April 26, 2010

Veterinary Assistant Externship: Day 2

Also titled: A Hard Lesson

I was a little less excited for my second day of the externship - not for any real professional reason - simply because I had a friend over from out-of-town and was fairly tired from a strenuous week. I wasn't really looking forward to coming home mid-afternoon, neck and head achy, back sore, feet throbbing. But, because I'm stoic like that, I pulled on my scrubs and got my tush down to the clinic like a good little student.

The morning was different, mostly because it was me and D, the front-desk/vet-tech guy. I got to stocking syringes and wiping down counters, taking down the chairs and setting out the trash bins... and then felt promptly useless. As I cleaned in the back, George the Bulldog (one of our boarders for the day) started barking incessantly. D came in the back and said, "that's it, you're going to iso." Promptly the barking quieted after George was placed in isolation. His companion, Gracie, was unfazed, and looked plainly bored. Much of the morning was spend hosing dog poo off the kennel mats, and sanitizing them for the next occupants.

Eventually folks came in, and I started real hands on work with restraint. First was a little puppy who had really thick skin, and it took a couple of us a few tries to finally get him the fluids he needed. He was a tough little guy, but it was a painful process, and it took a fair bit to keep him still when he couldn't take it anymore. Lesson learned: tiny dogs are difficult to restrain - their heads are really small and will slip right through your headlock if they squirm too much.

A couple of cats needed restraint too. Bloodwork, vaccines... mostly bloodwork. One poor kitty was on chemo. She was thin as a rake and fragile... but she was friendly and very patient with us. Given that she was dehydrated, it was hard to find her veins. But of all the poking from the techs, she didn't fight me. She protested in kind of a quiet, displeased "murrrr!", but no claws, no biting. Can't say the same for all the cats who came in that day. Fortunately nobody got hurt.

I ran my first UA on my own, although I got a second opinion from one of the other techs because... no way could the test be THAT positive for blood in the urine. Sure enough, um, yes there was. Hey, doc!

Got my first look as a UA under the slide. Normally T does that, he knows what he's looking for. But I asked if I could take a peek and he let me. I kept things clean, cleaned things that needed it, tossed used paper towels and soiled linens in the proper recepticle.

And then he came in.

He had an appointment, but he came in early. Apparently this patient - a large German Shepard - had bit his owner four days prior because he wasn't feeling well. Sent the man to the hospital with stitches. Looked like a badly-done ear-piercing. He "just ran out of gas", according to his owner, who brought him in with a few family members, all large and imposing men who had trouble fitting through our narrow hallway.

The owner was an unkempt fellow, and the dog wasn't exactly groomed. I imagined this was a yard dog that was never properly trained out of his aggression, probably in a less affluent area, and given that he was obviously unneutered and had several skin conditions, well... I can't judge people for how they choose to care for their animals, I suppose. It's not my place, unless it's cruelty or abuse or true neglect. But there's a part of me that pities the animal for having been taken up by someone who probably never thought to bathe them, much less take them in for a teeth cleaning or proper vaccination. But right then, as we brought the dog in on a stretcher - to weak to move at all - all the focus was on helping the dog, no matter how he got there.

A number of patients came in during that time. We tried to deal with them speedily, to get them taken care of without a terrible wait, but inevitably some people had to wait longer than they should have. One poor kitty was an "unsociable" lass who'd never been to the vet before. You'd never have guessed: she was as placid and well-behaved as any vet could ask for. Lots of teeth problems came in. Tartar, calculus, infections.

Hey - go get your pet's teeth cleaned. WORTH IT. Those little "dental snacks"? Yeah, not gonna cut it.

