bike commuting tips: flat tire edition

Oh hey everyone!

How are you?

This week, I replaced the rear tire on my bicycle. Mostly because I've had three flats in 10 days.


***PRO TIP!*** It's best to replace your tires before they are completely bald. Learning!

overnights are weird:

Overnight student: "Have you heard about the woman that knits out of her vagina?"


fun facts: urine

Today I learned the three absolute requirements for the production of concentrated urine:

1. The presence of ADH and the ability of the kidneys to respond correctly to it.
2. A concentrated renal medullary interstitium.
3. At least 33% of nephrons bringing their A-game.

no no no no no:

Oncologist: "Hi, Alacrity."

Alacrity: "Hey - oh wow, you sound like you have a cold. Are you okay?"

Oncologist: "Yes, this is my phone sex voice."

aging is fun:

The internal medicine resident just turned 30. The other day, he hurt his back for no apparent reason, which led to this helpful conversation:

Neurologist: "I think it's because you're getting older. Aging sucks."

Resident: "Yeah, I don't think it's that."

Neurologist: "Maybe you suddenly have arthritis?"

Resident: "No!"

Internist: "You know, aging is really great. It's like this - your body works just fine until you're about 30 to 33-34, at which point the metabolism switch flips from 'I can do no physical activity for six months and then run five miles without exerting myself' to 'Hey, I ate two pancakes yesterday and now I weigh four hundred pounds'."

Resident: "Thanks, you guys. This is really encouraging."

fun with the pharmacy:

Alacrity: "I'm here to pick up the melanoma vaccine for Sadie."

Pharmacist: "Do you know that Sadie is a horse?"

Alacrity: "Yes...I wrote the prescription."

Pharmacist: "Well, the melanoma vaccine is only labeled for dogs."

Alacrity: "Yes, it is."

Pharmacist: "So you're using the vaccine off-label."

Alacrity: "Yes, I am."

Pharmacist: "Well, a horse is much bigger than a dog."

Alacrity: "Yes."

Pharmacist: "I just have to tell you that you're using this product off-label."

Alacrity: "Yes, thank you. Message received."

pudgy cats are the best cats:

Surgeon: "I'm bringing my cat in on Tuesday."

Alacrity: "YES EXCELLENT! I can't wait to squeeze his fat face!"

Surgeon: "Make sure you squeeze his jungle pouch!"

oh no:

Oncologist: "Wait - shit - I've forgotten my bladder!"


Oncologist: "Now, here's the hooker."

while putting in lab requests:

Oncologist: "I got this new turtleneck that is really slick. It makes me look like a venture capitalist."

Alacrity: "..."

Oncologist: "It's just that the neck is too tight. I put a melon in it to stretch it out. Do you think that will stretch it too much?"



internship tips: style edition, redux

Hey you guys!

It's November.

Specifically November 13th, which means...THERE ARE 25 DAYS LEFT until our collective shit is due for the match!


Anyway! This is obviously the right time to write another intern style guide. As you know, I completed a rotating internship last year. I spent most of my time working in the emergency room and therefore also spent most of my time wearing scrubs.

Right now, I'm doing an oncology-specific internship at a university hospital. The dress code here is different from my last hospital: here, the technicians and surgical residents wear scrubs. The rest of us are required to wear "business attire".

"Business attire" is an excellent idea in theory, but what I wear to the hospital still gets chewed, shredded, and bled upon. Scrubs are designed to be thoroughly abused and still look somewhat decent after you wash them, which is just not true with most normal-person "business attire" garments.

So I wore my scrubs to work for a couple of weeks while I assessed my new professional situation, went shopping a couple of times, and emerged with the following intern "business attire" tips for you:

1. This is your WORK ATTIRE - and you have a messy job.

Don't buy expensive clothes. If you're an intern, let's face it - your take-home pay is about half minimum wage per hour if you divide your salary by the hours you spend in the hospital. If you're able to put any extra towards student loans or saving for an emergency fund, that's much more useful than spending it on your wardrobe.

This is doubly true when you consider that your work clothes will get destroyed at some point. Now that I've accepted this as an eventual inevitability, I'm not upset when a frightened cat tears holes in my shirt or I inadvertently kneel in a pool of blood.

2. Resale shops are your buddy.

Although I love traditional thrift shopping, this is one area where resale shops win. A resale shop is a store that specializes in buying and reselling used clothes/shoes/handbags/accessories that are gently used and still in style.

They can be sickeningly cutesy and geared towards [airquotes] frugal fashionistas [/airquotes], but if you ignore all of that there is often a core selection of serviceable, used (so cheaper), high-quality clothes.

3. All rules that govern scrubs still apply.

You still need to look presentable. You still need to be able to squat, sprint, and turn a cartwheel in your work clothes without hurting yourself or exposing any genitalia. That tight pencil skirt may look awesome, but it's going to make it so very not fun to jump up on the table to do chest compressions.

That being said, skirts and dresses are totally possible. Just make sure you wear opaque leggings underneath.

4. Outdoorsy brands are really good at practical yet classy.

In the Venn diagram of my new work wardrobe, there is significant overlap between the categories of "outdoorsy brands" and "purchased used or >50% off". Brands like Patagonia, Horny Toad, or Icebreaker have clothes that you can ride roughshod over and they (usually) will still look presentable.

Unfortunately, they cost many many dollars when purchased new. If you keep an eye out for these brands at thrift or resale stores, visit outlets, or check out discount websites you can score some sturdy work clothes for a small fraction of their original cost.

5. Figure out the precise terms of your dress code.

For example, I'm very comfortable in jeans and T-shirts. My current dress code prohibits blue jeans - but tapered-leg pants made from black denim (1) are permitted. T-shirts are not allowed, but a lightweight cotton shirt with short sleeves, a lace neckline, and embroidered details along the hem (2) is complimented at each wearing.

