week 2 on small animal medicine was pretty uneventful, just really freaking long...I am learning SO much, and I am realizing I know more then I thought. I am being taught great ways to manage cases and am starting to feel like "Wow, I am going to be a doctor in one year, and I will probably be a pretty good one!"
The hours this week have gotten me to school by 530 am almost every day, and I can't leave until 6-8pm. The only rough day was Tuesday when I took on more then I could chew. I got there at 6am, I had one case in the hospital already, and I took two transfers, but it just happens that I picked the two most complicated cases, so I struggled with them, but the doctors complimented me after since they were tough cases.
Case 1: an 8 year old cat withchronic renal failure that was JUST diagnosed, her BUN=180, her creatinine was 30!!! (anything over 15 is considered not really compatible with life). Well sadly the options were hemodialysis or euthanasia, so after all my hard work in the morning the owners opted for euthanasia (can't blame them, I probably would of too).
Case 2: a 6 year old golden retriever with a week of inappatence, vomiting, diarrhea, and melena (blood in the stool). The day before she had an episode of collapse and was brought to the ER. She was pale, icteric (yellow tinge from liver disease) and weak as hell Her pulses were crappy, and I thought she was going to die on me. Her bloodwork was crazy and showed severe liver damage. We signed her up for an abdominal ultrasound with a liver biopsy so we could see if it was hepatitis, cancer, or hyperplasia of her liver (some are treatable, some are not).
Well the craziness happened at 4pm when she got her ultrasound...yes her liver was fucked up, but they also found what looked like a long thin stick in her colon with thickened colon walls and fluid around it...the ultrasound people thought she might have had a teriyaki stick foreign body that perforated her colon and was causing her abdomen to be septic (severely infected).
The owners came to visit and we explained all this. It was a really good talk with the owners, and they said that had had teriyaki 4 nights ago! We explained that her liver was messed up, and she was VERY sick but it could also be that the stick perforated her colon and was making her septic. Theoretically, surgery could repair the hole from the stick and clean up her abdomen, and she might live, but it was a poor prognosis. We explained costs (over $4000 if successful) and told them that honestly the only options were euthanasia or surgery, and that either option was a good one. At this point there teenage son ran out of the room trying to hold in his tears until he got in the hall, at which point he screamed and ran outside to cry on his own. We tried hard not to make them think they needed to go to surgery since the dog was so sick she might not survive, but being a golden retreiver she perked up in the exam room, was trying to run around and wag her tail since she was so happy to see her owners. So her owners decided they wanted to try for surgery knowing the odds were not great.
So surgery...I was not on surgery, but being the student on the case I stayed late to watch and participate a bit...7pm we opened her up, and no stick or perforation was found...what was found was a HUGE mass on intestines blocking its blood supply that was bleeding out, and masses all throughout her liver. She started bleeding out so quick we hooked her up to a transfusion. The surgeon got a good look and explained he could not resect the mass without killing the dog's intestines, so the options were:1. euthanize on the table or 2. sew her up and let the owners see her alive (but comatose) one more time before euthanizing....we talked with the owners on the phone, I really liked the family and almost cried, but we decided to euthanize on the table, which was good since the dog started to die on her own as we did it. So sad, it was a long and rough night then.
The rest of the week was long hours but my patients did better then that rough day. I made lasagna but didn;'t back in on wednesday so that thursday after school I drove in to boston and cooked it for mark and I. we had a fun night but I did not get nearly enough sleep as always, but it was worth it since I am so smitten lately.
Today I had my second evaluation, this one from Dr. Lapelle. I heard from some classmates on medicine a couple weeks ago she was kind of tough on them in evals, so I was prepared for the worst. But I got lucky again. She was really nice and said I was doing a great job. She said my only problem was that I was not confident enough in myself. She said I should trust my instincts an speak up in rounds more since I often know the answer and seem to hesitate and question myself too much. Pretty nice eval, I was happy...maybe Dr. Freeman was right and clinics will really boost my GPA, since I am thinking with these evals I might be on my way to an A in most of my rotations.
Of course, sadly, my social life is suffering a bit, there is never enough time. I got invited to 6 parties this week, and I have missed the first 4 already due to my long hours...hopefully I can make the two this weekend.
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