25 year old female:

severe abdominal/flank pain, history of kidney stones x 10-12.

 

Hi there nurses and ER docs!  I read several nursing/ER blogs from time to time, and from what I’ve gathered, that brief signalment and history makes you shudder.  Maybe not quite as much as “35 year old male, 10/10 back pain, allergic to (all the non-narcotic pain meds), seventh ER visit this month”, or “50 year old female, obese, generalized pain, history of Lyme disease, fibromyalgia and chronic fatigue syndrome, brought pain contract”, but definitely a distinct twinge of apprehension.

Well, that person is me!  Through my body’s preference to make kidney stones at the rate of one every 6 months–several years for whatever reason, I’ve had the opportunity to visit many ERs over the course of my teenage and young adult life.  I’ve pursued the etiology of my weirdness with various nephrologists and urologists, but none have yet been successful at pinning it down*.  My urinary tract has been imaged from stem to stern in multiple modalities. I’ve completed more 24-hour urine collections than I care to admit. Sidenote – if you think your high school experience sucked, try carrying around a jug of your own urine for an entire school day while you pee in it every so often.  It’s like a scene from American Pie.  Anyways!

I am pretty good at drinking an insane amount of water per day. I don’t drink coffee, I pee more frequently than your grandmother on a 12-hour road trip, and I watch what I eat. Unfortunately, I’m not always successful at “washing it on through”.

I’ve met some nurses and doctors who are stunningly excellent at their jobs. I’ve met others who have shown me that some ER folks have a hard time dealing with a patient who seems at first glance like a drug seeker/chronic paineur/dying swan young woman…but actually isn’t.   Here are some tips and observations from my side of the curtain: 

1. Drug seekers want Dilaudid (or whatever). I vehemently don’t.

Most of the time, I end up in the ER by myself. Sometimes I’m traveling, and oftentimes I need to go to work/class early the next day. I will probably be driving myself home after discharge.

Although I’m very painful, I generally don’t want narcotics. Not only do I potently dislike the feeling of being high, it interferes with my ability to advocate for myself in the hospital. It also makes my adventures after discharge much more dangerous/funny**.

I will sometimes go the NSAID route, but (alas) I get all the GI side effects the next day. That’s not fun. So I usually just suck it up as long as I can.  I am very stoic about the pain aspect of the kidney stone adventure, but I am a total weenus about the nausea. Which brings me to…

2.  I WANT ALL THE ZOFRAN. ALL OF IT. AND A BUCKET.

My innards like to translate intense visceral pain as nausea as well (thanks guys), so yes please to the Zofran and the vomit pan. I am generally a very low maintenance patient – the one time I’ve ever pushed the call button was when I was just about to spray the walls with my dinner. The awesome nurse got me the bucket just in time. #winning!

3. Doctors! I know CT is easy and fast for you, but I’ve had about seven of them.

That’s a helluva lot of radiation for my ovaries (not to mention the rest of my abdomen/pelvis in the field).  Therefore, unless you can convince me that one of my internal organs is actually legitimately exploding at this moment, a CT is not happening.  Call your favorite friend the ultrasound technician!  He/she will get the job done.

4. Nurses! I want to be out of your hair as fast as possible.

My ER goals are usually pretty simple: get rehydrated, nausea/vomiting control, maybe pain control if it’s really awful and the stone is taking a long time to get to Bladderland, and peace out as quickly as I can. Not to be a hater, but the ER is not my first choice for where to spend my day or night. You understand.

I understand that I probably have the least emergent problem in the entire ER. I want you to spend all of your time taking care of the people that are ill and dying.  I want to be by myself in the “ignore” room with my fluids and meds.  I also have no idea what you are doing when 1) the last thing that has to happen before I leave is taking out my IV, 2) it’s a nonbusy night in the ER and 3) you guys are chatting at the counter instead of sending my ass on my way.  Shenanigans?  I don’t know.

5. Doctors! I am sexually active. I am not taking birth control. There is no chance that I could be pregnant. These statements are not contradictory.

I’m also not at all shy.  I will tell you straight up that I sleep with exclusively women. Feel free to believe me, feel free to not believe me and order a pregnancy test anyways, but those are your only two options. Hey, there - asshat physician who argued with me for a while about why I “could technically” be pregnant - NOPE. Don’t do that. It makes you instantly a douche.

* I’m optimistic about this latest guy!  He’s like a kidney ninja.  During the hospital visit where I met him, he kept bursting into my room, striding over to my bed, fixing me with a firm glare, and asking me questions like: “Are you abnormally short compared to your parents?” and “Did you ever eat lead paint chips as a child?”.  It was hilarious.

**Ohhhhh so this one time, I ended up in the scary hospital near the train station after becoming ill on the train. I was given assloads of narcotics, discharged into the inner city night while still remarkably high, and retrieved by some very kind friends.  Apparently, the ride home was peppered with my non-sequitur questions such as, “Hey, do fencing helmets have ear cutouts?”.  A few hours later that morning, I went to class. I turned to one of my classmates during discussion group and asked, “What month is it?”. My professor (a neuroscientist), laughed extensively and sent me home. 

oh, this just happened:

The medicine resident is holding a fractious little dog, who is wiggling as I take her temperature. It takes me several tries to hit the mark with the thermometer.

resident: "Is it in?"

me: "Yes."

(pause)

resident (conversationally): "You know, that's the most embarrassing question a woman can ask a man."