We finally managed to get through the majority of the other patients so we could focus everyone on the emergency. Muzzled for safety, he was ferried into the x-ray room by T and I. Not that a muzzle was really necessary... the dog couldn't even manage his bodily functions. T then took the opportunity to teach me even as he utilized my free pair of hands: we took two x-rays, one of the lateral recumbancy, one of dorsal-ventral. We needed to see what was wrong in that dog's abdomen. So, T - who is slightly smaller than I - and myself... we were tasked with wrangling this obviously-suffering dog who was about our own individual weights into a position for the x-rays. We did so as best we could, wearing our latex gloves... there was so much bile, and there were traces of vomit on the front foreleg. As we attempted to x-ray him, he started losing control of his bowels. Poor T nearly retched, but I didn't have the heart in me to react. I couldn't. How cruel would I be if I reacted to this animal's plight with revulsion? I didn't fault anyone else for avoiding contact and commenting on the smell. But I couldn't bring myself to do anything other than help as best I could.

T went back and forth, developing the film, getting a second opinion, taking more x-rays because the last ones weren't clear enough, getting cleanser, throwing away soiled towels, reading the chart, leaving, coming back, leaving, coming back. He was busy on his feet, and quick in knowing what needed doing next. I, however, was tasked with staying with the dog. Lesson learned: never leave an animal unattended on the exam table, as it may flail or fall and hurt itself.

Hours went by. I had to have spent two hours with my hand on the dog's head, stroking him gently, talking to him as soothingly as I could. At one point I knelt down to be eye-level, and looked into the big liquid-brown eyes. They were filled with pain. It was like looking into a cup or a jar that was filled to the brim with suffering. It was terrible. "Live," I told him quietly, "if you can. But if you need to, let go."

After about two and a half hours of me working with this terribly sick dog, the vet came into the x-ray room. He palpated and probed the abdomen. The dog barely moved. The vet's face was a mask of concentration. I just just begin to hold the front paws on one hand, an exposed ear in the other, trying to warm them. I told the vet his ears and paws were going cold, and his already labored breathing had gotten faster. The vet looked grim, and walked out, saying nothing. I was alone again. Ten minutes later, T came in again. "Did he say anything?" he asked. No, I told him. T nodded, said he'd be right back, and left again.

I'd felt it when the animal had come in. I didn't think he was going to make it. I'd hoped otherwise. But now...? Now I was pretty sure. There wasn't anymore time for this dog.

T came back, we gently hoisted him back onto the stretcher, and took him into the exam room to be with his owner. Just two of them now, the owner and another man, both big imposing fellows. The owner welcomed the dog back in, and murmured something about getting him help. A part of me sank. He believed he was going to make it. But I dare not say ANYTHING.

Time passed. I cleaned up as much as I could, sterilizing the holy bajeezus out of the x-ray table with bleach and isopropyl. I was a little dazed. Cleaning helped. As I was starting to feel better, I was helping B in the kennel... the companion of the dog's owner opened the door to the kennel area. You know, that back door in a veterinary exam room you're not supposed to go into. He poked his head in. "Excuse me," he said, disoriented, "we need help. The dog..." He stepped aside as B went in. I caught a glimpse of the owner, his face contorted in agony. In a voice I've had nightmares about, he said, "he's dying!" I looked at the dog, still on the stretcher on the floor, his muzzle off... and his jaw almost feverishly gulping at the air, his lungs fighting to breathe.

The dog did die. I did not witness it. But it could not have been any more ugly than it already had been. The suffering and agony hat animal suffered would finally be over, but from our side of the veil, it would look only like the suffering had frozen in place, transfixed upon the creature's body.

Animal Control was notified. They wanted the animal for rabies testing and incineration, since he'd bitten a human recently. Normally, said B, they go into the freezer right away for disposal. But we couldn't freeze it: Animal Control neede the brain intact and unfrozen.

And so, for the next two hours, the dog lay dead in the exam room.

At cleanup time, I swept around him. His sad form lay limp on the stretcher. His eyes were open, glazed. Why didn't they close his eyes? I will never know.

At closing Animal Control finally came. Unceremoniously he was bagged in two large black trash bags, and carried out to the Animal Control Vehicle. I didn't go with them. I stayed behind to mop the blood and urine and feces and bile from the floor with heavy amounts of bleach. It's not glorious work, and it occasionally thankless. It's dirty work. It has to be. Someone has to do it.

