Resident: "So I've been wondering..."
Surgeon: "Hmmm?"
Resident: "You know how you can have a 'hummer' with a blow job? What would the equivalent modifier be for the same action with a rim job?"
Surgeon: "Huh. I don't know."
Resident: "Right?"
Surgeon: "What about a 'rummer'?"
my pager looks awesome now:
ER doctor: "You did well today, Alacrity. Here, take some stickers for your pager. I have flying squirrels and pandas in inappropriate sexual positions."
rounds are fun:
This is a snippet of a conversation from rounds about a dog who got hit by a car and now has no tail or anal tone:
ER doctor: "So, then I sedated him and put some staples in his ass. Wait, the wound on his ass, not his actual assHOLE."
Neurologist: "Yeah, that would have been a bold treatment for absent anal tone."
ER doctor: "So, then I sedated him and put some staples in his ass. Wait, the wound on his ass, not his actual assHOLE."
Neurologist: "Yeah, that would have been a bold treatment for absent anal tone."
this is why i am mildly afraid of birds:
Exotics technician: "Why did you let a parrot walk all over your back?!? That was not a good idea!"
Alacrity: "Yes, correct. I couldn't catch him."
Exotics technician: "Well, who was helping you?"
Alacrity: "[The person helping me] couldn't catch him either."
Exotics technician: "So, what happened?"
Alacrity: "He totally dominated us for a while until we got him back in his carrier. He let me sort of examine him at one point. And he bit my finger."
Exotics technician: "He could have bitten your face! He could have broken your glasses! This is why we need a technician with exotics experience on overnights. Why was the bird here at midnight, anyway?"
Alacrity: "Well, his owner brought him in because he refused his evening cranberry."
Exotics technician: "I can't even."
Alacrity: "Yes, correct. I couldn't catch him."
Exotics technician: "Well, who was helping you?"
Alacrity: "[The person helping me] couldn't catch him either."
Exotics technician: "So, what happened?"
Alacrity: "He totally dominated us for a while until we got him back in his carrier. He let me sort of examine him at one point. And he bit my finger."
Exotics technician: "He could have bitten your face! He could have broken your glasses! This is why we need a technician with exotics experience on overnights. Why was the bird here at midnight, anyway?"
Alacrity: "Well, his owner brought him in because he refused his evening cranberry."
Exotics technician: "I can't even."
ER technician, on one of my overnights:
"I know you want to be an oncologist, but you've got ER in your blood. You can't do anything about that."
taking my own radiographs, with peanut gallery:
I had this patient the other day who needed abdominal radiographs, and since the radiology technician was at lunch, I decided to take them myself.
That was silly. Here is how it went:
First I found a technician assistant (TA) and a visiting student to help me. I asked the TA if she knew how to set up the system (she did), so while that was happening the student and I got the dog on the table and on his back. He was a big fellow, and he wasn't very keen on being on his back.
I tape the dog's hind legs to the table, get dressed in lead, and hold his front end still.
The machine whirrs and makes a funny sound.
Okay, so I start setting up the system again while the student holds the dog. A passing technician sees how this is going (not well), and comes over to help. The dog escapes and starts vomiting. We clean up, regroup, and get the dog back on the table.
I re-tape his hind legs, get dressed in lead, and hold his front end still (again). The dog wriggles. The radiologist (Dr. Nell, who has apparently been watching this whole thing) snickers. This conversation happens:
Dr. Nell: "ALACRITY!"
Alacrity: "WHAT."
Dr. Nell: "USE BONDAGE!"
Alacrity: "I AM using bondage!"
Radiology technician returns from lunch at this point, assesses the situation, and joins in:
Radiology technician: "Did you have to hold the dog in the worst way possible?"
Alacrity: "Come on, man! I'm wearing lead and everything!"
RT: "Yes, but did you have to sprawl across the table so you're spraying your entire body with radiation?"
It was basically awesome. But I got diagnostic films!
That was silly. Here is how it went:
First I found a technician assistant (TA) and a visiting student to help me. I asked the TA if she knew how to set up the system (she did), so while that was happening the student and I got the dog on the table and on his back. He was a big fellow, and he wasn't very keen on being on his back.
I tape the dog's hind legs to the table, get dressed in lead, and hold his front end still.
The machine whirrs and makes a funny sound.
Okay, so I start setting up the system again while the student holds the dog. A passing technician sees how this is going (not well), and comes over to help. The dog escapes and starts vomiting. We clean up, regroup, and get the dog back on the table.
I re-tape his hind legs, get dressed in lead, and hold his front end still (again). The dog wriggles. The radiologist (Dr. Nell, who has apparently been watching this whole thing) snickers. This conversation happens:
Dr. Nell: "ALACRITY!"
Alacrity: "WHAT."
Dr. Nell: "USE BONDAGE!"
Alacrity: "I AM using bondage!"
Radiology technician returns from lunch at this point, assesses the situation, and joins in:
Radiology technician: "Did you have to hold the dog in the worst way possible?"
Alacrity: "Come on, man! I'm wearing lead and everything!"
RT: "Yes, but did you have to sprawl across the table so you're spraying your entire body with radiation?"
It was basically awesome. But I got diagnostic films!
things I have consumed today:
1. Banana
2.Vega Sport Performance Protein chocolate shake
3. Carrots and hummus
4. Two mini chocolate bars
5. Three handfuls of oyster crackers
6. One handful of Raisin Bran (without the raisins)
7. Five spearmint breath mints
8. A small handful of Cadbury mini eggs
9. Chia crisps and hummus
10. Seven chocolate covered graham crackers
11. A handful of pretzel crackers
12. Five house-shaped cookies
13. Water
14. Apple cider with whiskey
2.Vega Sport Performance Protein chocolate shake
3. Carrots and hummus
4. Two mini chocolate bars
5. Three handfuls of oyster crackers
6. One handful of Raisin Bran (without the raisins)
7. Five spearmint breath mints
8. A small handful of Cadbury mini eggs
9. Chia crisps and hummus
10. Seven chocolate covered graham crackers
11. A handful of pretzel crackers
12. Five house-shaped cookies
13. Water
14. Apple cider with whiskey
female emergency doctor, to the electronic medical record system:
"I don't have time for this shit. 'Automated Error", you can suck my balls!"
Adrian:
have you heard hope whisper through this hospital?
it ghosts along corridors and seeps under doors
one clear morning, it swirled around four grey fetlocks
trembling in the stocks of the treatment room.
would you go to surgery, doctor? if he were yours?
well, i wouldn’t have the money.
say you did?
if i had fifteen thousand dollars to light on fire?
i guess i’d try.
twenty percent.
the thing about hope is,
it has no regard for odds.
six pairs of eyes lowered as we rolled to surgery
heads shook
and hope stayed.
it curled up next to a plush grey muzzle
and went to sleep.
the operating room hummed quietly
as the anesthesiologist’s nimble fingers
dosed out sleep
pressors, pain control, postive inotropes,
a careful finger on a pulse point, a grave expression.
i held his intestines as surgeons measured, cut and sutured.
and watched the dark coils brighten to pink.
it is surprising how slow the surgeons’ swift hands can seem
when each breath is a victory.
we left bloody footprints down the hall
spots and drizzles to recovery
the big grey horse soaked with red
stood up
swayed
and stayed standing
and the surgeon’s eyes danced.
fifty percent, maybe.
hope crept along as he stumbled to the ICU
dizzy with discomfort and residual drugs.
it melted into the warm bags of plasma
and brightened each golden and expensive drop
but he shivered in his ice boots
and his guts stayed sick and slow.
i watched the lazy loops on the ultrasound screen
and poured buckets of reflux away.
we weren’t sleeping.
i asked my stethoscope for anything but silence
a quiet query for the warm rumble of digestion
then i sat on the textured rubber floor
and watched him breathe.
i was filling a bucket of ice, maybe
when the resident came to his stall.
he said my big grey horse was dying
and i told him he was wrong.
see, though his bloodwork’s in the toilet
and you’d think he’s getting worse
hope is twirled through his forelock
and humming in his heart.
and he will be better tomorrow.
i said the words like ice chips
crisp and cold and tingly
just like that, they felt true.
and they were.
he dragged me across the pavement
two days later, or maybe it was three
so eager for the succulent grass
that he forgot his manners
you know, once –
in a dizzy day after a night in the OR
I heard an exasperated resident ask the air:
why do we even do colic surgery?
some days the horse dies on the trailer
or exsanguinates on the table
or expires after a septic stint in the ICU
but sometimes hope catches up
and hope is powerful.
it can carry a horse over and nudge him forward
get him on the trailer and send him home.
have you seen a grey horse gallop joyfully
with just a shadow of a surgical clip on his belly?
i have.
resourcefulness ftw:
Here are some things you can fix with extra suture:
1. Torn clothing.
2. Torn bedspread (thanks, cat).
3. Broken strap on shoe.
4. Torn scrub pocket.
5. Rip in pocketbook.
6. Worn-out seam on messenger bag.
7. Broken rivet in strap-on harness.
1. Torn clothing.
2. Torn bedspread (thanks, cat).
3. Broken strap on shoe.
4. Torn scrub pocket.
5. Rip in pocketbook.
6. Worn-out seam on messenger bag.
7. Broken rivet in strap-on harness.
internship tips: style edition
Hey there everyone!
So, my phone case is falling apart. It's almost two years old (like my phone), and has been shedding little rubber pieces for about six months. The bottom half is now so shredded that I have taped it back together with catheter tape so it doesn't totally separate from the phone. I've thought about getting a new case, but a) I'm not sure they make my phone case anymore, and b) I'd rather just get a new case when I get a new phone. Which will probably be when my phone stops working. Hooray!
Anyways! Here's some advice for dressing like a champion during your internship.
1) You need more scrubs than you think you do.
I, too, thought five sets of scrubs would be sufficient. I was wrong. Figure out whatever your longest stretch of workdays in a row will be (five days? eight days? eighteen days?), and multiply that number by 1.5. You should go get at least that many sets of scrubs.
2) Your scrubs should be the right kind of scrubs.
Simply put, your scrubs should not suck. If your internship is like my internship, you will spend upwards of 15 hours per day in your scrubs on a regular basis. The best kind of scrubs are:
- Comfortable
- Well-fitting
- Easily washable
- Dark in color
- Constructed with numerous pockets
Your scrubs should not be falling down or intimately hugging your ass cheeks (unless you're into that). You should be able to sprint, squat, and turn a cartwheel in your scrubs without a catastrophic wardrobe failure.
Sometimes you can find the right kind of scrubs inexpensively at thrift stores, or purchase them used from friends who do not need them anymore. Or, if you and your internmates are dramatically gaining and/or losing weight during your internship*, you can swap scrubs with each other.
3) Acquire some super-comfy long-sleeved shirts to wear under your scrubs.
These will keep you warm on chilly days, serve as an extra layer of protection against cat scratches/Shar Pei fur, and (if you are not particularly buxom) potentially allow you to not wear a bra, which on its own is a major win.
4) Your shoes should be amazingly comfortable.
I have this pair of flats that I wear almost every day:
I can chase a loose dog through the hospital, climb up to the top shelf in the pharmacy, and stand all day long in these shoes. Neither my back nor my feet hurt at the end of the day.
Four months in, these shoes are already profoundly scuffed/worn. They are unlikely to survive my internship as anything other than "kicking it with my buddies" shoes, whereas they originally began as "fancyish flats". This is totally okay - they are beyond comfy, and that is what matters.