*hysterical laughter*

non sequitur:

I walk into the service work area and immediately (seemingly randomly) this happens:

internist: "I don't like mammograms!"

me: "...does anyone?"

queer ladies I've encountered at the laundromat:

1) Salena, the (recently) ex-girlfriend of Caroline. Caroline is a stocky fireplug butch who coordinates local lesbian events and dances like a rowdy pit bull puppy when sufficiently motivated.  She has a charming smile and wears a tie better than any businessman.

I only know about the breakup because Caroline has cataloged the entire process on Facebook. Salena smiles at me awkwardly and futzes with her detergent bottle.  We make small talk about the unseasonably warm weather.

2) Bryce, a bartender at the local lesbian bar.   She seems to own more flannel than the combined population of Maine and Vermont.  Her specialty when bartending is a complicated cocktail with a vaguely obscene name.  She plays rugby.  We smile at each other and return to our laundry.

3) Jessica*, a slender, hemp-wearing woman with a blue-eyed dog at her feet. She has hexagonal wire-framed glasses and a pixie haircut. Her worn oxford button-down is haphazardly tucked into ripped jeans with a sturdy leather belt. She is a teacher.  We talk while we fold her six or seven loads of laundry.

* This one turns out to be straight.  Surprise! 

you guys, coconut oil is awesome:

Okay, so you know how I make green smoothies?  I've stepped up this practice since being on some more long-hours rotations (oh, hey surgery!  I'm lookin' at you!). This has led to some experimentation with their contents. 

IN PARTICULAR:

A tablespoon of coconut oil in your smoothie will make it smooth and delectable and ever-so-silky. I can feel my lips getting moisturized. It is glorious.  Mmmmmmmm coconut oil. I don't like coconut shavings, water, or flavoring, but coconut oil is quite tasty!

If you're like me and you don't drink coffee, you can get a coffee grinder for smoothie-making purposes. Coffee grinders are excellent for grinding flax seeds, sesame seeds, pumpkin seeds, hemp seeds (yes) and just about anything else that is seedy/gritty in its original texture.

Chia seeds go right in - no grinding. They take on some water and become like tiny tapioca pearls.

Peanut butter is another delicious protein-increasing option.  I get an organic kind that comes pretty cheaply from the co-op, but you have to stir the oil in before doing anything with the peanut butter proper. It's definitely worth it.

You should probably thoroughly scrub your blender more frequently than I do.

Happy smoothie-making!

crossfit vocabulary fail:

Female classmate, to male coach:

"Hey, can you watch my snatch?"

crossfit fun times:

I joined a CrossFit gym ("box") several months ago, and mostly it has been hilarious and awesome. If I go to the 6 am class, I can allllmost make it to morning treatments on time without racing to the vet school like a maniac.

What is CrossFit, you ask?

It's kind of like someone set out to design a training camp for zombie warriors.  There are monkey bars, climbing ropes, rings, giant boxes you jump on, and absurdly large tractor tires. Also, I'm fairly sure a CrossFit designer once said, "Hey, let's figure out the most awkward movement a person can do with this barbell."

The 6 am class consists of a group of sleepy/overly chipper people doing a prescribed set of exercises (called the WOD, or Workout Of the Day) either:

1) as fast as possible, or

2) as many times as possible within a set time limit.

It's pretty great.  It's keeping me sane(r), and making me stronger.  

your handy guide to rotations (here), part I:

Anesthesia:
Mostly, you monitor dogs and cats under anesthesia. You record heart rate, respiratory rate, blood pressure, and various other things every five minutes. Every now and again, the animal will begin to move/wake up, so you panic, push the extra propofol, and frantically page the technician. Sometimes your patient's blood pressure does scary things. Usually the surgeons take forever.

You'll spend a day in large animal, where you'll realize how amazing it is that any horse survives anesthesia ever. There's often food in the break room. The techs will probably yell at you when you do something silly. You'll usually get to eat lunch. The attire is awesome (scrubs all day every day). You'll get to place a lot of catheters and do your own intubations. You will almost certainly get called in every time you're on call.

Cardiology:
The hours are fantastic. You start at 8 or 9, and rarely do you finish later than 5. A cardiology inpatient is like a unicorn - a mysterious creature that is rarely sighted. There are lots of adorable puppies and older dogs. There will be the occasional angry cat. You will get exponentially better at hearing murmurs. The rounds are highly useful. You will probably not get called in when you're on call.

Oncology:
The rounds are fantastic. There may or may not be inpatients, depending on...who knows what. I did this rotation twice - once we had no inpatients, once we got many, many transfers. If you don't believe in oncology/have a hard time with cancer, this will be a challenging rotation. Paradoxically, you'll see lots of happy, tail-wagging dogs as well as some really sick ones. The afternoon rounds are when you get pimped - don't try to guess the answer if you don't know. 

Ophthalmology:
O-PHTH-almology. This matters to ophthalmologists. You'll see a zillion cases per day and get to see some interesting/horrifying surgeries (phacoemulsification can I get a what what). For some inpatients, your entire day will revolve around eye drops (every 5 minutes for some stretches of time). You will learn which end of the slit lamp to hold. You'll be able to use a tonopen without hurting yourself or others. I don't think we rounded more than once. I was oddly okay with that.

Orthopedic Surgery:
If you like elective surgeries, awesome. Otherwise, this rotation might suck for you. The hours are terrible. The chiefs do not care about this. There will be more surgeries scheduled than can physically be cut during the week. The dogs are all large and most of them are badly behaved.  The techs are no-nonsense and fantastic. The resident probably hasn't slept in the last three days.

