Others I can't quite remember.

So I do my physical exam. Her mucus membranes were pale pink. She was hydrated, and her heart and lungs sounded ok. When I palpated her abdomen something didn't feel quite right and I start to sweat. A radiograph of her abdomen confirmed it. She had a large honkin' spleen tumor.

Tumors of the spleen are not a good thing. Sometimes they can be benign but are mostly very nasty. And when you have a German Shepard, one pops to the front of your list: hemangiosarcoma. This tumor has multiple bleeding episodes where the patient feels puny than gets better until they don't stop bleeding. Usually then you are presented with a very pale dog in a lot of pain. Surgery can take out a spleen tumor, but prognosis is still poor. Most of the time once you diagnosis it and take it out it's already seeded metastasis to the liver. Usually even with aggressive chemo the survival time is four months or less.

It's hard to see elderly people cry. When you're telling somebody that their friend is going to die a horrible and painful death unless they have the courage to euthanize her it's hard. I started crying (as usual) while talking to them in the room. I'm not tough enough for this job most of the time. In the end she slipped away peacefully while her people talked to her. Faithful to the end.

The Countess of Monte Cristo

I find myself trapped in the dungeon again with the only windows and sources of light high above, far from my reach. The walls close in around me. There are too many people nearby and all are wearing frowns. I search desperately for some means of escape; perhaps I can dig out with a plastic spoon...

Okay, so maybe I'm over-dramatizing a little but I couldn't help it. After being away for 3 weeks the stark contrast between where I am and where I would like to be is even more apparent. I need the open spaces and was allowed to remember for a little bit that they do still exist. I need room where I'm not constantly tripping over the little ones and can have my other babies with me (my mom is watching them for me since I couldn't have them all here until I'm finished with the internship). I need good Southern food (artery clogging be darned) and the lovely Southern drawl and the smiles and friendliness that, to me, characterize home.

Coming back was one of the hardest things I've ever done. It is too crowded here, the traffic is horrendous, and I just plain don't like it and I "ain't a-skeered to say so!" The people here were glad to have me back though; I was told that I have manners and they appreciate it:) Some of them I like even if they are Yankees...

I live in a basement apartment that is tiny and the rent is huge due to the area where I am. I do lovingly refer to the place as my own little dungeon but am not actually trying to dig my way out with a plastic spoon--yet!! Ninety-one days left from today unless they allow me to leave early since my next internship starts before this one is complete. I'm sure that'll go over really well (sarcasm intended); fortunately the next group is at a university and they are willing to work with me regarding my start date if needed. I started packing what's left of my stuff today--one should be ready at a moment's notice, you know.

There is no way that I can possibly express how much I am looking forward in anticipation to returning to a university setting and a place where there is space!!! It'll probably be a little too flat to satisfy someone that grew up in the foothills of the Appalachians but at least there's room to breathe.

I found myself in an odd mood today. Typically, I'm a very non-confrontational person but I was arguing with the "adults" in rounds. I was quite surprised at myself. It was almost as if I grew up in some odd way while gone. I felt very disconnected as if I were watching the proceedings from afar and the commentary in my head went something like this: "What an arrogant, pompous group of people. They don't even really know what they are talking about as much as they think they do. And now, watch, they will shoot what you say down because 1) You're an intern and 2) They don't really know the answer or understand therefore they'll say it's a bad idea rather than admit there is something they don't know." A good friend of mine told me recently that one problem with private practice specialty groups is that the specialists eventually reach a point in which they think they know everything and become frightened if challenged (this also happens in general private practice unfortunately) where in the university/academic setting, there is always someone down the hall that knows more than you. I think he had a really good point. When I came here, I was very reluctant to argue since I felt they must know so much more than I do but this time away made me realize that is not always true. It's been an invigorating but somewhat disconcerting experience. One of my most important goals in life is to always question and search for better ways to do things--it frightens me to think that I could cease to wonder.

