Four-Legged Lexis

She's Got A Ring

Although three years older than my sister, I knew that I would be writing about her engagement long before mine.  A girl can't get engaged without a significant other, right?  Alas, I seem to be married to getting my degree right now.  But, my sister and her boyfriend have been together for...actually, I don't even know how long...almost two years?  Maybe?  No matter now, though.  The plan is for them to be together for the rest of their lives because now "she's got a ring."  He proposed at the Chicago Cubs game. And of course, she said, "yes." 

So congratulations to my sister and my new soon-to-be brother-in-law! 

Ups and Downs

The screen looked like something that you might see in the beginning of an alien movie.  I don't quite know why I put together that imagery with what I saw in the anesthesia room this morning.  On the table, a white "wolf-hybrid" was being watched by an anesthesia student.  The rest of us, all neurology students, watched while the doctor explained to us an EMG.  In front of us, a blue computer screen with a grid on it, and a green line with various ups and downs, peaks and valleys, and all at the same time, a chirping sometimes bleeping noise that signaled the electrical activity in the muscles.  After inserting probes into various muscles in a hindlimb and a forelimb, the dog was prepped for biopsy.  And within a few minutes, four small pieces of muscle, and one tiny piece of a nerve (which looked much like a tapeworm to me), were in tubes and a specimen jar, and ready to be sent on their way for analysis. 

After last night, I knew that the big thing on my plate for today was my patient's surgery.  A couple days ago, I admitted a patient who couldn't walk (a tetraplegic).  After her myelogram, we knew where the lesion was, and discussed the options with the clients.  The clients decided on surgery.  Last night when I came to do "the 8s" on my patient, I gave her a really good meal of Hill's Senior beef entree.  She scarfed it up, and although quite messy, seemed to enjoy her dinner.  When a patient is having surgery the next day, they cannot have food after a certain time the night before, usually 10 p.m.  Knowing it might be a little while before she felt up to eating again, I made sure she was content with the room service...err..."run" service.  Before I left for the evening, I submitted her anesthesia and surgery requests, and wrote out the obligatory SOAP. 

This morning, I SOAP'ed her again, and was all ready for surgery.  I brought a pair of scrubs so that I could change out of my regular clothes (khakis and a black stretchy tee from the GAP).  I changed just after the muscle biopsies from this morning, and met my roommate on the upper level of the college/hospital for lunch.  I had taken the time to read through the words in the Fossum surgery book about dorsal laminectomies.  While I read and understood, I knew that seeing it would give me an appreciation for the actual technique. 

When I returned from lunch, the technician came and talked to me about a phone message from my patient's owners.  Within just a couple hours, after first being put in a holding pattern, the owners decided to euthanize the dog.  It is certainly not a wrong decision by any means, but nonetheless, saddening.  Let's say the surgery was successful, in that, the patient recovered from anesthesia.  At that point, she still would have had a very long rehabilitation, including lots of physical therapy.  And of course, there's always the possibility that even with surgery, she might never had walked again.

I was with the doctor when she euthanized my patient.  The owners were there, too.  I pet her paw until she was gone.  And no one saw it, at least I think not, but my eyes did fill with a few tears, but I let none fall on my face.  I had gotten a little attached to the pet.  After all, I had spent several hours with her head propped up on my lap, just sitting in the run with her, keeping her company.  She would cry when I left, and recognize me (I think) when I came in to the room. 

After she was gone, I rolled out a Clay Paw and pressed down her left front paw into the soft clay.  I etched her name and today's date in the clay, and will take it home tonight to bake.  When the owners come to pick up the ashes, they'll have a little memory of their dog.  This was my first patient that was totally mine, outside of ICU.  To say the least, I cared about her.  While it may have been too much, I think that if I ever stop caring, or euthanasia is ever "easy," it will be time for me to leave this profession. 

So, now I have no patients in the hospital, until tomorrow.  Tomorrow is another day of admitting, and could be busy.  JS is flying in too, either late tonight or early tomorrow morning.  It will likely be tomorrow, but when the flight is free, you take what you can get.  I had hoped to introduce him to my recovering patient, but I'm sure there will be someone else to introduce him to here in the VTH.  I'm looking forward to our weekend together.  It will hopefully be a relaxing weekend, even with 8s over the weekend. 

Here's to ups and downs...and knowing that I will have many, many, and did I say "many," more of them in the course of my career. 

"Fill Your Boots"

"Fill your boots." It's a phrase said to me by the neurology resident, one I kind of wasn't sure I heard right the first time.  I still don't know what it means, really, but it brought a smile to my face, just because it was a little silly.  Whether I understand the meaning or not, the fact that the neurology resident said it, and she said it to me means one thing, if nothing else. 

