Jersey has been keeping me busy. The practice I'm at is great. The clinicians are nice, the technicians are helpful, and the caseload is high. I spent last week on the medicine service and then this week with the emergency department and I have seen so many cases. I've truly been enjoying my time here.

As much as I like the practice I'm at, and although they are doing their best to convince me to come back, I still think an internship isn't the right thing for me. From what I've gathered interns are overworked, underpaid, and still not treated like real doctors. The interns at this place don't have much primary case responsibility except for on the emergency service. They work 12 hours a day (at least), six days a week, and make very little money after taxes. That's not the life I want to lead, even for a year.

I've had several interesting cases come through that I have been able to be involved in. Many of the cases that are seen are very ill and have a poor prognosis. It's always been interesting to me how people react to bad news and when they draw the line at stopping.

Today a dog came in today for lethargy and a possible abdominal mass. Well, it most definitely had an abdominal mass and it most definitely was bleeding from it. Not good, but not altogether untreatable either. The owner wasn't expecting news like that. After going over her options with her she decided to euthanize. She didn't want the dog to undergo several diagnostics, blood transfusions, and major surgery. He was 11 and had about another good year or two left if (and that was a big if) the mass was benign. If it was bad and we treated he had at most 4 months. So her decision wasn't wrong. She said her goodbyes and that was it.

Then there is another patient with a far different story. Several months ago the dog was diagnosed with a brain tumor. The prognosis was poor and they gave her about 2 months to live. The owner refused to accept this and kept believing that the dog's brain tumor could be cured. As the dog worsened the owner was convinced it was from other problems that could be fixed, not the tumor. Now, the dog is moribund, unresponsive, sloughing its gut, and dying in front of our eyes. But her owner doesn't believe in euthanasia. The dog isn't really there anymore. She is breathing and her heart is beating but the essence of this incredibly sweet dog has passed on.

So when is it right to euthanize? When do we stop treating? When do we give up on resuscitation? Obviously there is no right answer to these questions. We can only take it on a case-by-case basis. What I would do is very different from what anyone else would do in the same situation. This is why I think I will have to keep myself at a distance emotionally from most of these cases. If I allow myself I could become very angry with the owner of the dog with the brain tumor. What is the purpose of that? Anger only upsets me more.

So far I haven't become emotional about any case really. Maybe I've been more attached to some patients than others. This past week a stray cat was brought in that had a broken leg and a wound which exposed her pelvis and had torn her rectum. She was wet, dirty and wailing. When I saw her crawl out of her carrier on her broken limb I suddenly teared up and would have cried if I hadn't thought better of it. I never expected that kind of reaction. I wanted to scream at someone to get the euthanasia solution as fast as possible so we could put this poor creature out of its misery. It was an odd reaction for me.

Over the next few years I'm sure I'll have more of those episodes and I will eventually find a balance between my own feelings and doing my job to carry out the wishes of my owners. I think I will have to in order to survive this job.

Thinking out loud

So like I said yesterday, I've had a lot of time to think during my recent driving adventure. I've also had time to listen to a book on tape about achieving goals (I know, I'm one of those people). The big question of the moment is: What do I want to do after vet school? I think for some people it's an easy answer, get a job, do an internship, join the army, etc. But when I was planning my life I only got as far as wanting to get into vet school. I never really thought about what I would do when I actually got there.

So here are my options as I see them:

1. Go to LA to do an internship and not have to worry about the match.

2. Do an internship and apply through the match to a couple of places.

3. Find a job.

Let's assume I decide to do an internship (and forget about where at this point). I would have to ask myself: Why is this what I want to do? Do I want to do a residency? I think at this point I've decided I'm not interested in pursuing a specialty. Even figuring this out was a big revelation. If I am honest with myself and look at where I truly want to be I come to the conclusion that I want to work as a general practitioner and a large, urban/suburban, multi-doctor practice.

Okay. So no residency. Then do I think I need more supervision once I graduate? Am I not confident in my skills and competency as a doctor? Again, being honest with myself, I feel that I am a relatively confident vet student and I am not actually afraid of going into practice. That being said, I do feel mentorship would be helpful.

Alright, that brings up a new question. Do I have to do an internship to get the benefit of a mentor? I don't think so. I believe that if I put the right amount of effort into a job search I can find a practice that will offer me as much guidance as an internship (with the benefit of a higher salary). I would have to work hard to find the right place but I really do think it is possible, I just have to be patient and not take the first thing that comes across my plate.

Back to the original question though. Why do I want to do an internship. I dug down deep inside and tried to answer that question as truthfully as possible. The reason I came to was that I feel as if it is expected of me to continue my education. But expected by whom? Not my parents. My professors? Perhaps some of them have given me the impression that wouldn't want to see someone like myself "wasted" as a general practitioner. But I don't ascribe to that elitist attitude among specialists. Is it me that expects it? Is it just what I think I'm supposed to do?