Pair 1 + 2 and you're essentially wearing jeans and a T shirt to work. Winning!

orthopedic surgeon, reviewing some radiographs:

surgeon: "Ah, I see the problem. His penis is in his knee."


Hey there everyone! As you may remember, I sold my car when I moved to this new town to begin this odd internship. Here are some things that are pretty awesome about car-free living:

1. Parking is always convenient (bike racks are plentiful and usually covered).

2. My transportation costs are absurdly low:

Car-share membership - $35/year
Bike maintenance - ~$50/year
Gas - $0
Car insurance - $0
Car payment - $0
Car maintenance - $0
Parking (home) - $0
Hospital parking pass - $0

3. I get fresh air and exercise commuting to and from work, complete with the daily challenge of dodge-the-texting-undergrads on the bike path.

4. Biking uses renewable energy - it's powered by me!

5. It's fun to meet other cycling commuters at the bike rack. The seasoned bike folks provide a large amount of useful information, tips, and encouragement for new bike commuters.

adventures in imaging:

Student: "What should I write in the box for 'history' on the radiology submission form?"

Technician: "Fucked."

Student: "...uhhhh."

Alacrity: "...or, you could write 'six week history of intermittent lethargy, collapsed this morning, suspect large splenic mass'."

oh is that it?

Oncologist: "Why aren't you going to the conference, Alacrity?"

Alacrity: "I'm saving for [this other thing], and my budget is pretty tight right now."

Oncologist: "It's really not that expensive. You just have to be clever about it."


oh no please no:

Oncologist: "I consider myself a pearl diver."

on securing a temporary tracheostomy tube:

Criticalist: "You're gonna want to wrap it like this and then reinforce the vetwrap with a piece of tape. Be sure you make an anti-buddy-fucker tab on the end of the tape."

so, reading the treatment sheet is good:

(Technician pokes her head into rounds)

Technician: "Hey Alacrity, can I have the fentanyl and lidocaine so I can start setting up your patient's CRIs while you finish rounds?"

Alacrity: "Oh thank you! That would be awesome. I would like the CRIs diluted in saline please, but I wrote recipes on the treatment sheet. If it's confusing, just leave it for me and I'll set them up in a few minutes."

Tech: "Okay, will do."

A few minutes later, in ICU:

Tech: "Why are you giving this dog so much fentanyl?"

Alacrity: "I'm not-wait, is that straight fentanyl in the syringe?"

Tech: "Yes, that's how we do fentanyl CRIs."

Alacrity: "It's supposed to be diluted in saline! Did you read the recipe that I told you about on the treatment sheet?"

Tech: "No."


veterinary households are weird:

 Here are some things that are true about my place of residence:

1. All the scissors in the apartment are bandage scissors.
2. There is a stethoscope hanging next to the door.
3. Some of my shoes have bloodstains on them.
4. There is a veritable herd of hemostats.
5. The number for the direct line to the ICU is hanging on the fridge.
6. Some of my pants have bleached cuffs.
7. Occasionally, blood tubes will turn up in random locations (such as the bottom of my tool bag).
8. There is an approximately three inch stack of oncology papers on my desk.
9. A fluid rate calculating wheel is peeking out from between books on the bookshelf.
10. You would not believe the number of highlighters.

what the actual fuck:

Oncologist: "I've been wanting an os penis tie clip for some time now. Perhaps this is my chance!"

on changing:

Surgeon: "Yeah, I just change right in my office. I don't cover the window. I figure if someone happens to look in and sees my frighteningly pale ass, they won't look again."

on penises:

Okay, so the other oncology hooligans and I were examining a patient being treated for transmissible venereal tumor (TVT). Whenever we see this dog, we pet him, give him treats, and then sit on him and look at his penis.

Dog penises (as you may know) generally live retracted inside a prepuce. If you want to get a look at the entirety of your patient's genitalia, you need to extrude the penis.

As you might imagine, dogs generally don't like this. Although this dog is very patient with our rude attentions, it's sometimes challenging to get the horse all the way out of the barn.

Our oncologist added some helpful commentary:

Oncologist: "You guys really need to work on your penismanship."

Our response:


no way this could go wrong:

My job is weirdly structured. There's two oncologists, one resident, two technicians, and me in the oncology department. Usually the oncologists are upstairs doing research (but swing by to advise on the cases), and the resident and the more senior technician run the service.

The junior technician and I would love to be involved and consistently try to help, but the resident and senior technician prefer to do everything themselves.

This is wildly frustrating.

This week, both the resident and the senior technician were away on vacation. You can imagine how this went:

The junior technician and I had a really interesting week. It's kind of hard to learn how to do your job if you only get occasional sidenotes on how to do it, which is what happens when the senior people are around...since it takes too much time (? or something?) for them to teach us what they're doing.

So, we both spent the week learning on the fly how to do things like reconstitute and administer chemotherapy. Gaaaaaaaah. You guys, when the big kids get back, I am sitting them down and explaining why this was a terrible idea.


This one afternoon, the technician was diluting out gemcitabine for one dog while I was mixing up another patient's zoledronate. This conversation happened:

Technician: "FUCK! I think I mixed this wrong."

Alacrity: "Wrong how?"

Technician: "I was only supposed to add 300 mg to the bag, but I added all 400."

Alacrity: "Oh. It's cool. We can just figure out the new concentration of the solution, and then recalculate the patient's dose."


Alacrity: "Why am I only supposed to get 2 ml of zoledronate back through the filter, but I'm getting 3 each time? Something is wrong."

Technician: "Yeah, this is all fucked up."

Alacrity: "This is like Beavis and Butthead in chemistry lab."