I've switched rotations. 

My ICU rotation ended on Sunday night at 7 p.m., although I was still finishing my evaluation of rotation mates last night.  On Monday morning at 8 a.m., I began neurology.  It's a 2 week elective rotation.  The fact that it is an elective rotation means that everyone there wants to be there.  That makes it more enjoyable from the start, for sure.  I decided to take the rotation for really only one reason.  I don't feel like I know enough about neurology, and want to know more.  So, while it will probably be a challenging rotation for me, already, in just 2 days, I feel like I'm learning.

One other feeling that I have is of importance.  Sure, veterinary students are like the bacteria growing on the bottom of dirty shoes of the interns in the importance of being hierarchy at the veterinary school, but I don't feel that way on this rotation at all.  I feel like what I have to say matters to the clinician.  And the clinician and the resident both are very helpful.  They are there as late as we are if not later, and checking in on us when we are doing our treatments in the evening to make sure everything is all right.  It's a very hands-on and interactive rotation.  I have no regrets about signing up for this elective rotation, despite that fact that I've put in two 12+ hour days already. 

I had one patient yesterday, and for a short time today, two patients.  My patient from yesterday discharged from the hospital just after lunch, but I had received another one earlier this morning.  The patient that I discharged earlier today was a transfer from the student previously on neurology.  It was a dachshund recovering from surgery, a dorsal hemilaminectomy in the lumbar vertebrae.  He had continued to improve each day, and by today was walking on his own, although slowly.  Slowly is better than not at all.  His "mom" really wanted to have him home, and we agreed, it was okay for him to head out of the hospital.  Over the next 4-6 weeks, the patient will recover at home, in his baby cradle (yes, baby cradle), and with the company of his housemate.  It was good to see the appreciation of the owners, even though I didn't have anything to do with the case, other than some supportive care yesterday. 

My new case is probably going to be with us the rest of my rotation.  I don't mind, she's a sweet patient.  She's an older, but not ancient, Doberman.  She came in this morning via the blue cart.  The blue cart is a four-wheel cart, low to the ground, and with a pull handle.  It reminds me of a childhood wagon, but blue and nearly flat to the ground.  My patient could not walk, at all.  After a physical exam (which I'm still improving upon my technique), I did the neuro exam.  I think there's still a little confusion/apprehension about the reflexes and some of the other neurological tests that we are supposed to do by the students.  But, we have confusion, we ask, and it's answered.  It's such a refreshing state of things. 

The neurological exam was not as happy as the normal physical exam.  Her front limbs were rigid and her back limbs were very, very weak...too weak to stand on them.  I could continue on about what other results I found on the neurologic exam, but most of the words wouldn't make sense to just anyone reading this.  Nonetheless, when I go back, someday, and read this, I'll remember this patient (I hope), and recall what I found, or at least some of it. 

To start the diagnostics on her, I requested several tests from the clinical pathology department.  My small achievement of the day was that I submitted several different blood tubes to that department using VetStar, and did most of it right.  I messed up a little, but nothing that was not able to be fixed.  Figuring out VetStar is like figuring out paperwork in ICU.  You just kind of have to do it, and hope for the best.  The blood work came back a-okay, and so she was off to anesthesia to be put under for her myelogram, which is a radiograph (x-ray) of an area of the spinal cord with contrast to outline a lesion, if it is present. 

While she was in for the myelogram, our group of six plus the two doctors and the technician made our way upstairs and secured a study room for rounds.  We had sit-down rounds, catching up on everyone's cases, and discussing some, but not nearly all, of the salient topics about the cases.  All in all, the six of us have 14 cases.  Although I only have one now, I'm sure I'll pick up another one through the week.  Sadly, at least two of our cases have lymphoma.  While both cases are pretty much heart-breaking, one is, in my opinion, more so than the other.  The dog is only barely a year old, and the cancer is aggressive, according to the clinical pathology report.  While I hope the owners decide to treat, probably chemotherapy, lymphoma can be a particularly nasty cancer.  In fact, that's our homework assignment, of sorts, for the night.  We are supposed to look up the staging of neoplasia, and be able to talk about tomorrow.  Being able to figure out just how bad is bad is important, especially when talking to owners who almost invariably say, "what would you do if it were yours?"  More than any board exam question or any question a clinician could ever ask me, I think THAT is the hardest question.