If I am completely honest with myself that is not a good enough reason to do anything. The expectations of others should not guide what I do with my life.

I enjoy client interaction. I'm excited to get out there and start practicing. I want to expand my business skills. I want to lead a comfortable life without having to sacrifice all my time and energy.

This only leads to one conclusion: I want to find a job.

It feels as if a burden has been lifted off my shoulders. Maybe now I can stop stressing about what I want and get started achieving it. That's an exciting thought.

Back on the road and already committing illegal activities . . .

I realized yesterday that I hadn't been on I-95 in 3 years. I felt a strange sense of coming home when I saw this sign:I drove to Charleston to visit with my sister who haven't seen in a while. She only yelled at me once for my political views (which, in all honesty, are pretty minimal), so it was a good trip. The truth is it was actually a really nice visit. My sis and I haven't always been so close and I think we bonded a bit this time around. I also got to try a new drink from Starbucks (which I can't remember the name of but it's like a smoothie), so all around, awesome time.

I left at about 8:3o this morning to head as far north as possible. I'm set to visit a practice in New Jersey starting on Monday. So I drove . . . and eventually ended up here:

Ahh, nothing like cheap novelties to break up the monotony of the road. I went to the top of the big hat (can't beat the ticket price of one whole dollar!). And yes, I bought fireworks. My mother informed me that it is illegal to transport fireworks over state lines. I'm not so sure that is true but I like feeling like a rebel for the day!

So then I kept driving . . . and driving some more . . . and then I drove a bit more . . .

I ended up in College Park, the home of my Alma Mater, the awesome University of Maryland. I'm spending the next few days here to visit friends. Oh, and I also happen to have a date while I'm here too! There will definitely be more on that later!

I had a lot of time to think during my 850 mile drive today. I think I may be starting to figure out what I want to do after graduation. But I should write about that when I'm not simultaneously watching Futurama and my friend play Rock Band. Oh it's good to be back with college buddies.

Other slightly interesting news: I officially registered to take the NAVLE this past weekend. Freaky.

I never thought I'd be so happy to be back

I am finally back home. It only took me about week to get here.

I had to spend some time with my parents and cats because the little devil, Murray, decided to eat my mom's bathrobe and needed surgery again. Yup, that's right, that would be foreign body removal #3 now. He is a horrible cat. He's lucky he's so damn cute. My dad, who is allergic, is totally in love with my cats now. He wants no expense spared when it comes to their health. This is a complete change from before they were taking care of them. I'm glad he understands why I love them so much.

I'm glad to be back to my apartment. As much as I love living out of suitcases, it's nice to have a real bed, my own washer and dryer and a kitchen again. My car is happy to. The little road warrior can rest for a week or so before I take her on any more major trips. So how many miles have I gone over the past month?

Total miles driven: 2767
Total miles flown: 2648

Total miles traveled: 5415

That's a lot of miles. And the summer ain't over yet!

Soon enough I'll be having to make some big decisions and I really don't want to. Being offered this internship has kind of thrown me for a loop. If it wasn't at such a respectable place that I know will open doors for me it wouldn't be as big of a deal. But now I really have to think hard about whether or not I want to get a job or do an internship. And if I do want to do an internship do I really want to do it there? I've been avoiding thinking about this by telling myself I still have 2 more externships to do.

I think I'm just going to continue to live in my own little world of avoidance for a few days more. Right now the only thing I'm concerned with is finishing my laundry and finding some food . . .

Life after La La Land

Someone once said, "Los Angeles is 72 suburbs in search of a city." That couldn't be more true.

L.A. is a horrible city filled with poverty, tourist attractions, pollution, and people with so much wealth it's sickening. Can you tell how much I liked it?

If I had only gone to visit and see the city I would probably say that I will never go back. But the truth is, I loved my externship. It's hard to describe but I seemed to fit in so perfectly at the practice. From the moment I started I had already made friends and found teachers. One of the cardiology residents took me under his wing for the two weeks I was there and taught me so much. Of course that was between all his sarcastic comments, anti-semitic jokes, and chauvinism (which was all a complete act, he really was a sweetheart!).

I got to see some amazing cases. There was a dog with severe immune-mediated thrombocytopenia, some blocked cats, a ridiculous number of dogs with mitral valve disease, a kitten with pulmonary stenosis, and even a cat with multiple myeloma. All of the clinicians, residents and interns tried to teach me as much as they could about each case. I even got comfortable with some of the cardiac drugs and how we use them (I am terrible at cardiology). It really was an all around amazing experience.