The vacation time was very good for me even though I was working through most of it. I think I've done some growing. It gave me a chance to make decisions about the future while taking a step back from the reality of the moment. I was able to refresh to the point that I no longer have violent tendencies (such as wanting to choke a client). There was time to see my babies at home, visit my mother, and even catch up with a few of the most important people in my life. I think I've regained some of my sense of humor and some of my usual happy disposition. Admittedly, I'm still not up to par since the really difficult months of January/February when I lost three of the little ones but that will take a lot longer to get through than it's been. I've been missing a support system, though, and it was good to be able to fall into the laps of some of my friends and family and soak up the comfort and caring. This was a much needed and enjoyed break and I even learned some things;)

Why can't people get this through their thick skulls?

Spay you dog. Three simple words. Spay your dog. There, was that hard?

I know that some people can't afford to have their dog spayed. However, nowadays there are several low-cost alternatives, including spay/neuter clinics, humane society vouchers, and adopting an already spayed dog from said humane society. If you can't afford a dog's basic necessities don't get the dog. It's that simple.

If you plan on breeding your dog, fine. Besides the fact that the world doesn't really need lots of extra puppies floating around, that is your choice and it's a personal one. But if you're NOT going to breed your dog, or if you're DONE breeding your dog, spay your dog.

I just saw the SECOND pyometra a client's had in six months. That's TWO is less than six months. They have probably 4-6 dogs at home, and all their males are neutered but none of the females are spayed. I euthanized the last one and euthanized this one because the owner couldn't afford the $500-700 emergency spay/pyometra bill. This dog was in congestive heart failure also, which didn't help her chances of surviving surgery. So, let's do the math here.

Emergency pyometra surgery- $500-700+
Routine spay at six months old- $100-200 depending on size of dog
Having your dog NOT get pyometra? Priceless

BTW, Dr. May B. Insane is safely back in the terrible place to finish out her three months of torture, er, internship. She'll post later.

The "Other" Gender

Being a female veterinarian can make life interesting to say the very least. Although the profession has become largely composed of females over the past several years, there is still the male domination attempts that you see in any walk of life. Thought it might be fun to share a few "man-stories" without beating up on the poor souls too much since they are so sensitive;)

My mother, like most mothers, is a bit disappointed that I have not yet found Mr. Right and provided some grandchildren (she loves kids). I keep explaining to her that she should just accept the four footed hairy ones she has since that is all that is likely to occur and I have those in abundance. It's not that I am uninterested in men, it's just that I don't have time in my life right now for a significant relationship; I mean, c'mon, I can't even keep up with my close friends at the moment--I certainly do not want to add more stress to life right now.

The funniest thing about my profession, is that you get very comfortable discussing uncomfortable subjects in mixed company. You become so comfortable after a while, that you find yourself discussing things probably not fit for the public in very public places and you fail to realize how uncomfortable your audience is while you ramble on unconcernedly. Take castration for instance. Men become very uncomfortable with this subject. I've explained the concept and pushed the idea many times to a very red-faced male and not realized until later why he looked so uncomfortable. Or prostatic neoplasia. Or just urinary catheterization which makes most men present squirm and press their legs together in sympathetic pain and suffering. The words testicle, penis, vulva, etc. are definite trigger points but we can't avoid these in common veterinary conversation.

One of my favorite experiences in mixed animal private practice involves this. My boss was male and older and had a horrid habit of taking our one ambulatory truck out when I was on call. One evening in the early spring while we had very muddy ground with a little snow left over and pretty chilly temperatures, I received a call from a desperate farmer wanting help with a dystocia. Being an idiot for all of my life, I agreed to go even though I had no truck and very limited supplies. I got to the farm and spent hours laying in the mud and muck behind a cow that was downhill from me trying to deliver a calf that was likely dead and in one of the worst malpositions possible. Finally, with the help of the farmer and his calf jack, we got it out. I knelt behind the cow and thought, "I need to palpate again but I can't remember why." (It's terrible when you reach that point of exhaustion!!) I totally screwed up and did not palpate then realized why I should have after getting almost halfway home. I called the farmer and advised him to palpate for a twin to be sure and he was fine with this, refused my offer to return, and stated he would be in to pay the next morning (regular client with long standing relationship). I had, by the way warned him that loss of the cow was likely since the dead calf had been in it for quite some time and she was not in good shape and he did not want further treatment. The next day he called and spoke to my boss saying that he wasn't going to pay. When asked why, he stated that he had done all the work and a woman shouldn't have come out anyway since it wasn't woman's work.

