Class of 2015... How ya doing?

[cowgirla]

What kind of job/internship? I kinda jumped in the deep end with an ER job right out of school where I was solo after about 4 training shifts. There are a couple other more experienced vets here on SDN that have done the same thing, but I think in general most people take a more ... measured ... approach to jumping in. You'll be fine. Promise.

LIS's rules for managing emergency cases:

1) Recite "Airway, Breathing, Circulation" (or whatever variant you like) over and over and over in your head. Virtually everything else on ER you can take time to stop and think about what you're doing. Most of the cases you see are vomiting/diarrhea dogs and inappetent cats, anyway. And the work-up is so standard for those you can just recite it in your sleep. Which is how you do it most of the time.

2) Don't give direct medical orders to your techs. Instead, mumble "Hmmm.... I suppose I should do X" under your breath. If your techs look at each other - change your mind. If they look like they approve, go with it. They know more than you do anyway. Figure out which are the really good ones, and when they say "Can we do X?" just go with it because that's their way of telling you "Um, smart doctors do X." When my techs come say something like "LIS, can we put a central line in this 4 week old chihuahua so that we can actually give it the therapy you've planned" it doesn't take a braniac to realize it's a good call that you should have already made had you not been busy heating up your 3am burrito.

3) Figure out which of your Facebook DVM friends you trust and bank on them to be online 24 hours a day just to help you out. If they aren't on, repeat call them on their cell phones until they wake up, because they aren't doing their job.

4) Pick a couple action-oriented textbooks (i.e. procedures, meds, etc - not the detailed internal medicine pathophys stuff that you can spend time hunting for) that you really like and keep them close at hand. Remember, pathophys is for real docs, not ER docs.

5) Be brutally honest (in a gentle way, obviously) with your clients about their pet's condition. Don't give them more hope than they should have, because then they'll be P.O.d when their pet dies and you were telling them fluffy had a great chance. I don't sugarcoat the situation - if I think their pet isn't going to survive surgery, I tell them that their pet likely won't survive surgery. Maybe that would get me an F in client communications in vet school, but damned if I'm going to say anything that later could be construed as misleading, lying, hiding, evading, etc.

The rest is just minor details and medical records.

Note to self: never give LIS your cell number

On the bright side, LIS, at least you get to avoid the "are you old enough to be a vet" questions

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[StartingoverVet]

On the bright side, LIS, at least you get to avoid the "are you old enough to be a vet" questions

replaced by "shouldn't you know that by now given how close you are to retirement?"

 

[LetItSnow]

Oh is that why I get walls of text?

Yes. And when you don't answer, haven't you noticed that I text your husband and ask him to wake you up? Every time I get a rabbit or guinea pig you're the first person I call.

 

[dyachei]

Yes. And when you don't answer, haven't you noticed that I text your husband and ask him to wake you up? Every time I get a rabbit or guinea pig you're the first person I call.

No, I haven't noticed. He's not doing a very good job.

 

[that redhead]

Note to self: never give LIS your cell number

On the bright side, LIS, at least you get to avoid the "are you old enough to be a vet" questions

A couple of clients have outright told me I look like I'm 12. Which I know to be true, and was expecting, and it's still kind of deflating. I'm working up the nerve to say, "Actually, I AM 12! Prodigy " to the next one...

 

[LetItSnow]

No, I haven't noticed. He's not doing a very good job.

Lazy bastard. And he still owes me $10M, but I can't remember why.

 

[dyachei]

A couple of clients have outright told me I look like I'm 12. Which I know to be true, and was expecting, and it's still kind of deflating. I'm working up the nerve to say, "Actually, I AM 12! Prodigy " to the next one...

I have had several tell me that I must be a prodigy because I'm so young but very knowledgeable....It's like a back-handed compliment. or tell me I must have been in the top of my class. Very flattering, but no.

 

[that redhead]

I have had several tell me that I must be a prodigy because I'm so young but very knowledgeable....It's like a back-handed compliment. or tell me I must have been in the top of my class. Very flattering, but no.

Ugh. And then they follow with, "But you'll appreciate it when you're older!" Not helping.

 

[DVMDream]

Ugh. And then they follow with, "But you'll appreciate it when you're older!" Not helping.

I hate this.

I don't think I look 12 but people say I do. Then they say the above and I'm like, doesn't help.

 

[LetItSnow]

Ugh. And then they follow with, "But you'll appreciate it when you're older!" Not helping.

Boo hoo. I'd trade places with any of you.

 

[dyachei]

Boo hoo. I'd trade places with any of you.

Nah. Cuz then I'd live in the great white north.

