Sunday, February 24, 2013

A poll.

I have a question to ask.

I have a +1 for banquet. Neither my husband nor my mom can come. I'm probably just going to give it away to someone else in my class who has family coming down. But a thought popped in my head...

My best friend of almost 10 years is going through a rough patch. She's unemployed, she's going through health insurance struggles to get access to medication she needs, her husband just had a death in the family, and she just found out her dad has cancer.

When thinking about people I'd like to have with me on banquet night, she's definitely in my top five. There's no way she could afford to come, though. And as much as I'd like to buy her a plane ticket and treat her to a weekend in the Caribbean, I can't afford it right now due to costs associated with moving back to the U.S.

I realized that a lot of people are turning to online help these days for this sort of thing, and thought that maybe I'd do something similar. Set up a donation account or something. It would only take two dozen people donating $25 to get her here, and then I could cover the rest with food, lodging and transportation.

If I set up something like that, how many of you would HONESTLY donate? You can leave an anonymous comment on this post. Only reply if you would donate, please.


There are three things that mark your time at Ross is at a close:

- 7th semester sales, where we all spread blankets on the lawn and sell our shit because we're getting out of here!
- 7th semester banquet, a night of fancy dresses, unlimited food and an open bar thrown with the money your semester has accumulated through bake sales, selling t-shirts, etc. during your time at Ross. The more money you raise, the fancier your party. Our semester has raised a ridiculous amount of money, so much so that we have extra left over for our graduation party in New York after clinics.
- Transition ceremony, where we celebrate moving into our clinical education by speeches from faculty and being awarded a pair of needle holders with our initials engraved on them.

Just got the invitation to our banquet in my email. HOLY COW GUYS, THIS IS REAL LIFE!

Friday, February 22, 2013

A real doctor now!

Today was stressful, exhausting, and incredibly rewarding.

A couple of weeks ago, my anesthesia partner and I performed our pre-op physical exam on our spay patient. While obtaining a heartrate, his forehead crinkled up and he got a look on his face. He stood up and said, "I think I hear a murmur. Listen and tell me what you think."

When I put my stethoscope to her chest, initially everything sounded perfectly normal. I didn't hear any murmur, but then, all of a sudden, there was a dropped beat. I waited until it had happened a few times before I assured myself that it was definitely a dropped beat and not a respiratory sinus arrhythmia. For the non-medical types in the audience, a RSA is when your heart speeds up and slows down while inhaling and exhaling. It's due to stimulation of the vagus nerve, which runs through the diaphragm. That's not what this was. The heart was not speeding up and slowing down, the rate was steady but every so often there would suddenly be a beat that went completely missing. And then during that time I thought I was hearing a third heart sound - likely what my partner was referring to as a murmur. But I didn't think it was a murmur, because it wasn't constantly present.

I told him that I definitely heard the third heart sound he was referring to, and that I thought she also had dropped beats. We called over a clinician and presented our findings to him. At this point I was thinking that she might have a 2nd degree AV block, but I didn't want to say it out loud because I'm a chickenshit about being wrong. The clinician, though, after listening to her, said he didn't hear anything abnormal. In his defense, it was very loud in that room and the dropped beats were very intermittent with no regular rhythm to them. It's very possible he didn't hear one in the 15 seconds that he listened to her chest. We figured we were just being hyperactive vet students and diagnosing zebras that are actually horses. In this case, an AV block instead of a simple respiratory sinus arrhythmia.

Today, in surgery, as soon as we got our patient hooked up to an ECG it was there, plain as day. Every 9-11 beats there was a P wave with no corresponding QRS. Dropped beats. A second degree AV block. BOOM! My partner and I high fived each other. We had totally diagnosed this just by listening to the patient's cardiac sounds two weeks prior and had a clinician tell us we were wrong. We should have listened to our gut, because we would have been more prepared for what happened next. During surgery her 2nd degree AV block degraded to a 3rd degree, with dropped beats every 2-3 heartbeats and VPCs all over the place (ventricular premature contractions are where the ventricles are desperately trying to compensate for a completely screwed up heart rate by initiating their own contractions instead of waiting for a signal from the SA node). She wound up on a lidocaine continuous rate infusion and she's staying in the intensive care unit overnight for monitoring.

