My cats live here, I'm just visiting.

That's how I feel these days. See, the last two weeks I've been on the small animal medicine rotation. Despite the fact that the service has been relatively slow I have been coming home only to eat dinner and sleep. This rotation is a little different from all the others because we are expected to act as the doctors. We are expected to make our own differential diagnoses and a plan. Then we report to our clinician with what we want to do only to have it promptly smacked down. The first few days were rough, I think we all felt as if we got thrown into the deep end of the pool and didn't know how to swim. I was dumb (or brave) enough to volunteer to be the very first to present at rounds. I didn't know enough about the interrogation I was facing to be scared. I presented a case about a vomiting cat with gall stones. I was not as prepared as I needed to be although I don't remember having that deep feeling of panic. Maybe I was just shell shocked. After that though I was inexplicably afraid to present again.

This past week my team has been on with Dr. Chase and I have been lucky enough to have her on my cases on both receiving days. Dr. Chase strikes fear into most students. She's tough, she'll try to lead you in the wrong direction, she'll let you talk until you back yourself into a corner, she'll make you play hangman if there's a word you can't think of and she'll keep asking questions until she trips you up. However, she's a fabulous teacher and forces you to challenge yourself. Personally, I love her.

My first long term in-patient was a 17 year old Jack Russell named Tas. Tas presented for chronic vomiting. We ran so many diagnostics on the little guy and kept him in ICU for days, we even had him on total parenteral nutrition. He was such a cute little guy, he liked to just wander around the hospital with his IV pole and one of the ICU techs in tow. We worked so hard to try and resolve his vomiting even though we couldn't explain why it was happening (my money is on GI lymphoma). Poor thing had to be euthanized last Saturday. The interesting thing about this story is that it was the first time I really felt like I saw an animal tell us it was time to go. He had been having more episodes of what we could only attribute to dementia (panicked barking, circling, panting, all around anxiety) but was still relatively stable. I thought he was worsening a little bit but when I took him outside and put him in his mom's arms I saw him close his eyes and I could almost feel him give up. I can't adequately describe it, I'm not sure anyone could. And it wasn't as if he gave up in a bad way, he was just telling us that he was old, he had a good life, and he was ready to rest. At that moment I really understood the gift of euthanasia. He was a great dog and he'll be greatly missed, but I know that he's happier now.

My other patients have not been nearly as intensive, or depressing. I actually did a re-check on a cat yesterday that survived a heartworm infection. Its been four months and yesterday he tested negative for heartworm antigen and is doing great. I also had Harvey, a former blood donor cat with chronic renal failure, who came in because he vomited and then passed out. Sounds horrible but he did very well in the hospital. He tried to maul me once or twice when I was messing with his catheter but other than that he was actually a really cool cat.

An interesting case. Yesterday I saw a young kitten (approximately 7 or so months old) with a chronic lymphocytosis (small cell, well differentiated). That's all that is wrong with her. Well, that and her cranial mediastinal mass which we're not quite sure what it is. We're actually going to do flow cytometry on her to differentiate her lymphocytes. Its a strange case because we can't really find an explanation. There have been reports of this in young kittens (random chronic lymphocytosis) but the look of that mediastinal mass is not promising. She has tested
FeLV negative three times already but who knows. Hopefully something cool will come back from the flow cytometery and we will know more.

All in all I'm liking medicine a lot. Its hard, its busy, I'm tired, and I have to work with Glen all day but for whatever reason, I'm really loving it.