Thursday, December 17, 2009

Neurologic and Hateful are a Dangerous Combination

My day started at 3:15 AM. This was when the 2VM extern at the clinic knocked on my door and asked me to come help with the neurologic horse we had been taking turns checking through the night. This horse had a fairly complicated history, but it all really can be traced back to him being a hateful, hard-headed beast.

He had come in for surgery about a month before to have a small plate put in a back ankle. He had bad ringbone as a result of his habit of kicking stall walls...hateful! He wasn't easy to work on and our surgeon had tried to dissuade the owners from sending him for surgery. He knew that the horse would not take treatment well, and that complications were likely. Last week, he became acutely lame. Suspecting infection in the joint, our surgeon put him back on the table. There was no sign of raging infection, but he pulled out one of the screws and put everything back together and we ran some cultures and infused the area with antibiotics, put the horse back in a cast and recovered him.

Three or four days later the technicians doing treatments noticed that one side of the horse's face was sagging and he was a little uncoordinated. This quickly progressed to dramatic neurologic signs and the horse could not be moved without being a danger to himself and others. Our best theory is that he had a stroke, possibly a clot resulted from the surgery or the catheter necessary to give him IV medication. The interesting part was that this horse would occasionally try to attack us, and his disposition didn't change with his coordination. Now we had a 1300 lb, uncoordinated alligator in a metal box.

Last night we ran his IV fluids as usual, finished around midnight and his condition was stable but not improving. At the 3:00 AM check he had gone completely off the rails. Somehow, in a stall that is as safe and danger-free as humans can make it, this horse had caved in the front of his skull, right between the eyes and the ears. He was bleeding profusely, and resisted any efforts to approach him by flailing wildly with all four legs, sometimes half-rising before falling back down. We eventually managed to get the bleeding slowed down and got some fluids in him to replace the blood volume he'd lost. We had to sedate him heavily, but he still fought with us. He managed to flop his way out into the barn aisle before we got him under control enough that we could at least keep him in one spot. We had to drag him back into the stall. It took four people and nearly an hour as he fought every effort we made. Finally the surgeon reached the owner around 4:30 AM and they agreed that it would be best to put the horse down.

It was a freak deal, a trainwreck. Everything we tried to do for this horse was met with resistance and fight. As much as I dislike this animal I have to admit that I'm a lot like him. His original problem was caused by his habit of kicking the wall; it was self-inflicted. Other than the stroke, every problem this horse had relates directly to the fact that he was a jerk. Even the stroke ties in because if he weren't a wall-kicking jerk he wouldn't have needed surgery. When he became neurologic, we could have helped him if he had let us. I don't know that we could have saved his life, but he would have had a chance if he had just stopped fighting us. I know that many times, the difficulties that I face in life are caused by me, acting like a jerk. I kick the wall, I break my foot. When I'm confused and hurting, I often lash out at those who try to help me, making it impossible for them to ease my pain, usually making the pain worse by bashing my head into the metaphorical wall. I'm going to file away a mental picture of a blood-streaked stall wall and hope that it will help me remember that sometimes the people trying to pull me back into the stall are doing it for my own good, and I should just relax and be grateful that they care enough to pull.

Friday, December 11, 2009

Field Trip to Reality!

Being a vet student around veterinarians is a cool thing. They all remember being in your position, and 99% of them want to hear all about it and help you in any way they can. I'm spending some time over the break in classes working for a clinic where I spent two years as a technician. It's funny to see the difference in the way the doctors interact with me. Don't get me wrong, they've always been great, and knowing that I was trying to get into vet school they were more than happy to teach me and make sure I got the experience I needed, but now it's like I'm part of the "club." Since I used to work with them every day, they know my skill level and trust me to do a lot of things that a new student wouldn't get to do right away. They also ask me questions that relate to things I should have learned in school and show me how it applies to whatever we happen to be working on. It's a much-needed field trip to the real world after getting beaten up by the books all semester.

It's important to be reminded of why I'm putting myself through the struggle of four years of intensive education. I LOVE vet work. Even shooting routine prepurchase x-rays today was fun. I still don't know that much about what I'm looking at, but it's good to be involved and see how my career path will put me in a position to really help people in a few years. We can keep somebody from making a $30,000 mistake by finding potential unsoundness in a yearling's x-rays before the buyer purchases the horse and puts the money into keeping him healthy and in training for two years. Of course, there's always a flip side. Some people are jerks. Sometimes you have to interpret a set of x-rays that aren't worth the time it took to shoot them. ("Lateral" means "LATERAL" and it's taken at this angle for a reason...if they're all oblique we're just guessing what's really in the joint.) Sometimes sellers get angry when a set of films doesn't go their way. Sometimes we have to try to get films on an unbroke horse that wants to paw your face off and kick the x-ray plate to pieces, if they'd brought him over sooner we could have used sedation, but you can't send a sleepy horse through the sale ring! I love it all. It's a challenge. The majority of the horses and people we deal with mean well, at least. It was a good day today. I got to see some old friends and some reallly nice horses, and I get to look forward to two more days of it. Life is good.