Every rotation has multiple students on it.  It's good when they can work together.  And I've decided that, even after only two days, I like who I'm working with on this rotation.  All six of us are female, if it makes a difference.  We all support each other, and offer help to each other when we can.  For 8s tonight, I finished up with my own patient, and then helped two of my rotation mates with there patients.  It was a great feeling to know that I could count on them if I needed them.  And tomorrow, I have to remember to stop at the grocery on the way to the hospital to buy some candy.  We're rotating candy duty through the room, a special treat for those sugar cravings in between patients.  Ah yes, one can definitely tell that we're all women in the neurology room!

Even though neurology has been busy, I have had time for lunch both days.  I spent some time in the cafe and in the lobby.  Yesterday, I ran into my ex at the school, pure odd coincidence.  He's much the same, but still different.  And all of what he was is now so unattractive to me.  Right or wrong, I made it a point to tell him that JS was visiting from CA this weekend.  And of course, both days, I spent a considerable amount of that lunch time talking to JS on the phone during my lunch break.  It was probably good for him, too...as his work has been quiet and by all of his accounts, boring, this week.

So tonight that plan is to very shortly find myself passed out in bed.  Sleep is precious these days for sure.  In the morning, I'll wake up early to do some reading for tomorrow, and then it's another day at the hospital.  We'll probably reassess my patient's status and talk to her owners tomorrow.  I might get to see a spinal cord on a live animal tomorrow.  While it means that there was a serious problem with the patient, it will still be absolutely cool to see her surgery, if it happens.

What Day Is It?

With only one day of the ICU rotation left, I have a hard time remembering exactly what day it is, and not just the numerical date (a lot of people have that problem), but literally, is it Monday, Thursday, or Sunday.  Since the first of July, I've been working overnight shifts, where one day blends right into the next.  I sometimes would catch myself writing the previous day's date on the drug disposition records after the clock hands swung past twelve midnight.  One line through the bad date and my little initials could right the wrong easily, but nonetheless it happened. 

Speaking of my initials, I've always thought that my handwriting looked particularly neat, especially when compared to my siblings and friends.  After four weeks on this rotation, and many incidences of having to write fast, my handwriting has become sloppy, and there has been some question over "what does this say," in my shift summaries.  With the advent of a new rotation on Monday, I hope this will improve. 

This week, I worked three overnight shifts in a row, followed by two days off, and ending tomorrow with a twelve-hour day shift.  Each night, Tuesday through Thursday, seemed to get increasingly busier, leading up to what the doctor in charge of ICU called a record number of patients on Friday morning during rounds.  All of the cages in ICU were full.  A set of four temporary white plastic cages were pushed into the hallway, and those were full.  Another set of temporary metal cages, which could hold two patients, was occupied on the bottom.  The room across the hall, labeled "ICU II" with four runs for larger patients, was full.  And there was one puppy in isolation, past the double doors and down the hall just a short distance, being monitored with a video camera from the main ICU room.

My routine during the week had been to work at night, obviously, return to my apartment as most people were only beginning their work days, pull the covers over my head, and sleep for five or six hours.  I would nap later in the evening, maybe, for an hour or two, just before having to go back and do it all over again.  The plan was to stay the same for Friday, that being the end of my overnight shifts.  However, my roommate's schedule changed, and our planned trip to Des Moines had to be moved to the morning instead of the afternoon.  So, with zero sleep, I changed clothes and tried to look presentable to trek through the mall in West Des Moines.  We were on a mission:  comfortable shoes for me and a solid-colored (and very specific color) dress for her. 

Before heading out of town, we stopped by school, where I had just left only about an hour ago.  In the large animal hospital, Gladys has been a patient through the week.  Gladys is a Brown Swiss cow, afflicted with gangrenous mastitis, only a few days after calving.  She hails from the dairy farm where my roommate spends her summers as an employee.  She's more like a pet at the farm than anything else.  She's the mascot for tours, and is very friendly to children, apparently.  One of my classmates is the student on her case.  When we arrived, that classmate was hand-feeding Gladys balls of hay soaked in water, and coaxing her with her voice as if this massive cow were a dog or a small child.  My roommate stepped into the stall and talked with the student on the case for a little while.  Over the past few days, Gladys had been improving.  Although she may never be a contributing member of a dairy herd again, it is likely she will live, and return to farm mascot status soon.  In the meantime, I talked to another classmate about shoes and jobs, and the ever-quickly approaching board exams.

