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."
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.
and no Tyvek suits were worn:
Chief of Service: "Okay, let's go up to isolation."
(we are in the middle of doing our morning walk-around rounds, where we go check on all the patients as a group and see how they are doing)
Resident: "Oh, we don't have any patients in isolation this morning."
Chief: "We seriously don't have any patients in isolation?"
Resident: "Nope. Let's go to C barn."
Chief: "Wait, can we just take a moment to relish how we don't have any patients in isolation? How did this happen?"
(we are in the middle of doing our morning walk-around rounds, where we go check on all the patients as a group and see how they are doing)
Resident: "Oh, we don't have any patients in isolation this morning."
Chief: "We seriously don't have any patients in isolation?"
Resident: "Nope. Let's go to C barn."
Chief: "Wait, can we just take a moment to relish how we don't have any patients in isolation? How did this happen?"
to do list:
Oh hi everyone!
I've been on the Large Animal Medicine service for a couple of weeks now. We've had colicky horses, septic foals, some horses with cancer, and the occasional neonatal calf. It's been a party!
Our resident decided to start making a daily to-do list on the white board with all of our patients and their plan for the day. The plan can include tasks we need to do to the patient, or milestones we hope they accomplish. The list says things like,
"Buttercup - draw blood, take thoracic radiographs, collect fecal"
or:
"Daisy - start eating again"
Here's the Thursday plan from a very pregnant goat that has evidently decided not to give birth, ever:
Another day spent waiting fruitlessly for tiny goatlings. Sigh. Perhaps tomorrow.
I've been on the Large Animal Medicine service for a couple of weeks now. We've had colicky horses, septic foals, some horses with cancer, and the occasional neonatal calf. It's been a party!
Our resident decided to start making a daily to-do list on the white board with all of our patients and their plan for the day. The plan can include tasks we need to do to the patient, or milestones we hope they accomplish. The list says things like,
"Buttercup - draw blood, take thoracic radiographs, collect fecal"
or:
"Daisy - start eating again"
Here's the Thursday plan from a very pregnant goat that has evidently decided not to give birth, ever:
Another day spent waiting fruitlessly for tiny goatlings. Sigh. Perhaps tomorrow.
and exactly zero fucks were given:
Okay, so the medicine service called this ambulatory clinician bright and early on a Saturday to go see a lethargic pig with a VIP (read: big donor to the vet college) owner. Her response can be roughly paraphrased as:
"It's out of my fucking call radius. The pig needs to come to the hospital."
"It's out of my fucking call radius. The pig needs to come to the hospital."
that's definitely a compliment:
fellow student, about one of the wizened old ambulatory clinicians:
"She is basically boarded in the specialty of 'weird practical shit'. There is a small chance she will kill your animal. But she's really fucking brilliant.""
"She is basically boarded in the specialty of 'weird practical shit'. There is a small chance she will kill your animal. But she's really fucking brilliant.""
the pen is mightier than the (whatever):
Let's talk about pens.
Pens are obviously necessary, and I lose them all the time. So does everyone else. Mostly they fall out of my pockets, or I set them down somewhere and then forget them. Or a resident takes my pen and never gives it back*.
Occasionally, pens fall into the enterotomy bucket. And sometimes (apparently) this happens:
I'm not entirely sure how. Anyway! I've developed some rules about pens.
Alacrity's Six Rules of Pen Management and Lending:
1. Have multiple pens. The composition of a good pen-stable is outlined herein:
2. At least one should be your "good pen" - the one that always works, feels good in your hand, and never explodes in your pocket. Guard this pen closely. My good pen is a Pilot G2 Gel Ink Retractable Fine Point (0.7 mm) pen. NEVER LEND YOUR GOOD PEN TO ANYONE. Others should not know that you have a good pen. It is a mythical creature that only appears to write sympathy cards or take notes in rounds when you want them to be legible. This rule is nonnegotiable. Keep the good pen in a separate pocket if you need to. It does not leave your person.
3. Two (or more) should be "average pens" - these are acceptable, functional pens, but they are decidedly not in the league of awesome. Mine are free pens from the bank and the urgent care center. You can lend these pens to others, but only if they need it for a second and/or are highly trustworthy.
4. Lastly, have a truly shitty pen. This pen either feels really awkward in your hand or is otherwise irritating to use in some way. It should at least nominally work, because this is your first-in-line pen to lend to people who are likely to steal it. While you don't want to (in good faith) lend a high-risk candidate a totally non-functional pen, you should by all means lend out the pen that you'd most like to cull from the pen-herd.
5. When lending pens, do your best to supervise their use. Ask for them back (yes, even from the chief of service). If a repeat borrower has stolen pens in the past, they get the shitty pen (if they get lent a pen at all).
6. Do not set your pens down in public spaces. An unattended pen is a free pen!
*One of the ophtho residents is a renowned pen-stealer. My pen was gone within the first five minutes of seeing appointments on the first day of the rotation. The ophtho tech purchases a steady supply of pens particularly for this guy.
