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.

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.

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.

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.

via flickr - supertroopers
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?

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."


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?"


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?"


8. "I'm taking her to another hospital because I read bad reviews of this place on the internet."


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."

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."

on the triage board:

chief complaint: "Lethargic post-swamp adventure"