Radiology:
The hours are 9 to 5. The rounds are useful. The chief-resident rounds in the morning are where the residents get torn new orifices while the students watch in horror. You'll learn how to take good radiographs and which end of the ultrasound probe to hold...if you want. Or you can sit in the student rounds room and eat doughnuts. It's really up to you.

Theriogenology:
 You will spend countless hours with your arm up a horse's rectum (+/- the ultrasound probe). You will rapidly acclimate to the horrid smell of plube (poop + lube. Kind of like Santorum, except this variety is not the by-product of anal sex).  It's very exciting when you realize that you can semi-competently ultrasound a mare's reproductive tract.

You will become intimately familiar with semen. You may have several terrifying experiences trying to capture an erect, thrusting stallion penis within an artifical vagina. All sex jokes, all the time. There will be foals. They are adorable and mostly naughty. The hours are terrible. You will probably hate getting up at 2 am for mare checks (ultrasounds every 6 hours to monitor for ovulation).

seriously this happened:

Friends, today I got the most ridiculous page.

The zenith (nadir?) of inane has been reached. It was better than "80085" on the purely numeric pagers, and much more hilarious than "8==D" on the alpha-numerics.

(for those of you who don't dick around with the pager system, these are "boobs" and "cockandballs", respectively.)

But first - the necessary back story:

I've been taking care of this horse for about a week now who we'll call Adrian. Adrian colicked very badly and had surgery that mostly fixed his problem, but his surgeons only gave him about a 20% chance of making it. He is so far doing very well (knock wood). Adrian and I, we've spent hours and hours together. It is fairly accurate to say that I have spent this entire week nursing him in the ICU. I have drawn his blood, given him his drugs, walked him, stood him in ice, caught his urine for testing, and generally fussed over his every need.  At this point, I know the horse well.

So! I get a page to the front desk, which I answer.  I then have the following conversation with Sandy, the front desk person:

Alacrity: "Hey, it's me. What do you need?"

Sandy: "Alacrity, I need you to go check Adrian to see if he has testicles."

A: "...he doesn't."

S "No, I need you to actually go look at him."

A: "I promise he doesn't have testicles."

S: "Well, someone looked in his stall, thought he had testicles, and changed his file to show that he's a stallion in the computer system. But I'm confused, since he came in to be gelded (castrated) three years ago."

A: "He does not have testicles."

S: "Please just go look at him."

A: "You're seriously making me do this."

S: "Yes."

I checked. He's a gelding, doy. Surgery report from the castration is right there in the computer system.

WOW.

hooray for the NAVLE!

rotation-mate: "Oh hey, you took boards!  How were they?"

other student: "Yes...(pause)...my asshole is larger now."

post-op commentary on a colic surgery:

"I guess we should take the 4x4s out of his asshole as well."

surgeons are weird:

"So, if all the forces in the world were suddenly applied on the top of my head, which way would my tibias break?"

surgeon to the technician during endoscopy:

"Can you make it look...like a DaVinci?"

surgeon, to me:

"You're never going to get married if you're that picky."

public service announcement:

You know what is really really excellent about a town full of the gay ladies?

It is a constant attractive dyke parade.

Since settling down at this coffee shop with a hot chai and an eclair, I've seen:

- A butch with a bright blonde buzz cut who looks like she could bench press me. 

- Two stately attorney-type dykes with power suits and men's shoes.

- A shy-looking lesbian with curly brown hair, a shapeless green vest, and a HUGE stack of papers.

- Not one, but TWO dykes in uniform.  When I settle, may I live in a place where the police department is comprised entirely of no-nonsense, steely-eyed butches?

This is awesome.  That is all.

professor, re: my stiletto boots:

"Oh, those must be safe out on the ice and snow!  They look hot, though."

during surgical pathology rounds:

pathologist:

"Alacrity, here's the nipple."

Oooh, that'll be a neurology consult.

owner: "He likes to bite and bark at imaginary creatures surrounding his head.  It's how he plays."

dentistry adventure!

Okay, so the equine-focused vet students* get to do this fantastic rotation where we learn all these secret side-note skills that are actually fundamental to equine practice. One of these skills is equine dentistry.

When you float (file) a horse's teeth, you're basically scraping away at sharp points and/or hooks on the teeth that you can't see very well.  This happens in a long, narrow, dark oral cavity that is also home to an insanely powerful tongue.  The tongue is always trying to get in your way.  You can use hand floats (which sounds like the sane option), or you can do what we did and use power floats - which are kind of like tiny long electric sanders mounted on a power drill.

We practiced on cadaver heads for a day.  The next day, we teamed up to float teeth on living horses.  This is how that process was supposed to happen:

1. Greet horse.

2. Sedate horse, place jugular catheter.

3. Position horse in dental station, begin IV infusion of sedation.

4. Place speculum (keeps the horse's mouth open for you), perform oral exam.

5. Float teeth.

6. Return horse to paddock.

Our dental stations were located at various intervals in a narrow corridor surrounding the back of a large run-in shed. So, one side was the wall of the shed and the other was the chain-link fence forming the edge of the field.

This is how our first horse's float went:

1. Greet horse.

2. Sedate horse, horse bounces around.  Place jugular catheter.

3. Position horse in dental station, begin IV infusion of sedation. Hang IV bag on chain-link fence.

4. Place speculum, perform oral exam. Another horse in field reaches through fence, grabs IV tubing, destroys infusion set-up. Drugs fountain liberally from IV bag over horse and vet students.