I washed my hands and arms (I'd gotten a fair amount of bodily fluids on myself as I held the dying dog), walked Gracie and George, gathered up the trash full of soiled paper towels and used latex gloves, washed down the counters, sanitized everything, and mopped all the floors. Sweating and achy, but not as bad as the prior week, I went home. A hot shower, a bottle of cold water, and hugs, followed by an afternoon of friends and Warcraft... I was feeling a little better. I could still smell him on occasion. Fiancé told me it was a hallucinated scent. I don't know.

Hard day, but a good one.

Hard lesson learned: I can't save all of them. But I can make it easier on them. And just because I can't save all of them, doesn't mean I can't save any.

April 19, 2010

Veterinary Assistant Externship: Day 1

So a couple weeks ago I finally sold a veterinary facility on the idea of having me come and shadow their staff in exchange for free labor. It surprised me how difficult it had been to do, given the idea that "free" is usually something people jump at. I'd finished my last chapter in straight book-learning back in December. All my tests had been on time, all had been passing grades (laboratory work being my weakest and animal behavior being my strongest), and I had been prepared to begin immediately.

In case you hadn't noticed, it's April now.

So for the past four months and change, I've been calling various locations in an attempt to volunteer as a student at their locations. Most places never called back, no matter how many times I called to talk to the office manager, got their names, or left messages for them. A couple of them I managed to even get their schedules so I could call during the time they'd be there. One place I hounded for an entire month before I finally got the manager on the phone... only to be met with "no". Discouraging to say the least. But I kept plugging away, hoping SOME place would take me that wasn't in, say, Los Angeles. I'd be willing to drive a fair distance. But budget being what it is, only so far was possible.

One week I finally got mad, and did a Google search to find every vet hospital in a 50 mile radius. I got a lot of returns, and filtered them down based on schedule and distance. With a substantial list of places open at hours I could work (Saturdays in particular) that weren't in Mexico, I began calling. Every. Day.

One place actually seemed interested in talking to me. HUGE step forward. So I worked out a time to come see the facility, printed up my resume, and dressed myself as professionally as I know how. It's less than two miles from my house. Bonus, I thought. Went in, and though it was a very small facility, everyone there seemed friendly and capable. I talked to the office manager for a goodly while, talking about what kinds of things I'd been taught, what my current skillset was, and why I wanted to volunteer. He said he'd talk to the doctor, but "didn't see any problem with it."

Fingers crossed and excited with the biggest break in months, I called my coordinator. She was ecstatic, and gave me a rundown of all the paperwork that would need to happen before I could officially walk through the door as a student. I'd be covered under the school's insurance to protect not just me but the facility as well, and they needed to sign a bunch of things...

Later in the week I got the call. The paperwork had been filed. I was on for the following Saturday, 8:30AM.

I was nervous and excited Friday night. I laid out my student scrubs, put a notebook and pencil out, and set my alarm for extra early. I slept well, although I did have trouble falling asleep initially, to jazzed about the next morning to drift off right away. I worried that I'd forgotten too much in the four months since my last exam, that I would make a huge mistake, that I'd do something that endangered a patient or worse. What if I looked like an idiot? What if I forgot how to scrub properly? What if I mixed up procedure?

I was up bright an early, washed, dressed, primped and groomed. I wore no scents (bad idea when around animals with sensitive noses) and limited makeup (proper professional etiquette). I made the hard decision to leave my engagement ring at home at the suggestion of my textbook, preventing the risk of damage or soiling on the ring itself but also the damage to the rubber gloves I might need to wear. Jewelry of most kinds is dangerous to wear in an environment where the patient might struggle and entangle hoops or loops with fur and fangs. Finally ready with plenty of time, I walked out the door with my hair pinned up primly, and drove down the quiet empty streets to the facility, enjoying the cool air and warm sunshine.

I arrived early and presented myself. Immediately I set about asking what I could do to help. We stocked rooms, wiped down exam tables, and walked the dog that was being boarded there. We set about putting new stickers on old files and setting up blank charts for new patients. We went over the schedule, prepared for our appointments, and made sure everything was in order. The doctor veterinarian came in, introduced himself (he's quite the talker), and our first appointment arrived.