(hysterical, panicked laughter)


bike commuting tips: accoutrements edition

So, it's September.

This means that it's been two months since I sold my car, during which time I've been moving across the country, starting my new internship, and commuting by bike!

Here's a list of handy items to improve your bike commuting experience:

1. Helmet.

I wear a Bern helmet. There's some debate as to whether or not you're statistically safer on a bicycle when you're wearing a helmet, but I'd rather have an extra layer of protection for my brain just in case something unexpected happens.

I've bonked my (helmeted) head on the ground during unscheduled bike/horse dismounts, and I am convinced that a helmet is a wise investment. Make sure it fits correctly, and replace it if you fall on it or drop it from a significant height.

2. Fenders.

Ohhhh you guys fenders are going to make you so happy when it's raining. With fenders, your wheels won't throw muddy water up onto your clothes. Enough said.

3. Rack(s).

I have a rear rack. Some people have a front rack. Some people have a front rack and a rear rack. You can tie and/or hang shit on your rack(s) so you don't have to stuff it awkwardly in a backpack.

Some people prefer the backpack, though. You do you.

4. Gloves.

You know what's cool about gloves? They keep your hands warm when it's chilly (unless you get the fingerless ones). They look awesome. And...if you ever fall onto pavement or gravel, you'll tear up your gloves instead of your palms. 

5. Rain pants.

Arriving at your destination mostly dry > arriving at your destination with rainwater running into your underwear.

6. Rain jacket/poncho.

See above, re: rainwater running into your underwear.

7. Waterproof/water resistant shoes.

It's pretty amazing how thoroughly wet you can get when you're riding your bike in the rain. Don't neglect your footwear, or you'll be squelching for the better part of your day.

8. Bike locks.

Locking your bike is a whole separate subject for another day, but for starters, I use two locks of different types (U-lock and chain lock) to lock my bike. Both keys go on my key chain, and both locks nestle in one pannier when I'm riding.

9. Pannier(s).

A pannier is a pretty sweet receptacle for whatever you might need to carry with you throughout the day. I have a pair of waterproof Ortlieb panniers that attach to my rear rack, and so far they've done a solid job of carrying:

- Groceries
- Stacks of journal articles
- Extra scrubs
- Lunch
- Extra jacket

I like that my panniers are easy to detach and carry around, and they can carry absurdly large volumes of stuff before the balance of my bike starts to feel weird.

10. Bike lights.

Bike lights help 1) you see in the dark and 2) other people see you in the dark. Both of these should happen as often as possible. Safety!

during medicine rounds:

We're discussing a patient in kidney failure with a heart murmur:

Internist: "Yeah, you have to turn up her fluids."

Resident: "But I'll push her into heart failure!"

Internist: "So?"

Resident: "'So?' You don't care?"

Internist: "I'm a cardiologist, and I don't care. That's why the good Lord invented furosemide."

my gaydar is broken:

Hello you guys!

I hope the summer is treating you well, and that you are enjoying plenty of sunshine and outdoor adventures.

I'm adjusting to my new town and my new internship. This oncology-specific internship is completely different from my rotating internship, and the adjustment has been a bit rocky. Also, the fine inhabitants of this town have completely destroyed my gaydar.

I've met a large number of women who look like this:

or this:



You guys, I went to Smith. I understand that gender identity, gender expression, sexual orientation, and biological sex are all best represented and understood as a set of continua.

And yet...this is blowing my mind. Hooray for diversity! Hooray for destroying my preconceived notions of queerness! Learning!

in the ICU:

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

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

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

in which i am sassy:

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

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

ahhh, university life:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10) There is so much hand sanitizer.

internship tips: food friday edition

Hi there everyone!

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




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

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

As delicious as this sounds, it can be problematic:

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

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

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

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

synonyms, sort of:

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

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

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

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

internship tips: navigating the match edition, part two

Hi there everyone!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


internship tips: navigating the match edition, part one

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Doesn't it sound like fun? Ugh.

internship tips: should i do an internship?

okay, cool:

Cubicle Administrative Person: "In order to activate your university card, you'll have to come by our office. We're open from 8:30 am to 4:30 pm, Monday to Friday."

Alacrity: "So, my workday completely encompasses those hours. Could I activate my card over the phone?"

CAP: "Why can't you just come on your lunch hour?"

A: "I work in a hospital. I don't have a lunch hour."

CAP: "Oh. Well, you just need to figure out a time to swing by."


Technician 1: "Hey, have you seen [the oncologist]?"

Technician 2: "Yes, he's...(looks out window) a kennel?"

(oncology resident walks over to oncologist)

Resident: "Dude! What are you doing?"

(oncologist is cleaning a kennel, wearing slacks and a pressed shirt)

Oncologist (turns on hose): "There's shit here. And here. There's actually shit everywhere."

mmm, delicious:

Alacrity: "So Internal Medicine is in charge of the emergency service these days, about which I'm sure they are super excited."

Oncologist: "Ha! Yeah...can we just make IM deal with all of our shit sandwiches henceforth?"

internship tips: moving across the country edition

Hey friends!

As previously mentioned, I just moved across the country. I've started my oncology internship (which, btdubs, could not possibly be more different from my last internship), and today seems like an excellent day for a collection of moving tips for you:

1) Find a place to live.

It's actually much harder to rent an apartment long-distance than it is when you're moving from one local-ish place to another. Unless you have many dollars, it's probably cost-prohibitive to fly back and forth to look at potential places/meet potential landlords and/or roommates.

Landlords are more reluctant to rent to you (see: what if you see the place and instantly hate it when you get here?), and potential roomies are somewhat hesitant about signing you on (see: she seems okay on Skype, but what if she's actually horrible in person?). It's just easier for everyone to rent to local folks.