5. Re-sedate horse.  Re-start IV infusion of sedation (new bag!), hang bag on opposite wall.

6. Instructor walks through IV tubing, gets tangled.

7. Re-sedate horse.

8. Float teeth.

9. Horse takes quite some time to wake up from sedation.

10. Return horse to field.

Okay, so that could have been significantly worse.  Here is how our second horse's float went:

1. Greet horse.

2. Sedate horse, place jugular catheter.

3. Horse becomes insanely ataxic, nearly falls down.

4. Flag down passing instructor.

5. Instructor is alarmed, considers reversing the sedation.

6. Discover that the horse has a history of neurologic problems, probably has lymphoma.

7. Decide not to float teeth.

8. Return horse to field.

All in all, it was a good day.  Learning!

*Before I wanted to be an oncologist, I wanted to be an equine surgeon.  Yes, those specialties are really different.  This is why I'm taking all the equine rotations even though I'm going into a (mostly) small animal field.

excellent idea:

clinician somehow drives the van into the building and down a corridor of the old large animal hospital, says:

"Don't worry - the worst thing that can happen is I'll screw the shit out of this van."

hello butches/butch-presenting/masculine-of-center ladies!

These must continue, please:

bow ties, skinny ties, classy oxford shirts, sweater vests, twinkly eyes, winks over teacups, suit vests, shy smiles, half smiles, polished shoes, dapper suits, rugby shirts, fedoras, freckles, crew cuts, nerdy glasses, pocket watches, dark jeans, thick belts, studs, argyle anything, leather jackets (yes), newsboy caps, and plaid scarves.

Thank you, that is all.

two ambulatory vets in the truck bay:

Clinician #1, singing:
"I love Paris in the springtime!"

Clinician #2:
"Can you move your truck?"

Clinician #1:
"I love Paris in the fall!"

Clinician #2:
"MOVE YOUR TRUCK."

theriogenologist, at a calving:

"There's bloody material coming from her rectum?"

...pause...

"That's less than ideal."

clinician:

"We're trying to be legitimate with our IACUC protocol this year."

this week, we have:

a visiting oncologist.

She is triple boarded in medical oncology, radiation oncology, and internal medicine. For the non-medical folks among us, this means she spent approximately ten years after graduating from vet school completing three residencies in different fields.

Most veterinarians don't pursue residency training at all, let alone three times.

Unrelatedly, she is a bold and flashy dresser. Today, her bright orange hair is accessorized with rhinestone encrusted combs. She's wearing a fluffy red and black fringed sweater, knee high wool and leather boots, and deep-plum-colored corduroys.

In her spare time, she works at Anthropologie.  'Cause she wants to.

AWESOME.

pre-DADT-repeal conversation:

me: Hey, Dr. AirForce, can I ask you a question about the lab?

Dr. AirForce: Sure, what's up?

(insert conversation about cell signaling here)

me: You mentioned that you used to teach in the Air Force?  That's awesome.

Dr. AF: I really enjoyed it. Hey, if you're interested, there are plenty of opportunities for veterinarians in the armed forces.

me: Thank you, but the military doesn't appreciate my lifestyle.

(pause)

Dr. AF: Well...times are a-changin'!

tips for visiting a veterinary school:

...as a client.

1. It mildly behooves you to know someone who is affiliated with the hospital.  This person can provide you with many useful tidbits. For example, at this hospital general practice appointments are given individual time slots, and seen almost immediately on time.

On the other hand, ophtho appointments are usually overbooked to the max. This means the folks with early appointment times are in and out in a reasonable time span, but by 11 am the clients have piled up like tweens at a Justin Bieber concert and you miiiiight be out by 2.  Maybe.

2. IF YOU ARE AT A TEACHING HOSPITAL, STUDENTS WILL TOUCH YOUR PET.

This is a basic truth that should be accepted, metabolized, and moved on from as quickly as possible.

3. You will probably not see the same doctor at each appointment. You may actually see multiple doctors in a day, and then see a whole new set the next time.  This is because service chiefs, interns and residents rotate on and off services weekly, and there are hordes of them.

4. You will probably wait for a very long time.  You might be here the whole day. Many services see all appointments in the morning, and then do all procedures in the afternoon.

5. If you leave your pet's collar/blanket/jacket with us when he or she is admitted to the hospital, it has an approximately 98% chance of being lost in the bowels of the hospital laundry system. Do not be a dick to your doctor when this happens.

6. The student assigned to your pet's case probably spends the most time out of anyone caring for and thinking about your pet.  Here, each service student has perhaps 1-3 patients. Each service resident has 6-20 patients. Each service chief has 15-ALL the patients.

Here, the student does the morning and evening treatments, calls you (the owner) twice a day, updates the resident with changes in your pet's condition, and updates the medical record with findings from the resident's exams. They are the person hand feeding your dog, sneaking chicken from the cafeteria to tempt a picky eater, and saying yes, maybe an antiemetic would be a good idea.

7. It is uncool to wander around the hospital.

8. It is also uncool to ask your student or doctor to tell you about other people's pets. That is not legal.

9.  The birthdate listed in the medical record is only there to give us the year of birth.  I've met several clients who find it deeply offensive that our records do not always reflect an accurate day/month of birth. Why is this, you may ask?  If you don't provide a specific birthday when you fill out your paperwork (just a year), we...make one up! Yaaaaaaaaay!