I advise you to find your pair of amazingly comfortable shoes. It will make a world of difference!
5) Get a watch. An analog watch. With a second hand.
Your phone is not your watch. Okay, I know your phone can act as your watch, but an actual watch is way easier. I challenge you to get out your phone and access the timer app to count the fetal heart rate in the pregnant bitch while one hand is holding the dog and the other is ultrasounding.
6) Get an easy-to-care-for haircut.
Friends, I am of the opinion that your haircut during your internship should be maximally simple. Go for the kind of haircut that allows you to spend 30 seconds or less on your hair in the morning. Why? Because...if you spend 30 minutes each morning straightening/curling/styling your hair before work, that is 30 minutes that you are not sleeping. Sleeping is better**.
My haircut is a short, vaguely androgynous alternative lifestyle haircut that requires exactly zero styling products, complicated maintenance, or extensive fussing. I shower, dress, vigorously rub my head with a towel, and go to work.
You can have low-maintenance long hair as well - I did in vet school. I mostly rocked a ponytail, French braid, or bun.
Good luck, fellow interns! Remember, if you have the right scrubs and all the comfy extras, wearing scrubs every day is kind of like getting to go to work in pajamas. Except...not.
*This happens, apparently - probably because we all have different stress responses re: food and exercise, and internships are really stressful.
**Unless the straightening/curling/styling is comforting to you in some way, or is your daily self-care moment. As Autostraddle would say, you do you.
So, my phone case is falling apart. It's almost two years old (like my phone), and has been shedding little rubber pieces for about six months. The bottom half is now so shredded that I have taped it back together with catheter tape so it doesn't totally separate from the phone. I've thought about getting a new case, but a) I'm not sure they make my phone case anymore, and b) I'd rather just get a new case when I get a new phone. Which will probably be when my phone stops working. Hooray!
Anyways! Here's some advice for dressing like a champion during your internship.
1) You need more scrubs than you think you do.
I, too, thought five sets of scrubs would be sufficient. I was wrong. Figure out whatever your longest stretch of workdays in a row will be (five days? eight days? eighteen days?), and multiply that number by 1.5. You should go get at least that many sets of scrubs.
2) Your scrubs should be the right kind of scrubs.
Simply put, your scrubs should not suck. If your internship is like my internship, you will spend upwards of 15 hours per day in your scrubs on a regular basis. The best kind of scrubs are:
- Comfortable
- Well-fitting
- Easily washable
- Dark in color
- Constructed with numerous pockets
Your scrubs should not be falling down or intimately hugging your ass cheeks (unless you're into that). You should be able to sprint, squat, and turn a cartwheel in your scrubs without a catastrophic wardrobe failure.
Sometimes you can find the right kind of scrubs inexpensively at thrift stores, or purchase them used from friends who do not need them anymore. Or, if you and your internmates are dramatically gaining and/or losing weight during your internship*, you can swap scrubs with each other.
3) Acquire some super-comfy long-sleeved shirts to wear under your scrubs.
These will keep you warm on chilly days, serve as an extra layer of protection against cat scratches/Shar Pei fur, and (if you are not particularly buxom) potentially allow you to not wear a bra, which on its own is a major win.
4) Your shoes should be amazingly comfortable.
I have this pair of flats that I wear almost every day:
Four months in, these shoes are already profoundly scuffed/worn. They are unlikely to survive my internship as anything other than "kicking it with my buddies" shoes, whereas they originally began as "fancyish flats". This is totally okay - they are beyond comfy, and that is what matters.
I advise you to find your pair of amazingly comfortable shoes. It will make a world of difference!
5) Get a watch. An analog watch. With a second hand.
Your phone is not your watch. Okay, I know your phone can act as your watch, but an actual watch is way easier. I challenge you to get out your phone and access the timer app to count the fetal heart rate in the pregnant bitch while one hand is holding the dog and the other is ultrasounding.
6) Get an easy-to-care-for haircut.
Friends, I am of the opinion that your haircut during your internship should be maximally simple. Go for the kind of haircut that allows you to spend 30 seconds or less on your hair in the morning. Why? Because...if you spend 30 minutes each morning straightening/curling/styling your hair before work, that is 30 minutes that you are not sleeping. Sleeping is better**.
My haircut is a short, vaguely androgynous alternative lifestyle haircut that requires exactly zero styling products, complicated maintenance, or extensive fussing. I shower, dress, vigorously rub my head with a towel, and go to work.
You can have low-maintenance long hair as well - I did in vet school. I mostly rocked a ponytail, French braid, or bun.
Good luck, fellow interns! Remember, if you have the right scrubs and all the comfy extras, wearing scrubs every day is kind of like getting to go to work in pajamas. Except...not.
*This happens, apparently - probably because we all have different stress responses re: food and exercise, and internships are really stressful.
**Unless the straightening/curling/styling is comforting to you in some way, or is your daily self-care moment. As Autostraddle would say, you do you.
internship tips: self-care edition
Hi friends!
How is it going with you? I hope you are also sitting in your favorite coffee-shop on your day off. I hope you (like me) are contentedly nestled next to the only outlet amongst a herd of adorable, curly-haired, (probably) lesbians. Perhaps you are sipping a delicious mug of chai, watching the delightfully charming parade of queers go by.
Anyways! It's time for a list of things you can do to make your internship less bad:
1. Cultivate an appreciation of some sort of morning beverage.
Mine is herbal tea. I'm a naturally energetic and weirdly hyper person, so caffeinated drinks upkick that and make me frenetic and/or wacky.
It should be a beverage that is easy to make, and you should make it yourself. Yes - obvs it would be faster to buy it, but if you're an intern you probably don't have money for that nonsense.
Make your coffee/tea/smoothie/whatever and sip it before you begin your day. This sounds quite simple, but having a routine and a comforting beverage will settle your mind - no matter how crazy your day is about to be!
If I don't have time to finish my tea during rounds, I leave it by the front desk - it makes it easy to grab a drink between patients.
2. Be kind to your future self.
You are absolutely, 100% not going to want to listen to your voicemail, check those lab results, or read that blood smear tomorrow morning before rounds. You are going to want to sleep in. I know it's probably 11pm, but just do [whatever it is] before you go home. Your future self will thank you.
3. Make a daily list of your tasks.
This does not have to be extensive or complicated or take a long time. Grab a piece of paper, write down your shit, stick it in your pocket. Mine looks kind of like this:
[Patient 1] - treatment sheet, SOAP, call owner, get biopsy results.
[Patient 2] - treatment sheet, SOAP, call owner, get rDVM records, check bloodwork, mass removal.
[Patient 3] - treatment sheet, SOAP, call owner, neuro exam, get neuro consult, check coags.
Daily list = improved efficiency = go home sooner = sleep more = less suck.
4. If you need to ask a specialist several questions (i.e. get advice on more than one patient), have all of your ducks in a row so you can have one (hopefully short) conversation. This will make your day go faster (this is good, see point #3), and the specialist's day go faster - meaning s/he will probably be more inclined to help you in the future because it wasn't particularly onerous this time.
5. Take cases that scare and/or confuse you.
Okay, so I have a hard time managing patients with diabetes. I don't know why. I think it's because I never know what insulin dose to start with, they often have numerous other problems, and there are approximately a zillion factors that make one more or less insulin-resistant.
So, I signed up to take care of a patient in DKA with Cushing's disease, hypothyroidism, and financially constrained owners. It was an endocrinology adventure, and I learned many things. Now managing patients with diabetes is a bit less frustrating for me.
Look, if you're doing an internship, your colleagues (hopefully) assume that you are trying to learn and are quite willing to teach you. If you somehow manage to avoid all the cases that are uniquely confusing to you during your internship, they will still pop up for you later in veterinary life (still as confusing as ever!) and I'd imagine that's going to suck.
Hooray for internships! By the way, if you are on the conventional US veterinary internship cycle and are reading this at time of posting, you are approximately 1/3 done with your internship. Also, go sign up for the match if you (like me) are doing the match again for residency/specialty internship purposes. The time is now.
How is it going with you? I hope you are also sitting in your favorite coffee-shop on your day off. I hope you (like me) are contentedly nestled next to the only outlet amongst a herd of adorable, curly-haired, (probably) lesbians. Perhaps you are sipping a delicious mug of chai, watching the delightfully charming parade of queers go by.
Anyways! It's time for a list of things you can do to make your internship less bad:
1. Cultivate an appreciation of some sort of morning beverage.
Mine is herbal tea. I'm a naturally energetic and weirdly hyper person, so caffeinated drinks upkick that and make me frenetic and/or wacky.
It should be a beverage that is easy to make, and you should make it yourself. Yes - obvs it would be faster to buy it, but if you're an intern you probably don't have money for that nonsense.
Make your coffee/tea/smoothie/whatever and sip it before you begin your day. This sounds quite simple, but having a routine and a comforting beverage will settle your mind - no matter how crazy your day is about to be!
If I don't have time to finish my tea during rounds, I leave it by the front desk - it makes it easy to grab a drink between patients.
2. Be kind to your future self.
You are absolutely, 100% not going to want to listen to your voicemail, check those lab results, or read that blood smear tomorrow morning before rounds. You are going to want to sleep in. I know it's probably 11pm, but just do [whatever it is] before you go home. Your future self will thank you.
3. Make a daily list of your tasks.
This does not have to be extensive or complicated or take a long time. Grab a piece of paper, write down your shit, stick it in your pocket. Mine looks kind of like this:
[Patient 1] - treatment sheet, SOAP, call owner, get biopsy results.
[Patient 2] - treatment sheet, SOAP, call owner, get rDVM records, check bloodwork, mass removal.
[Patient 3] - treatment sheet, SOAP, call owner, neuro exam, get neuro consult, check coags.
Daily list = improved efficiency = go home sooner = sleep more = less suck.
4. If you need to ask a specialist several questions (i.e. get advice on more than one patient), have all of your ducks in a row so you can have one (hopefully short) conversation. This will make your day go faster (this is good, see point #3), and the specialist's day go faster - meaning s/he will probably be more inclined to help you in the future because it wasn't particularly onerous this time.
5. Take cases that scare and/or confuse you.
Okay, so I have a hard time managing patients with diabetes. I don't know why. I think it's because I never know what insulin dose to start with, they often have numerous other problems, and there are approximately a zillion factors that make one more or less insulin-resistant.
So, I signed up to take care of a patient in DKA with Cushing's disease, hypothyroidism, and financially constrained owners. It was an endocrinology adventure, and I learned many things. Now managing patients with diabetes is a bit less frustrating for me.
Look, if you're doing an internship, your colleagues (hopefully) assume that you are trying to learn and are quite willing to teach you. If you somehow manage to avoid all the cases that are uniquely confusing to you during your internship, they will still pop up for you later in veterinary life (still as confusing as ever!) and I'd imagine that's going to suck.
Hooray for internships! By the way, if you are on the conventional US veterinary internship cycle and are reading this at time of posting, you are approximately 1/3 done with your internship. Also, go sign up for the match if you (like me) are doing the match again for residency/specialty internship purposes. The time is now.
medical math: CRIs
Hey there everyone! I just had my first overnights this past week, which were terrifying and awesome. I've heard the experience of a young vet's first overnights likened to riding a bike without training wheels for the first time.
I think a more accurate (if weirder) simile would be: A young vet's first overnights feel like riding a bike without training wheels blindfolded through a ravine. Hooray!
That being said, I learned several important truths:
1) Do not panic. Everything is worse if you panic. Nothing is better.