So! Jump on that. Search early and often. I'm a fan of craigslist, but others prefer sites with a broader net (such as Padmapper). Decide on your nonnegotiables (no basement apartments? rent < a certain $$? close to school or work), and call/email listings that look promising right away.

2) Get rid of your shit.

No, seriously. You probably have a lot of shit.  If you are legitimately moving across the country (or a similar distance), it's gonna be more expensive if you still have a lot of shit come moving day. Make a "thrift store" box, a "sell" box, a "throw away" box, and get sorting.

3) Decide how you're going to get there.

Are you driving? Renting a moving van? Flying? Flying and selling your car? Flying and shipping your car? Taking the train? Decide which mode of getting yourself to your new city works best for your lifestyle, traveling companion(s), and budget.

4) Decide how your belongings are going to get there.

I'm going to tell you something (as this person has already mentioned) - Amtrak is a secretly excellent way to ship your non-electronic, non-furniture items. I shipped 38 boxes across the continental US, and it cost just under $500. At the time of this writing, the cost was $72 for the first 100 pounds, with each additional pound costing 73 cents.

In theory, you cannot ship more than 500 pounds per shipment - however, at the Amtrak station I used, the gentleman did not enforce this. You also are not supposed to ship furniture or electronics (anything with a cord). The maximum size of a box is 36"x36" - bike boxes are exempt from this, but they count as their own shipment (I'm not 100% clear on the bike rules, as I did not send my Surly on the train). The boxes arrived when they were supposed to, and only one box had some minimal damage. Winning!

5) If at all possible, set aside some funds for the move.

There will be a fair few planned expenses (travel, shipping, +/- hotel, takeout after you pack your kitchen, etc) as well as some surprises. Any cash you're able to save for moving and associated costs will help reduce your panic and make the process a bit easier.


Hey Everyone!

So, some things have happened over the last month or so.

I finished my internship.

I sold my car.


And I moved across the country.


I'm starting an oncology internship at a university hospital, which is super exciting. This is a specialty internship, which is sort of like my last internship except with more oncology and less ER (also hopefully a step towards an oncology residency).

I start tomorrow. Wish me luck!

that's a capital idea:

There's a 5:30 am rush happening in the emergency room. I walk into the next exam room after stabilizing (sort of) several patients who are really sick. This conversation happens:

Alacrity: "Hey, I'm Dr. Alacrity. I'm sorry about the wait. It's been pretty crazy the past hour or so."

Client: "Yeah, you know, when I was in the waiting room, I was thinking, 'These dogs all look much sicker than my dog'."

Alacrity: "Yes, some of them are pretty sick. What's going on with your dog?".

Client: "Well, he just broke his toenail tonight, but it seems to have stopped bleeding. Do you think I can just go to my vet in 2 hours?"

Alacrity: "Absolutely. No need to stop at the desk - have a good morning!"

this is a text conversation I had yesterday with my internmate:

This is right before she came in to work the overnight:

Internmate: How was it today?

Alacrity: Holy shit crazy. [The supervising criticalist] is having a rage storm.

Internmate: Awesome I'm super excited.


this does not bode well:

Dr. Raeqe (criticalist): "I really hate the summer. There's far too much crying. The clients are crying because their pets are sick. We're crying because there's never enough doctors and we're all here until midnight. It's just bad."

weird emergency room skills:

1. Guessing weight.

Hey, that big dog is having a seizure! No time to get it on the scale. Instead, you guess, as in:

That looks like a 45 kilogram dog = 4.5 ml Valium (0.5 mg/kg, 5 mg/ml).

Also useful when you're tapping the sweet Golden's pericardial effusion and she goes into vtach:

That looks like a 30 kilogram Golden = 3 ml lidocaine slowly until she converts (2 mg/kg, 20 mg/ml).

You can also guess weight in multiples of cats. A medium-sized cat is 5 kilograms (12 pounds), so you go:

That dog looks like about the size of 7 cats = 35 kilograms.

2. The ghettecho.

Let's say it's the middle of the night, you have a patient with shitty cardiac output, and an ultrasound. With a little bit of knowledge, you can get yourself a lot of information:

- First, make sure your patient can breathe! Oxygen and sedation are your buddies.

- Once you've sort of stabilized and administered oxygen, Lasix, torb, or other drugs as needed, do a physical. Think about mucous membrane color, lung sounds (are there crackles? wheezes? are they...suspiciously dull or absent?), heart sounds (murmur? arrhythmia? can't hear the heart?), pulse quality (weak? thready? waterhammer? pulsus paradox?), etc.

- Chest x-rays would be pretty great, but your patient might not be stable enough for those yet. You can usually ghettecho while your patient sits or stands in a comfortable position, and you can totally do it through the oxygen cage porthole if needed.

- If your ultrasound has a cardiac preset or probe, use that.

- Figure out how to adjust your depth and gain settings.

- Find the heart with the ultrasound. Sometimes (especially if your patient is hypovolemic) this is harder than you think.

- Is the heart surrounded by a bag of fluid? Heeeey, pericardial effusion! Tap that! (caveat - sometimes you can be faked out by pleural effusion, which looks more like it has sharp corners on flash).

- Okay, next check out left atrial size. You don't need to actually measure it, but is it way bigger than the aorta? Lasix!

- Finally, find the short axis view, and look at ventricular function. The big muscular one is the left ventricle - does it look like it's adequately contracting to move the fluid inside it? If it looks like the walls move towards the center just a little bit, your patient's fractional shortening may be sub-optimal. If the right ventricle (the smaller, curved-around-the-big-muscular-ventricle one) looks really full, think about right heart failure.

- While you're there (if the patient is stable enough), check out the pleural space and the abdomen for free fluid.