10. If it's June or July and your doctor looks like they are shitting a brick, they probably are. They maaaaay have just started their current job yesterday. They know things. They are good doctors. Be nice.

vet school sports:

speed:

The six mile (okay it's shorter but it seems that far) dash from the hospital to the lab with blood from the ER case that arrived ten minutes before the lab closes.

The "racewalk" to keep up with the 6'5'' surgery chief without jogging.

The sprint after suddenly remembering that a clay paw has been in the oven for seven hours longer than the recommended thirty minute bake time.

strength:

The Olympic deadlift...of the 140lb neuro dog onto the gurney.

The attempted leading of the beef cow - often ends in a rousing drag through the barns and around the parking lot.

The multiple 5-liter fluid bag carry from the storage room to the treatment area.

stamina:

Scrubbed into a GI surgery?  Awesome!  Here, hold this retractor for five hours.

The neverending surgical pathology slide rounds - but, bonus! One can discreetly fall asleep by leaning into the eyepieces of the multi-headed scope. Just don't tip over.

 It's 9 pm on a Friday, and all the patient treatments are done.  Now sounds like an excellent time to round for three hours on fracture stabilization.

a stablehand in real life:

Before I went to vet school, I spent some time working as a groom for an upper level jumper rider. It was an inordinately stressful experience, but I learned a few weird/valuable lessons AND (most importantly) I had a lot of fun.

I worked for two women, who we'll call Susan (rider) and Jennifer (her romantic/business partner) We were a staff of 6-10 people, depending on the season and how successful Jennifer was at hiring replacements for the constant staff turnover. We also all lived in an apartment above the barn.  This was mostly cool with me, except for when:

1) one of my co-workers was a drug dealer and stole money from me/other co-workers/the farm.

2) Jennifer unknowingly hired a person who smuggled saddles out of her last place of work shortly before being fired. Her last boss contacted Jennifer, who then sent me to "supervise" this poor woman as she packed her things and left.  Wow, that was terribly awkward.

I worked very, very hard. It was my first experience working regular twelve hour days, with the occasional memorable stretch of several eighteen hour days in a row.  It was good, honest work. Cleaning stalls, scrubbing buckets, grooming/tacking up/caring for horses, tidying up the barn, and wrapping horses' legs are all tasks I love to do, and the horses were absolutely magnificent.

Plus, I learned some highly fancy medicine. Nothing like working for an Olympic rider to see the best equine sports medicine in existence!  Fun times.

this is mildly horrifying:

I have a Tupperware container full of equine leg bones under my rolling kitchen-butcherblock-thing.
The bones make up a front leg and a hind leg, and they were taken from my surgery pony last winter after he was euthanized.

I'm soaking them in Dawn soap to remove the residual tissue so they can be dried and re-assembled into articulated limbs.

*crickets*

Yes, I would love to have a discussion with you about the moral/ethical implications of these statements, but first I would like to tell you about the incident with the Dawn soap.

Dawn soap is apparently the dish soap of choice for gradually removing tissue residue via soaking (according to our specimen preparator), so I've been soaking these bones in Dawn for quite some time.  The Dawn needs to be changed occasionally.

So! One day while at the grocery store, I bought the economy-size gallon jug of Dawn in hopes of getting around to changing the soap. I left the Dawn in the back of my car for oh, three months or so. This is a thing that happens - I start a task in some small way, and then I get sidetracked while it waits patiently for me to remember about it.

This gallon jug of Dawn somehow opened itself in the backseat of my car and slowly infiltrated large areas of my backseat unbeknownst to me until yesterday.  THAT must be why my car has been smelling faintly of artificial freshness.

cardiologist, about Olympic high diving:

"I can't imagine being a diver.  All those flips and somersaults?  I'd be catching my own vomit on the way down while simultaneously releasing a shart in my pants."

cardiologist, during a pleural tap:

"Why is this not working? I need some stopcockery going on here."

cardiologist, during an echocardiogram:

"Look, there's Fudgie the Whale!  See, Fudgie is the left atrium, and the left auricle is his tail. Oh, this does not look good. Fudgie is a fat Fudgie."

cardiologist, during rounds:

"You see these two curves here that make up this valve? I call them ass cheeks. You should have symmetrical ass cheeks."

meanwhile, at this quietly excellent restaurant:

There are a couple of lesbians in their sixties or seventies eating dinner with their grandson.  One is explaining to him that they are waiting to get married until gay marriage becomes legal according to the federal government. 

She is describing her staunch resolve to hold out for nationwide marriage equality despite being able to legally marry in her state of residence.  Her grandson wants to know if he can be the ringbearer in the wedding.

minimalism and khakis:

Fact: I love minimalism primarily because I despise moving.

When I was in college, my parents (quite graciously, I might add. Hi, Mom!) came to help me pack all of my dorm room things into a storage pod after every year of school.  Every year, I would say to myself, "Okay this time I will actually be mostly packed by the time my folks get here.".

Alas, every year, my mother would open the door to my room and say some permutation of, "WOW you have so much stuff.  How does it all fit in here?".  Sigh.

I'd always start packing while I was taking finals, which admittedly was not the wisest plan in the world.  I'd pack the easy things first - books I never read, winter clothing, that giant array of crafty things on the bottom shelf of the bookcase, SO MUCH YARN, et cetera.  This meant of course that all the annoying/oddly shaped things were the ones left to pack by the time my parents arrived.

Tangent!  One year, I decided to store my stuff in the creepy basement of the house I lived in over the summer instead of using a storage pod.  I'm not sure why I decided to do this, since one of my first experiences at college was bleach-staining my pants trying to salvage a new buddy's stuff that she'd stored downstairs...and an entire gallon of bleach had spilled on her things.  Gah.