After that, we were on our way.  It had occurred to me earlier that if I could just stay awake all day, I would hopefully be able to "reset" my body's clock to a more normal schedule.  As tired as I knew I was, I felt like I was getting a second wave of energy.  After an IHOP breakfast and a stop at a Starbucks kiosk, we finally ended up in West Des Moines.  First stop, Scheel's, an incredibly large sporting goods store, where I knew from previous visits I could find Dansko shoes.  People in the hospital rave about two shoes, mostly.  Danskos and Crocs.  I couldn't get myself to buy into Crocs, not just yet.  They look like shoes to wear when playing in the rain, not so much when seeing patients.  I decided between three different styles, which all had names, but which I termed "shiny," "not so shiny," and "casual."  With the roommate's help, we decided that "casual" worked the best, citing that "shiny" and "not so shiny" would not look right with both scrubs and khakis.  So, while expensive, I hope these black shoes actually are comfortable and hold up for a while, or at least through the end of clinics.

Finding her dress was a not so easy task.  The dress was for a wedding, in which she is speaking, next weekend.  The bride had determined that only five colors are appropriate, and absolutely no pattern on the material was acceptable.  We searched through several stores in the mall, all with no luck.  And when we went to a bridal store, in hopes of finding something there, even though a bit more formal and expensive.  Alas, we still came up short.  Several times, we admonished the bride, who must not have thought that finding a dress to meet her specifications would be so difficult. 

By the time we ended our trip, it was nearly 3 in the afternoon.  It as all I could do to keep my eyes open on the way home.  I was approaching twenty-four hours without sleep.  And after about ten minutes in her truck, sure enough, I was napping.  I had only one more task to complete.  I parted ways with my roommate back at our apartment, and went back, once again, to the teaching hospital.    

Full House

I'm not a card player, but I think a full house is a decent hand.  In the ICU, it can be overwhelming.  With a little luck, though, and extra warm bodies, the night progressed smoothly.  When I walked in last night, all of the cages were full, and the temporary cages from the hallway had been wheeled in and positioned at the end of the desk.  Two patients were on the bottom of the set of four temporary cages, and most of the other cages were filled.  Inside the run, under a "tent" made of a blanket was a recovering St. Bernard, propped up on more pillows and blankets than I have on my own bed.  Lots of patients, but also a decent number of people to care for them:  two students and two technicians were on schedule to spend the hours when most of the world is sleeping in the ICU.

There was a degree of confusion last night that made each of us, students and technicians, question the procedures.  It's not that we had any questions about how to care for the patients, though.  Starting this week, the schedule in the ICU changed.  This week, the emergency interns started, three of them, one a graduate of Iowa State.  As a result, there are now two different designations of ICU students - both emergency and critical care.  The question came as to who was supposed to SOAP the cases and when.  The supposed attractiveness of the new system was that the emergency student would not have to return at either 8 a.m. or 8 p.m. to do SOAPs on the patients that they have admitted.  But if they do not, who does?  The critical care student?  Okay, but WHICH critical care student?  One of my classmates stared in disbelief at the list of problems of one of her patients.  The problem list began with two or three problems, and during the day, had grown to be thirteen problems long.  As it was already after midnight, she couldn't believe she would have to stay and write a SOAP for all thirteen problems.  Settling in to the surgery rounds room, she decided she would be here for several hours.  Luckily, a technician made a phone call, and saved her.  Apparently she was not responsible for the evening SOAPs.  I breathed a sigh of relief for her, as that would have been a ridiculous way to end an evening after a nine-hour shift. 

I'm sure the system will end up benefiting the ICU, but until the kinks are worked out, it's going to be a little confusing, and maybe even frustrating.  I've become so used to working until 8 a.m. that when I was scheduling a meeting this morning, I found that it was nearly impossible to do so.  It wasn't until I turned the corner onto my street, sleepily driving home, that I remembered that I the 12-hour emergency student tonight, meaning that I will be finished at 7 a.m. tomorrow.  I was able to get the time of the meeting changed, and I'll still be able to be in bed and asleep by 8:30 or 9:00 in the morning. 

Aaahhh, sleep.  Twice now during this rotation, I've woke up in the middle of the afternoon, and felt disoriented, and startled when reading the digital display of the time of my cell phone.  The most recent incident was today.  I heard a loud "bang" from somewhere in the apartment.  I looked around, realizing it was daylight, and thinking for a minute that it was Thursday.  Actually, it was Wednesday, I'd been sleeping for about five hours, and it was just my roommate, dropping something in the shower on the other side of my bedroom wall.  I do not mind the overnight shifts, but I will not complain when in just a few days, I'll switch to a more normal rotation with hours that coincide with daylight, for the most part. 