2) Your only job is to keep everyone alive (who you aren't euthanizing) until the morning.
3) Despite your best efforts re: #2, sometimes patients will die anyway.
I also learned how to reliably calculate and put together CRIs.
To those of you who say, "Alacrity, how are you almost four months into your internship and you just learned this?", I say, "Hush, fools. CRIs are tricky."
For those of you who don't know, a CRI is a continuous rate infusion of a drug. Any drug. We use CRIs for pain control, anesthesia, sedation, drugs to promote gastrointestinal motility, some chemotherapeutic agents, et cetera.
I discovered that I knew how to set up CRIs way better than I thought I did on my last overnight before switching back to days. I had this patient whose heart was doing a crazy thing, and I called the criticalist at about 4am for some advice. She told me to put him on a diltiazem CRI.
Okay, I had never heard of a diltiazem CRI. There was no dose for a diltiazem CRI in Plumb's (or in any of the six critical care or cardiology textbooks I checked). So, I Googled it. Found a paper. Found a dose. Set up the CRI. SWEEEEET.
Friends, here is how you do this:
1) Look up the dose of your drug. Every CRI dose that you find will be formatted somewhat like this:
(units of drug) per (units of animal weight) per (units of time)
This looks like:
3 mcg/kg/min or 50mg/kg/day or 0.01U/lb/hour
2) Go weigh your patient. Convert the weight to kilograms (there are 2.2 pounds in 1 kilogram).
3) Multiply the units of drug by the weight of your patient. Now you have the total dose of the drug for your patient per unit of time.
4) Convert the unit of time to "per hour". The dose may have already been given to you in "per hour", which is awesome. If not, convert. If it's in minutes, multiply by 60. If it's in days, divide by 24.
5) Figure out how (physically) you're going to deliver your drug. Will it be diluted (hint: probably)? In what fluid/by how much? Some options for this are "in a 60 mL syringe" or "in a 1L bag of LRS", "in a 250 mL bag of saline", et cetera.
6) Figure out how to make your delivery system/vehicle last a logical amount of time (I use about a day). For example, a 60 mL syringe of (whatever) running at 2mL per hour lasts 30 hours. A 250 mL bag of saline running at 10 mL per hour lasts 25 hours. This is so your technicians aren't re-making the CRI every 6 hours.
7) Make sure your drug won't react badly with whatever fluid you use to dilute it (doy).
8) So, now you have a dose of drug for your patient per hour, and a delivery system/vehicle that lasts a known number of hours. Figure out how many "hour doses" of drug go into your delivery system/vehicle so the hours match. For example, if you are running a 60 mL syringe at 2mL per hour to get 30 CRI hours, you need 30 hour-sized doses of drug to go into that syringe.
The way you do this with math is you multiply your hourly dose for your patient by the number of hours in your delivery system/vehicle to get the total amount of drug to add to the bag/syringe.
9) Figure out the concentration of the drug (usually in units/mL). Convert your total dose to a total volume. Remove an equivalent volume of diluent fluid from your delivery system/vehicle so your math isn't wrong once you add the drug. For example, if you're adding 50 mL of drug to a 250 mL bag of saline and you did your "how long will this bag last" calculation based on 250 mL, remove 50 mL of saline before you add the 50 mL of drug so you don't end up with 300 mL total.
10) Check all your math.
11) Write your shit down in a logical way for your technicians.
12) GO!
Does this make sense?
I think a more accurate (if weirder) simile would be: A young vet's first overnights feel like riding a bike without training wheels blindfolded through a ravine. Hooray!
That being said, I learned several important truths:
1) Do not panic. Everything is worse if you panic. Nothing is better.
2) Your only job is to keep everyone alive (who you aren't euthanizing) until the morning.
3) Despite your best efforts re: #2, sometimes patients will die anyway.
I also learned how to reliably calculate and put together CRIs.
To those of you who say, "Alacrity, how are you almost four months into your internship and you just learned this?", I say, "Hush, fools. CRIs are tricky."
For those of you who don't know, a CRI is a continuous rate infusion of a drug. Any drug. We use CRIs for pain control, anesthesia, sedation, drugs to promote gastrointestinal motility, some chemotherapeutic agents, et cetera.
I discovered that I knew how to set up CRIs way better than I thought I did on my last overnight before switching back to days. I had this patient whose heart was doing a crazy thing, and I called the criticalist at about 4am for some advice. She told me to put him on a diltiazem CRI.
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| via flickr - supertroopers |
Friends, here is how you do this:
1) Look up the dose of your drug. Every CRI dose that you find will be formatted somewhat like this:
(units of drug) per (units of animal weight) per (units of time)
This looks like:
3 mcg/kg/min or 50mg/kg/day or 0.01U/lb/hour
2) Go weigh your patient. Convert the weight to kilograms (there are 2.2 pounds in 1 kilogram).
3) Multiply the units of drug by the weight of your patient. Now you have the total dose of the drug for your patient per unit of time.
4) Convert the unit of time to "per hour". The dose may have already been given to you in "per hour", which is awesome. If not, convert. If it's in minutes, multiply by 60. If it's in days, divide by 24.
5) Figure out how (physically) you're going to deliver your drug. Will it be diluted (hint: probably)? In what fluid/by how much? Some options for this are "in a 60 mL syringe" or "in a 1L bag of LRS", "in a 250 mL bag of saline", et cetera.
6) Figure out how to make your delivery system/vehicle last a logical amount of time (I use about a day). For example, a 60 mL syringe of (whatever) running at 2mL per hour lasts 30 hours. A 250 mL bag of saline running at 10 mL per hour lasts 25 hours. This is so your technicians aren't re-making the CRI every 6 hours.
7) Make sure your drug won't react badly with whatever fluid you use to dilute it (doy).
8) So, now you have a dose of drug for your patient per hour, and a delivery system/vehicle that lasts a known number of hours. Figure out how many "hour doses" of drug go into your delivery system/vehicle so the hours match. For example, if you are running a 60 mL syringe at 2mL per hour to get 30 CRI hours, you need 30 hour-sized doses of drug to go into that syringe.
The way you do this with math is you multiply your hourly dose for your patient by the number of hours in your delivery system/vehicle to get the total amount of drug to add to the bag/syringe.
9) Figure out the concentration of the drug (usually in units/mL). Convert your total dose to a total volume. Remove an equivalent volume of diluent fluid from your delivery system/vehicle so your math isn't wrong once you add the drug. For example, if you're adding 50 mL of drug to a 250 mL bag of saline and you did your "how long will this bag last" calculation based on 250 mL, remove 50 mL of saline before you add the 50 mL of drug so you don't end up with 300 mL total.
10) Check all your math.
11) Write your shit down in a logical way for your technicians.
12) GO!
Does this make sense?
a sampling of an average ER shift:
1. "I won't let you examine my dog."
Are you even serious? Go home.
2. "But you guys told me the last time I was here that his kidneys don't work because of all the blood in his liver."
Hmm...
3. "She's feral. Have you ever touched a feral cat before? You won't be able to touch her."
Watch this: examine cat. Success!
4. "Why aren't you ultrasounding him now?" (It is 2:45 am)
Our radiologist sleeps, sometimes.
5. "Can't you send her home with the catheter so I don't have to give her pills?"
No.
6. "What if I just watch her at home?" (cat is in respiratory distress)
Do you have an oxygen cage at home?
7. "Do you have a drug that will just make him better for a little while?"
No.
8. "I'm taking her to another hospital because I read bad reviews of this place on the internet."
Okay!
9. "I won't let you take her out of my sight!"
Seriously? See #1.
10. "Why do you have to do all of these tests to figure out what's wrong with him?"
I can't even.
Are you even serious? Go home.
2. "But you guys told me the last time I was here that his kidneys don't work because of all the blood in his liver."
Hmm...
3. "She's feral. Have you ever touched a feral cat before? You won't be able to touch her."
Watch this: examine cat. Success!
4. "Why aren't you ultrasounding him now?" (It is 2:45 am)
Our radiologist sleeps, sometimes.
5. "Can't you send her home with the catheter so I don't have to give her pills?"
No.
6. "What if I just watch her at home?" (cat is in respiratory distress)
Do you have an oxygen cage at home?
7. "Do you have a drug that will just make him better for a little while?"
No.
8. "I'm taking her to another hospital because I read bad reviews of this place on the internet."
Okay!
9. "I won't let you take her out of my sight!"
Seriously? See #1.
10. "Why do you have to do all of these tests to figure out what's wrong with him?"
I can't even.
seems logical:
internist: "Why has this cat not been neutered if he's been anesthetized six times in the past four days?"
ER doctor: "See, he keeps urinating around his ucath and I don't want him peeing into his own scrotum."
internist: "Ah."
ER doctor: "See, he keeps urinating around his ucath and I don't want him peeing into his own scrotum."
internist: "Ah."
neurologist, seeing a consult:
"Does this owner realize that this dog might not have a brain? Like, legitimately he may not have a large part of his brain? This might be really bad."
oh, ketamine:
ER doctor, in rounds: "This cat got about twice the maximum recommended dose of ketamine, so last night he was totally insane. He's still aggressive this morning, but maybe a little better. I actually have no way of accurately assessing his mental status."
Internist: (sigh) "He's in the K-hole? Okay."
Internist: (sigh) "He's in the K-hole? Okay."
in rounds this morning:
Internmate, to our boss: "I gotta say, I have absolutely no idea what you're talking about."
Boss: "FUCK me! [gets up, stomps into office] Fuckity, fuck fuck fuck fuck..."
Boss: "FUCK me! [gets up, stomps into office] Fuckity, fuck fuck fuck fuck..."
don't miss:
So I'm walking down the hospital hallway when this happens:
ER Doc #1: "You're not seriously going to do that."
Alacrity: "Do what?"
ER Doc #2: "I'm going to do an intracardiac stick [on a guinea pig] in front of the owner."
Alacrity: "Your testicles are large."
ER Doc #1: "You're not seriously going to do that."
Alacrity: "Do what?"
ER Doc #2: "I'm going to do an intracardiac stick [on a guinea pig] in front of the owner."
Alacrity: "Your testicles are large."
anemia differentials:
Alacrity, rounding the overnight doctor: "So, this dog is anemic and thrombocytopenic for a reason I don't yet understand..."
Overnight doc, straight face: "Could it have been caused by excessive twerking?"
Alacrity: "...that's awesome."
Overnight doc, straight face: "Could it have been caused by excessive twerking?"
Alacrity: "...that's awesome."
that should obvs. go in the ultrasound report:
Radiologist, ultrasounding: "Holy shit."
Alacrity: "What?"
Radiologist: "This dog has raging, needs-more-cowbell pancreatitis."
Alacrity: "What?"
Radiologist: "This dog has raging, needs-more-cowbell pancreatitis."
chief complaint: wtf?
We have this huge white board that charts all the cases that come through the ER. It shows the patient's name, chief complaint, and time of arrival (or ETA).
Mostly, chief complaints are logical problems such as "hit by car", "trouble breathing", or "collapse".
However...occasionally the chief complaints are more entertaining. My two recent favorites are "acting friendly" and "bit FedEx man, then hit in head with FedEx transponder".
Mostly, chief complaints are logical problems such as "hit by car", "trouble breathing", or "collapse".
However...occasionally the chief complaints are more entertaining. My two recent favorites are "acting friendly" and "bit FedEx man, then hit in head with FedEx transponder".
that's a fantastic image:
ECC resident: "So [this cat] projectile vomited overnight."