 

[WildZoo]

A couple of clients have outright told me I look like I'm 12. Which I know to be true, and was expecting, and it's still kind of deflating. I'm working up the nerve to say, "Actually, I AM 12! Prodigy " to the next one...

This will be my response

 

[jmo1012]

I think I am the last to the party, but we finally had our graduation ceremony today in NYC lovely to see all of my classmates again after we said goodbye a year ago for clinics! My official degree date is June 1st but it was still fun all around! Wish I could have spent more than 17 hours in NYC, but alas now I have to head to FL...

 

[Coquette22]

I have a client that owns a parvo dog that I saw over the weekend that we're managing as an outpatient due to finances. She called Monday and Tuesday to tell me the dog was still vomiting every now and then. Today she called, and I mentally cringed before answering the phone. All she wanted though, was to tell me the dog was doing great. Little moments.

 

[yogapony]

For the recent grads: if you knew then, what you know now, what would you have done differently during school?

 

[Coquette22]

For the recent grads: if you knew then, what you know now, what would you have done differently during school?

More surgery and more dentals.

 

[LetItSnow]

For the recent grads: if you knew then, what you know now, what would you have done differently during school?

Less studying, more saying "you know what? A b is a fine grade," and more time hanging in a hospital/clinic/whatever.

But that's the perspective of someone who was 100% sure they weren't going to do an internship.

 

[scb44f]

I would've spent more random time in a vet clinic somewhere.

Because I'm in a good mood, here are some things I love about being a doctor: introducing myself as Dr. Scb44f, wearing coveralls with Dr. Scb44f on them, making judgment calls on my own, teaching students, reading SOAPs instead of writing them, being trusted enough to write discharges for my patients without an adultier adult, and last but not least, being called Gru by my students.

 

[pooter]

For the recent grads: if you knew then, what you know now, what would you have done differently during school?

Made friends with the clinicians sooner, esp. in my area of interest.

Also, more drinking and merrymaking.

 

[heylodeb]

For the recent grads: if you knew then, what you know now, what would you have done differently during school?

This may sound superficial BUT - I would have taken care of myself better. 4 weeks out of school and I feel like a completely different person. I'm not a super girly person but 4 years of sweatpants, yoga pants, t-shirts, hoodies, and scrubs...and you stop realizing how rough around the edges you've gotten! Get your hair, nails, eyebrows done. Look in the mirror - every morning. Little things don't take very long and are very very worth making the time for so you don't lose sight of the person you are.

Also - grades. Who cares. Seriously. Learn things in school because it is FUN and you have spent your entire life wanting to know these things NOT because you want an 'A'. Keep your eye on the forest not the trees. If you adopt that attitude - you will pass everything and end up having a much more enjoyable time. My last 2 years of school were SO MUCH better than my first two because I changed my mindset. (not gonna lie - my GPA went down as well but I got the internship of my dreams and I had a much better time doing it so I don't give a hoot )

 

[Coquette22]

Five minutes to close, emergency comes in. 13 year old lab with acute onset vomiting and lethargy. Did radiographs.... Big old splenic mass.

Also, my advice would be the opposite of heylodebs. Value this time in hoodies and scrubs. I love my job but boy do I hate having to put on real pants every day. (To be fair, no one would complain if I wore scrubs and one of the other vets does, but I worry I'd look too much like a technician - nothing against techs, I'm just not sure clients would believe I'm the doctor.) Though ultimately, the advice is the same - do what makes you feel comfortable and look after yourself.

And as further advice - don't underestimate your non-vet med skills. I'm amazed how much my clinic seems to appreciate my writing/journalism background.

 

[LetItSnow]

I'm amazed how much my clinic seems to appreciate my writing/journalism background.

I think the 'skill' (trait, really) that my staff value the most is the fact that I keep it light, don't get upset with them, and don't get worked up when the **** hits the fan.

Amazing how much your staff will like you if you just keep your cool. I lose my cool to @dyachei instead.

 

[DVMDream]

I loose my cool to @dyachei instead.

How do you make your cool less tight? I need to learn this, I think.

 

[LetItSnow]

How do you make your cool less tight? I need to learn this, I think.

Oh shut up. Don't you have patients to take outside to the bathroom?

 

[that redhead]

I agree with Coquette - more surgery and more dentals (the extracting part, especially), although that might be because I did a lot of lab animal electives my last few months thinking I'd find a LAM program and ended up in SA GP.

 

[Coquette22]

although that might be because I did a lot of lab animal electives my last few months thinking I'd find a LAM program and ended up in SA GP.

Ditto.

 

[scb44f]

Ugh dentals... better if I'm not having to watch someone perform half of it, but still painful nonetheless.