Anyways, the stuff stored in the "trunk room" had to meet various and sundry standards to avoid being thrown out over the summer.  No storage of furniture was allowed, yet anything that could be packaged into a box was permitted.  My mother constructed a large, awkward box for my papasan chair.  When I praised her for cleverly skirting the rules, she said, "It's not sneaky - it's technical compliance!".

Once in vet school, I realized - hey, if I have less stuff, I will have less of it to move.  The seemingly endless horrible dusty-handed, achy-armed, cobwebs-in-hair ordeal will not last as long.  THIS IS AWESOME.

Anti-consumerism, tiny living, and simplicity are all well and good, but I kid you not when I say that this is the thing that got me on the minimalism train.

So, you know, now I have two pairs of khakis, which is usually fine.  As a vet student on clinics, I can budge in enough time to do laundry approximately once a week.

However, sometimes it's rough when a dog explosively defecates all over your last clean pair of khakis (it's okay, it wasn't his fault). That's the moment when I fleetingly really want about eight pairs of khakis, all stain resistant and exactly the same.

at the urgent care center:

(because you have to go to the urgent care center for your minor problems when you don't have time off during business hours)

butch nurse, to me:  "I like the Human Rights Campaign sticker on your water bottle..."

(sidelong look)

"...you drive a Subaru?"

wisdom from the pharmacist:

pharmacy person: "I'm sorry it took so long to fill your prescription. I was tending to the pregabalin bush."

me: 'That's awesome."

pharmacy person: "At least it's easier to harvest than the hydrocodone tree."

rough day for the resident:

As far as I can tell, being a resident is like constantly getting punched in the face except for sometimes you get kicked in the kidneys instead.

Some specialties are inherently more or less hard for the residents (surgery = you get called in at 2 am ALL THE TIME vs derm = not so many derm emergencies), but they all seem to have several things in common:

1. You are on call all the time.

2. You are also working all the time.

3. When you're not working or on call, you're supposed to use your free time (hee hee!) to prepare for topic rounds, case rounds, book rounds, +/- do your research for your required publication, annnnnnd....study for your giant awful exams.

(sometimes the exam pass rates are less than 50%)

 Anyways!

This week, one of the residents had an especially hard day.  He came in early to examine the case that got transferred to him overnight, and the first thing he did was spill his blue Powerade all over his white coat and nice clothes.

Then he bent down to examine the dog, stood up to check the record, and hit his head on the fluid pump.

When he crouched down again, I said,

"Dude, I hate to have to say this given how your day is going, but you have a giant hole in the crotch of your pants."

(an orange could have fallen out of his pants through this hole.  it was not small)

Then!  Oh, it gets better!  Then...he went to get a particularly aggressive dog out of the kennels, and as he exited the ward, a most unfortunate thing happened.  He stepped on a patch of wet concrete floor, cartwheeled forward, and slammed his knee on the ground as the dog tore off down the hallway.

a thing I learned:

As a student, one of my jobs (oftentimes) is taking a history from clients while (or before) we start examining their pet.

[Tip! If you're in a veterinary hospital, giving a concise and accurate history of your pet's problem(s) will absolutely make your visit happen faster. Faster!  Faster is better!]

Good history:

"Okay, so Jerry started vomiting last night after I fed him dinner.  He vomited three times, and each time it looked like digested food.  He seemed okay overnight, but he didn't want to eat this morning.  He's been drinking okay, and he hasn't had any diarrhea.  I don't think he's eaten anything he wasn't supposed to."

Bad history:

"Jerry?  Well, I got him when he was three - no, maybe four.  You see, we don't actually know because we adopted him from the neighbor when they moved away.  I think they were moving to Spain so the husband could teach chemistry at a university there.  Maybe it was physics.  Anyway, he was really happy to come and live with us, but my other dogs stare at him all the time.  I think it stresses him out.  He comes and sits by me and breathes loudly.  Except sometimes he stands when he does it.  I don't know why.
Anyway, sometimes I let him out in the yard by himself, but I haven't done that in a while.  Sometimes he stands under the bird feeder.  Last night I fed him dinner while we were eating - we were having roast beef, and I fed him in the kitchen so he wouldn't whine - and after dinner while we were watching Project Runway...

(at this point the other person in the room interrupts)

"No, we were watching The X Factor."

"Whatever.  We were watching The X Factor and he threw up.  I don't know how many times because my husband cleaned them up and he doesn't remember.  I think it might have been four times"

"It was six times."

"How do you know? You never remember anything!"

Et cetera. 

a conversation in the co-op parking lot:

me: "Oh hey!  Are you enjoying your fourth of July?"

professor: "Well, I just did an at-home euthanasia, so there's a dead dog in the back of my truck."

me: "...so hopefully the day will get better."

rumen contents:

When I am sufficiently motivated, I make myself a green smoothie in the morning and bring it to school in a glass jar.  Yes, it's a glass canning jar, and yes, I carry it around with me throughout the day.

(what is a green smoothie, you ask?  um, try one - it's a blended-together mix of greens/fruit/berries/seeds/nut butter/whatever you want. although they range from simple [double handful of spinach+water+2 bananas+apple] to unusual [mango+kale+soy milk+raspberries+hot pepper+apple], they are very tasty.)

As you might expect, seeing a person drinking a bright green sludgy substance on a regular basis is a cause for curiosity or concern.  Most of the time, I explain what exactly is in the jar and offer the inquisitive person a taste.