Day ER doctor: "Okay."
ECC resident: "This was not a normal projectile vomit. It was a non-stop horrendous torrent of foul, brown liquid that gushed forth from the cat's mouth like a fire hose."
Day ER doctor: "Huh."
ECC resident: "I kept expecting it to stop, but it just continued. It shot right through the front of the cage. I was amazed at how much liquid came out of that cat."
Day ER doctor: "Okay."
ECC resident: "This was not a normal projectile vomit. It was a non-stop horrendous torrent of foul, brown liquid that gushed forth from the cat's mouth like a fire hose."
Day ER doctor: "Huh."
ECC resident: "I kept expecting it to stop, but it just continued. It shot right through the front of the cage. I was amazed at how much liquid came out of that cat."
internists are weird:
internist, on phone, after giving a history: "So, do you have any advice on this case?"
liver specialist: "That dog is sick."
internist: "Yes."
liver specialist: "That dog is going to die."
internist: "Probably."
liver specialist: "When that dog dies, I want you to send me a piece of its liver."
liver specialist: "That dog is sick."
internist: "Yes."
liver specialist: "That dog is going to die."
internist: "Probably."
liver specialist: "When that dog dies, I want you to send me a piece of its liver."
the 'a' and the 's' are next to each other:
Alacrity: "I'm glad [our electronic medical record system] has a spellcheck. Sending home discharge instructions with 'thrombocytopenis' in them would have been somewhat sub-optimal."
Oncologist: "Oh yeah...don't worry about that. You know how many times I've typed 'neutropenis'? Many times."
Oncologist: "Oh yeah...don't worry about that. You know how many times I've typed 'neutropenis'? Many times."
pericardial tap instructions:
Alacrity: "Hey, [ECC resident], would you be able to help me tap this dog's pericardial fluid please? I've never done it before."
ECC resident: "Sure. Do you know where you're going to stick your needle?"
Alacrity: "Nope."
ECC resident: "Take the elbow. Bend it. There."
ECC resident: "Sure. Do you know where you're going to stick your needle?"
Alacrity: "Nope."
ECC resident: "Take the elbow. Bend it. There."
gaydar fail, gaydar win:
so, these two conversations happened this week.
1) Alacrity and Dr. Treaphine (an ER doctor), discussing a case:
Dr. T: "Hey, is that puppy going home now?"
A: "Yes! He's doing really well. He's gonna wait with his owner while I finish his discharges."
Dr. T: "Awesome! I'm glad to hear it. (glances around, drops voice) Hey, you know...his owner is this really cute guy [wink] - I think he might be married, though."
2) Alacrity and Dr. Nell (radiologist), during an ultrasound:
Dr. N: "Alacrity, you went to vet school at the University of Awesome?"
A: "Yup! It was fantastic."
Dr. N (ultrasounding the dog's abdomen): "Oh, wow - check out this mass. You're gonna make these owners cry. (pause) Huh. (pause) Yeah, I think this is cancer. You'll need to get some aspirates of this, but we'll need to check her clotting times first."
A: "That sucks. I'll go talk to them."
Dr. N: "Sounds good - let me just see if there's anything else in here. (ultrasounding) So, did your partner move here with you, or does she live somewhere else?"
1) Alacrity and Dr. Treaphine (an ER doctor), discussing a case:
Dr. T: "Hey, is that puppy going home now?"
A: "Yes! He's doing really well. He's gonna wait with his owner while I finish his discharges."
Dr. T: "Awesome! I'm glad to hear it. (glances around, drops voice) Hey, you know...his owner is this really cute guy [wink] - I think he might be married, though."
2) Alacrity and Dr. Nell (radiologist), during an ultrasound:
Dr. N: "Alacrity, you went to vet school at the University of Awesome?"
A: "Yup! It was fantastic."
Dr. N (ultrasounding the dog's abdomen): "Oh, wow - check out this mass. You're gonna make these owners cry. (pause) Huh. (pause) Yeah, I think this is cancer. You'll need to get some aspirates of this, but we'll need to check her clotting times first."
A: "That sucks. I'll go talk to them."
Dr. N: "Sounds good - let me just see if there's anything else in here. (ultrasounding) So, did your partner move here with you, or does she live somewhere else?"
learning!
1st year ECC resident (frantic): "Is Dr. Raeqe placing the chest tubes in that cat? Is she doing it now?"
3rd year ECC resident (glances over): "It would appear that she is."
1st year ECC resident: "Augghh! I told her to page me when she was starting! I will fight for this education!"
3rd year ECC resident (calmly): "You will fail."
3rd year ECC resident (glances over): "It would appear that she is."
1st year ECC resident: "Augghh! I told her to page me when she was starting! I will fight for this education!"
3rd year ECC resident (calmly): "You will fail."
fun times in rounds:
ECC resident: "His penis is the most horribly sad thing I've ever seen."
Internist: "I've met your husband, so coming from you that is saying something."
Internist: "I've met your husband, so coming from you that is saying something."
alacrity's internship:
Hi you guys!
I figure internship comics are awesome, so I'm going to give it a go.
Here's my comic representation of myself and my little cat, Pudgy:
Let the games begin!
and love rained down from the surgery lights:
The couple of days right after vet school graduation were kind of insane. I was simultaneously trying to pack everything, turning in various important forms, getting the utilities turned on/off in the correct apartments, and meeting up with my buddies before we all left town.
One afternoon, I stopped by the vet school on an errand and tarried a while to use the free wifi (fun fact! I never set up wifi in my last apartment. Mostly because it was expensive and I spent most of my not-at-home hours in spaces with free internet). I settled on a couch at the end of a long hallway connecting the small animal hospital with the large animal one. It's a cheerful space, with a steady but not distracting stream of passers-by.
The door next to me opened and Dr. Quin emerged. Dr. Quin is a large animal surgeon. He is a suave, sarcastic man who constantly carries a mug of coffee. His ego is larger than the condom supply at a gay bath house.
He has a habit of looking up at his student in the middle of surgery and saying,
"So! Do you have a boyfriend? Or a girlfriend?"
He will then proceed to dispense romantic advice to said student.
Now, this never happened to me. I scrubbed in on one surgery with Dr. Quin during that rotation, and we somehow missed the topic. We've talked maybe eight or ten times in total, and always about veterinary subjects.
Also, I'm quite femme in manner and dress. Many a new friend or classmate has been surprised to discover that I'm into the ladies.
So, Dr. Quin, through the door. I glanced up at him. He paused next to me, fist-pumped, and said,
"Twelve states now!"
Oh my goodness. You guys, I cried. And holy shit, the Quinster's ninja gaydar skills blew my mind.
One afternoon, I stopped by the vet school on an errand and tarried a while to use the free wifi (fun fact! I never set up wifi in my last apartment. Mostly because it was expensive and I spent most of my not-at-home hours in spaces with free internet). I settled on a couch at the end of a long hallway connecting the small animal hospital with the large animal one. It's a cheerful space, with a steady but not distracting stream of passers-by.
The door next to me opened and Dr. Quin emerged. Dr. Quin is a large animal surgeon. He is a suave, sarcastic man who constantly carries a mug of coffee. His ego is larger than the condom supply at a gay bath house.
He has a habit of looking up at his student in the middle of surgery and saying,
"So! Do you have a boyfriend? Or a girlfriend?"
He will then proceed to dispense romantic advice to said student.
Now, this never happened to me. I scrubbed in on one surgery with Dr. Quin during that rotation, and we somehow missed the topic. We've talked maybe eight or ten times in total, and always about veterinary subjects.
Also, I'm quite femme in manner and dress. Many a new friend or classmate has been surprised to discover that I'm into the ladies.
So, Dr. Quin, through the door. I glanced up at him. He paused next to me, fist-pumped, and said,
"Twelve states now!"
Oh my goodness. You guys, I cried. And holy shit, the Quinster's ninja gaydar skills blew my mind.
we're nerds:
You guys, cardiology was a fantastic rotation. The hours were reasonable, the chiefs were kind and gave unbelievably thorough rounds, and the patients were well-mannered. Also, it was really fun.
So, there is this cardiologist at the University of Awesome who describes the left atrium and left auricle on echocardiogram as Fudgie the Whale. He will then wink at the students and lament that no one has ever brought him a Fudgie the Whale Carvel cake.
Well, thanks to one guy on our cardiology rotation, he'll need to find a new punchline:
"Palpable Krill". Friends, vet folks are nerds. Unapologetic, fantastically epic nerds. Hooray!
So, there is this cardiologist at the University of Awesome who describes the left atrium and left auricle on echocardiogram as Fudgie the Whale. He will then wink at the students and lament that no one has ever brought him a Fudgie the Whale Carvel cake.
Well, thanks to one guy on our cardiology rotation, he'll need to find a new punchline:
"Palpable Krill". Friends, vet folks are nerds. Unapologetic, fantastically epic nerds. Hooray!
furrrrrniture:
My new state is a reasonable driving distance (a little over six hours) from the University of Awesome. So! Moving was simpler than it might have been otherwise. All of the stuff in my apartment fit into the back of a pickup truck and a car, even with the front seat reserved for a certain someone:
My cat is awesome, btw. I met her in a palpation lab at the vet school during my first year, and at the time she was as fat as a house. She weighed approximately twice what her trim body weight should be. She sat fatly in her metal cage sternly regarding the world around her. I scooped her up in my arms (my lab partner said, "Lift with your legs!") and I instantly loved her.
She has since lost a significant amount of poundage, and enjoys snarfing every morsel of food she can find. We share the same name (I did not name her, she came with it), so for a time the two technicians in charge of the labs called us "Alacrity" and "Fat Alacrity". As in,
"Hey Alacrity! How's Fat Alacrity doing?"
She is also an excellent traveler, and always very polite. Sometimes she bites.
Anyway!
This was supposed to be a post about furniture.
I didn't have all that much furniture in my last apartment, but in the spirit of minimalism and having fewer heavy things to carry whilst moving, I winnowed said furniture down to the following:
1. Futon and frame
2. Nightstand
3. Coffee table
4. Two folding shelves
5. Meditation bench
6. Two stools
7. Freestanding kitchen butcher-block structure
8. Fish tank stand
9. Three disassemble-able small shelves for shoes, etc.
10. Sturdy plastic storage container with drawers
Also (not furniture exactly but heavy, big, and/or fragile:
1. Full-length mirror
2. Two small lamps
3. One tall lamp
4. Toaster oven
Here are some things I learned about moving a) furniture, and b) things that are heavy, big, and/or fragile:
1. Take the lightbulbs out of your lamps.
2. Get a box designed to move art for your big mirror (or your art also), or really extensively/absurdly wrap the mirror in soft, comfy blankets.
3. TAKE PICTURES OF HOW THINGS GO TOGETHER BEFORE YOU TAKE THEM APART.
4. Put all the screws and washers in a bag together for each piece of furniture and label them.
5. Do not let cords dangle and trip you while you are carrying a corded appliance.
6. If you are moving something with drawers without emptying said drawers, tape the drawers shut.
Happy packing! Hopefully you will lose your screwdriver, hammer and scissors fewer times than I did.
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| ALWAYS WATCHING |
She has since lost a significant amount of poundage, and enjoys snarfing every morsel of food she can find. We share the same name (I did not name her, she came with it), so for a time the two technicians in charge of the labs called us "Alacrity" and "Fat Alacrity". As in,
"Hey Alacrity! How's Fat Alacrity doing?"