The ghettecho is not as useful as a legitimate cardiologist or radiologist echo in any sense of the word, but it does have its place as a middle-of-the-night rough gander at heart function.

3. Euthanizing a wide variety of wildlife.

Ever done an intracardiac stick on a severely injured baby bunny or a tiny bird with a broken leg? It'll make you feel like a terrible person.

4. Standing high jump.

If your patient is larger than a medium-sized cat (see above) or if you are shorter than ~5'10'', you're gonna need to get on the table to do good chest compressions during CPR.

The fastest/least awkward way to do this (the CPR stool is never actually with the crash cart) is to put your hands on the table (while someone else is doing the compressions), vault onto the table in one jump, land (gently) on your knees, and take over.

5. Hitting a moving, challenging target.

You know what's fun? Intubating a healthy dog in sternal recumbency who has just gently drifted to sleep after receiving modest amounts of pre-meds and propofol.

You know what's less fun? Intubating a dog who has arrested in lateral recumbency while wedged between the crash cart and the technician placing the catheter whose head is moving because of the chest compressions while hemorrhagic fluid pours out of his mouth.

so you're at the ER and your pet is really sick:

First of all, I am so sorry if you've ever been in this situation. It is amazingly panic-inducing and sad. Here are some tips on how to expedite your pet's care and how to make your day maybe a little less terrible. First, one really important point:

If your pet is having trouble breathing, unconscious, having a seizure, has been hit by a car, is bleeding profusely, has collapsed, or has classic signs of a life-threatening problem, there is a good chance that a technician will take your pet from you right away.

This is good. Your pet is going to see the doctor immediately.

You will probably be asked to approve a quick verbal estimate for stabilization. It's usually in the neighborhood of $400, and covers the ER exam, a catheter, and some basic treatments and/or bloodwork (such as pain meds and fluids).

At the place where I work, all "stats" (or legit srsly emergency cases) are brought to the ICU right away by a technician. While this happens, the front desk folks have you (the owner) sign a form where you either approve or decline this emergency stabilization.

To be honest with you, for some emergencies I do not wait for this form. If the pet is very unstable, I place a catheter, start basic treatment, and do some free/under the table tests.

For example:

- If your dog is actively having a seizure when it arrives, a catheter and some diazepam to stop the seizure are not optional.

- If your cat was hit by a car and is yowling and miserable, a catheter and some pain meds are not optional.

If at all possible (I know you are panicking at this moment), please sign the form (or verbally approve the estimate), and give the technician or receptionist a one or two sentence insight into your financial situation and goals re: your pet, as well as any known health problems:

For example:

- "Okay, I have about $300 set aside. If this is really bad, I'll probably let him go."

- "He's a diabetic. I can't spend very much but I want to do everything I can for him with what I've got."

- "She just collapsed. Money is no object - I would do anything."

I totally understand if you are completely hysterical at this moment and cannot do any of these things. Just know that it helps me help your pet if (at all possible) you can be decisive, clear and forthright.

Okay, now some general do's:

1) Be honest, as in:

- "I think he got into my stash, doc!"
- "She just ate some rat poison - here's the package."
- "I think she swallowed my brother's Adderall!"

I am not at all concerned about the existence of your stash, your rat problem, or your brother's Adderall. It helps me get the train moving in the right direction faster if you tell me what your dog ate, rather than me trying to figure it out by clinical signs and guessing.

2) Understand that care at the hospital (especially if your pet is critical) is probably going to be expensive.

There is also likely not very much that your doctor can do to influence the cost. At the place where I work, I have maybe 20% influence over the cost of care (this is by both choosing the cheapest tests/treatments I can for whatever problem, and by sneakily sneakily doing some things under the table...shhhh...).

If you're rude to me, the technicians, or the front desk staff, my desire to secretly help you with respect to the bill goes right out the window. If you crumple up the estimate and throw it at me, you're paying full price for everything. If you call me a used car salesman and swear at the emergency technician, you're getting a letter from the HR department.

You can absolutely be angry that it's expensive. It IS expensive, and it sucks. Here is how to get me, personally (other vets are different, obvs) to help you cut cost corners to the best of my ability:

"Oh wow, that's a lot. I understand that it's expensive, and I want to do what I can. I'd really appreciate anything you can do to help keep the cost down."

That sentence (combined with good manners on your part) will get me to try everything I can (as well as enlisting the help of my colleagues on your behalf) to help decrease the cost.

3) Understand that you may be in the ER for a long time.

It's like a human ER - it takes (a variable amount of) time for tests to come back and treatments to happen. Make no mistake, we will have our asses in gear if your pet is really sick, but if she is stable and can chill with her pain meds while we tend to someone sicker, that's going to happen.

We'll be as quick as we can. Sometimes there's a big lineup for radiology, or we're waiting on the on-call surgeon or technician to drive to the hospital. Or there may be four or five dogs/cats sicker than yours, and limited doctors and technicians to tend to everyone.

I try to get pets who will definitely be staying the night or the day booked in for testing so you (the owner) can go home/get some lunch/get some coffee. Please take advantage of this. I will call you with results, or if anything major happens while you're gone. "Oh, well, we'll just wait for the bloodwork/x-rays/ultrasound," often = three or four hours of sitting in the waiting room.

Unfortunately, asking the receptionists to ask me what is taking so long delays whatever you're waiting for by ~5 minutes for every ask, since the receptionist then has to page/find me, ask me what's taking so long, then I have to stop what I'm doing and explain.

I'd say it delays whatever you're waiting for by about ~10-15 minutes if you bother the receptionist enough times that they ask me to come and update you myself. Instead (and more productively for everyone), ask if you can step out for a coffee and have us call you when [tests/imaging] are done.

4) Understand that some services are not available nights and weekends.