I have been scheduled with another house officer during my first 2 weeks as an intern, so one of the residents and I have been splitting cases. Knowing I'm a newbie, she let me dehorn a nasty infected fractured horn on a patient of hers today. So so so amazing. We are doing a bovine ovariectomy on Tuesday. So many amazing things going on.

 

[heylodeb]

Also, my advice would be the opposite of heylodebs. Value this time in hoodies and scrubs. I love my job but boy do I hate having to put on real pants every day. (To be fair, no one would complain if I wore scrubs and one of the other vets does, but I worry I'd look too much like a technician - nothing against techs, I'm just not sure clients would believe I'm the doctor.) Though ultimately, the advice is the same - do what makes you feel comfortable and look after yourself.

Oh gosh - I don't mean to NOT wear the hoodies and sweatpants. Do I look like a masochist?? Haha. I just mean that I wish I had taken time out of my schedule for ME. Ya know.... Shave more often than every 3 months.

 

[that redhead]

Been a busy last few days for me - we closed on and moved into our new house and I love it. There is a lot of cleaning to do, we don't have any furniture (well, we've got a mattress and we scooped a free dresser from Pottery Barn put out by the neighbors that weighed approximately 237218lbs) and a lot of unpacking to do but it's great to finally have our own place!

Started seeing my first official appointments at work - just wellness visits for now - but also took a drop-off ADR sweet old Corgi (combining my love of old dogs and Corgis ) and am working that up. I'm at an awkward stage in this job thing - they trust me to do stuff, I don't have to ask although I feel like I need to present my plan to someone who knows wtf they're doing before I get going. I need to build my confidence, which I know just takes time but ugh. I'm totally cool with client communication though, I love that part, so I guess it's just continuing to work through stuff. I guess I'm just impatient

 

[jmo1012]

1st ER shift tomorrow...eek!! I'm so scared! Granted, i'm not by myself - there's a senior on at all times and another intern comes in 2 hours into my shift, but the shifts are supposed to be extremely busy and we don't really have much oversight from the senior clinician. Everyone else has been shadowing an outgoing intern, but my rotation is new and so theres been no intern to learn the ropes from (i.e. all the paperwork, charges, and computer system).

I'm excited but terrified. I think i've forgotten everything I've ever learned. I was going to make a list of common drug doses, but I'm not sure what we stock (i've barely done anything during the 2 days). Review common ER scenarios...I'm so overwhelmed! I am definitely in awe of all of you who see ER cases all on your own!

 

[nyanko]

Just remember that rarely is anything critical enough that you don't have time to look something up if you have to. And if it is super critical, the basics will help you so much. Oxygen is always okay unless it's on fire. Divide the dog's weight in kg by 10 to get the mL of diazepam it needs for a seizure dose (assuming you have 5 mg/mL diazepam like everywhere I've been does). You can never go wrong with obtaining IV access early. Etc...

At my internship, we were on our own at night from midnight to 7 am. Those hours were sometimes terrifying but I learned so much during them. Then in the morning I went over cases with the seniors, even if I didn't have to, to see what else I could have done. Use the seniors around you to bounce ideas off of, make your own plan and then say here's what I am going to do. It's crazy for awhile and a bit intimidating but you'll get it.

Also your techs are your best friends. They see this every year, and if you are good to them and respect them, it will help you so much.

 

[Minnerbelle]

Getting through the night series through VIN is a godsend. They have transcripts of previous years. Just quickly sift though the topics covered and know which ones are there. Have a step by step plan for your shock/trauma/dyspneic/seizure/GDV patients at least to triage and stabilize. Then you always have time to formulate further plans, make an estimate, talk to clients, and admit. As long as the patient isn't actively dying, just find the sections for what you're looking for. Seriously, my first IMHA and DKAs were manageable on my own in a timely manner only thanks to this resource. Cote's vet advisor is also super helpful.

 

[DVMDream]

Here is a good link for quickly getting emergency drugs (click on the excel sheet and input the patient's weight), we used to print up one of these for every surgery patient where I worked...

http://csu-cvmbs.colostate.edu/vth/veterinarians/Pages/emergency-drug-calculator.aspx

 

[Minnerbelle]

Vasg.org is an awesome resource for CRIs as well. Post-trauma or surgery or whatever

 

[scb44f]

I love my job!! Even when someone releases a cow I've been trying to catch in the headcatch. Even when students push beef cows back onto their instructors. Even when the front desk schedules two appointments with the same people and cancels the wrong one.

 

[pooter]

Just had my first experience of "The exotics guy isn't picking up his phone and I have no clue how to treat this creature, but I guess I'm doing it anyway." Didn't end well. On the other hand, I guess I'm lucky to have an exotics guy at all.