She is also an excellent traveler, and always very polite. Sometimes she bites.
Anyway!
This was supposed to be a post about furniture.
I didn't have all that much furniture in my last apartment, but in the spirit of minimalism and having fewer heavy things to carry whilst moving, I winnowed said furniture down to the following:
1. Futon and frame
2. Nightstand
3. Coffee table
4. Two folding shelves
5. Meditation bench
6. Two stools
7. Freestanding kitchen butcher-block structure
8. Fish tank stand
9. Three disassemble-able small shelves for shoes, etc.
10. Sturdy plastic storage container with drawers
Also (not furniture exactly but heavy, big, and/or fragile:
1. Full-length mirror
2. Two small lamps
3. One tall lamp
4. Toaster oven
Here are some things I learned about moving a) furniture, and b) things that are heavy, big, and/or fragile:
1. Take the lightbulbs out of your lamps.
2. Get a box designed to move art for your big mirror (or your art also), or really extensively/absurdly wrap the mirror in soft, comfy blankets.
3. TAKE PICTURES OF HOW THINGS GO TOGETHER BEFORE YOU TAKE THEM APART.
4. Put all the screws and washers in a bag together for each piece of furniture and label them.
5. Do not let cords dangle and trip you while you are carrying a corded appliance.
6. If you are moving something with drawers without emptying said drawers, tape the drawers shut.
Happy packing! Hopefully you will lose your screwdriver, hammer and scissors fewer times than I did.
containers (and their contents!) that have spilled in my car:
1. Chinese food for 25 people.
To be fair, it was just the sauces. Lots and lots of sauces!
Okay, so my parents went to college together and were members of their school's science fiction and fantasy society. This group got together frequently during college and played games - tabletops and RPGs (role-playing games, for the non-nerds among you). One RPG emerged as dominant when graduation approached - a campaign run by a guy named Dale.
Dale's game had about 15-20 players (my parents among them), and continued after graduation in a semi-annual pattern. As the players dispersed and found fairly permanent places to work/live/have families, the players with bigger residences stepped up to host the game. This tradition continues now, even some thirty-odd years later.
The winter game is hosted on the east coast, and the summer game happens on the west coast (sometimes in the midwest). This is an effort to vaguely equalize travel headaches/expenses across all players. Oftentimes players' significant others and/or kids come as well. Attendance is obviously not mandatory. The game proper is played for 2-3 days, and we fill the rest of the time with tabletop games, random outings, and socializing with one another.
I grew up with this awesomeness. As in, it was not unusual to have a large group of adults descend on the house, sleep four to a room (including in closets), cook gallons of hot sauce from scratch (yes), and spend 10-12 hours a day in the basement poring over a vinyl map with tiny figurines on it.
So! Fast forward to me in college (or possibly early vet school, I'm not sure) and home for winter break. My parents are hosting the game, and we'd ordered Chinese food for dinner. Alas, the Chinese restaurant did not deliver. I volunteered to go pick up the food, and this tall, bear-like guy named Brian came with me. Brian is pretty fantastic. He told me hilarious stories as we drove across town.
When we got to the restaurant, it was readily apparent that the huge volume of food we had ordered was not adequately packaged for transport. I think we had maxed out the restaurant's size limits on to-go containers. The waiter handed us roughly a zillion boxes of rice and packets of fortune cookies in some plastic grocery bags, which presented no problems. The hot, saucy food was another matter. I regarded the eight large, flimsy boats with some trepidation. The boats were that same bendy foil that they use to make disposable loaf pans, and the lids were...vaguely secured to the tops. Each boat was about the size of a smallish sheet cake.
Brian's eyes got big and he shook his head. He helped me carry the food to the car, where we tried to find the best arrangement for minimizing jostling. You guys, I drove home so carefully. Each turn, brake, and acceleration was gentle and smooth. When we reached my house, I saw that the sauces from the boats had carefully, gently and smoothly fountained all over the backseat, other stuff in the car, and into the rivulets that hold the front seats.
Let me tell you, that was a fantastically awesome next hour or so. The floor mats in the backseat still have some ambiguous brown stains.
2. A gallon jug of Dawn dish soap.
We've discussed this. In short, I purchased said jug of Dawn and left it in my car for several months. It opened and all the Dawn leaked into/across my backseat. One corner of the seat is still sticky and blue-green.
3. A large, full sharps container.
So, I used to work for a large mostly equine, mostly sports medicine practice before I went to vet school. They did some lameness work for the Narnia farm, which is how I got the opportunity to work there. It was fantastic! I loved it. Full marks.
One ambulatory vet at that practice had the habit of breaking open the plastic top of the sharps container in her truck so she could dump it at the clinic and avoid getting a new sharps container. This is obvs NOT what you are supposed to do with your sharps container. Anyway! One day, this vet and I were at the Narnia farm, examining some horses until late. I was living at the clinic at the time, and she asked me to empty her full sharps container when I got back so she could go straight home.
I settled the several gallon, stuffed-to-the-gills sharps container in my backseat, and on the way to the clinic (you saw this coming) it tipped over. The broken plastic top fell off, and scads of needles, catheter stylets, spinal needles, and glass syringes (joint injections, friends) trickled into the nether regions of my backseat.
I retrieved...most of them when I got to the clinic. I found a glass syringe under the driver's seat many months after that job ended.
To be fair, it was just the sauces. Lots and lots of sauces!
Okay, so my parents went to college together and were members of their school's science fiction and fantasy society. This group got together frequently during college and played games - tabletops and RPGs (role-playing games, for the non-nerds among you). One RPG emerged as dominant when graduation approached - a campaign run by a guy named Dale.
Dale's game had about 15-20 players (my parents among them), and continued after graduation in a semi-annual pattern. As the players dispersed and found fairly permanent places to work/live/have families, the players with bigger residences stepped up to host the game. This tradition continues now, even some thirty-odd years later.
The winter game is hosted on the east coast, and the summer game happens on the west coast (sometimes in the midwest). This is an effort to vaguely equalize travel headaches/expenses across all players. Oftentimes players' significant others and/or kids come as well. Attendance is obviously not mandatory. The game proper is played for 2-3 days, and we fill the rest of the time with tabletop games, random outings, and socializing with one another.
I grew up with this awesomeness. As in, it was not unusual to have a large group of adults descend on the house, sleep four to a room (including in closets), cook gallons of hot sauce from scratch (yes), and spend 10-12 hours a day in the basement poring over a vinyl map with tiny figurines on it.
So! Fast forward to me in college (or possibly early vet school, I'm not sure) and home for winter break. My parents are hosting the game, and we'd ordered Chinese food for dinner. Alas, the Chinese restaurant did not deliver. I volunteered to go pick up the food, and this tall, bear-like guy named Brian came with me. Brian is pretty fantastic. He told me hilarious stories as we drove across town.
When we got to the restaurant, it was readily apparent that the huge volume of food we had ordered was not adequately packaged for transport. I think we had maxed out the restaurant's size limits on to-go containers. The waiter handed us roughly a zillion boxes of rice and packets of fortune cookies in some plastic grocery bags, which presented no problems. The hot, saucy food was another matter. I regarded the eight large, flimsy boats with some trepidation. The boats were that same bendy foil that they use to make disposable loaf pans, and the lids were...vaguely secured to the tops. Each boat was about the size of a smallish sheet cake.
Brian's eyes got big and he shook his head. He helped me carry the food to the car, where we tried to find the best arrangement for minimizing jostling. You guys, I drove home so carefully. Each turn, brake, and acceleration was gentle and smooth. When we reached my house, I saw that the sauces from the boats had carefully, gently and smoothly fountained all over the backseat, other stuff in the car, and into the rivulets that hold the front seats.
Let me tell you, that was a fantastically awesome next hour or so. The floor mats in the backseat still have some ambiguous brown stains.
2. A gallon jug of Dawn dish soap.
We've discussed this. In short, I purchased said jug of Dawn and left it in my car for several months. It opened and all the Dawn leaked into/across my backseat. One corner of the seat is still sticky and blue-green.
3. A large, full sharps container.
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| thanks, smartpractice.com |
So, I used to work for a large mostly equine, mostly sports medicine practice before I went to vet school. They did some lameness work for the Narnia farm, which is how I got the opportunity to work there. It was fantastic! I loved it. Full marks.
One ambulatory vet at that practice had the habit of breaking open the plastic top of the sharps container in her truck so she could dump it at the clinic and avoid getting a new sharps container. This is obvs NOT what you are supposed to do with your sharps container. Anyway! One day, this vet and I were at the Narnia farm, examining some horses until late. I was living at the clinic at the time, and she asked me to empty her full sharps container when I got back so she could go straight home.
I settled the several gallon, stuffed-to-the-gills sharps container in my backseat, and on the way to the clinic (you saw this coming) it tipped over. The broken plastic top fell off, and scads of needles, catheter stylets, spinal needles, and glass syringes (joint injections, friends) trickled into the nether regions of my backseat.
I retrieved...most of them when I got to the clinic. I found a glass syringe under the driver's seat many months after that job ended.
do not do this #1:
Hello you guys!
Unpacking is especially fun when you have feline assistance.
I found a spool of thread behind the bookcase. How might that have gotten there? Might it be the same cat that sneakily devoured all the dental treats that I got in my dentistry goodie bag?
Now that I am somewhat moved in and settled, I am exploring both the small town I've moved to and the nearby big city. I attended the Pride festival in the city, and frolicked gaily in the streets with my people. It was awesome.
In the spirit of gleeful frolicking (heh), I have a cautionary summertime tale for you:
During my senior year of college, I attended a series of tea dances.
Tea dances?
Yes.
These tea dances were mid-afternoon Sunday affairs, hosted by a local queer event-organizing group on a monthly basis.
I noticed a flyer for one such tea dance on a community board at Smith, and fairly dragged Bryce along with me. A community queer event! Possibly there would be older butch dykes (mmmm, yes please)! Ladies we would never awkwardly see in class! We obviously had to attend. Bryce was unconvinced, but humored me.
That first tea dance was an epic affair. The dance was packed with a wide variety of fascinating lesbians. Shortly after arriving, I grabbed Bryce's arm, discreetly indicated a blonde, twinkly-eyed butch, and said,
"I'm going to go try to pick that one up."
Bryce stared at me. I smiled back, walked across the dance floor, and introduced myself.
We danced, made out in a nightclub some weeks later, and then decided to become friends. Hooray!
(Later, I would realize that this moment began my change from a queer, bookish, shy person to a queer, bookish, astonishingly forward reverse cougar. Anyway!)
So, tea dances. I attended every one, intent on romancing the bashful yet absurdly attractive butches who lined the walls of the room. Oh my goodness, there were so many! I was like a small child in the bulk candy section at Wegman's, except all the sweets bins were free and at my height. WHAT.
Two or three dances in, I started to notice this one butch in particular. She was about fifty, and had jet black hair with a few silver streaks. Her arms were lithe and muscular, and she wore her shirts tucked into snug black jeans. She was from another state, and drove an hour or more to get to each dance.
We exchanged e-mails, then agreed to meet up for a breakfast picnic at Smith. The next morning, I brought her a purple flower. I was envisioning a trip to one of the dining halls, followed by a foray down to Paradise Pond. NOPE!
She asked me to get in her truck, and then started driving out into the country. We mostly sat in silence. I asked her some questions, which yielded some short answers. More silence. After about twenty minutes, I asked,
"So, where are we going?"
She turned to look at me, and said,
"I don't know."