We have one radiologist. She works daytime hours, during the week. If you come through the ER for an ultrasound at 11pm on a Friday or 4pm on a Sunday, ultrasound is not an option until the radiologist is back in the hospital.

This is okay if your dog is here with a possible intestinal obstruction, since x-rays are always available. We also have the flash ultrasound to find free fluid in places where it shouldn't be. However, if you're coming in for chronic gastrointestinal problems or because your primary care vet said, "Hey, the next step is an ultrasound," do yourself a favor and call ahead to see if that's an option today.

I have also had folks ask me in the middle of the night which internal medicine specialists are available right now for consultation. The answer is: none of them, you've got the overnight doc until the morning.

Most specialists work daytime hours, during the week. Some criticalists work on the weekends, and there's always a surgeon on call for surgery/an internist on call for emergency endoscopy, but no specialist is seeing regular appointments or doing consults at 4am.

5) Know your pet's medical history, and what medications (and doses) your pet is currently taking. You can bring the bag of drugs if you need to.

And here's some general don'ts:

1) Don't be mean.

I understand that you're very stressed +/- angry +/- sad. These are legitimate feelings. We are all trying to help make your pet well or help you let him/her go. You are welcome to be stressed/angry/sad. However, you may not abuse me, the technicians, or the front desk staff. If you need a minute to go scream or cry outside, that's totally okay.

2) Relatedly, don't accuse us of being money-hungry or only in it for the cash.

There are numerous articles on the interwebs detailing the approximate cost of a veterinary education (~$250,000-$300,000, not including undergrad). The average starting salary of a veterinarian is hilariously less than that. If you're doing an internship, your salary is likely miniscule.

We're not in it for the money. It's insulting to suggest that we are. Also (see point 3, above), it makes us less inclined to help you catch a financial break in whatever ways we can.

3) Don't freak out if we don't have the records from your primary care vet.

I once had a guy refuse to let me treat his cat (the cat was having trouble breathing) because I didn't have his vet's records. The vet had faxed over the records (but for whatever reason only the first page had arrived) and the vet's office had since closed for the day.

This is insane.

You guys, obviously it is ideal and helpful to have good records, but we operate without them all the time. Unless you brought your own copy with you, I don't get any primary care vet records when I take in cases at night or (for most clinics) on the weekends. We can get them in the morning.

Also, your ER vet is also a vet, and can probably also figure out what is wrong with your pet. Refusing to allow your pet to be treated for this reason is profoundly counterproductive and crazy. Don't be that guy.

Also, if your pet has a relatively rare condition (hemophilia, some uncommon cancers, unusual genetic problem), know the name of the condition (see point 5, above) and how (if) it's currently being treated.

4) Don't automatically reject differences in veterinary opinion.

There are about as many opinions on how to practice medicine as there are veterinarians (possibly more). If your ER doctor suggest something different than your primary care veterinarian, this does not mean that one of the two is necessarily crazy, untrustworthy, or wrong.

If you don't understand the difference, ask. We're happy to explain.

Relatedly, complementary medicine (acupuncture, herbal remedies, et cetera) is really excellent for some things. Western medicine is really excellent for some other things. Some times the circles on that Venn diagram overlap, and sometimes they don't. If your pet has a bleeding tumor in his belly, the Yunnan Bai Yao may help slow the bleed, but he likely also needs a blood transfusion and surgery to remove the mass.

5) Don't panic too much - although it's scary, your pet is in good hands.

Although this may be the first time your dog has been hit by a car, your cat has developed a urinary obstruction, or your puppy ate the entire stash of baker's chocolate, she/he is likely not your vet's first HBC, UO, or chocolate tox. And if it is (heeeeeey, new interns!), there's someone looking over her shoulder making sure she stays on track.

too many cooks in the kitchen, redux:


Alacrity: "What?!?"

ER doctor: "It's just...every single person in this hospital is in my butthole right now, and it's kind of stressing me out."

Alacrity: "Ah."

on the overnight:

It's 1 in the morning. I walk into radiology, where the scrappy ER tech is wrestling with a ~75lb dog who is flailing on the table. He's holding an uncapped syringe and needle in his mouth.

Alacrity: "Hey, do you want me to take this uncapped syringe and needle out of your mouth?"

Tech: "Mrrrrmmmph!"

Alacrity: "Dude, this night is going to get way worse if you inadvertently sedate yourself."

ER doctor, singing:

"Na-na-na-na-na-na-na-na....BABY BUNNY!"

criticalist (calmly) to the radiologist:

"I will punch you in the ball sack."

a veterinarian friend of mine, about the location of his job:

"It's pretty much in an ideal spot. It's 200 feet from the beach. It's 100 feet from the gay bar."

i can't unthink that:

Radiologist: "Hey, you know what a quince is?"

Alacrity: "No."

Radiologist: "They're a fruit. They look like Big Bird's testicles. If birds had testicles. On the outside."

mental blocks:

Okay, so you know how there are some things that you should be able to remember, but for whatever reason you always forget/are bad at them? Yup, you know. Here are (some of) mine:

1) Neurolocalization/most of neurology, actually.

Sometimes I try to chalk this up to never having a neuro rotation in vet school, but that's not it. I mean, I can generally sort out "brain problem" from "neck dog" from "back dog" from "lower lumbar dog", but most of the time the rounds-pimping by the neurologist goes like this:

Neurologist: "Okay, so what else could cause [these signs]?"


(neurologist kicks me under the table)

Alacrity: "Neoplasia."

Neurologist: "Yes. What else?"


Alacrity: "Inflammatory disease."

Neurologist: "EEEHHHH wrong. What else?"

