in the ICU:

Alacrity, to criticalist: "Okay, so what are your feelings about-"

Criticalist: "I'm a man. I don't have feelings."

Alacrity: "-so, what are your man-feelings about giving contrast if the patient is azotemic?"

in which i am sassy:

Internist, to my student: [Student], have you considered that wearing those dangly earrings to work might be hazardous to your health?"

Alacrity: "Although that is true, Dr. [Internist], have you considered that commenting on a woman's wardrobe at work might be hazardous to your health?"

ahhh, university life:

You guys, I'm currently working at a university, and that means:

1) About 85-90% of my work conversations include some permutation of the phrase: "But did you read the paper/study that showed (whatever)?"

Usually this is followed by, "No," which is then followed by "I'll send it to you/print it for you."

2) Everyone is very, very impressed if you can quote the authors when you're quoting a study to prove a point. At this point, I'm just excited if I can remember the study.

3) Stuuuuuuudents! Vet students are awesome. But seriously, you guys:

- Someone may care if you appear to be fire-stormingly fascinated with (whatever rotation you're on), but that person is not me. I know that those of you who are gonna be cow vets are probably about as interested in the intimate details of the canine cutaneous mast cell tumor prognostic panel as I am in the intimate details of synching herd ovulation: not much. You don't have to fake it.

- Don't let anyone make you feel small if you don't know the answer to a question. There is so much to know that you cannot possibly know it all. BUT it totally behooves you to look that shit up and recon with the person who was quizzing you when you DO know the answer.

- Sleep is really, really important. Take advantage of all opportunities to sleep. Sleeping is magical.

4) Ultrasounds take at least 45 minutes, sometimes over an hour. Also, everyone looks at you like it's your fault when the sedation wears off or the patient loses patience.

5) Appointments regularly take 6+ hours. I am not even kidding. If you're bringing your pet to a university for a consult, plan for it to be a day's event.

6) The anesthesia department is absolutely not fucking around. Neither is the ICU staff.

7) Some sort of conference, thesis defense, or guest lecture is always happening. I get e-mails about all of them. Sometimes there is food involved.

8) There are six or seven different on-call schedules for various situations that may happen in the night or over a weekend. They are all posted in different places and are varying degrees of accurate.

9) A parade of work-study students and residents wander by the oncology department at regular intervals. They ask for blood and/or urine samples from particular patients who have diseases that are relevant to their research.

10) There is so much hand sanitizer.

internship tips: food friday edition

Hi there everyone!

Today we're gonna talk about a vet school phenomenon with which you may be familiar:

FOOD FRIDAY!

thanks catercow.blogspot.com

Yes.

Food Friday is a tradition that exists at many vet schools where every Friday, each rotation organizes a potluck lunch of sorts. Everyone is assigned/chooses a dish to bring, and then each service has their own private buffet.

Yesterday at my current place of employment, the oncology service had burrito bowls, cardiology had nachos, radiology had french toast breakfast, and I'm not sure what medicine and surgery were doing.

As delicious as this sounds, it can be problematic:

- Allergies/dietary preferences are challenging. What do you do when that one kid on your rotation is gluten-free and lactose-intolerant? Heeeey rice and beans for the win!

- Interns and vet students (on average) have small to nonexistent salaries. This can make compulsory food-buying every Friday taxing on the wallet, especially if you're buying a particular ingredient that you won't be able to use again.

My favorite kind of Food Friday is the kind where everyone brings whatever they want, if they want to. That way they amount of dollars and time invested is purely voluntary, and no one has to go buy fresh basil and make a pot of quinoa (or whatever) every Friday.

So! Moral of the story: if you're ever in charge of organizing Food Friday, be sure no one feels pressured to participate. Also, don't feel like you have to be in on the plan if you're really not up for it (financially or otherwise). No one can make you make quinoa without your consent!

synonyms, sort of:

Regarding a dog with lymphoma (presumably) localized to the spleen:

Oncologist: "Okay, we're gonna get a splenic aspirate and send it out for flow cytometry with the blood. We just read a paper on how they're looking at markers to identify T-zone lymphoma via flow."

Alacrity: "Yeah - CD45, man! Good stuff!"

Oncologist: "CD45 is the shit! Wait, I probably shouldn't say that in front of the students. CD45 is the feces!"

internship tips: navigating the match edition, part two

Hi there everyone!

So you've decided you want to sign up for the match. Congratulations (sort of)! Next comes the part where you sift through the hundreds (yes) of potential internships and decide which ones might be for you. Here are some hints to help you with that:

1. Sit down with yourself and figure out why you're doing an internship.

If you are doing an internship as a prerequisite for a residency, know that academic internships and fancy/famous private practice internships (read: the AMC, Angell Memorial, etc.) are rumored to better your chances for matching to a residency.

This is because these institutions are well-established, (usually) well-respected, and oftentimes have residencies in various specialties as well. Some institutions take their own rotating interns back as residents (hey, the devil you know...), and some prefer not to do that.

The tradeoff is that your hours will be unbelievably, potently terrible, and you will (probably) spend a large amount of time watching other people do cool things instead of doing them yourself. It will be so crowded at the operating table.

If your goal is to learn how to be a veterinarian in a practical sense so you can be a solid general practitioner or ER doctor, I would strongly consider a solid private practice internship. You will (usually) see more cases, get more hands-on experience, and get to do more cool things yourself.