Now, everyone knows doctors wade through blood and pus. And nurses, too. But sometimes I think folks don't really realize that vets and vet staff have it tough, too. See, while we don't have quite the myriad of maladies to treat that human-doctors do, we do have to run tests on animals that humans would find abhorrent. Animals can't say "hey, doc, it hurts here when I do this and the pain is sharp (or dull)". Take, for example, the urinalysis. In humans, we ask the patient to pee in a cup, right? Well, in animals we can't do that. We have to flip them onto their backs (secure in the foam safety-wedge for comfort), and withdraw the urine directly from the bladder with a needle and syringe. It's not graceful or dignified, but it gets the job done. And don't even get me started on poop.

You can tell a lot about an animal by its poop. Hydration, diet, internal health, parasitic infection... and to determine all this, we have to smush it on a slide with solution and look at it under a microscope. It smells bad, the animal hates it, and it's messy. But it's important, even necessary. The animal's well-being is more important than the bad smell. So the staff ignores it and does the fecal smear with all the professional precision one might expect of medical staff.

My first real hands-on animal experience was one of the most disgusting procedures I can name. Fiancé gets green around the gills every time I mention it. It doesn't bother me, partly because it needs to NOT bother me if I'm going to expect to do this kind of work, and partly because I've gotten so used to urine, feces, blood, pus, and vomit from owning animals my whole life that it just doesn't shock me anymore. I am referring, of course, to the procedure known as "anal gland expression". From a medical standpoint, it's interesting and important. Cats and dogs have these little glands that can become impacted, infected, and downright problematic, and need to be cleared out. The fluid itself is a vile-smelling goo that would fit in well at the Bog Of Eternal Stench, and, like the Bog itself, one drop has enough potency to last for a week on your clothes. And while nasty and uncomfortable for both the animal and the staff, it's incredibly good for the critter's system. Was it gross? Oh yes. But did it bother me? Not so much.

The rest of the day was mainly cleaning. At one point my eyes burned with the bleach and I needed to take a break. I sanitized two surgical wards, dry-mopped the floors, then bleach-mopped the floors, walked the dogs again for their noontide breaks, took out the trash, stocked the rooms with syringes, and socialized with a poor kitty whose bladder refused to give a urinalysis and had been poked and prodded no less then five times that day. Such a sweetie. At day's close the owner came to take her home, and we noticed a puddle of pee in the bottom of the cage... with blood in it. She was immediately rescheduled for another exam. I hope she's okay.

It was a slow day. We had pizza, and chips and homemade guacamole. We shot the breeze as we ran lab tests. I got to see two urine tests run, two fecal floats, two smears, and one blood draw. We teased each other and talked about training methods for dogs and cats. We chatted about our own pets and why it was silly to call up old clients from five years past who had brought in their rodents. They taught, I listened. I asked questions, they demonstrated answers. They explained, I took notes. We talked about music and significant others.

It was a great day.

After the doctor went home following the last appointment, we started cleaning up. Nobody else was due in for the day, we'd had no calls, and it didn't look like anyone was coming in. We walked the boarding dogs one last time, moved the barker out of isolation, and sanitized everything. I worked up a sweat mopping the whole facility. I was proud of my work. It felt honest and solid, "true" in a fashion. Wholesome. Right. I cleaned up the mop and bucket, grabbed my stuff, and went home, back by 3PM.

My back hurt, my feet throbbed from standing all day, and my head ached enormously from having my hair tied back for so long. I took a hot shower to clean up, washed my scrubs, and relaxed for the rest of the afternoon with equally-achey Fiancé, who'd spent the better part of the day in physical exercise and activity.

And I get to do it all again next week.

I love my life.

April 12, 2010

Green Growing Things

I never thought I had mom's green thumb. She always had this magical ability to somehow know what was ailing a plant, what kind of soil it needed, whether it needed more or less water, how to make it bloom with the biggest and most colorful blossoms. She knew their names and species, the light they craved, the nutrients they wanted most, and how to set them together to create the most colorful array such that the garden was alive with color year round.