However...when the associate dean of the vet school (a wizened old ambulatory practitioner) raised an eyebrow and inquired about my drink, I instead said:

"Oh, I dipped this out of the surgery rumenotomy bucket this morning.  It's delicious!"

first emergency shift:

Oh hey!  It's the first day of my emergency and critical care rotation.  I've been looking forward to this day, although there is this nagging feeling that I'm going to get my ass handed to me in short order. 

hour 0 (7 am):
I cheerfully stroll into the vet school, water bottle and bananas in hand.  Sustenance is important, friends - the café closes at 4:30, and after that you have to scavenge for free food.  However, your competition for any leftover pizza is a gang of rapacious, hyena-like classmates.  It's kind of like dropping a chicken wing into a tank of piranhas. 

hour 3:
Three hours of orientation later, I realize my shift doesn't actually begin until noon.  I walk down campus to grab some lunch, then spend the next half an hour eating a delicious burrito and catching up on Autostraddle articles. 

hour 6:
Sitting in the emergency room.  No cases!  La di da!

hour 7:
Still sitting in the emergency room.  Spinning around in the wheeled chairs is no longer entertaining.  We begin quizzing each other with boards review questions.

hour 8:
I'm holding a large, wolfish dog on an exam table, trying to hook up the ECG leads, and answering (mostly incorrectly) rapid-fire questions from the resident.  The pixie-like technician snaps, "Alacrity!  Pay attention!  Hold the dog still!" 
The dog and I are roughly comparable in weight.  He gets muzzled when he growls at the clippers.

hour 10:
I answer a phone call, which can be summarized as:
"I think my dog is [clearly very ill] because he's [having concerning and messy symptoms] much worse and more frequently than he has been the past couple of days.  Do you think I should bring him in?

hour 12:
My severely ill patient is sleeping in the middle of the floor.  She is in the eye of the ER storm.

hour 14:
Positioning the dog and taking a radiograph by myself is totally possible - as long as I can grab the sandbags from the shelf with my foot.  Couldn't be simpler!

hour 15:
I begin rocking out to a Rihanna song in the ICU. 

hour 17: 
The overnight intern and I are sitting in an exam room with a client.  The client is vacillating between two treatment options that will cost about the same and will have about the same outcome.  She begins telling stories about her dog when she was a puppy.  Time crawls by like a lethargic insect.

hour 18.5 (1:30 am):
I get pulled over while driving home.  The officer tells me I have a headlight out, and inquires if I've been drinking.  I tell him I've just finished an emergency shift at the vet hospital.  He waves away my license and registration, and says, "I figured when I saw the scrubs.  Go home.".

large animal surgeon advising a resident:

"If you lacerate anything down in there, you are screwed.  Totally and completely screwed."

conversation between surgeons:

Two surgeons are preparing for a skate surgery, which is a surgery where the animal is euthanized at the end after the surgical residents practice techniques.

The animal in question is a horse donated for the teaching lameness course who has a penchant for kicking students.

Surgeon 1:  "I'll just anesthetize the horse myself.  What's the worst that could happen?"

Surgeon 2: "...the horse could wake up during surgery, destroy all the surgery lights, leap off the table, and run around the surgical suite?"

Surgeon 1: "Okay, I'll get one of the anesthesia students to do it."

while dicussing student duties on the theriogenology rotation:

technician: "It's my understanding that rectums are off limits, but vaginas are okay."

me: "Let's just ride right past all the possible directions we could go with that statement."

after collecting a stallion:

therio resident: "Well, most of it ran down my leg."

while preparing to collect a stallion:

me: "How does Winston prefer the artificial vagina?"

therio resident: "He likes it hot and sloppy."

today we had wine rounds.

What are wine rounds, you ask?

After our epic day of receiving cases, a total hip replacement, and a flexor tendon surgery, we rounded on the hospitalized patients while drinking wine.

Out of urine cups.

We're classy.

at the nurses' station:

orthopedic surgeon: "You know, you can get Sharpie off of radiographs with alcohol."

resident: "The drinking kind, or the rubbing kind?"

legit srsly a sign in the vet school:

yes, thank you for that helpful insight:

Me: "Do you have any particular tips on writing orthopedics discharge statements?  I know each service has different preferences."

Intern: "Well, they should be complete."

with a condom!

The other day, we scoped a dog with:

1) a golf ball
2) a large piece of ruminant hoof

in his stomach.  Let me tell you, a slippery golf ball is really hard to grab.
After we tried the little endoscopy net and grabbers, we then moved on to using a condom (Magnum, since apparently they're the largest.  Who knew?  Not me.), a plastic lunch baggie, and then...

(drumroll please)

...a sterile ultrasound probe cover (read: GIANT condom)!  And it worked!

The medicine resident delicately scooped the golf ball into the giant condom and pulled it up the esophagus and out the dog's mouth.  It was awesome.

oncology resident, giving life advice:

1. Show up on time.
2. Do your work.
3. Keep your mouth shut!

during intern rounds:

surgeon: "So...how do you herd the maggots?"

cheerful oncologist:

"There's no crying in oncology!"

because this hypothetical scenario is totally possible:

Oncology student rounds:

Clinician: "Okay, what are the five front-line drugs for treating lymphoma?"

Students: "Cyclophosphamide, Doxorubicin, Vincristine, Prednisone, and L-asparaginase."

Clinician: "So if you were going to randomly not use one of those drugs, which one would you eliminate?"