As frightening and stressful as that was, I am over the moon right now. This is what we live for in vet school. That moment when a few of the puzzle pieces that you've been collecting seemingly at random suddenly snap together in a moment of pure, clear clinical understanding.

Wednesday, February 20, 2013

And on, and on, and on...

Still keep all your hands and feet inside the vehicle, kids! 7th isn't slowing down anytime soon.

This past weekend was particularly brutal. I had the FCP spay day from 8am-3pm on Saturday, a meeting with my Grand Rounds group at 5pm, an exam on Monday to study for, and a three hour long clinical pathology rotation on Monday with nine assigned cases to read through, interpret the CBC/chemistry/urinalysis/etc. for, and come up with three Ddx and any other tests we want to run. I was pretty much ready to drop dead by Monday afternoon, but nope! Gotta keep going, because I had to prepare two anesthesia protocols for this Thursday and Friday.

Spay day was super fun, though. I spayed two cats and neutered four more. My third spay turned out to have already been spayed at some point (even though we didn't see a scar). So that was disappointing, but a good learning experience because the surgeon I was paired with showed me how to reassure myself that there really wasn't a uterus in there.

My flight home is booked for April 20th (my mom's birthday). Mama will be joining me, which could be interesting. After that I have six weeks until my start date at University of Illinois. I had thought previously that I would take an externship, but right now I'm leaning heavily toward just resting and recollecting myself. Maybe getting a couple of NAVLE test books and the Nerd Book by Sophia Yin and go into clinics like a rock star, refreshed and ready to kick ass. I just don't see it going well for me if I rush into a four week externship and then to Illinois. As much as I feel lazy for not using six weeks off to do something beneficial for my career, I have to listen to what my body and self-awareness is telling me. And right now it's telling me, "Girl, you need to rest."

Wednesday, February 13, 2013


Like, all nine of you.

So, I accidentally clicked just to the right of my message box on Facebook today and wound up on a page with names that I didn't recognize. I almost clicked back, but then I noticed that all of them began with, "Hi, Julie..." (Except for one that started, "Hey, beautiful..." *shudder*)

So anyway, apparently some of you have been messaging me on FB for months now and I had no clue. I don't know why I don't get a notification when I receive messages from people I don't know. I apologize, I didn't mean to ignore anyone!

In the future, please shoot me an email if you have questions.

Crawling out of my hole.

7th semester is still devouring my life. It's exhausting, frustrating, insane? All of the above.

First off, you have no free time. Exams, surgeries, SOAPing twice a day, labs... It never ends. You're so tired you could fall asleep at any moment, but that's not all. Oh, no! You're going to be constantly on the verge of throwing things and screaming because you get a half dozen conflicting messages from different clinicians about the right way to do things. Oh, and that's after going into a surgery with absolutely zero information about what you're supposed to be doing. In previous semesters, if we had a lab we would have a handout to read through and maybe 1-2 other ancillary materials on top of that (videos, powerpoints, etc.) This semester I have literally not known what I'm doing the morning of a surgery. True story.

I'm one of those people who doesn't do well with uncertainty. I need a schedule, I need clear instructions, and I need to be prepared. Ross is oh-for-three on providing any of those things this semester and I've felt like just sitting down and rocking myself while crying a couple of times.

I feel like this semester is going to be a hellish, wild ride until the last final exam is taken and suddenly I'm brought up hard to deal with the fact that I'm leaving a country and people that I love. And then ALL THE FEELS will come crashing down at once and I'll just sob hysterically in my apartment with my cat. Until then, just power through it and pray clinics isn't like this.

Monday, February 4, 2013

Quickie update.

Been busy. Did an arthrocentesis on a donkey last week, removed my spay patient's sutures today, and later today I have to place an orogastric tube in a cow. Nothing really to talk about. Have a couple of pics, instead.

Laura was looking pretty for her Grand Rounds presentation, so she wanted a picture. I'm not sure why she wanted me in it, too. Maybe to serve as contrast for her prettiness.
Me and Mirissa after our primate research rotation.