I always figured I am to animals what mom is to plants. There's a gift there, a knack, an uncanny sense of what it is and how to relate to it. Mom's roses were my cats. Mom's birch were my turtles. Mom's gladiolas were my fish. Mom's Johnny-Jump-Ups were my bunnies. And sometimes my animals and her plants interacted... sometimes favorably, sometimes not so much. (Bunnies like to eat pansies, btw.)

But this year I craved the soil. I live on the third floor of an apartment in a city. Granted, it's not like I'm in the downtown metro area where there's nothing but concrete and lampposts in every direction... but I don't exactly have a yard, either. I have animals - a cat, a mouse, a fish - but the plants were absent for the longest time. I started sneaking clippings and buying those silly little short-lived things at grocery stores, needing them somehow like a starved thing. You may or may not have remembered my minor battle with the landlord over a patch of ground. I craved the earth, and the things that grow from it... quietly, surely, determinedly.

So something happened. I'm not sure what, or how, or why. I pulled out an old seed-starter kit I bought years ago with the intent to use it for herbs and never did. Dusty and aged, I poured good potting soil - again, bought for a use it never fulfilled - into the little trays and poked seeds gathered from various places into the waiting dirt. Carefully I watched them, watering them. A few seedlings I'd nabbed from Pantheacon sat in timid pots, and I hovered over them like a mother hen, tending them carefully, needing them to survive, to sustain me even as I sustained them.

Lo and behold, the weather warmed, and little green things poked their tender shoots out of the dark moist earth. I had to guard them against the cat, who - as an indoor-only entity - saw them as a snack. Slowly but surely they grew in strength and size, joined by others of different species and type: cat-grass, nasturtium, a strange unidentifiable black-spotted bean thing. Soon I had a little army of seedlings. Quickly they outgrew the starter kit.

In one afternoon, I potted a half-dozen of the little living things. Even plants previously in pots, struggling to survive from my neglect and inattention, were repotted and carefully tended. Dirt went everywhere, old pots were dragged out of the storage, and sweat dripped down my temples to mix with the grime.

I LOVED it.

Now, on my little balcony, are two tiny pots of nasturtium, a tray of crocus, a tall pot of fresia, another of daffodil, a happy squash in flower, a tall green trunk of plumaria, three plastic pots of wide-leaved bean-thingy, another of yarrow, a cactus and aloe, all watched over by a hanging pot of cat-grass. Perhaps I don't have a garden... or maybe I made one where there wasn't one before.

Perhaps I have a green thumb after all.

April 06, 2010

Shakin'

There was an earthquake Sunday. It started as a bit of a gentle shake, then intensified a bit... and then hung about a bit at that intense level.

I lived through the Loma Prieta Quake of 1989. I was a wee tyke, seven or so, and one of my uncles was over. We had this big chandelier in the breakfast nook, a big wagon-wheel thing with lamps on it. We're sitting around doing whatever and my uncle says, "earthquake!". Mom thought he was kidding, until she saw the chandelier swaying back and forth like a drunken sailor. Next thing I knew we were outside on the grass in the back yard. The cats were going nuts, running from one side of the yard to the other, ears pinned back and tails fluffed to the max. And then we watched the pool empty out about three feet of water as it sloshed... back and forth... back and forth... like some kind of child playing in the tub.

I know quakes can be devastating. Heck, some of the nasties have reared their ugly heads in the past decade. The last 9-pointer caused a tsunami that killed almost a quarter of a million people. And then of course there's Chile and Haiti. They're not to be taken too lightly.

And yet, most quakes are hardly a sneeze. Every now and again the earth trembles, but it's gone within moments.

Mom and dad described the one that happened earlier this year as a rumble, then a BANG. I once sat through one of those (not anywhere near as strong). The bang was frightening. A sudden jolt as though a truck had hit the building. And having been in a building hit by a truck, I'd know. So when this one came, that's what I was expecting. It lasted too long to be an "ordinary" quake, and soon I tensed, awaiting the jolt... that never came.

Just a leisurely rumble, enough to shake a few things out of their places, but nothing more.

Yes, we are lucky.

Does anyone else notice how much the earth is waking up lately?