Tuesday, May 3, 2011

Small Animal Medicine rotation

I have just surfaced from the three weeks of my Small Animal Medicine rotation, in which I worked with Internal Medicine specialists. This is widely known as the most stressful of the core (required) rotations. I will sort of miss the reactions that I got when I ran into a classmate in the hallway and they asked conversationally, “So what are you on?” When I told them, I got a respectful “Ohhhh.”

I got up at 4 am. It takes me an hour and a half to get out of the house now that I have the high energy puppy to exercise in the mornings; I had to do this with a flashlight so that I could see the ball when she retrieved it. I arrived on campus around 6 am, just as the sun was coming up. Before 8 am, I had to do physical exams on all my patients, do their morning treatments, review their test results from the previous day, and write up my assessment of their status, my list of their problems from most to least important, and my plan for them for the day. This was a long process, but got faster as time went on. For the first few days, I was completely flummoxed by things like how to unhook a dog from its IV fluids so that I could take it outside to pee.

From 8-9 am we had topic rounds, in which a clinician would talk us through some topic — feline lower urinary tract disease, common vaccinations and parasites, kidney disease, and so on. After that, we rounded on our patients. I had to stand in front of the cage of each of my patients and try to sound intelligent about what was going on with them. Inevitably I ended up feeling like an idiot, but so did all my rotation mates, so I don’t think I did exceptionally badly.

After rounds, we did whatever our patients needed that day. They had x-rays, ultrasounds, cardiology consults, got scoped to see what sorts of things were up their noses or in their intestines, etc. I did not get to do as many procedures as I wanted, but I did get to perform an abdominocentesis: putting a needle in an abdomen to draw out all the fluid that was in there (and should not have been). I pulled out 800mL of fluid from that cat, and there seemed to be quite a bit left when I was done. These tended to be very sick animals, animals that got referred to our specialty hospital when general practice veterinarians didn’t feel comfortable handling the case (for lack of specialty training, or because they did not have 24-hour care facilities).

In the afternoons, we saw appointments. I did the initial physical exam and took the patient’s history, then put together my problem list and treatment plan, and reported to the veterinarian on the case. The vet then went in to see the animal, did their own physical, and told the owner what was actually going to happen (which sometimes had some overlap with my suggestions).

Several of my patients died — the ones that were diagnosed with large tumors. Several did very well — the chronic kidney disease patients who needed rehydration and supportive care. I was lucky not to lose a patient that I had cared for for longer than a day. I saw a surgery student crying in the hallway after her patient, who had been in the hospital for two weeks, arrested in the ICU and could not be brought back after ten minutes of resuscitation attempts.

I was often at the hospital until 6 pm (a 12 hour day). I had several 14 hour days, and one very memorable 8.5 hour day (on which there was much celebration). The hospital was slow during those weeks, so I did not have to experience the usual regular 15 hour days that most students deal with on this rotation. I only had 2-3 patients at a time; many students had to deal with many more than that.  I did work most weekend days, but had one day completely free (I slept for 12 hours) and another day in which I had to go in at 6 am, but discovered there were no patients for me, and got to go back home (and back to bed for 4 hours).

I am still tired today. I am now on a writing week, writing up some of my Master’s research to submit for publication. It is exceptionally pleasant to sit on my couch with the windows open and the spring air blowing in, writing. One of my rotation mates said to me dubiously, “A writing week... Um, you like that stuff, right?”

Yes. I like that stuff.

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