Wednesday, December 9, 2009

Exhaustion and Anatomy

This has been one of the longest weeks of my life...and it's only Wednesday! Finals in vet school are a whole new experience. It's taking four months worth of information overload and having to be able to recall all of it at random. It's brutal. In a way it's a good test of how much you really want this, and how far you can push yourself. In a few years (if all goes according to plan), I will be making life and death decisions that will generally involve someone's dearest companion and/or a significant financial investment. Either way, I'd better be able to pull my crap together when I've been up all night with an emergency and something starts going south in the morning. I've been around the industry long enough to know that I will make mistakes. If I'm unlucky, my mistakes could result in the death of your pet. Sometimes they survive because of what we do, and sometimes they survive in spite of what we do. Unfortunately, this principle also applies when they don't survive. It's hard to see the relevance in some of our classwork, but if I don't have a firm grasp of the basics I have no business taking on responsibility for a life. It takes an odd balance of arrogance and humility to be a good veterinarian. We have to be confident enough to look at something God created and say "I'll fix this," but we also have to be humble enough to know that we are only one wrong decision away from no longer having the opportunity to fix it. We have to maintain confidence even after things have gone wrong. Sometimes it's our fault, and sometimes things just happen.

One more exam tomorrow, then a blissful month of relaxation...yeah, right, that'll happen! I suppose relaxation is relative and it will be nice to at least be running in a different direction for a few weeks.

Saturday, December 5, 2009

Testing, testing...1,2,3,4

Are finals over yet? Oh right...they haven't actually started yet...dangit! If I survive this journey I will know that I can handle anything. We have one final every day through Thursday next week...if only they were like undergrad courses and I could pull an A or B by cramming the night before I'd be all set!

And thanks to that fine fellow Murphy, the brand new clutch I spent $400 on a couple of weeks ago is already going out...I love my truck. It really is a good truck, but it has horrible timing. All the neglect it's been getting this semester is finally catching up with me. It has a slow leak somewhere in the power steering system...no problem there, just have to add fluid once a month or so. It doesn't start when it's hot, a mechanic friend thinks it may be a solenoid on the fuel injection pump going bad but I haven't had time to take it to him and get it checked out...and the part is around $200 (if he's right about the problem...) so I just don't shut it off unless I'm going to be somewhere long enough for it to cool down good. Then the other day I noticed a steady drip of diesel fuel from the top of the filter housing...fabulous. With the price of diesel these days I'm tempted to rig up a bucket to catch it so I can put it back in the tank! The primary goal over the winter break will be to find the time and make enough money to get my truck back in fighting shape for a several months of spring semester neglect!

One good thing about vet school is that it is improving my ability to handle crisis. Things are bad, sure, but this is the opportunity cost of doing what I love. Sometimes I question whether or not it's all worth it, but so far the answer has always been yes. It would be nice to be out making enough money to take care of everything, but creativity is an asset and every day that I survive is a victory for me. I don't want to struggle like this all my life, but I can cope as long as I feel like I'm working toward a future where I can be something and work at what I truly enjoy.

Tuesday, December 1, 2009

Nothing dies without Dex!

Glucocorticoids have recently become a common theme in my life. I used to think of them in a positive light. A vet I used to work for had a saying... "Nothing dies without dex!" Basically it meant that if you'd done everything you could and an animal was still trying to die, pump them full of dexamethasone and see what happens. Sometimes steriods can work miracles.

More recently, steroids have become a nuisance to me. We've got to have a pretty good grasp of them for the upcoming physiology final. We had to calculate and verbally defend a dosage of dex to administer to a live dog after we insulin-crashed it in a lab session. (Picture a professor in a white coat casually hanging on to a bottle of dex while a sweating first-year student fights the urge to scream "JUST GIMME THE DRUGS, MAN!!!) Of course, the whole thing was fairly controlled, they wouldn't REALLY have let us put a dog in a diabetic coma for a lab exercise...but at the time it seemed pretty high risk!

And on a personal front, I realized that my own cortisol levels may have entered the red zone when I caught myself having a one-sided, profanity-laced argument with a bag of cheese earlier today. ("Easy-tear," my os coxae!) Based on my past experience as a vet technician, I've come to the conclusion that I need a "life" technician. My job as a technician was to assist my doctor in whatever it was he was trying to do, whether that meant taking his truck to town for an oil change or doing a flying body tackle on an un-broke foal that had suddenly decided it wasn't feeling so sickly after all and was now bouncing around the stall like a ping-pong ball on acid. (Epinephrine is a rather amazing chemical, as well!) If I had a life technician, they would have opened the cheese for me, put it on my baked potato, and brought me my dinner as I used my brilliant medical mind to store all the info I'm going to need for finals next week. Now taking applications...