When I return to the ICU in a few hours, I'm sure there will be some of the same patients in the cages.  And because there were orthopedic surgeries today, the floor and runs across the hall will probably have some patients too.  I do hope that one patient remains, a three-month old Weimeraner.  Through the night, another dog decided at about 3:30 in the morning to bark, and bark, and continue barking even after a blanket was placed over the door to his cage.  The Weimeraner tried to bark to be heard too.  It was probably her first night away from home, and in a strange place.  When the time came to give her an antibiotic into her catheter, slowly over fifteen minutes, I opted to hold her instead of leaving her in the cage with a syringe pump.  I disconnected her IV fluid line, and she put her front paws on my shoulders.  I lifted her out of the cage, and held under her for support.  Just as I walked out of the room, she settled her head down on my shoulder.  She just wanted attention, and I didn't mind giving her a little extra TLC.  I slid down to the floor, and rested my back against the wall.  She laid very still on my lap, and I slowly injected the antibiotic while scratching behind her ears and petting her behind the E-collar.  Had I stayed there much longer than fifteen minutes, the dog would not be the only one sleeping.

Just a few hours after the Weimeraner TLC break, the ICU woke up, and people were in and out, students, interns, and technicians.  I presented rounds to the group with little trouble, and then was given permission to go home and sleep.  There were only a couple things I had to do before I made it home to my bed.  In the building, I needed to find a computer to print two case reports.  As part of the requirements to get credit for my time spent in California, I had to write about two of the cases that I had seen.  I chose one from the hospital in Orange County and one from the hospital in San Diego.  I found an open computer lab upstairs, an area I rarely go to anymore, where I was the sole person in the room.  I reread the reports one last time, and then printed them.  Stapled and clipped, they found their way back to the mailbox of  my faculty sponsor.

And on the way home, I stopped at the Post Office.  Another inevitable causality of being on ICU is that daily living type stuff that normally occurs during daylight hours gets pushed aside and done at the earliest possibility.  I went to the Post Office last night, but the automated machine was "experiencing technical difficulties."  That figures.  But now, it's all done, and on its way through the U.S. Postal system.  My loan paperwork was mailed today to the right person for a signature.  And soon, I'll have the money to pay for my national and state board exams, approximately $750 in total. 

The last three and a half weeks have gone by quickly.  It's already almost the middle of July, and almost time to switch rotations.  I have three more ICU shifts, today/tonight, tomorrow night, and Sunday during the day.  On Monday, I switch to neurology for two weeks.  Of course, I'm looking forward to the switch for several reasons, not the least of which is the return to a normal sleeping schedule, or at least somewhat normal.  The other piece of excitement to look forward to is a visit from JS next week.  Despite the fact that I might have patients in the hospital to take care of, he's agreed to come out and see me, and even come along for the 8s.  With so much to look forward to, it will be next Friday before I know it.  And with time seeming to fly by faster each day, it means I should really start studying for those board exams...now! 

Back in the Comfort Zone

The lights are dimmed in the main ICU room now.  After all, the critical care patients need their rest too.  Nonetheless, we have a couple that insist on barking, just for the sake of barking.  Tonight, I'm in my element.  While I don't know everything I need to know about ICU (not even close), I feel more comfortable in here, save the code procedure.  As of yet, on my shift, there's not been a code that I've helped with, other than to squeeze the Ambu-bag.  I suppose I'm a bit scared of "codes" and having to resuscitate a patient as much as receiving a large animal emergency.  It will all become more natural, I suppose, as time progresses.  We are only in Week 9 of the 4th year; 43 weeks to go. 

I learned something new tonight.  When I learn something new (like CVP normal range and how to measure it the last time I was on the small animal side), I feel like my tuition dollars are being well-spent.  One of the paid student techs showed me how to clean a tracheostomy (or just "trach") tube tonight.  A patient has been in the ICU for several days with a trach tube in place that needs cared for and cleaned every six hours.  When I was on swing shifts in the small animal ICU at the end of June, there was another patient, on a ventilator, who also had a trach tube.  I avoided cleaning it.  And I believe that my avoidance was in part due to lack of knowledge about how to do it.  It was also easy to avoid, as there was a possibly infectious puppy in the ICU.  The person handling the puppy for treatments was not supposed to handle the trach care.  So, I volunteered to do the puppy.

It was a fairly sterile procedure.  Or as the student put it , "as sterile as you can be."  It's not done in the surgery suite - just on the floor of the ICU.  But, we use sterile gloves, saline, bowl, sponges, and long "Q-tips."  The non-sterile person holds up the patient's head while the person with the sterile gloves twists off the lock on the tube.  The tube slides out of the trachea; a short tube, maybe 4-5 inches long, with a downward curve. 