Silence.
Um.
After a little while longer, we pulled over by the side of the highway. It was at one of those rural truck stops, you know - the ones with just a pulloff and a picnic table or two.
I jumped out of the truck and sat on a picnic table. She pulled out two packaged McDonald's breakfasts and handed me one. We ate breakfast and talked a little more, maybe. The situation started to seem more normal, maybe a little.
We finished breakfast and held hands. She slid her hand down my shirt. I pulled back and told her to bring me back to school, which she did.
She came back to my room with me, and I made her some tea. We talked some more. We sat on the bed. Then we made out for the next eighteen hours.
I am actually not exaggerating.
Friends, this woman had insane amounts of stamina. There was some handsiness (I think we took our shirts off), but no buck nakedness and no hard-core fucking. We literally kissed and kissed the day and night around. It was fascinating.
At one point, Bryce insistently banged on the door to my room (so, I lived in a first floor room and my front door was adjacent to the house's front door). After the fourth or fifth knocking coupled with, "Alacrity, I know you're in there!", I pulled away from my guest and threw open the door in my jeans and bra.
Bryce said something to the effect of, "Well, fuck you!", and stormed out of the house.
(Later, she explained that she had wanted to commiserate about single life/recent breakups, only to find that I was getting some action. I told her that her response was totally understandable.)
Around dinner time, I insisted that I was hungry. My guest insisted that she wasn't. I briefly escaped from my room, grabbed some cookies in the common room, and ravenously scarfed them. A couple of housemates grinned at me with knowing winks and chuckles (first floor room! yay!).
Finally, at 7 am the next morning, I put my foot down:
"Okay, thanks for coming over. You have to go now. I have to go to the hospital to get an MRI of my neck."
(This was actually true. I was having some weird tingling in my hands and was seeing a neurologist.)
"Oh, that's okay. I can come to the hospital with you."
"No, you can't! You have to go now. I'll talk to you later."
She drove away. I meditated on what the fuck had just happened in the peaceful cacophony of the MRI.
You guys, I am very lucky that this odd situation turned out reasonably okay for me. I had a weird, nearly 24 hour date. It was not exactly bad. It was definitely strange. My thoughts during the marathon makeout session were sort of like:
Oh wow, she is really enjoying this. Like, REALLY enjoying it. She told me she hasn't been on a date in fifteen years. I guess that's what happens to all that pent-up sexual energy! Huh. I wouldn't be into her as a girlfriend, but I think this is okay. Seeing how awesome it is for her is interesting and kind of cool. Is that wrong? I hope not.
We ended up going out once more, having an awkward we-feel-differently-about-each-other conversation, and then I spent the rest of the tea dances avoiding her with my new girlfriend.
She snuck up on me and grabbed my side (high, up by my breasts) at one dance a year or two later. I chased her down in the parking lot and told off, telling her that touching me without warning was scary and not acceptable.
We still run into each other at Pride, sometimes. It's a little...weird.
In conclusion, do not get into a truck with someone you don't know well and allow them to drive you out into the country. Do not ignore that nagging voice in your head that tells you that something is not quite right. And if you are going to bring someone back to your room, have an exit strategy that is better and sooner than your MRI the next morning.
Unpacking is especially fun when you have feline assistance.
I found a spool of thread behind the bookcase. How might that have gotten there? Might it be the same cat that sneakily devoured all the dental treats that I got in my dentistry goodie bag?
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| OM NOM NOM |
In the spirit of gleeful frolicking (heh), I have a cautionary summertime tale for you:
During my senior year of college, I attended a series of tea dances.
Tea dances?
Yes.
These tea dances were mid-afternoon Sunday affairs, hosted by a local queer event-organizing group on a monthly basis.
I noticed a flyer for one such tea dance on a community board at Smith, and fairly dragged Bryce along with me. A community queer event! Possibly there would be older butch dykes (mmmm, yes please)! Ladies we would never awkwardly see in class! We obviously had to attend. Bryce was unconvinced, but humored me.
That first tea dance was an epic affair. The dance was packed with a wide variety of fascinating lesbians. Shortly after arriving, I grabbed Bryce's arm, discreetly indicated a blonde, twinkly-eyed butch, and said,
"I'm going to go try to pick that one up."
Bryce stared at me. I smiled back, walked across the dance floor, and introduced myself.
We danced, made out in a nightclub some weeks later, and then decided to become friends. Hooray!
(Later, I would realize that this moment began my change from a queer, bookish, shy person to a queer, bookish, astonishingly forward reverse cougar. Anyway!)
So, tea dances. I attended every one, intent on romancing the bashful yet absurdly attractive butches who lined the walls of the room. Oh my goodness, there were so many! I was like a small child in the bulk candy section at Wegman's, except all the sweets bins were free and at my height. WHAT.
Two or three dances in, I started to notice this one butch in particular. She was about fifty, and had jet black hair with a few silver streaks. Her arms were lithe and muscular, and she wore her shirts tucked into snug black jeans. She was from another state, and drove an hour or more to get to each dance.
We exchanged e-mails, then agreed to meet up for a breakfast picnic at Smith. The next morning, I brought her a purple flower. I was envisioning a trip to one of the dining halls, followed by a foray down to Paradise Pond. NOPE!
She asked me to get in her truck, and then started driving out into the country. We mostly sat in silence. I asked her some questions, which yielded some short answers. More silence. After about twenty minutes, I asked,
"So, where are we going?"
She turned to look at me, and said,
"I don't know."
Silence.
Um.
After a little while longer, we pulled over by the side of the highway. It was at one of those rural truck stops, you know - the ones with just a pulloff and a picnic table or two.
I jumped out of the truck and sat on a picnic table. She pulled out two packaged McDonald's breakfasts and handed me one. We ate breakfast and talked a little more, maybe. The situation started to seem more normal, maybe a little.
We finished breakfast and held hands. She slid her hand down my shirt. I pulled back and told her to bring me back to school, which she did.
She came back to my room with me, and I made her some tea. We talked some more. We sat on the bed. Then we made out for the next eighteen hours.
I am actually not exaggerating.
Friends, this woman had insane amounts of stamina. There was some handsiness (I think we took our shirts off), but no buck nakedness and no hard-core fucking. We literally kissed and kissed the day and night around. It was fascinating.
At one point, Bryce insistently banged on the door to my room (so, I lived in a first floor room and my front door was adjacent to the house's front door). After the fourth or fifth knocking coupled with, "Alacrity, I know you're in there!", I pulled away from my guest and threw open the door in my jeans and bra.
Bryce said something to the effect of, "Well, fuck you!", and stormed out of the house.
(Later, she explained that she had wanted to commiserate about single life/recent breakups, only to find that I was getting some action. I told her that her response was totally understandable.)
Around dinner time, I insisted that I was hungry. My guest insisted that she wasn't. I briefly escaped from my room, grabbed some cookies in the common room, and ravenously scarfed them. A couple of housemates grinned at me with knowing winks and chuckles (first floor room! yay!).
Finally, at 7 am the next morning, I put my foot down:
"Okay, thanks for coming over. You have to go now. I have to go to the hospital to get an MRI of my neck."
(This was actually true. I was having some weird tingling in my hands and was seeing a neurologist.)
"Oh, that's okay. I can come to the hospital with you."
"No, you can't! You have to go now. I'll talk to you later."
She drove away. I meditated on what the fuck had just happened in the peaceful cacophony of the MRI.
You guys, I am very lucky that this odd situation turned out reasonably okay for me. I had a weird, nearly 24 hour date. It was not exactly bad. It was definitely strange. My thoughts during the marathon makeout session were sort of like:
Oh wow, she is really enjoying this. Like, REALLY enjoying it. She told me she hasn't been on a date in fifteen years. I guess that's what happens to all that pent-up sexual energy! Huh. I wouldn't be into her as a girlfriend, but I think this is okay. Seeing how awesome it is for her is interesting and kind of cool. Is that wrong? I hope not.
We ended up going out once more, having an awkward we-feel-differently-about-each-other conversation, and then I spent the rest of the tea dances avoiding her with my new girlfriend.
She snuck up on me and grabbed my side (high, up by my breasts) at one dance a year or two later. I chased her down in the parking lot and told off, telling her that touching me without warning was scary and not acceptable.
We still run into each other at Pride, sometimes. It's a little...weird.
In conclusion, do not get into a truck with someone you don't know well and allow them to drive you out into the country. Do not ignore that nagging voice in your head that tells you that something is not quite right. And if you are going to bring someone back to your room, have an exit strategy that is better and sooner than your MRI the next morning.
everything is new and different!
Hi there everyone!
Let me tell you, I am so excited to be mostly moved in.
Here are some things I have learned during this last week or so:
1. 5 drops of citrus essential oil and 5 drops of dish soap mixed in a spray bottle of water is a fairly effective spider repellent.
2. It costs $3.75 to wash a load of laundry here, compared with $2 where I last lived.
3. It is important to have your shit together when you visit the DMV. Relatedly (and, seemingly, illogically), the DMV will not take a copy of your lease as proof of your residence in your new state.
4. There are a number of ways to assemble a futon that are not correct. Most of these ways will result in the futon folding upon itself when sat upon.
5. Parking in the city is the worst part about driving into the city.
6. There is a sex shop several doors down from my landlord's office, and a head shop across the street.
7. There is a store down the street from my apartment that makes the best cupcakes in existence.
I start my internship next week. I am really excited!
Let me tell you, I am so excited to be mostly moved in.
Here are some things I have learned during this last week or so:
1. 5 drops of citrus essential oil and 5 drops of dish soap mixed in a spray bottle of water is a fairly effective spider repellent.
2. It costs $3.75 to wash a load of laundry here, compared with $2 where I last lived.
3. It is important to have your shit together when you visit the DMV. Relatedly (and, seemingly, illogically), the DMV will not take a copy of your lease as proof of your residence in your new state.
4. There are a number of ways to assemble a futon that are not correct. Most of these ways will result in the futon folding upon itself when sat upon.
5. Parking in the city is the worst part about driving into the city.
6. There is a sex shop several doors down from my landlord's office, and a head shop across the street.
7. There is a store down the street from my apartment that makes the best cupcakes in existence.
I start my internship next week. I am really excited!
exotics resident to imaging resident:
"Hey, can you ultrasound the intumescence on this trouser snake?"
surprise underwear on my pathology rotation:
As it turns out, surgical residents need to do a pathology rotation during their residency. The third year large animal surgery resident did his pathology rotation when I did mine, which was pretty awesome.
This resident - the good Dr. Marvelous - is a proper Southern gentleman. He never uses profane language, he always holds the door for women, and he gets teased mercilessly for his 'benevolent sexism' by the chiefs of service.
Now, Dr. Marvelous got along well with us hooligans, despite our rowdy behavior and tendency to say things like "fuck" and "cocksucker" from time to time. He maintained a cool demeanor throughout the rotation, with one notable exception:
It was an average Wednesday. I ran into my friend Colleen on the way to pathology, and she told me that she'd left a gift for me in my mailbox. I stopped by and picked it up as I walked to the conference room where we met each morning for necropsy readouts. It was wrapped in shiny silver paper.
I opened the door to the aforementioned conference room, and took a seat at the table opposite a glass wall facing the diagnostic lab foyer. My rotation-mates were mostly already there, including Dr. Marvelous. As we waited for our pathology chief of service - Dr. O'Flanagan, a crotchety fellow with a keen eye for detail and a wickedly dark sense of humor - I remembered Colleen's present in my bag.