The other great story from that job was when I went out to an older Amish farmer's farm to replace a vaginal prolapse on a cow. The look on his face when I requested sugar was absolutely priceless. Sugar, by the way, is used to shrink the prolapsed vagina by pulling edematous fluid from the tissue and make it easier to replace. The man and his family were very nice and polite but I think they were quite puzzled by the female veterinarian. I was probably the first to ever go to their farm.

I have many male friends and often enjoy their company better than my female friends but do find that they get much more uncomfortable about many subjects that arise in vetmed. Perhaps this is why I haven't found Mr. Right. Could also be related to the fact that I sometimes remind them that I know how to castrate many, many things and there is a wicked gleam in my eye as I say it. I dunno, maybe that's intimidating somehow...

I Need A Keeper...

The longer I live, the more convinced I become that I need a keeper to watch out for my insanity and make all of my decisions for me. That would make life a lot simpler...

As indicated by Can'tSpell, I am spending a week with her while going daily to a nearby veterinary school for a refresher in ophthalmology (I LOVE eyes!!!) In driving yesterday, I drove completely past my turn and kept going until I reached the next redlight and woke from my apparent delirious state to realize I had no idea where I was. Oops. This morning, in following a new route that Can'tSpell was kind enough to reveal to me I ran a stop sign then ran off the road because I realized, almost too late, that I was supposed to follow the curve not the straight part of the road (Can'tSpell had only reiterated that point a mere dozen or so times). I'm dangerous when allowed out alone.

The other thing I've noticed is that it becomes more and more difficult to say simple words, spell common/ordinary words (you know, things like "Macracanthorhyncus hirudinaceus" are no problem, it's things like "horse" that get you), or just put together a simple sentence these days. "Talking take two (or three, etc.)" has become a routine break in my conversations of late. And decisions, oh my, these have become quite challenging. I was once a reasonably decisive person who considered options then made a concise decision; very thorough in researching facts but having no need for second-guessing afterwards. No more. I now question and pick apart every little detail then convince myself I've done the wrong thing a million times over. If I learned anything in vet school, it was how to question myself even more than I did previously.

No, I should definitely not be allowed out and about without supervision from some adult-type individual. I'm a danger to myself and to society as a whole...Anybody out there want to apply for the job of full-time zookeeper with little or no pay in compensation? I am, after all, only a poor intern:)

On a different note, I just don't understand the worry and fuss about a little bit of glue. I can't help it that I snuck in my favorite clinician's office while visiting the vet school and taped down various and sundry office utensils like, oh, the computer mouse and keyboard, the tin of tea, the refrigerator door, etc...What's to worry about a little glue?

A tale of lots of dirt

I was talking to the receptionist at my dentist's office the other day. She happens to be married to my uncle (don't you love small towns?). We were talking about my job and I told her something that is really true: I spend much of my life covered in icky stuff.

What prompted my statement was an observation by her that I had black stuff on my hands. It was ink from tattooing some rabbits. And I realized that for work or play, I often end up getting quite dirty.

The other day I drew blood from six alpacas here at the clinic. We have an alley in the back that they pulled up to with the trailer and we did them in the back yard. It was a lot of fun for me. My assistants wanted to see but were all too chicken to actually do any of the holding work. I ended up kneeling in the grass/dirt/mud a lot- when I was done it looked like I'd been crawling around in a garden. As I sit here I've only seen three patients today so far and already am covered with black dog hair and have blood on my lab coat sleeve. Yesterday I somehow got blood on my pants. Blood, urine, feces, anal glans, more feces, afterbirth... long is the list of the stuff I get covered in. Oh well, the life of a veterinarian...

I had a dog with a fish hook in it's mouth the other day. This is pretty common, then people bring the dog in for us to remove the hook. I sedated the dog, and used the wire cutters to extricate the hook. It's so nice to have instant gratification of a cure like that. The dog left with some antibiotics and pain medication and was happy as can be. So were the owners.

Dr. May B. Insane is staying with me this week while she's on her opthamology portion of her vacation. It's nice to see her and reminisce about vet school. She looks a bit more relaxed too, which is good. I'm just waiting for her to do some horrible practical joke on me. I'm sure there's going to be one. She asked me where my glue was yesterday.........

When I ran the spell checker there were only five words misspelled on this post! Wow, I must be improving!!!