Haaaa fun times! Also, if we're in vestibular-land, I have a bugger of a time sorting out central vestibular (unless the dog has other central signs) from peripheral vestibular (unless the dog has gross ears) +/- paradoxical vestibular (what even is this really).

2) Acid/base.

THIS SUCKS. You know, I've read my vet school acid-base notes an embarrassingly large number of times (and worked through this handy acid/base practice simulator developed by the University of Awesome's engineer-turned-criticalist) and I still internally panic every time I go to read a blood gas.

3) Reading thoracic x-rays.

I'm starting to get better at this one. Dr. Nell (radiologist) has taught the intern herd some quick tricks to help get through the overnights, and I'm hopeful that (with practice and epic mistakes along the way) I'm improving.

I secretly want to be better at this, not only because it's an important workplace skill but also because queers are supposed to be good pattern-recognizers. Think about it! If your dating life depends on good pattern-recognition skills (read: gaydar), you'll get good at it. And radiology is exactly that.

the more you know...

In rounds this morning:

My boss: "Wait everybody! This is important. How would you survive on a desert island with nothing but a Bic pen?"

Overnight doctor: "Hey, can we move along?"

My boss: "No. How would you survive?"


My boss: "You would use the shaft of the pen to funnel salt water into your butthole! Your colon would absorb the water, but not the sodium or the chloride. You could drink without getting salt poisoning. Cool, huh?"

wtf why:

So, this happened in the ICU the other day:

ER doctor: "Alacrity! Come here!"

Alacrity (comes over): "What?"

ER doc: (drops a pubic hair in my palm) "Here."

Alacrity: "Is this a pubic hair?"

ER doc: "I think so. It's not mine. Is it yours?"

calling for help is fun, redux:

I just finished another set of overnights, and on one of these overnights, I had a 75 kg dog come in with a gastric dilatation and volvulus (GDV). He was huge, he was adorable, and he needed to go to surgery immediately. So I consulted the on-call schedule, and called the resident on call:

Resident: "Hello?"

Alacrity: "Hey dude, I have a GDV."

Resident: "Okay...I'm in Texas."

(Note: our hospital is nowhere near Texas. It's approximately half the country away from Texas.)

Alacrity: "How are you on call if you're in Texas?"

Resident: "...I don't know."

Alacrity: "Okay, I'll call the other resident."

Now the other resident was not on call (duh), and was at a bar singing karaoke (like you do when you're not on call). So I called the surgeon who was working the OR today, and the guy who is technically on back-up call for the resident:

Surgeon: "Hello?"

Alacrity: "Hey, sorry to wake you up. I have a GDV, and James is in Texas. Would you mind coming in?"

Surgeon: (pause) "Well, who's the primary on-call?"

Alacrity: "James."

Surgeon: "How did this happen? How can James possibly be on call when he's in Texas?"

Alacrity: "I don't know."

Surgeon: "Well, this is just ridiculous! Why wasn't this taken care of ahead of time?"

Alacrity: "Look, man, I don't know. I just have this GDV that needs to go to surgery. Are you in, or do you want me to call someone else?"

Surgeon: (sigh) "Fine. I'll come in."

what should we call Alacrity on surgery rotation?

Watching a TECABO:

"Hey Alacrity, can you set up the minidriver?":

Watching the surgeon cut through the tibia:


banana, redux:

I'm at an upstairs cafe-like space in a multi-level, quirky, pedestrian mall.  A tomboi-ish person several tables over from me just methodically ate three bananas in a row, and then came over to give me the wireless password to "the best network in the building".


many cooks, small kitchen:

Hiiii Everyone!

So I'm just finishing up with one of my surgery rotations. My internship is a rotating internship, which means I spend different weeks working in different parts of the hospital. I'm mostly on ER, occasionally on surgery, occasionally on medicine, and occasionally on elective time (which includes things like radiology, oncology, and ophthalmology).

Surgery is the scarier for me than ER. Actually, surgery is scarier for me than overnights. I think it's because there are SO MANY THINGS that can go wrong in surgery, and although this is also true on ER, it's far more frightening for me when I'm in the operating room. Dog with pericardial effusion? Okay, I'll tap that. Heart failure cat? Heeeeeey lasix, ghett-echo, and oxygen (and some other stuff later)! But if I'm holding the scalpel? Better not fuck up...

 Also, I pass out sometimes. On my very first day of my very first surgical rotation of my internship, I passed out in a surgery on a dog with carpal valgus. The anesthetist's hands were full as I started to fall, so he caught me by lodging his foot between my ass cheeks, then guided my head to the ground once he freed his hands. Then I crawled out of the room so I wouldn't vomit in the orthopedic OR.

Anyway! The other day, I was draining this dog's abscess. This happened:

Surgeon #1: "Okay, I think you should lance the abscess like this, and then place the drain with the exit hole here, then tack it to the other side like this." [walks away]

Surgeon #2 strolls by, says: "Hey, why are you placing that drain like that? That's not how I do it. I would place the drain like this [shows me a different way], and tack it here like this."

Resident comes over, says: "Dude, why are you placing a drain? I would have just removed this whole abscess en bloc."

Resident #2 comes over, looks, says: "Ooooh. Oh, why are you doing that?"

Surgeon #1 returns: "Alacrity, why are you placing the drain that way? I would have used a much shorter piece, and placed it like this."


Surgical technician, running anesthesia: "Baaaaaahahahaha that was awesome!"


the current contents of my messenger bag:

1. Loaf of sourdough bread in paper bag.
2. Lecture handout on thyroid disorders.
3. Several receipts.
4. T-shirt.
5. Stethoscope.
6. Box of thank-you cards.
7. Plastic grocery bag.
8. Blue and purple bandanna.
9. Nail (the kind you hammer).
10. Pencil.
11. Several highlighters.
12. Pen.
13. Scrub cap.
14. Thompson's Small Animal Medical Differential Diagnosis.
15. Several cough drops.
16. Checkbook.
17. Stamps.
18. Unlabeled blood sample.
19. Chapstick.
20. Hemostats.
21. Wallet.
22. Pair of earrings.
23. W2.
24. Landlord's business card.