I pulled it out and unwrapped it to reveal a pair of Consent underwear!
Sidenote! Here you can read more about how and why my pair of Consent underwear came to be in my hands (besides that Colleen made them).
I held them up and said, "Hey, sweet!"
Dr. Marvelous glanced up, screamed, and involuntarily recoiled from the table. When he regained his composure, his ears were a deep crimson color.
While holding my prize aloft, I looked through the glass wall into the foyer...to see Dr. O'Flanagan bearing down on the conference room. I quickly buried the underwear in my lap.
All in all, it was an excellent start to the day. Nothing like a little consent to liven up pathology!
This resident - the good Dr. Marvelous - is a proper Southern gentleman. He never uses profane language, he always holds the door for women, and he gets teased mercilessly for his 'benevolent sexism' by the chiefs of service.
Now, Dr. Marvelous got along well with us hooligans, despite our rowdy behavior and tendency to say things like "fuck" and "cocksucker" from time to time. He maintained a cool demeanor throughout the rotation, with one notable exception:
It was an average Wednesday. I ran into my friend Colleen on the way to pathology, and she told me that she'd left a gift for me in my mailbox. I stopped by and picked it up as I walked to the conference room where we met each morning for necropsy readouts. It was wrapped in shiny silver paper.
I opened the door to the aforementioned conference room, and took a seat at the table opposite a glass wall facing the diagnostic lab foyer. My rotation-mates were mostly already there, including Dr. Marvelous. As we waited for our pathology chief of service - Dr. O'Flanagan, a crotchety fellow with a keen eye for detail and a wickedly dark sense of humor - I remembered Colleen's present in my bag.
I pulled it out and unwrapped it to reveal a pair of Consent underwear!
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| source: tumblr |
Sidenote! Here you can read more about how and why my pair of Consent underwear came to be in my hands (besides that Colleen made them).
I held them up and said, "Hey, sweet!"
Dr. Marvelous glanced up, screamed, and involuntarily recoiled from the table. When he regained his composure, his ears were a deep crimson color.
While holding my prize aloft, I looked through the glass wall into the foyer...to see Dr. O'Flanagan bearing down on the conference room. I quickly buried the underwear in my lap.
All in all, it was an excellent start to the day. Nothing like a little consent to liven up pathology!
quotes from the Narnia farm:
Okay, you may remember that I worked as a groom for a while before going to vet school. Let's call my bosses Susan (Olympic rider) and Jennifer (Susan's romantic/business partner), and their stable the Narnia farm.
Susan had a habit of stating exactly what she was thinking:
"TERRRRRRRRIBLE! That was TERRRRRRRRRIBLE!!!" - after a student jumped a fence
"A good horseman would have done it quickly, without making a big deal out of it!" - to me, after I adjusted a horse's flash noseband
"Yeah...you're a wimp."
"Do you speak English?"
Often ringside, publicly, at large horse shows:
"You're a paid professional! This isn't Pony Club!"
"MOTHERFUCKER! Get your act together!"
Actually, Jennifer had a similar habit:
"A fucking stallion? I mean, that's what he does, right?"
"You like my pants? The old Gap pants that come right up to your boobs?"
"Nothing like shoeing on a wet mat." - Farrier
"Yeah, but you've got these big nipples!" - Jennifer
"I'm not having all this sex in my barn! Tighten up!"
"I love a clean barn. It really turns me on."
"Just do my balls."
"It's a fucking blower! Excuse me."
"Fucking golf carts! Oh, hi Amanda."
Granted, we grooms said some strange things ourselves:
"It's like he shits through a cheese grater!"
"You can't polish a turd and make it a diamond."
"Please refrain from demolishing my face."
"C'mon, vacuum! Pull your shit together!"
"Hey, do you remember what to do when the walker says, 'FOOL' and stops working?"
"Is that a Sour Patch Kid on the windshield wiper? [it was, actually]"
"How much shit can you fit in the shitter...[singing]"
"I can't imagine what I would do if I got my pants torn off by a horse." - Alacrity
"I've gotten my pants torn off, but not by a horse." - Farrier
Ah, memories! Don't you want to work there? It was pretty awesome.
Susan had a habit of stating exactly what she was thinking:
"TERRRRRRRRIBLE! That was TERRRRRRRRRIBLE!!!" - after a student jumped a fence
"A good horseman would have done it quickly, without making a big deal out of it!" - to me, after I adjusted a horse's flash noseband
"Yeah...you're a wimp."
"Do you speak English?"
Often ringside, publicly, at large horse shows:
"You're a paid professional! This isn't Pony Club!"
"MOTHERFUCKER! Get your act together!"
Actually, Jennifer had a similar habit:
"A fucking stallion? I mean, that's what he does, right?"
"You like my pants? The old Gap pants that come right up to your boobs?"
"Nothing like shoeing on a wet mat." - Farrier
"Yeah, but you've got these big nipples!" - Jennifer
"I'm not having all this sex in my barn! Tighten up!"
"I love a clean barn. It really turns me on."
"Just do my balls."
"It's a fucking blower! Excuse me."
"Fucking golf carts! Oh, hi Amanda."
Granted, we grooms said some strange things ourselves:
"It's like he shits through a cheese grater!"
"You can't polish a turd and make it a diamond."
"Please refrain from demolishing my face."
"C'mon, vacuum! Pull your shit together!"
"Hey, do you remember what to do when the walker says, 'FOOL' and stops working?"
"Is that a Sour Patch Kid on the windshield wiper? [it was, actually]"
"How much shit can you fit in the shitter...[singing]"
"I can't imagine what I would do if I got my pants torn off by a horse." - Alacrity
"I've gotten my pants torn off, but not by a horse." - Farrier
Ah, memories! Don't you want to work there? It was pretty awesome.
HOLY BUCKETS:
I GRADUATED!
Yes.
I am ever so excited. Now I am hurriedly packing everything in my apartment, discovering large numbers of dust bunnies, and preparing to move/start my internship. Um, what?
Everything is happening so quickly, but I haven't enormously panicked yet.
There have been some small panics:
1. While packing the kitchen, I discovered that all of my drinking glasses are now Mason jars, and Mason jars in large quantities are heavy. Now I have too many heavy, fragile, kitchen boxes. Balls.
2. OH HEY I guess I should send in my now-finalized transcript to the licensing board so I can be licensed in my new state! That's important!
3. A group of industrious ants has been slowly devouring a lone, forgotten horse treat in the bottom of a basket on my dresser.
4. There are SO MANY SPIDERS in the loft. I am viscerally afraid of spiders.
This Autostraddle Guide to Moving has been enormously helpful. Oh, moving. One day I may be skilled at moving. That day is not today!
Yes.
I am ever so excited. Now I am hurriedly packing everything in my apartment, discovering large numbers of dust bunnies, and preparing to move/start my internship. Um, what?
Everything is happening so quickly, but I haven't enormously panicked yet.
There have been some small panics:
1. While packing the kitchen, I discovered that all of my drinking glasses are now Mason jars, and Mason jars in large quantities are heavy. Now I have too many heavy, fragile, kitchen boxes. Balls.
2. OH HEY I guess I should send in my now-finalized transcript to the licensing board so I can be licensed in my new state! That's important!
3. A group of industrious ants has been slowly devouring a lone, forgotten horse treat in the bottom of a basket on my dresser.
4. There are SO MANY SPIDERS in the loft. I am viscerally afraid of spiders.
This Autostraddle Guide to Moving has been enormously helpful. Oh, moving. One day I may be skilled at moving. That day is not today!
excellent choice of words, coach:
My CrossFit buddy Millie is very short. Probably 4'10''. She is also awesome. She has bouncy brown curls, several kids, and a wicked sense of humor:
Millie is standing on a box under the pull-up rig. I'm waiting to use the same box.
Coach: "Millie! Why aren't you sharing your box!?"
Millie: "Oooo, my husband wouldn't like that very much."
Millie is standing on a box under the pull-up rig. I'm waiting to use the same box.
Coach: "Millie! Why aren't you sharing your box!?"
Millie: "Oooo, my husband wouldn't like that very much."
no reason to panic, none at all:
emergency and critical care resident:
"I really don't understand why everyone panics during emergencies. Don't panic. Seriously. The worst thing that can happen is that the animal dies, and then you know exactly what to do: start chest compressions."
"I really don't understand why everyone panics during emergencies. Don't panic. Seriously. The worst thing that can happen is that the animal dies, and then you know exactly what to do: start chest compressions."
your handy guide to rotations (here), part 2:
Clinical Pathology:
The hours are excellent. The rounds are practical. The lab technicians teach you how to make blood smears, which is much harder than it looks. You get to see the blood smear "Box o' Shame", which includes some truly epic specimens of failure. You will finally be able to differentiate segmented neutrophils from bands (well, sometimes), and learn what a monocyte is.
Dermatology:
Your first day of Derm starts at 12:30. Need I say more? You see patients occasionally. There is almost no busywork. You learn useful things about common skin diseases, and all of the service chiefs are jolly and/or extraordinarily and hilariously strange. There are never any inpatients or emergencies. This is a good rotation to catch up on sleep and study for boards.
Emergency and Critical Care:
The hours are actually not that bad, except for the overnights (which totally blow). I don't know about you, but my brain straight up rejects rational thinking when I'm on a reversed sleep schedule. Fun! The techs are extra badass. You never know what the fuck is going to happen. There will be really slow stretches where you will putz around on VetPrep for six hours, and then seven severely injured and/or dying patients will arrive in the space of five minutes. You will get pissed and shat upon regularly. Bring extra scrubs!
General Practice:
Oooooooh this is a great rotation. You get to do actual surgery. You get to make decisions about patient care. You also do mind-bendingly large amounts of paperwork. The service chief is a quaint and quirky old fellow who knows, um, everything.
Large Animal Medicine:
This one is seasonal. Spring? Septic foaaaaals! Summer? Septic foals, colics, and horses with diarrhea! Fall? More colics! And Potomac Horse Fever! Winter? Not a damn thing. All the time? ADR cows, crias with choanal atresia/failure to thrive, and the calves from all the c-sections. And colitis. You will see some really, really weird shit (lymphoma in a pig, can I get a what what). You will never leave the hospital. More specifically, you will never leave the isolation ward.
Large Animal Orthopedic Surgery:
The doctors are fucking rockstars. You may have six cases at once. Do not feed the wrong hay to the throat horses. You will spend years in the OR wearing lead under your surgery gown if you're doing an arthroscopy. You will get to help put some insane fractures back together. Hope you like racehorses!
Large Animal Soft Tissue Surgery:
Ooooohhhh this is a fun rotation. Mass removals, colic surgery, all the weird dental shit (dental week is a crazy week!), eye surgeries (yes) and wound repairs. Castrations! You will castrate legions of horses. The rounds are fantastic. It is very important to the surgeons that you pass the hemostats with the tips up. TIPS UP, MOTHERFUCKERS! And know your instrument names cold. I am not kidding.
Small Animal Soft Tissue Surgery:
It is almost impossible for the hours to be any worse than they are on this rotation:
***Actual conversation between group of students and chief of service***:
Chief: Okay, so you know we don't have an overnight ER student anymore to give the 2 am doses of hydro to your spay and neuter dogs. This means that you guys will have to come in at 2 am* to dose the dogs yourselves.
Student: Hey, what if we use a pain management protocol that doesn't require 2 am meds?
Chief: Nope, we're going to stick to the way we've always done it. We're** just going to have to suffer. Sorry guys!