I did my rotating internship at a well-established (but not fancy/famous) private practice internship. As such, I spent absurd amounts of time working in the emergency room, saw many many many cases, and got to unblock more cats, enucleate more eyes, do more bone marrow aspirates, drive the bus during more endoscopies, practice more ultrasounds, repair more wounds, figure out more weirdass 4 am puzzles, and help with more dog and cat CPRs than the average academic intern.

At an academic hospital, the chiefs of service are doing their research, seeing some cases, and lecturing. They are also training the residents, the vet students, +/- the specialty interns, and the rotating interns.

At a private practice, the chiefs of service are seeing their cases and teaching...you. You're (usually) not jockeying with a herd of residents, students, and other interns for various opportunities. It is awesome.

2. Next, figure out what factors matter to you.

Some people care about location. Do you want to be on the East Coast? Only in California? Only in places with appropriate attitudes re: the excellent variety of sexualities and gender presentations?

Do you care about having protected days off? What about vacation? Health care (Hint: you should care about these things, especially health care).

What about the percentage of time you'll spend working overnights? Will someone be with you on your overnights? If you're interested in neurology, it's probably important that you have access to a neurologist during your rotating internship.

You can use all of these and more to help you narrow your list of possible options. Be aware that there's no organization that oversees all of these internships and ensures that they treat/train their interns in a reasonable manner. Pretty much any place can register with the match and offer an "internship", which leads us to...

3. Once you have a preliminary list of practices - call, e-mail, visit.

Many places allow you to extern (spend a couple of weeks shadowing) to get a feel for the practice and how it works. If you can, arrange to do this at your top choices. It will be so very worth it.

If you can't extern or visit, make sure to call and speak with your potential boss/intern director and/or a current intern. DO NOT SKIP the "speaking with a current intern" part. Current interns are the most useful resource you have in your quest to determine if any given program is an earnest, enthusiastic training program for new grads, or a shithole salt mine that will tear away at the fabric of your sanity.

Ask the current interns if they like their job. Ask them what they like least about it, and if they would do it again. A favorite mentor of mine says it is easy to damn with faint praise, so be on the lookout for non-committal or evasive answers that are secretly your signal to run. The average intern will be tired, stressed, and out of patience, but if she can't say that the program is fair, forthright, and good training, don't rank it.

You guys, make sure you don't assume anything. Ask.

ALSO! Once more, so you realize how insanely important this is:

DO NOT RANK A PLACE IF YOU DO NOT WANT TO MATCH THERE!

internship tips: navigating the match edition, part one

Hiiii you guys! So you've decided (perhaps via the flow chart in the last post) that you want to do an internship. Hooray!

First, an aside: Large animal (particularly equine) folks, your internships are by and large not organized through the match (some academic ones are). Search the AAEP website, consult with your peers, and do externships AS EARLY AS POSSIBLE in your clinical year. Some crazy folks even do externships before clinical year. You generally have to do an externship (think two weeks at least) at a hospital to be considered for an internship. That is the sum total of what I remember about getting an equine internship before I switched teams, so aaaanyways, the following guide is mostly for small animal internships.

Okay, so almost all small animal internships are applied for and obtained through the AAVC's Veterinary Internship and Residency Matching Program, aka the match. Residencies also (except anatomic pathology, since those folks are on their own drumbeat).

The match is a computer database and...algorithm that tries to match hundreds of internship programs with the candidates that best suit them (and vice versa). Here is a quick and dirty rundown of how it works:

1. In approximately October, you sign up for the match. You choose an initial "tier" to buy, or number of programs you can apply to. At the time of this writing, applying to 10 or fewer programs costs $85, applying to 11-20 programs costs $250, and applying to >21 programs costs $350. You can upgrade at any time, but you cannot downgrade.

2. You have to fill in some information (where you went to school, GPA, class rank, upload resume, upload application essay...) to complete your application package. This is due by approximately December.

3. You also have to get 3-4 (hopefully) smart, influential veterinarians to write you recommendations, all of which are also due by approximately December.

4. You then apply to a number of internship programs (see tier, above), and rank them according to your preference. This rank order list gets finalized at some point and you get an official-looking e-mail to confirm your decision.

5.You panic for two months, during which time the institutions are arranging and finalizing their ranked lists of candidates.

6. In mid-February, Match Day happens. This is when the match algorithm pairs each candidate with their best-suited internship program, as determined by "highest mutual level of preference". There is an explanation on the VIRMP website that is pretty good, but essentially, the institutions make offers (in the running of the algorithm) to their most preferred candidates, and the algorithm moves down the ranked lists until all positions have been filled or all candidates have been "offered" a job.

The intention is that you will match with your highest-ranked program that has a position to offer you, as determined by the programs' ranking of you as a candidate. You will never match with a program that you did not rank, and you will never match with a program that did not rank you.

Here is my first and perhaps most important piece of match advice:

***Do not rank a place where you would not want to go! If in your mind, "no internship" is better than "internship at Shitty Practice", DO NOT RANK "Shitty Practice"!***

7. There are intense, career-altering, being-banned-from-the-match-for-three-years sorts of ramifications for candidates that match to a place and then do not follow through on accepting the internship.

8. If you do not match, you enter a process called "the scramble". This is where all the unmatched candidates and programs desperately try to find each other, like lost lambs and panicked sheep in a crowded sale barn. There are apparently many frantic phone calls, e-mails, and hurried job offers flying back and forth.

Doesn't it sound like fun? Ugh.