The tube was filled with "goobers."  And yes, that's the very technical and scientific term.  Swish, swish, swish in the sterile saline.  I used several sterile saline soaked sponges to wipe around the hole into the dog's trachea while the tube soaked in the bowl of sterile saline.  And then the fun part came!!  Using the long "Q-tips," I tried to scrape at and dig out the caked on "goobers" inside the tube.  The tech suggested trying to use the sponges like dental floss (and with the goobers in the tube, that made for GREAT mental images), and shoving in down into the tube until it came out the opposite end before wiggling it back and forth.  That worked amazingly well.  Soon we had a "goober-free" tube.  I carefully attached the tube back to the dog.  And voila, I had just cleaned my first trach tube.  It wasn't that scary, and I did an okay job.   I wouldn't be afraid to do it again on this patient, or another.  Learn by doing, I suppose.  (Even though the "rule" is something like "see it, do it, teach it.")

Bruises, Forgotten (almost) Rounds, and Cat Pee

I almost made it through my four nights in large animal ICU unscathed.  I can say, though, that I didn't have to admit any emergencies.  In the process of the four nights, I did lose my name tag.  That's the second time I've lost that little piece of burgundy plastic.  The first time it was found.  This time, I've given up the idea that it will ever be found.  I have a problem losing things lately.  Remember the Nerdbook that came up missing?  I did find it after returning to Iowa, wedged tightly underneath the folded-down back seats of my Jeep. 

Perhaps the name tag was stuck in my scrub shirt pocket, and when I bent over to take off the poly-boots in and out of isolation, I dropped it.  If so, it's long ago swept up with shavings and other barn leftovers and in some pile somewhere that I'm certainly not digging through.  A replacement name tag only costs $3.50.  I ordered two more just to be safe.  My roommate pointed out that maybe I will find my old one, though.   Then I'll have three and never even need a replacement again.  After all, she says, in less than a year, I'm going to need one that says "Dr. Andrea (my last name)."

Back to that almost making it out of the large animal portion of my ICU rotation unscathed thing...it's easy to become distracted, and maybe that's why I lose things.  All night we (the paid student and I) were giving an electrolyte solution via a nasogastric tube to a Clydesdale mare.  I thought she was a Percheron, like all the others, but at rounds the next morning, a fellow classmate informed me that Percherons were not brown.  I never said I was an expert horse breed identifier.  It went okay all night.  I would pour the solution from the bucket into the funnel, which the paid student held above his head.  I held the mare's halter, trying to prevent her from putting her head down. 

It worked every hour until about 6 a.m.  The mare had enough of our games, and wasn't agreeable at all, tossing her head this way and that, leaning against the stall wall, and backing up away from us.  In general, she was not going to "acquiesce to our request."  During this toddler-like event, she managed to get the nasogastric tube out of her nose.  When we saw two ends of the tube, that was a bad thing.  And while removing the other end of the tube from her halter, she was pushing against me, pinning my arm between her and the stall door that was stationary.  It's hard to explain without pictures.  I moved my arm away, as I thought if she put much more pressure on my arm, it would break.  And that was the end of the electrolyte solution for her.  No breaks for me that morning, but I did walk away with a bruise on the lateral aspect of my upper arm the size of a tennis ball.  It's still a little tender, a day and a half later. 

Just before 8 a.m. that morning, I was beginning to think of how soft and warm my bed would be, and how soon I would be there.  About the same time, a rotation mate walked down the hallway in front of the room that I was sitting in, where I was diligently clock-watching.  After the causal "hi, how are yous," I asked why she was even here, as she was not wearing scrubs.  She replied, "Rounds." 

Ugh.  What day was it again?  Tuesday?  When I left my apartment it was still Monday, but I guess it was Tuesday now, and sure enough, we were supposed to have topical rounds at 8 a.m.  The thought to skip this week's was oh-so-tempting, as we can miss one of the four sessions without penalty, other than lack of personal knowledge.  My eyelids were heavy, and unfortunately, my chai ran out a few hours ago.  But somehow, I managed to stay awake for the discussion, and unfortunately, for several hours after that, too.  I must have hit some sort of threshold and then crossed it, finding some renewing energy deep within my subconscious reserve.  Physiology works against me like that, I suppose.  (And I never did like that subject as a first year veterinary student, anyway!)   

A "Bad Cat" Plug

A while ago, I mentioned that there was a calendar release coming up soon from my friend Jim Edgar and his many "bad cat" friends.  On his website, there is now a preview page from the calendar.  In the past, I've had many a page-a-day calendars that get stuck on January 18th or so.  I guarantee this one will get torn every day, though.  And no worries about putting this one in my Christmas stocking.  I've been told that Jim will be signing a copy for me. 