Pens are obviously necessary, and I lose them all the time. So does everyone else. Mostly they fall out of my pockets, or I set them down somewhere and then forget them. Or a resident takes my pen and never gives it back*.
Occasionally, pens fall into the enterotomy bucket. And sometimes (apparently) this happens:
I'm not entirely sure how. Anyway! I've developed some rules about pens.
Alacrity's Six Rules of Pen Management and Lending:
1. Have multiple pens. The composition of a good pen-stable is outlined herein:
2. At least one should be your "good pen" - the one that always works, feels good in your hand, and never explodes in your pocket. Guard this pen closely. My good pen is a Pilot G2 Gel Ink Retractable Fine Point (0.7 mm) pen. NEVER LEND YOUR GOOD PEN TO ANYONE. Others should not know that you have a good pen. It is a mythical creature that only appears to write sympathy cards or take notes in rounds when you want them to be legible. This rule is nonnegotiable. Keep the good pen in a separate pocket if you need to. It does not leave your person.
3. Two (or more) should be "average pens" - these are acceptable, functional pens, but they are decidedly not in the league of awesome. Mine are free pens from the bank and the urgent care center. You can lend these pens to others, but only if they need it for a second and/or are highly trustworthy.
4. Lastly, have a truly shitty pen. This pen either feels really awkward in your hand or is otherwise irritating to use in some way. It should at least nominally work, because this is your first-in-line pen to lend to people who are likely to steal it. While you don't want to (in good faith) lend a high-risk candidate a totally non-functional pen, you should by all means lend out the pen that you'd most like to cull from the pen-herd.
5. When lending pens, do your best to supervise their use. Ask for them back (yes, even from the chief of service). If a repeat borrower has stolen pens in the past, they get the shitty pen (if they get lent a pen at all).
6. Do not set your pens down in public spaces. An unattended pen is a free pen!
*One of the ophtho residents is a renowned pen-stealer. My pen was gone within the first five minutes of seeing appointments on the first day of the rotation. The ophtho tech purchases a steady supply of pens particularly for this guy.
the prepuce is not the umbilicus:
student, after another student hurriedly clamped the wrong dangly structure on the newborn bull calf (wooo, he woke up fast):
"Yeah, I guess if you put a pair of Ochsners across my penis, I'd wake up fast, too."
"Yeah, I guess if you put a pair of Ochsners across my penis, I'd wake up fast, too."
that's unfortunate:
crossfit coach:
"Ah, medball cleans. I mindfuck myself every single time I do medball cleans."
"Ah, medball cleans. I mindfuck myself every single time I do medball cleans."
a sheltered life, indeed:
I just finished another general practice rotation, and our first week was pretty slow.
Therefore, I spent a lot of time calling owners to check up on their pets and researching various clinical pathology oddities. It was great! I learned many things.
During one of our nonbusy periods, I found myself in an odd conversation with the head clinician of the hospital-affiliated general practice. Now, he's a shy, curmudgeonly, blindingly clever man who commands great respect throughout the hospital. He is fantastic. His skills are insane - he's the sort of guy who could detect a mildly dilated ureter via abdominal palpation. He is the stuff of which legends are made.
On this particular instance, he told me about how his first exposure to marijuana was when a student fed him a pot brownie. Oooohhhh let me tell you how much I wish I could have seen that happen!
Then, he waxed lyrical on how he's led a pretty sheltered life, in that he's never been streaking. However, he did once swim naked across a large lake with a lit cigar in his mouth.
I think it was at this point that another veterinarian walked over and asked us wtf we were talking about (which was a legitimate response to overhearing this conversation, I think). Hooray for storytime!
Therefore, I spent a lot of time calling owners to check up on their pets and researching various clinical pathology oddities. It was great! I learned many things.
During one of our nonbusy periods, I found myself in an odd conversation with the head clinician of the hospital-affiliated general practice. Now, he's a shy, curmudgeonly, blindingly clever man who commands great respect throughout the hospital. He is fantastic. His skills are insane - he's the sort of guy who could detect a mildly dilated ureter via abdominal palpation. He is the stuff of which legends are made.
On this particular instance, he told me about how his first exposure to marijuana was when a student fed him a pot brownie. Oooohhhh let me tell you how much I wish I could have seen that happen!
Then, he waxed lyrical on how he's led a pretty sheltered life, in that he's never been streaking. However, he did once swim naked across a large lake with a lit cigar in his mouth.
I think it was at this point that another veterinarian walked over and asked us wtf we were talking about (which was a legitimate response to overhearing this conversation, I think). Hooray for storytime!
my first pride, part 2:
Okay, so after my Friday night adventures, I slept for approximately three hours before waking up to get ready for EMT class.
Before going to the parade and associated Pride festivities, I had to attend a vehicle extrication training at a local fire house that began around 7 am.
For those of you who haven't had this particular adventure in emergency medical training, this is a step-by-step guide to replicating exactly what happened:
1. Get lost on the way to the firehouse, which is located in a rural wrinkle of western MA far, far from the land of cell phone reception.