*this is after regular 14-16 hour days in the hospital, mind.
**clearly, this chief had some confusion regarding the meaning of pronouns. I refuse to accept "we're" as the correct choice unless she is also in the hospital medicating a rambunctious pit bull at 2 in the morning.
The hours are excellent. The rounds are practical. The lab technicians teach you how to make blood smears, which is much harder than it looks. You get to see the blood smear "Box o' Shame", which includes some truly epic specimens of failure. You will finally be able to differentiate segmented neutrophils from bands (well, sometimes), and learn what a monocyte is.
Dermatology:
Your first day of Derm starts at 12:30. Need I say more? You see patients occasionally. There is almost no busywork. You learn useful things about common skin diseases, and all of the service chiefs are jolly and/or extraordinarily and hilariously strange. There are never any inpatients or emergencies. This is a good rotation to catch up on sleep and study for boards.
Emergency and Critical Care:
The hours are actually not that bad, except for the overnights (which totally blow). I don't know about you, but my brain straight up rejects rational thinking when I'm on a reversed sleep schedule. Fun! The techs are extra badass. You never know what the fuck is going to happen. There will be really slow stretches where you will putz around on VetPrep for six hours, and then seven severely injured and/or dying patients will arrive in the space of five minutes. You will get pissed and shat upon regularly. Bring extra scrubs!
General Practice:
Oooooooh this is a great rotation. You get to do actual surgery. You get to make decisions about patient care. You also do mind-bendingly large amounts of paperwork. The service chief is a quaint and quirky old fellow who knows, um, everything.
Large Animal Medicine:
This one is seasonal. Spring? Septic foaaaaals! Summer? Septic foals, colics, and horses with diarrhea! Fall? More colics! And Potomac Horse Fever! Winter? Not a damn thing. All the time? ADR cows, crias with choanal atresia/failure to thrive, and the calves from all the c-sections. And colitis. You will see some really, really weird shit (lymphoma in a pig, can I get a what what). You will never leave the hospital. More specifically, you will never leave the isolation ward.
Large Animal Orthopedic Surgery:
The doctors are fucking rockstars. You may have six cases at once. Do not feed the wrong hay to the throat horses. You will spend years in the OR wearing lead under your surgery gown if you're doing an arthroscopy. You will get to help put some insane fractures back together. Hope you like racehorses!
Large Animal Soft Tissue Surgery:
Ooooohhhh this is a fun rotation. Mass removals, colic surgery, all the weird dental shit (dental week is a crazy week!), eye surgeries (yes) and wound repairs. Castrations! You will castrate legions of horses. The rounds are fantastic. It is very important to the surgeons that you pass the hemostats with the tips up. TIPS UP, MOTHERFUCKERS! And know your instrument names cold. I am not kidding.
Small Animal Soft Tissue Surgery:
It is almost impossible for the hours to be any worse than they are on this rotation:
***Actual conversation between group of students and chief of service***:
Chief: Okay, so you know we don't have an overnight ER student anymore to give the 2 am doses of hydro to your spay and neuter dogs. This means that you guys will have to come in at 2 am* to dose the dogs yourselves.
Student: Hey, what if we use a pain management protocol that doesn't require 2 am meds?
Chief: Nope, we're going to stick to the way we've always done it. We're** just going to have to suffer. Sorry guys!
*this is after regular 14-16 hour days in the hospital, mind.
**clearly, this chief had some confusion regarding the meaning of pronouns. I refuse to accept "we're" as the correct choice unless she is also in the hospital medicating a rambunctious pit bull at 2 in the morning.
we do?
radiologist, during a lecture:
"For some reason, we have an infatuation with folded spleens [at this institution]."
"For some reason, we have an infatuation with folded spleens [at this institution]."
sodium blunt:
Hi everyone!
I'm in ECC (emergency and critical care) class right now. The criticalists are utterly fantastic. I love the entire department. They are snarkily hilarious and teach us highly practical shit. Hooray!
Currently, we're talking about hypernatremia (too much sodium in the blood). If an animal becomes hypernatremic slowly, her body will adapt to its new overly salty state. More specifically, she will produce idiogenic osmoles. These hold water in the brain while all the extra sodium tries to pull the water into the blood.
So we're discussing what to do with a patient that presents with a sodium of (holy shit) 185 or so. You definitely want to start some IV fluids to rehydrate her and bring that sodium down, but if your fluids have a way lower sodium than your patient, the sodium will drop really fast.
If the patient has adjusted to her hypernatremic state and has made idiogenic osmoles, this is bad. Why, you ask? Because as the sodium in the blood drops rapidly, those idiogenic osmoles in the brain will pull water into the brain and cause it to swell like a gummy bear in a cup of Coke. Since the cranial vault has a fixed volume and since bone is not particularly bendy, your patient's brain will get squished. Bad, right? Yes.
So, what do you do?
We (as a class) said: "We're going to make our own fluids! With a sodium concentration similar to that of the patient!"
Our professor responded: "We ARE going to make our own! We're going to roll our own fluid. Absolutely."
I'm in ECC (emergency and critical care) class right now. The criticalists are utterly fantastic. I love the entire department. They are snarkily hilarious and teach us highly practical shit. Hooray!
Currently, we're talking about hypernatremia (too much sodium in the blood). If an animal becomes hypernatremic slowly, her body will adapt to its new overly salty state. More specifically, she will produce idiogenic osmoles. These hold water in the brain while all the extra sodium tries to pull the water into the blood.
So we're discussing what to do with a patient that presents with a sodium of (holy shit) 185 or so. You definitely want to start some IV fluids to rehydrate her and bring that sodium down, but if your fluids have a way lower sodium than your patient, the sodium will drop really fast.
If the patient has adjusted to her hypernatremic state and has made idiogenic osmoles, this is bad. Why, you ask? Because as the sodium in the blood drops rapidly, those idiogenic osmoles in the brain will pull water into the brain and cause it to swell like a gummy bear in a cup of Coke. Since the cranial vault has a fixed volume and since bone is not particularly bendy, your patient's brain will get squished. Bad, right? Yes.
So, what do you do?
We (as a class) said: "We're going to make our own fluids! With a sodium concentration similar to that of the patient!"
Our professor responded: "We ARE going to make our own! We're going to roll our own fluid. Absolutely."
snippet from my ECC notes, verbatim:
Bicarb:
Bicarb deficit is 0.3 x body weight x base excess.
Do not give your patient an iatrogenic alkalosis! You cannot
treat these if you make them.
The kidneys have to fix it.
Dilute the fuck out of your NaHCO3 – about 1:6 with sterile water. Be conservative (1/4 to 1/3 of calculated dose) you can always give more, you can’t take it away.
Dilute the fuck out of your NaHCO3 – about 1:6 with sterile water. Be conservative (1/4 to 1/3 of calculated dose) you can always give more, you can’t take it away.
weird combined metaphor for the win:
Criticalist is lecturing about very ill patients, and how one cannot shy away from treating them. He shows this picture:
and says:
"The only way you get to dance with the cats is if you don't stick your head in the sand."
and says:
"The only way you get to dance with the cats is if you don't stick your head in the sand."
new perspectives are fun:
radiologist: "We're assuming that our bodies (and animal bodies) are sort of skin-confined water bags."
dysfunctional doors:
Hi everyone!
I hope you're doing well.
I have a horrifying story for you about doors. Ready? Here you go!
A couple of months ago, I was on a surgery rotation. This means I was spending approximately 14 hours per day at the hospital and subsisting on an amusingly tiny ration of sleep. As I stumbled in early one Sunday morning, I noticed several women in scrubs pushing a dog on a gurney towards the hospital doors.
Now, the emergency entrance at the University of Awesome vet hospital is clearly marked. The "EMERGENCY" sign is a helpful beacon for frantic clients who are (understandably) lost in the twisty insane campus roads leading to the hospital.
There's a set of automatic doors that "whoosh" open as you approach, allowing you into a vestibule. Then there's a set of card-access-only automatic doors that let you enter the hospital waiting room. AND THEN there's yet another set of card-access-only (different card needed from the first set of doors*) doors to enter the hospital proper.
I caught up with the ER doctors as they wheeled the gurney towards the automatic doors. We all piled into the vestibule, and one doctor swiped her card for entry. The doors beeped and remained closed. She tried again - no luck. I tried my ID, which the doors also rejected.
The big black dog on the gurney turned her head a tiny bit. She looked at me with big liquid brown eyes. She blinked. One of the doctors punched the doors and cursed.
I dropped my bag and sprinted out the first set of doors, around the building (it's a big building), through the also-card-access-only academic-entrance doors, down the picture hallway, through the internal hospital entrance, past the surgery and medicine departments, around by pharmacy and through the waiting room. I met the group trapped in the vestibule from the other side, and we pried the doors apart.
We raced the big black dog through the waiting room and the last set of doors, and down the long hallway to the emergency room. I retrieved my bag and checked in on my surgery patient. When I peered in the ER windows a few minutes later, the ER docs were performing CPR on the big black dog. The minutes lost while fighting with the doors - those minutes mattered.
You guys, I understand that doors are important. It is very, very key that we have systems in place to prevent psychotic humans from rampaging around the vet hospital with violent intentions.
However, we have an emergency room. When there's an emergency, the doors to the emergency room need to motherfucking open. Right?
*so essentially, we need two separate IDs to get into different portions of the hospital after hours.
I hope you're doing well.
I have a horrifying story for you about doors. Ready? Here you go!
A couple of months ago, I was on a surgery rotation. This means I was spending approximately 14 hours per day at the hospital and subsisting on an amusingly tiny ration of sleep. As I stumbled in early one Sunday morning, I noticed several women in scrubs pushing a dog on a gurney towards the hospital doors.
Now, the emergency entrance at the University of Awesome vet hospital is clearly marked. The "EMERGENCY" sign is a helpful beacon for frantic clients who are (understandably) lost in the twisty insane campus roads leading to the hospital.
There's a set of automatic doors that "whoosh" open as you approach, allowing you into a vestibule. Then there's a set of card-access-only automatic doors that let you enter the hospital waiting room. AND THEN there's yet another set of card-access-only (different card needed from the first set of doors*) doors to enter the hospital proper.
I caught up with the ER doctors as they wheeled the gurney towards the automatic doors. We all piled into the vestibule, and one doctor swiped her card for entry. The doors beeped and remained closed. She tried again - no luck. I tried my ID, which the doors also rejected.
The big black dog on the gurney turned her head a tiny bit. She looked at me with big liquid brown eyes. She blinked. One of the doctors punched the doors and cursed.
I dropped my bag and sprinted out the first set of doors, around the building (it's a big building), through the also-card-access-only academic-entrance doors, down the picture hallway, through the internal hospital entrance, past the surgery and medicine departments, around by pharmacy and through the waiting room. I met the group trapped in the vestibule from the other side, and we pried the doors apart.
We raced the big black dog through the waiting room and the last set of doors, and down the long hallway to the emergency room. I retrieved my bag and checked in on my surgery patient. When I peered in the ER windows a few minutes later, the ER docs were performing CPR on the big black dog. The minutes lost while fighting with the doors - those minutes mattered.
You guys, I understand that doors are important. It is very, very key that we have systems in place to prevent psychotic humans from rampaging around the vet hospital with violent intentions.
However, we have an emergency room. When there's an emergency, the doors to the emergency room need to motherfucking open. Right?
*so essentially, we need two separate IDs to get into different portions of the hospital after hours.
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