Check out the calendar preview and buy it here. 

The Last (Large Animal) Overnight

I woke up with a neck cramp after napping on the couch just before I had to leave to come into the hospital tonight.  My roommate was at the other end of the couch watching "Oceans 12," a movie I will have to watch in its entirety later, maybe on one of my upcoming days off. 

The night air was much cooler this evening than last night, but still warm.  I did not see the exploding color of fireworks in the sky, but there were a great number of stars shining down tonight.  Once again, I neglected to even try to locate any constellations.  It's a rarity that I can even find the "big dipper."  Besides that, I was pushing the limits on time, even though the route to school is exactly 4 minutes, if I hit the two lights on the way correctly, 5.5-6 minutes if I don't. 

Next year, I will hopefully get to see fireworks, wherever I am in the United States.  I can vividly remember birthdays as a child when I would wait all day until it was dark, anticipating the trip to the stadium in my hometown to sit with my family and grandpa to watch the fireworks.  In college, it lost some of the appeal, I guess, but I still have a fond memory of staring up at the sky in the bed of a truck with an ex watching fireworks.   And I suppose that whenever I do have the chance to see fireworks on my birthday, it creates a bit of nostalgia that I like to dwell on for just a moment, remembering a time that was much simpler, before I had to think about having real patients and studying for the boards. 

When I arrived in the parking lot tonight, there were virtually no other cars.  This is a good sign in my eyes.  Looking through the windows of the garage door that leads to the barns, I saw two people walking toward the stalls.  I put my stuff in the rounds room, and caught up with them doing 11 p.m. treatments.  Walking down the aisle in the barn, I noticed that all of the stalls formerly occupied by the Percherons were empty.  Wherever they are tonight, I'm sure they are much happier to be home.  The mini and her baby are still here - bright, alert, and seemingly happy.  So far tonight, the baby has not kicked over their shared bucket of water.  It's early, though.  The isolation case is here too, for another night.  And new to the crew of patients is a potential colic case.  And besides all the four-legged beings, there's another human with me tonight too.  Being a weeknight, there's a paid student, one from the class below me, who will be here until 7 a.m.  I don't know about company, but at least it's someone else to walk through the barns and help me with the treatments. 

Having someone else with me makes a lot of sense tonight.  It's not just from the aspect of having someone else to hold the horses during treatments, though; because whether right or wrong, I've done okay on my own for the past three nights.  But during the barn walk-through tonight, the in-house student told me of a skirmish (that might not be the correct word to use here - maybe "incident" is better) with an unknown man in the building.  Said unknown man was found in the women's locker room, rifling through a classmate's locker.  The police were here, but whether or not they located the unknown person was not clear.  Though the exterior doors were locked, apparently the garage door to the barns was open around that hour.  If I were alone tonight, I think I might be a little scared, knowing that only a few hours earlier, some creep was lurking about where he should not be.   So besides the friendly DPS guy with the white iPod earphones coming out of his backpack, there's one other guy here tonight to add to my feeling of safety and security. 

I slept through much of my birthday.  I did find time to be awake and in real clothes (not scrubs) for a couple hours tonight when the roommate and I went to dinner.  The restaurant we chose was mostly quiet, which was to be expected, as most everyone was probably grilling out with family and friends today.  We could have grilled out too, but that would have involved going to the grocery and some preparation on our part.  That idea was nixed early on in the decision making process.  I enjoyed a very tasty "stars and stripes" pina colada with dinner, which probably induced the nap when we got home.  Earlier in the day, my family called from Michigan where they are visiting my younger sister.  Over the phone lines from far away, all but my brother, who wasn't there, joined in a chorus of the traditional birthday song.  And my dad reminded me that this is my last birthday until I become a doctor.  I need little reminding of that fact, though. 

It's hard to believe that it's already Tuesday.  My whole schedule is off because of my day-sleeping routine as of late.  All of my shifts from now until the end of this rotation are overnights, except the very last one.  The Sunday before the next switch day, I work a 12-hour mostly daytime shift.  After all, they could not have me staying up all night before I supposed to be on the neurology rotation the next morning.  In between the night shifts, though, I have an amazing six days off, with day number one being tomorrow...err...today!  Again, you see that my timing is all "off."  I have no plans yet for some of those days off, but I hope that will change. 

Thanks to all who sent me birthday wishes, including a couple blog readers, and one person I don't even know.  Check this out...Trent wished me a happy birthday (scroll down past all the pictures).  Who's Trent?  Your guess is as good as mine, and I even read the "100 Things" about him page.  And lastly, before it's time to do a walk-through the barns again, I've added a new veterinary student to the list on the left with the addition of the blog "Premenopaws."  She's a non-traditional student "up north" whose blog I randomly happened across last night.  It's a new perspective on this plight to become doctors of the four-legged.