Sometimes when I work the overnight shift, my internal quirks blossom in ways that are amusing and hard to understand:

Every day around 5 pm, the day doctors round the overnight doctor before they leave. This means if I am the overnight doctor, each day doctor gives me a rundown on each of their inpatients. It's good to write down the details so I don't have to try to remember them when, later, the dog in ICU 7 starts randomly having seizures (or whatever).

There are usually 25-30 patients staying the night, and I am receiving new ERs while keeping an eye on them. Fun!

Everyone does it differently. I sit down and write a bullet-pointed list of the facts that come out of each day doctor's mouth while she is talking. If a particular day doctor is not here the next morning to re-take over her patient (say, she has the day off), I have to know enough about the patient to intelligently round the new group of day doctors.

If you think this sounds like a game of telephone, it's because it's exactly what it is. Except you cannot let the message mutate. Yaaaaaay!

One morning at rounds, I was talking about a patient when I realized that (for an unknown reason) I had written "to go home banana" on my list of facts.

I'm not sure what that meant. Perhaps I was hungry at the time?

overhead pages, translated:

1. "Emergency tech to reception for triage."

Someone is here to see us!

2. "Emergency tech to reception STAT." (bored voice)

The spaniel who ate a bag of chocolate chips is here, and he looks quite pleased with himself.

3. "Emergency tech to reception STAT!" (frantic voice)

Someone is here and they are dying. Or, the owner is hysterical.

4. "Emergency tech to reception STAT WITH A GURNEY!"

A large dog is here and is actively dying.

5. "Emergency tech to reception for a room 6 triage."

A potentially contagious patient is here.

6. "Emergency tech to reception for a triage. Emergency tech to reception for a second triage. Emergency tech to reception for...four triages."

Everyone has just arrived home from work. Or the football game ended. Also, the next hour or so is going to be awesome.

7. "Emergency tech to reception STAT! Emergency tech to reception for a second STAT! Emergency tech to reception STAT!"


8. "Kennel assistant to reception for a cleanup."

Someone has pissed, vomited, or shat upon the floor.

9. "Any available emergency doctor to the ICU."

There is a case that needs a doctor and everyone is busy and/or hiding.

10. "Dr. Raeqe (criticalist) to the ICU, STAT!"

A patient is dying.

11. "Dr. Alacrity to the ICU, STAT!"

Specifically, my patient is dying.

12. "Any available emergency doctor, please call the front desk."

This could be one of three things:
- A person is calling for test results or a prescription.
- A person is calling about a recently discharged pet who is [doing something concerning]. Does the pet need to be rechecked right away?
- A person is calling because their pet ate [something strange] or is [doing something concerning]. Does the pet need to be seen?

13. "Any available intern, please call the front desk."

The front desk has a particularly onerous and/or menial task to assign.

14. "Dr. Alacrity, [your boss] is holding on line 1 for you."

1. SWEET! She is calling me back with advice on this diabetic dog with a septic abdomen and cancer who I just admitted.
2. I'm about to get scolded for an unknown mistake.

intern adventure day:

Our boss gave the interns all the same day off one day in January, at approximately the midpoint of the internship. The other doctors in the hospital (kindly) chipped in to ensure that we all got to leave a little early the day before.

This was so we could drive to a local resort casino, where we had rented rooms for the night.

The surgeon instructed the surgery intern to leave early after all the surgeries were done. This happened:

Surgeon: "Okay, get on your way. I'll finish up here. Thanks for your help today."

Intern: "Thanks! I SOAPed everyone and hung the treatment sheets for tomorrow. All that has to be done is rounding the overnight doctor when she gets here."

Surgeon: "Rounding the overnight doctor?"

Intern: "...yes?"

Surgeon: "Okay...wait, who's in the hospital?"

ECC resident:

"I've seen labs poop out t-shirts."

you know what's fun? calling for help is fun:

1. The right time to call the on-call surgeon is highly surgeon-dependent.

Dr. Fox wants to be called when the dog is 15 minutes from being in the OR, fully cleared for surgery, deposit paid, anesthetized, and not a moment before. He has no time for your "so...I might have a back dog" bullshit. He only cares if he needs to put on his scrub pants in the next half an hour.

Dr. Roman wants to be called when you miiiight have a septic abdomen. Then he wants to be called when the dog is an hour from being in the OR.

Do not mix this up. 

2. "On call" is a flexible term:

Got a surgery? Call the on-call surgeon. Sometimes this person is an ER doctor who is comfortable performing emergency surgery.

Unless it's a back dog, a septic abdomen, or an open chest. Then you have to call the actual surgeon, who is whichever surgeon was scheduled in the OR that day.

Unless the third year resident is on call. That guy can cut whatever.

I'm not sure what you do if the on call spot is blank on the schedule. That's fun.

3. "On call" is a flexible term, redux:

You can call the exotics specialist, the criticalists, the surgeons, and sometimes the ophthalmologist in the middle of the night. The neurologist wants you to call the criticalist instead.

The criticalist wants you to call the ECC resident. Unless the first year resident is on call, then she wants you to call the resident first (so she gets the experience of being called at 3 am) and then her. Unless it's really busy, in which case you can just call her. Or if it's about one of her cases. Or you can call the third year resident who is essentially always on call anyway.


cardiologist, emphatically:

"If you remember just ONE thing that comes out of my face during this internship, it should be this: 99% of murmurs discovered in cats are due to dynamic outflow tract obstructions."