WTF being a new grad is rough

ugh. I find a lot of things frustrating right now. I think my constant questioning of everything I do and everything that is done by employer is somewhat exhausting. Recently though I didn't question enough. I had a patient who was seen at the emergency service the night before who they diagnosed with UTI, R/O neoplasia and stones (none were visible on the radiographs). I saw him because he had not improved on the abx. The ER had checked his prostate and said it was WNL. I ended up not repeating that diagnostic and recommending an ultrasound... well he goes to ultrasound and he has a huge prostate as well as TCC of the trigone of his bladder, and I just feel like such a jerk because I missed this, I trusted the physical exam that was performed... So now I don't know what to think if I should question everything all the time, or trust when possible. It's so difficult I guess you just keep doing whatever feels right in the moment... but honestly I will probably always check the prostate no matter what now! and probably I'll always re-check other peoples physical exams...

On call

I was on call last weekend. It was my second weekend on call. The weekend started with a horse that may have been bitten by a snake. I went out and she was sweating and agitated with no evidence of a snake bite. I gave her dexamethasone and benadryl and told the owner to spray her with fly spray. He did and she took off bucking and kicking and overall freaking out. So I suspected that she was reacting to the fly spray and told the owner to wash her. I left thinking that would be the end of it. So u continued my weekend and was called out another 10 times. some of the highlights were a female cat who was flat out and barely responsive who had previously diagnosed with fip. So I was thinking she had fluid in her chest. She did not. But she did have a creat of 23 a bun of 210 and a potassium of 10. So i unblocked her but spent the rest of the weekend thinking she was going to die. Somehow she did not die and went home a few days later. After I recommended euthanasia about 4 times. I also successfully pulled a calf, unsuccessfully treated a down cow and did two c-sections back to back on two bulldogs back to back starting at 8 pm and ending at 2am. The first was successful and the 4 puppies and momma did well. The second one, not so much. So I opened her up and found that she had adhesions from uterus to body wall. I tried to break them down to get the uterus out but as I did I tore the uterine serosa. So I left them alone and cut into the uterus. I pulled out 9 puppies that were half bulldog and half lab. Oops, the unneutered lab in the house got to her before she was sent to the stud. So I got all the puppies out and get all the placentas out and then notice that it looks like there is still a puppy. So I squeeze the uterus and huge blood clots come out. And she is still bleeding from the inside of her uterus and from the adhesions and from somewhere else that i can't find. The tear that I caused was not bleeding and had that been the only issue everything would have been fine but I can't get the bleeding under control. The owner is in the other room with the puppies so I call her in and tell her that her dog needs spayed because she is bleeding and that's the only way to stop it that I know of. She agrees and I start spaying her. But she's still bleeding and I don't have suction and c ant see well. I came so close to panicking and it was 1 am and I was alone with my technician. I told her to run fluids wide open and I was finally able to stop the bleeding when I clamped the uterus. The lesson I learned there is to clamp everything and then remove things. She walked out pretty anemic but at least she walked out. Her post op bp was 50 and she was very pale.
So the weekend finally was over at three am. The horse I saw first was no better by tues and was acting neuro and depressed. I drew blood for encephalitis panel but had no good way to treat her. So
Igive more dex since it helped a little bit and leave. Fri another was showing neuro signs. So crap we start suspecting ehv and have to call the state vet. So Monday I have to go draw blood and get nasal swabs from all horses on the property some of which have never had a halter on. Needless to say it was a rodeo. We overnighted samples to state lab. While I was there the owner pointed out a dead bird and asked if herpes affects birds..... Herpes doesnt but west Nile does.....(which was one of my first ddx because all are unvaccinated until the second one was affected and also she had been at a racetrack recently) So today we get a call from antech saying the horse tested positive for west Nile.... Still waiting for herpes test

So i find this practice thing to be much like my golf game. Sometimes i hit really nice shots, i don't know how or why but i do. Then there are some days where i just flub...whats changed...who knows. It seems that that is how my surgeries go as well, some beautiful, and some i don't even know if i have gotten into the abdomen or not.

it seems talking to people on the phone though that this is normal. and it seems that everyone is having their "oh crap i screwed up" moments. i guarantee it won't be as bad as mine, so when you have your moment, give me a call and i'll share you my ineptness (i'd do it here but i don't need that out there in writing ;) ).

i've had some eureka all star moments as well, which feels good. but then i have a moment like yesterday where i had an 18 lb cat come in and they barely feed it anything, just a few handfuls a day. I was stumped what to tell them except to try to cut food more, until one of the other Drs pointed out that a few handfuls is a lot of food....i pictured handfuls like i make which isn't much at all.

besides work things though, i miss company of people i enjoy hanging out with . i am trying to be social here, but its so much work and often i am bored.

So there are many things I don't know. I spend a lot of time reading these days. I'm not booked heavily which is a blessing because I have plenty of time to prepare... So as the fully prepared individual that I am I had a case of reverse sneezing this morning. I read that many people empirically treat for nasal mites, so I decide that I shall do this. Ivermectin PO or SQ...
I'm here to tell you choose PO, unless you enjoy the sound of puppies screaming... which I do not. So I had that fuck up moment, where my boss comes and says you're supposed to give that PO it stings like hell SQ... why don't they put that in Plumb? Bastards! Now I feel like an unforgivable sadist and guilty as hell, considering that my boss looked at me like I had three heads when I said I was going to treat for nasal mites in the first place...

Surgery is not my favorite thing

So I finally figured this thing out after a half hour of trying to be a contributor instead of a follower. Anyhow, I started my job on July 5. On July 3 I got a text from my boss asking me to go look at his down horse. He was on a trip and the on call doc was on the other side of town. Mind you I had not started working yet. So I go to look at the horse armed only with a stethoscope thermometer and penlight because anything else was still in a box somewhere. When I pulled up to the paddock where the horse was I knew I wasn't going to need those things because the horse was pretty bad off and was going to need to be euthanized. So the farm worker pulled up around this time as I was calling my boss. After only about a three second conversation I asked him if he wanted the horse put down and he said yes and gave me all the clinic info to get the stuff I needed. I had to ask h how much euth solution to use because I had no clue. My hands started shaking around now as I drew up the solution. So then I went out to do what I needed to do armed with my 120 mL of with solution, a 16 g 2 in needle and a pen light. ( it was almost 10 pm). I turned my headlights on and inserted the needle into the vein. I could feel blood but couldn't see it and my needle wasn't in all the way so I pushed it in further. And the blood stopped. I tried redirecting with no luck. Luckily I brought 2 because after one pass through the skin that needle was done. So I tried again. This time I got it and I injected the euth solution. He whinnied halfway through which made me tear up a bit. I cleaned up everything and got a blanket to cover him til the could bury him in the morning. My hands and instruments were covered in blood. Turns out you don't really need a 16 g 2 in needle to euthanize a horse. A shorter 18 g would have been sufficient, probably less bloody and easier. I came back to make sure my first patient was in fact dead and when I touched his eye to check a corneal reflex he let out a huge breath. Naturally that totally freaked me out despite knowing that was a normal thing. So I did what any logical person would do: I drove back three times that night to make sure he was dead. Luckily I live 1/4 mile from there. So lessons learned: save the 16 g needles for the cows, learn to work by flashlight, penlight and if you're lucky, headlight, horses that let the air out of their lungs post euthanasia are probably actually dead and there's no need to check three times.

So I have another story but I'm sort of tired of typing on my phone so perhaps tomorrow.

Thanks

Xpost: Thanks.

Encouragement for those still looking

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