...and the iPod is playing:  "Beck:  Guero"

ICU Overnight #3

Nothing can rightly describe what this summer evening feels like in the Midwest.  The only way to truly understand is to experience it.  But for what it's worth, the air tonight is sticky, stagnant, and heavy.  I would imagine that the horses in the barn can be nothing less than uncomfortable, trying to find the coolest place in their stalls.  The same characters are here again tonight, with the addition of one gray gelding.  Just after midnight, I walked the miniature horse and her foal, who is feeling much better today.  Baby wanted to run, but luckily I had her on a "leash" (lead rope).  There are a few other horses that need to be walked in the middle of the night, but all in all, I expect a quiet night, pending the dreaded (for me anyway) emergency.

When my shift ended this morning..err...yesterday morning...I was very ready to sleep.  I left my Nikes (not the Shox, but another older pair), with soles now tinged with the faded green of the Rocal boot soak, on the linoleum.  After a brief conversation with my roommate, I answered the meow of Elly at my bedroom door.   She probably feels a bit neglected, being alone when it's dark outside.  My black scrubs smelled of the barn, a mix of hay and horse, and faint traces of my lotion.  It's another sensory that can only be experienced, not explained.  As tired as I was, there was no way I would sleep in those scrubs.  By just after 9 a.m., though, I was comfortable, under the covers, and quickly thereafter, asleep.  I vaguely remember something the reporter on FOX News was saying, and from that point on, everything is blank.  Dreamless daytime sleep ended around 3 p.m., but I still felt tired.   The rest of my day felt wasted, just waiting on the time until I had to get ready to do this all over again.

A perplexing situation came up last night.  I thought I was doing the right thing, but apparently, that was not the case.  It was a judgment call, and lacking extensive equine experience, I did what made sense to me.  Most of the night, mini mom and baby didn't mind that I came in every hour to do something.  Around 5 a.m., though, both mom and baby seemed a little tired of the routine.  Baby became difficult to handle, so I called for reinforcements from the small animal ICU.  Even with another person helping to hold the now-feeling-better baby, I still attached the lead rope to the halter, and tied the lead rope to the stall.  On the other side of the stall, I did the same thing with mom.  When mom wasn't tied, she was nice, but always a bit nosy, trying to figure out what I was doing with baby - perhaps a quality of any concerned mother, human or animal.   

When the time came to give fluids again at 7 a.m., I did the same thing, but couldn't get someone from the other end of the building to assist.  With both minis tied, I knelt down in the stall and had no problems giving the baby fluids through her catheter.  I was told later, though, that it's never right to tie horses in a stall while doing treatments.  I couldn't see any other way to do the treatment by myself, though.  Chase baby around the stall and stress her out, trying to do a simple procedure, or restrain her and make it easy on both of us.  Further, I was told that I should never be alone during treatments.  And as far as I know, there's never more than one ICU student assigned to the large animal overnight shift.  And the small animal ICU students have their own set of hourly treatments to do.  It's a conundrum that I do not see an easy resolution to from my perspective as a student.

My comfort level told me that I was okay with the minis in the stall.  They are both literally the size of large dogs.  Had I been treating a Percheron, though, I certainly would not have ventured into the stall and tied it to do anything.  I guess I probably wouldn't even go into a stall alone with a horse of that size.  Being alone in a stall with a horse of that size and power could easily go all wrong.  If something happened, no one may know until either the DPS guy walked through and happened to see an injured person in the stall, or 8 a.m., when everyone else arrives for the day's activities.   So, I can see the point of the person who informed me of what I was doing wrong, but I also see what I think to be exceptions to the rule.  It's frustrating not to have any set protocols, or if they are in place, not knowing them because I do not spend much time on this side of the hospital.   In any case, baby hasn't needed any treatments other than a couple TPRs tonight, so it's been a non-issue with that case tonight.  Nonetheless, I did work with the horse in isolation by myself all night.   Right or wrong.

And now morning is here, and the sun is coming up on the horizon, pinking the sky.  I just came back in from walking a horse around in the grassy area outside of the teaching hospital.  She seemed to appreciate the release from the monotony of the stall.  Though the couple of rabbits that I saw outside weren't too sure about her.  It was still quiet, when most of this part of the country is still asleep.  And soon, so I will be too.

Happy birthday to America, and happy birthday to me. 

...and the iPod is playing: "Snow Patrol:  Final Straw"