Students: "Why?"

Clinician: "You're traveling to a desert island.  You have 100 dogs with lymphoma, and you only have room for four drugs per dog.  Which one do you leave behind?"

Students:  "..."

(In case you were wondering, the answer is L-asparaginase)

pre-clinical evolution of a vet student:

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Orientation
OMG HOLY SHIT I AM IN VET SCHOOOOOOOOL!  Wow, look at us!  We are the University of Awesome CVM Class of 2013!  WOOOOO!!!!  Look, the ornate U of A seal is on that lectern!  Right there!  At the front of this lecture hall!  I’m sitting in a lecture hall!  In vet school!  WOOOOOO!!!!!!

Anatomy

Day 1:

Today is the first day of class in Vet School.  I must be an adult.  None of this undergraduate tomfoolery - I am a serious Vet Student now.  I will wear professional clothing.  I will take notes the Right Way.  I will write down everything the professor says.  Verbatim.  Including the pauses (with estimated pause length in parentheses). 

Day 1, later: 

Shit, where is anatomy lab?

Day 3:

I don’t have enough highlighters in enough colors.  Emergency Staples run!

Day 14:

My classmates must know more than I do.  They must study harder.  I knew it was a mistake to take that shower the other day.  I could have been studying. 

Day 37:

That fresh horse larynx smells really terrible.

Day 41:

Out of highlighters again.

Day 83:

Well, these cranial nerves and all their associated foramina can just go fuck themselves. 

Day 114:

Singing:

“Sar-tor-i-us!  (do do do do) Sar-tor-i-us! (do do do do)”

Week before the final:

Cricoarytenoideusdorsalislatissimusdorsiforamenovalepiamaterischialtuberosity

WHAT IF I DON’T PASS PANIC PANIC PANIC

(flapping around in a cloud of flashcards, carefully highlighted handouts, and dirty mnemonics)

Microbiology

Day 1:

I wonder if I passed anatomy.

Day 33:

If I can master the intricate details of this impossibly complex cellular signaling pathway, it will undoubtedly make me a better veterinarian one day.

Neuroanatomy

Day 14:

Hey Dr. Professor, you remember how the first day of Neuro you told us this material would be easy, and that it’s all just a bunch of hype about this class being insanely hard?  This word “easy” – I do not think it means what you think it means.

Week before the final:

Classmate sends out a video allegedly explaining the rubrospinal tract - Rick Rolls the entire listserv.  Excellent.

Physiology

Day 1:

Oh, this won’t be so bad.  The professor is making an analogy about grass clippings and urine.  He must have a sense of humor.

Day 15:

Oh that’s what a spleen does.

Day 39:

Why are kidneys so weird?  And who is Henle?

Bacteriology, Virology, Immunology

Day 7:

Reciting:

“Respiratory tract bacterial pathogens of horses.  Actinobacillus equuli, Streptococcus equi ssp. equi, Streptococcus equi ssp. zooepidemicus, Rhodococcus equi, Mycoplasma felis…”

Day 34:

Classmate:

“Hey, so if rinderpest has just been eradicated, do we have to know it for the final?”

Parasitology

Day 15:

I want to eat nothing but autoclaved sand.

last day of the general practice clinic rotation:

Chief work study student: "Have we assigned and taken care of all the e-mails from the clinic e-mail account?"

Student on the rotation: "None of us know the password to the account."

CWSS, panicked: "So no one's checked it the whole rotation?!?"

Students on the rotation, in chorus: "Nope!"

clinician, writing up case reports (indoors):

"Do I smell rain?  Is it my imagination?"

can I send this in to yo, is this racist?

Friday morning rounds, 7:30 am.

First slide up says:

"Becoming Dr. DRE: Mastering the Digital Rectal Exam"
with a picture of Dr. Dre, the musician.

Oh yes.

Chief of service strolls around the corner, takes a look at the slide.  He ponders briefly.
Says, "Oh, I thought that was Dr. (the only black male resident in the hospital's) picture for a minute."

WOW.

student, typing a case report:

"Where is the urinalysis MOTHER OF GOD oh, here it is."

clinician, morning rounds:

"What types of neoplasia can be prevented by ovarihysterectomy?"

silence.

TAPTAPTAPTAPTAPTAPTAPTAP of the whiteboard marker on the board.

someone says: "Mammary neoplasia."

"What else?"

silence.

TAPTAPTAPTAPTAPTAPTAPTAP

someone else says: "Granulosa cell tumor."

"What else?"

silence.

TAPTAPTAPTAPTAPTAPTAPTAP

someone else says: "Because that is supposed to help us THINK?!?"

radiologist to students:

"It's a Standardbred, so it does one of two things.  It races, or it belongs to the Amish."

radiologist to students:

"Cows are cool 'cause they heal."

radiologist, during rounds:

(the radiograph being shown is of a dog who supposedly ate a bone)

"I would say the bone has been digested.  Happy days.  You own a carnivore."

radiologist to students:

"I assume you all have worked with machine guns here."

radiologist to resident:

"Can you feel my laser pointer burning into the back of your head?"

resident to room at large:

(indicates the above Nat'l Geographic photo)

"This is my metaphor for rounds.  We are, of course, the fish."

resident to students:

"So then, if you instill a sword into the thorax..."

resident to room at large:

"They want me to put the probe on cellulitis and say it's cellulitis?  A monkey could do that."

radiologist to resident:

"OMG you tell the same story multiple times every morning!"

about the theriogenologist:

"He has the magic penis fingers."