2. Find the firehouse. Sit with my classmates and several burly firemen. Listen to a safety presentation. Eat a donut.
3. Watch a team of firemen cut apart a car with hydraulic tools.
4. Team up with two other classmates.
5. Sit in the front seat of my car.
6. Get collared, buckled into a KED, and hauled out onto a backboard by said classmates.
7. Repeat the procedure with a different classmate sitting in the seat.
8. Repeat again. Get timed this time by the instructor. Nearly drop classmate to shouts of "FIVE MINUTES, PEOPLE! This should take you FIVE MINUTES!"
9. Lock my keys in my car.
10. Call AAA. Learn that AAA doesn't respond to this particular part of the state, and definitely not on Saturday morning.
11. Release a quiet torrent of profanity.
12. Eat another donut.
13. Convince two of the firemen to try to break into my car.
14. The firemen succeed. My classmates cheer!
15. Return to Northampton. Get lost again on the drive back.
Once I had gotten myself unlost and had safely nestled my car back in the student parking garage, I raced back to my room to get changed for the festival. I had arranged to meet my buddies Robin and Bryce downtown, and due to the morning's shenanigans I was running somewhat late. I hurried towards the big cluster of white tents in my skirt and sandals, and caught up with Robin and Bryce next to one of the food trucks. Bryce bought a giant plateful of funnel cake. I stole a piece.
Ohhhhh the Pride festival was glorious. There were more flavors of queerfolk than you could imagine. There were dainty gay boys in tight-fitting tees and fancy jeans, enormous hairy yet benevolent-looking bears comparing their leather trappings, and one wizened gnome-like fellow in a wheelchair with a sign proclaiming his gayness (for 86 years and counting!).
I admired the fancy femmes in their flouncing sundresses paired with peep-toe heels, and quietly lusted after a pair of butches in muscle shirts that perfectly highlighted their tattoos. Bryce had to drag me away from the EMT tent, where a tall, slender policewoman with curly black hair was talking to a stocky, twinkly-eyed EMT. Women in uniform get me every. single. time.
We lazily strolled through the rows of tents while Bryce's little black dog frolicked around our feet. The dazzling sun played over our shoulders, and when we got too hot, we ducked into an activist organization tent to sign up for politically-themed newsletters. We ran into numerous friends, who we greeted with hugs and "Happy Pride!"s. I lingered so long at the festival with Bryce and Robin that I had to hurry back to campus to change for the two dance parties later that night!
Before going to the parade and associated Pride festivities, I had to attend a vehicle extrication training at a local fire house that began around 7 am.
For those of you who haven't had this particular adventure in emergency medical training, this is a step-by-step guide to replicating exactly what happened:
1. Get lost on the way to the firehouse, which is located in a rural wrinkle of western MA far, far from the land of cell phone reception.
2. Find the firehouse. Sit with my classmates and several burly firemen. Listen to a safety presentation. Eat a donut.
3. Watch a team of firemen cut apart a car with hydraulic tools.
4. Team up with two other classmates.
5. Sit in the front seat of my car.
6. Get collared, buckled into a KED, and hauled out onto a backboard by said classmates.
7. Repeat the procedure with a different classmate sitting in the seat.
8. Repeat again. Get timed this time by the instructor. Nearly drop classmate to shouts of "FIVE MINUTES, PEOPLE! This should take you FIVE MINUTES!"
9. Lock my keys in my car.
10. Call AAA. Learn that AAA doesn't respond to this particular part of the state, and definitely not on Saturday morning.
11. Release a quiet torrent of profanity.
12. Eat another donut.
13. Convince two of the firemen to try to break into my car.
14. The firemen succeed. My classmates cheer!
15. Return to Northampton. Get lost again on the drive back.
Once I had gotten myself unlost and had safely nestled my car back in the student parking garage, I raced back to my room to get changed for the festival. I had arranged to meet my buddies Robin and Bryce downtown, and due to the morning's shenanigans I was running somewhat late. I hurried towards the big cluster of white tents in my skirt and sandals, and caught up with Robin and Bryce next to one of the food trucks. Bryce bought a giant plateful of funnel cake. I stole a piece.
Ohhhhh the Pride festival was glorious. There were more flavors of queerfolk than you could imagine. There were dainty gay boys in tight-fitting tees and fancy jeans, enormous hairy yet benevolent-looking bears comparing their leather trappings, and one wizened gnome-like fellow in a wheelchair with a sign proclaiming his gayness (for 86 years and counting!).
I admired the fancy femmes in their flouncing sundresses paired with peep-toe heels, and quietly lusted after a pair of butches in muscle shirts that perfectly highlighted their tattoos. Bryce had to drag me away from the EMT tent, where a tall, slender policewoman with curly black hair was talking to a stocky, twinkly-eyed EMT. Women in uniform get me every. single. time.
We lazily strolled through the rows of tents while Bryce's little black dog frolicked around our feet. The dazzling sun played over our shoulders, and when we got too hot, we ducked into an activist organization tent to sign up for politically-themed newsletters. We ran into numerous friends, who we greeted with hugs and "Happy Pride!"s. I lingered so long at the festival with Bryce and Robin that I had to hurry back to campus to change for the two dance parties later that night!
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