Four Days. Fourty Eight Hours.

Externship, week 1, completed.

It was a great week, and it helped remind me where I came from and where I am going. The clinic I spent a week at is the same one that I worked as a tech at for a year prior to starting vet school. I will forever be thankful to the clinic, its patients,  and its staff for all that they have taught me.

As I tell this story, please keep in mind that all medical decisions were discussed with and approved by a veterinarian. I was allowed to come up with differentials and diagnostics to run, and then recommend treatments based on our findings. Also, it is a story with a sad ending, I warn you here.

A very special patient in particular was able to remind me why I love what I have chosen to do so much, and that yes, I did learn something and school, and yes I have learned how to use that knowledge. This kitty, a very dearly loved kitty, came in three days in a row because she just wasn't doing well. We performed bloodwork the first day, which came back with very non-specific findings. No help. The second day we took radiographs. From those, we were able to tell that something was not right in her abdomen, but it could be a number of things with very different treatments. The last day she came in very weak and unable to hold herself up, she was struggling to get by. This was a much more sudden change from the evening before, when I had seen her last. We knew if we had any chance at helping her, we needed to move quickly. The goal was to stabilize her, then go to surgery  to explore her abdomen, and hopefully find the source of her disease. Unfortunately, it was a very busy day at the clinic, and the doctor was still in surgery with another patient. I became this kitty's primary care giver, as best as I can describe. At this point, I felt responsible for this kitty's life, and I needed to find out more about her health status. Currently, all she had was an IV catheter. A fellow vet student was working on getting her IV fluids. She was gasping for breaths, she needed more. I started to give her oxygen, took her vitals, and determined that something else in her body was causing her to feel very ill. Her heart and lungs were still trucking along, but her body was not responding. I took her blood pressure, it was acceptable. What else could it be? I took her blood glucose. It was almost nonexistent.

Low blood glucose is much more worrisome than high blood glucose. She had not been eating for a few days, but normally your body can compensate and provide an adequate level in your blood. Plus, we had syringe fed her a decent amount of calories the night before. At that point I thought back to my classes and what I knew about hypoglycemia and determined that she could be septic (infection in her abdomen), have liver failure, or have a tumor secreting insulin causing her blood sugar to constantly be low. Her blood work didn't show overt signs of liver failure. Insulinomas aren't terribly common in cats, and they tend to not cause such an acute drop in health, like this kitty was experiencing. She must be septic. But from where? How? That we still didn't know. Maybe if we could just get her to surgery and explore her abdomen, we could fix her. We were able to keep her stable for a few hours of providing supportive care. Unfortunately, after hours of monitoring her vitals and treatment with antibiotics, glucose, dextrose, and IV fluids, her body was not able to continue fighting. With many caring technicians at her side and the doctor on the phone with her loving owner, she passed. We were given permission to necropsy her (like an autopsy, but on animals) to find the source of her demise. She had cancer, a very angry cancer, that ate away at her intestines and allowed contents from her GI tract to spill out into her abdomen. This was what made her very sick, very quickly. Her cancer had progressed quite a bit, and had spread to other organs in her body. Even if she had made it to surgery, the cancer would not have allowed her to live much longer.

A sad story indeed, but an all too common one in medicine. This kitty taught me a lot, and I will forever be thankful to her for that. I love my chosen profession, even in moments like these, because at least we were able to provide compassionate care to her, and provide an answer and closure to her owner, who loved her dearly.

On a much happier note, here are some more fun things I got to do this week:
- Surgically remove a (suspected) lipoma (fatty benign tumor) from a dog's chest.
- Remove a bone piece lodged in the cheek and soft palate of a dog's mouth. (Ouch!!)
- Observe an FHO/try not to pass out. Orthopedic procedures are not my forte.
- Help close a dog spay, and learn some new techniques for ligating pedicles.
- Diagnose lymphoma from a lymph node fine needle aspirate. (Okay, sad, but still exciting in my book)
- Treat a kitty abscess, complete with a drain placement
- Learn how to extract teeth, and read dental radiographs
- See a wonderful client and kitty from when I was a tech. So happy to hear that this little white kitty with chronic renal failure is doing so well!
- Follow up with a patient of mine from a rotation at OSU, who is continuing treatment at this clinic.

I love vet med. I think I will be a vet when I grow up.

Oh, and I got a pretty new stethoscope. It is pretty much the coolest thing ever. I can hear ALL the things with it! :)