 

[LetItSnow]

Just had my first experience of "The exotics guy isn't picking up his phone and I have no clue how to treat this creature, but I guess I'm doing it anyway." Didn't end well. On the other hand, I guess I'm lucky to have an exotics guy at all.

Enrofloxacin. That's how you're going to treat it.

 

[Minnerbelle]

Enrofloxacin. That's how you're going to treat it.

And critical care. Don't forget the critical care. And sq fluids.

 

[LetItSnow]

And critical care. Don't forget the critical care. And sq fluids.

Right, right. There I go, always forgetting to jack up the outpatient with a boatload of fluids.

 

[Minnerbelle]

Seriously, all I know about rabbits is: Sq fluids, critical care, baytril/TMS, reglan, and home you go. And a handout on proper feeding/husbandry. I hope whatever infection plus gastric stasis is all you had! This is why I no longer see exotics because I don't have to anymore. I just don't see enough caseload to feel like I do them justice. In all actuality, 90% of other vets would have done the same, but it still make me feel ****ty

 

[LetItSnow]

Seriously, all I know about rabbits is: Sq fluids, critical care, baytril/TMS, reglan, and home you go. And a handout on proper feeding/husbandry. I hope whatever infection plus gastric stasis is all you had! This is why I no longer see exotics because I don't have to anymore. I just don't see enough caseload to feel like I do them justice. In all actuality, 90% of other vets would have done the same, but it still make me feel ****ty

I know. That's pretty much how all my exotics visits go. Well. Most of them end up euthanized because by the time they bring them in they're mostly dead anyway, and I can't do much. I've had a few I shoot rads of, convince myself of some respiratory dealio, and send them off on enro or whatever. I should just quit shooting rads; it's not like it's going to change the treatment. But it's kinda fun to send them off to the radiologist and picture them all trying to duck the case because none of them know anything about exotics either.

 

[Minnerbelle]

I know. That's pretty much how all my exotics visits go. Well. Most of them end up euthanized because by the time they bring them in they're mostly dead anyway, and I can't do much. I've had a few I shoot rads of, convince myself of some respiratory dealio, and send them off on enro or whatever. I should just quit shooting rads; it's not like it's going to change the treatment. But it's kinda fun to send them off to the radiologist and picture them all trying to duck the case because none of them know anything about exotics either.

When I did emergency, I'd STAT consult them over. But then it turns out the exotics radiologists aren't available over the weekend or something so I just never got the consults back even though the client paid a ton. So you know, I'd twiddle my thumb while the poor sick rabbit was sitting in a cage with IV fluids plus the rest of the stuff.

Nowadays, I only see nonwitnessed euthanasia visits where the client is sure they don't want a medical opinion. I'm pretty darn good at tech and handling skills with the tiniest of exotics from my lab animal and wildlife days. I can probably do a lot of good mice surgeries, but ain't no client got money for that. I can do euthanasia well... But that's about all I can say for my exotics medical skills.

 

[that redhead]

I can probably do a lot of good mice surgeries, but ain't no client got money for that. I can do euthanasia well... But that's about all I can say for my exotics medical skills.

When I was a kid, I convinced my parents to pay $90 for an enucleation of one of my mice. The mouse did well and survived a while longer. I'm pretty sure the GP was like, "Well I'll look like a good guy and offer enucleation but ain't nobody gonna pick that!" and then we did and he was like "Sht."

 

[that redhead]

Also, paid my first payment toward my loans. I know I'm in the 6mo grace period but I'm getting paid and the husband is covering our living expenses so no time like the present, eh?

 

[dyachei]

I know. That's pretty much how all my exotics visits go. Well. Most of them end up euthanized because by the time they bring them in they're mostly dead anyway, and I can't do much. I've had a few I shoot rads of, convince myself of some respiratory dealio, and send them off on enro or whatever. I should just quit shooting rads; it's not like it's going to change the treatment. But it's kinda fun to send them off to the radiologist and picture them all trying to duck the case because none of them know anything about exotics either.

you forgot the calling me in a tizzy step.

 

[LetItSnow]

you forgot the calling me in a tizzy step.

I don't know that I'd call it a tizzy.

 

[dyachei]

I don't know that I'd call it a tizzy.

That's what makes us different. One of many things

 

[Coquette22]

I don't know that I'd call it a tizzy.

I've never been privy to your conversations with dyachei, but I'm sure it's a tizzy.

 

[LetItSnow]

ER work is total feast or famine. After getting slaughtered the previous few shifts I just got off a 12 hr shift with exactly one bee sting reaction patient. Wth.

Not complaining too much, but...... A little middle ground would be ok.

 

[Coquette22]

I've done 5 euthanasias in the past 24 hours.