Probably the best thing came at the end though. One of the clinicians sat down with me to talk about my experience. I told her that I had a great time and really enjoyed the practice. She then told me that they were very impressed with me and would like to see me back for an internship. That blew me away. I am used to my teachers liking me but to hear that I was impressive to "real" people out in the "real" world was something else.

So what am I going to do? I'm not entirely sure. I still have the rest of the summer and two more externships until I have to start seriously thinking about post-graduation stuff. I'm sure I'll be thinking this out on my blog at a later date. Right now I'm exhausted. I flew in to Dallas yesterday and left for my parent's place today to help take care of Murry (the jackass had to have surgery again today . . . I'll explain later). I made it to Eutaw, Alabama. Yeah, long day of driving. Now it's off to bed for me . . . *yawn* . . .

Scared

I don't want to leave Dallas today.

These past two weeks I've learned a lot about about myself. Verdict on a surgical residency: not for me. I love surgery but I don't think I have the drive to pursue it as a specialty. I don't think I could handle doing what these interns did and going through 2 internships just to spend another 3 years in a residency. Some of them didn't even match so they are back where they started trying to find a job as a general practicioner.

I have also learned that I miss being in a city. I love the activities and culture of being in a metropolitan area. Dallas is too far from my family, which is its only downside.

I'm terrified to go to L.A. Not only am I afraid of the city (for no real apparent reason) but I also have a sick feeling in my stomach because I'm staying at a hostel that I know very little about. I think it's in a decent area (the south end of Westwood) but I have no idea. I've read mixed reviews, some raves and some telling people to stay away. I hope it's okay. Maybe that sick feeling is just because I'm hungry.

I have to believe everything is going to be okay.

Plastic surgery for pets?

Tonight is my last night in Dallas. I realize I have not posted much from this city but that is because I have just been so busy having an amazing time. I explored the Uptown district, saw "You Don't Mess With the Zohan" (hilarious by the way), went to a sculpture garden, listened to live jazz at the art museum, saw a production of "Othello" in a park, and learned all about the Kennedy assassination at The Sixth Floor Museum (according to the local gurus on the Grassy Knoll Lee Harvey Oswald was not the gunman and there were multiple shooters).

This past week was more enjoyable at my externship since there was a different group of interns (they all rotate through 4 clinics over the year) who were easier to get along with. We also had some interesting cases. For example, a very small and frail dog that was attacked by a much larger dog came in with spinal fractures. The surgeon placed an awesome external fixator on that made the dog look bionic. We somehow managed to not pierce the spinal cord or aorta, woohoo! When I left the dog was doing great and will be sent home for a while on Monday. I also got to see a total hip replacement and the removal of an abscessed kidney (which exploded and was super awesome . . . the dog did awesome too).

There was also a very interesting case that brought up a lot of issues for discussion. An owner wanted her dog to have perky ears so one of the surgeons placed implants to help them stand up. The dog is not a show dog and has no history of ear problems. This was a pure cosmetic procedure. Unsurprisingly, she was still not happy with the results and flipped out at the surgeon (who really brought this on himself, he knew she was nuts).

This brings up a very interesting question though. Is it ethical to perform an unnecessary cosmetic procedure on an animal? And what is considered unnecessary? We have been ear cropping and tail docking for ages, does that make it right? I don't know too much about either of those to make a comment (although I think these have to do with breed standards?). As far as fixing the ears I do have a few thoughts.

First, death is a possible risk of anesthesia, even in healthy patients. I do not think that any animal (or human) should be put under anesthesia unless it is absolutely necessary. If an animal were to die from anesthetic complications while undergoing a frivolous procedure it would be a great tragedy.

Second, the animal is not consenting to having its body changed. Humans must get cosmetic surgery of their own accord. No one ever performs a boob job on someone without asking. I realize that animals cannot give consent for any surgery but not all humans do either. Patients come into human ERs all the time and go to surgery whether they're conscious or not. This argument of no consent is why some people are against kidney transplants in cats (but that is another topic . . .).

Lastly, in this particular situation it was clear that the owner was not rational about this topic. She admitted that she was willing to risk the dog's life to have his ears the way she wanted them. This is a person who needs medical help, not veterinary.

After a bit of thought I decided that if someone asked me to perform this surgery I would decline. I do not think it is ethical. So where do I stand on declaws, neuticles, tail docking, and the rest? I don't know yet. Perhaps it depends on the situation and why the owner wants these things done. I may be less likely to declaw a kitten with no scratching post than an older cat that the owner's may get rid of because it keeps scratching their children. It is an interesting topic and one I think we all as veterinarians need to figure out for ourselves.