Tuesday, August 31, 2010

Orthopedic Surgery 1

Wow, I cannot believe it's been 18 days since my last entry. To catch up, I finished off neurology with some interesting cases, but the communication among clinicians was a little frustrating. We can just leave it at that. I did learn that corneal ulcers as a result of anesthesia, however, do occur, and can progress quickly.

My first week of orthopedic surgery was organized, fun, and a success. I had my first favorite patient, a well-behaved sweet sheltie with a rheumatoid polyarthropathy that needed a bone plate removal. We removed a bone plate that was infected, and the owners were the nicest people. I also repaired a calcaneal fracture on a cat, and even got to drive the IM pin.

Week 2 has started off a little rougher however. Monday we had a very slow caseload, and I was tired from attempting a 5:30 am crossfit class. We were released early and I took a nap, studied for boards and rounds and still went to bed at 9:30. Today I admitted my one patient for a cranial cruciate partial tear (expected), and took on a GDV on emergency (unexpected). Sadly, she was euthanized on the table. I practiced suturing her up by myself and returned her to her owner.

After surgery I was hypoglycemic, tired, and disappointed. Ortho was not suppose to be a sad block and I was expecting a better outcome, despite that GDV is often life compromising. I was so excited to see a surgery, I asked for the case. Afterward, I thought to myself why on earth did I want that case? I enjoyed learning about how to proceed with this surgery and emergency care beyond just passing the stomach tube which I have done in the past. I just could use some more happy outcomes than sad outcomes these days. I am beginning to think I am bad luck in cases with a poor likelihood of recovery.

I truly hope there will be many better days with better outcomes. I may defer treating future dogs named Maggie for a while. I am 0 for 2 in just 2 weeks.

I hope tomorrow has a better ending. Joys of 4th year continue...

Thursday, August 12, 2010

Feast or Famine

This week started off with a bang. On Monday, I had 1 case, but the bureaucracy of a teaching hospital made me run around like a crazy person to work the case up. The dog had disc disease in the cervical spine, but needed an MRI to see if surgery was a viable option. The owners had a hard time deciding if they should do the MRI and put their 15 year old dog, who is otherwise in good health, through an MRI and possibly surgery. They decided to get answers. Two days later en route to the imaging center, however, they turned around and decided his time was done and euthanized him. While I know how much they cared for the dog and the cost was steep, they wrote him off because of age. Old age is not a disease and he very well had 1-2 good years left. It was disappointing and the news came after an even more disappointing Tuesday.

On Tuesday, we admitted a lab for a clinical treatment trial for a brain tumor. The procedure went very well and his recovery from anesthesia went well at first. Two hours after waking up, he had a seizure which we caught early. The second seizure did not respond to valium and we put him on a CRI of propoflo. After 6 hours we took him off the propoflo and he did fine, but 30 minutes later he went into cardiac arrest and died. He died of aspiration pneumonia caused by delayed gastric emptying. It was such a shame to see a dog with a brain tumor die of aspiration pneumonia. The reality of how common this occurs as a complication to anesthetic procedures hit me hard. I really held out hope that he would make a great recovery and live out some time with a shrunken brain tumor. Before the necropsy, I also wasn't sure if it was our fault for not intubating him while he was on the CRI of propoflo. Around 7 pm his heart rate picked up, blood pressure spiked, and his oxygen saturation was low. I knew something was wrong, but the doctors elected that he was okay. I now know it couldn't have been prevented or alleviated. He had a full stomach, but hadn't eaten in 12 hours before surgery, so something else was going on. He was an amazing dog with a dedicated owner and the story was tragic for me.

Besides being exhausted from 13 hour days, I was questioning how I would get through this year on lack of sleep and so much mental stimulation. For the millionth time in vet school, I was wondering "can I do this?"

Of course the latter half of this week our neurology service caseload has slowed down, perhaps someone looking out for me or just pure luck. I appreciate that I had time to process my feelings and get rest. I am terrfiied of surgery next block though, when a day off will cease to exist.

My mid-block evaluation went well. I need to "own" my cases more, and be more independent of the clinician, which has come a long way since last Monday, but has a long way to go. I have no clue how I will be ready to be a DVM in just 9 months. Time to take things just 1 day at a time again.

Sunday, August 8, 2010

Back to Vet School and the "Real" 4th Year

Sadly, my 2 blocks of personal growth and development are over, and so are the fun and games. I am so happy and fulfilled that I had both of those amazing opportunities in China and at the Humane Society, but it was time to learn how to become a doctor. After my first week back, I realized how much I have to learn.

I was humbled by how difficult it was to take an accurate history. I was also so nervous meeting clients and trying to do a complete physical exam in front of them. I missed tons of things, most that were obvious, like the patient was dehydrated. I had major confidence issues that I haven't had since high school and it showed to my clinicians. Most importantly, I have no idea how I will pass boards or be a doctor in less than 3 months and a year, respectively.

On a positive note, my first discharge and SOAP's were pretty good and by the end of the week things were turning around. My shifts in ICU went well since my main exprience was working as an emergency technician. I also really enjoyed following up with clients on the phone.

What makes 4th year so hard is that you are part student, part technician, and part doctor (or trying to be). Who has time to wear that many hats and sleep? It's also hard because your best friends may not be around for the support they provided the 3 years before. This weekend I remembered why my vet school friends are so amazing.

I miss having a life, but I got some reprieve with the terrific Steppin' Out Festival in town with friends Friday and Saturday night and a lazy Sunday with Matt and our dog. It's been 1 year since I brought her home from Washington and she now listens off leash. She is a great compliment to our family.

The hours are long again. I had an 18 hour welcome back Monday and 12 hour days except for Friday. The best part is you're suppose to read for rounds and study for boards on top of that! The truth is compared to surgery, that isn't even as bad as it will get. Finding time and energy to work out or eat was difficult. I will just do my best and take it one day at a time. I will also enjoy neurology since next block is surgery and having a life and sleeping will be harder to do.